POR Number: 028-17
Contract Number: HT372-173280-001-CY
Contract Award Date: 2017-09-22
Date of Submission: 2018-03-27
Prepared for: Health Canada
For more information, please contact: hc.cpab.por-rop.dgcap.sc@canada.ca
March 2018
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Health Canada commissioned Phoenix SPI to conduct qualitative research to test mock-ups of 39 potential health warnings (HWs) for cigarette packages, and 11 potential taglines designed to appear on cigarette packages as part of the pan-Canadian toll-free quitline number and the Web portal section (Quitline section) of HWs. The research was conducted with members of each of the following populations:
The research consisted of a set of 48 focus groups conducted from November 20 to December 16, 2017, in four cities (12 groups per city): Halifax, Toronto, Vancouver, and Quebec City (French). More details on the methodology can be found in the Methodology section of the Introduction.
Four different sets of HWs were rotated across groups in order to ensure adequate review of all 39 messages. With one exception, each set included 10 potential HWs1 (divided into two groups of five to minimize the response burden on participants). Within each set, one group of HWs was presented to participants in flip top cigarette package format and the other in slide and shell format, with the order of presentation rotated across groups. In total, each of the four sets was tested in 12 groups (three times with each of the four audiences).
The results from this research only provide an indication of participants’ views about the issues explored and cannot be generalized to the full population of any of the groups represented in the study.
Research shows that, for HWs to be effective, they must be memorable, noticeable, and engaging. The administration and enforcement of the Tobacco Act and its regulations is Health Canada’s responsibility.
Findings from this research will: 1) test the effectiveness of proposed new HW, and provide information on which regulatory decisions can be made with respect to new labelling requirements; 2) help to generate a better understanding of varying literacy levels with regards to the effectiveness of the new HW approach; and 3) help Health Canada to better inform Canadians about health impacts and health hazards of tobacco use.
There was widespread agreement that the textual part of the HWs are clear and easy to understand (i.e. headlines and sub-text). While participants sometimes offered suggestions to improve the textual part of the HWs, they tended to focus on the length of the text or the possibility of adding emphasis (i.e. bolding), as opposed to improving clarity and ease of understanding. They routinely emphasized the contribution of short, direct, to-the-point text in making a message effective.
Participants were also of the opinion that the picture and the text in most HWs work together or convey the same message. The HWs in which text and picture were most frequently described as not working together were the three testimonials (i.e. HWs 14, 28, and 30). It was routinely observed that the pictures do not depict someone suffering from the conditions described in the text. It should be noted that all testimonials featured the actual persons who are suffering from tobacco-related illnesses.
Similarly, participants tended to view the information provided in the HWs as credible and believable. The only circumstances in which the credibility of information came into question involved conditions perceived as so extreme as to be improbable as a result of smoking alone. For example, in reaction to the gangrenous foot depicted in HW20 some participants observed that such an extreme condition could not be brought on by smoking alone, or that it was unlikely that anyone could smoke the number of cigarettes required to bring on such an extreme condition.
Participants made it clear that much of the information in the HWs was not new to them. Information identified as new tended to be consistent across locations and age groups. To the extent that there was any noticeable difference in awareness, it tended to be by age group, with youth smokers and non-smokers more likely to describe information about the health effects and health hazards as new. New information contained in the HWs was routinely described by participants as relevant and useful.
In the course of discussing the HWs, participants identified two factors related to the images that contribute to their effectiveness. First, graphic images were generally viewed as an effective way to convey the health effects and/or hazards associated with smoking. Clear evidence of this is the fact that the HWs judged to be most effective in each and every group in which they were tested all contain graphic health/disease-related images. In addition, images and pictures depicting the effects of smoking on babies (including the unborn) also tended to resonate with participants both because of the emphasis on harm done to others (as opposed to oneself) and because of the impression that this harm is inflicted on innocent and vulnerable beings unable to protect themselves. These factors were identified regardless of whether the HWs were tested in SS or FT format.
The fact that there is no single, overriding theme or type of HW that resonates with all smokers and youth non-smokers was also evident in differences regarding which colours and styles of presentation were most likely to contribute to the effectiveness of the HWs. There was enough positive feedback to suggest that, when it comes to ‘WARNING’, white text on red background and black text on yellow background would be effective as would including the message once and/or twice (with participants more likely to think that including it three times is excessive or unnecessary). In addition, participants across all locations and age groups routinely identified framed text and bolded text as factors contributing to the effectiveness of HWs.
The HWs most likely to be considered effective in terms of informing people about the health effects and hazards associated with smoking include the following:
What these HWs all have in common is that they contain graphic health/disease-related pictures and short categorical statements. In addition, they tended to contain information that was new to participants and aspects of their colour/layout were described as vivid and attention-grabbing
The HWs least likely to be considered effective include the following:
These HWs tended to rate poorly due mainly to a perceived weak picture and/or poor coordination between text and image. Additional criticism focused on a lack of new information and aspects of design and color.
Nearly all participants believe that the Quitline section of the HW would be more effective or more noticeable if a tagline accompanied the phone number and web address. Two reasons were routinely provided for retaining a tagline. One reason is motivational, specifically the impression that a tagline could be effective in encouraging smokers to use the cessation services. The other reason is informational, specifically the impression that a tagline provides contextual information making clear the purpose of the phone number and website address.
The following taglines were most often considered effective:
Among Francophone participants, two of these taglines were also among those considered most effective: You can quit. We can help/Vous pouvez arrêter. Nous pouvons vous aider, and No judgement. Just help to quit/Pas de jugement. Juste de l’aide pour arrêter. Two additional taglines ranked among those considered most effective in Francophone groups: Ne cessez jamais d’essayer, vous pouvez y arriver/Never quit quitting and Vous avez la volonté. Nous pouvons vous aider/You have the will. There is a way.
Participants who consider these taglines effective tended to point to their emphasis on support or available assistance in combating smoking. Two of these taglines (You can quit. We can help and No judgement. Just help to quit) were also described as effective because they include a motivational factor (the idea that quitting is possible in the former, and the absence of a guilt trip in the latter).
The most noticeable difference between language groups regarding assessment of the taglines is that Never quit quitting (Ne cessez jamais d’essayer, vous pouvez y arriver) was more likely to be included among the most effective taglines in Quebec City. Reasons provided to explain its effectiveness included recognition that quitting is difficult (i.e. it can take many attempts before being successful, accompanied by hope and a motivational factor (i.e. keep trying because success is possible).
The following two taglines were least likely to be considered effective:
Those who did not consider them effective tended to describe them as too slogan-like or cliché-like. Many also suggested that the call to action in both taglines is too vague or general (i.e. why click or call?). Both were most likely to be considered effective by youth participants. Reasons included their emphasis on smokers taking the initiative and the ‘catchiness’ of the phrasing. In other words, the absence of an explicit rationale for clicking or calling and the jingle-like nature of these taglines did not bother these youth.
One of the main findings to emerge from this research is that there is no single, overriding theme or type of HW that resonates with smokers and youth non-smokers. Rather, it was apparent that a range of themes or approaches is considered effective. While a variety of approaches work, feedback from participants makes it clear that there are specific things to keep in mind related to the creation and/or improvement of HWs. These include:
The contract value was $249,949.22 (including applicable taxes).
I hereby certify as a Senior Officer of Phoenix Strategic Perspectives that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not contain any reference to electoral voting intentions, political party preferences, standings with the electorate, or ratings of the performance of a political party or its leader.
Alethea Woods
President
Phoenix Strategic Perspectives Inc.
One of the four sets included nine not 10 HWs.