Evaluating the Effectiveness of Tobacco Control Policies in Low and Middle Income Countries

Investigator: Neal Benowitz, MD
Sponsor: Roswell Park Cancer Institute

Location(s): India; Malaysia; Thailand; Uruguay


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.