The impact of MPOWER tobacco control policies on tobacco use in African countries

Abstract Aim This study aims to evaluate the impact of MPOWER tobacco control policies on smoking and smokeless tobacco (SLT) use prevalence in Africa, between 2007 and 2018. Subject and Methods: This is a longitudinal ecological study using panel data from 40 African countries at 6 time-points between 2007 and 2018. MPOWER scores and tobacco use prevalence data were obtained from the WHO global health repository. Two-way fixed effects regression models were used to assess the impact of the MPOWER policies on smoking and SLT use prevalence among African adults. The analysis was stratified by sex and UN African sub-region. Results In the primary analysis of all included countries, only the fiscal tobacco control measure (represented by the price of cigarettes) was significantly associated with a decrease in tobacco use among African adults – each $10 increase in the price of a 20-cigarette pack was associated with a 2.90 (95% CI: 0.30, 5.50) percentage point decrease in smoking prevalence, and a 1.10 (95% CI: 0.02, 2.00) percentage point decrease in SLT use prevalence, among men. In the stratified analysis by UN African sub-regions, the greatest impact was observed in Western and Northern Africa, and MPOWER policies appeared to be more effective in reducing smoking prevalence than SLT use prevalence. Conclusion The MPOWER package (especially its fiscal component) has had an impact on tobacco use in African countries. However, more attention needs to be paid to SLT use in Africa, which appears to have been impacted to a much lesser extent than smoking.