Table 3.

Main characteristics of the studies that used the TCS from a secondary source and estimated the scores of the countries using TCS methodology (N=10)

Reference, location	Objective	Study design	Use of TCS (Type of variable, original data, total score and/or components)	Main results	Limitations	Conclusions
So et al.26 2019, UK	To describe changes in smoking prevalence over time within EU member states from 2009–2017; to describe how within-country and between-country variations in the implementation of tobacco control policies are associated with current smoking in individuals; and to describe how these variations affect individuals of different socioeconomic positions.	Observational, multilevel, and longitudinal	Independent variable, not original data, only total score	A general trend of decreasing smoking prevalence over the last decade was found in the EU. There was significant variation at the country level and country-year level, indicating that countries differed significantly in their smoking prevalence trajectory. Strong tobacco control policies were significantly associated with lower odds of being a current smoker, with a greater effect in upper class occupations	No limitations reported about the TCS as a variable	Research
Serrano- Alarcón et al.27 2019, Portugal	To evaluate the impact of tobacco control policies on smoking among older adults in Europe from 2004–2013	Observational, multilevel, and longitudinal	Independent variable, not original data, total score and by components	A 10-point increase in the TCS score was associated with a drop in the probability of smoking by 1.1 percentage points (not significant). Pricing and smoke-free policies were significantly associated with smoking	No limitations involving the use of TCS	Research
Bosdriesz et al.31 2016, the Netherlands	To assess whether tobacco control policy was associated with socioeconomic inequalities in smoking across the EU in the period 2006– 2012	Observational, multilevel, and longitudinal	Independent variable, not original data, total score and by components	An association was found between tobacco control policies and smoking cessation among higher educated smokers. In middle- and high-educated smokers, policies were also associated with a decrease in smoking intensity	No limitations involving the use of TCS	Advocacy
Bosdriesz et al.32 2015, the Netherlands	To assess whether developments in tobacco control policy in the Netherlands were associated with smoking cessation and smoking intensity.	Observational, multilevel, and longitudinal	Independent variable, not original data, only by components score	Progress in tobacco control policy in the Netherlands was significantly associated with an increase in the quit ratios (2001–2011) but were not significantly associated with smoking intensity among smokers. The strength of the associations was similar for low- and high-education groups	No limitations reported about the TCS as a variable	Advocacy and research
Bosdriesz et al.30 2015, the Netherlands	To assess variations in the progress of tobacco control policy development in Europe and to identify whether the variations can be decomposed into specific patterns or components	Observational, ecological, and longitudinal	Dependent variable, not original, only by components score	Progress in tobacco control policy development in Europe was not uniform. Consistent progress was observed in several areas but was lacking in tobacco prices and smoking cessation support	a. TCS score sometimes fails to express the degree to which policies are enforced; b. some policy areas could not be quantified readily; c. not able to include each separate measure of the TCS in its own right	Research
Klumbiene et al.29 2015, Lithuania	To evaluate the association between tobacco control policies and trends in smoking cessation in Lithuania in 1994–2010	Observational, ecological, and longitudinal	Independent variable, not original data, total score and by components	Great progress in the development of tobacco control policy has been achieved in Lithuania. This progress was associated with an increase in smoking cessation. This association was stronger among younger than older people	No limitations reported about the TCS as a variable	Research
Kuipers et al.28 2015, the Netherlands	To examine the association between tobacco control policies and adolescent smoking, and to investigate the differences in this association between adolescents of high and low socio-economic status (SES)	Observational, multilevel, and cross-sectional	Independent variable, not original data, only total score	Adolescent smoking prevalence rates were higher among low-SES respondents than their high-SES peers. Stronger national-level tobacco control policies were associated with lower odds of daily smoking	The TCS used in the current study contains five domains of tobacco control, not all of which may be as likely to affect adolescent smoking	Advocacy and research
Bosdriesz et al.6 2015, the Netherlands	To provide insight into the role of political factors in the development of tobacco control policy over time	Observational, ecological, and longitudinal	Dependent variable, not original, total score and by components	An association was found between left-wing government and TCS over the period 1996–2003, but not over the whole studied period (1996–2010). The association between government effectiveness and TCS was significant and negative over the whole period, but positive between 2001 and 2005	The TCS contains little information on their enforcement in practice	Advocacy
Movsisyan et al.33 2014, Armenia	To measure the 5-year progress in the implementation of FCTC in Armenia	Observational, ecological, and cross-sectional	Dependent variable, not original, total score and by components	The estimated TCS score for Armenia for smoke-free public places, advertising ban, health warnings, and treatment are below the European average (2005–2007). However, the score estimate for price and public spending are above average	a. Potential measurement error; b. inadequate accuracy and comparability of data; c. the estimates could have been affected by exchange rate fluctuations	Advocacy and research
Heydari et al.34 2012, Iran	To obtain an overview of tobacco control strategies in the Eastern Mediterranean region	Observational, ecological, and cross-sectional	Dependent variable, not original, total score and by components	Afghanistan scored highest for tobacco pricing. Oman scored higher than others for regulations and enforcement of bans on smoking in public places. The Islamic Republic of Iran had the top score on budgeting for tobacco control activities, in prohibition and enforcement of tobacco advertising, and placement of health warnings on cigarette packets. Syrian Arab Republic, Tunisia, and Kuwait had the best provision of smoking cessation services, whereas Pakistan, Saudi Arabia, Somalia, and Yemen scored zero	As the data were extracted from sources such as MPOWER measures and the Tobacco Atlas, they may not cover all important variables and the results may not be conclusive	Research