{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:42:48Z","timestamp":1779928968126,"version":"3.53.1"},"reference-count":41,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:00:00Z","timestamp":1745020800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: As tobacco is the main risk factor for oral cancer, it is important to understand the burden of this disease in light of the Framework Convention on Tobacco Control. For MERCOSUR, tobacco control is a topic of interest. The aim of this study was to describe MPOWER measure scores and to evaluate the trends in lip and oral cavity cancer (LOC) incidence, mortality and Disability-Adjusted Life Years (DALYs), from 2005 to 2021, in MERCOSUR countries. Methods: This is an ecological descriptive study, where the MPOWER measure scores were extracted from the Global Health Observatory of World Health Organization, and the Age-standardized Rates (ASRs) of LOC for MERCOSUR countries were obtained from the Global Burden of Diseases 2021 results tool. The trends of LOC ASRs were obtained using the Prais\u2013Winsten method. Results: Paraguay and Venezuela had lower MPOWER scores over time than Argentina, Brazil and Uruguay. These last three countries showed LOC trends decreasing for most indicators among males, while Paraguay and Venezuela showed increasing trends in incidence for both males and females, and no decreasing trends. Conclusion: This study suggests that MERCOSUR countries with a history of more rigorous MPOWER tobacco control policies are exhibiting decreasing trends in LOC burden.<\/jats:p>","DOI":"10.3390\/ijerph22040644","type":"journal-article","created":{"date-parts":[[2025,4,20]],"date-time":"2025-04-20T20:31:36Z","timestamp":1745181096000},"page":"644","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["MPOWER Tobacco Control Policies\u2019 Effects on Lip and Oral Cavity Cancer Trends in MERCOSUR Countries"],"prefix":"10.3390","volume":"22","author":[{"given":"Laila Menezes","family":"Hagen","sequence":"first","affiliation":[{"name":"Department of Stomatology, Federal University of Paran\u00e1, Curitiba 80210-170, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernanda Joly","family":"Macedo","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Federal University of Paran\u00e1, Curitiba 80210-170, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda Ramos da","family":"Cunha","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health, University of S\u00e3o Paulo, S\u00e3o Paulo 01246-904, SP, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Neves","family":"Hugo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Health Promotion, New York University College of Dentistry, New York, NY 10010, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9755-6870","authenticated-orcid":false,"given":"Jos\u00e9 Miguel","family":"Amen\u00e1bar","sequence":"additional","affiliation":[{"name":"Department of Stomatology, Federal University of Paran\u00e1, Curitiba 80210-170, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2527","DOI":"10.21873\/anticanres.13374","article-title":"Survival Rates According to Tumour Location in Patients with Surgically Treated Oral and Oropharyngeal Squamous Cell Carcinoma","volume":"39","author":"Jehn","year":"2019","journal-title":"Anticancer Res."},{"key":"ref_2","first-page":"100633","article-title":"Perspective on enhancing quality of life in oral cancer patients: Integrative approaches and comprehensive care","volume":"11","author":"Arshad","year":"2024","journal-title":"OOR"},{"key":"ref_3","unstructured":"GBD 2019 Lip, Oral, and Pharyngeal Cancer Collaborators (2023). The Global, Regional, and National Burden of Adult Lip, Oral, and Pharyngeal Cancer in 204 Countries and Territories: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol., 9, 1401\u20131416."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"GBD 2019 Cancer Collaboration (2022). Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019 A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol., 8, 420\u2013444.","DOI":"10.1001\/jamaoncol.2021.6987"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s00432-025-06098-w","article-title":"The global, regional, and national burden of oral cancer, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021","volume":"151","author":"Wu","year":"2025","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2849","DOI":"10.1007\/s00784-019-02958-1","article-title":"The synergistic effect of tobacco and alcohol consumption on oral squamous cell carcinoma: A systematic review and meta-analysis","volume":"23","author":"Mello","year":"2019","journal-title":"Clin. Oral. Investig."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.oraloncology.2008.06.002","article-title":"Global epidemiology of oral and oropharyngeal cancer","volume":"45","author":"Warnakulasuriya","year":"2009","journal-title":"Oral. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1007\/s10555-017-9689-6","article-title":"Tobacco-related carcinogenesis in head and neck cancer","volume":"36","author":"Jethwa","year":"2017","journal-title":"Cancer Metastasis Rev."},{"key":"ref_9","unstructured":"WHO World Health Organization (2003). WHO Framework Convention on Tobacco Control, World Health Organization. Available online: https:\/\/fctc.who.int\/resources\/publications."},{"key":"ref_10","unstructured":"WHO World Health Organization (2023). WHO Report on the Global Tobacco Epidemic, 2023: Protect People from Tobacco Smoke, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240077164."},{"key":"ref_11","unstructured":"GBD 2019 Cancer Risk Factors Collaborators (2022). The global burden of cancer attributable to risk factors, 2010\u20132019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet, 400, 563\u2013591."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1002\/cre2.265","article-title":"The worldwide burden of smoking-related oral cancer deaths","volume":"6","author":"Nocini","year":"2020","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_13","unstructured":"Instituto Nacional de C\u00e2ncer (INCA) (2025, January 10). Relat\u00f3rio Evolutivo da Comiss\u00e3o Intergovernamental para o Controle do Tabaco, Available online: https:\/\/ninho.inca.gov.br\/jspui\/."},{"key":"ref_14","unstructured":"Herrera-Serna, B.Y., Lara-Carrillo, E., Toral-Rizo, V.H., and Amaral, R.C. (2019). Efecto de las Pol\u00edticas de Control de Factores de Riesgo Sobre la Mortalidad por C\u00e1ncer Oral en Am\u00e9rica Latina. Rev. Esp. Salud P\u00fablica, 93."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2991\/jegh.k.191105.001","article-title":"Relationship between the Human Development Index and its Components with Oral Cancer in Latin America","volume":"9","author":"Amaral","year":"2019","journal-title":"J. Epidemiol. Glob. Health"},{"key":"ref_16","unstructured":"WHO World Health Organization (2024, December 01). The Global Health Observatory. Available online: https:\/\/www.who.int\/data\/gho."},{"key":"ref_17","unstructured":"WHO World Health Organization (2021). WHO Report on the Global Tobacco Epidemic 2021: Addressing New and Emerging Products, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240032095."},{"key":"ref_18","unstructured":"IHME (2024, November 30). GHDx: GBD Results Tool. Available online: http:\/\/ghdx.healthdata.org\/gbd-results-tool."},{"key":"ref_19","first-page":"391","article-title":"Trends and spatial distribution of deaths of children aged 12\u201360 months in S\u00e3o Paulo, Brazil, 1980\u20131998","volume":"80","author":"Antunes","year":"2002","journal-title":"Bull. World Health Organ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1136\/tc-2022-057262","article-title":"Projecting the impact of implementation of WHO MPOWER measures on smoking prevalence and mortality in Japan","volume":"33","author":"Yang","year":"2022","journal-title":"Tob. Control"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Ramadan, M., Alhusseini, N., Samhan, L., Samhan, S., and Abbad, T. (2023). Tobacco control policies implementation and future lung cancer incidence in Saudi Arabia. A population-based study. Prev. Med. Rep., 36.","DOI":"10.1016\/j.pmedr.2023.102439"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"de Vries, E., Gallego, A., and Gil, F. (2025). Trends in cancer mortality in the elderly and oldest old in South America. Cancer Epidemiol., 95.","DOI":"10.1016\/j.canep.2025.102761"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.26633\/RPSP.2024.30","article-title":"Trends in tracheal, bronchial and lung cancer attributed to smoking in South America: Global Burden of Disease analysis 1990\u20132019","volume":"48","author":"Salerno","year":"2024","journal-title":"Rev. Panam. Salud Publica"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Da Silva, B.M., Hagen, L.M., Da Cunha, A.R., Hugo, F.N., and Amenabar, J.M. (2025). Incidence, mortality and oral cancer disability-adjusted life years in 204 countries and territories before and after the adoption of FCTC\/WHO: Interrupted time series study. Tob. Control, 058882.","DOI":"10.1136\/tc-2024-058882"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/s41591-020-01210-8","article-title":"The effects of tobacco control policies on global smoking prevalence","volume":"27","author":"Flor","year":"2021","journal-title":"Nat. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Herrera-Serna, B.Y., Betancourt, J.A.O., Soto, O.P.L., Amaral, R.C., and Correa, M.P.C. (2022). Trends of incidence, mortality, and disability-adjusted life years of oral cancer in Latin America. Rev. Bras. Epidemiol., 25.","DOI":"10.1590\/1980-549720220034.2"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1136\/tobaccocontrol-2021-057007","article-title":"Achievements, Challenges, Priorities and Needs to Address the Current Tobacco Epidemic in Latin-america","volume":"31","author":"Barnoya","year":"2022","journal-title":"Tob. Control"},{"key":"ref_28","unstructured":"GBD Study 2019 Collaborators (2021). Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019. Lancet, 397, 2337\u20132360."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.amepre.2022.12.002","article-title":"Patterns of Birth Cohort\u2014Specific Smoking Histories in Brazil","volume":"64","author":"Tam","year":"2023","journal-title":"Am. J. Prev. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2811","DOI":"10.1002\/ijc.23430","article-title":"Socioeconomic inequalities and oral cancer risk: A systematic review and meta-analysis of case-control studies","volume":"122","author":"Conway","year":"2008","journal-title":"Int. J. Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Freire, A.R., Freire, D.E.W.G., Ara\u00fajo, E.C.F.d., de Lucena, E.H.G., and Cavalcanti, Y.W. (2021). Influence of Public Oral Health Services and Socioeconomic Indicators on the Frequency of Hospitalization and Deaths due to Oral Cancer in Brazil, between 2002\u20132017. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18010238"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Freire, A.R., Freire, D.E.W.G., Ara\u00fajo, E.C.F., Carrer, F.C.A., Pucca J\u00fanior, G.A., Sousa, S.A., Lucena, E.H.G., and Cavalcanti, Y.W. (2021). Socioeconomic indicators and economic investments influence oral cancer mortality in Latin America. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-10419-2"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1016\/S0140-6736(12)60826-5","article-title":"Tobacco control campaign in Uruguay: A population-based trend analysis","volume":"380","author":"Abascal","year":"2012","journal-title":"Lancet"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Salgado, M.V., Mok, Y., Jeon, J., Jaffri, M., Tam, J., Holford, T.R., S\u00e1nchez-Romero, L.M., Meza, R., and Mejia, R. (2024). Smoking patterns by birth cohort in Argentina: An age-period cohort population-based modeling study. Lancet Reg. Health Am., 36.","DOI":"10.1016\/j.lana.2024.100823"},{"key":"ref_35","unstructured":"WHO Framework Convention on Tobacco Control (2025, January 10). Protocol to Eliminate Illicit Trade in Tobacco Products. Available online: https:\/\/fctc.who.int\/news-and-resources\/publications."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s12117-009-9078-9","article-title":"Illegal trade in tobacco in MERCOSUR countries","volume":"12","author":"Ramos","year":"2009","journal-title":"Trends Organ. Crime"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1136\/tc-2021-056891","article-title":"Regional implications of the tobacco value chain in Paraguay","volume":"31","author":"Masi","year":"2022","journal-title":"Tob. Control"},{"key":"ref_38","unstructured":"GBD Study 2021 Collaborators (2023). Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990\u20132021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet, 403, 2133\u20132161."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1038\/sj.bdj.2018.922","article-title":"The changing epidemiology of oral cancer: Definitions, trends, and risk factors","volume":"225","author":"Conway","year":"2018","journal-title":"Br. Dent. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1182","DOI":"10.1080\/01635581.2012.721155","article-title":"Do tobacco and alcohol modify protective effects of diet on oral carcinogenesis?","volume":"64","author":"Toporcov","year":"2012","journal-title":"Nutr. Cancer"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1111\/j.1601-0825.2009.01563.x","article-title":"Oral squamous cell carcinoma: Overview of current understanding of aetiopathogenesis and clinical implications","volume":"15","author":"Scully","year":"2009","journal-title":"Oral. Dis."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/644\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:17:52Z","timestamp":1760030272000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/22\/4\/644"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,19]]},"references-count":41,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["ijerph22040644"],"URL":"https:\/\/doi.org\/10.3390\/ijerph22040644","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,19]]}}}