Islamabad: 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 retailersthat appear to target children to encourage uptake of tobacco products.
As part of this campaign, trained data collectors monitored 268 tobacco retail points of sale (POS) within 100 meters of 133 schoolsin eight cities across Pakistan including Islamabad, Murree, Larkana, Peshawar, Hafizabad, PindiBhattian, JalalpurBhattian, and Shakar Dara. The research documented fourpoint-of-sale marketing tactics that were most often observedboth 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 in 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.
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 yearandnearly 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 thatcompliance 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.
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About the Institute of Global Tobacco Control
Established in 1998, the Institute for Global Tobacco Control (publichealth.jhu.edu/igtc) has informed tobacco control measures in countries around the world for 25 years. As part of the Department of Health, Behaviour and Society at the Johns Hopkins Bloomberg School of Public Health, the institute is a Collaborating Centre of the World Health Organization and a partner in the Bloomberg Initiative to Reduce Tobacco Use, guided by a mission to prevent death and disease from tobacco products by generating evidence to support tobacco interventions.
 Source: Big Tobacco, Tiny Targets – Tobacco Advertisement, Sales, Product Displays, and Purchase Incentives Around Kindergartens, Primary, and Secondary Schools.
 Source: Global Burden of Disease (GBD) 2019. Seattle, WA: Institute for Health Metrics and Evaluation (IHME), University of Washington; 2021.
 Source: Pakistan Global Youth Tobacco Survey (GYTS). World Health Organization; 2013.
 Source: Advertisements, Promotions and Display of Tobacco Products at Points-of-Sale in Pakistan