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Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study

Open access
Gravely, Shannon, Giovino, Gary A, Craig, Lorraine, Commar, Alison, D'Espaignet, Edouard Tursan, Schotte, Kerstin, Fong, Geoffrey T·2017·The Lancet Public Health
DOI 10.1016/s2468-2667(17)30045-2
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Abstract

BACKGROUND: The WHO Framework Convention on Tobacco Control (WHO FCTC) has mobilised efforts among 180 parties to combat the global tobacco epidemic. This study examined the association between highest-level implementation of key tobacco control demand-reduction measures of the WHO FCTC and smoking prevalence over the treaty's first decade. METHODS: We used WHO data from 126 countries to examine the association between the number of highest-level implementations of key demand-reduction measures (WHO FCTC articles 6, 8, 11, 13, and 14) between 2007 and 2014 and smoking prevalence estimates between 2005 and 2015. McNemar tests were done to test differences in the proportion of countries that had implemented each of the measures at the highest level between 2007 and 2014. Four linear regression models were computed to examine the association between the predictor variable (the change between 2007 and 2014 in the number of key measures implemented at the highest level), and the outcome variable (the percentage point change in tobacco smoking prevalence between 2005 and 2015). FINDINGS: Between 2007 and 2014, there was a significant global increase in highest-level implementation of all key demand-reduction measures. The mean smoking prevalence for all 126 countries was 24·73% (SD 10·32) in 2005 and 22·18% (SD 8·87) in 2015, an average decrease in prevalence of 2·55 percentage points (SD 5·08; relative reduction 10·31%). Unadjusted linear regression showed that increases in highest-level implementations of key measures between 2007 and 2014 were significantly associated with a decrease in smoking prevalence between 2005 and 2015). Each additional measure implemented at the highest level was associated with an average decrease in smoking prevalence of 1·57 percentage points (95% CI -2·51 to -0·63, p=0·001) and an average relative decrease of 7·09% (-12·55 to -1·63, p=0·011). Controlling for geographical subregion, income level, and WHO FCTC party status, the per-measure decrease in prevalence was 0·94 percentage points (-1·76 to -0·13, p=0·023) and an average relative decrease of 3·18% (-6·75 to 0·38, p=0·079). This association was consistent across all three control variables. INTERPRETATION: Implementation of key WHO FCTC demand-reduction measures is significantly associated with lower smoking prevalence, with anticipated future reductions in tobacco-related morbidity and mortality. These findings validate the call for strong implementation of the WHO FCTC in the WHO's Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013-2020, and in advancing the UN's Sustainable Development Goal 3, setting a global target of reducing tobacco use and premature mortality from non-communicable diseases by a third by 2030. FUNDING: Health Canada, Canadian Institutes of Health Research, Ontario Institute for Cancer Research and Canadian Cancer Society Research Institute.

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Figure 1 WHO criteria for the highest level of achievement of key tobacco control demand-reduction measures
Figure 1 WHO criteria for the highest level of achievement of key tobacco control demand-reduction measuresCC-BY-NC-ND · From the PDF
Figure 2 Relation between change in the number of five key WHO FCTC demand-reduction measures implemented at the highest level between 2007 and 2014 (x-axis) and change in smoking prevalence between 2005 and 2015 (y-axis)
Figure 2 Relation between change in the number of five key WHO FCTC demand-reduction measures implemented at the highest level between 2007 and 2014 (x-axis) and change in smoking prevalence between 2005 and 2015 (y-axis)CC-BY-NC-ND · From the PDF

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Metadata

Authors
Gravely, S., Giovino, G. A., Craig, L., Commar, A., D'Espaignet, E. T., Schotte, K., & Fong, G. T.
Affiliations
  • University of Waterloo (CA)
  • University at Buffalo, State University of New York (US)
  • World Health Organization (CH)
  • Ontario Institute for Cancer Research (CA)
Corresponding author
Fong, Geoffrey T
ORCID
Venue
The Lancet Public Health
Publisher
Elsevier BV
Published
2017-04
Volume
2
Issue
4
Pages
e166-e174
ISSN
2468-2667 (ISSN-L)
DOI
10.1016/s2468-2667(17)30045-2
OpenAlex
W2602423745
Cited by
260
References
15
Citations by year
2026: 29 · 2025: 19 · 2024: 19 · 2023: 28 · 2022: 28 · 2021: 28 · 2020: 32 · 2019: 34 · 2018: 33 · 2017: 9
FWCI
21.86
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Public Health (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • RUNE (Research UNE) (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Canadian Institutes of Health Research Foundation Grant (FDN-148477)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Public Health Policies and Epidemiology
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
Framework Convention on Tobacco Control, tobacco control, smoking prevalence
MeSH terms
Smoking Prevention, Humans, International Cooperation, Smoking, Global Health, World Health Organization, Prevalence

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