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Tool to monitor tobacco control policy implementation: the Tobacco Control Scale in Latin America. Adaptation process and pilot study
  1. Ariadna Feliu1,2,3,4,
  2. Cristina Martinez1,2,3,4,5,
  3. Armando Peruga1,2,4,6,
  4. Luk Joossens7,
  5. Eduardo Bianco8,
  6. Marco Cornejo1,9,
  7. Sarah O Nogueira1,2,3,4,
  8. Esteve Fernández1,2,3,4
  1. 1 Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Catala d'Oncologia, L'Hospitalet de Llobregat, Catalonia, Spain
  2. 2 Tobacco Control Research Group, Institut d'Investigacio Biomedica de Bellvitge, L'Hospitalet de Llobregat, Catalonia, Spain
  3. 3 School of Medicine and Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Catalonia, Spain
  4. 4 Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
  5. 5 Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA 94118, USA
  6. 6 Center for Epidemiology and Health Policies, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Las Condes, Región Metropolitana de Santiago, Chile
  7. 7 Tobacco Control Expert, Leuven, Belgium
  8. 8 Regional Coordinator for the Americas, Framework Convention Alliance (FCA), Montevideo, Uruguay
  9. 9 Institute for Research in Dental Sciences, Faculty of Dentistry, University of Chile, Santiago, Chile
  1. Correspondence to Prof Esteve Fernández, Tobacco Control Unit, Institut Català d'Oncologia, L'Hospitalet de Llobregat 08908, Spain; efernandez{at}


Background Monitoring tobacco control policy implementation is one of the keys for tobacco consumption reduction in Latin America (LA). This study reports on the adaptation of the Tobacco Control Scale (TCS) for use in LA countries and the level of tobacco control policy implementation in this region according to the scale.

Methods Ecological cross-sectional survey. The questionnaire to measure tobacco control policies was a translated (into Spanish and Portuguese) and adapted version of the last TCS as used in Europe. The resulting TCS-LA maintains the same structure as the original TCS, with eight policy domains and 100 points (pts) as maximum score; however, four policy domains were adapted because the exact same rationale could not be applied. At least two non-governmental tobacco control experts were contacted per country to answer the TCS-LA.

Results Informants from 17 out of 18 countries completed the questionnaire. Using the TCS-LA, Panama (70 pts), Uruguay (68 pts) and Ecuador (61 pts) exhibited the strongest tobacco control policies, while Guatemala (32 pts), Bolivia (30 pts) and Dominican Republic (29 pts) have implemented a lower number of tobacco control policies. Eight countries reached 50% of the TCS-LA total possible score, indicating a relatively good implementation level of tobacco control policies.

Conclusions Panama, Uruguay and Ecuador are the tobacco control policy leaders in LA; however, tobacco control in the region has room for improvement since nine countries have a total score under 50 pts. The TCS is a feasible and adaptable tool to monitor tobacco control in other WHO regions beyond Europe.

  • public policy
  • surveillance and monitoring
  • global health

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors Conceptualisation and design of the study: AF, AP, CM and EF. Adaptation of the TCS to LA (rationale): AF, AP, CM, EB, EF and LJ. Translation of the questionnaire: AF and SON, with the contextual language validation of AP, EB and MC. Allocation of the scores: AF, CM and EF. Visualisation: AF. Data curation: AP, EB, EF and LJ. Drafted the manuscript: AF. Critically revised the manuscript: all authors. Approved the final manuscript version: all authors. Guarantors: EF and CM, and both are considered senior authors.

  • Funding The Tobacco Control Research Group is partly supported by the Ministry of Business and Knowledge from the Government of Catalonia (2017SGR319) and by the Instituto de Salud Carlos III, Government of Spain (CIBERES CB19/06/00004). SON has received funding from the European Union's 2020 research and innovation programme under the Marie Sklodowska-Curie (grant agreement number 7136730). SON has received financial support through the ‘La Caixa’ INPHINIT Fellowship Grant for Doctoral Studies at Spanish Research Centres of Excellence, ‘La Caixa’ Banking Foundation, Barcelona, Spain (LCF/BQ/DI17/11620022).

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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