|KIDS AND ADOLESCENTS
|Year : 2010 | Volume
| Issue : 5 | Page : 24-29
Secondhand smoke in public places: Can Bangalore metropolitan transport corporation be a role model for effective implementation of cigarette and other tobacco products Act, 2003?
NS Nayak1, VB Annigeri1, DR Revankar1, S Kenchaigol2
1 Center for Multidisciplinary Development Research, R.S.No. 9A2, Plot No. 82, Dr. B.R. Ambedkar Nagar, Near Yalakki Shettar Colony, Dharwad - 580 004, India
2 Institute for Social and Economic Change, Nagarbhavi, Bangalore, Karnataka, India
|Date of Web Publication||9-Jul-2010|
N S Nayak
Center for Multidisciplinary Development Research, R.S.No. 9A2, Plot No. 82, Dr. B.R. Ambedkar Nagar, Near Yalakki Shettar Colony, Dharwad - 580 004
Source of Support: None, Conflict of Interest: None
Background : The Indian government enacted 'The cigarettes and other tobacco products act, 2003' (COTPA), which prohibits smoking in public places. Aim : To validate the efficacy of the Act of 2003, enacted by the Government of India, to prevent secondhand smoking in public places. Settings and Design : The study is based on a non-random sample survey of 2,600 bus passengers carried out in the premises of three mega public road transport organizations in Karnataka state, India, in June 2007. Methods and Material : The information was gathered through administration of structured schedules. A sample of 1,000 each for the terminus of Bangalore Metropolitan Transport Corporation (BMTC) and Karnataka State Road Transport Corporation (KSRTC) in Bangalore and, 600 for North West Karnataka Road Transport Corporation (NWKRTC) in Hubli-Dharwad city was distributed proportionately according to the number of platforms in each terminus. Statistical Analysis Used : Simple Averages. Results : There is some reduction in smoking in general as perceived by 69% of the passengers as compared to the scenario a year before the enactment of COTPA. The observed smoking is lower in the bus premises of BMTC where there is strict regulation, and higher in the bus premises of NWKRTC, which has not taken any regulatory measures. Conclusions : Knowing smoking is banned in public places can itself create awareness depending on the coverage extended by media and implementing an agency to reach the public. The implementation of an act depends on the willingness of stakeholders to act upon it. The implementation of COTPA as done by BMTC could well become a role model for replication elsewhere, if BMTC can strive harder to accomplish a 100% smoke-free zone.
Keywords: Public transport organizations, secondhand smoke, tobacco control
|How to cite this article:|
Nayak N S, Annigeri V B, Revankar D R, Kenchaigol S. Secondhand smoke in public places: Can Bangalore metropolitan transport corporation be a role model for effective implementation of cigarette and other tobacco products Act, 2003?. Indian J Cancer 2010;47, Suppl S1:24-9
|How to cite this URL:|
Nayak N S, Annigeri V B, Revankar D R, Kenchaigol S. Secondhand smoke in public places: Can Bangalore metropolitan transport corporation be a role model for effective implementation of cigarette and other tobacco products Act, 2003?. Indian J Cancer [serial online] 2010 [cited 2020 Jun 5];47, Suppl S1:24-9. Available from: http://www.indianjcancer.com/text.asp?2010/47/5/24/65316
Publication of the supplement was supported by the funds from the 14th World Conference on Tobacco or Health, March 8-12, 2009, Mumbai. The Guest Editors, Editors, Authors and others involved with the journal did not get any financial or non-financial benefit from the sponsors.
| » Introduction|| |
Tobacco smoke contains harmful chemicals. Scientific studies across the world have revealed that tobacco use is one of the main causes of many cancers, as also respiratory and cardiovascular diseases. Around one million deaths occur every year in India due to tobacco consumption, thus imposing a heavy burden on the economy and society. The recent data on tobacco use from the National Family Health Survey (NFHS) carried out during 2005 - 2006 indicates that 57% of men and 11% of women in India use tobacco in some form.  Furthermore, 35.8% of rural males and 29.1% of urban males in the age group 15 - 49 are smokers.
As tobacco smoking is harmful to the smoker it is also harmful to those who inhale the smoke exhaled by smokers. Such type of smoking is generally referred to as secondhand smoking, passive smoking, environmental smoking or involuntary smoking. Secondhand smoke has become an issue of public concern, as it affects non-smokers for no fault of theirs. A single smoker who smokes regularly can affect the health of many who work with him or stay around at home, at his work place or during travel.
The June 2006 report of the US Surgeon General on 'The Health Consequences of Involuntary Exposure to Tobacco Smoke' throws substantial information on secondhand smoke. The report also quotes that secondhand smoke has been designated as a 'known human carcinogen' (cancer causing agent) by the US Environmental Protection Agency, the National Toxicology Program, and the International Agency for research on cancer. The report gives a key message that secondhand smoke is not just an annoyance, it is a serious health hazard that can lead to disease and premature death in children and non-smoking adults. 
In compliance with the COTPA many state governments, institutions, and autonomous bodies started taking concrete action to implement its provisions, for the benefit of the public. In Karnataka, media reports indicated that the authorities of the Bangalore Metropolitan Transport Corporation (BMTC) and Karnataka State Road Transport Corporation (KSRTC) have taken action to strictly prohibit smoking in their premises. This is a massive task we thought, for the transport staff, as around eight lakh passengers travel daily from these two termini. If the law has enabled imposing restrictions on smoking in one place then why not in other places (BMTC and KSRTC vs. NWKRTC)? There was a need to probe this. As the Act was applicable to all the transport organizations in the state, the Center for Multidisciplinary Development Research (CMDR), Dharwad, carried out a sample study in the year 2007, involving 2600 passengers, across the three major RTCs in the state of Karnataka. This study was funded by the American Cancer Society. It was felt that the sample drawn from BMTC and KSRTC, which restricted smoking versus the sample from any other city, would be the best for comparative analysis, to understand what promotes and what demotes the best practices.
The cigarettes and other tobacco products (Prohibition of advertisement and regulation of trade and commerce, production, supply, and distribution) act, 2003 (COTPA) 
Considering the high incidence of tobacco consumption in India and the evidences on health risks associated with its use, the Government of India thought it proper to enact a legislation to regulate tobacco production and supply in the country. To this effect COTPA, 2003, was enacted by the central government with effect from May 2004.
The COTPA passed by the Parliament in 2004, prohibited smoking in public places. Implementation of the Act had been so weak that during May 2008, the Government had to notify new rules to strengthen the existing rules. Agencies or persons responsible for managing the notified public places were expected to ensure that there would be no smoking. The fine, a minimum of Rs. 200, would vary, depending on the number of offences (for details see http:mohfw.nic.in/noti.html).
| » Material and Methods|| |
The objective of the survey was to validate the efficacy of the Act, 2003, enacted by the Government of India to prevent secondhand smoking in public places. We selected the bus termini of North West Karnataka Road Transport Corporation (NWKRTC) in Hubli-Dharwad twin city, and the Bangalore Metropolitan Transport Corporation (BMTC) and Karnataka State Road Transport Corporation (KSRTC) in Bangalore city, for an empirical survey.
The key issues that were examined include
BMTC terminus with 26 platforms has 12,646 daily trips carrying around six lakh passengers. BMTC has banned smoking in its premises from November 1, 2005. KSRTC terminus with 30 platforms has daily trips of 5,000 buses carrying around two lakh passengers and has banned smoking in its premises from the year 2006. The NWKRTC in Hubli-Dharwad has two rural termini, two city termini, and two inter-city / state termini with 79 platforms, serving the rural areas, city population, and the inter-district and inter-state travelers. The total number of trips per day is around 4,725 buses carrying on an average around three lakh passengers, and NWKRTC has not taken any additional measures to implement the ban.
- The current level of secondhand smoke in selected public places
- The extent of reduction in secondhand smoke in public places following implementation of COTPA
- Methods adopted and cost involved in reducing secondhand smoke
- Public response to the COTPA
- The role of stakeholders in reducing secondhand smoke
The study carried out in June 2007, followed a non-randomized sample survey of passengers in the premises of three public transport systems. Simultaneously, discussions were held with other stakeholders, namely the implementing authorities, including transport officials and police, security personnel, and staff members. Third, we deployed our investigators to keep a vigil on the passengers, staff, and security at the bus stations, to observe the situation in each terminus. The information was gathered from the respective respondents through administration of structured schedules and by organizing formal and informal discussions. As stated earlier, a total of 2,600 passengers with a distribution of 1,000 each, for the termini of BMTC and KSRTC in Bangalore, and 600 (100 in each of the six termini) for NWKRTC in Hubli-Dharwad city were interviewed. The sample was distributed proportionately according to the number of platforms in each terminus and the number of bus stops in each platform. To cover all the bus stops we divided the sample per terminus by the number of bus stops. In all the bus stops, for every pre-calculated time interval the first passenger in the queue was our respondent. The time interval was worked out on the basis of the sample allotted for each bus stop. If he / she denied response then the next passenger was approached.
| » Results|| |
Prevalence of smoking and tobacco use among passengers
The study indicates that totally 35% of the passengers surveyed in the premises of public transport corporations consume tobacco. Among them 43.7% are cigarette smokers, 17.5% are bidi smokers, 22.5% are gutkha users, and 12% are those who consume tobacco with betel nuts. The average number of bidis smoked per day is higher (20) than the number of cigarettes smoked (6). The average amount spent per day on tobacco by tobacco consuming passengers in all the three transport corporations is highest on cigarettes (Rs.16.37), followed by gutkha (Rs.9.14), and bidi (Rs.6.63). Per capita per day expenditure on tobacco products is highest for passengers of KSRTC (12.69) followed by BMTC passengers (Rs.11.47), and then come the passengers of NWKRTC (Rs.9.02). Cigarette smoking is higher among passengers in the metropolitan city of Bangalore, whereas, bidi smoking and use of gutkha and tobacco with betel leaf is higher in the moffusil regions of Hubli-Dharwad. The percentage of smokers is higher among passengers with a higher level of education.
As shown in [Table 1], the majority of the smokers prefer smoking in work places followed by home, restaurants, and colleges, in order of their ranking. Only 3% reported that they smoke often in bus stands and none of the smokers reported smoking while traveling in the bus.
Although only 3% reported smoking often in the bus stand (as given in [Table 1]), 37% of the smokers admitted that they smoke for about 20 minutes. Even though it may be one or two, this point needs to be noted. [Figure 1] shows that smoking while waiting for the bus is higher among passengers (who are smokers) in the premises of NWKRTC.
Smoking is lower among frequent travelers (27%) compared to non-frequent travelers (43%). While 39% passengers suffered due to secondhand smoke when waiting for the bus in the BMTC terminus, 35% in KSRTC, and 50% in the NWKRTC premises inhaled secondhand smoke. None of the bus stations are 100% smoke-free. Instances of smoking in BMTC premises, which claims that it has imposed a 100% ban on sale and consumption, reveals the difficulty in managing public health safety measures without the support of the public. This is also because, while frequent travelers are aware of the ban on smoking, the floating population may be visiting BMTC for the first time.
The ban on smoking was introduced in BMTC from November 1, 2005. One of the Assistant Traffic Managers of BMTC initiated the drive, to make the premises smoke-free. A few simple methods followed by BMTC are as follows:
- Before imposing the ban BMTC made announcements every hour, continuously for eight days, with regard to the restrictions on smoking.
- It did not deploy a separate squad for vigilance. The staff members (conductors, drivers, cleaners, and security guards) were motivated to stop smoking and prevent others from smoking in the premises.
- Counseling was done by the Assistant Traffic Manager and his non-smoking support staff to help the chain smoking staff members give up smoking.
- Labels restricting smoking in the premises were glued on the walls near the entrance, bus stops, and toilets.
- The strategy adopted by the authorities to stop smoking is very interesting. If the staff found somebody smoking they would go near him and start shouting without directly addressing the smoker. In general they would say in loud voice, "Oh! People are so unabashed! Although we have displayed that smoking is banned in BMTC premises they smoke and harm others' health". As a result of the hullabaloo public would gather and the smoker would realize by then that he should follow the rules. They did not use any harsh words, but followed this unusual indirect way to propel the message, as the public even till today, does not consider smoking as an offence.
- The authorities of BMTC took sudden inspections of the premises after noticing that every morning the sweeper was finding lots of pieces of smoked bidis and cigarettes in some corridors of the premises. The duties of the staff members who allowed smoking were shifted from night duty. As smoking was higher in the winter and rainy seasons the authorities kept a strict vigilance during these days.
- The senior authorities held meetings with the staff every three days in this connection.
- The implementation of the ban enforcement drive did not impose any significant cost on BMTC. BMTC did not employ nor feel the need for any additional staff to regulate smoking in its premises. The display of posters was part of BMTC's routine activities, to keep the environment clean. The point of appreciation was that the staff members did their duty efficiently with the support from police (the number of cases registered is given a little later in the text).
- In addition, to restricting the availability of the products, BMTC has taken measures to stop the sale of bidi and cigarettes at petty shops in its premises from November 1, 200, the day it implemented the ban on smoking.
- In the first year of implementation, that is, 2005, around 600 cases were handed over to the police. After two years of implementation, the authorities felt that smoking was a very rare sight at the BMTC bus station. In 2007, during the period of five months only 40 cases were registered. This reduction is attributed to the growing awareness among the passengers regarding the ban on smoking in BMTC bus stations.
- On one particular day of survey, 12% of the passengers who did not consume tobacco saw persons smoking at the BMTC bus stop, while the percentage of those who saw smoking at the KSRTC and NWKRTC bus stops, was 20 and 38%, respectively.
- There was a reduction in smoking as perceived by 78% of the passengers in BMTC who did not use tobacco. However, perceived reduction in smoking was observed by only 66 and 56% of such passengers at KSRTC and NWKRTC, respectively.
- Ninety-two percent of the tobacco users among the BMTC passengers were aware that smoking was banned in the premise, whereas, only 78 and 55% of them were aware of this at the KSRTC and NWKRTC premises, respectively.
Why has the ban on smoking failed in the other two RTCs?
- KSRTC, Bangalore, also makes announcements on the ban at the Kempegowda terminus and has asked its traffic controllers and security to prevent smoking in the premises. However, the frequency of announcements and vigilance is lower as compared to BMTC (twice or thrice in a day, as against hourly announcements made in BMTC). Moreover, KSRTC provides services to a floating population who travel from other cities and states and are less likely to be frequent travelers.
- The percentage of rural passengers is higher in KSRTC and NWKRTC bus termini as compared to BMTC bus stops.
- There is no restriction on the sale of cigarettes and bidis in the petty shops located at the bus termini of KSRTC, Bangalore, and NWKRTC, and Hubli-Dharwad, whereas, BMTC strictly prohibits sale of these items. NWKRTC, which has six bus termini in Hubli-Dharwad city, has not taken any action against smoking; as such the prevalence of secondhand smoking is very high in its bus stations. Stickers displaying prohibition of smoking are glued in the new bus stands of Hubli-Dharwad, where the number of passengers is very low. These stickers are not visible in other bus termini, where there is heavy traffic of buses and inflow and outflow of passengers.
- The incidence of smoking by the staff is also higher in the bus stations of NWKRTC. However, not a single case of smoking has been registered or fined by police or transport authorities in the premises of NWKRTC in Hubli-Dharwad city, which has the highest (62%) percentage of smokers, who reported smoking at least once while waiting for the bus. Therefore smoking is found unabated in the premises of NWKRTC.
- A majority of the implementing authorities including the police are unaware of the Supreme Court Order (2001) and the provisions of COTPA, 2003.
We assume that smoking by one passenger affects on an average at least five passengers around him. The number of smokers who reported smoking while waiting for the bus is different for the three transport corporations. The current level of secondhand smoke estimated for different bus stations is lowest (24%) in the BMTC premises. This indicates that the intervention by the BMTC authorities has helped in reducing the menace of secondhand smoke. Hence, the incidence of secondhand smoke estimated by using the number of smokers in each terminus varies accordingly, as specified here: BMTC - 24%; KSRTC - 35.5%; and NWKRTC - 68.3% [Figure 2]. The number of passengers exposed to secondhand smoke every day (in the termini covered under the study) could be 1, 44,000 in the BMTC bus terminus, 71,000 in the KSRTC bus terminus, and, 2,04,900 in the NWKRTC bus termini. In the BMTC bus stops, although the estimated percentage of secondhand smoke is lower, in absolute terms, the number of passengers affected is higher than the KSRTC's passengers, because everyday six lakh passengers travel from the BMTC terminus.
| » Discussion|| |
We can conclude that the simple and cost-effective method of implementing COTPA, as done by BMTC, could well become a role model for replication elsewhere, as there has been a substantial reduction in smoking during the last one year, as perceived by the passengers. The study reveals that the implementation of rules under COTPA by public authorities, as reported by the BMTC authorities, does not impose a significant cost burden to the implementing agencies, as the duties of the bus stand authorities, in addition to transport management, include maintaining a pleasant environment in the premises and ensuring a safe journey to the passengers. The expenditure toward the display was made through a miscellaneous account, amounting to Rs.500 (approximately). The difference that BMTC made was that it glued the posters in the right positions, made announcements at regular intervals for ban on smoking, along with those made for the cautions on safety.
- The fact that 39% of the passengers experienced secondhand smoke while waiting for the bus in the BMTC terminus, which claims that it has imposed a 100% ban on sale and consumption, reveals the difficulty in managing public health safety measures without the support of the public. This indicates that none of the bus stations are 100% smoke-free. Therefore, there is a need for greater efforts in terms of awareness creation, staff coordination, and vigilance. BMTC therefore has to strive harder to accomplish a 100% smoke-free zone.
- Many a times the laws are not taken seriously by the public. This is because the implementation is always weak, maybe on account of corruption, practical problems, lack of awareness among public, and lack of understanding of the law by the implementing authority itself. The situation is not very much different with COTPA, with an exception of BMTC, which is one of the cases studied. However, it should also be noted that the mere enactment of the Act, 2003, itself has resulted in reducing smoking to some extent through the spreading of news and effects of display.
- The study shows that the three transport corporations exhibit different levels of tolerance to smoking in their premises. Smoking is found unabated in the premises of NWKRTC, while KSRTC has not been regularly following the measures that it has initiated to prevent smoking. BMTC, which has taken preventive measures to restrict the use of tobacco has a comparatively higher percentage of passengers who are aware of the ban.
- COTPA can be effectively implemented in bus stations by banning the sale of bidi / cigarettes in the premises. If not feasible, there should be complete ban on advertisements at all places including points of sale, namely, petty shops, general stores, and so on.
- The percentage of passengers who smoke often at workplaces, at home, and at restaurants is higher as compared to those who smoke often at bus stands. Nevertheless, it does not mean that the risk is lower at the bus station and can be ignored.
- The risk will obviously be higher wherever there is a heavier load of passengers, for example, the BMTC bus station.
- Although the percentage of passengers smoking in the premises of BMTC is lower compared to other bus stations, the number of people exposed to secondhand smoke is significant, as around six lakh passengers travel daily from this place. Therefore, while there is a continued need for implementation of smoke-free zones at bus stations, there is a greater need for a simultaneous and effective implementation of COTPA at other high smoking zones, such as, work places and restaurants, which will strengthen the drive for smoke-free bus stand/s in any place.
- The regulating authorities have to adopt zero tolerance level for violation of COTPA.
Expected support from NGOs
As a majority of the passengers as well the regulatory authorities responsible for preventing smoking in public places are not aware of the provisions of the Act, NGOs should be engaged in conducting countrywide workshops for training regulatory and implementing authorities and creating awareness.
Smoking in a workplace is already banned under COTPA, 2003. With regard to passive smoking at residences, there is a need for a concerted effort to mobilize public opinion against it: Civil society and the State governance can play a greater role in this regard.
The positive response from the media, public, and NGOs is encouraging and can be mobilized for putting a full stop on secondhand smoking.
| » References|| |
|1.||International Institute of Population Sciences (IIPS): National Family Health Survey 2005-06 (NFHS-3). Mumbai, India: IIPS, 2007. |
|2.||The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General U.S. June 2006. Available from: http://www.surgeongeneral.gov/library/secondhandsmoke/ [last accessed on 2007 Dec 8]. |
|3.||Government of India. The Gazette of India. New Delhi. Ministry of Law and Justice. 19 th May, 2003:3. |
[Figure 1], [Figure 2]
|This article has been cited by|
||Evaluation of research on interventions aligned to WHO ‘Best Buys’ for NCDs in low-income and lower-middle-income countries: a systematic review from 1990 to 2015
| ||Luke N Allen,Jessica Pullar,Kremlin Khamarj Wickramasinghe,Julianne Williams,Nia Roberts,Bente Mikkelsen,Cherian Varghese,Nick Townsend |
| ||BMJ Global Health. 2018; 3(1): e000535 |
|[Pubmed] | [DOI]|