BACKGROUND-AIM:
Effective monitoring of tobacco control policy implementation is crucial for evaluating impact, tracking progress, identifying gaps, and informing evidence-based public health action. Standardised instruments enable systematic assessment of policy adoption and enforcement. Two widely used country-level tools are the Tobacco Control Scale (TCS) and MPOWER. The TCS evaluates six cost-effective measures: price, smoke-free laws, public spending, bans on tobacco advertising, promotion and sponsorship [TAPS], health warnings, cessation treatment, with a maximum of 100 points indicating full implementation. MPOWER also covers six components with a composite score of 29 pts derived by summing ratings for each component (1–5, except for monitoring [M] 1-4). While both instruments assess tobacco control policy adoption, their comparability has not been systematically evaluated. This study examined the extent to which TCS and MPOWER scores capture similar dimensions of tobacco control implementation across countries.

METHODS:
A comparative cross-sectional analysis was conducted using 2019 TCS and MPOWER data from 45 countries (28 European, 17 Latin American). The year 2019 was selected as it is the only year with a TCS report available for Latin America. TCS and MPOWER total scores were standardised as z-scores to facilitate comparability. Pearson (r) and Spearman (rank, r_(s)) correlations were calculated to assess linear associations between paired components and composite scores. Agreement between scores and ranking concordance was examined using Bland–Altman plots and Kendall’s tau-b correlation. Non-parametric bootstrapping used to estimate 95% confidence intervals (CIs).

RESULTS:
Paired-components assessing adoption of smoke-free laws (r=0.42, p=0.001), TAPS bans (r=0.69, p<0.001), health warnings (r=0.50, p<0.001), and treatment (r=0.69, p<0.001) were moderately to highly correlated. TCS and MPOWER composite (r=0.54, 0.29–0.72, p<0.001) and official total scores (r=0.62, 0.40–0.77, p<0.001) were also moderately correlated across countries. Spearman’s rs for ranking position also showed a positive and statistically significant correlation for both total scores (r=0.38, 0.05–0.65; r=0.52, 0.22–0.74, respectively). Kendall’s ô confirmed moderate rank agreement for both composite (ô=0.27, 0.02–0.50, p=0.01) and official total scores (ô=0.40, 0.17–0.60, p<0.001). Bland–Altman analysis revealed no systematic bias between scales, though wide limits of agreement suggest substantial variability for specific countries.

CONCLUSIONS:
The TCS and MPOWER scores measure overlapping but not identical aspects of tobacco control policy adoption. Their moderate correlations indicate that both tools consistently identify countries with strong or weak policy performance but differ in how they weigh and aggregate domains. Consequently, they should not be used interchangeably for research or policy evaluation purposes.