Background and challenges to implementation:
In India, more than 275 million adults use tobacco, which kills 1.2 million of these every year. More than one-quarter of India´s youth begin tobacco use before they are 16 years old and 85% of all users begin before they are 18, the legal age of tobacco use. A diversity of tobacco products spurs India´s hidden epidemic. In May 2003, the Indian Parliament passed a landmark tobacco control legislation - the Cigarettes and other Tobacco Products Act (COTPA). Following this the Government of India launched the National Tobacco Control Programme (NTCP) in 2007, with the aim to protect children and youth and to enforce the tobacco control legislation.

Intervention or response:
We assess the progress of tobacco control efforts in the states by analysing the compliance towards provisions of COTPA and achieving goals of The NTCP. We use third party compliance studies, analyses done by civil societies, orders and action taken reports of state governments and district administration, and media report from states. We prepare a semi-structured report card based on compliance towards criteria specified under NTCP and COTPA.

Results and lessons learnt:
The achievement in tobacco control have been mixed. We will present a state-wise, updated assessment of performance of tobacco control efforts in India, and identify drivers for their success and reasons for their limited progress. We find that political and administrative commitment and leadership are critical to get tobacco control started at sub-national level.

Conclusions and key recommendations:
Sustainable enforcement and adoption of evidence-based strategies, investing in developing skilled human resources, and financial commitments (especially co-investments from sub-national sources) are key factors in achieving goals under National Tobacco Control Programme and ensuring long-term gains that advance tobacco control.