Challenges and Outcomes of Tobacco Control Laws on Oral Cancer in Odisha

Abstract

Background: Odisha bears a high burden of oral cancer, closely linked to the widespread consumption of tobacco and areca nut products. Despite comprehensive laws like the Cigarettes and Other Tobacco Products Act (COTPA) and state-level bans, significant gaps remain between policy and on-ground enforcement.
Objectives: This study analyses the implementation of tobacco control policies across districts in Odisha, focusing on COTPA compliance, enforcement effectiveness, and the real-world availability of banned products. It aims to identify challenges in enforcement and policy-practice disconnects, assessing their impact on oral cancer prevention.
Methods: A mixed-methods approach was used, including multi-district compliance surveys, policy document analysis, stakeholder interviews, and economic modelling. District-level data were compared to assess enforcement variability. Interviews with State Tobacco Control Cell (STCC) officers, district authorities, and community representatives provided context.
Results: Despite strong policies, non-compliance with COTPA and the continued availability of banned products were widespread. Enforcement effectiveness varied significantly by district, with challenges such as institutional barriers, resource limitations, and low public awareness. The economic cost of inadequate enforcement exceeded the investments in tobacco control activities.
Conclusion: Closing the gap between policy and practice is essential for reducing oral cancer in Odisha. Strengthening enforcement, raising public awareness, and improving interdepartmental coordination are critical for effective tobacco control. Findings offer actionable recommendations for statewide tobacco regulation.