Abstract
India has 274 million tobacco users and a tobacco use prevalence of 38% in rural areas. Tobacco consumption causes 1 million deaths and costs the health system nearly US$23 billion annually. Tobacco control policies exist but lack proper implementation. In this article, we review the Tobacco-free Village (TfV) program conducted in Maharashtra state in India and describe its process to help villages in rural India achieve "tobacco-free" status (i.e., the sale and use of tobacco are prohibited by law). We reviewed program documents and conducted 22 qualitative interviews with program staff and village-level stakeholders. From 2008 to 2014, Salaam Mumbai Foundation implemented the TfV program in 60 villages in Maharashtra state. The program used a number of strategies to help villages become tobacco free, including collaborating with a community-based organization, leveraging existing health workers, conducting a situation analysis, training health workers, engaging stakeholders, developing TfV assessment criteria, mobilizing the community, conducting health education, imposing sanctions, and offering incentives. By 2014, 4 villages had achieved tobacco-free status according to 11 assessment criteria. Successful villages demonstrated strong local leader involvement, ownership of the program, and commitment to the cause by residents. The TfV program faced barriers including poor motivation of health workers, difficulty in changing social norms of tobacco use, and refusal of local vendors to stop tobacco sales due to financial losses. This low-cost, community-driven program holds promise for helping public health practitioners and governments implement and achieve the goals of tobacco control policies, especially in resource-scarce settings.
Highlights
Global Health: Science and Practice 2017 | Volume 5 | Number 3 smokeless products
Tobacco consumption is strongly associated with low socioeconomic status.[9,10,11]
Following advocacy efforts at national and regional levels, the Indian government enacted the Cigarettes and Other Tobacco Products Act (COTPA) in 2003.12 The COTPA prohibits smoking in public places, advertisements of tobacco products, and sale of tobacco products to and by minors; bans the sale of tobacco products within 100 yards of all educational institutions; enforces a mandatory display of pictorial health warnings on tobacco-product packaging; and mandates testing of all tobacco products
Summary
Global Health: Science and Practice 2017 | Volume 5 | Number 3 smokeless products. Many view tobacco use as a traditional practice,[2] and many believe that tobacco relieves stress and reduces oro-dental pain.[7,8] Tobacco consumption is strongly associated with low socioeconomic status.[9,10,11]. In 2004, India became the eighth country in the world to ratify the World Health Organization’s (WHO’s) Framework Convention on Tobacco Control.[6] Despite these strides in tobacco control policy, studies assessing the implementation of the WHO’s Framework Convention on Tobacco Control via the COTPA in India found lack of compliance with almost every provision.[13,14] In Maharashtra, 1 of the 5 major tobacco-producing states in the country where 1 in 3 adults and 15% of adolescents consume tobacco,[15,16] an observational study revealed only partial compliance with COTPA provisions on smoking and sale of tobacco to minors.[17]. The aim of the Tobacco-free Village (TfV) program, implemented between 2008 and 2014, was to stop the sale and use of tobacco in villages in Chandrapur district, in rural Maharashtra state, in order to reduce tobacco-related morbidities and mortality
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