From 2002 to 2007, Michael Cummings, Ph.D., M.P.H. at the at the Roswell Park Cancer Institute, a cancer research center located in Buffalo, N.Y., and colleagues at Health Research, Inc., Rensselaer, N.Y., conducted surveys that compared tobacco policies in four demographically similar countries—Australia, Canada, the United Kingdom and the United States—to understand the impact of national-level policies on smoking behavior.

Key Results

• The researchers conducted the first three waves of the four-country survey with RWJF support: a baseline survey in October 2002 and follow-up surveys in June 2003 and February 2004.
• The researchers published findings from the first two survey waves in a June 2006 supplement to Tobacco Control that included 12 research articles. The project team reported that they published over 60 additional papers and seven book chapters and made 192 oral or poster presentations all over the world. (See the Bibliography for details of publications.)

Key Findings
An introductory article in the supplement summarized the findings from the research papers—most of them published in the supplement—according to each policy examined. Among the findings:

• Increasing warning label size makes the warning more salient and noticeable for smokers, increases content-specific knowledge and increases the likelihood that smokers think about quitting smoking and quit smoking.
• Compliance with comprehensive smoke-free legislation can be achieved when accompanied by pre-implementation campaigns.
• The United Kingdom's comprehensive advertising ban significantly reduced smokers' exposure to pro-tobacco marketing and messages. Introducing controls on labeling reduced smokers' misperceptions of light and mild cigarettes.
• The level of tobacco-specific nitrosamines (a potent carcinogen) found in the smoke of leading cigarette brands varied widely across countries. Setting minimum toxin cigarette yields is ineffective because tobacco companies respond by increasing filter ventilation, a design change for which smokers compensate by increasing their puff volume.
• The incidence of smokers who buy cigarettes from sources where cigarette taxes are low or do not exist to avoid higher taxes varies considerably across countries. The incidence is more frequent among younger, non-White, male, higher-income smokers who smoke more cigarettes per day. Additionally, an increasing prevalence of roll-your-own cigarettes is a response to higher cigarette prices.
• Lower socioeconomic status is associated with lower awareness of the harms of smoking and greater misunderstanding about nicotine.

Funding
The Robert Wood Johnson Foundation (RWJF) supported the project with a grant of $1,499,633 to Health Research, Inc. between August 2002 and July 2007.