This study was conducted from August 2017 through July 2018 among 32 educational institutions and 157 points-of-sale (PoS) of Shimla using a structured observational checklist based on the COTPA 2003 specifications and guidelines; and a guide jointly developed by John Hopkins School of Public Health, Tobacco Free Kids and International Union against Tuberculosis and Lung Disease. [9,10]. Necessary prior permission was obtained from concerned administrative authorities of the Shimla city and Head of the educational institutes selected for the study. Ethical approval for the study was taken from the institutional human ethics committee.

Data collection was done by all the authors comprising two research teams of public health experts. The quality of data collected was ensured by observation of the same facility twice by two different teams of researchers on separate days and at different times of the day. On both occasions each of these facilities were observed for at least an hour. The educational institutes and PoS were observed during official hours and peak business hours, respectively.

This is a part of larger study where we evaluated all 10 sections of COTPA 2003. However, we are here in presenting findings of Section 6 which addresses the protection of children from the menace of tobacco and second hand smoke. An exhaustive list of 521 different categories of public places was procured from the concerned authorities and a separate list of PoS in the city was also prepared. A sample proportionate to the strength of each sub-category was selected from the list of various public places and PoS in the city. Thereafter, the educational institutes and PoS were selected randomly by using lottery method.

An educational institute or PoS was labelled as compliant, partially compliant and non-compliant, if all, some or none of the indicators defined under Sections 6 of the Act were met, respectively. To assess the overall compliance to this section, a few key indicators were stressed upon. Good compliance was defined as having fulfilled more than 80% of those key indicators.

Statistical analyses: The data was analyzed using Epi info version 7.2.2.6 software. Association between catego-rical variables was analyzed using Pearson’s　chi-square or Fisher exact test. P value of <0.05 was considered as statistically significant.

In the present study a total of 32 educational institutes and 157 PoS were observed. Compliance of PoS/shops to COTPA 2003 is summarized in Table I. On comparing different type of PoS establishments, permanent shops were significantly more likely to display signages prominently (P=0.03) and also display of signages of ban of sale to a minor person (P=0.02). Temporary kiosks were least likely to display the signage at a prominent place. Permanent shops and permanent kiosks were better compliers regarding display of signage displaying ban on sale of a tobacco product to a person aged less than 18 years (Table II). In general, Government institutes performed better than private institutions; however, the difference was statistically not significant. (Table III). On an average 4 out of 7, and 4 out of 5 key indicators were fulfilled in section 6 (a) and 6 (b), respectively. Only 7.6% of the PoS in the city showed good compliance to the sub-section 6 (a). For the sub-section 6 (b), high compliance was seen among educational institutes with about 88% of the institutes displaying more than 80% compliance to the key indicators.

TABLE I	Cotpa Section 6 (A) Compliance of Points of Sale of Shimla City (N=157)

TABLE II COTPA Section 6 (A) Compliance: Different Points of Sale of Shimla Compared

TABLE III Cotpa Section 6 (B) Compliance of Educational Institutions

In the present study almost a quarter of PoS were found within 100 metres of the educational institutions; however, a negligible number of PoS were found selling tobacco products to minors and majority refrained from tobacco advertisement. Overall good compliance was observed to the provisions of Section 6 of COTPA 2003. Educational institutions in Shimla on the whole conformed to the specified norms of the Act. There was complete absence of tobacco product vending machines at all observation sites.

A study conducted in Chandigarh [11] found that 27% of the PoS were compliant to all indicators whereas none of the PoS showed such compliance in Ahmedabad [12]. Majority of the vendors in our study were non-minors. This was corroborated with the findings conducted in Bihar, Kerala and Maharashtra [13-15]. In the present study, partial compliance was observed in display of such warning signages by the PoS. These violations were noticed in the form of specifications of the signage boards (size and content) not being met and their obscure placement. These results were similar to a previous study [16], which found only one-third compliance. Better compliance was seen in Rajasthan where 93% shops displayed such signage [17]. Most of the vendors did not enquire about the age of the purchaser while selling tobacco products which could possibly lead to unregulated purchase of tobacco products by children. Similar findings were reported by two different studies conducted in Rajasthan and Karnataka [17,18].

The presence of PoS near to the school and absence of warning signages induce easy accessibility and substantial vulnerability to tobacco use. Such risk-taking behaviour in childhood tends to increase exponentially due to peer pressure, once established persists throughout life and is resistant to change. The reasons for partial compliance in a few areas can be attributed to lack of awareness and apathetic attitude of both, those selling tobacco products as well as the law enforcing agencies.

There is still a dearth of literature on this topic. Not much suggestions are found to implement the Act. Information pertinent to non-communicable diseases, their risk factors and legislations like COTPA should be included in the school curriculums to sensitize the children at an early age. The effective implementation of any legislation is a collective responsibility of multiple stakeholders, each with clearly defined roles and responsibilities.

The ill health-effects of tobacco and second hand smoke on children were not assessed as this was beyond the scope of this study. Owing to the limited duration of observation of a facility, the possibility of underestimation of the violations of the Act cannot be ruled out.

Contributors: AC,AM,VB: concept and design of study, collection of data, statistical analysis and preparation of manuscript; AT,TC: concept and design of study, reviewed manuscript; SC, BS: collection of data and preparation of manuscript. All authors approved the final version of manuscript.

Funding: None; Competing interest: None stated.