Implementation and Enforcement of Smoke-free Laws Across Indian States: Challenges, Successes, and the Way Forward – A Narrative Review

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Tobacco use remains a major public health concern in India, causing over 1.35 million deaths annually and costing more than 1% of the GDP. Despite strong legislation under the Cigarettes and Other Tobacco Products Act (COTPA, 2003), the National Tobacco Control Programme (NTCP), and India’s commitment to the WHO Framework Convention on Tobacco Control (FCTC), enforcement of smoke-free laws is inconsistent across states. This review aims to assess the implementation and enforcement of smoke-free laws in India, examine compliance trends, identify key barriers, and highlight best practices for improved policy action. A narrative synthesis was conducted using literature from 2010 to 2025 sourced from PubMed, Google Scholar, national surveys (GATS), WHO reports, and Ministry of Health and Family Welfare publications. Studies addressing compliance levels, enforcement gaps, and community-based interventions were analyzed across five domains: compliance, barriers, industry interference, public health impacts, and innovative practices. Compliance with Section 4 of COTPA varies widely, with higher enforcement in Himachal Pradesh, Rajasthan, Tamil Nadu, Kerala, Karnataka, Delhi, and Punjab, and weaker implementation in Bihar, Uttar Pradesh, Gujarat, and northeastern states. Barriers include limited institutional capacity, rural–urban disparities, low awareness, and tobacco industry interference. States emphasizing decentralized governance, awareness drives, and community participation achieved better compliance and reduced second-hand smoke exposure. India’s smoke-free legal framework is comprehensive but unevenly enforced. Strengthening institutional capacity, adopting FCTC Article 5.3, and promoting equity-focused monitoring are essential. Scaling successful state models and integrating tobacco control into local governance can accelerate progress toward a smoke-free India.