BACKGROUND: The MPOWER package was introduced to facilitate the implementation of the Framework Convention on Tobacco Control (FCTC). However, evidence on the relationships between their components and associations with tobacco use remains limited. We aimed to explore how FCTC articles and MPOWER measures are grouped by implementation levels and examine their associations with tobacco use prevalence.
METHODS: Using the WHO data, an Exploratory Factor Analysis (EFA) was conducted to identify FCTC-MPOWER measure combinations based on country-specific implementation levels (2020, 2022). Regression models examined associations between factor scores and adult cigarette smoking (CS), smoked tobacco use (ST), and smoked/smokeless tobacco use (SST) prevalence. Income levels and Global Tobacco Industry Interference Index were included as covariates.
RESULTS: EFA was conducted on data from 76 countries after excluding missing values, identifying five factors(policies arranged by factor loadings): (1) Government-led policy initiatives (Articles 16, 11, and R), (2) Infrastructure-based empowerment policies (Articles 14, 12, 5, 20, and O), (3) Protection from tobacco smoke exposure (Article 8 and P), (4) Regulation on tobacco advertising, promotion and sponsorship (Article 13 and E), and (5) Content and disclosure regulations (Articles 9-10). The results of regression analysis after adjustment(n=44) showed the factor scores of (2) had negative associations with female tobacco use across all years and types of tobacco use (2020 β[SE]: CS=-0.346[0.125], ST=-0.348[0.132], SST=-0.341[0.153], all p<0.05). For males, the factor scores of (3) demonstrated negative associations with tobacco use in 2022 (β[SE]: CC=-0.302[0.156], p=0.06; ST=-0.316[0.157], p=0.05; SST=-0.385[0.154], p<0.05).
CONCLUSIONS: The correlation between factor scores and tobacco use prevalence indicates a significant connection linking the underlying structural components of detailed policy implementations to the observed prevalence. This study showed that MPOWER functions cohesively with FCTC in P, O, and E, and the combinations like (1) and (2) showed gender-specific associations with tobacco use, indicating a need for potentially more effective policy groupings.