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Usually, smoking is a major risk factor for lung disease, but environmental pollution and climate change are becoming increasingly significant threats to respiratory health

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In 2011, 14.6% of adolescents (over 35 million people) were current users of varied forms of tobacco products.2 In the same year, the economic burden of tobacco-related diseases in India was INR 1 04 500 crores (US$ 22.4 billion), which was 1.16% of the countrys gross domestic product.3 Prior to the WHO Framework Convention on Tobacco Control (FCTC) ratification in 2004, India passed a comprehensive tobacco control lawthe Cigarettes and Other Tobacco Products Act (COTPA), 2003 to prohibit (1) smoking in public places, (2) direct and indirect advertisements of tobacco products, (3) sale of tobacco products to minors and within 100 yards of any educational institutions and (4) sale without specified graphic health warning labels.4 To support the implementation of this law, the Government of India launched the National Tobacco Control Program (NTCP) in the year 20072008 to (1) create awareness regarding the harmful effects of tobacco consumption, (2) reduce the production and supply of tobacco products, (3) ensure effective implementation of the provisions under COTPA 2003, (4) help people quit tobacco use and (5) facilitate implementation strategies for prevention and control of tobacco advocated by the WHO FCTC.5 Despite a national policy and programme, the outcomes in Indian states is varied