MPower groups

In 2008, WHO introduced the MPOWER package to assist in the country-level implementation of six effective measures to reduce demand for tobacco products. Each measure reflects at least one provision of the WHO Framework Convention on Tobacco Control.

MPOWER M Monitor

The letter M in MPOWER denotes the "Monitor" measure. Reliable prevalence data provide the information needed to assess the impacts of tobacco control actions adopted by a country. Surveys that include data on tobacco use should be repeated at regular intervals using comparable questions, sampling, data analysis and reporting techniques. Comparable data across different survey periods are required to accurately monitor and evaluate the impact of tobacco control interventions over time. This indicator measures the implementation status of the M measure. The implementation status of the Monitoring measure was classified by grouping countries into four groups. The groups for this indicator are:

• 1 = No known data or no recent* data or data that are not both recent* and representative**
• 2 = Recent* and representative** data for either adults or youth
• 3 = Recent* and representative** data for both adults and youth
• 4 = Recent*, representative** and periodic*** data for both adults and youth

Recent means in the data year or the 5 years prior to the reporting year.
** Survey sample representative of the national population.
*** Survey repeated at least every five years. Survey is considered an “adult survey” if it is a household survey sampled from the general population with respondent ages not limited to those under 15.

MPOWER P Protect from tobacco smoke

The letter P in MPOWER denotes the "Protect from tobacco smoke" measure. Second-hand tobacco smoke is present in virtually all places where smoking is permitted, and there is no safe level of exposure. Breathing secondhand tobacco smoke has serious and often fatal health consequences.

Globally, it is estimated that about one third of adults are regularly exposed to secondhand tobacco smoke. 100% smoke-free environments (without designated smoking rooms or areas) are the only proven way to adequately protect the health of people from the harmful effects of secondhand tobacco smoke. This indicator measures the implementation status of the P measure in eight selected indoor public places.

Country's legislation is assessed to determine whether each of the following places is required to be completely smoke-free (without designated smoking rooms or areas allowed)

• healthcare facilities;
• educational facilities other than universities;
• universities;
• government facilities;
• indoor offices and workplaces;
• restaurants;
• pubs and bars;
• public transport.

The implementation status of the Smoke-free environments measure was classified by grouping countries into five groups. The groupings for this indicator are:

• 1 = Data not reported
• 2 = Complete absence of ban or up to two public places completely smoke-free
• 3 = Three to five public places completely smoke-free
• 4 = Six to seven public places completely smoke-free
• 5 = All public places completely smoke-free (or at least 90% of the population covered by complete subnational smoke-free legislation
• No = Where smoking is banned but designated smoking rooms are allowed, this indicator is reported as “no”.

MPOWER O Offer Help to Quit Tobacco Use

The letter O in MPOWER denotes the "Offer help to quit tobacco use" measure. Tobacco dependence treatment is primarily the responsibility of each country’s health-care system. Individual cessation interventions have a significant impact on individual health and are extremely cost-effective compared with many other health system activities. People who quit smoking, regardless of their age, smoking history or health status, experience immediate and profound health benefits and can reduce most of the associated risks within a few years of quitting. This indicator measures the implementation status of the O measure.

Information from countries on the availability and non-availability of particular tobacco cessation aids is assessed to determine the comparative level of assistance countries provide to help tobacco users quit. The groupings for this indicator are:

• 1 = Data not reported
• 2 = None
• 3 = NRT* and/or some cessation services** (neither cost-covered)
• 4 = NRT* and/or some cessation services** (at least one of which is fully or partially cost-covered)
• 5 = National toll-free quit line, and both NRT* and some cessation services** (fully or partially cost-covered)

* Nicotine replacement therapy.
** Tobacco cessation support available in any of the following places: health clinics or other primary care facilities, hospitals, office of a health professional, the community or other settings.

MPOWER W Warn about the dangers of tobacco

The letter W in MPOWER denotes the "Warn about the dangers of tobacco" measure. Despite conclusive evidence regarding the dangers of tobacco, relatively few tobacco users worldwide understand the full extent of the risk to their health. Prominent warning labels on tobacco product packaging provide the most direct health messages to all smokers, as well as to non-smokers who see the packs. Warning labels encourage smokers to quit and discourage nonsmokers from starting, are well accepted by the public, and can be implemented at virtually no cost to governments. This indicator measures the implementation status of the W measure regarding legislation mandating health warnings on cigarettes packaging.

Country's legislation is assessed to determine whether health warnings with specific criteria are mandated. The groupings for this indicator are:

• 1 = Data not reported
• 2 = No warnings or small warnings*
• 3 = Medium size warnings** missing some*** or many**** appropriate characteristics***** OR large warnings****** missing many**** appropriate characteristics*****
• 4 = Medium size warnings** with all appropriate characteristics***** OR large warnings****** missing some*** appropriate characteristics*****
• 5 = Large warnings6 with all appropriate characteristics *****

* Average of front and back of package is less than 30%.
** Average of front and back of package is between 30 and 49%.
*** One to three.
**** Four or more.
***** Appropriate characteristics: specific health warnings mandated; appearing on individual packages as well as on any outside packaging and labelling used in retail sale; describing specific harmful effects of tobacco use on health; are large, clear, visible and legible (e.g. specific colors and font style and size are mandated); rotate; include pictures or pictograms; written in (all) the principal language(s) of the country.
****** Average of front and back of the package is at least 50%.

MPOWER W Anti-tobacco mass media campaigns

The letter W in MPOWER denotes the "Warn about the dangers of tobacco" measure. The media play a key role in shaping tobacco-related knowledge, opinions, attitudes and behaviors, and can be extremely powerful in influencing both individuals and policymakers regarding tobacco use and tobacco control issues. As a result, mass media anti-tobacco campaigns have become a key component of tobacco control programmes in countries. This indicator measures the implementation status of the W measure regarding anti-tobacco mass media campaigns.

The implementation status of the Anti-tobacco mass media measure was classified by grouping countries into five groups. The groups for this indicator are:

• 1 = Data not reported
• 2 = No national campaign conducted in the reporting period with a duration of at least three weeks
• 3 = National campaign conducted with 1-4 appropriate characteristics*
• 4 = National campaign conducted with 5-6 appropriate characteristics*, or with 7 characteristics excluding airing on TV and/or radio
• 5 = National campaign conducted with at least 7 appropriate characteristics* including airing on TV and/or radio

* Characteristics of a high-quality campaign are:

• the campaign was part of a tobacco control programme;
• before the campaign, research was undertaken or reviewed to gain a thorough understanding of the target audience;
• campaign communications materials were pretested with the target audience and refined in line with campaign objectives;
• air time (radio, television) and/or placement (billboards, print advertising, etc.) was obtained by purchasing or securing it using either the organization’s own internal resources or an external media planner or agency;
• the implementing agency worked with journalists to gain publicity or news coverage for the campaign;
• process evaluation was undertaken to assess how effectively the campaign had been implemented;
• and an outcome evaluation process was implemented to assess the campaign impact.

MPOWER E Enforce bans on tobacco advertising, promotion and sponsorship (TAPS).

The letter E in MPOWER denotes the "Enforce bans on tobacco advertising, promotion and sponsorship" measure. Tobacco advertising, promotion and sponsorship increase tobacco use, therefore tobacco companies pour billions into advertising each year and deploy a sophisticated array of TAPS approaches to recruit new customers including youth. Evidence demonstrates that TAPS bans effectively reduce tobacco consumption worldwide. However, these bans must be comprehensive: partial restrictions are not effective, in part because tobacco companies excel at finding and exploiting loopholes. This indicator measures the implementation status of the E measure regarding bans on tobacco advertising, promotion and sponsorship.

The implementation status of the Enforce bans on tobacco advertising, promotion and sponsorship measure was classified by grouping countries into five groups. The groups for this indicator are:

• 1 = Data not reported
• 2 = Complete absence of ban, or ban that does not cover national television (TV), radio and print media
• 3 = Ban on national TV, radio and print media only
• 4 = Ban on national TV, radio and print media as well as on some (but not all) other forms of direct* and/or indirect** advertising
• 5 = Ban on all forms of direct* and indirect** advertising (or at least 90% of the population covered by subnational legislation completely banning tobacco advertising, promotion and sponsorship)

* Direct advertising bans: national television and radio; local magazines and newspapers; billboards and outdoor advertising; point-of-sale (indoor).

** Indirect advertising bans: free distribution of tobacco products in the mail or through other means; promotional discounts; non-tobacco goods or services identified with tobacco brand names (brand stretching); brand names of non-tobacco products used for tobacco products (brand sharing); appearance of tobacco brands (product placement) or tobacco products in television and/or films; sponsorship (contributions and/or publicity of contributions).

MPOWER R Raise taxes on tobacco

The letter R in MPOWER denotes the "Raise taxes on tobacco" measure. The effectiveness of tobacco taxes is well-documented. Price and tax measures are an effective and important means of reducing tobacco consumption. For this indicator, countries are grouped according to the percentage contribution of all tobacco taxes to the retail price of a pack of 20 of the most popular brand of cigarettes. Taxes assessed include excise tax, value added tax (or sales taxes), import duty (when the cigarettes were imported) and any other taxes levied. In the case of countries where different levels of taxes applied to cigarettes are based on length, quantity produced or price level, only the rate that applied to the most popular brand is used in the calculation. This indicator measures the implementation status of the R measure regarding raising taxes on tobacco.

The implementation status of the Raise taxes on tobacco measure was classified by grouping countries into five groups. The groups for this indicator are:

• 1 = Data not reported
• 2 = < 25% of retail price is tax
• 3 = ≥ 25% and < 50% of retail price is tax
• 4 = ≥ 50% and < 75% of retail price is tax
• 5 = ≥ 75% of retail price is tax

• M group Country reported surveys, scored according to the definition of this indicator (1-4).
• P group WHO assessment of country’s legislative documents (1-5)
• O group Country reported surveys, scored according to the definition of this indicator (1-5).
• W Group Warn WHO assessment of country’s legislative documents (1-5).
• W Group Mass media campaigns Country reported surveys, scored according to the definition of this indicator (1-5).
• E Group WHO assessment of country’s legislative documents (1-5).
• R group Country WHO calculation of country’s tobacco taxes (1-5).

Biannual

Biannual