Anti-tobacco control industry strategies in Turkey

Cigarette consumption increased from 10 billion to 2.2 trillion sticks between 1880 and 1960, and reached 5.7 trillion sticks in 2000 concurrent with the process of trade and investment liberalization [5].

MPOWER consists selected demand-side measures of the FCTC: monitor tobacco use and prevention policies; protect people from tobacco smoke; offer help to quit tobacco use; warn about the dangers of tobacco; enforce bans on tobacco advertising, promotion and sponsorship; and raise taxes on tobacco.

Through the changes in packaging and with cigarettes [34, 52, 56‐61], product innovation maintains an international brand’s image and persuades poorer smokers not to downgrade to cheaper brands, give up smoking or switch to illicit trade [62]. Also, as alternatives to cigarettes, smokeless tobacco (chewing tobacco and snuff) and electronic cigarettes allow users to evade the indoor smoking ban [63‐65]; and they can delay quitting smoking [66].

The tobacco industry escapes the advertising, promotion and sponsorship ban by developing unconventional new methods [58, 67]. The industry uses brand stretching; brand sharing; product placement; promotion and distribution of sample products; promotions and sales via electronic mail, the Internet and text messages; and sponsoring sport, music, fashion and art activities [24]. CSR campaigns are organized to restore corporate image and get involved in policymaking processes [25, 52].

TTCs use foreign investment to gain a share in new markets [52]. The acquisition of privatized local tobacco companies by the TTCs leads to aggressive marketing, effective distribution and lower prices, all of which increase the demand for cigarettes [51, 68‐70]. They also sustain profitability via continuous cost management [9, 51, 52].

The high market concentration in the global tobacco sector [71] ensures pricing power for a small number of TTCs [72, 73]. The effectiveness of sales taxes in terms of reducing tobacco consumption depends, in part, on pricing strategy [71]. Higher sales taxes generally make tobacco products more expensive, but the level of price increase depends on the decisions by manufacturers regarding how much of the tax will be passed on to consumers [74]. Tobacco manufacturers may increase retail cigarette prices over and above sales tax increases, leading to an overshifting of taxes; or they may decrease retail prices, causing an undershifting of taxes. Limited empirical evidence shows mixed results: tobacco manufacturers have preferred to apply one of the two strategies in various national markets at different times according to the price segments of their brands, industry structure, tax structure etc. [53, 74]. In general, TTCs use low prices in emerging markets to reach as many consumers as they can [24] while they offer products at various price segments in established markets [59] to reach customers with different income levels [34].

Illicit trade is an important strategy among TTCs’ market entry tactics [52, 75‐77]. It is used to launch their products in nearby economies, to circumvent sales tax increases, and to maintain access of the youth and low-income consumers with cheap tobacco products [52].

Lobbying serves to obtain market access, to block or delay implementation of tobacco-control policies and to manipulate individual policymakers and political parties to influence tobacco control policy making agendas [24, 48, 67, 78, 79].

The industry also uses deceptive and/or manipulative interference in scientific research: it manipulates the results of studies which prove that tobacco products cause cancer, that second hand smoke is harmful, and that nicotine is an addictive ingredient, by financing studies that claim the opposite [24, 57, 78, 80, 81].

The supply-side proposals in the literature have a range of foci: they target product specifications, the marketing-sales end, manufacturing conditions, or both manufacturing and trade of tobacco products. The following are some examples of supply-side policies: reducing nicotine content in cigarettes, controlling tobacco marketing through a public agency, imposing progressive limits on the amount of commercial tobacco released for legal sale, controlling before-tax prices, and transferring responsibility for the supply of cigarettes to a sole supplier and distributor of tobacco products not driven by profit [4, 25, 72, 82‐91].

For a review of the entries of foreign tobacco companies into the Turkish market and accompanying tobacco control measures see [14].

Although tar levels – and what is considered high, medium and low tar - vary across countries, for the sake of consistency when making comparisons, the following definitions are applied to Euromonitor data: high tar cigarettes = tar content of greater than 10 mg; mid tar cigarettes = tar content of 6–10 mg, low tar cigarettes = tar content of 4–6 mg; ultra low tar cigarettes = tar content of less than 4 mg [10].

Firstly, nominal prices (Additional file 3) were multiplied by the sales quantities of the cigarette brands (Additional file 4) to find out nominal sales revenues for each brand (Additional file 5). Next, nominal sales revenues and sales quantities of the brands by price segments were aggregated (Additional file 6 and Additional file 7 respectively). Then, nominal weighted prices (Additional file 8) were calculated by dividing nominal sales revenues to sales quantities of cigarette brands for each price segment. Finally, real weighted prices (Additional file 9) were determined using the Turkey’s CPI (2003 = 100) for Turkey.

Before-tax (net) nominal weighted prices (Additional file 10) are calculated by deducting the tax amount from nominal weighted prices (Additional file 8) using the formula below. Then, before-tax (net) nominal weighted prices are calculated in real terms by using Turkey’s CPI (2003 = 100) index and net real weighted prices (Additional file 11) are found out.

Before-tax (net) nominal weighted price = N - [(N × SCT) + (N × VAT) + (S)]

N: Nominal weighted prices

S: Amount of specific tax (if any) for relevant year

SCT: Special consumption tax

VAT: Value added tax

The Tobacco Fund was removed from the import of ‘homogenized tobacco or reconstituted tobacco’, ‘expanded tobacco’, ‘expanded stem’ and any kind of tobacco. The Fund was reduced for imported leaf tobacco.

Indeed, in the 2010s, the diminished border security because of the ongoing war in Syria and higher consumption prevalence of around 2 million immigrants than the average of Turkey contributed to the increase in both official and contraband trading of tobacco and tobacco products [21]. However, due to recently strengthened border controls, the fight against smuggling of tobacco products has intensified and significant smuggling have been curtailed [45]. This partially shifted consumption from contraband to registered tobacco products. Henceforth, the rise in official cigarette sales between 2013 and 2016 from 91.6 to 105.5 billion sticks was noteworthy. In the rising official sales, the loose implementation of tobacco control measures, insufficient inspection has especially played a role.

The ratio of excise taxes in resale prices has risen dramatically: for example, for a cigarette package sold at 8 TL, it was 40.88% in 2009, 48.38% in 2010, 80.25% in 2011, 81.66% in 2013 and 82.84% in 2015 [21].

For example, when one adds to the official sales (94.7 billion sticks), the consumption of contraband cigarettes (around 14% of the official sales - 14 billion sticks), brought total cigarette consumption 108.7 billion sticks for 2014.