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Int. J. Environ. Res. Public Health 2016, 13(10), 1039; doi:10.3390/ijerph13101039

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

Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
Institute of Public Health, University of Heidelberg, 69120 Heidelberg, Germany
Author to whom correspondence should be addressed.
Academic Editors: Linda Bauld and Rosemary Hiscock
Received: 22 August 2016 / Revised: 12 October 2016 / Accepted: 13 October 2016 / Published: 24 October 2016
(This article belongs to the Special Issue Tobacco Control and Priority Groups)
View Full-Text   |   Download PDF [835 KB, uploaded 24 October 2016]   |  


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

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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    Description: Appendix A: Trends of tobacco control policy by geographical region and year. Measurements as ‘n or mean% (range)’ as indicated. Per region, full range (0-100%) assumed unless otherwise indicated.

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MDPI and ACS Style

Anderson, C.L.; Becher, H.; Winkler, V. Tobacco Control Progress in Low and Middle Income Countries in Comparison to High Income Countries. Int. J. Environ. Res. Public Health 2016, 13, 1039.

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