P01 Program Project

Evaluating How Tobacco Control Policies are Shaping the Nicotine Delivery Market

Project 1: Natural History of Cigarette Smoking and Vaporized Nicotine Product Use in Countries with Different Policy Environments

Project 2: Nicotine and Cigarettes Across Policy Environments

Project 3: Vaporized Nicotine Product Initiation Among Youth in the US, Canada, and England: Methods to Predict Uptake and Policy Efficacy

Project 4: The Experimental Tobacco Marketplace (ETM)

Project 5: Modeling Industry Behavior and the Use of Vaporized Nicotine Products on Population Health

The goal of this Program Project is to extend the work of the International Tobacco Control Policy Evaluation (ITC) Project and to characterize the effectiveness of current and potential future policies to regulate NVPs. This research is premised on the belief that to thoroughly assess policies regulating NVPs it is essential to do so at both the population level and at the individual-level under controlled experimental conditions. The multi-method approach is carried out in three countries: the United States (US), England, and Canada, selected because each have similar smoking rates and histories of cigarette product regulations, but divergent policies regulating NVPs.

This set of five inter-related studies and two core services addresses three overall aims:

  1. To provide a more thorough understanding of how the policy environment influences uptake of and transitions from smoked tobacco to NVPs. The research team implements naturalistic studies of broadly representative adult and adolescent samples (Projects 1 & 3) and surveillance of the vaporized nicotine market (Project 2) to allow between country and within-country policy effects to be studied and combining these data with data from experimental studies testing how theoretical policy options might affect the demand for NVPs in non-smoking youth (Project 3) and adult smokers (Project 4);
  2. To contribute to the development of methods for monitoring response to NVPs and future alternative nicotine products. The team will investigate differences in methods in data collection (Projects 1 & 2), study samples (Projects 1, 3 & 4), and experimental protocols (Projects 3 & 4) to see which approaches are most cost-efficient and yield the highest quality data for real-world applications in predicting responses to policy changes; and
  3. To develop methods to assist policymakers in forecasting the population health impact of different product regulatory schemes. Project 5 integrates the data from observational (Projects 1, 2 & 3) and experimental studies (Projects 3 & 4), plus additional data, to model the impact of different policies on population health outcomes. Collectively, the proposed studies comprehensively examine how different NVP policy environments are influencing NVP and smoked tobacco use behaviors in the real world and the measured impact of theoretical policy options in the experimental setting. The end product of this holistic program of policy research will be a unique, multi-country evidence base with strong potential to inform policies and regulations in the US, England, and Canada and perhaps other countries as well.

ITC 4 Country Smoking and Vaping Survey

The 4 Country Smoking and Vaping (4CV) Survey is a longitudinal survey of representative cohorts in the United States (US), Canada (CA), England (EN) and Australia (AU). The 4CV Survey was initiated after the conclusion of the ITC Four Country (4C) Survey in 2015. The 4CV Survey is designed to investigate the relationship between the use of vaping devices (such as e-cigarettes) and tobacco use, and to evaluate and inform emerging policies on nicotine vaping products (NVPs) in the four countries. The ITC 4CV Survey expanded upon the existing ITC 4C Survey infrastructure, conceptual model, and methodologies to examine the use and evolution of the NVP market and policy environments by surveying adult smokers, recent former smokers, and vaping device users (i.e., vapers) in AU, CA, EN, and the US—four countries with similar cigarette-smoking rates, but divergent policies related to NVPs.

Over the past few years, demand for NVPs has grown rapidly, and data are required to inform public health policies. While NVPs may be less harmful compared to combustible tobacco products—the known leading preventable cause of premature death in high-income countries—the effect of NVP use on tobacco cessation, uptake, and/or sustained use is currently not well understood.

The specific objectives of the ITC 4CV Survey are to:

  1. Describe how NVP and cigarette use differ among smokers and recent former smokers, both over time and between important subgroups (e.g., age, gender, income, intention to quit cigarettes, nicotine dependence level), in particular whether the interactions between NVP and cigarette use vary across countries,
  2. Examine how differences in tobacco control and NVP policies between countries are related to different patterns of NVP and cigarette use; and
  3. Contribute to the methods for monitoring health behaviours (e.g., NVP use) by comparing characteristics of the online samples recruited in this study with samples collected by conventional methods, and explore the extent to which behaviours of the self-identified early adopters of NVPs provide useful indications of the behaviour of the broader adult smoker population.


The Program Project has received funding from the US National Institute of Health (P01 CA2005512) and the Canadian Institutes of Health Research (FDN-148477). The Australian component in the ITC 4 Country Smoking and Vaping Survey has received funding from the National Health and Medical Research Council of Australia (APP1106451).