|Year : 2016 | Volume
| Issue : 1 | Page : 127
Comparison of tobacco control programs worldwide: A quantitative analysis of the 2015 World Health Organization MPOWER report
Gholamreza Heydari1, Fahimeh Chamyani2, Mohammad Reza Masjedi3, Lida Fadaizadeh4
1 Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Library, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Research Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Telemedicine Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
|Date of Submission||03-Mar-2016|
|Date of Acceptance||29-Oct-2016|
|Date of Web Publication||12-Dec-2016|
Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
Background: A report of the activities of countries worldwide for six main policies to control tobacco use is published once every 2 years by the World Health Organization (WHO). Our objective was to perform a quantitative analysis for it in countries and regions to make a simple view of its programs.
Methods: This was a cross-sectional study by filling out a validated checklist from the 2015 WHO Report (MPOWER). All ten MPOWER measures got scores and were entered independently by two individuals and a third party compared the values.
Results: Fifteen countries, which acquired the highest scores (85% of total 37), included Panama and Turkey with 35, Brazil and Uruguay with 34, Ireland, United Kingdom, Iran, Brunei, Argentina, and Costa Rica with 33, and Australia, Nepal, Thailand, Canada, and Mauritius with 32 points.
Conclusions: Comparison of scores of different countries in this respect can be beneficial since it creates a challenge for the health policymakers to find weakness of the tobacco control programs to work on it.
Keywords: Control, tobacco, World Health Organization
|How to cite this article:|
Heydari G, Chamyani F, Masjedi MR, Fadaizadeh L. Comparison of tobacco control programs worldwide: A quantitative analysis of the 2015 World Health Organization MPOWER report. Int J Prev Med 2016;7:127
|How to cite this URL:|
Heydari G, Chamyani F, Masjedi MR, Fadaizadeh L. Comparison of tobacco control programs worldwide: A quantitative analysis of the 2015 World Health Organization MPOWER report. Int J Prev Med [serial online] 2016 [cited 2019 Jan 23];7:127. Available from: http://www.ijpvmjournal.net/text.asp?2016/7/1/127/195562
| Introduction|| |
Tobacco use remains the first preventable cause of morbidity and mortality worldwide. , Therefore, the first and the most important strategy to confront this is the comprehensive implementation of tobacco control programs. , However, this implementation cannot be easily achieved because tobacco companies try their best to seek new customers for their products and replace those who quit smoking or died of it.  In this regard, the World Health Organization (WHO) negotiated the Framework Convention on Tobacco Control Treaty in 2004, and so far, 177 countries have ratified it.  In 2008, a package was proposed to be implemented and included six main components, namely, monitoring tobacco use and prevention policies, protecting people from tobacco smoke, offering help to quit tobacco use, warning people about the dangers of tobacco, enforcing bans on tobacco advertising, promotion, and sponsorship, and raising taxes on tobacco.  Global experiences have revealed that implementation of the above-mentioned six strategies can effectively decrease the rate of consumption and resultantly the consequences and complications of tobacco use. ,, The WHO publishes a report of the activities of countries worldwide with regard to the six aforementioned strategies once every 2 years.  The aim of our study was to compare MPOWER programs among the countries of the six WHO regions to highlight what has been achieved and what till needs to be addressed by the countries to strengthen these programs and also to find the best parties on it.
| Methods|| |
This was a cross-sectional study by filling out a validated checklist from the data on pages 118-129 of the 2015 WHO MPOWER Report. A checklist of ten indicators such as six plus one policy in MPOWER, one adult daily smoking prevalence, and two compliance was initially designed by the Iranian and international tobacco control specialists, which was validated in two studies. , There were seven indicators with five possible scores ranging from minimum 0 to maximum 4. There were also three indicators with four possible scores ranging from 0 to 3. The item with no available data would be scored as zero. Hence, the possible total score is 37 (7 × 4 + 3 × 3) as shown in [Table 1]. The scores were given by two raters separately and compared and confirmed by a third person as acting supervisor. Two raters administered the assessment, and the interclass correlation confidence = 0.85 was used to assess agreement between the two raters. The scores were classified and the ranking was done.
|Table 1: The checklist of ten indicators and its scores based on the World Health Organization MPOWER Report measures 2015 |
Click here to view
| Results|| |
Countries which had at least 85% of total score (32 from 37) and percentage by the regions are as follows:
As shown in [Table 2], the highest mean points were scored by Europe (24.35), and the other regions were West Pacific (23.29), Southeast Asia (22.36), America (20.37), East Mediterranean region (19.45), and Africa (16.29); There was a significant difference (P < 0.05) for means in this regard.
- Africa: Mauritius 32, 1 from 47 countries, 2.1% of region
- America: Panama 35, Brazil and Uruguay 34, Argentina and Costa Rica 33, Canada 32, 6 from 35 countries, 17.1% of region
- Southeast Asia: Nepal and Thailand 32, 2 from 11 countries, 18.1% of region
- Europe: Turkey 35, Ireland and the United Kingdom 33, 3 from 53 countries, 5.6% of region
- Eastern Mediterranean Regional Office: Iran 33, 1 from 22 countries, 4.5% of region
- Western Pacific Regional Office: Brunei 33, Australia 32, 2 from 27 countries, 7.4% of region.
|Table 2: Countries ranked by total MPOWER World Health Organization score on tobacco control in 2015 |
Click here to view
| Discussion|| |
This study showed that none of the countries scored full in the tobacco control programs; however, Mauritius, Panama, Nepal, Thailand, Turkey, Iran, and Brunei were superior status in each region. In addition, Europe Region had a superior position over others as well. This has been previously done in two studies by Heydari et al. , for the Eastern Mediterranean countries, showing that although Iran and Egypt acquire high scores, they still face weaknesses in raising the tax on tobacco (Iran) and banning tobacco use in public places (Egypt). Europe gained the highest mean score and it might be from high scored for raising taxes on tobacco and enforcing bans on tobacco advertisement. In contrast, Africa gained the lowest mean score and acquired the least points in the two above-mentioned policies. The superior position of European countries in this regard has also been mentioned in a study by Joossens.  In addition to the aforementioned two policies, he mentioned, "offering help to quit tobacco use" and "enforcing bans on tobacco use in public places" to be among the most influential policies. , This kind of comparison could create a strong incentive for tobacco control policymakers in different countries to adopt the MPOWER package policy more strictly in the future. The results of this study and a similar one indicate that the implementation of tobacco control programs can substantially reduce tobacco-related mortality and morbidity. ,,
| Conclusions|| |
These 15 countries may indicate as the best model for other parties to implementation and enforcement of tobacco control program. Comparison of scores of different countries in this respect can be beneficial since it creates a challenge for the health policymakers to find weakness of the tobacco control programs to work on it.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al.
Smoking prevalence and cigarette consumption in 187 countries, 1980-2012. JAMA 2014;311:183-92.
Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442.
Peto R, Lopez AD, Boreham J, Thun M, Heath C Jr., Doll R. Mortality from smoking worldwide. Br Med Bull 1996;52:12-21.
Levine R, Kinder M. Millions saved: Proven success in global health. Washington, DC: Routledge; 2006. Available from: http://www
.cgdev.org/initiative/millions-saved. [Last accessed on 2016 Apr 17].
Battling Big Tobacco: Mike Wallace Talks to the Highest-ranking Tobacco Whistleblower. CBS News; 2005. Available from: http://www
.cbsnews.com/2100-500164-162-666867.htlm. [Last accessed on 2007 Dec 05].
FCTC. Available from: http://www
.who.int/fctc/text_download/en/-24k. [Last accessed on 2016 Apr 17].
MPOWER. Available from: http://www
.who.int/entity/tobacco/mpower/en/-32k. [Last accessed on 2016 Apr 17].
Guindon GE, Boisclair D. Past, Current and Future Trends in Tobacco Use. Washington, DC: World Bank; 2003. Available from: http://www
. 1.worldbank.org/tobacco/pdf/Guindon-Past,%20current-%20whole.pdf. [Last accessed on 2007 Dec 05].
Basu S. Glantz S, Bitoon A, Millet C. The effect of tobacco control measures during a period of rising cardiovascular disease risk in India: A mathematical model of myocardial information and stroke. PLoS Med 2013;10:e1001480.
Levy DT, Ellis JA, Mays D, Huang AT. Smoking-related deaths averted due to three years of policy progress. Bull World Health Organ 2013;91:509-18.
MPOWER. Available from: http://www
.who.int/tobacco/global_report/2015/en/. [Last accessed on 2016 Apr 17].
Heydari G, Talischi F, Algouhmani H, Lando HA, Ahmady AE. WHO MPOWER tobacco control scores in the Eastern Mediterranean countries based on the 2011 report. East Mediterr Health J 2013;19:314-9.
Heydari G, Ebn Ahmady A, Lando HA, Shadmehr MB, Fadaizadeh L. The second study on WHO MPOWER tobacco control scores in Eastern Mediterranean Countries based on the 2013 report: Improvements over two years. Arch Iran Med 2014;17:621-5.
Joossens L, Raw M. The Tobacco Control Scale: A new scale to measure country activity. Tob Control 2006;15:247-53.
Heydari G, Talischi F, Masjedi MR, Alguomani H, Joossens L, Ghafari M. Comparison of tobacco control policies in the Eastern Mediterranean countries based on Tobacco Control Scale scores. East Mediterr Health J 2012;18:803-10.
Shrivastava SR, Shrivastava PS, Ramasamy J. World Health Organization: Do we have to intensify global tobacco control efforts? J Res Med Sci 2015;20:716-7.
Shrivastava SR, Shrivastava PS, Ramasamy J. Public health interventions to reduce the incidence of tobacco associated cancers. Int J Prev Med 2016;7:19.
Heydari G, Masjedi M, Ahmady AE, Leischow SJ, Lando HA, Shadmehr MB, et al. A
comparative study on tobacco cessation methods: A quantitative systematic review. Int J Prev Med 2014;5:673-8.
[Table 1], [Table 2]