The WHO’s Framework Convention on Tobacco Control postulates demand and supply reduction strategies for comprehensive tobacco control. As mentioned earlier, it shall not be wrong to say that Kerala can rightfully claim a tick for demand reduction strategies. However, we are yet to begin effective measures relating to reducing the supply of tobacco. Restriction of sales to and by minors is critical, especially as Kerala’s Health Policy 2018 has highlighted the increasing tobacco use among youngsters in
the state. All these factors gave the impetus for the study to assess the sales and purchase patterns of cigarettes and other tobacco products in the state.

HAP took up this study with an  aim to 
1. To map the commercial establishments selling tobacco products in the selected wards of the three cities of Kerala – Trivandrum, Kollam and Kochi
2. To determine the purchase pattern among persons using tobacco products in urban areas of three districts of Kerala during 2018
3. To determine if the commercial establishments selling tobacco products follow the legal regulations mandated by the Indian tobacco control law COTPA, 2003 regarding the sale of tobacco products

This was s a community-based cross-sectional survey covering urban areas of three districts of Kerala, namely Trivandrum, Kollam and Kochi. The study was initiated after the approval of the Institutional Ethics Committee (IEC) of HAP; which is registered under the Ethics Committee Registration Process of the Government of India. Field investigators were identified in three cities and given a day-long training
cum orientation on COTPA, 2003 besides a detailed walk-through on the study questionnaires and observation formats. Mock sessions with the field investigators posing as respondents and HAP staff members as interviewers were conducted to help the investigators get a feel of the process.
The wards included in the study were Chempazhanthy, Kunnukuzhy, Thycaud, Kanjirampara, Punchakkary and Pettah in Trivandrum; Sakthikulangara, Kureepuzha, Kadappakada, Pallimukku, Thekkumbhagam and Thirumullavaram in Kollam and Mundamveli, Chullikkal, Elamakkara, Chalikkavattom, Poonithura and Perumanoor in Kochi.
I n each wards, households and commercial establishments were selected. Purchase and sales (including display) pattern of the commercial establishments selling tobacco products were determined in the commercial establishments selling tobacco products. Trained field investigators visited all shops in the selected wards asking if they sold tobacco products. Two structured questionnaires were used for data collection. One was for the household interviews, and the second one was for documenting display and sales pattern in the commercial establishments selling tobacco products. For the secondary objectives, the study investigator used Google maps of the ward, with pre-marked borders for the ward by the study supervisor, to map the commercial establishments selling tobacco products. GPS reading of the area was taken through a mobile or tablet. A request was made to the Director, Kerala State IT Mission under the IT Department of Kerala to help plot the tobacco selling shops in ward maps using geo-points.

Kerala has set itself a target of a one-third reduction in tobacco use in sync with the Sustainable Development Goals as a means to fighting non-communicable diseases. The second round of the Global Adult Tobacco Survey GATS-2 has shown a decline of 8.7 percentage points in the prevalence of any tobacco use in Kerala, from 21.4 per cent in GATS 2009-10 to 12.7, in its 2016-17 edition. Even while cherishing the hardearned laurels brought forth through collective efforts; it is also equally important that
the successes achieved are not allowed to slide back. As such, it requires greater collective efforts to not just see that we do not slip back but also keep marching ahead! As examples from advanced countries of the world have shown, the key lies in integrating both demand and tobacco supply reduction strategies. A stringent licensing system for tobacco products that reaches the grassroots of our governance and one
that is integrated with the existing Dangerous & Offensive Licensing practices of our Panchayats, Municipalities, and Corporations is the way forward for bringing supply side reductions. This study would serve as a prelude to introducing tangible supply reduction methods in the state.

The study results were submitted to the authorities through workshops in 3 district levels and finally a state level workshop to the state authorities.