Examining Implementation of Tobacco Control Policy at the District Level: A Case Study Analysis from a High Burden State in India

Table 1

Key emergent themes and responses (stages 1 and 2).

Key emergent themes	Response of cases ()		No/neutral response
	Positive	Negative
() Awareness on socioeconomic/financial/health impact; (Positive = 42)	⁢All the respondents responded positively to the awareness of ill effects of tobacco use; Yes it is financially burden for the people; It is economic burden and also health problem; TB, Cancer, Liver disease, digestion related problems, mouth Cancer, brain-tumor, Lung Cancer and those who have BP, Sugar will (suffer from heart) attack…
() Perception on effective implementation of the smoke-free laws; Positive = 25; Negative = 10; Neutral = 7	Majority of the respondents were familiar with the laws and regulations towards tobacco use; Regularities of the 2003 policy and no smoking in public places; If they smoke in public places if it is for first time acts 100 Rs fine and second time 200 RS	Very few respondents were unaware of the policy per se but were familiar with the norms of the policy; Don’t have that much idea about that policy; Don’t know about policies	Few cases viewed lack of public support from the masses as an important barrier in implementation of the law; Can’t say much about it because policy are just policies because people just read it and forget they; No they (people) don’t feel at all that tobacco control is their responsibility
() Integration and its effectiveness; Positive = 37; Negative = 5	Most respondents responded positively to the idea of integration of tobacco control program within other health programs; By integrating with that (NGO) we can get support like in technical and financial support. It will be better; Integrating with NRHM gives more profit	⁢Few respondents raised concern about the idea of integration; If we give 10 programs likes that (together) it (tobacco control issue) gets diluted; It should be separate program not integration; It should be individual program
() Organizational Barriers
(4.1) Tobacco: lack of prioritization Positive = 42	⁢All the participants agreed that tobacco control lacks prioritization; The tobacco control program is very small; I think they (government) are not taking it (tobacco control) as big issue
(4.2) Lack of resources; Positive = 41; Negative = 40	Majority of the respondents recognized lack of resources to be a barrier; Yes there are no human resources; We need funds, man power, material; Lack of supervision and motivation, lack of self-motivation also; We don’t have awareness camps here; No monitoring and supervision is done, strict implementation is not there; There are many problems, like corruption	⁢One respondent denied the lack of resources as barriers to effective implementation of tobacco control program; No new human resources needed, present human resources are enough
(4.3) Lack of monitoring and interdepartmental coordination; Positive = 42	⁢All the respondents recognized lack of monitoring and coordination as a barrier; No monitoring and supervision is done, strict implementation is not there; There are many problems, like corruption; Once policy (smoke-free policy) is made then there should not be politician interference