TY - JOUR
AU - Gumus,, Sevtap
AB - Abstract Background This study aims to uncover strategies executed by the tobacco industry against tobacco advertising, promotion and sponsorship (TAPS) bans at points of sale (PoS) in Turkey. Methods The data are based on a field study conducted in the city of Izmir. There are 10 750 PoS in all of Izmir; the 6200 PoS in the 11 central districts were considered as potential subjects. Using a proportional sampling method (95% confidence interval, 5% margin of error), it was calculated that 384 PoS could adequately represent the whole. Face-to-face interviews were conducted with PoS administrators, using survey form consisting of 53 questions. Descriptive statistics methods have been used to analyze the data. Results Of a total of 384 PoS visited; 96.4% featured at least one type of display/TAPS ban violation, 94.5% featured display settings creating brand dominance on display units, 76.7% received promotional payments and 14.8% received free tobacco products for featured display settings. Additionally, 29.2% of PoS had tobacco product displays visible from outside, 26.8% sold tobacco products on the counter, 24.7% featured advertising items on display units, 19.3% sold tobacco products as single stick and 11.7% had price tags with fonts larger than the legally fixed 20 pt. Conclusions An official institution specializing in tobacco control must be established to continually inspect the tobacco market. Tobacco products must stay hidden, in closed cupboards or under the counter, and communication between PoS and tobacco industry must be limited. In addition, tobacco products must be distributed by government institutions rather than the industry. Introduction After the Framework Convention on Tobacco Control (FCTC) entered into force on 27 February 2005,1 the tobacco industry responded with counter strategies to derail tobacco control implementations. These strategies were deployed globally, but low- and middle-income countries (LMIC) were particularly vulnerable to the industry’s efforts.2 As a result, at the eighth meeting of the Conference of the Parties to the FCTC, ‘Global Strategy to Accelerate Tobacco Control’ was adopted. This strategy aims to strengthen FCTC implementation; however, many articles of the Convention have yet to be put into practice strongly enough on a global scale.3 This situation is well described by Hoffman et al.,4 who state that, after adoption of the FCTC, high-income European countries showed a decrease in annual tobacco consumption. In contrast, low- and middle-income Asian countries experienced an increased annual tobacco consumption, showing no evidence to indicate that global progress in reducing cigarette consumption has been accelerated by the FCTC treaty mechanism. Turkey, a middle-income country,5 has put into practice very detailed tobacco control legislation after adoption of the FCTC, including implementation of the National Tobacco Control Programme Action Plan, as of 2008. In 2013, World Health Organisation announced Turkey as a unique country that implements all six measures of MPOWER policy package for tobacco control due to these efforts.6 Cigarette consumption in Turkey was 107.5 billion sticks in 2009, which decreased to 93.3 billion sticks in 2010 and 91.2 billion sticks in 2011. As of 2013, however, cigarette consumption began to rise again, reaching 118.5 billion sticks in 2018—the highest historic number of cigarettes consumed.7 Moreover, the total consumption reached 119.7 billion sticks in 2019.7 Many authors have examined Turkey’s fall from its position as the leading country in terms of tobacco control.8–11 Notably, though Turkey ranked ninth of the 35 European countries in the Tobacco Control Scale of 2016, it regressed to 17th rank in 2019 of the 36 countries.12 Evidence supports that there is a positive association between smoking and exposure to points of sale (PoS) tobacco promotion.13–15 In Turkey, while 16.2% of adults were exposed to tobacco advertising at PoS in 2016,16 26.8% of 13–15-year-old students encountered tobacco advertising at PoS in 2017.17 The execution of tobacco advertising, promotion and sponsorship (TAPS) strategies the tobacco industry at PoS in Turkey is considered one of the most important reasons for the abovementioned increase in consumption.18–20 Three studies have made observations about TAPS at PoS in Turkey, which include price tag violations, visibility of tobacco products from outside the PoS, degree of accessibility of tobacco products by customers, existence of TAPS materials, display units in more than one place in the PoS, displays hiding health warnings and tobacco products sold as a stick and brand-promoting displays.21–23 Since effective implementation of the FCTC’s Articles 13 and 16 has been a priority since its inception, detailed case studies are always needed.24 This study focused on closing the gap in the literature regarding direct/indirect TAPS practices of the tobacco industry in Turkey. Another goal was to achieve accelerative and facilitative effects, especially in LMIC, by sharing supplementary experiences on PoS strategies of tobacco industry. Methods Izmir, the third most populous city in Turkey, was determined as the research area. Izmir is composed of 30 districts: 11 districts that constitute the city centre and 19 districts outside the city centre, beyond the borders of Izmir’s metropolitan municipality. The number of PoS with licences to sell tobacco products is 10 750 in all of Izmir, investigated via the ‘Online Sale Certificate System Detailed Seller Information Inquiry Screen’25 of the Tobacco and Alcohol Market Regulatory Authority. Of these 6200 PoS, those in the 11 central districts were included in this study’s research area. The sample size was calculated using a proportional sample size formula, as follows in equation 1: n=t2pq/d2 where n is the sample size, P is the probability of occurrence (0.5), q is the 1 − P (the frequency of non-occurrence) (0.5), d is the acceptable margin of error for proportion being estimated = 0.05 and t is the theoretical value found according to t table at a certain significance level (1.96 at 95% CI). According to this equation, 384 PoS adequately represent the whole. The number of PoS to be visited in each district was determined according to population percentage as it relates to the total population of the 11 central districts. PoS in main streets and squares of each district were chosen randomly as subjects. Face-to-face interviews were conducted between September 2017 and May 2018. Data were collected from PoS administrators and owners in the form of a survey consisting of 53 questions, itemized as the following main topics: types of tobacco products, sales of tobacco products as a stick, sales of contraband/counterfeit tobacco products, sales of tobacco products on the counter, written/visual TAPS materials inside/outside the PoS, types/methods of promotional payments, whether colours or shapes of the display unit shelves evoke a certain tobacco product brand, existence of a sales representative hired from an advertising agency to promote a certain tobacco product brand, placement methods of cigarette packages that create brand domination, types/methods of advertising, exposure of children and youth to tobacco products, positioning of display units in the PoS, visibility of display units from outside the PoS, price tag violations, degree of PoS owner knowledge of TAPS bans and visibility of pictorial health warnings of the packs on the display units. Descriptive statistics methods were used to analyze the data in SPSS 24. Ethical considerations Although the ethical principles of The Declaration of Helsinki were taken into consideration, ethical board approval was not obtained for this study since the purpose of the survey was to collect data about the TAPS strategies of the tobacco industry rather than personal information of the PoS owners or administrators. The participants were included in the study after they were informed about the questionnaire. In this regard, informed consent was not obtained. Results General findings All PoS (n = 384) had valid sales licences and sold cigarettes. An additional 30.2% (n = 116) of PoS sold cigars/cigarillos, and 19.3% (n = 74) of PoS sold cigars and cigarillos as a stick (Supplementary figure S1). No contraband/counterfeit products, cigarette tubes filled with RYO tobacco, other types of tobacco product or sales of cigarettes as a stick were detected. All PoS (n = 384) had price tags as a list or strip under each brand. The 11.7% (n = 45) of PoS had price tags with fonts larger than 20 pt, breaching the law. All PoS owners stated that price tags were provided by tobacco companies. Pictorial health warnings on the packages in display units were visible in 99.5% (n = 382) of PoS. Despite the ban, display units and tobacco products could clearly be seen from outside 29.2% (n = 112) of PoS. Inside the PoS, 73.2% (n = 281) had display units positioned to provide maximum visual dominance over the other sections, while 16.4% (n = 63) had partial visual dominance and 10.4% (n = 40) had no dominance. Also, in violation of the ban, tobacco products were sold on the counter next to chocolates and sweets at 26.8% (n = 103) of PoS, with 85.5% (n = 85) selling cigars and cigarillos on the counter and 17.5% (n = 18) selling cigarettes on the counter (Supplementary figure S2). No display units were painted in multiple colours. None of the PoS owners was aware of the TAPS bans. It was determined that only a certain number of tobacco companies execute TAPS strategies at PoS. Types and methods of TAPS One or more advertising promotion materials were detected at 24.7% (n = 95) of PoS (figure 1). Special printed materials of different colours, sized between 5–10 and 10–20 cm, with brand name, price information and large fonts were observed at 63 PoS. Showcards that gave brand information but not price, sized between 10–20 and 15–25 cm, were found on display units at 12 PoS. Price tags of font size 30–50 pt (legally required: 20 pt) were detected at 45 PoS (figure 2). Advertising agencies hired sales representatives to promote a certain tobacco brand at only 1 PoS (Supplementary figure S3). All PoS owners stated that all materials were placed by sales representatives of tobacco companies. Figure 1 Open in new tabDownload slide Some of the advertising and promotion materials Figure 1 Open in new tabDownload slide Some of the advertising and promotion materials Figure 2 Open in new tabDownload slide Price tags with fonts larger than legally fixed 20 pt Figure 2 Open in new tabDownload slide Price tags with fonts larger than legally fixed 20 pt Cigarettes were placed on display units to create brand dominance through four different methods. The first method, having a unit consisting solely of the brands of one tobacco company, was used by 7.0% (n = 27) of PoS (Supplementary figure S4). The second method, having a unit where packages for each company are placed vertically on two or three shelves, was used by 38.0% (n = 146) of PoS (Supplementary figure S5). In the third method, a PoS had a unit consisting of the brands of only one tobacco company—except for two or three shelves at the bottom of the display unit, which are used for other tobacco companies’ brands. This method was used by 49.5% (n = 190) of PoS (Supplementary figure S6). The last method, having a unit in which cigarettes are organized by the owner according to the best-selling brands, was used by 5.5% (n = 21) of PoS. Where a PoS had more than one display unit behind the counter, cigarettes were placed to create brand dominance of one company per display unit (figure 3). In PoS with only one display, the unit was divided into three main categories. The first four shelves on the upper side of the unit are defined as the first category. The four shelves in the middle of the unit are defined as the second category. The other four shelves at the bottom are defined as the third category. The placement of brands into these categories was determined according to promotional materials the PoS received from tobacco companies. Figure 3 Open in new tabDownload slide A PoS which has multiple display units with tobacco power walls Figure 3 Open in new tabDownload slide A PoS which has multiple display units with tobacco power walls A company highlights its new brands by having them placed in additional shelves at the top of the display unit (Supplementary figure S7). Top-selling brands are placed next to these new brands on the shelves. Upon purchase, a salesperson will take the top-selling brand from this top shelf, exposing the customer to the new brand beside it. While tobacco companies gave financial incentives to create brand dominance in display units to 79.7% (n = 306) of PoS owners, 14.8% (n = 57) of owners merely received a free display unit. The main types of financial promotion given to PoS owners are cash, free tobacco products, discounts on invoices and gifts. A PoS owner can also benefit from more than one promotion. It was documented that 203 PoS owners received cash, 121 PoS owners received free cigarettes, 94 PoS owners received discounted invoices and 8 PoS owners received various gifts. Promotional payments are determined annually. Payment methods to the PoS owners include: money transferred directly into a bank account, a lump sum payment given in cash, free tobacco products, both cash and free tobacco products in different amounts (i.e. 70% cash and 30% tobacco products), monthly instalments of both cash and free tobacco products and discounts on invoices in a lump sum or monthly instalments. Location and sales volume of the PoS are the most important variables for determining the amount of promotional payment. PoS located on central streets, squares or closer to places that students and youth frequent are given more valuable promotions. According to PoS owners, while small businesses, especially those on side streets, are paid between 200 and 500 USD per year, PoS located on central streets and squares with higher sales volumes are paid between 3000 and 5000 USD per year. This payment is termed shelf money. Additionally, some tobacco companies give extra points to PoS on the basis of yearly sales volume. These points can be redeemed by PoS owners at a website created by tobacco companies to get free items such as air conditioners, fuel oil checks and electronic devices. Other companies gift about 100 lighters on a monthly basis to PoS. Additionally, different promotional strategies intended to increase the loyalty of high-sales PoS include test driving luxury sports cars or race cars and free holidays in foreign countries. Point-based reward systems were found to be prominent. One system, called Platinum Membership, works as follows: when a customer wants to buy X brand of company A, PoS offers the customer a similar item, Y brand of company B. PoS has an agreement with company B. If the customer accepts the offer, PoS requests the customer’s contact information. If the customer gives their contact information, PoS forwards it to Company B and gains a high volume of points by doing so. Occasionally, tobacco companies select a particular street as a project area to design display units for creating brand dominance at all PoS on the selected street. They offer higher payments to PoS there to convince them to abandon other companies they may have an agreement with. Discussion This study has several key findings which demonstrate that tobacco companies consistently execute various TAPS strategies, directly and indirectly, at PoS in Turkey despite the ban. Detected violations in all 384 PoS are summarized in table 1. The main difference between this study and previous studies is that different types and methods of TAPS at PoS were detected based on face-to-face interviews with PoS owners/administrators on topics never before published in any tobacco study in Turkey, such as types/methods of promotional incentives paid by the industry, factors affecting the value of promotional payments, promotional incentives, such as gifts and invoice discounts, placement types of cigarette packages in tobacco display units, presence of industry-trained PoS personnel working as sales representatives of the industry and different advertising and promotional strategies executed by PoS personnel. Table 1 Compliance of 384 PoS with current TAPS legislation Type of violation . Violated legislationa . Violation rate . Compliance rate . Total . Number of PoS . % of PoS . Number of PoS . % of PoS . Number of PoS . % of PoS . At least one type of display/TAPS ban Law No. 4733. Law No. 4207. S&P By-Law 370 96.4 14 3.6 384 100 Featured display settings emphasizing certain brands Law No. 4733. S&P By-Law 363 94.5 21 5.5 384 100 Financial incentives for featured display settings Law No. 4733. S&P By-Law 306 79.7 78 20.3 384 100 Free tobacco display unit for featured display settings Law No. 4733. S&P By-Law 57 14.8 327 85.2 384 100 Tobacco product displays visible from outside Law No. 4207. S&P By-Law 112 29.2 272 70.8 384 100 Sales of tobacco products on the counter Law No. 4207. S&P By-Law 103 26.8 281 73.2 384 100 Featured advertising items on display units Law No. 4207. Law No. 4733. S&P By-Law 95 24.7 289 75.3 384 100 Sale of tobacco products as single stick Law No. 4733. Law No. 4207. S&P By-Law 74 19.3 310 80.7 384 100 Price tags larger than legally fixed 20 pt font sized S&P By-Law 45 11.7 339 88.3 384 100 Displayed packs by hiding pictorial health warnings S&P By-Law 2 0.05 382 99..95 384 100 Tobacco packs without price tags – 0 0.0 384 100 384 100 Tobacco display units painted multiple colour – 0 0.0 384 100 384 100 Sales of contraband/counterfeit tobacco products – 0 0.0 384 100 384 100 PoS without valid tobacco product sales licence – 0 0.0 384 100 384 100 Type of violation . Violated legislationa . Violation rate . Compliance rate . Total . Number of PoS . % of PoS . Number of PoS . % of PoS . Number of PoS . % of PoS . At least one type of display/TAPS ban Law No. 4733. Law No. 4207. S&P By-Law 370 96.4 14 3.6 384 100 Featured display settings emphasizing certain brands Law No. 4733. S&P By-Law 363 94.5 21 5.5 384 100 Financial incentives for featured display settings Law No. 4733. S&P By-Law 306 79.7 78 20.3 384 100 Free tobacco display unit for featured display settings Law No. 4733. S&P By-Law 57 14.8 327 85.2 384 100 Tobacco product displays visible from outside Law No. 4207. S&P By-Law 112 29.2 272 70.8 384 100 Sales of tobacco products on the counter Law No. 4207. S&P By-Law 103 26.8 281 73.2 384 100 Featured advertising items on display units Law No. 4207. Law No. 4733. S&P By-Law 95 24.7 289 75.3 384 100 Sale of tobacco products as single stick Law No. 4733. Law No. 4207. S&P By-Law 74 19.3 310 80.7 384 100 Price tags larger than legally fixed 20 pt font sized S&P By-Law 45 11.7 339 88.3 384 100 Displayed packs by hiding pictorial health warnings S&P By-Law 2 0.05 382 99..95 384 100 Tobacco packs without price tags – 0 0.0 384 100 384 100 Tobacco display units painted multiple colour – 0 0.0 384 100 384 100 Sales of contraband/counterfeit tobacco products – 0 0.0 384 100 384 100 PoS without valid tobacco product sales licence – 0 0.0 384 100 384 100 a Related legislation: Law No. 4733 Regarding the Organization and Duties of the Tobacco and Alcohol Market Regulatory Authority. Law No. 4207 on Prevention and Control of Hazards of Tobacco Products. S&P By-Law: By-Law on Rules and Procedures regarding the Sale and Presentation of Tobacco Products and Alcoholic Beverages. Open in new tab Table 1 Compliance of 384 PoS with current TAPS legislation Type of violation . Violated legislationa . Violation rate . Compliance rate . Total . Number of PoS . % of PoS . Number of PoS . % of PoS . Number of PoS . % of PoS . At least one type of display/TAPS ban Law No. 4733. Law No. 4207. S&P By-Law 370 96.4 14 3.6 384 100 Featured display settings emphasizing certain brands Law No. 4733. S&P By-Law 363 94.5 21 5.5 384 100 Financial incentives for featured display settings Law No. 4733. S&P By-Law 306 79.7 78 20.3 384 100 Free tobacco display unit for featured display settings Law No. 4733. S&P By-Law 57 14.8 327 85.2 384 100 Tobacco product displays visible from outside Law No. 4207. S&P By-Law 112 29.2 272 70.8 384 100 Sales of tobacco products on the counter Law No. 4207. S&P By-Law 103 26.8 281 73.2 384 100 Featured advertising items on display units Law No. 4207. Law No. 4733. S&P By-Law 95 24.7 289 75.3 384 100 Sale of tobacco products as single stick Law No. 4733. Law No. 4207. S&P By-Law 74 19.3 310 80.7 384 100 Price tags larger than legally fixed 20 pt font sized S&P By-Law 45 11.7 339 88.3 384 100 Displayed packs by hiding pictorial health warnings S&P By-Law 2 0.05 382 99..95 384 100 Tobacco packs without price tags – 0 0.0 384 100 384 100 Tobacco display units painted multiple colour – 0 0.0 384 100 384 100 Sales of contraband/counterfeit tobacco products – 0 0.0 384 100 384 100 PoS without valid tobacco product sales licence – 0 0.0 384 100 384 100 Type of violation . Violated legislationa . Violation rate . Compliance rate . Total . Number of PoS . % of PoS . Number of PoS . % of PoS . Number of PoS . % of PoS . At least one type of display/TAPS ban Law No. 4733. Law No. 4207. S&P By-Law 370 96.4 14 3.6 384 100 Featured display settings emphasizing certain brands Law No. 4733. S&P By-Law 363 94.5 21 5.5 384 100 Financial incentives for featured display settings Law No. 4733. S&P By-Law 306 79.7 78 20.3 384 100 Free tobacco display unit for featured display settings Law No. 4733. S&P By-Law 57 14.8 327 85.2 384 100 Tobacco product displays visible from outside Law No. 4207. S&P By-Law 112 29.2 272 70.8 384 100 Sales of tobacco products on the counter Law No. 4207. S&P By-Law 103 26.8 281 73.2 384 100 Featured advertising items on display units Law No. 4207. Law No. 4733. S&P By-Law 95 24.7 289 75.3 384 100 Sale of tobacco products as single stick Law No. 4733. Law No. 4207. S&P By-Law 74 19.3 310 80.7 384 100 Price tags larger than legally fixed 20 pt font sized S&P By-Law 45 11.7 339 88.3 384 100 Displayed packs by hiding pictorial health warnings S&P By-Law 2 0.05 382 99..95 384 100 Tobacco packs without price tags – 0 0.0 384 100 384 100 Tobacco display units painted multiple colour – 0 0.0 384 100 384 100 Sales of contraband/counterfeit tobacco products – 0 0.0 384 100 384 100 PoS without valid tobacco product sales licence – 0 0.0 384 100 384 100 a Related legislation: Law No. 4733 Regarding the Organization and Duties of the Tobacco and Alcohol Market Regulatory Authority. Law No. 4207 on Prevention and Control of Hazards of Tobacco Products. S&P By-Law: By-Law on Rules and Procedures regarding the Sale and Presentation of Tobacco Products and Alcoholic Beverages. Open in new tab It is well documented that tobacco companies offer PoS owners several incentives, such as cash, various gifts, free display units and point schemes leading to gifts or cash. The incentives are offered with the aim of ensuring advertisement display, prime placement of their products, increased sales, gathering of customer contact information and promotion of new brands.26–30 A large volume of the tobacco industry’s promotional budget is spent on PoS promotions in many districts.31 The findings of this study indicate that the primary incentives received by PoS owners in Turkey are cash, discounts on invoices and free tobacco products as a reward for creating brand dominance on display units and allowing advertisement materials at the PoS. In addition, retailers are given incentives to increase their sales through reward point systems.28,29 One such system is used to gain customer contact information, giving the industry an opportunity to contact customers indirectly and create a database via PoS without facing legal action. Collection of contact information is rewarded by a high volume of points, with points also being rewarded for yearly sales volume. These points are used on websites created by tobacco companies to get free gifts. This study uncovered that the tobacco industry uses PoS personnel as their own sales representatives by training them regularly and in detail about their products. Industry-trained PoS personnel can identify product characteristics and make comparisons with the products of rival companies. As such, they are able to influence customer choices. This conduct is one of the most important findings of this study. Similar strategies have been reported in Scotland and Australia.28 Notably, this study also found that there is a type of sales representative that promotes tobacco products at PoS. These representatives are hired via advertising agencies, trained by the industry and assigned to the PoS to influence consumer preferences and promote new brands. According to the legislation in Turkey, tobacco product display units cannot consist of the brands of just one company, since it distorts competition and minimizes customer preferences. Despite these guidelines, this study suggests that the tobacco display unit, which is transformed into Power Walls,32–34 is the most-used instrument by tobacco industry at PoS. Rooke et al. reported similar results from UK, indicating that the extensive involvement of tobacco companies in providing and monitoring retail displays suggests the importance of implementing policies to end this form of advertising.30 The findings of this study show that sales of cigar/cigarillos as single sticks are common due to the high price of one package for occasional users. Similarly, the sale of single sticks is especially widespread in LMIC, as single sticks are cheaper than a full pack of tobacco products.29,35,36 This study indicates that the children and youth are the group most exposed to tobacco products since the display units are located in highly prominent positions and are quite visible from other sections of the PoS, which are also well documented in the literature.37–40 Additionally, tobacco products are often on the counter together with chocolates, chewing gums and sweets. It has been documented that promotional showcards are often printed with statements, for example ‘Printed to inform sales personnel, cannot be used for the purpose of advertising’. Tobacco companies try to avoid advertising bans by writing such statements on advertising materials; however, these materials are placed on the display units to promote their brands regardless. An integrated approach must be put into practice to counteract the diverse strategies of the tobacco industry. Most importantly, existing laws must be amended to keep tobacco products out of sight, stowed away in closed cupboards or under the counter at PoS. The other primary issue is to limit communication between the industry and PoS owners, since industry-trained PoS personnel serve the tobacco industry to promote their deadly products. Within this context, distribution of tobacco products to PoS by the industry must be banned and instead conducted by state institutions. Additionally, interpretation and implementation of Article 5.3 of the FCTC should be expanded to include PoS. Given that there were 173 000 PoS in Turkey in 2019,25 an institution specializing in tobacco control must be established to conduct consistent inspections and observations alongside other relevant government institutions. The creation of this controlling body will be a very important supplementary factor of the other measures to be taken. Data sharing statement Data are available on reasonable request. Conflicts of interest: None declared. Key points Turkey is the best practice country that has implemented all six measures of MPOWER since 2013. This study found that although all forms of TAPS at the PoS are banned in Turkey, weak enforcement is a serious problem. For the first time in Turkey, types and methods of promotional payments to PoS were defined. Tobacco companies benefit from PoS personnel directly by training them. 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TI - Uncovering TAPS strategies of the tobacco industry at PoS in low- and middle-income countries: the case of Turkey
JF - The European Journal of Public Health
DO - 10.1093/eurpub/ckaa067
DA - 2020-10-01
UR - https://www.deepdyve.com/lp/oxford-university-press/uncovering-taps-strategies-of-the-tobacco-industry-at-pos-in-low-and-82PHmZe0Nb
SP - 996
EP - 1001
VL - 30
IS - 5
DP - DeepDyve
ER -