P01 Program Project: 4 Country Smoking and Vaping Survey (2021-2026)

Predicting and Understanding the Use of Nicotine Products in a Rapidly Evolving Nicotine Marketplace: The International Nicotine Product, Policy and Market (INPAM) Study


Administrative Core: Responsible for the overall operation and scientific direction and all dissemination and implementation activities

Data Management Core: The hub for data management including policy tracking

Emerging Products Core: Conducting market scans to identify emerging new products

Project 1: Examining transitions between cigarettes and other nicotine delivery products among adults in countries with different regulatory environments: the ITC Nicotine Product Adult Survey

Project 2: Examining uptake and use patterns of cigarettes and other nicotine delivery products among youth in countries with different regulatory environments: ITC Nicotine Product Youth and Young Adult Survey

Project 3: The Experimental Tobacco Marketplace (ETM)

Project 4: An Economic and Public Health Analysis of the Evolving Nicotine Marketplace


The renewal of this P01 builds upon the longstanding International Tobacco Control Policy Evaluation Project, which has used cross-country comparisons and a common mediation model to evaluate the behavioral impacts of national-level tobacco control policies. The previous P01 (P01CA200512) has extensively researched and documented the transitions between cigarettes and nicotine vaping products and how policies impact their use. For this renewal, we have added heated tobacco products, thus extending our previous two-product model to three products, but otherwise maintaining a similar team structure and research approach.

The goal of this P01 is to address the question “What have different countries done to regulate tobacco products and how has this impacted tobacco use behaviors?” Our common integrated theoretical framework enables us to examine how and why policies and industry actions exert effects, as well as explore under what conditions products or policy interventions might translate into actual population-level impacts. This work is guided by the Host-Agent-Vector-Environment model integrated with the 4 ‘P’s’ – product, price, placement, and promotion, and how public health policy and industry actions impact consumer perceptions, behavior, and ultimately health endpoints. Comparing the experiences of different countries with varying regulatory approaches is intended to inform United States public policy, based upon the best science available to maximize population health.

To accomplish this, we aim to analyze policies and industry actions in different jurisdictions to answer the following three integrated questions: 1) Does the policy/industry action have an impact? (causality); 2) Under what conditions is it effective? (moderation); and 3) How is it effective? (mediation). The studies assess both direct effects but also indirect or unintended effects that can affect the overall impact of a policy or action. We will conduct this work with four interrelated Projects, an Administrative Core, and two Shared Resource Cores, which collectively will: 1) track cohorts of adult tobacco users in seven countries (Australia, Canada, United States, England, New Zealand, Japan, and Republic of Korea); 2) conduct repeated cross sectional surveys of youth and young adults in 3 countries (Canada, England, and United States); 3) utilize the Experimental Tobacco Marketplace to evaluate the effects of product availability, policy actions, and the illicit marketplace; and 4) perform simulation modeling using inputs from the other Projects to predict public health outcomes. The three P01 specific aims are to: 1) understand how policies and industry actions impact consumer behavior; 2) develop scientific methods for assessing response to policies; and 3) forecast population impact of different policy approaches. Ultimately, this work will collectively contribute to a greater understanding of the impact of tobacco control policies by triangulating the findings derived from different studies using different designs and data sources to inform public health policy.


The Program Project received funding from the US National Institute of Health (P01 CA200512) and the Canadian Institutes of Health Research (FDN-148477).

Institutions: Medical University of South Carolina (USA), University of Waterloo (Canada), Roswell Park Comprehensive Cancer Center (USA), Georgetown University (USA), Virginia Polytechnic Institute and State University (USA)

Grant Period: September 1, 2021 through August 31, 2026

Multi-Principal Investigator(s): K. Michael Cummings, Geoffrey T. Fong & Andrew Hyland

Press Releases:

Media Coverage: