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Tob Control. 2019 Mar;28(2):220-226. doi: 10.1136/tobaccocontrol-2018-054290. Epub 2018 May 9.

Compliance with point-of-sale tobacco control policies and student tobacco use in Mumbai, India.

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Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA.
Healis Sekhsaria Institute for Public Health, Mumbai, India.
Department of Health Policy and Management, University of California, Los Angeles, California, USA.
Department of Preventive Oncology, Tata Memorial Hospital, Mumbai, India.



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.


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.


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).


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.


adolescents; global health; low/middle income country; prevention; public policy; smokeless tobacco

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