Research Article Examining Implementation of Tobacco Control Policy at the District Level: A Case Study Analysis from a High Burden State in India Divya Persai, 1 Rajmohan Panda, 1 and Adyya Gupta 2 1 Public Health Foundation of India, New Delhi 110019, India 2 School of Public Health and Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA 5005, Australia Correspondence should be addressed to Divya Persai; dpersai@gmail.com Received 7 September 2015; Accepted 8 December 2015 Academic Editor: John Iskander Copyright © 2016 Divya Persai et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. While extensive scientifc evidence exists on the tobacco epidemic, a lack of understanding of both policies and their appropriate way of implementation continues to hinder efective tobacco control. Tis is especially so in the developing countries such as India. Te present study aims to understand current implementation practices and the challenges faced in mainstreaming tobacco control policy and program. Methods. We chose a qualitative study design to conduct the case analysis. A total of 42 in- depth interviews were undertaken with seven district ofcials in six districts of Andhra Pradesh. A conceptual framework was developed by applying grounded theory for analysis. Analysis was undertaken using case analysis approach. Results and Discussion. Our study revealed that most program managers were unfamiliar with the comprehensive tobacco control policy. Respondents have an ambiguous opinion regarding integration of tobacco control program into existing health and development programs. Respondents perceive lack of resources, low prioritization of tobacco control, and lack of monitoring and evaluation of smoke-free laws as limiting factors afecting implementation of tobacco control policy. Conclusion. Te fndings of this study highlighted the need for a systematic, organized action plan for efective implementation of tobacco control policy and program. 1. Introduction Tobacco use is the world’s leading preventable cause of death. It has been the cause of 5.4 million deaths annually and the toll is expected to account for 10% of all deaths globally by 2015 [1]. In the 21st century, tobacco’s toll is expected to be responsible for 1 billion deaths globally [2]. It has been estimated that tobacco smoking was a single most preventable cause of 1 million deaths a year in India in early 2010 [3]. To curb this growing menace, National Tobacco Control Program (NTCP) was piloted in India in 2007-2008 to strengthen the implementation of tobacco control policy. Te program is currently implemented in 21 states and 42 districts in India. Te NTCP in its current form has a national, state, and district tobacco control cell. Te national cell is responsible for planning of activities, policy formulation, and monitoring and evaluation [4]. Te district tobacco control cell is responsible for over- all planning, implementation, and monitoring of diferent activities and achievement of physical and fnancial targets planned under the program in the district. Te NTCP outlines the involvement of district level health functionar- ies in implementation of various tobacco control policy measures which includes enforcement and monitoring of implementation of tobacco control laws [4]. It also envisages that district tobacco control cell should develop awareness and mass media campaigns for awareness generation on the harmful efects of tobacco. However, the district level health system lacks sufcient capacity to mainstream tobacco control in health and developmental activities [5]. It has also been recognized that there is a lack of efective monitoring mechanism in about half of the states where NTCP is under implementation [6]. In order to manage the enforcement and Hindawi Publishing Corporation Advances in Preventive Medicine Volume 2016, Article ID 4018023, 8 pages http://dx.doi.org/10.1155/2016/4018023