Policy strictness, enforcement and public health effectiveness of tobacco control in India: integrating world health organization framework convention on tobacco control compliance and public perceptions

The objective of this study is to examine the extent to which India's tobacco control policies have been implemented in practice and to analyse public perceptions of their effectiveness and alignment with WHO-FCTC provisions. A mixed-method design was adopted. A systematic review of national tobacco control policies was conducted to examine their alignment with selected world health organization framework convention on tobacco control (WHO-FCTC) provisions. Concurrently, a cross-sectional survey involving 95 participants was administered using the policy perception scale. The instrument measured policy strictness, enforcement rigidity, effectiveness of tobacco control initiatives, and policy alignment with international standards. Structural equation modelling (SEM) was performed to test hypothesized relationships among latent constructs and to determine predictors of perceived policy effectiveness. Our review of the policies showed that India is doing well with smoke free rules and warnings on packages but there are still problems with taxes and indirect promotion controls. When we asked people what they thought we found that they believe tougher policies lead to enforcement and g