Academic journal article Bulletin of the World Health Organization

Smoking-Related Deaths Averted Due to Three Years of Policy progress/Des Deces Lies Au Tabagisme Evites Grace a Trois Ans D'avancee politique/Fallecimientos Derivados del Tabaco Evitados Gracias Al Progreso De Las Medidas De Control a Lo Largo De Tres Anos

Academic journal article Bulletin of the World Health Organization

Smoking-Related Deaths Averted Due to Three Years of Policy progress/Des Deces Lies Au Tabagisme Evites Grace a Trois Ans D'avancee politique/Fallecimientos Derivados del Tabaco Evitados Gracias Al Progreso De Las Medidas De Control a Lo Largo De Tres Anos

Article excerpt

Introduction

The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) has been one of the most rapidly embraced treaties in the history of the United Nations. To assist countries with implementing FCTC obligations, in 2008 WHO introduced the MPOWER package of evidence-based tobacco control measures. The MPOWER package includes: monitoring tobacco use and tobacco control policies; protecting people from the dangers of tobacco smoke; offering help to quit tobacco; warning the public about the dangers of tobacco; enforcing bans on tobacco advertising, promotion and sponsorship; and raising tobacco taxes. These measures are supported by substantial evidence of their impact for reducing smoking. (1-4)

Since their introduction, countries have steadily implemented recommended MPOWER policies. Early leaders in adopting rigorous MPOWER measures include Brazil, (5) Ireland (6) and Thailand. (7) As the movement to adopt MPOWER policies gains momentum, more countries have passed laws and many others have put advocacy efforts in place to support legislation. This progress has also been aided by significant support from private donors.

In 2008, WHO began systematically gathering information about MPOWER measures in every Member State to assess progress with the adoption of legislation, motivate further change and provide examples of excellence. In 2008, 2009 and 2011 WHO published reports that provide information about MPOWER implementation. (8-10) Findings of the most recent report, which includes data from 2010, showed that 3.8 billion people were covered by at least one MPOWER category globally and demonstrated progress in every MPOWER category.

The goal of the MPOWER package is to reduce smoking-attributable deaths (SADs), which are projected to rise to 8.3 million annually by 2030. (11) The purpose of this study is to determine the number of SADs averted as a result of the implementation of MPOWER policies. By capitalizing on the previously-validated SimSmoke mode (15-7,12-20) to estimate the impact of MPOWER policies for reducing SADs, we employ a simple but powerful method to estimate the long-term impact of MPOWER policy implementation in the first three years.

Methods

Assessment of incremental policy change

The WHO reports (8-10) show the status of each MPOWER policy, by country or territory, for 2007, 2008 and 2010 using a five-level categorization. The highest level comprises the MPOWER measures that WHO placed in the highest category in terms of the completeness of the legislation. For example, WHO categorizes smoke-free laws at the highest level as those calling for "all public places smoke-free or [greater than or equal to] 90% of the population covered by subnational smoke-free legislation."

Using these criteria, we created a list of countries and territories that had adopted a highest-level policy after 2007, commensurate with the timing of WHO reports. We also used WHO corrigenda to clarify or correct policy status based on additional knowledge gained after publication of the reports. (21) The list of countries and territories adopting highest-level policies was confirmed by representatives of the WHO Tobacco Free Initiative.

We compared 2010 data for the POWER (monitoring is excluded from this report) categories to 2007 data to determine which countries not in the highest-level category in 2007 had progressed to the highest level by 2010. For each country that had adopted a highest-level policy by 2010, policy data from earlier reports were used to determine incremental policy changes because the effect of a policy change depends upon the initial policy level (e.g. the incremental effect of a complete ban is less if a partial ban was in place than if no policy existed).

Effect size parameters

Effect sizes for incremental policy change were derived from the SimSmoke tobacco control policy model. …

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