Background:
China is the largest producer and consumer of tobacco products worldwide, with 16.5% of all deaths attributed to tobacco use in 2010. While direct marketing and advertisement of tobacco products has been restricted, indirect marketing still exists under the guise of sponsorship and corporate social responsibility (CSR). This case study is focused on tobacco industry-sponsored elementary schools in Chinese rural areas and discusses the success story of a major tobacco control campaign to remove tobacco-related branding and logos from school buildings.

Methods:
Field visits were undertaken to 3 tobacco industry-sponsored elementary schools in Yunnan in 2012, and semi-structured interviews were conducted with students, teachers, school principals and parents to understand their perceptions of the tobacco industry and its sponsorship of schools. In 2016, semi-structured interviews with tobacco control activists were conducted in Beijing, where respondents discussed the outcome of those field visits and the resulting work in petitioning government sectors to remove tobacco-related branding from school buildings. Interview data was transcribed and coded, and key themes were developed using thematic analysis.

Results:
While health consequences of smoking were generally known, attitudes towards the tobacco industry and its CSR activities remained positive among the general public. Educators and parents did not perceive any impacts on schoolchildren from exposure to “pro-tobacco propaganda” created by the industry's CSR activities. Attitudes among tobacco control activists were drastically different, with consensus that CSR activities constitute indirect marketing attempts that should be banned.

Conclusions:
The successful removal of branding from tobacco industry-sponsored schools shows that meaningful action is possible even in the absence of relevant legislation, and can be achieved through the mobilization of stakeholders, including academics and civil society organizations. National tobacco control legislation banning all forms of indirect marketing including sponsorship and CSR activities is needed in order to protect the health of the future generations.