Adherence to the National Tobacco-Free School Policy in Selected Schools of Puducherry District in India: A Cross-Sectional Exploratory Study

Introduction: The objective of this study was to estimate the level of compliance and the factors associated with high adherence to the Tobacco -Free Educational Institutions (ToFEI) guidelines of the Government of India among schools in the district of Puducherry, India. Methods: This cross-sectional study was conducted among schools (N=50) in the Puducherry district in 2021-2022 using a "Self -Evaluation Scorecard" of the ToFEI guidelines. The assessment was done through in -person interviews with the schools' heads/representatives. The level of compliance to indicators was presented as proportions, and factors associated with high compliance were assessed using the chi-square test. Results: No school met all the ToFEI indicators. The majority (88%) showed no evidence of the use of tobacco products inside the premises. More than half of the schools (58%) adhered to the criteria of not having tobacco shops within 100 yards and 56% reported the inclusion of the "No Use of Tobacco" norm in their guidelines. Schools located in rural areas (p -value <0.01) and those with teachers who attended any tobacco -related workshop were more likely to comply with the ToFEI indicators (p -value 0.05). After relaxing the criteria for 'High Adherence' to at least four indicators, we found that 20% of schools showed high adherence to the ToFEI indicators. Conclusion: Overall compliance of schools to the ToFEI guidelines is low in Puducherry. Sensitizing the relevant stakeholders in the district for implementing ToFEI guidelines and institutionalizing tobacco control activities in the school are the needs of the hour.