Is the Ban on Smoking in Public Places Working?

The law to ban smoking in public places in India came into force in 2004 and was further amended in 2008 to make it more stringent. Tobacco use accounts for 40% cancers in India and ‘The Public Health Foundation of India’ estimates that economic costs from all diseases in India in 2011 due to the use of tobacco amounted to a staggering Rs.1,04,500 crore or 12% more than the combined state and central government expenditure on health care in the same year.

A recent study published in the National Medical Journal of India, “Monitoring smoke-free laws in restaurants and educational institutions in Chennai, India,” by Prabhdeep Kaur, Daniel Rajashekar Thomas, Elavarasan Govindasamy, Manoj V. Murhekar, has analyzed the extent to which the smoking law has been successful in the Tamil Nadu capital city of Chennai and has come up with some shocking results. The law called ‘Cigarettes and Other Tobacco Products Act (COTPA)’ was passed by the Government of India in 2003 and the sale of tobacco products, within 100 yards of educational institutions was banned in 2004. It also prohibited smoking in public places.

The study assessed compliance with smoke-free laws by various restaurants and educational institutions in Chennai, Tamil Nadu, with the presence of a warning signage and smoking events as objective indicators. About 400 restaurants, 287 schools and 54 colleges in Chennai were sampled for the survey.

The results of the survey were shocking but not surprising. Only 29 of the 400 restaurants that were surveyed had any signage that displayed ‘No Smoking.’ Of the 29 restaurants that did have the sign, only 4 had displayed them as per specifications. At the time of visit for survey, there were about 62 smoking events in the restaurants.

Among educational institutions only eight of the 287 schools surveyed had the sign displaying prohibition of smoking and two had the sign on ban on sale of tobacco products. In the case of colleges, only eight of the 54 had the ‘No Smoking’ sign and the ban on sale of tobacco products sign was displayed in seven colleges.

The results of the survey clearly indicate that the compliance with law against smoking in public places was inadequate in restaurants and educational institutions in Chennai. The study also found that the data was consistent with a similar 2008 survey taken in the same city. This survey had shown detectable amounts of nicotine in the air around schools and restaurants. The current study is the first of its kind in the country and hence a very representative study of the state of affairs. If this study were replicated in other cities or towns the results would not be much different.

Comprehensive smoke-free laws that prohibit smoking in public places, such as bars, restaurants and workplaces, have been shown to protect the population from the dangers of passive smoking in many countries.

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In 2012, a random-effects meta-analysis of 45 studies of 33 smoke-free laws with a median follow-up of 24 months (range: 2–57 months) found that comprehensive smoke free laws were associated with lower rates of hospital admissions or deaths for:

• Coronary events or heart attacks (relative risk: 0.848)
• Other heart disease (relative risk: 0.610)
• Cerebrovascular accidents such as stroke (relative risk: 0.840)
• Respiratory disease such as asthma (relative risk: 0.760)

In another study on smoke-free laws that looked at the effect on health of children, researchers from the University of Edinburgh, Maastricht University, Hasselt University in Belgium, Harvard Medical School and Brigham and Women's Hospital found that the effective implementation of the law resulted in a 10% reduction in premature births and severe childhood asthma attacks within a year of smoke-free laws being introduced. Prof Ronnie Lamont of Royal College of Obstetricians and Gynecologists said, "Study provides clear evidence that smoking bans have considerable public health benefits for perinatal and child health and provides strong support for WHO recommendations to create smoke-free public environments on a national level."

According to the World Health Organization (WHO), tobacco kills around 6 million people a year worldwide, including more than 600,000 non-smokers who die from exposure to second-hand smoke.

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There is apathy among the state administration in India in implementing this law. The fine for violation is small and is a maximum of Rs.200 (just over $3), which is less than the cost of a coffee at a star hotel in India.

How can we ensure that there is a better compliance to the anti-smoking law in India? Medindia makes following recommendations for individual and public places violations:

• There must be a separate enforcement directorate in each state for its implementation
• There should be a recruitment of citizens, who would be able to report violations through photographs or videos that can be easily captured through cell phones and reported to the directorate
• The fine amount should be increased from Rs.200 to a maximum of Rs.1000 for an individual who violates the law
• All public places should have compulsory signage against smoking and violations should result in fines that should range from Rs.10,000 to Rs.50,000
• Repeated violations in public places like bars, restaurants, shops, malls, cinema houses, schools and colleges should result in temporary closure of such premises for a short period of time

In conclusion, it is important to remember that cigarettes are ‘weapons of mass destruction packed in small attractive boxes.’ If cigarettes could speak they would say, ‘Today you may turn me into ash, but tomorrow is my turn.’



Source-Medindia