Introduction:
India with effective tobacco control policies has seen 6% reduction of tobacco prevalence from GATS-1 (2009-10) to GATS-2 (2016-17) while Kerala, a state in south India with a population of 34.5 million (2018) witnessed 8.7% reduction. India has a tobacco control law called Cigarettes and Other Tobacco Products Act (COTPA) which has provision for smoke free. Kerala was the best state in term of COTPA implementation with 34.38% of total COTPA cases and only 2.76% population of India.

Objectives:
Examining factors responsible for significant reduction of tobacco prevalence in Kerala in relation with implementation of smoke free rules.

Methods:
Data from Kerala Police for action under COTPA from year 2013 to 2018 was collected and examined. GATS-1 and GATS-2 data of Kerala was also screened for tobacco prevalence pattern. It was observed that from GATS 1 to GATS 2, prevalence of any tobacco use has decreased from 21.4% to 12.7% while there was 4.1% points decrease in the prevalence of smoking. As per Kerala Police, total 812654 violators were fined under different section of COTPA between year 2013 to 2018 in Kerala, out of which 96.5% i.e. 7,84,203 were fined for smoking in public places. Year wise details are shared below. Year 2013 2014 2015 2016 2017 2018 Violators fined for public smoking 57937 90396 162151 201085 162606 110028

Results:
Due to rigorous and sustained implementation of COTPA in Kerala, there was 40.65% absolute reduction in tobacco prevalence. There was 10% reduction in exposure to SHS at any public place. It also inspired 2.3% more smokers to make a quit attempt.

Conclusion(s):
Sustained enforcement of smoke free rules by the Kerala Police induced to social behavior changes which lead to reduction in tobacco consumption and ultimately to lesser burden of tobacco induced diseases.