Research Across Pakistan Documents Tobacco Industry Tactics Targeting Children

A new paper from the Institute for Global Tobacco Control (IGTC) at the Johns Hopkins Bloomberg School of Public Health highlights positive outcomes in Pakistan following the release of findings from the “Big Tobacco, Tiny Targets” campaign, led by the Campaign for Tobacco-Free Kids (CTFK), which sheds light on the advertising and promotional tactics employed by tobacco companies at retailers that appear to target children to encourage uptake of tobacco products.

As part of this campaign, trained data collectors monitored hundreds of tobacco retail points of sale (POS) within 100 meters of schools in Pakistan. The research documented four point-of-sale marketing tactics that were most often observed both in Pakistan and globally: positioning cigarettes near snacks and drinks popular among children, placing of tobacco advertisements at children’s eye level, selling and advertising flavored cigarettes, and selling single cigarette sticks (as a lower-cost alternative to full packs).

Of the 268 tobacco-selling points of sale surveyed near 133 schools in eight cities across Pakistan, in 2017, 89% had visible advertising, 95% of displays were approximately 1 meter off the ground (at children’s eye level), 62% had no health warnings, 94% of displays were beside items marketed to children (candies, sweets, snacks), 99% sold single sticks, and 27% offered price discounts while 8% offered free tobacco products.

Beginning in December 2018, these findings were publicized in Pakistan, including among policymakers, government officials, and journalists. In 2020, Pakistan approved SRO 72(I)/2020, a comprehensive ban on tobacco advertising, promotion, and sponsorship (TAPS) at the point of sale.

A continuation of this study led by CTFK occurred in nine cities across Pakistan, in 2022, surveying 855 tobacco product points of sale near youth points of interest including schools/universities, playgrounds/parks, shopping malls, and restaurants.

The 2022 wave found that 94% had visible advertising, 60% of displays were at children’s eye level, 31% of displays were beside candies, sweets, and toys marketed to kids, and 42% offered price discounts while 27% offered various rewards on purchase (such as free samples).

It also noted the growing presence of other nicotine product inventory including nicotine pouches (82%), e-cigarettes (29%) and heated tobacco products (8%).

Based on recent data, Pakistan continues to face significant public health challenges due to the tobacco epidemic, with an alarming rate 163,600+ tobacco-caused deaths each year and nearly 1 in 10 children aged 13-15 reported to smoke.

These statistics highlight the ongoing, critical importance of enforcement of existing measures such as SRO 72(I)/2020, as well as implementing other effective tobacco control measures to safeguard public health.

According to Jennifer Brown, a scientist from the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Health, and lead author of the paper, “We strongly believe that the ‘Big Tobacco, Tiny Targets’ campaign offers invaluable evidence to strengthen forward-looking tobacco control regulations that protect children from tobacco industry marketing.

By strengthening enforcement of and improving compliance with Pakistan’s comprehensive ban on all forms of point-of-sale tobacco advertising and product display, future generations will be shielded from exposure to the tobacco industry’s dangerous products and be spared from the deadly tobacco epidemic.”

Indeed, a follow-up study by IGTC of 8 cities in Pakistan (Gilgit, Islamabad, Karachi, Lahore, Multan, Muzaffarabad, Peshawar, and Quetta), in December 2021, indicated that compliance with the 2020 ban was low, with displays of tobacco products at the point of sale occurring frequently and in positions that were readily accessible to minors, as well as oral nicotine pouches commonly displayed and advertised.

Among its recommendations, the study proposes training enforcement officers and educating retail venue owners on the national tobacco control law, to increase compliance and enhance enforcement.

The “Big Tobacco, Tiny Targets” campaign likely resonated with policymakers and government officials in Pakistan because it appealed to both emotional and intellectual sensibilities through its focus on the protection of children and youth as a universal priority (rather than previous tobacco control narratives that emphasized the individual consequences of smoking).

With recent evidence indicating that children and youth are still bombarded with tobacco marketing exposure and have access to deadly products easily within reach, the same emotional and intellectual response should be taken to prioritize compliance and enforcement with tobacco product display and point-of-sale advertising and promotion policies in Pakistan.