Tobacco use constitutes a global epidemic that results in 5 million deaths each year (World Health Organization, 2008). If current trends in tobacco use continue, the number of tobacco-related deaths is expected to rise to 8 million deaths annually by 2030 – with 80 percent of these deaths taking place in low and middle-income countries (LMICs) (Mathers & Loncar, 2006).
Currently, about 10 percent of the world’s smokers live in India (World Health Organization, 2008). The 2009-2010 Global Adult Tobacco Survey, a nationally representative household survey, found that 34.6% of adults over the age of 15 in India currently use tobacco (International Institute for Population Sciences (IIPS), 2010). The prevalence of tobacco smoking in Gujarat, India, including those using smokeless as well as smoked tobacco is estimated to be 19.8% among males and 1.5% among females(International Institute for Population Sciences (IIPS), 2010). Most smokers in India consume bidis, small cigarettes containing, on average, 25 percent less tobacco than the average cigarette (Jha et al., 2008). Despite the smaller amount of tobacco in bidis, they can produce more nicotine, carbon monoxide, and tar than the average manufactured cigarette because of the way smokers puff on them (Mackay J et al., 2006). One recent nationally representative case-control study found that about 70% of smoking-related deaths in India take place during productive years of life between 30-69 years of age (Jha et al., 2008). In addition, the study projected that smoking will kill one million people each year starting in 2010 (Jha et al., 2008).
Since 2005, the World Health Organization (WHO)'s Framework Convention on Tobacco Control (FCTC) offers a legally binding treaty that mandates evidence-based tobacco control policies and programs to reduce morbidity and mortality from tobacco use. Countries such as India that have ratified the FCTC are legally required to implement its provisions, including interventions to reduce secondhand smoke exposure (World Health Organization, 2005). Article 8 of the FCTC requires signatories to adopt and implement measures to protect their populations from exposure to SHS in indoor work places, public transportation, and closed public spaces.
Since ratifying the FCTC in 2004, India’s tobacco control policies and programs have undergone improvements necessary to create the evidence-based strategies suggested in the FCTC text. The Cigarettes and Other Tobacco Products Act (COTPA) was enacted by the national government of India on May 1, 2004 (Ministry of Health and Family Welfare, 2008b; Ministry of Health and Family Welfare, 2008a). This legislation contains most of the areas covered by the FCTC's articles – including provisions on advertising, promotion and sponsorship, health warnings, and a ban on smoking in public places. COTPA’s Section 4, which bans smoking in public places, contains an exemption that allows separate...