Knowledge and perception regarding Indian tobacco control regulations among retailers selling tobacco products in slum areas of Bhubaneswar, India

To check the tobacco menace, Cigarettes and Other Tobacco Products Act (COTPA) was introduced by the Government of India. The aim of the study was to assess the knowledge and perception of tobacco retailers regarding COTPA regulations. A cross sectional study was undertaken during May-September, 2017 among 84 tobacco retailers from 11 slums of Bhubaneswar city. Using a structured schedule, relevant data were collected, analyzed using SPSS version 21.0 software and expressed as percentages. Most of the retailers had no knowledge regarding different sections of COTPA regulations such as minimum age of a person to whom tobacco products can be sold, minimum distance for opening a tobacco shop from educational institution, penalty for not displaying board stating “sale of tobacco products to minor is a punishable offence” etc. It highlights the need for educating slum retailers regarding COTPA regulations which is important for controlling the tobacco epidemic.

Introduction

Tobacco use is one of the leading causes of preventable diseases and premature deaths worldwide [1]. In response to the global tobacco epidemic, Government of India formulated a comprehensive tobacco control legislation titled “The Cigarettes and Other Tobacco Products (Prohibition of advertisement and regulation of trade and commerce, production, supply and distribution) Act” (COTPA) in 2003, which came to force on May 2004 [2]. Tobacco retailers who are the mediators between the manufacturers and the people represent one of the important stakeholders for tobacco control as they are directly or indirectly involved in negligence of COTPA regulations. Lack of awareness on COTPA regulations among tobacco retailers [1,3], is a hindrance in achieving the objectives of COTPA in terms of reducing the consumption rate and preventing new users of tobacco. Recent studies have reported high prevalence of tobacco consumption (exceeding 80%) among slum dwellers in India [4,5]. In this context, the present study has been undertaken to explore the knowledge and perception about COTPA regulations among retailers selling tobacco products in slum areas of Bhubaneswar city.

Methods

Ethics approval for the study was obtained from the Institutional Ethics Committee of the authors’ institution.

The present cross sectional study was conducted in 11 slum areas of Bhubaneswar, the capital city of Odisha during May 2017 – September 2017. Out of 3 geographical zones in Bhubaneswar, North zone was randomly selected and then 50% of the wards in this zone. From each selected ward, one slum area was randomly chosen to constitute the final 11 study clusters. All the retail shops that sold tobacco products in the selected slums were approached for inclusion in the study. Overall, 91 retailers selling tobacco were contacted, informed about the purpose of the study, and told they could withdraw from the study at any point of time. Finally, 84 (92.3%) retailers agreed to participate and thus constituted the study population. After obtaining the informed consent, the investigators asked questions to the retailers to collect important information regarding their knowledge and perception on Indian tobacco control regulations using a structured schedule. The schedule consisted 20 items that assessed the retailers’ knowledge on various sections of COTPA which specify the following rules [2,6,7]. To prepare these items, we considered only the relevant sections of COTPA which helped to assess the minimum basic knowledge which is a “must know area” for a tobacco retailer.

Sale of tobacco products to and by persons below eighteen years of age is prohibited, violation of which is considered as an offence and punishable with fine [Section 6 (a), 24].

Sale of tobacco products in an area within a radius of 100 yards of any educational institution is prohibited, violation of which is considered as an offence and punishable with fine [Section 6 (b), 24].

The Pictorial Health Warning (PHW) and Textual Health Warning (THW) are required to cover at least 60% and 25% of the principal display area of the package respectively. PHWs include images of throat cancer and oral cancer for smoking and smokeless form of tobacco respectively. THWs include phrases “Smoking causes throat cancer” and “Tobacco causes mouth cancer” for smoking and smokeless tobacco respectively (Section 7, 8).

A board containing the warning “sale of tobacco products to a person below the age of 18 years is a punishable offence” should be displayed at the entrance of the place where tobacco products are sold. Such board should not have any advertisement or promotional messages or pictures or images of tobacco products. The board should be of a minimum size of 60 cm by 30 cm of white background (Section 5).

Tobacco products should not be displayed in a manner that enables easy access of tobacco products to persons below age of 18 years. Violation of this rule is punishable with fine or imprisonment for a term or both (Section 5).

Smoking of tobacco in any form in a public place is prohibited violation of which is punishable with fine (Section 4, 21).

Promotion of tobacco products via discounts, gifts, prizes, and rewards in conjunction with a tobacco product purchase is prohibited, violation of which is punishable with fine or imprisonment for a term or both (Section 5, 22).

Data were analyzed using SPSS version 21.0 software for descriptive statistics.

Results

The mean age of retailers in the present study was 38.7 ± 11.5 years (Range 20 – 59 years). Among 84 tobacco retailers, 19 (22.6%) were illiterate, 26 (31.0%) had education upto 5th standard, and rest had higher education upto 8th standard. More than half of the study participants told that they were unaware about Indian tobacco control regulations. When asked about specific questions related to COTPA regulations, the awareness of study respondents ranges between 6.0% - 40.5% (Table 1). More than 65% of retailers could not give correct answer regarding the minimum age of a person to whom tobacco product can be sold or minimum distance for opening a tobacco shop from an educational institution. More than 90% of retailers did not know the correct size limit of textual or pictorial health warning on a tobacco package or that of the board displayed at the point of sale. Less than one fourth of retailers knew that brand name or image or picture could not be used for advertisement or promotion of tobacco products. However, all the retailers were aware about the harmful effects of tobacco consumption on health and more than three fourth of them knew about the harmful effects of second hand smoking in nonsmokers. Majority (> 70%) of retailers agreed that people should not smoke at workplace/home/public place. Also most (66.7% - 79.8%) of the retailers showed positive attitude by agreeing that tobacco products should not be displayed at shops, favoring banning of advertisement of tobacco products, and not supporting provision of gift/free sample/coupon/discount on purchase of tobacco product.

Discussion

The present study explores tobacco retailers’ poor knowledge regarding Indian tobacco control regulations in slum areas of Bhubaneswar city. In this study, we observed that almost 70% of retailers did not know the minimum age of customers to whom tobacco products could be sold. Similar result has been reported in another study [1], whereas Ravishankar et al. showed higher proportion of retailers were aware of legal age of buying tobacco products [3]. In our study, 65.5% of retailers were unaware of the fact that tobacco products could not be sold within the radius of 100 yards of educational institutions. Compared to our result, one study showed higher proportion (80.6%) of retailers having no knowledge about minimum distance for opening a tobacco shop from educational institutions [1] and contrasting result in another study [3]. In the present study, majority of retailers had no knowledge about PHW or THW on tobacco packages, prohibition of any advertisement which directly or indirectly promotes the use of tobacco products at point of sale and penalty for violating the COTPA regulations. The poor knowledge of the tobacco retailers about the COTPA regulations might be attributed to their poor education background.

Despite slum retailers’ poor awareness regarding COTPA regulations, most of them knew about the harmful effects of tobacco consumption and second hand smoking on health. The present study also revealed that majority of retailers had positive attitude towards smoking ban in public places, banning advertisement of tobacco products, and not supporting provision of gift or free sample or coupon or discount on purchase of tobacco product. Ravishankar et al also reported in their study that 75% of retailers were in support of Government imposing ban on the advertisement of tobacco products and 52% strongly believed that it was right to stop tobacco consumption in public places [3].

Conclusion

The present study showed lack of knowledge regarding COTPA regulations among the tobacco retailers in slum areas of Bhubaneswar city. Hence, conducting awareness programs at regular intervals for this influential group might be helpful in increasing their compliance with COTPA regulations thereby helping in reduction of tobacco burden.

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