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Revisiting the association between worldwide implementation of the MPOWER package and smoking prevalence, 2008–2017
  1. Muhammad Jami Husain1,
  2. Biplab Kumar Datta1,
  3. Nigar Nargis2,
  4. Roberto Iglesias3,
  5. Anne-Marie Perucic3,
  6. Indu B Ahluwalia4,
  7. Angela Tripp4,
  8. Sohani Fatehin5,
  9. Muhammad Mudabbir Husain6,
  10. Deliana Kostova1,
  11. Patricia Richter1
  1. 1Global Noncommunicable Diseases Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  2. 2Economic and Health Policy Research, American Cancer Society, Washington, District of Columbia, USA
  3. 3Health Promotion Department, World Health Organization, Geneva, Switzerland
  4. 4Global Tobacco Control Branch, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  5. 5Department of Economics, Dickinson College, Carlisle, Pennsylvania, USA
  6. 6Department of Economics, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Dr Muhammad Jami Husain, Global Noncommunicable Diseases Branch, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30329-4018, USA; MHusain{at}


Background We revisited the association between progress in MPOWER implementation from 2008 to 2016 and smoking prevalence from 2009 to 2017 and offered an in-depth understanding of differential outcomes for various country groups.

Methods We used data from six rounds of the WHO Reports on the Global Tobacco Epidemic and calculated a composite MPOWER Score for each country in each period. We categorised the countries in four initial conditions based on their tobacco control preparedness measured by MPOWER score in 2008 and smoking burden measured by age-adjusted adult daily smoking prevalence in 2006: (1) High MPOWER – high prevalence (HM-HP). (2) High MPOWER – low prevalence (HM-LP). (3) Low MPOWER – high prevalence (LM-HP). (4) Low MPOWER – low prevalence (LM-LP). We estimated the association of age-adjusted adult daily smoking prevalence with MPOWER Score and cigarette tax rates using two-way fixed-effects panel regression models including both year and country fixed effects.

Results A unit increase of the MPOWER Score was associated with 0.39 and 0.50 percentage points decrease in adult daily smoking prevalence for HM-HP and HM-LP countries, respectively. When tax rate was controlled for separately from MPOWE, an increase in tax rate showed a negative association with daily smoking prevalence for HM-HP and LM-LP countries, while the MPOWE Score showed a negative association for all initial condition country groups except for LM-LP countries.

Conclusion A decade after the introduction of the WHO MPOWER package, we observed that the countries with higher initial tobacco control preparedness and higher smoking burden were able to reduce the adult daily smoking prevalence significantly.

  • WHO MPOWER Measures
  • Smoking Prevalence
  • Global tobacco epidemic
  • MPOWER Score
  • implementation of MPOWER package

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  • Contributors All authors participated in the development of the study plan and analysis, interpretation of results and the writing of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention, the World Health Organization and the American Cancer Society.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available in a public, open access repository. We used data from the six rounds of the WHO Reports on the Global Tobacco Epidemic, available at

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