Making a compelling case for Tobacco-Free Central Armed Police Forces Training Centres.

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This preprint proposes a policy framework and phase-wise implementation plan to make Central Armed Police Forces training centres tobacco-free, focusing on recruits and current tobacco users. The authors outline high-level methods including prohibition of tobacco and non-therapeutic nicotine possession/use within training-centre premises and selected outdoor duty contexts, restrictions on sale/advertisement within and around the premises, and institution-embedded cessation support via in-centre medical facilities, referral to local cessation centres, and the national quitline, implemented through four operational domains: strategic leadership, policy coordination, operational execution, and ground-level enforcement with measurable indicators. A key limitation is that the paper is not peer reviewed and relies on planned baseline assessment and organizational implementation rather than reporting new outcome data. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Arunjeet Singh, Rakesh Gupta, Amitav Banerjee, J. S. Thakur This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8429492/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 4 You are reading this latest preprint version Abstract The widespread use of tobacco among personnel of central armed police forces has real implications for their health, discipline and operational efficiency. The proposal underscores the need to establish their training centres tobacco-free by focusing on behavioural transformation to prevent the use of tobacco and non-therapeutic nicotine products among recruits and assist their current users quit through an implementable framework grounded in institutional leadership and peer support. By embedding tobacco control strategies within these training institutions, the framework aspires to foster a culture of wellness and resilience in the life of a recruit right from the beginning of their career. The paper lays down a policy framework and presents a phase-wise implementation plan with well-defined timelines for a tobacco-free environment within the training institutions of the central armed police forces. Police Central Armed Police Health Training centres Tobacco-free training centres Policy framework Operational readiness Figures Figure 1 Introduction The use of tobacco, smoked or smokeless is associated with several adverse health outcomes. ( 1 ) Tobacco users also exhibit higher mortality rates than non-users across all age groups, with a distinct dose–response pattern, suggesting that the risk of mortality escalates with increased frequency of smoking. ( 2 ) The decline in physical fitness and pulmonary function is greater in smokers than in non-smokers ( 3 ) Since ratifying the World Health Organization’s Framework Convention on Tobacco Control (FCTC) ( 4 ) the largest global treaty on tobacco regulation and in line with its commitment to curb tobacco use nationwide, Ministry of Health and Family Welfare, Government of India has implemented a series of sustained and impactful interventions which include the enactment of the Cigarettes and Other Tobacco Products Act (COTPA) 2003 ( 5 ) the National Tobacco Control Programme. ( 6 ) provision of cessation support through the National Tobacco Quitline Services and many others at the sub-national level. ( 7 ) Sensing the gravity of the situation, the leaders of the police forces have acknowledged that tobacco use not only undermines physical fitness, compromises deployment readiness, mission safety but also contributes to a significant increase in their healthcare costs. ( 8 ) And, therefore, ensuring a tobacco-free environment requires a policy that shall promote a healthy lifestyle among all divisions and cadres of the police forces. A community-based cross-sectional study conducted by Puthia et al among active duty personnel of an uniformed organisation reported that 47% of the study participants were ever tobacco users, while 35% were current users. While 56% reported to be smokers, the prevalence of smokeless tobacco use was noticeably high (97%). The study, limited to male personnel, did not assess passive smoking among non-smokers- a gap that may underestimate the overall health burden of tobacco exposure within such organisation. ( 12 ) India has six Central Armed Police Forces (CAPFs) training centres (TCs) functioning under the operational control of the Ministry of Home Affairs. ( 13 ) While the exact number of recruits undergoing training at any given time remains difficult to ascertain as recruitment figures are dynamic, influenced by factors such as operational requirements and policy directives, the total sanctioned strength of personnel across the Central Armed Police Forces (CAPFs) stands at 10,03,776 ( 14 ) representing a significant cohort. Given the scale, it is reasonable to infer that a substantial number of recruits are engaged in preinduction training at any given time before being inducted into their respective organisations. This paper provides the necessary inputs to make a CAPF training centre (TC) tobacco-free through a site-specific policy, a structured work-plan to be tobacco-free and stay tobacco-free in a sustainable manner. Methodology Following points in a site-specific policy are essential for making a CAPF training centre tobacco-free: Possession and use: Prohibit possession, use and/or sharing of any form of tobacco and /or unprescribed nicotine products (inclusive of smoking as per COTPA rule 4) regardless of rank within its premises including barracks, training grounds, class rooms, drill squares, officers' mess, non- gazetted officer’s mess, cook houses, public spaces, administrative blocks, without fail and in a sustainable manner. Further, the prohibition will be extended to personnel in uniform during duty hours official parades and their outdoor events. Sale and advertisement: Prohibit sale, advertisement, sponsorship, promotion and distribution of tobacco products within the premises of TC as well as within 100 yards of its perimeter (as per COTPA rules 5 and 6 (1)). Quitting: Support current tobacco users to quit and former users to stay quit by providing cessation assistance in a sustainable manner through the medical centre within the premises of the TCs as well as through their timely referral either to a Tobacco Cessation Centre (TCC) in a nearby district hospital, medical or dental college and/or toll-free National Quitline Service (1800-11-2356) on all week days except Mondays. ( 20 ) Implementation framework of Tobacco Free Training Centre: To achieve a sustainable and an institutionally embedded tobacco-free environment, it was imperative to adopt a structured, multi-tiered approach. The four domains are strategic leadership, policy co-ordination, operational execution, and ground-level enforcement were conceptualized (Fig. 1 ). Strategic leadership establishes the vision and commitment from senior commanders which positions tobacco control as essential to the health, discipline, and operational readiness of the force. It ensures policy legitimacy, allocates resources and drives a culture of wellness Policy coordination translates strategy and policy into tangible, time-bound actions. It facilitates co-ordination between various stakeholders. Operational execution converts plans into tangible actions through structured programs, personnel training, awareness drives, cessation support and surveillance that translates intent into measurable outcomes (Table 1 ). Table 1 Delineated roles and responsibilities of identified appointments within the Training centre. Domain Appointment Key responsibilities Role in implementing TFTC Objectively verifiable indicator Strategic Leadership Director Training centre (Project In-Charge) Command and control, policy formulation and enforcement. Approves and integrates tobacco-free initiatives into TCs Establishes Standard Operating Procedures(SOPs). Allocates resources and ensures apex-level monitoring. Communicates policy objectives and issues enforcement orders Oversees compliance and policy implementation. Ensure seamless integration of tobacco cessation programs within the institution . Delegates monitoring and enforcement powers to sectional heads for effective implementation of the policy Conduct half yearly meetings to review policy implementation Resource allocation Policy Coordination Administrative Officer TCs (to serve as the Nodal Officer) Translates policy directives into actionable steps. Coordinates inter-departmental efforts for generating awareness, empowerment and compliance. Conduct sensitization sessions and awareness campaign. Liaises with dependant Composite Hospital (CH) for counselling and cessation support. . Weekly coordination meetings documented with minutes and action points. Follow up on pending issues Number of sensitization sessions conducted by Administrator/ Sectional heads/ Training Centre Medical Officer Number of recruits requiring cessation support and referred to CH by the TCMO Implementation & Enforcement Training of the Sectional Heads of a TC Leads ground-level enforcement of the policy. Ensures compliance among recruits. Monitors and evaluates the effectiveness of the implementation on weekly basis Conduct routine awareness sessions, surprise inspections to identify non-compliant cases and ensures prompt referral of cases to Tobacco cessation centres Facilitate peer-led interventions and behavioural change programs. Weekly compliance report submitted by training battalions to Nodal officer Number of surprise checks and violations addressed. Operational Execution Administrator of the TC Implements the tobacco-free mandate at the grassroots level. Provides direct supervision, mentorship, and enforcement. Identifies at-risk personnel and refer them for cessation support. Enforce adherence to the no-tobacco policy during training and daily routines. Identify and report policy violations and ensures that corrective actions are taken. Weekly supervision reports verifying tobacco-free status to Training Battalion commander . Number of at-risk recruits identified and put on cessation support Peer-led sessions conducted with participation records. Ground level enforcement ensures tobacco-free norms are practiced daily. It promotes peer accountability and positive reinforcement by encouraging compliance. The following workplan details the steps for implementing the policy to be tobacco-free in TC. The timelines given here are tentative and shall vary depending upon the size and staff strength of a training centre as well as its administrative capabilities: Phase 1: Policy approval, baseline assessment and empowerment of sectional heads and the medical centre within the TC (First month): Draft a Tobacco-Free Policy aligning with existing national health guidelines and obtain concurrence and approval of Director of the TC. Identify key stakeholders within the TC to form a core implementation team of the sectional heads of each and every cadre working within the TCs including those managing their contractual works. Empower these in tobacco control and managing tobacco-free environment within their premises and outdoor activities. Develop strategic work-plan for achieving Tobacco-free status with clear timelines and responsibilities. Conduct baseline survey to assess the prevalence of tobacco use among recruits . Establish a TCC within medical centres of the TCs prior to policy implementation or having the staff (a doctor and a paramedic) and trained in tobacco cessation delivery will be necessary. Following guidelines issued by the National Resource Centre for Oral Health and Tobacco Cessation, Maulana Azad Institute of Dental Sciences, New Delhi may be useful. ( 20 ) Phase 2: Communication, capacity building & assisting current users to quit (Second month): Conduct awareness programs through the empowered sectional heads within their respective section with an aim to promote a culture of collective responsibility and working through concurrence by encouraging peers to lead by example, support each other in maintaining a tobacco-free environment. Once there is concurrence to be tobacco-free among all working within the TC, one of the sectional heads and the medical officer in-charge may conduct a lecture on the adverse health risks of tobacco and provide an overview of the tobacco-free policy to the recruits. Since the program is more likely to be successful when it is leadership-driven, this event should be presided by the head of the respective TC and/or a higher official from their headquarter. Establish a structured support system for tobacco cessation, beginning with peer-led assistance to facilitate early engagement of at-risk and tobacco dependant recruits; followed by initial counselling by named staff from the medical centre (at least a doctor and a paramedic). Their training may be conducted either in-house if someone is already trained in tobacco cessation delivery or through the TCC being run by the district hospital in the vicinity. ( 21 ) Phase 3: Policy enforcement (Third month): Engagement of the Administrative in-charges of the TCs ensure adherence to the tobacco-free policy in respective TCs will be vital to achieve the tobacco-free status of the respective TCs and sustain it on a permanent basis. Holding review meetings regularly presided by the Administrative Head of the TCs is critical to achieve the goal. Signages highlighting to promote tobacco-free culture, motivate the current users to quit tobacco use at the earliest and not to relapse to be able to lead a tobacco-free Life be displayed within the TCs to reinforce awareness of all working within their premises and facilitate the necessary behavioural change. Institute a Tobacco-free champion program wherein the successful quitters advocate and serve as ambassadors to motivate the rest to lead a tobacco-free life. Reinforce exit protocols by encouraging the entire staff and the qualifying recruits to commit to a tobacco-free lifestyle through a formal pledge taken during the at the pass-out parade. Phase 4: Formal declaration of a TFTC The TC should be tobacco-free as per the criteria laid out for at least 3 months subject to fulfilment of the following criteria: No incidence of Tobacco Use: No reported cases of consumption (smoked/smokeless) in the last 3 months, confirmed via inspection records. No Tobacco Litter: No presence of tobacco-related waste (cigarette butts, wrappers, gutka/paan sachets) during inspection. No Possession, storage, or distribution of tobacco Display of standardised, clearly visible bi-lingual tobacco-free zone signages at: (a) Main gate and administrative block; (b) Drill squares /training areas/ class rooms; and (c) Cook houses and barracks. Discussion The Training centres play a critical role in shaping disciplined, physically fit and mentally robust force while the TCs may not have formal directives that explicitly discourage tobacco use within recruits. While certain corrective actions may have been taken at some institutions to limit tobacco consumption among recruits, there is a gap due to lack of a structured and a formal institutional mechanism to systematically monitor and enforce a tobacco-free environment which is largely missing. Effective enforcement of smoke-free regulations can be accomplished through a policy framework pivoted by a supportive ecosystem, targeted awareness campaigns and accessible cessation support, which can cultivate a generation of combatants who could remain tobacco-free throughout their service. A study by Banerjee ( 15 ) in an armed forces TC reported 43% respondents identified themselves as smokers and 34.1% as smokeless tobacco (SLT) users. Among smokers; 13.7% had experimented with tobacco and 8.2% had progressed to occasional use which highlights an early pattern of dependence. Smokers when further categorized by intensity of consumption, comprised of 5.2% light, 4.4% regular, 2.3% heavy and 1.0% in the very heavy smokers respectively. Identified factors for smoking included parental tobacco use, limited awareness of health risks and peer pressure. USS Theodore Roosevelt was the first Naval ship to adopt a modified tobacco-free policy, reflecting the US Navy’s efforts to curb tobacco use. Measures included limiting smoking to designated areas and during specific hours, with a gradual shift toward a complete ban while at sea. Though the policy was in effect for only four months before being rescinded, it yielded promising results with 73% of personnel reduced tobacco use onboard, 22% quit permanently, 57% remained smoke-free during deployment and 46% expressed intent to stay tobacco-free over the following year. ( 16 ) In February 2008, the Rajasthan Police Academy launched an initiative to achieve tobacco-free status. A formal declaration was made on the World No Tobacco Day, 2008 (31 May 2008) after adoption of an academy-specific policy in February 2008. A focused and comprehensive implementation could be done through a concurrence by all its stakeholders and in a participatory manner. This policy was derived from Global Smokefree Partnership ( 17 ) through the support received by the Academy from American Cancer Society working then in India for sharing and implementing its workplace solutions. ( 18 ) Subsequently, the policy was extended to all six police TCs. These centres became tobacco-free similarly by January 2010. The academy has maintained its tobacco-free status till date, serving as a replicable model and offers a reliable blueprint to emulate. ( 19 ) One of the foreseen challenges in achieving a tobacco-free environment could be the easy accessibility of tobacco within TCs. Recruits could have access to canteens, operated by contractual civilian vendors which sell daily use items such as groceries, savouries, sweets and tobacco products. While regulating the supply chain or banning sales within campus premises can yield temporary gains, the long-term solution lies in institutionalizing a comprehensive policy that not only restricts access but also transforms the organizational culture. This requires embedding tobacco-free norms into the very ethos through consistent leadership messaging, regular sensitization sessions and integration of tobacco control into training curricula. Strengthening vendor contracts with explicit tobacco-free clauses, ensuring periodic inspections and providing cessation support to both staff and recruits can reinforce compliance. Over time, such sustained measures help shift attitudes, making the absence of tobacco a matter of pride, discipline, and identity within the regimental community rather than a mere administrative rule. Conclusion For recruits in CAPF, a TC is the first institutional exposure to a regimented life. Instilling tobacco-free values here has the potential to prevent lifelong addiction and shape lasting behavioural to safeguard health and enhance operational capability of the future soldier. A healthy culture where tobacco use is viewed as incompatible with the ethos of a soldier and military life needs to be encouraged. Hence, for every recruit getting trained in a tobacco-free environment will represent a long-term investment in a healthier, more resilient force thereby reducing future healthcare burden to the organisation and loss of training days and hospitalisation during and after service. Declarations Conflict of interest: None. Funding: None. Author Contribution A.S. conceptualised it.R.G. edited the initial draft to finalise the main script. A.S. prepared Figure 1 and Table 1.All authors reviewed the manuscript. References Mitchell BE, Sobel HL, Alexander MH. 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Available from: https://dciindia.gov.in/Download/Reference%20Manual%20for%20Tobacco%20Cessation.pdf Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 26 Dec, 2025 Editor assigned by journal 24 Dec, 2025 Submission checks completed at journal 24 Dec, 2025 First submitted to journal 22 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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1","display":"","copyAsset":false,"role":"figure","size":47319,"visible":true,"origin":"","legend":"\u003cp\u003eFour major domains for achieving Tobacco free training institutions\u003c/p\u003e","description":"","filename":"Picture1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8429492/v1/49c38afae965ecaf4d15514a.jpg"},{"id":99323689,"identity":"33dc3568-7755-4e1e-83cd-df9e85eed05b","added_by":"auto","created_at":"2025-12-31 16:45:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":471580,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8429492/v1/b9cdca75-2386-4372-aaed-45b4faf48abd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eMaking a compelling case for Tobacco-Free Central Armed Police Forces Training Centres.\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe use of tobacco, smoked or smokeless is associated with several adverse health outcomes.\u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e Tobacco users also exhibit higher mortality rates than non-users across all age groups, with a distinct dose\u0026ndash;response pattern, suggesting that the risk of mortality escalates with increased frequency of smoking.\u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e The decline in physical fitness and pulmonary function is greater in smokers than in non-smokers \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSince ratifying the World Health Organization\u0026rsquo;s Framework Convention on Tobacco Control (FCTC) \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e the largest global treaty on tobacco regulation and in line with its commitment to curb tobacco use nationwide, Ministry of Health and Family Welfare, Government of India has implemented a series of sustained and impactful interventions which include the enactment of the Cigarettes and Other Tobacco Products Act (COTPA) 2003 \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e the National Tobacco Control Programme. \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e provision of cessation support through the National Tobacco Quitline Services and many others at the sub-national level.\u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSensing the gravity of the situation, the leaders of the police forces have acknowledged that tobacco use not only undermines physical fitness, compromises deployment readiness, mission safety but also contributes to a significant increase in their healthcare costs.\u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e And, therefore, ensuring a tobacco-free environment requires a policy that shall promote a healthy lifestyle among all divisions and cadres of the police forces.\u003c/p\u003e \u003cp\u003eA community-based cross-sectional study conducted by Puthia et al among active duty personnel of an uniformed organisation reported that 47% of the study participants were ever tobacco users, while 35% were current users. While 56% reported to be smokers, the prevalence of smokeless tobacco use was noticeably high (97%). The study, limited to male personnel, did not assess passive smoking among non-smokers- a gap that may underestimate the overall health burden of tobacco exposure within such organisation. \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIndia has six Central Armed Police Forces (CAPFs) training centres (TCs) functioning under the operational control of the Ministry of Home Affairs.\u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e While the exact number of recruits undergoing training at any given time remains difficult to ascertain as recruitment figures are dynamic, influenced by factors such as operational requirements and policy directives, the total sanctioned strength of personnel across the Central Armed Police Forces (CAPFs) stands at 10,03,776 \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e representing a significant cohort.\u003c/p\u003e \u003cp\u003eGiven the scale, it is reasonable to infer that a substantial number of recruits are engaged in preinduction training at any given time before being inducted into their respective organisations. This paper provides the necessary inputs to make a CAPF training centre (TC) tobacco-free through a site-specific policy, a structured work-plan to be tobacco-free and stay tobacco-free in a sustainable manner.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003eFollowing points in a site-specific policy are essential for making a CAPF training centre tobacco-free:\u003c/p\u003e \u003cp\u003ePossession and use: Prohibit possession, use and/or sharing of any form of tobacco and /or unprescribed nicotine products (inclusive of smoking as per COTPA rule 4) regardless of rank within its premises including barracks, training grounds, class rooms, drill squares, officers' mess, non- gazetted officer\u0026rsquo;s mess, cook houses, public spaces, administrative blocks, without fail and in a sustainable manner.\u003c/p\u003e \u003cp\u003eFurther, the prohibition will be extended to personnel in uniform during duty hours official parades and their outdoor events.\u003c/p\u003e \u003cp\u003eSale and advertisement: Prohibit sale, advertisement, sponsorship, promotion and distribution of tobacco products within the premises of TC as well as within 100 yards of its perimeter (as per COTPA rules 5 and 6 (1)).\u003c/p\u003e \u003cp\u003eQuitting: Support current tobacco users to quit and former users to stay quit by providing cessation assistance in a sustainable manner through the medical centre within the premises of the TCs as well as through their timely referral either to a Tobacco Cessation Centre (TCC) in a nearby district hospital, medical or dental college and/or toll-free National Quitline Service (1800-11-2356) on all week days except Mondays.\u003csup\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eImplementation framework of Tobacco Free Training Centre:\u003c/p\u003e \u003cp\u003eTo achieve a sustainable and an institutionally embedded tobacco-free environment, it was imperative to adopt a structured, multi-tiered approach. The four domains are strategic leadership, policy co-ordination, operational execution, and ground-level enforcement were conceptualized (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eStrategic leadership establishes the vision and commitment from senior commanders which positions tobacco control as essential to the health, discipline, and operational readiness of the force. It ensures policy legitimacy, allocates resources and drives a culture of wellness\u003c/p\u003e \u003cp\u003ePolicy coordination translates strategy and policy into tangible, time-bound actions. It facilitates co-ordination between various stakeholders.\u003c/p\u003e \u003cp\u003eOperational execution converts plans into tangible actions through structured programs, personnel training, awareness drives, cessation support and surveillance that translates intent into measurable outcomes (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDelineated roles and responsibilities of identified appointments within the Training centre.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDomain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAppointment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eKey responsibilities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRole in implementing TFTC\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eObjectively verifiable indicator\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStrategic Leadership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDirector Training centre (Project In-Charge)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommand and control, policy formulation and enforcement.\u003c/p\u003e \u003cp\u003eApproves and integrates tobacco-free initiatives into TCs\u003c/p\u003e \u003cp\u003eEstablishes Standard Operating Procedures(SOPs).\u003c/p\u003e \u003cp\u003eAllocates resources and ensures apex-level monitoring.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCommunicates policy objectives and issues enforcement orders\u003c/p\u003e \u003cp\u003eOversees compliance and policy implementation.\u003c/p\u003e \u003cp\u003eEnsure seamless integration of tobacco cessation programs within the institution .\u003c/p\u003e \u003cp\u003eDelegates monitoring and enforcement powers to sectional heads for effective implementation of the policy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eConduct half yearly meetings to review policy implementation\u003c/p\u003e \u003cp\u003eResource allocation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolicy Coordination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdministrative Officer TCs (to serve as the Nodal Officer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTranslates policy directives into actionable steps.\u003c/p\u003e \u003cp\u003eCoordinates inter-departmental efforts for generating awareness, empowerment and compliance.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConduct sensitization sessions and awareness campaign.\u003c/p\u003e \u003cp\u003eLiaises with dependant Composite Hospital (CH) for counselling and cessation support.\u003c/p\u003e \u003cp\u003e.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWeekly coordination meetings documented with minutes and action points.\u003c/p\u003e \u003cp\u003eFollow up on pending issues\u003c/p\u003e \u003cp\u003eNumber of sensitization sessions conducted by Administrator/ Sectional heads/ Training Centre Medical Officer\u003c/p\u003e \u003cp\u003eNumber of recruits requiring cessation support and referred to CH by the TCMO\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImplementation \u0026amp; Enforcement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraining of the Sectional Heads of a TC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLeads ground-level enforcement of the policy.\u003c/p\u003e \u003cp\u003eEnsures compliance among recruits.\u003c/p\u003e \u003cp\u003eMonitors and evaluates the effectiveness of the implementation on weekly basis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eConduct routine awareness sessions, surprise inspections to identify non-compliant cases and ensures prompt referral of cases to Tobacco cessation centres\u003c/p\u003e \u003cp\u003eFacilitate peer-led interventions and behavioural change programs.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWeekly compliance report submitted by training battalions to Nodal officer\u003c/p\u003e \u003cp\u003eNumber of surprise checks and violations addressed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperational Execution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdministrator of the TC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImplements the tobacco-free mandate at the grassroots level.\u003c/p\u003e \u003cp\u003eProvides direct supervision, mentorship, and enforcement.\u003c/p\u003e \u003cp\u003eIdentifies at-risk personnel and refer them for cessation support.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEnforce adherence to the no-tobacco policy during training and daily routines.\u003c/p\u003e \u003cp\u003eIdentify and report policy violations and ensures that corrective actions are taken.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWeekly supervision reports verifying tobacco-free status to Training Battalion commander .\u003c/p\u003e \u003cp\u003eNumber of at-risk recruits identified and put on cessation support \u003c/p\u003e \u003cp\u003ePeer-led sessions conducted with participation records.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eGround level enforcement ensures tobacco-free norms are practiced daily. It promotes peer accountability and positive reinforcement by encouraging compliance.\u003c/p\u003e \u003cp\u003eThe following workplan details the steps for implementing the policy to be tobacco-free in TC. The timelines given here are tentative and shall vary depending upon the size and staff strength of a training centre as well as its administrative capabilities:\u003c/p\u003e \u003cp\u003ePhase 1: Policy approval, baseline assessment and empowerment of sectional heads and the medical centre within the TC (First month):\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eDraft a Tobacco-Free Policy aligning with existing national health guidelines and obtain concurrence and approval of Director of the TC.\u003c/p\u003e\u003cp\u003eIdentify key stakeholders within the TC to form a core implementation team of the sectional heads of each and every cadre working within the TCs including those managing their contractual works. Empower these in tobacco control and managing tobacco-free environment within their premises and outdoor activities.\u003c/p\u003e\u003cp\u003eDevelop strategic work-plan for achieving Tobacco-free status with clear timelines and responsibilities.\u003c/p\u003e\u003cp\u003eConduct baseline survey to assess the prevalence of tobacco use among recruits .\u003c/p\u003e\u003cp\u003eEstablish a TCC within medical centres of the TCs prior to policy implementation or having the staff (a doctor and a paramedic) and trained in tobacco cessation delivery will be necessary. Following guidelines issued by the National Resource Centre for Oral Health and Tobacco Cessation, Maulana Azad Institute of Dental Sciences, New Delhi may be useful.\u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ePhase 2: Communication, capacity building \u0026amp; assisting current users to quit (Second month):\u003c/p\u003e \u003cp\u003eConduct awareness programs through the empowered sectional heads within their respective section with an aim to promote a culture of collective responsibility and working through concurrence by encouraging peers to lead by example, support each other in maintaining a tobacco-free environment.\u003c/p\u003e \u003cp\u003eOnce there is concurrence to be tobacco-free among all working within the TC, one of the sectional heads and the medical officer in-charge may conduct a lecture on the adverse health risks of tobacco and provide an overview of the tobacco-free policy to the recruits. Since the program is more likely to be successful when it is leadership-driven, this event should be presided by the head of the respective TC and/or a higher official from their headquarter.\u003c/p\u003e \u003cp\u003eEstablish a structured support system for tobacco cessation, beginning with peer-led assistance to facilitate early engagement of at-risk and tobacco dependant recruits; followed by initial counselling by named staff from the medical centre (at least a doctor and a paramedic). Their training may be conducted either in-house if someone is already trained in tobacco cessation delivery or through the TCC being run by the district hospital in the vicinity. \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003ePhase 3: Policy enforcement (Third month):\u003c/p\u003e \u003cp\u003eEngagement of the Administrative in-charges of the TCs ensure adherence to the tobacco-free policy in respective TCs will be vital to achieve the tobacco-free status of the respective TCs and sustain it on a permanent basis.\u003c/p\u003e \u003cp\u003eHolding review meetings regularly presided by the Administrative Head of the TCs is critical to achieve the goal.\u003c/p\u003e \u003cp\u003eSignages highlighting to promote tobacco-free culture, motivate the current users to quit tobacco use at the earliest and not to relapse to be able to lead a tobacco-free Life be displayed within the TCs to reinforce awareness of all working within their premises and facilitate the necessary behavioural change.\u003c/p\u003e \u003cp\u003eInstitute a Tobacco-free champion program wherein the successful quitters advocate and serve as ambassadors to motivate the rest to lead a tobacco-free life.\u003c/p\u003e \u003cp\u003eReinforce exit protocols by encouraging the entire staff and the qualifying recruits to commit to a tobacco-free lifestyle through a formal pledge taken during the at the pass-out parade.\u003c/p\u003e \u003cp\u003ePhase 4: Formal declaration of a TFTC\u003c/p\u003e \u003cp\u003eThe TC should be tobacco-free as per the criteria laid out for at least 3 months subject to fulfilment of the following criteria:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNo incidence of Tobacco Use: No reported cases of consumption (smoked/smokeless) in the last 3 months, confirmed via inspection records.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNo Tobacco Litter: No presence of tobacco-related waste (cigarette butts, wrappers, gutka/paan sachets) during inspection.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eNo Possession, storage, or distribution of tobacco\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDisplay of standardised, clearly visible bi-lingual tobacco-free zone signages at: (a) Main gate and administrative block; (b) Drill squares /training areas/ class rooms; and (c) Cook houses and barracks.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe Training centres play a critical role in shaping disciplined, physically fit and mentally robust force while the TCs may not have formal directives that explicitly discourage tobacco use within recruits. While certain corrective actions may have been taken at some institutions to limit tobacco consumption among recruits, there is a gap due to lack of a structured and a formal institutional mechanism to systematically monitor and enforce a tobacco-free environment which is largely missing.\u003c/p\u003e \u003cp\u003eEffective enforcement of smoke-free regulations can be accomplished through a policy framework pivoted by a supportive ecosystem, targeted awareness campaigns and accessible cessation support, which can cultivate a generation of combatants who could remain tobacco-free throughout their service.\u003c/p\u003e \u003cp\u003eA study by Banerjee \u003csup\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/sup\u003e in an armed forces TC reported 43% respondents identified themselves as smokers and 34.1% as smokeless tobacco (SLT) users. Among smokers; 13.7% had experimented with tobacco and 8.2% had progressed to occasional use which highlights an early pattern of dependence. Smokers when further categorized by intensity of consumption, comprised of 5.2% light, 4.4% regular, 2.3% heavy and 1.0% in the very heavy smokers respectively. Identified factors for smoking included parental tobacco use, limited awareness of health risks and peer pressure.\u003c/p\u003e \u003cp\u003eUSS \u003cem\u003eTheodore Roosevelt\u003c/em\u003e was the first Naval ship to adopt a modified tobacco-free policy, reflecting the US Navy\u0026rsquo;s efforts to curb tobacco use. Measures included limiting smoking to designated areas and during specific hours, with a gradual shift toward a complete ban while at sea. Though the policy was in effect for only four months before being rescinded, it yielded promising results with 73% of personnel reduced tobacco use onboard, 22% quit permanently, 57% remained smoke-free during deployment and 46% expressed intent to stay tobacco-free over the following year. \u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn February 2008, the Rajasthan Police Academy launched an initiative to achieve tobacco-free status. A formal declaration was made on the World No Tobacco Day, 2008 (31 May 2008) after adoption of an academy-specific policy in February 2008. A focused and comprehensive implementation could be done through a concurrence by all its stakeholders and in a participatory manner. This policy was derived from Global Smokefree Partnership\u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e through the support received by the Academy from American Cancer Society working then in India for sharing and implementing its workplace solutions.\u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e Subsequently, the policy was extended to all six police TCs. These centres became tobacco-free similarly by January 2010. The academy has maintained its tobacco-free status till date, serving as a replicable model and offers a reliable blueprint to emulate.\u003csup\u003e\u003cb\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOne of the foreseen challenges in achieving a tobacco-free environment could be the easy accessibility of tobacco within TCs. Recruits could have access to canteens, operated by contractual civilian vendors which sell daily use items such as groceries, savouries, sweets and tobacco products. While regulating the supply chain or banning sales within campus premises can yield temporary gains, the long-term solution lies in institutionalizing a comprehensive policy that not only restricts access but also transforms the organizational culture.\u003c/p\u003e \u003cp\u003eThis requires embedding tobacco-free norms into the very ethos through consistent leadership messaging, regular sensitization sessions and integration of tobacco control into training curricula. Strengthening vendor contracts with explicit tobacco-free clauses, ensuring periodic inspections and providing cessation support to both staff and recruits can reinforce compliance. Over time, such sustained measures help shift attitudes, making the absence of tobacco a matter of pride, discipline, and identity within the regimental community rather than a mere administrative rule.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFor recruits in CAPF, a TC is the first institutional exposure to a regimented life. Instilling tobacco-free values here has the potential to prevent lifelong addiction and shape lasting behavioural to safeguard health and enhance operational capability of the future soldier. A healthy culture where tobacco use is viewed as incompatible with the ethos of a soldier and military life needs to be encouraged. Hence, for every recruit getting trained in a tobacco-free environment will represent a long-term investment in a healthier, more resilient force thereby reducing future healthcare burden to the organisation and loss of training days and hospitalisation during and after service.\u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eConflict of interest:\u003c/strong\u003e \u003cp\u003eNone.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNone.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.S. conceptualised it.R.G. edited the initial draft to finalise the main script. A.S. prepared Figure 1 and Table 1.All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMitchell BE, Sobel HL, Alexander MH. The adverse health effects of tobacco and tobacco-related products. 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Healthy Lifestyle: From Pediatrics to Geriatrics. 2022:173\u0026thinsp;\u0026ndash;\u0026thinsp;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKulothungan V, Ramamoorthy T, Sarveswaran G, Jadhav SY, Mathur P. Association of Tobacco Use and Cancer Incidence in India: A Systematic Review and Meta-Analysis. JCO Global Oncol. 2024;10:e2400152.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerma M, Rana K, Bhatt G, Sharma N, Lal P. Trends and determinants of tobacco use initiation in India: analysis of two rounds of the Global Adult Tobacco Survey. BMJ open. 2023;13(9):e074389.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuthia A, Yadav A, Kotwal A. Tobacco use among serving army personnel: An epidemiological study. Med J Armed Forces India. 2017;73(2):134\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGovernment of India. Ministry of Home Affairs. Rajya Sabha. Unstarred Question No. 2448; Answered on 07 Dec 2016. Digital Sansad. Annexure-A, Page 1 of 1. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://sansad.in\u003c/span\u003e\u003cspan address=\"https://sansad.in\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 2025 Jul 18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eParliament of India. Rajya Sabha Secretariat. Department-related Parliamentary Standing Committee on Home Affairs. Working conditions in non-border guarding Central Armed Police Forces (Central Industrial Security Force, Central Reserve Police Force and National Security Guard). Two Hundred Fifteenth Report. New Delhi: Rajya Sabha Secretariat; 2019 Nov 14. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://dciindia.gov.in/Download/Reference%20Manual%20for%20Tobacco%20Cessation.pdf\u003c/span\u003e\u003cspan address=\"https://dciindia.gov.in/Download/Reference%20Manual%20for%20Tobacco%20Cessation.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Police Central Armed Police, Health, Training centres, Tobacco-free training centres, Policy framework, Operational readiness","lastPublishedDoi":"10.21203/rs.3.rs-8429492/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8429492/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe widespread use of tobacco among personnel of central armed police forces has real implications for their health, discipline and operational efficiency. The proposal underscores the need to establish their training centres tobacco-free by focusing on behavioural transformation to prevent the use of tobacco and non-therapeutic nicotine products among recruits and assist their current users quit through an implementable framework grounded in institutional leadership and peer support. By embedding tobacco control strategies within these training institutions, the framework aspires to foster a culture of wellness and resilience in the life of a recruit right from the beginning of their career. The paper lays down a policy framework and presents a phase-wise implementation plan with well-defined timelines for a tobacco-free environment within the training institutions of the central armed police forces.\u003c/p\u003e","manuscriptTitle":"Making a compelling case for Tobacco-Free Central Armed Police Forces Training Centres.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 09:57:31","doi":"10.21203/rs.3.rs-8429492/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-26T08:33:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-24T05:55:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-24T05:54:52+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-12-23T02:52:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0888c9b8-ff26-44e3-b21b-e3a284b2c21f","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T08:39:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 09:57:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8429492","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8429492","identity":"rs-8429492","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}

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