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While Kerala succeeded due to the COTPA dedicated website of State Police,[29] Rajasthan succeeded by implementing a ban on (a) advertisements of tobacco products by its State transport buses, (b) display of tobacco products at the PoS, and (c) sale of loose cigarettes and due to integrated enforcement review by the State Police in monthly crime review meetings.[30] Chandigarh attributed lower compliance (3.8%) to the multitasking done by the State Nodal Ocer and decient funding to sustain the implementation.[25] Overall, lower compliance (58.95%) to Section 5 [Table 3] was reported to be due to (1) tobacco industry exploits at the PoS Figure 2: Forest Plot depicting compliance to Section 47, NoSmok, and Tobacco Free Institution Deshmukh, et al.: Compliance of section 4,5,6a and b, 7, no smoking and tobacco free institution signage of cigarette and other tobacco product act (COTPA) 2003 in IndiaA systematic review and meta-analysis 57 Indian Journal of Community Medicine Volume 48 Issue 1 January-February 2023 57 by promoting and advertising its products through attractive displays in the form of dangles, boards,[31,32] posters,[33] brand colors[34] and the unit cost of the tobacco products[35] and/or (2) weaker enforcement unable to eliminate existing ambiguity in board size, number, area of placement.[22,32,36] Additional factors for its lower compliance are prime time TV shows with movie stars advertising for pan masala,[37] the eld level ocials not having access to guidelines that are usually in electronic form and mostly in English, besides lack of guidance from their higher ocials towards prompt enforcement,[35] lack of empowerment to the vendors on PoS laws,[38] and general stores selling tobacco products.[35,38] India Tobacco Interference Index (TII Index) 2020 reports a small but denite improvement in the implementation of WHO FCTC Article 5.3 from 2017 onwards [Figure 2].[39] Section 6 a and b: Uttar Pradesh (93%), Maharashtra (96.24%), Karnataka (97.49%), and Himachal Pradesh (99.79%) reported good compliance with Section 6a with national compliance of 94.11% for tobacco sold by minors [Table 4]

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