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Letter to the Director
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Available online 14 September 2023
The WHO MPOWER Package and the Tobacco Control Scale: Two Tools to Monitor Country-level Tobacco Control Policy Implementation in Latin America
Ariadna Feliua,b, Cristina Martineza,b,c,d,e, Armando Perugaa,b,c,f, Esteve Fernandeza,b,c,g,
Corresponding author

Corresponding author.
a Tobacco Control Research Group, Institut d’Investigació Biomèdica de Bellvitge, L’Hospitalet de Llobregat, Spain
b Center for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
c Tobacco Control Unit, WHO Collaborating Centre for Tobacco Control, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Spain
d School of Nursing, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Spain
e Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, United States
f Center for Epidemiology & Health Policies, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
g School of Medicine & Health Sciences, Campus Bellvitge, Universitat de Barcelona, Hospitalet de Llobregat, Spain
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To the Director,

We read with great interest the Editorial from Luhning et al.1 in the Journal, which effectively summarizes the current state of tobacco control in Latin America, based on 2020 data from the WHO Report on the Global Tobacco Epidemic 2021. While acknowledging the significance of monitoring tobacco control policies, we emphasize that information on policy implementation and enforcement is also crucial. Comparing implementation levels across countries has been shown to enhance the adoption of more stringent policies and, therefore, to ensure progress in tobacco control. To complement the editorial, we provide data from two tools that systematically monitor country-level tobacco control policy implementation, allow valid cross-national comparisons, and minimize biases: the WHO MPOWER package2 and the Tobacco Control Scale (TCS).3

The MPOWER package is structured around six demand reduction policy areas aligned with the WHO Framework Convention on Tobacco Control (FCTC)4: (1) monitoring tobacco use and prevention policies (Article 20); (2) protecting people from smoke (Article 8); (3) offering help to quit tobacco use (Article 14); (4) warning about the dangers of tobacco (Articles 11 and 12); (5) enforcing bans on tobacco advertising, promotion and sponsorship (Article 13); and (6) raising taxes on tobacco (Article 6). According to the most recent WHO MPOWER package data of 2022, Brazil, followed by Costa Rica, Uruguay, and Panama, are leading the tobacco control in the region with five or six MPOWER measures implemented at the highest level.

Alternatively, the TCS assesses the implementation level of five cost-effective demand reduction policies and one supply reduction strategy. This results in a weighted score across eight domains aligned with the World Bank recommendations and the WHO FCTC: price, smoke-free legislation; public spending, advertising bans, health warnings, treatment, industry interference, illicit trade protocol and FCTC ratification. Results from the Latin America TCS in 2020 indicate Panama, Uruguay, and Ecuador as the top-three leading countries in tobacco control (Fig. 1).5

Fig. 1.

Total scores of the Tobacco Control Scale in Latin America (year 2020).5.


These tools show there is still room for improvement in tobacco control across Latin America, consistent with the editorial's conclusions. Of 20 Latin American countries, nine scored ≤50 points out of a potential maximum of 100 in the TCS. Four of these countries reported no MPOWER measures implemented at the highest level and two reported only one. Positive trends are also manifest, with Brazil, Costa Rica, Ecuador, Panama, Uruguay, and Ecuador leading in tobacco control and receiving high scores on either scale.

All these data complete and strengthen Luhning et al. insights. We hope that this information will be used to inform future tobacco control policies in Latin America and will help to accelerate progress in tobacco control in the region.


The Tobacco Control Research Unit at IDIBELL is partially funded by the Ministry of Research and Universities of the Government of Catalonia (grant 2021SGR00906). The authors also acknowledge CERCA Programme/Generalitat de Catalunya for institutional support to IDIBELL.

Conflict of Interests

The authors state that they have no conflict of interests.

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Evolution of tobacco control in Latin America: what has been achieved and what is pending.
Arch Bronconeumol, 59 (2023), pp. 476-478
MPOWER: un plan de medidas para hacer retroceder la epidemia de tabaquismo.
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Tobacco Control Scale website.
Institut Català d’Oncologia, Association of European Cancer Leagues, SmokeFree Partnership, (2021),
WHO Framework Convention on Tobacco Control.
World Health Organization, (2005),
A. Feliu, C. Martínez, A. Peruga, L. Joossens, E. Bianco, M. Cornejo, et al.
A tool to monitor tobacco control policies’ implementation: The Tobacco Control Scale in Latin America. Adaptation process and pilot study.
Copyright © 2023. SEPAR
Archivos de Bronconeumología
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