The total number of premature deaths caused by tobacco in the 20th century was around 100 million, if current trends in tobacco usage continue, this number is projected to reach 1 billion in the 21st century.1 Currently, around 80% of the estimated 1 billion smokers in the world now reside in low and middle income countries (LMICs). Every year, smoking kills 8 million people, and second hand smoke kills another 1 million.2 According to the World Health Organization (WHO), India will have the highest increase in tobacco-related mortality in the coming years.3 The majority of these fatalities would be discovered during the productive years of adult life as a result of childhood addiction.3
India's tobacco issue is likely more complicated than that of any other country globally, with a significant burden of tobacco-related diseases and mortality.4 According to the Global Adult Tobacco Survey India report in 2016-17, over 267 million adults in India (15 years and older) use tobacco (representing 29 percent of all adults).5 The most prevalent form of tobacco usage in India is smokeless tobacco and popular products include khaini, gutkha, betel quid with tobacco, Paan (leaves of the betel plant wrapped around tobacco and betel quid) and zarda (flavoured tobacco used in paan). Tobacco smoking methods include bidi, cigarettes, and hookah.5As cigarette smoking are the most prevalent and well-studied type of tobacco use worldwide, the global literature is only of limited assistance in analysing the problem of tobacco use in India. Cigarette smoking accounts for a small portion of the tobacco smoking problem in India.6 The most popular form of tobacco use in India is beedi smoking, and oral use of smokeless tobacco products is a substantial contributor to the country's tobacco consumption. As a result, extendingthe findings of tobacco research in developed countries would not provide a complete picture of the extent of the tobacco problem in India.6
Over the past few years, the government of India has taken a more active role in addressing the challenges of tobacco control. Few comprehensive preventive interventions or precautionary methods were introduced between 1975 and 2000.7 According to Cigarette and Other Tobacco Products Act (COTPA) and the Framework Convention on Tobacco Control (FCTC) were passed in 2003 and 2005, respectively. The COTPA made it illegal to promote smoking out in the open, to advertise tobacco products, and to sell deals and bundles of tobacco products.7 Signatories to the FCTC agreement, led by the World Health Organization, agreed to make long-term efforts to reduce tobacco use, control tobacco products, assist people in quitting smoking, protect minors and those who do not buy tobacco, limit the stash market, and compensate for the negative effects of the tobacco industry.8 The FCTC and COTPA support a number of ways to stop people from smoking, such as regulating tobacco products, marking them correctly (including health warnings), educating the public about tobacco, limiting advertising, and using other new methods, such as starting programmes to help people stop smoking, stopping the sale of tobacco to minors, and giving tobacco workers other ways to make a living.7 The Government of India prioritised the FCTC, and as a result, NTCP was implemented to assist in achieving this objective.9 Among the efforts' aims are smoking cessation centres, teacher training programmes, educational mediations for use in schools and large communities, and systems for verifying regional support for tobacco control laws.9
The World Health Organization first initiated the international agreement with the WHO-Framework Convention on Tobacco Control (WHO-FCTC). There are presently 181 signatories to the Convention. The World Health Assembly passed it on May 21, 2003, and it went into effect on February 27, 2005. It has subsequently become one of the most rapidly and widely approved treaties in United Nations history.10 The WHO-FCTC was the first international public health convention to address the global public health issue of tobacco control, and India ratified it in 2004. The WHO-FCTC asks for a variety of initiatives to reduce the tobacco demand and supply. India was the regional coordinator for South-East Asian nations and played a vital role in completing the FCTC's requirements during its negotiations.11
Tobacco control should be a top priority not only for health reasons but also to help reduce poverty. India can fulfil its responsibilities to achieve the 2030 agenda for Sustainable Development Goals (SDGs) to reducing poverty and promoting health by implementing effective tobacco control measures. Despite many efforts, tobacco use remains a severe public health risk, with one-third of the Indian population consuming tobacco.12 India is the second largest consumer and producer of the tobacco products in the world, with 275 million tobacco consumers.12 The country is also recognized for producing and consuming various smokeless tobacco products. India has not always complied with the Framework Convention. While some states have made significant progress, the majority of nations struggle with a lack of regulatory oversight, widespread noncompliance, and legislative gaps.13 Tobacco manufacturers and supporters in India say that a ban on tobacco products negatively affects the country's economy and employment. Efforts to reduce tobacco use are underway across the country, but these obstacles pose significant challenges.13
Scoping reviews provides the depth and breadth of the study conducted on a particular topic, which improves the understanding of the phenomena under investigation.14 A scoping review on tobacco control (Halas G et al., 2014), focuses on how the FCTC revealed the specific action areas and demographics most commonly addressed in tobacco control studies in the United States.15 A systematic review on tobacco control and the outcomes of related randomised controlled trials of interventions was conducted in India.16 Another review, studied by Puljevic et al. in 2022, and examined how tobacco endgame plans aim to reduce smoking to minimum levels quickly and permanently.17In India, beedi smoking is a serious problem, and oral use of smokeless tobacco products contributes considerably to the total tobacco problem compared to cigarette smoking populations.6 Evidence available from previously published scoping reviews 14,15 lack identified data on these aspects which are more important for the Indian context. Besides, more recent data on implementation is needed to identify gaps in implementation of policies. A systematic review on the same topic was done in 2015, no scoping reviews on the Indian context were found in the last few years.[16] Previous reviews are very old and lack current policies and strategies. So, the present scoping review fulfils the gaps of the previous reviews and also represents the present policies and strategies of tobacco control.
Effective tobacco control techniques are continually being developed and refined. Due to this variety and complexity, it is necessary to compile evidence on India-specific tobacco control techniques that have proven to be effective. Given the variety of programmes, governmental initiatives/policies, and potential interventions, the least restrictive approach is selected for the scoping review in order to maximise the understanding of the existing diversity of the tobacco control measures in India. After careful deliberation, it was determined that a scoping review of tobacco control measures in India would best serve the purpose of this study. The protocol has been submitted according to the PRISMA-ScR for scoping review checklist guidelines (Appendix-III).18