Background:
Tobacco control policies are critical to tackling the global tobacco epidemic. Unfortunately, little research has documented the factors that facilitate the implementation of tobacco control policies in low- and middle-income countries. In this study, we explored tactics and arguments used in India to advocate for the implementation of the 2014 rules increasing the size of pictorial health warning labels (HWLs) on tobacco products from 20% to 85% of the principle display area.

Methods:
A case study approach was used. Key informant interviews (N=22) were conducted between June and September 2017 with individuals who were purposively selected based on their significant role in the fight for implementation of the 2014 HWL rules. Sixty-eight documents were purposively selected for review. Documents and interviews were analyzed using inductive and deductive coding in HyperRESEARCH, then triangulated.

Results:
Litigation, media advocacy using personal anecdotes, sensitization of key political figures, scientific evidence of tobacco-caused disease, and lobbying emerged as the most impactful tactics. Collaboration between anti-tobacco organizations facilitated the presentation of a consistent message to the media and to policy makers, and also ensured that efforts were not duplicated and each organization could prioritize tactics that utilized their expertise. Arguments countering opponents' claims regarding economic impact of the law, anecdotes from individuals with tobacco-caused diseases, and scientific evidence were used to persuade key decision makers and judges to support HWL implementation.

Conclusions:
The use of multiple, complementary tactics facilitated the success of the advocacy campaign to increase the size of HWLs in India. Arguing from both a scientific evidence base as well as a more humanizing standpoint using anecdotes through lobbying, litigation, and media advocacy was successful in the case of implementing larger HWLs in India. Advocates in other countries hoping to pass and implement tobacco control legislation may find these arguments and tactics helpful in their own countries.