Tobacco Control Progress in Low and Middle Income Countries in Comparison to High Income Countries

Abstract

The study aimed to describe worldwide levels and trends of tobacco control policy by comparing low and middle income countries with other income categories from 2007 to 2014 and to analyze the corresponding relation to recent changes in smoking prevalence. Policy measure data representing years 2007 to 2014 were collected from all available World Health Organization (WHO) reports on the global tobacco epidemic. Corresponding policy percentage scores (PS) were calculated based on MPOWER measures. Age-standardized smoking prevalence data for years 2010 and 2015 were collected from the WHO Global Health Observatory Data Repository. Trends of PS were analysed with respect to WHO region and OECD country income category. Scatter plots and regression analysis were used to depict the relationship between tobacco control policy of 2010 and change in smoking prevalence between 2015 and 2010 by sex and income category. Combined PS for all countries increased significantly from 47% in 2007 to 61% by 2014 (p < 0.001). When grouped by income category and region, policies were strengthened in all categories, albeit with varying progression. By 2014, tobacco control policy legislation had reached 45% in the Least Developed Countries (LDCs), 59% in Low Middle Income Countries (LMICs), 66% in Upper Middle Income Countries (UMICs) and 70% in High Income Countries (HICs). Overall, there was a negative relationship between higher policy scores and change in smoking prevalence. Although policy strengthening had been conducted between 2007 and 2014, room for considerable global improvement remains, particularly in LDCs.

Keywords: MPOWER; global tobacco epidemic; low income countries; middle income countries; policy measures; smoking prevalence; tobacco control.

Figure 1

Progression over time of the calculated combined policy score by (i) income category and report year (top four panels) and by (ii) World Health Organization (WHO) geographical region and year (bottom six panels).

Figure 2

Relationship between combined policy percentage scores (PS) of 2010 and change in current tobacco smoking between 2010 and 2015 in relation to smoking prevalence in 2010 by gender and country income category (labeled data points indicate countries with a smoking prevalence change of >4% for males and >1% for females; Congo = Republic of Congo).