Evaluating the Impact of Nicotine Regulatory Policies in a Rapidly Changing Market: Findings From the ITC Project in the United States, Canada, United Kingdom, and Australia

PURPOSE Tobacco smoking is the leading preventable cause of death, projected to claim up to one billion deaths in the 21st century. Smoking is the leading cause of cancer, accounting for approximately 30% of cancer cases globally. The recent surge in nicotine vaping products (NVPs), such as e-cigarettes, has led to astounding global changes in the tobacco/nicotine landscape, prompting vigorous debate about whether these products represent a positive or negative public health impact. METHODS In 2016, the International Tobacco Control (ITC) Project created a multimethod program of 5 linked projects to examine NVP design/content, the interplay between NVPs and cigarettes in adults and youth, the impact of NVP regulations, and implications of NVPs on public health in 4 countries that vary in regulatory approach to NVPs: the United States, United Kingdom, Canada, and Australia—the first ever multicountry longitudinal study of e-cigarettes and other NVPs. RESULTS This presentation will describe the overall research program and then review key findings from these 5 linked international projects: the ITC Four-Country Adult Smoking and Vaping Survey, the ITC International Youth Smoking and Vaping Survey, the ITC product testing project, the experimental marketplace project, and the simulation study estimating the impact of different parameters, including the prevalence of NVP use and restrictiveness of policies on NVPs. The overall objective of these ITC projects was to evaluate and understand the impact of different policies on the uptake, use, reasons for use, and impact of use among youth and among adults over time and across countries. CONCLUSION The ITC project’s multimethod, multicountry research program illustrates the unique value of cross-country research to examine the public health impact of the evolving nicotine marketplace and of regulations on the broadening array of nicotine products throughout the world.