Prevalence and factors associated with the sale of loose cigarettes at Point of Sale: A cross-sectional analytical study from four Indian states.

BACKGROUND The Framework Convention on Tobacco Control (FCTC) has established that sale of loose cigarettes increases the affordability and accessibility of tobacco for minors. Acknowledging this threat to public health, the Department of Consumer Affairs, Government of India amended the Legal Metrology Act to prohibit sale of loose cigarettes. Regardless, over 70% of the total cigarette sale in the country is in the form of loose cigarettes majority of which is being sold at unrecognized, unrecorded and unregulated informal sector of economy. However, there is a paucity of studies examining the factors associated with sale of loose cigarettes and further research is warranted in the country to know the dynamics of this issue. OBJECTIVE To determine the prevalence and the factors associated with the sale of loose cigarettes at Point of Sale (PoS) in the selected four Indian states. METHODS A community based cross-sectional analytical study was conducted among a total of 2044 PoS in the project states of Meghalaya, Odisha, Puducherry and Telangana using purposive sampling technique. The characteristics of tobacco vendors and the status of loose cigarettes sale were collected using a structured and pre-tested checklist. Proportion for prevalence estimate, bivariate and multivariable log binomial regression analysis were done. RESULTS The prevalence of loose cigarette sale was 93.05% [95% CI: 91.89-94.1]. Sale of loose cigarette showed a significant association with area (aPR 1.03; 95% CI: 1-1.06; p = 0.025), sale of tobacco products to minors (aPR 1.07; 95% CI: 1.04-1.11; p < 0.001), sale of smoking aids to customers (aPR 1.05; 95% CI: 1.01-1.09; p = 0.02), sale of flavored chewable tobacco (aPR 1.08; 95% CI: 1.03-1.12; p = 0.001) and presence of pack warning (aPR 1.18; 95% CI: 1.11-1.25; p < 0.001). CONCLUSION Our findings infer an open disregard for the laws specific to sale of loose cigarettes at PoS. The factors associated with the sale of loose cigarette needs to be addressed through prompt implementation of the tobacco control laws and suitable policy formulation.