P01 Program Project: 4 Country Smoking and Vaping Survey (2016-2021)

Evaluating How Tobacco Control Policies are Shaping the Nicotine Delivery Market


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

Project 2: Nicotine and Cigarettes Across Policy Environments

Project 3: Vaporised 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: Modelling Industry Behaviour and the Use of Vaporised Nicotine Products on Population Health


There is debate about whether nicotine vaping products (NVPs) will prove to have a net positive or negative impact on population health. Policies regulating NVPs are rapidly evolving and data are needed to guide policy development. This Program Project presents an innovative and integrated set of studies that will fill this gap by contributing high impact science and novel research methods useful for evaluating how the evolving NVP marketplace and tobacco control policy environment are impacting individuals and population health outcomes.

This Program Project builds upon the longstanding International Tobacco Control Policy Evaluation Project (ITC Project) which has used cross-country comparisons and a common mediation model to evaluate the behavioral impacts of national level tobacco control policies implemented as part of the World Health Organization Framework Convention on Tobacco Control. The overarching research paradigm is founded on the premise that to thoroughly assess policies to regulate NVPs it is essential to do so at the population level in the real world and at the individual-level under controlled experimental conditions. Our research addresses this need by examining the use and evolution of NVP marketplace in the United States, England, and Canada. These three countries were selected because of similar smoking rates and similar 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.

In summary, policies regulating NVPs are rapidly evolving and data are needed to guide policy development.  This Program Project presents an innovative and integrated set of studies that will fill this gap by contributing high impact science and novel research methods useful for evaluating how the evolving NVP marketplace and tobacco control policy environment are impacting individuals and population health outcomes.


The Program Project has received funding from the US National Institute of Health (P01 CA200512) 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).

Institutions: Medical University of South Carolina, USA, & University of Waterloo, Canada

Collaborating Institutions:  Roswell Park Comprehensive Cancer Center, USA, Virginia Polytechnic Institute & State University, USA, & Georgetown University, USA

Grant Period: April 19, 2016 through March 31, 2021

Principal Investigator(s): K. Michael Cummings & Geoffrey T. Fong

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