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WHO Policy Could Have Big Effect on Smoking Rates

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Without implementation of a World Health Organization policy package called MPOWER, the number of adult smokers around the world will continue to grow over the next two decades, even as prevalence retreats slightly, researchers estimated.

Without any major policy changes, the adult smoking prevalence is estimated to drop from 23.7% in 2010 to 22% by 2030, according to David Mendez, PhD, of the University of Michigan School of Public Health in Ann Arbor, and colleagues.

But because of population growth, the total number of smokers is estimated to rise to 872 million in 2030, from 794 million in 2010, the researchers reported online in Tobacco Control.

In an alternate scenario, if countries around the world had fully implemented MPOWER in 2010, the adult smoking rate would decline at a rate that would put it to just 13.2% in 2030.

“As approximately half of lifetime smokers die of tobacco-related diseases, the implementation of MPOWER would prevent many millions of premature tobacco-related deaths,” Mendez and colleagues wrote.

“However, the MPOWER strategies alone are not enough,” they added, noting that full implementation of the Framework Convention on Tobacco Control (FCTC) — adopted by the WHO member countries in 2003 — and other steps would be needed to further reduce tobacco use.

The FCTC, which has been ratified by 174 countries, calls for steps to reduce the supply of and demand for tobacco products. As a way to help guide countries in meeting those goals, WHO released the MPOWER policy package in 2008.

It consists of six basic strategies:

Monitor tobacco use
Protect people from tobacco smoke through clean air laws
Offer people help to quit tobacco use
Warn about the dangers of tobacco using mass media and package warnings
Enforce bans on tobacco advertising, promotion, and sponsorship
Raise taxes on tobacco
Mendez and colleagues set out to evaluate the potential impact of the recommendations had they been fully implemented in 2010 around the world and sustained over time.

A key part of their projections was the assumption that cigarette taxes would be increased to maintain a doubling of prices.

The researchers acknowledged that full implementation of the policies worldwide and a sustained 100% increase in the price of cigarettes is a “highly unrealistic assumption.”

The researchers used data from the WHO’s Global InfoBase Database and Global Adult Tobacco Survey to estimate adult cigarette smoking prevalence over time for the 60 countries that account for 90% of the world’s smokers and 85% of its population.

They incorporated published estimates of the effects of each of MPOWER’s policies on smoking initiation and cessation.

For example, a national mass media and package warning campaign would increase cessation rates by 23% and reduce initiation rates by 20%, according to prior research. And a doubling in cigarette prices would decrease the prevalence of smoking by 20% within 2 years and cut initiation rates by 70%.

Without any major changes to policy and rates of initiation and cessation, the adult smoking prevalence would decrease only slightly by 2030, according to the researchers’ projections.

Europe, the Western Pacific, the Americas, and Southeast Asia would likely see declines in smoking prevalence, whereas Africa and the Eastern Mediterranean would see increases.

However, based on the assumption of full implementation of MPOWER in 2010 and a 100% increase in cigarette price, the smoking rate would drop to 15.4% in 2020 and 13.2% in 2030, with declines evident in all regions of the world.

The estimates do not take into account any reaction by the tobacco industry, the researchers noted.

“As such, our results should not be taken as forecasts, which are based on what are believed to be realistic assumptions of what will occur in the future,” they wrote. “Rather, our estimates indicate the magnitude and trajectory of the global smoking pandemic and of the impact we could expect if evidence-based tobacco control policies were applied immediately and universally throughout the world.”

The authors acknowledged that their study was limited by minimal data from some countries, the use of studies from developed countries for the estimates of the policies’ impacts, the lack of separate analyses for men and women, and the focus strictly on cigarette smoking.

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