Revisiting the association between worldwide implementation of the MPOWER package and smoking prevalence, 2008-2017

Abstract

Background: We revisited the association between progress in MPOWER implementation from 2008 to 2016 and smoking prevalence from 2009 to 2017 and offered an in-depth understanding of differential outcomes for various country groups.

Methods: We used data from six rounds of the WHO Reports on the Global Tobacco Epidemic and calculated a composite MPOWER Score for each country in each period. We categorised the countries in four initial conditions based on their tobacco control preparedness measured by MPOWER score in 2008 and smoking burden measured by age-adjusted adult daily smoking prevalence in 2006: (1) High MPOWER - high prevalence (HM-HP). (2) High MPOWER - low prevalence (HM-LP). (3) Low MPOWER - high prevalence (LM-HP). (4) Low MPOWER - low prevalence (LM-LP). We estimated the association of age-adjusted adult daily smoking prevalence with MPOWER Score and cigarette tax rates using two-way fixed-effects panel regression models including both year and country fixed effects.

Results: A unit increase of the MPOWER Score was associated with 0.39 and 0.50 percentage points decrease in adult daily smoking prevalence for HM-HP and HM-LP countries, respectively. When tax rate was controlled for separately from MPOWE, an increase in tax rate showed a negative association with daily smoking prevalence for HM-HP and LM-LP countries, while the MPOWE Score showed a negative association for all initial condition country groups except for LM-LP countries.

Conclusion: A decade after the introduction of the WHO MPOWER package, we observed that the countries with higher initial tobacco control preparedness and higher smoking burden were able to reduce the adult daily smoking prevalence significantly.

Keywords: Global tobacco epidemic; MPOWER Score; Smoking Prevalence; WHO MPOWER Measures; implementation of MPOWER package.

Figure 1

Countries by initial conditions of adult daily smoking prevalence and MPOWER Score note: Three-digit country codes are used in the scatter plot (online supplementary appendix table A2). The horizontal and the vertical dashed-lines indicate the median adult daily smoking prevalence (19.5%) and the median MPOWER Score (20), respectively, and the intersection of these two lines creates four quadrants indicating four country categories (ie, HM-HP, HM-LP, LM-LP, LM-HP). Country observations are color-coded by who regions—Africa is orange, the Americas is gold, Eastern Mediterranean is blue, Europe is green, South-East Asia is red and Western Pacific is magenta.

Figure 2

Change in MPOWER Score (2008 to 2016) and change in adult daily smoking prevalence (2009 to 2017) by initial condition note: observations are color-coded by who regions—Africa is orange, the Americas is gold, Eastern Mediterranean is blue, Europe is green, South-East Asia is red, and Western Pacific is magenta. The straight line is the linear fitted line for each initial condition group.