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In this paper, we share background on the ‘Big Tobacco, Tiny Targets’ campaign, three short case studies from countries where the campaign had a substantial policy impact, keys to campaign success and campaign challenges. The campaign—which demonstrated that the world’s biggest tobacco companies are targeting the world’s youth with tobacco marketing and advertising—can be adapted by others in their tobacco control policy campaigns.
Big Tobacco, Tiny Targets: a global campaign
The point-of-sale (POS), places where consumer goods are sold, is an important platform for marketing tobacco. Greater exposure to tobacco advertising and promotion at POS is associated with a greater likelihood of smoking among youth.1 2 In the USA, POS that adolescents visit regularly display more tobacco advertising than POS in the same community that are less popular with youth.3
In 2015, the Campaign for Tobacco-Free Kids (Tobacco-Free Kids), a US-based non-profit advocacy organisation focused on reducing tobacco use globally, collaborated with civil society organisations in Indonesia to monitor cigarette advertising and promotional tactics at POS near schools and playgrounds. When monitoring revealed concerning patterns of cigarette marketing targeting children and youth, Tobacco-Free Kids partnered with Johns Hopkins Bloomberg School of Public Health (BSPH) and civil society organisations in other countries to observe tobacco marketing tactics, focusing on low- and middle-income countries.
Public health professionals and volunteers, with support from Tobacco-Free Kids, the Africa Tobacco Control Alliance and BSPH, have systematically collected data on cigarette advertising and promotional tactics at POS near primary and secondary schools and playgrounds in 42 countries since 2015. Four advertising and promotional tactics have been observed at POS in most countries: (1) display of cigarettes near snacks, sweets or sugary drinks, (2) placement of cigarette advertisements near the eye-level of children, (3) product display and advertisements for flavoured cigarettes and (4) sale of single cigarette sticks.4 These strategies were associated with cigarette brands of international tobacco companies, including Philip Morris International, British American Tobacco, Japan Tobacco International and Imperial Brands.4
Tobacco-Free Kids leads the Big Tobacco, Tiny Targets campaign. They engage with communities, provide technical assistance to organisations launching their own investigations and collaborate to disseminate research findings and advocate for stronger tobacco control policies. Their website, www.takeapart.org/tinytargets, allows the public to download reports on findings, share findings and effective policy interventions on social media and provides access to a mobile application that hosts a standardised form used to observe tobacco advertising and promotions at POS. The application also allows users to visualise and download data.
The Big Tobacco, Tiny Targets campaign has been effective in raising awareness of tobacco industry targeting of children and youth at POS and contributed to policy change. Of the 42 countries where data on tobacco advertising and promotion were collected, 32 countries have engaged in advocacy campaigns. Campaign activities have received extensive media coverage and contributed to positive tobacco control policy outcomes in at least 16 countries.
The Big Tobacco, Tiny Targets blueprint
Establishing a shared vision and defined policy goal
Monitoring and campaign efforts coalesced around a shared vision and defined policy goal—to hold the tobacco industry accountable and protect children and youth from tobacco industry exploitation by strengthening tobacco advertising, promotion and sponsorship (TAPS) regulations at POS. This policy is in line with Article 13 and Article 13 implementation guidelines of the WHO Framework Convention on Tobacco Control which calls for a comprehensive ban on TAPS. The scope of a comprehensive TAPS ban includes banning the display of tobacco products at POS and extends to mobile vendors.
Using a standardised monitoring methodology across countries
Monitoring focused on observing the tobacco advertising and promotional tactics used at POS located within 100–250 m of schools and playgrounds. Data were primarily collected by volunteers. Maps of areas around schools or playgrounds were created within the 100- to 250-m radius drawn around them using an online tool. The printed maps were followed by data collectors, and all POS located within the radii were observed. An observational checklist, typically programmed in a mobile application, was used to capture information on cigarette advertising and promotions. The observation form was made available through a free, user-friendly mobile data collection application, KoboToolbox, beginning in 2017 and made it easy for volunteers to conduct monitoring and ensured that the same data points were being systematically collected across countries. A detailed description of how monitoring was conducted and the findings from 42 countries has been previously published.4
Strategic dissemination of findings
The launch of findings was often scheduled to coincide with legislative sessions where TAPS regulations were to be discussed. Advocates conducted outreach to relevant stakeholders, such as policy-makers, by publishing open letters calling for the adoption and implementation of comprehensive TAPS policies, organising private meetings to share findings and organising study tours where government leaders travel to jurisdictions with stronger TAPS policies to observe their implementation and speak with other government leaders. Advocates also used traditional and social media and special events to release the findings and influence policy discussions.
Campaign wins
Closely following the release of findings from monitoring and campaign activities, seven countries adopted new national TAPS bans, six countries strengthened their existing TAPS bans, three countries adopted new subnational TAPS bans and three countries strengthened enforcement of their existing TAPS bans (online supplemental table 1). Examples of countries where the campaign had a substantial impact include Burkina Faso, Georgia and Pakistan.
Supplemental material
Burkina Faso
In 2016, the African Tobacco Control Alliance worked with Afrique Contre la Tabac to collect data at 148 POS around 16 schools in Ouagadougou, Burkina Faso.5 They developed a media campaign to share the findings and engaged with journalists. Advocates conducted guided visits around the areas surrounding three of the schools visited during monitoring with journalists to show them the tobacco advertising and promotion observed during data collection firsthand. Findings were shared with policy-makers and the public during two press conferences and several small meetings. They drew the attention of the media, Ministry of Education, Ministry of Health and School Parents Association. The media coverage highlighted findings and called on policy-makers to take action to save children’s lives.6–9 Policy recommendations were well received by policy-makers, but not adopted in entirety.
In 2016, Decree No 2016-926 on the Protection of Schools was adopted and banned tobacco advertising within 400 m of schools.10 Decree No 2020-0259 was adopted in 2020—it amended Decree No 2016-926 and prohibited the sale of tobacco products, direct and indirect advertising and promotion of tobacco products, and tobacco industry sponsorship within 400 m of educational structures.11
Georgia
In 2016, data were collected at 640 POS within 250 m of 104 schools in Tbilisi, Georgia.12 Findings were shared by the Institute of Social Studies and Analyses at a conference attended by 50 stakeholders and journalists. Tobacco Control Alliance member organisations engaged in meetings with stakeholders, including the Ministry of Health, the National Center for Disease Control and Public Health, the public defender and the Healthcare Committee of Parliament throughout 2016 and 2017. The results were considered by Parliament when debating new TAPS restrictions.
In 2017, Law No 860-IIS amended the Georgia Law on Advertising, making the TAPS restrictions more comprehensive.13 Previously, tobacco advertising and product display were allowed at POS with the content regulated and accompanied by a warning. Law No 860-IIS banned advertising outside of POS and product display (figure 1) beginning in 2018 and banned indoor advertising at POS (except for duty-free stores in airports) beginning in 2021.
Tobacco product displays at convenience stores in 2016 (left) vs 2019 (right) following implementation of Law No. 860-IIS
Pakistan
In 2017, data were collected at 268 POS within 100 m of 133 schools across eight cities in Pakistan: Islamabad, Murree, Larkana, Peshawar, Hafizabad, Pindi Bhattian, Jalalpur Bhattian and Shakar Dara.14 In December 2018, findings were shared at a media event with government officials, civil society representatives, students, academicians, parents and journalists.15 16 Advocates also shared findings with policy-makers and created a sense of urgency to pass a policy to protect youth from being targeted by tobacco advertising and promotion near their schools. In Pakistan, where the tobacco control narrative had previously been focused on the individual consequences of smoking, details on how the tobacco industry attracts children and youth and encourages them to begin smoking resonated with policy-makers and government officials.
In 2020, Pakistan approved a comprehensive TAPS ban, SRO 72(I)/2020, that includes prohibition of POS advertising and product display at fixed and mobile vendors.17
Keys to success
The Big Tobacco, Tiny Targets campaign is successful at making an emotional and intellectual appeal to protect children from tobacco industry marketing and adopt more comprehensive TAPS policies. Key elements of the campaign’s success are the following:
Mobilisation of a diverse group of advocates: The campaign mission, relative ease of data collection and the cost-effectiveness of conducting the campaign mobilised and united a diverse group of advocates. Advocate participants included organisations dedicated to children’s rights, environmental rights, family values, women’s rights and tobacco victims.
A message that resonates: The campaign message that stresses protection of children and youth as a universal priority resonates with policy-makers and the public. This contributed to increased support for strengthening TAPS policies.
Going beyond the quantitative data: The campaign builds a narrative around the data that highlights how common it is to see cigarette ads and promotions at stores near venues that are intended to be safe spaces of learning and play for children and youth. It uses compelling visuals, like maps illustrating the density of tobacco vendors and proximity to schools and playgrounds and photos of tobacco marketing and promotion, as supporting evidence.
Local evidence: Local evidence that lends credence to the message that children and youth are being targeted in their ‘own backyard’ is hard for policy-makers to ignore.
A clear ‘villain’: Similar findings across multiple countries make it clear that the world’s largest multinational tobacco companies are behind a pattern of targeting children and youth, increasing the sense of urgency for policy-makers to take action to pass strong tobacco control policies.
Call to action: The campaign emphasises that there is a solution to the problem—enactment of tobacco control policies, like TAPS bans.
Challenges
Many challenges were raised during monitoring and campaign activities. The technology used for data collection (ie, mobile phones, tablets, mobile applications) was not always user-friendly and had to be modified. While largely standardised, the observational form sometimes included country-specific questions and a balance had to be reached regarding what data could be collected versus the burden placed on data collectors. While efforts were made to make data collection as feasible as possible, barriers included a lack of funding for costs such as a space to train data collectors, data collector transportation, data for mobile phones and personnel to manage campaign activities. Safety was an issue in some places and therefore, some areas were avoided during data collection, potentially creating a bias in the data. COVID-19 presented challenges—some data were collected after March 2020 and likely underestimated the extent of tobacco advertising and promotion at POS prior to and following COVID restrictions. Lastly, tailoring the data collection methods and developing tailored campaign messages were resource intensive at times, and activities may not always be replicable in low-capacity settings.
Conclusion
Successful policy advocacy campaigns deploy several advocacy strategies and factors related to the political climate affect the potential for achieving desired outcomes. Consequently, we cannot apportion the extent to which the Big Tobacco, Tiny Target campaign activities directly contributed to the policy changes that followed. Elements of the campaign can provide advocates with insights on how to successfully engage stakeholders and promote tobacco control policy change. The campaign materials and keys to success outlined here can be leveraged by advocates in a variety of settings to advance tobacco control policy, keeping in mind the need for adaptation given the country context as well as how the campaign complements the other elements of a broader policy advocacy campaign.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Acknowledgments
Thank you to all of the partners who collaborated on the Big Tobacco, Tiny Targets activities: Fundación InterAmericana del Corazón Argentina (FIC Argentina), PROGGA Knowledge for Progress, Bangladesh Center for Communication Programs (BCCP), Fundación InterAmericana del Corazón Bolivia (FIC Bolivia), Progressive Reinforcement of Organizations and Individuals (PROI), Smoke Free Life Coalition (SFLC), Framework Convention on Tobacco Control Implementation and Monitoring Center in Georgia (FCTC IMCG), Consumer Information Network (CIN), Centrul Pentru Politici și Analize în Sănătate (PAS Center), Universidad Católica Redemptoris Mater (UNICA), Comisión Nacional Permanente de Lucha Antitabáquica (COLAT), Clearpoint Communications Associates (CCA), University of Western Cape (UWC), No Excuse, Ligues de la Santé/CIPRET-Vaud, National Association of Consumers of Armenia, Contrôle du Tabac en Afrique (ACTA), l’Education et le Contrôle du Tabac (IECT), African Tobacco Control Alliance (ATCA), Afrique contre le tabac (ACONTA), Coalition Camerounaise Contre le Tabac (C3T), Progressive Reinforcement of Organizations and Individuals (PROI), Framework Convention on Tobacco Control Implementation and Monitoring Center in Georgia (FCTC IMCG), Consumer Voice, Voluntary Health Association of India, Childrens’ Media Monitoring Foundation (Yayasan Pengembangan Media Anak), Indonesia Childrens’ Lantern (Lentera Anak Indonesia), Smoke Free Agents (SFA), Smoke-free Kazakhstan Coalition, Public Health Protection Foundation, NY SAHY, Fundación Interamericana del Corazón México (FIC Mexico), Progressive Reinforcement of Organizations and Individuals (PROI), Juventas, Nigeria Tobacco Control Alliance, SPARC, ImagineLaw, Association Prevent, Health for All Coalition, Türkiye Yeşilay Cemiyeti, Uganda National Health Consumers’ Organisation (UNHCO), DEPOCEN, Corporate Accountability Colombia. A special thanks to Leonce Sessou, Malik Imran and George Bakhturidze for providing details on campaigns in Burkina Faso, Pakistan and Georgia.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
Contributors All authors made a substantial contribution to the monitoring efforts that informed the campaign and developing the manuscript. All authors contributed to the conceptualisation of monitoring and design of data collection tools. DR, MC, NP and MH were involved in campaign activities. JB, DR and NP oversaw monitoring at different points in time. DR and NP collated the data. JB wrote the initial draft of the manuscript, and DR, MC, NP, MH and JEC contributed to revisions and finalisation of the manuscript. All authors approved the final version. JLB had access to the data and accepts responsibility for the work.
Funding This work was supported with funding from Bloomberg Philanthropies' Bloomberg Initiative to Reduce Tobacco Use (bloomberg.org).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.