Chile’s Tobacco Strategy: A Scoping Review of Tobacco Measures Over Time

Abstract

Chile currently has a relatively robust tobacco control policy approach. Nonetheless, it has one of the highest tobacco consumption prevalence rates among adults worldwide. Better knowledge regarding changes in tobacco control policy over time may provide a comprehensive understanding of the observed changes in the prevalence of tobacco consumption. We aimed to carry out a scoping review to explore the evolution of Chile’s tobacco control consumption policies. We searched legal instruments, including laws and decrees, in the Chilean National Library of Congress from inception to December 2018. One author screened potential legal instruments; two authors independently systematized research records found. We included any legal instrument issued by the President of the Republic or the Chilean National Congress. We used the MPOWER strategy as a guideline to classify interventions. The institutional change theory proposed by van der Heijden and Kuhlmann was applied to interpret policy changes. We identified 499 legal instruments related to tobacco. Of these, three laws and ten decrees were included for analysis. We observed an uneven implementation of measures recommended by the WHO over time. The dimensions Protect, Warn, and Enforce showed consistent progress, measures in the Monitor and Raise dimensions were unsustained, and no measures for the dimension Offer were found. In Chile, measures to tackle tobacco consumption over the last three decades have focused predominantly on regulating individual choices rather than on the tobacco industry. Future research assessing the effects of Chile’s tobacco control consumption policies should account for their multifaceted and heterogeneous implementation.

Tobacco policies and changes in the tendency of smoking cessation in cigarette users in Chile: a longitudinal cross-sectional study

“…First, we have created a Tobacco Policy Index, a metric designed to encapsulate the gradual implementation of regulations represented by laws and decrees enacted over time in Chile. To construct this index, we have adapted the visual representation of the evolution of tobacco control policies in Chile based on the MPOWER strategy, which was previously outlined in another study 11. To each intervention, a numerical score was assigned (low=1; moderate=2; high=3), culminating in a composite index with scores ranging from 1 to 55 points (online supplemental table 1).…”

“…To construct this index, we have adapted the visual representation of the evolution of tobacco control policies in Chile based on the MPOWER strategy, which was previously outlined in another study. 11 To each intervention, a numerical score was assigned (low=1; moderate=2; high=3), culminating in a composite index with scores ranging from 1 to 55 points ( online supplemental table 1 ). Complementary, we also used the rates of Tobacco Policy Infractions per 100 000 inhabitants within each region of the country, issued since 2008, as a proxy for gauging the manner in which regulations were put into practice.…”

“…This law was then strengthened with the enactment of Law 20 660 in 2013 and other decrees. In spite of this efforts, the overall evolution of Chile’s tobacco policies portrays an uneven implementation of measures 11. For instance, while the dimensions protection, warning and enforcement have consistently progressed, measures related to Monitoring and Raising, on the other hand, have shown inconsistent advancements.…”

“…For instance, while the dimensions protection, warning and enforcement have consistently progressed, measures related to Monitoring and Raising, on the other hand, have shown inconsistent advancements. Lastly, the dimension offers show no progress whatsoever 11. This observation is important, considering that interventions included in the MPOWER strategy have differential effects depending on the target population 12 13…”

“…Lastly, the dimension offers show no progress whatsoever. 11 This observation is important, considering that interventions included in the MPOWER strategy have differential effects depending on the target population. 12 13 …”