31 May 2022
By: Jennifer L Brown, Debra Rosen, Maria G Carmona, Natalia Parra, Mark Hurley, Joanna E Cohen Source: BMJ Journals
Most of the published literature on cigarette advertising and promotion at points-of-sale is on research conducted in high-income countries. We report findings from monitoring cigarette advertising and promotion at points-of-sale near schools and playgrounds in 42 countries, the majority low-income and middle-income. Four strategies were detected across most of these countries: (1) display of cigarettes near snacks, sweets and sugary drinks, (2) placement of cigarette advertisements near the eye-level of children, (3) advertisements and display of flavoured cigarettes and (4) sale of single sticks of cigarettes. These advertising and promotional tactics target children and youth and demonstrate that multinational tobacco companies use similar strategies to promote cigarettes at points-of-sale. The widespread violations of existing laws and regulations, the exploitation of regulatory loopholes and lack of existing tobacco control policies that apply to points-of-sale call for adoption and enactment of provisions recommended by the WHO Framework Convention on Tobacco Control such as comprehensive bans on tobacco advertisement, promotion and sponsorship, bans on sale of single cigarette sticks and regulation of flavours. These strategies will help to protect children and youth from exposure to tobacco advertising.
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In many markets, policies prohibiting tobacco advertising via traditional media such as radio and television and on billboards have led the tobacco industry to focus on the point-of- sale (POS) as a critical channel to advertise and promote their tobacco products. For example, in the USA, the 1998 Master Settlement Agreement included a number of restrictions on advertising but did not include a ban on advertising at POS; by 2008, POS advertising accounted for over three-fourths of tobacco marketing expenditures.1 In many countries, tobacco advertising and promotion at POS is nearly ubiquitous and extends beyond product display to include indoor and outdoor advertisements, branded walls and shelves and other branded store accessories.
Tobacco companies have historically targeted children and youth with tobacco product advertising. In an internal document from 1990, R.J. Reynolds’ staff were encouraged to set up promotions at stores frequented by young people, saying ‘those stores can be in close proximity to colleges or high schools’.2 In the USA, extensive tobacco advertising at POS near schools has been documented3 and there is evidence that stores where adolescents shop regularly display more advertising than other stores in the same community.4
Tobacco advertising at POS is associated with youth smoking initiation and progression to regular use.1 Children and youth who have frequent exposure to tobacco advertising and promotion at POS have higher odds of already having tried smoking and higher odds of being susceptible to smoking than those not frequently exposed.5 POS advertising also discourages cessation efforts and normalises smoking.6
Despite our knowledge of tobacco advertising targeted to children and youth near schools, our understanding of the extent of tobacco advertising and promotion across geographic regions is incomplete. Most of the published literature on tobacco advertising at POS has been conducted in high-income countries, except for research conducted in Guatemala, Russia and Indonesia.7–13 Our monitoring efforts across multiple countries, the majority low-income and middle-income (LMIC), extend knowledge of the advertising and promotional practices used to promote cigarettes at POS and indicates prevalent marketing efforts that target some of the world’s most disadvantaged populations. Findings from this monitoring document tobacco marketing tactics that are used by the world’s largest tobacco companies—including British American Tobacco (BAT), Imperial Brands, Japan Tobacco International (JTI) and Philip Morris International (PMI)—to promote their deadly products to children and youth across the globe.
Methods: documenting tobacco industry tactics
From 2015 to 2021, public health professionals and volunteers, with support from the Campaign for Tobacco-Free Kids and the Johns Hopkins Bloomberg School of Public Health, systematically collected data on cigarette advertising and promotional tactics at POS within a short walking distance of schools and playgrounds in 42 countries across the globe, spanning all six WHO regions (figure 1). Table 1 includes the city/cities where data collection took place, the year data were collected and the number of POS observed in each country. In most countries, data collection took place in the capital city. The number of POS observed ranged from 29 in Nigeria to 2670 in Vietnam.
A list of schools and playgrounds to focus on for data collection was generated by in-country public health professionals in each country. Online tools were used to map the selected schools and playgrounds and draw a 100–250 m radius around them. Zoomed-in images of the maps were printed and distributed to data collectors who then followed the maps to locate individual schools or playgrounds and identify POS within the drawn radius. Data collectors were instructed to walk down every street and alley, including both sides of the road, to identify POS and trace their route on the paper map to cover all the area within the radius. If the POS identified sold tobacco, they completed an observational form, acting like a customer while completing the form.
Most of these investigations used mobile applications, Magpi and KoboToolbox, on phones or tablets that allowed users to complete forms offline and later upload them to the cloud or online and record geographic coordinates. The applications were populated with an observational checklist to systematically capture data, allowing for comparison of cigarette marketing tactics used at POS across countries. The observational checklist included questions on retailer location; retailer type; cigarette product display; display of cigarettes near sweets, snacks and soda; promotion of cigarettes; advertisement of cigarettes, including placement of signage; cigarette brands advertised and sold and sale of single cigarette sticks. Data were exported from the applications used into Excel and descriptive analyses were conducted in Stata or Excel.