Understanding implementation gaps in tobacco control legislation: a mixed-methods study of COTPA compliance in urban...

The Cigarettes and Other Tobacco Products Act (COTPA), 2003 is India's key legislation to control tobacco use. This study aimed to assess compliance with Sections 4 and 6(b) of COTPA in an urban setting in western India and to explore institutional awareness and enforcement practices.

A mixed-methods cross-sectional study was conducted across 71 public places, including educational institutions, government offices, hospitals and informal public areas. Quantitative data were collected using structured observation checklists to assess signage, smoking activity and tobacco vendor presence. Qualitative data were obtained from semistructured interviews with 64 institutional heads, analysed thematically to explore awareness, enforcement and barriers to implementation.

Compliance with Section 4 (prohibition of smoking in public places) was partial. Section 6(b) compliance was suboptimal: only 18 (39.1%) educational institutions displayed 'Tobacco Free Institution' signage at entrances, while 2 (4.3%) had tobacco vendors within 100 yards. Awareness of COTPA provisions among institutional heads was relatively high (82.6% in educational institutions, 92.9% in government offices, 75% in hospitals), but enforcement actions-such as warning shops or collecting fines-were infrequent. Thematic analysis revealed barriers including weak monitoring, manpower shortages, normalisation of tobacco use and limited institutional accountability. These findings indicate a significant policy-to-practice gap driven by system-level, institutional and sociocultural implementation barriers.

Although awareness of COTPA is high, compliance in urban settings remains partial, particularly regarding signage and tobacco sales near educational institutions. Weak enforcement and sociocultural acceptance of tobacco use undermine implementation. Addressing these implementation barriers through strengthened accountability systems, institutional governance and intersectoral coordination is essential to improve real-world effectiveness of tobacco control policies.