Establishing Priorities for the Effective Implementation of Tobacco Control Program at National and Subnational Level in India: A Delphi Study.

India faces unique challenges in tobacco control, with 266.8 million adults using tobacco. Despite these challenges, the country has made progress with the National Tobacco Control Program (NTCP). Effective execution of these policies is crucial to combat the growing tobacco epidemic. This study aims to establish consensus on national and subnational NTCP priorities using a modified Delphi technique. A three-stage modified Delphi process involved 21 experts from government, nongovernmental organizations, and academia. In the first stage, experts identified key tobacco control priorities. In the second stage, they rated these priorities on a Likert scale (0-4), and the top 10 were determined using a weighted mean. The final stage included an in-depth discussion and ranking of these top priorities by the expert panel. In the initial round, experts proposed 20 national and 17 subnational priorities, which were then rated and ranked to achieve consensus on the top 10 for each level. The top three national priorities identified were amending the National Tobacco Control Legislation (COTPA), monitoring NTCP implementation, and protecting health policy from tobacco industry interference. The top three subnational priorities were: enforcing COTPA and the e-cigarette ban (PECA), engaging civil society in tobacco control efforts, and promoting tobacco-free schools and villages. While national policies and legislation are vital for strengthening the overall tobacco control framework, effective implementation and enforcement at both national and subnational levels are essential for curbing the tobacco menace in India.