Eexcutive Summary

POR Number: 096-17
Contract Number: HT372-174391 001 CY
Contract Award Date: 2018-02-09
Contract Value: $215,112.45 (including HST)
Date of Submission: 2018-08-09

Qualitative Public Opinion Research of draft Health Information Messages and Toxic Statements for cigarette packaging

Executive Summary

Health Canada commissioned Phoenix SPI to conduct qualitative research to test new Health Information Messages (HIM^{Footnote 1}) and Toxic Statements (TS) for cigarette packages. The target audience was smokers, aged 18 and older. The research consisted of a set of 36 in-person focus groups conducted from March 12 to 27, 2018, in four cities: Halifax, Toronto, Vancouver, and Montreal (French). More details on the methodology can be found in the Methodology section of the Introduction.

Four different sets of HIMs were rotated across groups to ensure sufficient review of all 26 messages. Sets A and C each included six HIMs and Sets B and D each included seven HIMs. Within each set, half the HIMs were presented to participants in slide and shell (SS) cigarette package format and the other half as inserts for flip top (FT) packages. The order of the HIMs was rotated across the groups. Participants were asked to review each HIM on their own and then answer two questions about it on an exercise sheet. One question asked them to rate the effectiveness of the HIM in terms of informing and educating about the health effects and hazards of smoking and the other asked them to rate effectiveness in terms of making them think about quitting smoking. This was followed by a group discussion which focused on the following: the teaser, the motivational power of the HIM, the clarity of the text and message, the relevance and credibility of information, as well as suggestions for improvement.

In addition to the HIMs, 24 potential TS were reviewed as part of the research. In order to limit the response burden placed on participants, statements were divided into four sets of six TS. This resulted in participants in each group reviewing six TS with each of the four sets being reviewed by nine groups. After reading the statements, participants were asked about the clarity, length and credibility of each statement. Following their review of content, participants reviewed three different design elements being considered for the TS: text layout, background colour, and format/colour combinations. Participants were shown five options in each of these three areas.

Findings from this research are intended to: 1) provide information which can inform regulatory decisions 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 HIM and TS approach; and 3) help Health Canada to better inform Canadians about health impacts and health hazards of tobacco use and the benefits of quitting. Health Canada will use the information to finalise and select the next HIMs and TS. The HIMs and TS that were reviewed as part of this research are draft only and will either be discarded or edited to make them more effective.

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.

There was consistent feedback that the text in the HIMs (the teaser and message) are clear and easy to understand. Rarely were any issues related to clarity identified by focus group participants. While participants sometimes offered suggestions to improve the teaser and/or message, they tended to focus on the length of the text only, routinely emphasizing that short, direct text makes a HIM effective.

In addition, issues of credibility were seldom raised by participants, and when they were, they were more likely to be raised by older smokers (i.e. those age 25 and older). In general, participants viewed the information provided in the HIMs as believable and credible. The few circumstances in which the credibility of information came into question involved what participants considered worst case scenarios, such as the reference to possible amputation and blindness resulting from diabetes in HIM 6, and when participants’ personal experience called into question the validity of the information in a HIM. An example of the latter is smoking being linked to low birth weight (mentioned in HIM 2) and children being less likely to smoke if their parents are non-smokers (mentioned in HIM 9).

When discussing the HIMs, participants identified a number of factors that resonated with them and contributed to the effectiveness of the HIMs. These include short, pithy messages and teasers that pose questions, which leave the reader wanting more information (and more inclined to continue reading the HIMs). As well, the use of novel design features, such as vibrant colours or cartoons, tend to be attention-grabbing, resulting in participants being more likely to read the HIMs. Regarding themes, references to monetary savings resulting from quitting smoking tended to resonate with participants, as did new information about how to quit/ways to quit smoking, information about health effects participants were not aware of, and messages that emphasize the concrete or immediate effects of quitting smoking.

In addition to the teaser and the health information, participants were also asked about the placement of the quitline information on each HIM. In response, it was often suggested that moving the quitline telephone number and website information to the teaser would increase the likelihood that this information is read. When it appears only in the message portion of a HIM, participants consistently noted that they might not notice the quitline information. Furthermore, there was a strong preference for including both the phone number and the website as part of the quitline information as opposed to splitting the placement of the contact channels (e.g. the phone number in the teaser and the website in the health information).

Turning to the TS, the following were most often rated most effective in terms of informing and educating about the toxic substances found in tobacco and tobacco smoke and the health effects arising from them (presented in set order, not order of preference):

With only a few exceptions, assessments of the effectiveness of statements were similar across Anglophone and Francophone groups. The exceptions included ‘There is no safe level of exposure to cigarette smoke’, which was much more likely to be chosen as most effective in Anglophone groups, and ‘Tobacco smoke can damage the blood vessels in your eyes, causing blindness’, which was much more likely to be chosen as most effective in Francophone groups, as well as ‘Toxic chemicals in a tobacco smoke harms almost every organ in your body’, which was much more likely to be chosen as most effective in Anglophone groups, and ‘Cigarette smoke is toxic and can cause death and disease in children and non-smokers’ which, was much more likely to be chosen as most effective in Francophone groups.

Following their review of the statements for clarity and ease of understanding, participants assessed different design elements being considered for the TS. This included text layout, background colour, and format/colour combinations. The materials tested can be found in the following section of the report: Design Elements.

Regarding text layout, there was widespread agreement across audiences and regions that the option with the side-by-side bilingual format and ‘WARNING’ across the top in white text with a black background makes the TS easiest to read and that it is the most noticeable layout. The design feature singled out as making it the most noticeable option was the WARNING. The colour contrast (i.e. white text on black background), font size, and the black rectangle distinguishing ‘WARNING’ from the statement were routinely identified as attention-grabbing features. Nearly all participants said ‘WARNING’ should be by itself on top rather than integrated into the statement and most participants preferred when the English text and French text in the toxic statements was displayed side by side rather than one language on top of the other.

When it came to background colours, the yellow background with black text format was most often chosen as the background colour most likely to catch participants’ attention. In explaining why, participants identified one or more of the following three factors: the brightness or vividness of the colour, the habitual association of the colour yellow with ‘warning’ or ‘danger’, and the contrast between the yellow background and the black text, described by many as attention-grabbing. A number of participants, though considerably fewer, chose the option with red background with white text as the background colour most likely to catch their eye.

The format/colour combination that was most often chosen as the most attention-grabbing was the ‘WARNING’ in white text with a red background, and TS in black text with a yellow background. In explaining why participants regularly identified the following factors, usually in combination: the red and yellow backgrounds, the contrast between the text and background, the clear separation of ‘WARNING’ from the text, and the bilingual format (display of languages side-by-side).

The contract value was $215,112.45 (including HST).

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.

Footnotes

Footnote 1

When referring to a single Health Information Message in the report, “HIM” is used. When referring to multiple Health Information Messages, “HIMs” is used.

Return to footnote 1 referrer