Tobacco Policy Evaluation in Low and Middle Income Countries: The ITC Surveys, Project 1


This project commences and/or continues the ITC cohort surveys in four developing countries (India, Thailand, Malaysia, and Uruguay) over five years to support the ITC Project’s overall efforts to evaluate the impact of Framework Convention on Tobacco Control (FCTC) policies in key low- and middle- income countries (LMICs). Although the survey fieldwork in these four countries are being supported explicitly, the conceptual and analytic comparisons of this proposed project include the other ITC LMICs: China, Bangladesh and Mexico (with Sudan joining ITC project by late 2008). In addition, the efforts to evaluate FCTC policies in LMICs run in comparison to FCTC policy evaluation in the high-income countries of the ITC Project: United States, Canada, United Kingdom, Australia, Ireland, South Korea, New Zealand, France, Germany, and the Netherlands, with additional high-income countries. The ITC Survey in each of these 17 countries includes measures of smoking behavior, psychosocial predictors of smoking and quitting, and policy-relevant measures in six major policy domains:

  1. Enhancement of warning labels
  2. Elimination or restriction of the terms “light” or “mild” as cigarette brand descriptors
  3. Elimination or restrictions on advertising and promotion of tobacco products
  4. Changes in price and taxation
  5. Smoke-free laws
  6. Use of cessation aids

The quasi-experimental design includes both between-country controls and within-country controls, thus allowing rigorous tests of national-level policies. This study seeks to not only determine whether a given policy has its desired effect, but also on how and why those policy effects are achieved with particular interest in how those effects might differ across countries that vary in economic level and culture. In addition to specific hypotheses that are tested about policy effects, the infrastructure established for this study serves as the basis for future, yet unanticipated policy evaluations. There are 7 specific aims. These include:

  1. To examine whether a policy introduced in one country affects self-reported smoking behavior, in comparison to other countries where that policy is not changing,
  2. To examine whether a policy introduced in one country enhances policy-relevant psychosocial variables, that is, those that are closely related to the policy, in comparison to other countries where that policy is not changing,
  3. To examine whether a policy introduced in one country leads to enhance levels of psychosocial variables known to be related to smoking and quitting behavior, in comparison to other countries where that policy is not changing,
  4. To examine whether the effects of tobacco control policies may be offset by compensatory behaviors (e.g., price increases leading to shifts toward discount brands rather than to quitting),
  5. To examine whether the effects of tobacco control policies are moderated by situational and individual difference factors, with special emphasis on the (potential) moderating impact of socioeconomic status, both within countries and across countries,
  6. To identify the psychosocial mechanisms that may explain how tobacco control policies achieve (or fail to achieve) their goals,
  7. To identify similarities and differences the psychosocial and behavioral effects of FCTC tobacco control policies in high income countries and in low- and middle-income countries.

In addition to these 7 specific aims, we are comparing and contrasting the impact of policies across the entirety of the 17 ITC countries and seek to develop a more general model of FCTC policy impact, which may include comparisons of the relative impact of FCTC policy domains. This project has considerable time urgency because the FCTC has progressed into the implementation phase and as such, ITC Project data is of singular value in contributing to the growing movement toward strong evidence-based implementation of tobacco control policies throughout the world.

Affiliated Center/Program

Principal investigator
Funding Agency

National Institutes on Cancer through University of Waterloo

Start date
End date
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About this grant

This study is subcontracted through another institution.

Parent Study
Evaluating the Effectiveness of Tobacco Control Policies in Low and Middle Income Countries
PI of Parent Study
Geoffrey Fong, PhD
University of Waterloo

Related publications

Shang C, Chaloupka FJ, Zahra N, Fong GT. The distribution of cigarette prices under different tax structures: findings from the International Tobacco Control Policy Evaluation (ITC) Project. Tob Control. 2014 Mar;23 Suppl 1:i23-i29. [See abstract.]