Commercial Determinants of Tobacco Control Policy and Smoking Prevalence in High and Low and Middle Income Countries- Is Corporate Power the Smoking Gun?

Abstract

Background: The tobacco industry has a record of weakening tobacco control policies. We investigate whether the association between corporate power and tobacco consumption is mediated by tobacco control policy. We test whether this relationship is stronger in Low and Middle Income Countries (L&MICS) than in High Income Countries (HIC) and within L&MICS than within HICs. Methods: We used variations in the Corporate Permeation Index (CPI)- a proxy for corporate power - between 2010 and 2015 to explain variations in: the prevalence of smoking, scores on the Tobacco Control Scale (TCS) in Europe and in compliance with smoke free regulations in HICS and L&MICS. Using path analysis, we tested if tobacco control policy mediates the relationship between corporate permeation and smoking rates. We used random and fixed effects models to test whether these associations are stronger across LMIC than across HICs and within L&MICS and HICS, respectively. Findings: In the HICs of Europe, corporate power was associated with higher smoking prevalence and weaker tobacco regulation. Higher TCS scores were associated with lower smoking prevalence and mediate the positive association between corporate power and smoking. Globally, there was a negative effect of corporate power on compliance with smoke free regulation, within and across countries which is stronger in L&MICs than HICS. Interpretation: The ability of corporate power to boost smoking prevalence seems to work via the weakening of tobacco control policy in Europe. The tobacco industry deploys its structural and agency power to weaken enforcement of tobacco control regulations in L&MICS. Funding Statement: Joana Madureira Lima was a recipient of a Doctoral Scholarship from the Portuguese Foundation for Science and Technology at the time of writing. Declaration of Interests: Dr. Madureira Lima has nothing to disclose. Sandro Galea has nothing to disclose. Ethics Approval Statement: This type of paper does not require an ethical approval for as all the data is secondary and collected from publicly accessible sources.