Tobacco Control Policies on Cancer Prevention in the Eastern Mediterranean Region, 2025–2050: A Modeling Study Publisher Pubmed



Nemati S ; Rajabpour MV ; Feng X ; Taheri N ; Rumgay H ; Heidari F ; Karimi E ; Abdi S ; Johansson M ; Sheikh M
Source: PLOS Medicine Published:2026

Abstract

Background Despite the implementation of control policies, smoking prevalence remains high in Eastern Mediterranean Region (EMR), and the impact of tobacco control efforts on cancer prevention is unclear. We assessed the potential impact of key policy interventions on tobacco-related cancer incidence in EMR countries from 2025 to 2050. Methods and findings We conducted a modeling study using a country-level historical data to project tobacco smoking prevalence in EMR countries under four scenarios: (i) full implementation of the MPOWER (Monitor, Protection, Offer, Warn, Enforce, and Raise) policy package, (ii) a 10-unit increase in the cigarette affordability index (Higher values of the affordability index indicate that cigarettes are less affordable) (iii) maximized literacy rates (100% adult literacy), and (iv) combined implementation of all three policies. For each scenario, we estimated the Population Attributable Fraction (PAF) of tobacco smoking for 13 cancer types causally linked to tobacco use. The number of preventable cancer cases was calculated using the difference in PAFs between the current and alternative scenarios, referred to as the Potential Impact Fraction (PIF). An estimated 14.3 million tobacco-related cancer cases will occur in the EMR between 2025 and 2050, with over 3 million attributable to current smoking prevalence (PAF = 21.3%; [95% CI: 18.4, 24.6]). Combined implementation of all assessed policies could prevent 442,292 cases (95% CI: 226,987, 660,045) (3.1% of all projected cases; [95% CI: 1.6, 4.6]). The greatest impact was observed in low HDI (Human Development Index) countries, where up to 291,425 (95% CI: 198,186, 388,546) cases could be averted. Maximizing literacy showed the highest preventive potential in low (n=224,463; [95% CI: 149,521, 307,386]) and medium HDI (n=84,569; [95% CI: [2,801, 177,317]) countries, while full implementation of MPOWER had the greatest effect in high HDI countries (n=11,890; [95% CI: 8,397, 15,378]). As our main limitation, we assumed a causal relationship between previously implemented policies and concurrent changes, while other potential causes of these changes have not been considered in the current study. Conclusion Strengthening tobacco control policies particularly improving literacy in low HDI countries may potentially contribute to reductions in future cancer burden in EMR. Copyright: © 2026 Nemati et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.