Tobacco Policy Evaluation Across 17 Countries: The ITC Project

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The International Tobacco Control Policy Evaluation Consortium (i.e., ITC Project), was established in 2002 with the aim of applying rigorous evaluation methods to understand the impact of the tobacco control policies implemented as part of the Framework Convention on Tobacco Control (FCTC). The study design combines quasi-experimental methods and theoretically defined mediational models that allow predictions about how specific policies will influence tobacco use beliefs, attitudes and behaviors. FCTC policies that are evaluated as part of the ITC Project include: (a) enhanced warning labels; (b) elimination of "light", "mild" and other misleading descriptors; (c) the reduction or elimination of advertising, promotion, sponsorship of tobacco products; (d) changes in taxation and price, (e) policies to reduce exposure to tobacco smoke; and (f) policy changes relevant to regulation of tobacco products. The ITC Project is now being conducted in 15 countries inhabited by over half of the world's smokers. This application seeks funding to continue the ITC Project evaluation in key middle-income countriesThailand, Malaysia, and Uruguayand to expand the ITC Cohort Survey into India. The application describes our plans for conducting prospective cohort surveys in each country using probability sampling methods as follows: -2,000 in Thailand and Malaysia (using a three- stage sampling design); -1,500 in Uruguay; and 10,000 in India (within 4 states). Sampled participants will be interviewed annually to assess tobacco use behaviors, exposure to specific policies and mediator and moderator variables specified by our conceptual model. We will link the data from these four countries with ongoing ITC Project evaluations in other countries funded by other sources. The proposed study has eight aims, which fall into three broad categories: 1) testing the effectiveness of FCTC policies in different countries; 2) evaluating mediators and moderators of policy effects, and 3) describing the natural history of smoking cessation and the factors that predict smoking and quitting across all of the ITC countries. The requested funding will allow the continuation and extension of the ITC Project into key LMICs to permit us to test the generality of policy effects across differentcountries. RELEVANCE (See instructions): Tobacco use is a major cause of premature mortality and in low and middle-income (LMICs) it constitutes not only a looming health catastrophe but also a drain on economic development. Tobacco control policies implemented through the WHO FCTC represents the best hope to significantly lessen the impact of the tobacco epidemic in LMICs.