Background We measured how student tobacco use and psychological risk factors (intention to use and perceived ease of access to tobacco products) were associated with tobacco vendor compliance with India’s Cigarettes and Other Tobacco Products Act provisions regulating the point-of-sale (POS) environment.
Methods We conducted a population-based cross-sectional survey of high school students (n=1373) and tobacco vendors (n=436) in school-adjacent communities (n=26) in Mumbai, India. We used in-class self-administered questionnaires of high school students, face-to-face interviews with tobacco vendors and compliance checks of tobacco POS environments. Logistic regression models with adjustments for clustering were used to measure associations between student tobacco use, psychological risk factors and tobacco POS compliance.
Results Compliance with POS laws was low overall and was associated with lower risk of student current tobacco use (OR 0.48, 95% CI 0.26 to 0.91) and current smokeless tobacco use (OR 0.40, 95% CI 0.21 to 0.77), when controlling for student-level and community-level tobacco use risk factors. Compliance was not associated with student intention to use tobacco (OR 0.50; 95% CI 0.21 to 1.18) and perceived ease of access to tobacco (OR 0.73; 95% CI 0.53 to 1.00).
Conclusions Improving vendor compliance with tobacco POS laws may reduce student tobacco use. Future studies should test strategies to improve compliance with tobacco POS laws, particularly in low-income and middle-income country settings like urban India.
- public policy
- global health
- low/middle income country
- smokeless tobacco
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Contributors RM originated the study concept and design, conducted the data analysis and wrote the paper. MSP assisted with developing the student survey protocol and provided comments on drafts of the paper. SAP and GAM assisted with developing the vendor survey protocols and provided comments on the paper. WJM, PCG and KR provided guidance on the overall paper concept, and critically edited the paper. H-FH provided input on data analysis and critically edited the paper. All authors agreed to the content of the submitted version.
Funding Fulbright-Nehru Scholar Program, Jonsson Cancer Center Foundation and National Cancer Institute/National Institutes of Health (R01CA201415).
Competing interests None declared.
Patient consent Not required.
Ethics approval Institutional Review Boards of Tata Memorial Hospital, Healis Seksharia Institute for Public Health, University of California Los Angeles and University of Michigan.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement De-identified data from the study can be made available from the corresponding author on reasonable request.
Correction notice This article has been corrected since it published Online First. The % values have been added to Table 1 for the ’Tobasso harms education at school' rows.