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NOT PEER REVIEWED I commend the authors on a significant effort involved in conducting
this rather insightful research.
Having conducted qualitative research on FCTC implementation in the
Pacific, I can provide comment in relation to the Cook Islands which may
explain why MPOWER measures mentioned here did not achieve decreases in
prevalence (at least in the figures obtained in this study).
Firstly, the Cook Islands Tobacco Control Act was introduced in 2007
and accompanying regulations in 2008, and stakeholders informed me that
compliance to these regulations was not strictly enforced until 2009 -
hence their implementation on the ground may not have been felt until the
latter period of or after this data was collected.
Secondly, accurate, timely, comparative data on prevalence is
extremely difficult to obtain in many small island nations such as those
in the Pacific. I am unsure of the exact calculations behind the MPOWER
reports and how these figures were extrapolated, but they are likely to be
an estimation that is rather different to what other (national) studies
suggest. The Cook Islands Census suggests a decrease in prevalence from
29% in 2006 to 20% in 2011. The Cook Islands GYTS (limited to those aged
13-15) suggests a decrease from 45% in 2003 to 35% in 2008, indicating the
trend in prevalence is contrary to the statistics obtained in MPOWER.
These potential limitations are duly noted in your study, but I
thought this additional information would (a) be of interest and provide
some context to these issues, and (b) serve to caution anyone who may
suggest that MPOWER measures have not been effective in the Cook Islands
Of course it would also be great to see further points of data
collection beyond 2009, which would also give a better indication of
trends over time.