COTPA Section 4 Compliance in Udupi City Municipal Corporation: An Exploratory Survey From Coastal Karnataka

Background: The Cigarettes and Other Tobacco Products Act (COTPA), 2003, prohibits smoking in public places under Section 4 to protect individuals from second-hand smoke (SHS). However, compliance with this provision remains inconsistent across India. Aim: To assess compliance with Section 4 of COTPA in public places in the Udupi City Municipal Corporation (UCMC) of Karnataka. Methods: A cross-sectional observational study assessed compliance with smoke-free regulations in 189 public places selected by convenience sampling using a structured observational checklist. Compliance was categorised as full, partial, or non-compliant. Data were analysed using descriptive statistics, chi-square tests with Bonferroni-adjusted post hoc analyses and binary logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Results: Of 189 sites, 38% were compliant (17.5% fully and 20.5% partially), while 62% were non-compliant, primarily due to absent signage (48%); active smoking was observed at 14%. Place category significantly predicted compliance (p < 0.001), with higher adherence in recreational venues (90%) and healthcare facilities (86.7%). Educational institutions, government offices, hospitality venues and hotels showed substantial non-compliance (45.5%–51.8%) and significantly lower odds of compliance compared with healthcare facilities (ORs 0.09–0.15). Marketplaces exhibited very poor compliance (77.8% non-compliant; OR = 0.03), while transportation hubs and religious sites were uniformly non-compliant due to the absence of mandated signage. Conclusion: The findings highlight the need for stronger enforcement, routine monitoring and targeted awareness initiatives to improve compliance with smoke-free legislation and protect public health.