Suite 5001, 7071 Bayers Road
Halifax NS B3L 2C2
www.cra.ca
1-888-414-1336
POR Registration Number: 099-17
PSPC Contract Number: HT372-17-4410
Contract Award Date: February 16, 2018
Delivery Date: April 2018
Contracted Cost: $95,897.45
Evaluation of Possible Labelling Elements for Vaping Products - Phase I and Phase II
Final Report
Prepared by:
Corporate Research Associates Inc.
Prepared for:
Health Canada
Ce rapport est aussi disponible en français.
For more information on this report, please email:
hc.cpab.por-rop.dgcap.sc@canada.ca
Suite 5001, 7071 Bayers Road
Halifax NS B3L 2C2
www.cra.ca
1-888-414-1336
Corporate Research Associates Inc.
Contract Number: HT372-17-4410
POR Registration Number: 099-17
Contract Award Date: February 16, 2018
Contracted Cost: $95,897.45
Once Bill S-5 receives Royal Assent, vaping products will be subject to various labelling requirements. Health Canada commissioned Corporate Research Associates to conduct qualitative research to support the establishment of appropriate regulatory requirements for the labelling of vaping products. The research, conducted over two phases, included an initial phase aimed at informing the development of key messages, and a second phase to test proposed labelling messages. The following provides an overview of the research methodology for each phase:
Phase 1: Message development consisted of a total of 6 in-person focus groups, two groups in each of Toronto, Vancouver and Montreal (conducted from March 19 to March 26, 2018). In each location, one group was conducted with vapers (a person that has vaped at least once per week for the last four weeks) and one group with smokers (a person that has smoked at least once per week for the past four weeks). Sessions held in Toronto and Vancouver were conducted in English, while sessions in Montreal were conducted in French. The target audience included adults aged 18 years or older.
Phase 2: Testing of messages consisted of a total of 6 in-person focus groups, two groups in each of Toronto, Montreal and Vancouver (conducted from June 25 to June 28, 2018). Again, in each location, one group was conducted with vapers while the second group was conducted with smokers, based on the same selection factors used in Phase I of the research.
This report presents the findings from both phases of the study. Caution must be exercised when interpreting the results from this study, as qualitative research is directional only. Results cannot be attributed to the overall population under study, with any degree of confidence.
I hereby certify as a Representative of Corporate Research Associates Inc. that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Directive on the Management of Communications. Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate or ratings of the performance of a political party or its leaders.
Signed
Margaret Brigley, President & COO | Corporate Research Associates
Date: June 29, 2018
Findings from the Evaluation of Possible Labelling Elements for Vaping Products - Phase I reveal a large information gap related to vaping product information among both vapers and smokers, with both groups acknowledging a lack of knowledge related to the health effects and health hazards of vaping products. There is a clear interest on the part of those using vaping products and smokers that do not vape to learn more about vaping. Further, participants clearly endorse further regulation of vaping products, indicating that cigarettes and vaping should be treated equally, with similar amounts of research, information and regulation.
In general, curiosity about the products and a desire to stop smoking tobacco explain decisions to start vaping. Most obtain feedback on vaping products and experiences through word-of-mouth from current users, as well as from speciality store staff selling these products, as well as internet searches. Other than specific information on the device itself and on the overall experience of vaping, few have actively looked for information about the liquids and their health effects. As such, awareness and knowledge of vaping remains limited across audiences, though it is slightly more evident among product users, and among Vancouver focus group participants. Of note, product-related information is not currently an important consideration in purchasing decisions of vaping products other than the flavouring and nicotine content.
A lack of perceived need to change smoking habits and a lack of curiosity explain why some smokers have never tried vaping. Some smokers that had tried vaping products indicated that their interest in vaping stopped as it is felt to be less satisfying than smoking cigarettes, notably in terms of the physical sensation of inhaling. It should be noted that vaping is generally seen as a less satisfying experience than smoking cigarettes, even among exclusive vapers who had previously smoked. A perception that the health effects of vaping are similar to those of smoking cigarettes also supports smokers' decision to ignore or stop vaping.
Despite the long-term health effects not being clearly understood, vaping is seen as different from smoking cigarettes, notably in terms of being a more affordable, socially-acceptable, and by some, a healthier alternative to smoking. Vaping usage is largely dependent on the environment, notably the location and people who are present. It is seen as an attractive alternative to cigarettes indoors, and more socially-acceptable when in the presence of non-smokers or children. Other appreciated attributes of vaping include that it is less expensive, its odour is less pervasive and offensive, it does not stain clothing or furniture, it is seen as less addictive than cigarettes, it includes fewer ingredients, and it provides the ability to control the amount of nicotine consumed. Conversely, vaping liquids are deemed less accessible for purchase than cigarettes, and the devices are seen as more fragile and bulky to transport and to use. The terms, 'vaping products' and 'e-cigarettes' are considered different by vapers, though they are perceived as the same by many smokers.
Although little is known regarding the health effects of vaping, it is still perceived as less harmful than smoking cigarettes, notably by vapers, although the lack of verified information on the long-term health effects of vaping is a concern across audiences. As such, there is a strong desire among both vapers and smokers to learn more about vaping, notably its long-term health effects, ingredients listings, nicotine levels, any differences or issues with vaping devices, and how vaping compares to cigarettes in terms of health effects, nicotine content, and addiction.
The lack of labelling regulation on vaping products sends mixed messages. To some smokers and vapers, it suggests that these products are safe to use as they do not need controls, while for others, it implies that insufficient research is available to inform legislation, thus posing a risk to users. Further, unaided commentary in Vancouver on this topic centred on participants feeling that there was a clear need for regulation to inform users if the products are safe, and that there should be parity of treatment between types of products, from cigarettes to vaping. Although labelling information is seldom used to inform choices of vaping products at this time, there is a desire for vaping product labelling regulations across audiences. While information is of interest to both vapers and non-vapers, those who currently do not use vaping products do not believe this information would inform their consideration of vaping products in general.
Both vapers and smokers identified a variety of topics related to vaping they are interested in. Most top-of-mind questions pertained to how vaping compares to smoking cigarettes, its health effects, ingredient listings, nicotine levels, legislation on accessibility and usage, and technical aspects of the vaping devices. It was believed that having this kind of information online on the Health Canada website would be most accessible, convenient and trustworthy. While there is interest in a wide range of information, smokers and vapers recognize that limited space is available on labels. With this in mind, it was believed that ingredients listings, amount of nicotine, a product expiration date, a website URL for additional information, major side effects or health risks and warning messages on maximum consumption should be considered for vaping product labels, with the other information available online or on a leaflet included in vaping product packaging. Mixed opinions were offered regarding the preferred message format or tone to attract attention to the product labels.
Findings from the Evaluation of Possible Labelling Elements for Vaping Products - Phase II suggest that participants welcome the provision of regulated labelling information to assist with their choices of vaping liquids. While there is currently mixed reliance on vaping product labelling to inform consumer choices, participants in the research voiced an interest for mandatory labeling information that would include ingredient listings, nicotine content, and warnings or information related to possible harmful health effects.
The proposed label information was generally seen as clear, concise, legible, and easy to remember, as it uses simple font, short sentences, and a plain background on a label that is not overcrowded. That being said, some of the information conveyed was not fully understood, and some components were interpreted in multiple ways. Further, the individual meaning of each statement or component is weakened by the lack of clear perceived relationship between the various elements. Some of the components were also considered too vague or incomplete to provide effective guidance to consumers.
When considering each of the proposed label components, suggestions were provided by participants for improvement. The skull and crossbones symbol were interpreted to mean that the product has harmful health effects, especially when combined with the word "poison". That said, there is some confusion regarding how the product can be harmful, with some participants understanding that swallowing the product is poisonous, while others under the impression that the symbol means that overusing the product, in its intended manner, can also have serious health effects.
Participants suggested the meaning of this warning should be clarified by adding a statement (poisonous if swallowed) or by positioning it near the first aid treatment information. There is also a lack of clarity as to what ingredient can be poisonous, with some participants suggesting that ingredients other than nicotine were potentially poisonous and as a result, this may imply that all vaping products can be harmful, not just those that contain nicotine.
It was mentioned by participants that the first aid treatment does not provide sufficient information on what kind of medical attention is required, and when it should be sought. At the same time, some participants suggested that consideration should be given to provide basic first aid to administer (e.g., whether to induce vomiting) while waiting for medical assistance, if deemed essential.
There is a strong desire among participants to know if a product contains nicotine or not, and what levels of nicotine are included even in trace amounts. This information is relied upon for those who use vaping products as a means to stop smoking tobacco and among some current smokers. While consumers look for a measure of nicotine content, they are most interested in one that provides a point of comparison across vaping products, and would ideally like to have a comparison to the nicotine content in cigarettes. Knowing the concentration of nicotine on its own, without comparative information, is not as important to participants in comparison. For products without nicotine, the label "nicotine free" is most familiar though it implies the product does not include even negligible amounts of nicotine.
It was considered important by participants to include a warning on the label that the vaping product includes nicotine and that nicotine can be highly addictive. Participants felt that both messages - i.e. that the product contains nicotine and that nicotine is highly addictive - should be included in one short, simple statement for added clarity, prefaced by the word "warning". The Health Canada signature was considered important to participants to establish credibility.
Knowing what vaping liquids are made of is very important to participants, who believe that the ingredient listing must be shown on the label to inform their choices. There is an expectation among participants that the relative proportion of ingredients will be communicated, either by listing ingredients in order from the highest to the lowest amounts included or by indicating the proportion of each. For added transparency and to foster increased trust, participants expressed an interest in having all of the ingredients listed. This was considered most important for such listed items as "flavour", as the word itself does not specify what it is made of.
Participants expressed a preference for simple, yet informative labels that will enable them to choose the product that best fits their needs based on ingredients used and nicotine strength. At the same time, warning consumers of the possible harm of nicotine and of mishandling the product is considered important by consumers, though it was felt that greater clarity may be needed in how the product can be harmful and what should be done to alleviate the harmful effects. Consumers also felt that the skull and crossbones symbol should be replaced or better explained, in order to ensure the risks it is meant to warn about are properly understood.
Finally, participants expressed a desire for more information about vaping products from Health Canada to support the regulated labelling elements, notably in terms of regulations being in place, information on the appropriate use of these products and the possible health effects and health risks resulting from their use.
Bill S-5 received Royal Assent on May 23, 2018, giving Health Canada the authority to prescribe labelling requirements by regulations for vaping products including those that contain nicotine. Health Canada commissioned Corporate Research Associates to conduct qualitative research to support the establishment of regulatory requirements for the labelling of vaping products. Most notably, the research will guide Health Canada with regard to the nature and most effective presentation of information that will help inform Canadian vaping product consumers about the health hazards and health effects of using vaping products, including safety risks, while ensuring that they are not misled about the harms of vaping. Ultimately, it is expected that the package information will help consumers make informed choices about their health in the context of vaping product use.
Overall, the goal of the research was to evaluate the expectations of Canadian vapers and smokers with respect to information on vaping products in the initial research phase, and to evaluate the effectiveness of proposed labels for vaping products in follow-up research. As such, the research was conducted over two phases, with the first phase aimed at informing the development of key messages while the second phase was aimed at testing labelling messages.
Specifically, research objectives for each of the two phases included:
Phase 1 (March 2018):
Phase 2 (June 2018):
This report presents the combined findings from both phases of the research. It includes a high level executive summary, the description of the detailed methodology used, the detailed findings of the focus group discussions, and conclusions derived from the analysis of research findings. The working documents are appended to the report, including the recruitment screeners and the moderator's guides.
The target audience of this study was adults aged 18 years or older who are either vapers or smokers. For the context of this project, a vaper is defined as a person who has vaped at least once a week for the four weeks prior to recruitment. Vapers included dual users who currently smoke and vape, former smokers who now vape, and those who have never smoked and currently vape. Smokers included individuals who have smoked at least once a week for the past four weeks, but who do not currently vape or have vaped less than once a week in the past four weeks. For both phases of the study, recruitment was conducted through qualitative panels stored on Canadian servers, with follow up calls to confirm the details provided and to ensure quotas were met. An additional confirmation call was done approximately one day prior to each focus group. Participants were also asked to sign a consent form upon their arrival to the focus group. In each location, participants were asked to show a piece of ID to confirm their identity. Each group included a mix of age, gender, education level, household income, as well as various levels of vaping and smoking frequency.
The study included a two-phased qualitative research approach consisting of a total of 12 in-person focus groups. Phase 1 assisted in guiding the development of key messages, with these messages being tested during the second phase of the research. Each phase consisted of a total of 6 focus groups in 3 locations, including two groups in each of Toronto, Vancouver and Montreal. For the research, a smoker was defined as a person that has smoked at least once per week for the past four weeks, and who do not currently vape, or has vaped less than once a week in the past four weeks. In the smoker groups, a mix of smoking frequency was recruited. By contrast, a vaper was defined as a person that has vaped at least once per week for the last four weeks and do not exclusively vape cannabis products. Vapers could be dual users who currently smoke and vape, former smokers who vape and those who have never smoked but vape. A mix of vaping frequency was recruited in each group.
In each location, one group was conducted with vapers and one group with smokers. Participants in the research included a mix of gender, ages, education, and household income. All participants reported having lived in their respective markets for a period of at least two years. The Phase I focus groups were conducted from March 19 to March 26, 2018, while Phase II groups were conducted from June 25 to June 28, 2018.
Sessions held in Toronto and Vancouver were conducted in English, while sessions in Montreal were conducted in French. Across both phases, a total of ten participants were recruited for each group, totalling 120 recruits. Across locations, 99 participants actually attended the discussions. All participants were recruited per MRIA guidelines and per the recruitment specifications for the Government of Canada. Recruitment was conducted by telephone from the general population or from general population online panels. Following the initial recruitment, a confirmation call was conducted one or two days before the focus group to confirm attendance and confirm key qualifying criteria. Those who took part in the discussion each received a compensation of $100 as a token of appreciation for their time, as per market standards. Group discussions each lasted 1 ½ to 2 hours.
The following provides a summary of participation in each location:
| Location | Date | Language | Audience | Time | Participants |
|---|---|---|---|---|---|
| Phase I | |||||
| Vancouver, BC | March 19, 2018 | English | Vapers | 6:00 PM | 9 |
| Smokers | 8:00 PM | 9 | |||
| Toronto, ON | March 21, 2018 | English | Vapers | 6:00 PM | 8 |
| Smokers | 8:00 PM | 10 | |||
| Montreal, QC | March 26, 2018 | French | Vapers | 6:00 PM | 9 |
| Smokers | 8:00 PM | 8 | |||
| Phase II | |||||
| Toronto, ON | June 25, 2018 | English | Vapers | 6:00 PM | 7 |
| Smokers | 8:00 PM | 7 | |||
| Montreal, QC | June 26, 2018 | French | Vapers | 6:00 PM | 7 |
| Smokers | 8:00 PM | 8 | |||
| Vancouver, BC | June 28, 2018 | English | Vapers | 6:00 PM | 9 |
| Smokers | 8:00 PM | 8 | |||
Qualitative discussions are intended as moderator-directed, informal, non-threatening discussions with participants whose characteristics, habits and attitudes are considered relevant to the topic of discussion. The primary benefits of individual or group qualitative discussions are that they allow for in-depth probing with qualifying participants on behavioural habits, usage patterns, perceptions and attitudes related to the subject matter. This type of discussion allows for flexibility in exploring other areas that may be pertinent to the investigation. Qualitative research allows for more complete understanding of the segment in that the thoughts or feelings are expressed in the participants' "own language" and at their "own levels of passion." Qualitative techniques are used in marketing research as a means of developing insight and direction, rather than collecting quantitatively precise data or absolute measures. As such, results are directional only and cannot be projected to the overall population under study.
The following section provides an overview of the findings from the focus groups conducted during the first phase of the study. Where appropriate, differences in opinions are outlined by each of the key audiences under study.
Participants were first asked to briefly describe their smoking and vaping habits. In each of the smoking groups, a few participants were currently using or had used a vaping device in the past. Similarly, a few in the vaper groups reported also smoking cigarettes at the present time, with nearly all others having done so at some point in the past. In fact, all vapers across locations first began to smoke cigarettes or other tobacco products, before starting to vape. The frequency and length of time vaping varied across and within groups.
Curiosity and a desire to stop smoking tobacco primarily explain decisions to start vaping.
The discussions attempted at understanding the motivations for vaping, either now or in the past. A desire to try something new or to quit smoking often explains the initial decision to start vaping. Indeed, when asked why they had initially chosen to use or try a vaping device, many vapers indicated that they either were drawn to it based on a positive experience from someone they know, curiosity in general, or that they tried vaping as a means to stop or reduce smoking tobacco. These reasons are also mentioned by smokers who have vaped in the past but decided to stop.
"I tried [vaping] because it is new, to see if I could quit smoking or at least cut down." Vancouver Vaper
A less offensive smell was also mentioned as a key reason for using vaping products. Those who currently vape do so for the perceived health benefits of vaping over smoking cigarettes, notably as it is perceived to be healthier or less risky compared to smoking cigarettes, and a more acceptable option when socializing with non-smokers. Some participants expressed that they chose to vape because it would not be harmful to others, compared with the dangers of second-hand smoke. Many also appreciate that is it odourless (or has a non-permanent and pleasant smell) and that it can easily be used indoors.
"There's no scent that comes from the vape. So even though it's controlling your addiction, it's not really harming people around you." Toronto Vaper
"You just can't smoke everywhere now, it's easier to have the vape. I don't know of any places that don't let you use it, it terms of public places and stuff like that, so it's just easier and more convenient." Toronto Vaper
"Pour moi c'était de ne pas toujours être à l'extérieur isolé quand je fume." (For me it was not always being outside alone when smoking.) Montreal Vaper
Many of the participants who currently exclusively vape indicated having started vaping as a means to ease and eventually stop their cigarette smoking habits. For the most part, they do not intend to stop vaping, though some indicated that they did or plan to choose vaping liquids with reduced nicotine levels over time, with the ultimate goal of only vaping nicotine-free products. A few vapers hold hopes to stop vaping eventually. That being said, a few vapers expressed an interest to quit vaping altogether at some point in the future, though they did not have a specific plan towards it.
"I'm feeling like it's a bit more of a habit now than an addiction, so I'm going to transition down to the liquid that has no nicotine in it." Toronto Vaper
"C'est pour essayer d'arrêter de fumer; d'abandonner la cigarette. Les timbres ça n'a jamais fonctionné pour moi. Mais la cigarette électronique ça a l'air de marcher." (It's to try to stop smoking cigarettes. The patch has not worked for me but electronic cigarettes appear to be working.) Montreal Vaper
To a lesser extent, the lower costs of vaping products was mentioned as motivating the choice of these products over cigarettes.
A lack of perceived need to change smoking habits and a lack of curiosity explain why some smokers have never tried vaping.
A number of smokers across groups indicated having never vaped for a variety of reasons. Most notably, not feeling the need or desire to change their smoking habits was commonly mentioned, as well as a general lack of curiosity about these products. These smokers were comfortable with their current decision to smoke cigarettes and did not see any reasons to consider switching. For some smokers in Vancouver, cigarettes were felt to be easily accessible for purchase at many convenient locationsFootnote 1, whereas vaping products were felt to be more difficult to access at specific shops only. In addition, it was considered inconvenient to have to go to a speciality shop to purchase e-liquids, as well as refilling, charging, and cleaning the vaping device. In addition, the process of vaping and the purchase of vaping products appeared overwhelming and somewhat 'foreign' to some smokers, thus making them reticent to try vaping. This 'fear of the unknown' coupled with the lack of perceived need to vape explained their lack of interest.
In many instances, smokers were of the impression that the health risks of vaping were similar to those from smoking cigarettes, thus not providing a clear advantage to them. Finally, the perceived risks associated with the vaping devices, notably in terms of exploding devices, made vaping unappealing to a few smokers. Similarly, a few smokers found the device too big and cumbersome to be attractive, and they found that it looked fragile and as such, prone to breaking.
Interest in vaping stops as it is believed to be less satisfying than smoking cigarettes and is not perceived to have health benefits over smoking cigarettes.
In a few instances, smokers had tried vaping but decided not to continue based on their experience. Most of them did not like the feeling and the taste of vaping and voiced a preference for the warm, familiar burning sensation of smoking cigarettes.
"When I smoke a cigarette, I feel more relaxed, but with a vape, I just don't get that feeling." Toronto Smoker
"The kick in your throat is just not the same." Toronto Smoker
"I like to feel the heat of cigarettes. Smoking just feels more natural to me." Vancouver Smoker
Not knowing exactly the benefits of vaping over smoking cigarettes, and perceptions that the health effects may not be that different, made their decision to continue smoking or quit vaping easier. That being said, there was some interest in considering the product if it was clearly demonstrated that its health effects and health hazards were less severe than those of smoking cigarettes, notably among Toronto and Vancouver smokers. These smokers would look for sound evidence supporting these types of claims.
"If [vaping] was exactly like a cigarette [smoking], but the health risks weren't as bad, I'd be all over it." Toronto Smoker
The convenience and accessibility of buying tobacco was also mentioned as a reason to choose cigarettes over vaping products. Indeed, a few participants mentioned having stopped vaping in favour of smoking cigarettes for this reason. It was mentioned that access to vaping products is more limited than access to cigarettes, which can be purchased from convenience stores that are opened late in the evening.
Vaping is seen as a less satisfying experience than smoking cigarettes, even among some exclusive vapers.
Those who currently or have used a vaping device mentioned that the feeling when vaping is markedly different from that of smoking cigarettes. Indeed, differences are noted on various fronts. To begin, the actual gesture of holding and using a vaping device was deemed significantly different than that of smoking cigarettes. Many of the devices are felt to be heavier and held differently than a cigarette, and the smoking gesture is different, with cigarettes being 'sucked on' while less physical contact was required with a vaping device. In itself, this contributed to vaping being seen as a less satisfying and less familiar experience than smoking cigarettes.
At the same time, the taste of e-cigarettes is considered lighter and cooler (temperature) than that of cigarettes, and the vapour does not feel as though it reaches as far into the lungs as does cigarette smoke. With the addition of flavouring, the taste of e-cigarettes is also different than that of cigarettes, with varying levels of appreciation for this product feature. Vaping also appeared to produce more smoke than cigarettes, thus impacting the user experience.
"La cigarette c'est encore meilleur que la cigarette électronique. C'est une différente sensation dans la gorge et dans les poumons. C'est moins fort et ça comble moins." (Cigarette is still better than e-cigarette. It is a different feeling in your throat and your lungs. It is not as strong and it is less fulfilling.) Montreal Vaper
Altogether, these differences equate to the feeling of being less satisfied when vaping than when smoking cigarettes, with current and former vapers often describing the experience as 'less smooth' or 'less satisfying' overall.
"Vaping is unfulfilling. It just feels like breathing." Vancouver Smoker
"Smoking is a certain experience. You can't replace it." Vancouver Smoker
"Cigarettes are more satisfying, the relief you feel is more satisfying, but they stink!" Vancouver Vaper
The choice of where to vape is socially-dependent and often influenced by the presence of non-smokers.
Vaping usage patterns of those who both vape and use cigarettes appears to be highly influenced by their environment, specifically where they are and who is accompanying them at the time. The choice is often made based on a desire not to smell like cigarette smoke, or not to bother others when in public places. The location itself is not as important as who is with them, with vaping at home, in other private homes, or in public places being mentioned.
"I vape in cars with people in them." Vancouver Vaper
"You can be more liberal about where you vape compared to smoking. You don't have to worry about vaping around kids." Vancouver Smoker
"Si mon ami est non-fumeur, j'essaie de fumer la cigarette électronique pour l'accommoder." (If my friend is a non-smoker, I try to use an e-cigarette to accommodate them.) Montreal Vaper
Those who exclusively vape, for their part, report vaping anywhere and with anyone, although in a few instances, the length of time spent vaping in any given occasion may vary. For example, one vaper in Toronto explained that when vaping at home, she sometimes limits the length of time vaping based on the extent to which the vapour is bothering others in the household. In this instance, it was mentioned that at times, the length of time vaping is difficult to assess, as there is no natural end or 'break' as there would be when smoking cigarettes. That is, each cigarette smoked provides an opportunity to stop smoking at any given time, whereas vaping can continue until the liquid runs out in the device.
"I notice that because it's easier to use indoors and it doesn't smell up the place and it's a bit more acceptable, I probably use it more often than I should because of that." Toronto Vaper
Regardless of smoking habits, vaping is generally done indoors, either at home or in a public place where smoking is prohibited, or in a car. Across locations, many appreciate the opportunity to vape indoors during the winter months, rather than having to go outside to smoke a cigarette. Those who do not smoke cigarettes also mentioned vaping outdoors, while dual smokers/vapers generally prefer to smoke if possible when outdoors, rather than using a vaping device.
"I vape more than smoke because you don't have to go outside." Vancouver Vaper
Ownership of a vaping device depends on the frequency of usage. Pre-mixed e-liquids are most commonly purchased, with the choice of flavoured depending on personal taste. Most vapers buy liquids that contain nicotine.
Ownership of a vaping device is most prevalent among people who vape often, while occasional vapers largely borrow the device when needed given the perceived high cost of purchasing it. Indeed, it was reported that the device costs from fifty dollars upwards to hundreds of dollars, an investment they are prepared to make only if planning on using the device regularly.
There were very few vapers who currently blend their own e-liquids, with only one or two reported in each location. Those vapers are generally looking for better control of nicotine levels, buying the ingredients they need online.
"Pour le taux de nicotine je fais mon propre liquide. Et pour l'arôme aussi." (I mix my own liquid for the nicotine level and for the aroma as well.) Montreal Vaper
Most vapers, however, purchase pre-mixed liquids from a variety of locations, but most notably from vaping lounges and e-cigarette retail stores. While most preferred the simplicity of buying off-the-shelf products, many were unaware they had the option of mixing their own e-liquids. Regardless of mixing preferences, a few vapers indicating buying their products online, with delivery either in Canada or in the United States for pick up.
Preferred flavour is by far the most important consideration in the choice of e-liquids, with the choice based on a personal taste preference. There is a clear preference for sweet flavours (fruits, vanilla, peach, marshmallow, candy, and root beer), with only a few expressing a preference for other flavours including menthol, tobacco, bark ('woodsy' flavours), and popcorn. In Vancouver, a few vapers indicated that they eat less dessert and candy because of vaping, and others felt that they prefer sweet vaping products as an alternative to smoking, given that menthol cigarettes are no longer available.
Usage of products with or without nicotine varies, though across locations, most of those using vaping products voiced a preference for liquids that includes nicotine, as it provides a physical sensation that is closer to that of smoking cigarettes. Interestingly, this was even mentioned by both those who exclusively vape and those who smoke cigarettes in addition to vaping. It should be noted that a few of the occasional vapers, notably in Toronto, did not know if the product they use included nicotine.
"[Liquid without nicotine] doesn't do anything for me." Toronto Vaper
"J'ai choisi un produit avec de la nicotine parce que je fume déjà la cigarette. Je recherchais le même effet." (I chose a product with nicotine because I already smoke cigarettes. I was looking for the same feeling.) Montreal Vaper
The terms, 'vaping products' and 'e-cigarettes' are considered different by vapers, though they are generally perceived as the same by smokers.
Vaping products and e-cigarettes are seen as referring to different products by vapers, though many smokers tend to consider both terms to refer to the same thing. Where differences were noted, vaping products are considered to be the liquids used in vaping devices, or as a more generalized term that can refer to nicotine or marijuana products, while e-cigarettes are considered to be referring to the device itself or an exclusive label for nicotine products.
"Vaping is what an e-cigarette does." Vancouver Smoker
"Vaping is sometimes a clunky machine whereas e-cigarettes are often shaped like a cigarette." Toronto Vaper
Vaping is clearly seen as different from smoking cigarettes, notably in terms of being a more affordable, socially-accepted, and healthier option compared to smoking cigarettes.
Participants were asked to describe how smoking cigarettes and using e-cigarettes compared based on what they know or have heard. A number of differences are reported between vaping and smoking cigarettes, with current vapers more likely than smokers to identify the benefits of vaping, as follows:
Costs
Across both audiences, vaping is widely perceived as a more affordable option than cigarette smoking, following the initial purchase of the device. Indeed, although the cost of the vaping device is seen as substantial, the price of e-liquids compared favourably to that of cigarettes, thus giving the impression that vaping is less expensive than smoking cigarettes. It was also recognized by many that purchasing e-liquids is done less frequently.
"Having transitioned from smoking a pack a day to vaping the equivalent, it's much less expensive." Toronto Vaper
Social Acceptance
Vaping is seen as a more socially-acceptable option, though a few participants in each location mentioned that there remains a stigma in society to the use of e-cigarettes and purchasing vaping products.
"They are popular, but people are still against the vaping subculture." Vancouver Vaper
Health Effects and Risks
Vaping is also seen as a healthier option compared to smoking cigarettes, though more so by those who currently vape than by smokers. More in-depth discussion on the perceived health effects of vaping is discussed later in this report.
"I felt like [vaping] was easier on my lungs." Toronto Vaper
"I'm betting that vaping is better [health-wise] than smoking." Toronto Smoker
Smoke / Vapour and Stains
In general, there is a perception that the smoke resulting from vaping is primarily steam that does not have harmful effects, though these were most commonly expressed as 'hopes' rather than opinions based on factual knowledge. Participants indicated a lack of knowledge about what was 'in' the 'cloud of smoke' that is exhaled when vaping. In an individual exercise, participants commonly reported a low to moderate level of agreement to the statement "second-hand vape from e-cigarettes is as harmful as second-hand smoke from cigarettes", suggesting that they disagree with this statement. While there is a degree of uncertainty regarding this perception, it seems to still be prevalent among those who vape. Based on their own experiences, many also noticed that the smoke from vaping does not smell like anything or has a pleasant odour and does not 'stick on clothes' the same was that cigarette smoke does.
"It doesn't stick on your clothes, it doesn't stick to you and it doesn't bother the people around you." Toronto Vaper
While stained fingers and teeth resulting from smoking cigarettes was mentioned, it was felt that the same is not true of vaping.
Addiction
Participants generally believe that vaping is less addictive than smoking. Interestingly, in an individual exercise, Vancouver is the only location where smokers are more likely than vapers to believe smoking cigarettes is more addictive than vaping e-cigarettes. At the same time, a large majority of participants disagreed with the statement "you can't get addicted to e-cigarettes", indicating that there is a common perception that while those smoking e-cigarettes could be less likely to become addicted than those smoking cigarettes, they are an addictive product all the same.
Accessibility
E-liquids are not as easily accessible as cigarettes, as they are limited to specialty shops, while cigarettes can be purchased in convenience stores. As such, purchasing vaping products requires more planning than purchasing cigarettes. That said, it was recognized that the need to purchase vaping products is less frequent than cigarettes.
Ingredients
Other than flavouring and nicotine, there is little knowledge of what ingredients are in e-liquids, even among those who regularly use these products. There is a general perception, notably among smokers, that e-liquids contain 'some kind of chemicals' though what exactly is not known. In Vancouver, vapers were more knowledgeable than participants in other locations about the products' contents, listing several key ingredients (such as vegetable or propylene glycol).
"I have no idea what's in it, I'd like to analyze the contents." Toronto Vaper
"I don't know a lot about the chemicals and vape flavouring, but at least I know when I'm smoking tobacco, I'm smoking tobacco." Toronto Smoker
In each location, the one or two vapers who mixed their own liquids tended to be more knowledgeable of the specific ingredients. Those vapers mentioned that e-liquids contain nicotine, a flavouring agent, propylene glycol and preservatives. Those participants generally mentioned that e-liquids contains fewer ingredients than cigarettes. The number and nature of ingredients in e-liquids suggested to those participants that these products have fewer health effects than cigarettes.
It was recognized, most notably by vapers, that e-cigarettes do not contain tar, a carcinogenic product contained in cigarettes.
"There's no actual smoke, so you're going to get less tar and noxious chemicals from that." Toronto Smoker
Nicotine
There is a general recognition that most vaping products contain nicotine. While many take note of the level of nicotine in vaping products they use, it is unclear for them how it compares to the intake levels from cigarettes. Indeed, vapers indicated that it is difficult to determine how much they are vaping compared with a fixed number of cigarettes smoked, which makes it difficult to assess their level of nicotine intake.
"Si tu prends plus de puff avec une e-cigarette, tu vas avoir le même montant de nicotine que si tu fumes quelques cigarettes." (If you use e-cigarettes longer, you will ingest the same amount of nicotine as smoking just a few cigarettes.) Montreal Smoker
"I never even realized that there was nicotine and the different strength of nicotine until I got home and started to read, but I couldn't find a comparison, like what was in one cigarette." Toronto Vaper
"You're getting the nicotine, but you're not getting as strong a nicotine going through your system." Toronto Smoker
Equipment
From a negative standpoint, the vaping equipment is seen as more cumbersome and fragile than cigarettes. Some have also heard of the risks of exploding vaping devices. It was mentioned in Toronto that the risk of explosion may be dependent on the quality of the device, assessed by some based on where it is manufactured.
It was noted that the material in the coil could be problematic, as could the quality of material making up the wick. In both Toronto and Vancouver, concern was expressed with the safety related to specific components of the device. More specifically, one vaper expressed concerns with the coils overheating and the risk of burning lips and a few vapers wondered if devices could overheat while being charged.
Other Known Facts
Very few other known facts about vaping were mentioned by participants. In Vancouver, it was mentioned that vaping is not a combustible process, which is the case of smoking cigarettes.
The lack of verified information on the long-term health effects of vaping is a concern across audiences, though vapers clearly hope that their choice to vape is a healthier option than smoking cigarettes.
In an individual exercise, participants were asked to indicate what they believe to be the risks or health effects of smoking cigarettes as well as those of vaping. In terms of smoking cigarettes, the risks or health effects most often mentioned include various cancers, nicotine addiction, respiratory problems such as shortness of breath and emphysema, cardiovascular problems, skin damage, yellowing of teeth, sexual and reproductive issues and the second-hand smoke effects, among others.
"Cancer, emphysema, chronic pulmonary disease, bad teeth." Vancouver Vaper
"Risque aussi pour des personnes qui vivent dans le même environnement." (Also a risk for people living in the same environment.) Montreal Smoker
By comparison, the number of perceived risks or health effects of vaping mentioned by participants were far fewer. Many participants reported that they simply do not know enough about these products and are unsure of what the risks are.
The most commonly-mentioned risk of vaping is dependence or addiction, though some participants indicated that vaping could lead to respiratory problems, 'popcorn lung' and the same health effects as smoking cigarettes, but to a lesser degree. While some have heard of 'popcorn lung', this concept is questioned by many.
"Not clear on the true health effects." Toronto Smoker
"Aucun risque sauf si les liquides contiennent des additifs. " (No risk unless the liquid contains additives). Montreal Vaper
"There is something called 'popcorn lungs', but I don't know what that means." Toronto Vaper
Interestingly, many vapers are not aware of the health effects of nicotine, despite knowing that this ingredient is present in both e-cigarettes and cigarettes. While some believe it is linked to addiction, others believe that it is carcinogenic. These perceptions were more common in Toronto and Montreal, where vapers in the focus groups were less astute regarding vaping products than those in Vancouver.
"[Vaping poses risks] possibly cancer, especially if there is nicotine. I don't think the [vaping products] without nicotine would have the same effects." Toronto Vaper
Despite vapers being more knowledgeable of these products in general compared to cigarette smokers, vapers remain very unsure of the health risks of vaping products, as do non-vapers, though there is a clear hope that vaping is a healthier choice than smoking cigarettes.
"Il y a des risques des deux côtés, mais on ne sait pas bien lesquels." (There are risks on both sides, but we do not know what they are.) Montreal Smoker
A few participants, notably in Vancouver, questioned how someone's health might be affected by the metals / plastics used to make the vaping device or the fiber used to make the wick. Many across locations have also heard of the risks of exploding vaping devices.
Participants generally base their knowledge either on hearsay or experiences with the product, though some had read blogs or online stories related to vaping.
Little personal research has been conducted about vaping, even among those who use these products, with information about the device itself and the experience of vaping being of greatest interest.
Across groups and locations, there is limited personal research conducted regarding vaping, even among those who use these products. Some looked for information, though most times being unsuccessful with locating the desired information. Nonetheless, vapers are marginally more likely than smokers to have looked for related information, and it should be noted that awareness was higher in Vancouver compared to the two other locations. Likewise, vapers who mix their own liquids had researched these products more than those who purchase pre-mix.
In general, word-of-mouth and personal experiences are the primary sources of information regarding vaping. Most notably, others who use the products are relied upon for product referral. Topics such as what devices to choose, new flavours, and health benefits experienced are all primarily sourced through word-of-mouth.
Store staff where e-liquids and vaping equipment are purchased are also relied upon for their knowledge. In some instances, other sources of information are used to verify information provided in-store. Specific information of interest to a few, pertaining to the device, include the type of coil, if the device comes with replacement coils, the size and weight of the device, the battery life, the overall 'look and feel' when holding it, and the price. The information on the device itself is most valued for this group given the financial investment of purchasing the device. In some instances, vapers were also interested in practical information regarding the purchase of e-liquids, including the size of bottles, how long it will last, what the nicotine content is, and the various flavours available.
"I'm much more likely to go into a shop, take a look at what they've got, take that info home, do a bit of research on the brand, the model, there are newer versions, so what's been improved, that sort of thing. Then I'll go back to the brick and mortar shop." Toronto Vaper
"I was just looking at the physical product itself; how it's structured; how it feels; how do you charge it; operate it; take care of it." Toronto Dual Smoker/Vaper
"C'était plus pour l'utilisation. C'est très mécanique tout ça donc mes questions étaient essentiellement sur le fonctionnement plutôt que sur les produits." (It was more for usage information. It is very mechanical so my questions were essentially on how it works rather than the products.) Montreal Vaper
Very few vapers turned to other sources, including the internet, although this appeared more commonly used in Vancouver, and by vapers who mix their own e-liquids in other locations. Google, or other search engines, is generally the starting point for sourcing information online. These vapers have also looked at various blogs on the topic, though no specifics were provided, and have looked at product usage videos on YouTube. A few smokers in Montreal mentioned having learned about vaping through news media reports, in addition to word-of-mouth.
Very few participants across groups and locations had ever discussed vaping with a health professional. Those who did mentioned that physicians shared limited information. One smoker mentioned that their doctor was not favourable to using vaping as a means of quitting smoking, while another smoker indicated that their doctor introduced vaping as a means of quitting cigarette smoking.
It should be noted that while vapers in Vancouver were very astute and aware, they had nonetheless not done much reading on vaping. In a few instances, participants looked for information from sources considered as reputable, such as Health Canada, without being able to find desired information. That said, some said that they had looked at information online before beginning to use vaping products, and some compare ingredients before purchasing new brands of vaping liquid. The information currently available on-package was felt to be too small to read and difficult to interpret. For example, some were unable to determine how much nicotine they were inhaling, and how the amount (as a percentage) would compare to the amount of nicotine in cigarettes.
Labelling information is seldom used to inform purchase choices of vaping products.
There is little awareness of what information is found on vaping product labels, even among those who use these products, although Vancouver vapers appeared more aware in general and many there had noted small warnings about keeping the product away from children, for example. Very few in other locations noticed any warning on the product labels. In Toronto, one vaper noticed warning signs on the device package about possible overheating.
"There was a warning. Did I read it? No." Toronto Vaper
"Yes - there was a baby with a no smoking sign - it was to keep it away from children, and not to swallow or get it on your skin." Vancouver Vaper
A few here and there had noticed other labelling information, including specific ingredients (e.g., propylene-glycol ratio; nicotine levels), though it was recognized by those few that not all products labels specifies ingredients.
"The fact that I cannot see a full ingredient list is bothersome to me." Toronto Vaper
Across locations, no one currently relies on the labelling information to inform their choice of products, with the exception of flavouring choices and price, as well as initial information when first starting to vape.
"Before I switched over [from smoking to vaping] I looked for one particular ingredient, as well as where it was manufactured. I try for made in Canada, but even then it's not regulated." Vancouver Vaper
In Quebec, the law requires that retailers hide products from customers' views, much the same as for cigarettes. As such, labelling information is not used to inform purchase decisions.
There is a strong desire among both vapers and smokers to learn more about vaping, notably its long-term health effects.
Despite limited efforts to source information about vaping, there is a clear need and desire by vapers for more information. Health Canada was mentioned unaided as a potential trusted source of information, and there was a desire to understand what regulation was in place, as well as what testing and research had been done. For the most part, smokers have not looked for information on vaping, though they expressed an interest in knowing more about the product itself and the potential health risks if they were considering using these products.
"There just isn't enough information yet. It's all a bit of a mystery." Vancouver Smoker
What is of great interest to both audiences is to better understand how vaping compares to smoking cigarettes, and the long-term health effects of vaping. Of note, knowing that information is supported by research is of importance in how trustworthy it will be considered.
"I'd like to see the information on the studies. Even if they've started them and they've only been going for five years." Toronto Smoker
In Montreal, smokers also mentioned they would trust information, notably research findings, released by the World Health Organization. Two vapers in Montreal would also trust users posting videos on YouTube for their unbiased point of views. It was also mentioned by one vaper in Montreal that community organizations that help people manage substance abuse would be good places to have this information available that could be used to assist with smoking cessation initiatives.
"Ce sont des utilisateurs qui parlent à des utilisateurs." (They are users speaking to users.) Montreal Vaper
Questions related to how vaping compares to smoking cigarettes, its health effects, ingredient listings, nicotine levels, legislation, and vaping devices are most top-of-mind.
Both smokers and vapers identified a number of questions they have regarding e-cigarettes or vaping products. Most notably, how vaping compares to smoking cigarettes, what are the ingredients of e-liquids (including levels of nicotine), and what are the long-terms health effects are common topics of interest across audiences and locations. Many of the questions also relate to the product itself (functionality; safekeeping; expiry date), and some of the questions also relate to the toxicity of second-hand smoke/vape from vaping. The following provides a more detailed overview of the topics considered of greatest interest to vapers and smokers across locations.
Questions Regarding to the Health Effects of Vaping:
Vapers and smokers are most interested in the health effects of vaping, notably those that will have a long lasting effect. Many wonder how vaping will affect their lungs and what kind of permanent damage can be expected. While some participants were most interested in knowing the general effects of vaping, others expressed a particular interest for understanding the effects associated with each specific component or chemicals included in e-liquids. Specific questions were mentioned regarding the risks associated with nicotine and flavouring agents. In a few instances, among those who mix their own e-liquids, questions were raised with respect to the potential health effects of vegetable or propylene glycol.
Questions Related to Ingredients:
As there is widespread recognition that the ingredients in vaping products would likely affect vapers' health, many questions also related to the composition of e-liquids. Most notably, many vapers and smokers across locations are interested in seeing the list of ingredients included in e-liquids. While many questions related specifically to nicotine, a few also wonder if e-liquids contain tar, and what ingredients might be carcinogenic. A few questions were also raised regarding the possible interactions of vaping products with medications, as well as allergens being included in the ingredient listing.
Questions Specific to Nicotine:
As mentioned, most of participants' questions related to specific components of e-liquids pertained to nicotine. While vapers and smokers recognized that nicotine poses a health risk, a few remained uncertain of whether vaping products contain nicotine, or what concentration of nicotine it contains. A few questions also pertained to the health effects of nicotine beyond being an addictive substance. Participants were uncertain at present what its other effects are. Most notably, most participants across locations expressed a desire to better understand nicotine in vaping products as compared to nicotine in cigarettes, specifically in terms of the type (whether the same or different) and amount or level of nicotine (how it compares and how to control nicotine amounts).
It was suggested to develop a standardized scale to assist vaping users in determining the amount of nicotine in vaping products. As nearly all were current or previous smokers, their point of reference was nicotine consumption per cigarette, and as such, some felt that in addition to including nicotine amounts in milligrams, labels should indicate the amount of nicotine in a bottle in terms of the number of cigarettes smoked to achieve the same level of nicotine. The overall purpose in this case would be to have a point of reference that could be used to assess vaping products, across brands.
"Like Tylenol, we know what low-dose and extra strength is. If all the liquids are playing by the same rules, at least we know where they all lie." Toronto Smoker
In terms of current measures of nicotine, many vapers in Vancouver and Montreal were aware that nicotine is currently measured in milligrams in e-liquids, though they are uncertain of how the concentration compares between e-liquids and cigarettes. Awareness of how nicotine is currently measured in e-liquids was lower in Toronto.
Questions Related to How Vaping Compares to Cigarette Smoking:
As all vapers are either current or former cigarette smokers, it is not surprising to see that they are widely interested in better understanding vaping in comparison to cigarette smoking. Indeed, their level of familiarity and perceived knowledge of cigarettes makes it their point of reference of choice. Topics of interest in comparing both products included the level of nicotine, the health effects of vaping in general and of second-hand smoke/vape, the addictive nature of each product, and the cost difference. Many participants would also welcome information on the equivalence of vaping (by length or quantity) compared to the number of cigarettes smoked. Specifically, knowing how much vaping would equate to smoking one cigarette was most desired, in terms of nicotine ingestion and health effects. Those who have never vaped also expressed an interest in learning more about how vaping products compare to cigarettes, although they showed greater interest in knowing the health effects than in other types of information.
Questions Related to Legislation:
A few questions relate to legislation around vaping. Specifically, a few smokers and vapers across locations would like to know if vaping is regulated, if the manufacturing of e-liquids is controlled, if vaping is allowed in public indoor spaces, the age restrictions for vaping, what research is conducted on vaping, and what testing is conducted by government to ensure the safety of these products. Interestingly, participants were asked to jot down their questions at the beginning of the focus group, before any discussion on vaping.
Questions Related to Vaping Devices:
Very few questions related specifically to the vaping devices. Most notably among those who are curious to find out more, the differences between e-cigarettes and vaping products were of greatest interest, as well as the risks associated with the device itself (e.g., exploding device, metal content).
Other Topics of Lesser Interest:
A few other topics were mentioned as being of interest, though to a much lesser extent that those identified above. These include the pros and cons of vaping in general, what information is available to consumers and where to find it, how to properly refill or store vaping products, how to determine the expiry date of e-liquids, whether vaping can be a good option to stop smoking cigarettes, how costly is it to manufacture vaping products and equipment, how to assess the length of time a manufacturer has been in business, and whether vaping is recommended by health professionals.
As part of the discussion, participants were asked to indicate the importance of a series of topics on their choice of vaping products or e-cigarettes, either now, or if they were to consider these products in the future. Consistent with the spontaneous discussion on questions vapers and smokers have, interest is highest for information on health effects, ingredients and chemicals, information on choosing nicotine levels and comparisons of e-cigarettes to cigarettes.
"The chemicals don't necessarily mean anything to me, I would need the information behind them." Toronto Vaper
Mixed reactions were given related to information about device defects, safety, product reviews and recommendations, laws about where e-cigarettes can be used and the cost of using e-cigarettes, some of which vapers felt would be more appropriate as online information as it was felt to be less important and therefore something that could be sought proactively, if individuals were interested.
Online information on vaping on the Health Canada website is considered most accessible and trustworthy.
Across groups and audiences, the internet is believed to be the best way to access information about vaping and its products, most notably from a trusted, independent and objective source such as Health Canada. Ads on Google were also mentioned as an effective way to inform those looking for information of where to find relevant information online. YouTube was also mentioned by vapers, to access product reviews and usage instruction videos.
"I don't want the company to tell me that the product is safe, I want Health Canada to tell me that the product is safe." Toronto Vaper
Apart from these channels, participants believe that information on vaping should be available in doctors' offices, where these products are sold, on social media (Facebook and Instagram), and on the product labels. Outdoor advertising, notably in public transportation, was recommended to reach a broader audience. Likewise, a few mentioned the use of other mass media such as radio, though these are not deemed as preferred information sources for this topic.
In Toronto, a few vapers believed that information on vaping should be available through Telehealth Ontario, or through services that help people quit smoking.
The lack of labelling regulation on vaping products raised questions about the safety of these products and the risks to users.
Participants were asked what the lack of regulation about labelling on vaping products suggests about this kind of products. In general, mixed opinions were offered. On one hand, it was believed that this situation suggests there are no controls regarding the manufacturing of the product, thus eliciting questions on product safety and a lack of product oversight, which currently exists with cigarettes and more widely with food and other consumer products. In essence, it gave the impression that there is no monitoring of vaping products.
"What it says to me is that there's no control over what's actually in the bottle." Toronto Vaper
A few also mentioned that it implies that research on the long-term effects are inexistent, and thus information is insufficient to inform regulations. While for some, this implies that the risks of using these products is unknown, others believed that the lack of government regulation suggests that the product is safe to use, and thus does not require controls.
"I try for [vaping] products made in Canada, but I know it's not regulated." Vancouver Vaper
"C'est trop jeune pour que Santé Canada prenne une décision à ce sujet-là." (Vaping is too young for Health Canada to take any decisions on those products.) Montreal Smoker
There is a desire for vaping product labelling regulations across audiences, though smokers believe it would not change their consideration of these products.
Regardless of usage or perceptions of vaping products, there was a sense that cigarettes and vaping should have similar approaches when considering research, information and regulation. Labelling regulations would create an increased sense of trust in vaping products across audiences, though many smokers indicated that it would not change their usage consideration of these products. A few indicated, however, that if health implications were conclusively less for vaping compared with smoking based on research, that they would consider switching.
Ingredients listings, amount of nicotine, product expiry date, website URL, side effects or health risks and warning messages on maximum consumption are considered more important information for vaping product labels.
While there is interest for a wide variety of information, participants recognized the limited space available on the labels would prevent everything from being included. As such, they expressed an interest for additional information to be attached to the product (i.e. a leaflet similar to that found with medicine), or on a dedicated website, with prioritization given to key pieces of information.
"If it can't fit on the little bottle, it should be like other medicines with a little fold out piece of paper." Toronto Smoker
"J'aimerais bien avoir des renseignements détaillés comme dans les médicaments sur un papier inséré dans le paquet." (I would like to have detailed information the same as we see on medication; printed on a piece of paper inserted in the packaging.) Montreal Smoker
It was believed that the following information should be included on the product label, at a minimum: list of ingredients; amount of nicotine in milligrams or as a chart comparing it to the amount included in cigarettes; expiry date of the liquid; URL for website where more information is available; known side effects or health risks; and warning messages regarding maximum or recommended consumption levels.
"Maybe the packing should have better labels on it, what it contains, what it can do to you, what it can't do to you." Toronto Vaper
"I want to make an informed choice. I can make comparisons with labels on food. Why not the same for vaping?" Vancouver Vaper
"J'aimerais voir les risques et les effets néfastes pour la santé et aussi quelles sont les équivalences par rapport aux cigarettes traditionnelles." (I would like to know the risks and negative health effects and how it compares to traditional cigarettes.) Montreal Smoker
Fewer considered the following information as important for the label, though they would still like to have access to this information from a trusted source: risks associated with second-hand smoke/vape; in what country the product is manufactured; warnings on the addictive nature of vaping products; if product has been inspected; counter-indications / interactions with medications or health conditions such as diabetes or heart conditions; and the phone number for a 'quit smoking' helpline.
"I would want to know any negative interaction with prescription drugs or a health condition that I may have." Toronto Smoker
It was believed that if a website was developed with information specific to vaping, it should serve as a central repository of information and resources. As such, the website should allow users to search for ingredient information, with the ability to find out what ingredients are included in vaping products, as well as what would be the known or possible health impacts of each specific ingredient.
It was suggested in Toronto that if a website or information line are available to obtain information on vaping, these should be advertised in a way to engage the public rather than positioned only as a source of information. Specifically, it was suggested to say, "To join in the conversation, go to…", thus positioning these tools as engaging and active resources rather than being passive sources of information. As such, it was mentioned that they could include a Q&A section, or engagement tools such as chats and blogs. It was also suggested that new content be included regularly, as they become available.
There are mixed opinions regarding the preferred format for labelling information. Some consider that visual warnings are more effective, while others simply do not pay attention to graphic depictions. There does not seem to be a preference based on vaping product usage. That being said, many participants recognized that information on labels need to be large enough to be readable.
At the same time, some prefer a serious, low-key, factual approach to relaying information using neutral colours, while others believe that a sense of urgency or shock value would attract more attention.
"Des couleurs moins flashy, plus neutre sinon ça attire l'œil et on a envie d'essayer. Neutre on le prendrais plus au sérieux." (Less flashy colours, more neutral, otherwise i twill grab attention and encourage us to use it. With neutral, we would take it more serious.) Montreal Smoker
"It's not necessary to have images. They're so negative. I'm sick of the pictures on cigarettes, they're too extreme. Don't sensationalize - you become numb to it. Just say the facts. The level of risk - the long-term use, if possible." Vancouver Vaper
In Montreal, smokers were asked their opinion on messaging that would position vaping positively rather than indicating the risks of using these products. For the most part, smokers would be skeptical about this kind of information, as it would need to be supported by sound research to ensure it is believable. As they do not believe that research is available on the health effects of vaping, they would remain skeptical with these kinds of claims.
"Si tu mets les choses positives tu n'as pas de preuve. Si tu dis que ça ne cause pas le cancer du poumon, c'est quoi la preuve? Je préfère qu'ils disent que ça peut causer quelque chose plutôt que de dire que ça ne cause pas quelque chose." (If you show something positive, you don't have proof. If you say that it does not cause lung cancer, what is the proof? I prefer that they say that it can cause something rather than affirming that it won't cause something.) Montreal Smoker
The following section provides an overview of the findings from the focus groups conducted during the second phase of the study. Where appropriate, differences in opinions are outlined by each of the key audiences under study.
There is mixed reliance on vaping product labelling to inform the choice of which e-liquids to purchase.
Across groups, very few participants who currently or formerly vaped reported having used product labelling information to inform their choices of e-liquids, other than to identify products that contain nicotine and at what level, or to help with the choice of flavour. Moreover, recall of what information is currently found on the label is mostly limited to those two types of information (nicotine and flavour) in addition to the bottle size and the price. Frequent vapers appear more aware of label content, though they report limited use of that information. Smokers were less familiar with labels and what information is currently available. There is, however, greater reliance on the knowledge and advice of staff at stores selling vaping products.
"I look to see if it's natural - what chemicals are there. Ingredients. And I check the nicotine levels - I ask for the 3mg - and ratio of oils." Vancouver vaper
"Do they even have labels? It's really just a bottle." Vancouver smoker
Ingredient listing, proper usage guidelines and possible health effects were considered the most critical information for vaping product labels.
Regardless of vaping experience, all participants were asked to indicate what information they found critical to appear on the e-liquid label, considering its small size. For the most part, nicotine content, the name of the flavour, usage guidelines and possible health risks were the topics considered of greatest importance. Participants were also interested in knowing the maximum amount that can be safely used to avoid any harmful effects. Most participants also expressed an interest in seeing the ingredients listed on the label, including the relative proportion of each ingredient. A few participants also mentioned that instructions as to how to safely keep the product, any warnings regarding keeping away from children or not to ingest should also be listed on the label.
It was suggested that not all information needed to be on the label, and it was considered acceptable to provide more detailed information on the health effects or risks of vaping or using e-cigarettes elsewhere (online, on a leaflet accompanying the product). A few participants suggested including supplementary information on the back of the bottle label (one that can be "peeled off"), much the same way it is currently used for analgesic or other types of medication.
Participants were informed that until just recently, vaping products labelling was not regulated in Canada, but as of this past May, certain vaping liquid containers require a hazard symbol, safety instructions and first aid statements, but other aspects of labelling are not regulated. Participants were notified that Health Canada is considering further labelling requirements for vaping products, with proposed label information being tested during the focus group discussion.
The labeling associated with four products were tested, including a 15ml bottle (that includes a tag attached to it), a 30ml bottle and box, a 60ml bottle and a vaping cartridge box. Participants were each provided with a sample of each product to review before discussing the label content. For the purpose of the discussion, instructions were provided to focus on the information itself, how it is presented and where it is located on the packaging rather than the overall label design, because each manufacturer would still be allowed to use their own branding, and they would only need to incorporate the prescribed information with their own design. As such, the packages participants looked at were non-branded examples.
The process entailed participants individually reviewing the labelling provided with each product, one at a time. After having looked at the sample, participants were asked to individually rate the readability and clarity of label information, before a short discussion ensued regarding those two aspects in addition to understanding what grabbed their attention. Once this process was repeated for all four products tested, participants were asked to complete another individual exercise to capture their overall opinion of the information included on the labels, followed by a group discussion that focused on how the information was presented on the label, what it suggested about the product and how it influenced participants' opinions towards it.
The following provides an overview of participants' reactions to the labelling information, based on each aspect assessed during the focus groups.
Across products, the labelling information was considered legible and easy to read, though not particularly noticeable.
Generally, the labelling information presented was considered to be shown in a clear and concise manner but not particularly noticeable. That is, participants generally felt that they would not necessarily notice what is on the label, other than in instances where they would be purposefully looking for information (when purchasing a product for the first time, for example).
That being said, across groups, the skull and crossbones symbol and the word "poison" (on the 60 ml bottle) consistently grabbed participants' attention because of the graphic and its status as a known warning sign, and thus would likely be noticed when picking up the bottle. In fact, it was even noticed when missing from the label in some instances.
"I notice the poison symbol - but it needs a description of why it's got a skull!" Vancouver vaper
While labelling information on the larger bottle and packaging was considered easier to read, participants generally felt that the printed information on the 15ml bottle was still legible despite its small size. The clear, simple font, plain background, and space between information were mentioned as helping with legibility. Having all of the information positioned together (such as on the 60ml bottle which lists information together on the label) helped with readability.
The tag attached to the 15ml bottle often captured participants' attention, though many recommended that the font size of the text printed on the tag be bigger for this particular information, given that there is room for it. In some instances, participants felt that attaching a tag to the bottle grabbed their attention and led them to read its content. On the other hand, many mentioned that they would discard the tag, thus losing access to information they deem important, especially the ingredient listing. As such, it was commonly suggested to find a way to include all of the regulated information on the bottle itself, even if it meant requiring manufacturers to print larger labels or use double-sided labels that can be peeled.
"The ingredients should be right on the bottle. I'd throw out the little tag, or a box." Vancouver vaper
The fact that the first aid treatment information was surrounded with a border also helped catch participants' attention. Given the perceived importance of this topic, they felt that this was a good way to present this information, though there were suggestions to make the border even more prominent to make this information stand out to a greater extent.
A few participants questioned why the information on the box was in such small font given the space available to enlarge it. It was felt that the warning and first aid statements should be larger to grab attention.
While labelling information is seen as credible and easy to remember due to familiarity, the messages' impact and meaning are weakened by muted presentation and the lack of a clear relationship between them.
All messages included on the labels were widely seen as credible, though many participants also believed that they were vague or incomplete, thus causing them to ask themselves questions about those claims. In essence, what is written is clearly stated, but what is seen to be missing may be as important. For example, stating that nicotine is addictive was considered to be true, but participants did not know what they would do with this information since they were already aware of this fact. Similarly, the listing of ingredients was evaluated as simple to understand, but the information tested did not provide the level of desired details regarding the type of flavouring used (natural or chemical) and what it is composed of (e.g. 'flavour'), or the origin of ingredients included. Nonetheless, the pieces of information themselves were considered concise, simple, direct, and to the point, despite their simplicity and perceived lack of depth or comprehensiveness. Some participants noted that despite not being informative to them personally, they felt that message around nicotine being addictive was important to include more generally for public awareness. In Vancouver, it was considered an important consideration to inform youth that nicotine is addictive.
"C'est pas mal basique alors c'est facile à retenir." (It's quite basic so it is easy to remember.) Montreal Smoker
"Of course I know nicotine is addictive, but it's important to still say. Kids may not know that." Vancouver smoker
In addition, the relationship between messages was at the time unclear to participants, thus weakening the clarity of each component individually. For example, the skull and crossbones symbol was not systematically associated with the danger of ingesting the e-liquids, though there is greater clarity when considered in combination with the first aid treatment which included the wording "if swallowed…". Indeed, some participants believed that overuse of the product could also lead to harmful health effects. As such, it was suggested by participants to show both components (symbol and first aid treatment) together on the label. Likewise, the statement that the product is harmful (skull and crossbones symbol) or "poison" causes confusion, as it is not readily associated with the risks of nicotine by swallowing. As such, many participants, both vapers and smokers, believed that the warning may apply to using the product in general, or to the presence of other chemicals they are less familiar with, such as propylene glycol.
It should also be noted that participants expressed trust in the information discussed during the focus group as they knew this was regulated by Health Canada, but that this is not evident to them from the package itself. As such, the information may be seen as being as credible without clear acknowledgement that it is a regulated message from Health Canada. It was therefore suggested that a public education campaign be implemented to support the change in regulation.
While memorable to some due to previous familiarity with the information, others felt that the simple, visually uncluttered or 'calm' presentation of information, coupled with the presence of many messages on a single package, would cause them to forget the information.
"It's not impactful - the same emphasis is everywhere. The health warning should be bigger. This looks like a perfume bottle." Vancouver Smoker
While the regulated information was all considered important, it was believed that the labelling requirement should also require that manufacturers provide more detailed information on the safe use of the product (vaping dosage or limits), and more impactful and clear information on the possible health effects. In addition, knowing how vaping or using e-cigarettes compared to smoking tobacco was of great interest to participants. For some, however, the detailed information on the health risks or health effects of vaping could be found through other channels, such as a dedicated government-sponsored website or a leaflet included in the vaping product package.
The perceived harm of vaping or e-cigarettes as compared to cigarettes appears to stay the same or worsen based on the labelling information.
To assess the overall impact of all labelling elements combined, participants were asked to answer the same question individually prior to, and after looking at the labels. This exercise helped understand the extent to which the label information, and the discussion surrounding those, influenced participants' opinions. Participants were asked to indicate, on a scale from minus five to plus five, how the harm of vaping or e-cigarettes compared to the harm associated with smoking (with ratings of minus 5 to minus 1 meaning it is more harmful; a rating of 0 meaning that it is the same; and ratings of plus 1 to plus 5 meaning that vaping or e-cigarettes are less harmful than smoking cigarettes).
It should be noted that both before and after the label review, most Toronto participants held the opinion that vaping or using e-cigarette is less harmful than smoking cigarettes to varying degrees, with a few suggesting that they are the same in that regard. In Montreal, vapers were all of the opinion that vaping or e-cigarettes are less harmful than smoking, while smokers offered mixed opinions with a few believing the contrary applied. In Vancouver, participants across groups generally initially believed vaping to be less harmful than smoking before the review, but ratings mostly fell after review of the materials.
In Toronto, opinions of vapers and smokers were similar which may be explained by the presence of a number of dual smoker and vapers in each group. In Montreal, none of the smokers were current vapers although a few had tried it in the past. These participants' level of familiarity with vaping products was low, which may have impacted a more prevalent perception within that group that vaping and using e-cigarettes are more harmful than smoking cigarettes.
Perceptions that vaping or e-cigarettes are MORE harmful than smoking:
For the most part, those who believe that vaping or e-cigarettes are more harmful than smoking cigarettes profess a lack of clear understanding of these products. This lack of familiarity, and information provided on the test packages explains some participants' negative reaction towards vaping products. This opinion was most prevalent among current smokers.
"Il manque d'information et il n'y a pas assez d'éléments connus ou de recherche. Comment en fait-on une? Y a-t-il un circuit à l'intérieur? Plus de fumée passive?" (Information is missing and there isn't enough known or research done. How do we make one? Is there is circuit inside? More passive smoke?) Montreal Smoker
In Montreal, perceptions surrounding the safety of the device itself appear as important as a lack of knowledge of what is included in e-liquids to support most participants' opinions that vaping or e-cigarettes are more harmful than cigarette smoking.
"Parce qu'à la base, c'est électronique. Cela émet une sorte de rayon qui je pense sera prouvé cancérigène dans quelques années en plus d'être un objet que je peux qualifier de dangereux puisque ça peut couler ou même prendre feu." (It is electronic and the device has emissions that I believe will be proven carcinogenic in a few years. In addition, the device is dangerous as it can leak or catch fire.) Montreal Smoker
Perceptions that vaping or e-cigarettes are as harmful as smoking cigarettes:
Within each group, a few participants believed there are no differences in the harm caused by vaping or using e-cigarettes and smoking. For the most part, these participants believed that both types of products contain nicotine which has negative health effects, thus making them comparable in the harm they are causing. This opinion was most pronounced among smokers.
"I can't see any difference. Vaping also contains nicotine which is harmful." Toronto Smoker
Perceptions that vaping or e-cigarettes are LESS harmful than smoking cigarettes:
A perception that vaping or e-cigarettes contain fewer chemicals and less harmful ingredients leads to the idea that vaping or using e-cigarettes is less harmful than cigarette smoking. In addition, the ability to adjust nicotine levels with vaping appears to be positioning these products as a little less harmful than cigarettes. Amongst current vapers, a few also cited their own perceived healthier experience using vaping or e-cigarettes as proof these products are less harmful.
"Ma plus grande preuve c'est que je suis capable de faire de l'exercice et être en forme tandis qu'avec la cigarette, non." (My biggest proof is that I am able to exercise and be in good shape while with I can't with a cigarette.) Montreal Vaper
"I have heard that the chemicals present when vaping are not as harmful to the body as those found in cigarettes. I've also heard that there are a lot less chemicals involved in vaping." Toronto Smoker
Despite a positive perception of vaping and e-cigarettes compared to cigarettes, a few participants in Montreal indicated that their position would be reinforced if more sound research was available on those products.
"Il faudrait des études sur le liquide pour savoir s'il est dommageable à long-terme, plus que la cigarette." (Research is needed to know if it is more harmful than cigarettes in the long-term.) Montreal Vaper
How Opinions Changed
When comparing the pre and post ratings, the analysis shows that the label information had a small impact on participants' perceptions of the harm associated with vaping or using e-cigarettes compared to smoking cigarettes. Most notably, while opinions of some participants in each group stayed the same, others who initially believed that vaping or e-cigarette use was less harmful than smoking cigarettes were less likely to believe so after seeing the label information. Only a handful of participants, across groups, believed to a greater extent that vaping is less harmful than smoking after review of the proposed materials. In essence, most of the opinion shift was neutral or negative in the level of confidence that vaping or e-cigarettes are less harmful than cigarettes.
By far, the negative connotation associated with the skull and crossbones symbol, and to some extent, the associated word, 'poison' was most influential in negatively impacting perceptions of vaping or e-cigarettes after seeing the labels. To a lesser extent, if participants saw the inclusion of nicotine in the products, it influenced their negative perceptions. Finally, some participants found that the lack of clear information around comparative research or long-term effects of vaping made them more wary.
"My opinion has changed to be more harmful than before because of our discussion about nicotine and the strength of its addictive quality." Toronto Smoker
"Because there is not enough research, I will assume that it is the same or at best only slightly less harmful than cigarettes." Vancouver Smoker
In addition, the simple fact of regulation by Health Canada made some participants feel that vaping may be more harmful than they had previously considered.
"The regulation by Health Canada allows me to be mindful that I should possibly consider it is still harmful." Vancouver Vaper
In addition, a lack of detail on certain ingredients caused participants to feel that smoking and vaping were of equal consequence.
"Product contents are still not clear enough in terms of component breakdown verbiage ("flavour", "aroma", what is that?)." Vancouver Smoker
A few participants felt more confident in vaping products after reviewing materials due to the understated nature of the presentation information on the labels, particularly in comparison to cigarette labelling.
"Considering the light-hearted approach taken on the packages in comparison to cigarette packages, they must be safer." Vancouver Vaper
The following section presents reactions to each of the individual parts of the labelling information discussed during the focus groups.
The first aid treatment statement does not clearly identify when medical attention should be sought and what kind, in addition to providing basic first aid to administer while waiting for medical assistance.
A first aid treatment warning was included on 3 of the 4 product labels and read: "First aid treatment: If swallowed, seek medical attention immediately". While the participants believed that such a statement is important to include if the product can be toxic when ingested, the tested message was seen to lack clear instruction on what kind of medical attention should be sought. Indeed, participants would like to know if they needed to call the poison control centre, go to emergency, call 911, or simply make an appointment with their health practitioner as a result of ingesting the product. While to most the inclusion of the word "immediately" implied sufficient urgency, to others it was unclear. At the same time, many participants wondered if medical attention should be sought for ingesting any amount of liquid, or if there is a minimum amount needed to be harmful. These perceptions may stem from the interpretation of the words "immediately" and "medical attention" which did not provide clear enough instructions.
"It's too passive and there is no sense of urgency. It tells me to go to the walk-in clinic." Toronto Smoker
"Does it depend on the amount or does any amount mean go to the doctor?" Vancouver Smoker
"Just how toxic is it? What do I do? Go to the doctor? Call poison control? Go to emergency? It's not clear, it should say 'poisonous if swallowed'." Vancouver Vaper
Further, it was believed that basic instructions on how to administer first aid while waiting for medical help to arrive was important, especially in situations where a child might have ingested the liquid or if medical assistance was not readily accessible or available. These types of instructions were mentioned as being common for products that include a skull and crossbones symbol, thus perhaps explaining these expectations.
"I think the first aid treatments should be elaborated on in order to contain more treatment advice if medical attention isn't available right away." Toronto Smoker
Bolding the headline, "First Aid Treatment" and including a border around the statement were considered an effective and important means of attracting attention. Given its perceived importance, it was suggested to change the background colour to make the statement stand out against other label components.
For added clarity, it was suggested to add a statement warning that the product should not be ingested or swallowed ("Do not ingest") with or near the first aid treatment warning.
"It should be bolder, stand out more, and it should be closer to the poison message if that's what they mean." Vancouver Vaper
One Montreal participant suggested changing the tense of the verb "obtenir" to "obtenez" to more forcefully suggest that action is required.
The skull and crossbones symbol is attention-getting and positions the product as being a hazard to health if ingested or consumed, though which ingredient is harmful is unclear.
A skull and crossbones symbol was featured on the front of the bottle labels, below the product name. In addition to the symbol, the 60ml bottle also included the word "poison" underneath the image of skull and crossbones. Consistently, this symbol most commonly attracting the attention of participants when first looking at the labels, regardless of the bottle size. In fact, not only did they notice its presence, but some also noticed where it was not included.
"Est-ce que c'est la nicotine qui est poison ou les autres ingrédients?" (Is nicotine poisonous or the other ingredients?) Montreal Vaper
"This symbol reinforces the fact that these products are not good for you." Toronto Vaper
While the symbol captured participants' attention and identified a product that is "dangerous", "harmful", "toxic", and "poisonous" and to some extent "lethal", the exact purpose for including it on a vaping liquid label was less evident to them. Some interpreted it as a health warning, similar to cigarettes, where the product itself was a health hazard, even when used as intended. At the same time, adding the word "poison" next to the symbol enhanced the dangerous nature of the product. In Toronto, one participant noted that this term is typically seen on products which use can cause death, such as rat poison, thus implying the extreme caution needed when using these products.
"It says it's dangerous. It makes me not want to vape. I'm scared! Seems like it will kill you - it's as bad as cigarettes." Vancouver Vaper
"It's clearly not healthy - not good for you, but it's not clear what the poison is." Vancouver Smoker
To a small number, the skull and crossbones symbol was intended to communicate that when ingested, the product would be harmful to someone's health. These participants believed so in part because a first aid treatment included on the label referred to swallowing. That said, it took some time for many participants to make those connections as both elements (symbol and statement) are not located side-by-side on the label. When combined with the word "poison", the warning nature of the symbol is increased, as it implies possible deadly consequences.
Others believed that the symbol implied that the product may have harmful health consequences either when ingested or when used in large amounts, even as intended (vaped). As such, clarity may be needed in describing precisely how the product is dangerous or poisonous.
"C'est poison sous toutes ses formes; qu'on le boive ou qu'on le vapote." (It's poisonous whether we swallow it or vape it.) Montreal Vaper
Further, what would happen when ingested was unclear and caused participants to ask themselves questions on the severity of the consequences, whether it could affect their health temporarily or permanently, or lead to their death. Further, they wondered what amount of liquid needed to be ingested to cause harm. In Montreal, one participant noted having inadvertently ingested a small amount of liquid that leaked from their device, without any noticeable health effect.
When asked how else consumers should be warned of the dangers of ingesting vaping products without using a skull and crossbones symbol, suggestions included spelling out the warning alongside the visual (poisonous when swallowed) or replacing the symbol with one showing the outline of a person swallowing a liquid inside a red circle with a cross bar.
Participants also felt it important that a statement that recommends keeping the product away from children be added to the label as an additional safety measure.
The actual amount of nicotine included in the products should be marked on the label in a way that allows for product comparison.
The nicotine content was marked on the label with the following: "Nicotine 6mg/mL". Across groups, there was some confusion regarding the measure used to indicate the nicotine amount. While for the most part, the acronym "mg/mL" was correctly understood as meaning milligrams per millilitre, the amount of nicotine it referenced was unclear to some. Specifically, there were a few who believed that each bottle, regardless of size, would include 6 milligrams of nicotine. In other instances, the measure was understood as representing the concentration of nicotine in the liquid, though what this exactly meant was unclear. Just a few participants in each group grasped the intended concept, some of them having a scientific background or having had WHMIS training. Vaper participants in Vancouver were more familiar with the information.
"This is exactly what I'm used to, it's very familiar." Vancouver Vaper
Most importantly, the level of nicotine specified on the label (i.e., 6 mg/mL) was not clearly understood, as smokers particularly, and many vapers do not have a point of reference or point of comparison, unless they are regularly vaping. This explains why many participants, especially smokers, expressed an interest for a measure of nicotine that would compare vaping to smoking cigarettes (e.g., comparing the nicotine content in a bottle of e-liquid to the number of cigarettes smoked for the same amount of nicotine). Most importantly, there is an expectation that the nicotine content labelling will allow consumers to compare vaping products across brands and product types. Moreover, a few participants indicated that the level of nicotine can be useful to determine a product "strength" in terms of taste or "feel", and in terms of guiding smokers who wish to slowly wean themselves off of nicotine addiction.
"There is no reference. What does it mean? I'd google it… I could be exposing myself to ten times the nicotine. I just don't know." Vancouver Smoker
There is an expectation that all levels of nicotine will be marked on the product label, including the absence of it and the presence of traceable amounts.
Participants were informed that nicotine content would be specified on products that contain this substance, but that some products do not contain any nicotine or had only trace amounts in them. Knowing this, participants expressed a desire for product labels to indicate whether or not they include nicotine in order to allow them to make an informed choice and be confident with their selection of products.
Three statements were tested to be included on nicotine-free products. They were presented one at a time for discussion, with the presentation order rotated between groups. In general, all statements were considered to communicate the same information, namely that the product has no nicotine in it. The statements, and participants' reactions to each, are as follows:
Nicotine free (Sans nicotine)
This statement was considered clear, concise, familiar, and effective at conveying that the product does not contain nicotine. Comparisons were made by some participants to organic or natural products that use similar wording regarding contents (e.g. pesticide free). That said, a couple of participants indicated that some products bearing that label sometimes included trace amounts of the substance, such as sugar free or alcohol free products. As such, these very few participants felt the statement might be misleading unless it was one hundred percent nicotine free.
"It's less forceful, and reminds me of sugar free gum." Vancouver Vaper
Does not contain nicotine (Ne contient pas de nicotine)
This statement, though clear and easy to understand, was considered too wordy to effectively grab attention. In addition, some felt that this statement clearly states that there is no nicotine at all, and implies that the product is not addictive or harmful.
"If this is Health Canada saying it, I'd trust it more, unless it's a lie! It says there is none." Vancouver Smoker
Zero nicotine, 0mg/mL
This statement was considered overly complicated and including duplicate information. Most considered that "zero nicotine" and "0 mg/mL" communicated the same thing and did not need to appear together. The milligram amount of nicotine made sense as an actual amount if included, but it appeared odd to communicate the absence of nicotine altogether. As such, a number of participants mentioned that "zero nicotine" would suffice.
Trace Amounts
Participants were told that sometimes labels say a product is free of a certain substance even though there is a trace amount of that substances included. They were provided the example of "sugar-free" drinks that can still include a trace amount of sugar, or alcohol-free drinks still have trace amounts of alcohol. Participants were asked how they felt about the three statements knowing that these e-liquids may still include trace amounts of nicotine. It was widely perceived as misleading to suggest that a product is free from a substance (or does not contain it, or includes zero amount) even if it includes traces of the substance. This was notably the case with wording such as "does not contain" or "zero nicotine", but less so with statements that suggest that products "may contain nicotine".
"If it may contain traces of nicotine, do not write zero nicotine." Toronto Smoker
"Just say trace amounts if there is any. Don't lie!" Vancouver Smoker
The statement, "Caution: Nicotine is highly addictive - Health Canada / Attention : la nicotine crée une forte dépendance - Santé Canada" was preferred for its simplicity, though it does not clearly indicate that the product contains nicotine.
The original statement, and two alternative caution statements were presented and each discussed one at a time. The presentation order of these two additional statements were rotated across groups to minimize order biases. After all three statements were discussed, participants were asked to individually select which is most impactful and explain their choice. Across groups, it was clear from participants that the inclusion of the Health Canada signature was considered essential to give credibility to any of the statements.
Across groups, the preferred statement was "Caution: Nicotine is highly addictive - Health Canada / Attention : la nicotine crée une forte dépendance - Santé Canada", with the statement, "This product contains nicotine which is a highly addictive substance. - Health Canada / La nicotine contenue dans ce produit crée une forte dépendance - Santé Canada" being second-most preferred, and only a few individuals across groups and locations preferring the statement "Warning: This product contains nicotine. Nicotine is an addictive substance. - Health Canada / Avertissement : ce produit contient de la nicotine. La nicotine crée une dépendance - Santé Canada" statement. Reactions to each individual statement are presented below.
Caution: Nicotine is highly addictive - Health Canada / Attention : la nicotine crée une forte dépendance - Santé Canada
Comments specific to the caution statements were captured during the initial discussion, as the statement printed on the labels read: "Caution: Nicotine is highly addictive - Health Canada " Attention : la nicotine crée une forte dépendance - Santé Canada". While participants were widely aware of this fact and believed this claim, they endorsed that it should still be included on vaping product labels to inform those new to vaping and as a reminder of the possible health risks of vaping or using e-cigarettes.
That said, the statement was considered too vague and inconspicuous to have a significant impact. While it specifies that nicotine is harmful, it does not mention that the vaping product includes nicotine. It was believed that some people who are not familiar with these kinds of products may not make the link, thus weakening the intended message.
In addition, the word "Caution" was felt to be a soft approach, with some participants comparing it to the words "be careful" rather than a more forceful "warning".
At the same time, it was believed that more prominence should be placed on the information, either visually (bolded, framed information) or by indicating why this information is important to consider. The use of the word "highly" was considered critical to highlight the important health consequence of nicotine.
"I think the caution statement should be more severe. Possibly printed in bold to catch attention." Toronto Smoker
Those who preferred the statement "Caution: Nicotine is highly addictive - Health Canada / Attention : la nicotine crée une forte dépendance - Santé Canada" liked its clarity and simplicity and found that the word "caution" preceding the information was effective at grabbing their attention.
"It always will get my attention. It's less wordy and to the point." Toronto Vaper
"It's simple and sweet. Still a warning, but very simple. Nothing cumbersome of lengthy." Toronto Vaper
"It's precise and concise. The word 'highly' is important because it's true, but they should change 'caution' to 'warning'." Vancouver Vaper
"Parce que c'est prouvé que la nicotine crée une forte dépendance alors on devrait le mentionner. On devrait aviser ou le rappeler au monde avant qu'ils essaient de 'vaper'." (Because it's proven that nicotine is addictive and we should mention that. We should let people know or remind them before they try vaping.) Montreal Smoker
"[Les mots] « attention », « forte » et « dépendance » sont les mots clés qui attirent mon attention. Santé Canada nous dit que le gouvernement est d'accord et qu'on devrait croire l'énoncé." (The words 'caution', 'highly', and 'addictive' attract my attention. Health Canada tells us that the government agrees with the claim and that we should believe it.) Montreal Vaper
Those who did not choose this statement mostly found that it does not clearly state that the vaping product contains nicotine, thus lessening the relevance of the warning statement for people who are not aware that vaping products contain nicotine.
Alternative statement: "Warning: This product contains nicotine. Nicotine is an addictive substance. - Health Canada / Avertissement : ce produit contient de la nicotine. La nicotine crée une dépendance - Santé Canada"
Though the use of the word "warning" attracted attention and the fact that it clearly indicated that the product included nicotine, this statement was considered too wordy. It was, however, often perceived as the one that conveyed the most harm, along with the "caution" statement.
Among English-speaking participants, the word "WARNING" implied a more serious situation or imminent risks, while the word "CAUTION" implied a call to attention and was akin to saying "pay attention", "be aware", "heads up", "be careful"..
"Caution is more like a yield whereas warning means a bigger deal." Toronto Smoker
"Caution is like 'be careful'." Vancouver Vaper
The reverse is, however, apparent in the French groups. Specifically, the word "ATTENTION" (equivalent to the word "caution" in English) was considered more attention-grabbing and implied danger, while the word "AVERTISSEMENT" (associated with the word "warning" in English) applied to situations requiring caution more so than immediate attention.
"The word 'caution' is more of a yield, whereas 'warning' is a bigger deal." Toronto Smoker
Among French and English-speaking participants who chose the statement "Warning: This product contains nicotine. Nicotine is an addictive substance" as most compelling found that the first word grabbed attention, while the statement linked nicotine addiction to the use of the product. The length of the statement was mentioned as the main reason it was not selected as most compelling.
"The word 'warning' is more eye catching and severe. This statement also reiterates that this product contains nicotine rather than just a lonely statement stating that nicotine is highly addictive." Toronto Smoker
Alternate statement: "This product contains nicotine which is a highly addictive substance. - Health Canada / La nicotine contenue dans ce produit crée une forte dépendance - Santé Canada"
This statement was generally seen as more clearly indicating that nicotine is a component of the vaping liquid and as a result, that using the product would introduce the health risks associated with nicotine.
That being said, the statement is considered too long or wordy and somewhat cumbersome, as it includes two ideas in the same sentence. For many participants, the lack of a signal word preceding the statement made it less effective at grabbing people's attention, and minimized the importance of the claim.
Finally, the statement "This product contains nicotine which is a highly addictive substance - Health Canada" was most commonly selected as compelling for the manner in which it implies that the product may lead to addiction as it contains nicotine. Those who did not find this statement most compelling indicated that it is too wordy and the phrasing awkward as it combines two thoughts into one sentence.
"Il me parle directement du produit que j'ai entre les mains et non d'une manière générale." (It speaks to me about the product specifically rather than in general terms.) Montreal Smoker
Listing the ingredients is considered important and additional details on the relative quantity of each are desired.
The ingredient listings included on the labels were discussed. The labels read: "Ingredients: Propylene glycol, glycerine, nicotine, flavour". Participants widely recognized some of the ingredients, notably nicotine and flavour, and to a lesser extent, propylene glycol and glycerine. Having the ingredients listed on the label was considered important across groups and locations, both as a means to inform consumers of the liquid's content, and as a way to compare products prior to purchasing them. In fact, it was deemed critical to include the information on the bottle label rather than on other types of packaging.
Some participants were also pleased to see the limited number of ingredients, especially compared to what they know of cigarette content, with some indicating that it positions vaping products favourably against tobacco.
A few participants mentioned that they would either like to see the exact amount contained in the liquid for each ingredient or the relative proportion, allowing them to compare products. In addition, one participant suggested ordering the ingredients listing from the highest to the lowest amount contained in the product. A couple of Montreal and Toronto vapers also expressed interest in knowing the origin of ingredients, notably if chemical or natural flavour is used.
"I would like to see what type of flavours they are using; natural or artificial?" Toronto Vaper
What is most important to consumers, however, is to know that the list of ingredients is complete. This was considered most important as many were surprised to see how few ingredients are included in vaping products based on the example presented. Consumers also look for more precise information regarding the ingredients, notably in terms of flavours included.
"Il n'y a pas beaucoup [d'ingrédients] sur la liste. Je doute que la liste soit complète." (There are not a lot of ingredients on the list. I doubt that this is a complete list.) Montreal Smoker
To conclude the discussion, participants were asked to share their recommendations as Health Canada moves forward with implementing its vaping product regulations. The following provides a summary of suggestions, with some being paraphrased based on participants' responses:
The following conclusions are drawn from the analysis of focus group discussions.
Vaping often begins out of curiosity to try these products, or as a means to reduce or stop smoking for health or social reasons. The environment also plays an important role in the choice of when and where to vape, as vaping can be done while remaining indoors or when in the presence of non-smokers. While vaping is widely seen as a less satisfying experience than smoking cigarettes, it is perceived as (or at least hope to have) having fewer negative health effects, despite participants not having concrete or conclusive information to that effect. In some instances, interest in vaping stops as it is believed to be a less satisfying experience than smoking cigarettes or because of insufficient evidence showing how vaping has less harmful health effects than smoking cigarettes. Cigarette smokers who have never vaped do not feel the need to change their smoking habits or show little curiosity for vaping. There is simply nothing motivating them to consider these products. Overall, these findings suggest that a decision to vape is primarily influenced by anecdotal evidence of its benefits over smoking cigarettes and a desire to move away from smoking tobacco. There is a clear need for information about vaping products and how they compare to cigarettes, which would allow vapers to make more informed choices regarding these products.
Vaping usage varied across focus group participants. Because of the initial investment costs, ownership of a vaping devices depends on the frequency of usage. In terms of the vaping liquids, pre-mixes are most commonly purchased, with the choice of flavours being a key consideration dependant on personal taste. Controlling the nicotine amount is the most common reason mentioned by the very few participants who mix their own liquids. Regardless, most vapers buy liquids that contain nicotine, though how these compare to nicotine content in cigarettes is unclear. Overall, there is limited knowledge of what product options are available to vapers, notably in terms of what ingredients are included.
Vaping is clearly seen as offering a different experience than smoking cigarettes, notably in terms of offering a less satisfying sensorial experience. The manner in which the vaping device is held, its shape and weight, and the way to inhale the vape all contribute to making the experience less enjoyable. That being said, despite limited knowledge about vaping, the perception is generally that it is a better option than smoking tobacco. Indeed, vaping is perceived as being more affordable, socially-accepted and healthier than smoking cigarettes. Despite these perceived differences, the lack of verified information on the long-term health effects of vaping is a concern. These findings point to the need for more widely distributed information on vaping from a credible source, such as Health Canada to position vaping products against tobacco products.
Even among regular vapers, very few people have looked for information on vaping other than discussing it with current users of these products. In general, information about the device itself and the experience of trying out the product to taste it are of greatest interest to those who are contemplating using these products. Word-of-mouth from current vapers and retailers selling these products are most common sources of vaping information. Some have also looked online, though there is a general sense that there lacks a reliable, neutral, and comprehensive source of information on this topic. Product labelling information is seldom used to inform purchase choices of vaping products, other than nicotine content and flavouring. In fact, there is little recall of other labelling information even among frequent vapers.
Despite vapers not actively looking for vaping information through formal sources of information, there is a strong desire among both vapers and non-vapers to learn more about the long-term health effects of vaping and how it compares to cigarette smoking. In addition, ingredient listings, nicotine levels and a comparison to cigarettes, what legislation is in place regarding vaping, and information about the device itself hold the greatest interest. The possibility of accessing this kind of information online on the Health Canada website is appealing, given the source's credibility.
Both vapers and non-vapers expressed a desire for the Government of Canada to regulate what information appears on vaping product labels. The current lack of labelling regulations sends mixed messages, notably on the product's safety. On one hand, it was believed that the situation implies that the product is safe enough to use that controls are not required. By contrast, this situation sends a different message to some, whereby it implies that insufficient research on vaping is available to inform regulation, ultimately resulting in potential risks to users. Many expressed a desire for cigarettes and vaping to be treated equally in terms of information and regulation.
It should be noted that while supportive of regulation, non-vapers believe that knowing there are labelling guidelines in place would not change their consideration of these products. Given limited space on labels, regulated information should focus on the ingredient listing, nicotine amounts, product expiry date, most important side effects or health risks, and warning messages on maximum consumption recommended. Additional information are still of interest and should be made available on a dedicated section of the Health Canada website, with the URL identified on vaping product labels.
Casual or occasional vapers do not rely on vaping label health-related information to inform their choice of product, other than looking at nicotine content and flavouring, while frequent vapers pay more attention, though still have little reliance on this information. Regardless of usage of vaping products, consumers believe that some information should be consistently included on vaping product labels, most notably the list of ingredients, nicotine content, proper usage guidelines for the product, health warnings, and possible health effects from consumption.
Across labels reviewed, label information was generally considered as legible, clear, concise, and easy to remember, though not particularly noticeable. The use of simple font, short sentences, and a plain background, as well as the labels not being overcrowded helped with visibility.
While each statement is seen as credible on its own and easy to remember, their specific meaning is weakened by the lack of clear relationship between them. At the same time, some of the statements appear incomplete or not providing the depth of information desired to assist consumers with their purchase and consumption decisions and to fulfill their knowledge about vaping products in general (e.g., list of ingredients and first aid treatment). For example, participants were left questioning such things as which chemical is poisonous, what is the breakdown of ingredients within the product, how much liquid needed to be swallowed to require medical attention, and what kind of medical attention would be needed, among a few. The link between labelling components is therefore too weak to ensure the intended messages are properly communicated.
It should also be noted that credibility is influenced by knowing that there are labelling requirements in place by the Government of Canada, something that is not evident only by looking at the product label.
The participants were left with the impression that the product labels were not as informative as they would have liked to educate them on the product, with many indicating they still had questions about vaping products after reviewing the labels. This may in part explain why focus group exercise results reveal that the perceived harm of vaping or e-cigarettes as compared to cigarettes stayed the same, or worsened, based on the labelling information.
The analysis of findings leads to the following conclusions for each of the label components included in the testing:
First Aid Treatment: Though deemed critical for product labelling, the first aid treatment does not clearly specify when medical attention needs to be accessed, and what kind of medical attention is appropriate. At the same time, it was considered lacking instructions to administer basic first aid while waiting for medical attention.
Skull and Crossbones Symbol: This symbol is attention-getting and positions the product as having serious health effects. That said, when seen on its own without the first aid treatment warning, its meaning can be confusing. How the product is harmful or poisonous is unclear, whether only through swallowing or through overuse as well. In addition, which ingredients are harmful is unclear.
Nicotine Content: There is a strong desire to know if a product includes nicotine or not, and what levels of nicotine are included even in trace amounts. The level of nicotine is also important, especially if vaping is used as a means to stop smoking tobacco. Nicotine levels should be reported in a way that is simple to understand, and that allows for product comparison. There is also an expectation that all levels of nicotine will be marked on the label, including the absence of it. In this case the statement "nicotine free" appears most familiar and accurate. Trace amounts of nicotine must be identified on the label.
Nicotine Caution Statement: It was deemed important to inform the public that nicotine is an addictive substance and that the product contains nicotine, using a short, simple, and attention-getting statement. Of the three options tested, "caution: nicotine is highly addictive" was preferred with modifications to indicate that the product contains nicotine ("caution/warning: nicotine contained in this product is addictive"). Of note, the word 'caution' was felt to be much less forceful than 'warning', with participants indicating that 'warning' conveys a stronger message. The Health Canada attribution is important to establish credibility.
Ingredient Listing: Knowing what the product includes is considered very important for product comparison. That said, there is an expectation that the relative amount of each ingredient will be indicated, much the same way they are on food product labels. In addition, there is an expectation that all ingredients will be listed, including the nature of the flavouring used (natural or artificial and what chemicals are used as flavouring agents).
Recruitment Screener
Phase I
Vaping Products Labelling Study Screener: Phase 1 - FINAL
Name:
Daytime phone:
Evening phone:
Email:
Group 1 2 3 4 5 6
FOCUS GROUPS:
Vancouver, BC (ENGLISH)
Date: Monday, March 19, 2018
Location: Vancouver Focus
1080 Howe Street
Suite 503
Time: Group 3 - 6:00 pm - Vapers
Group 4 - 8:00pm - Smokers
Toronto, ON (ENGLISH)
Date: Wednesday, March 21, 2018
Location: CRC Toronto
1867 Yonge Street
Suite 200
Time:Group 5 - 6:00 pm - Vapers
Group 6 - 8:00pm - Smokers
Montreal, QC (FRENCH)
Date: Monday, March 26, 2018
Location: CRC Montreal
1610 Ste-Catherine St W
Bureau 411
Time:Group 1 - 6:00 pm - Vapers
Group 2 - 8:00pm - Smokers
Specification Summary |
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|
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Hello/Bonjour, my name is _ and I am with Corporate Research Associates, a market research company. We are conducting a study on behalf of the Government of Canada, specifically for Health Canada, and we are looking for people to take part in a small group discussion. We would like to speak with someone in your household who is at least 18 years old. Would that be you? IF NO, ASK TO SPEAK WITH SOMEONE ELSE AND REPEAT INTRO
Would you prefer that I continue in English or in French? Préférez-vous continuer en français ou en anglais? [IF FRENCH, CONTINUE IN FRENCH OR ARRANGE CALL BACK WITH FRENCH INTERVIEWER:] Nous vous rappellerons pour mener cette entrevue de recherche en français. Merci. Au revoir.
The purpose of the study and the small group discussions is to hear people's views on health-related issues that affect Canadians. Those who qualify and participate in the group discussion will receive $100 in appreciation for their effort.
May I ask you a few quick questions to see if you are the type of participant we are looking for to take part in this small group discussion? This will take about 6 or 7 minutes. The information you provide will remain completely confidential and you are free to opt out at any time. The information collected will be used for research purposes only and handled according the Privacy Act of Canada.*Thank you.
*IF ASKED: The personal information you provide is protected in accordance with the Privacy Act and is being collected under the authority of section 4 of the Department of Health Act. The information you provide will not be linked with your name on any document including the consent form or the discussion form. In addition to protecting your personal information, the Privacy Act gives you the right to request access to and correction of your personal information. You also have the right to file a complaint with the Office of the Privacy Commissioner if you feel your personal information has been handled improperly. For more information about these rights, or about our privacy practices, please contact Health Canada's Privacy Coordinator at 613-948-1219 or privacy-vie.privee@hc-sc.gc.ca.
THANK & TERMINATE WHERE REQUIRED IN THE SCREENER: Unfortunately, we will not be able to include you in this study. We already have enough participants who have a similar profile to yours. Thank you for your time today.
Gender (By Observation):
Female 1 Recruit 5 per group
Male 2 Recruit 5 per group
To begin, how many years have you been living in [MARKET]? [RECORD # of Years:_]
Less than 2 years 1 THANK AND TERMINATE
At least 2 years or more 2
Do you, or does anyone in your household currently work or have ever worked in any of the following areas?
Marketing/Market Research 1
Public relations, communications, graphic design, or creative agency 2
Advertising or media (TV, Radio, Newspaper) 4
Health sector 6
Government department, federal, provincial or municipal that is
responsible for health or public health 7
An association, organization or company which activities relate in any way
to tobacco, smoking or vaping 8
IF YES TO ANY OF THE ABOVE, THANK AND TERMINATE
In to which of the following age groups do you fall? Are you…?
Less than 18 1 THANK AND TERMINATE
18-29 2 Recruit 2-3 per group
30-39 3 Recruit 2-3 per group
40-49 4 Recruit 2-3 per group
50-59 5 Recruit 1-2 per group
60-69 6 Recruit 1-2 per group
Over 70 7 Recruit max 2 per group
At the present time, do you…
a. Use electronic cigarettes, also known as e-cigarettes?
b. Smoke cigarettes?
Yes 1
No 2
NOTE TO RECRUITER:
VAPER ONLY: IF Q4A=YES AND Q4B=NO - CONSIDER FOR GROUPS 1, 3, 5
SMOKER ONLY: IF Q4A=NO AND Q4B=YES - CONSIDER FOR GROUPS 2, 4, 6
COMBO SMOKER AND VAPER: IF Q4A=YES AND Q4B=YES - CONSIDER FOR GROUPS 1, 3, 5 first
IF Q4A=NO AND Q4B=NO, THANK AND TERMINATE
[ASK IF Q4A=YES (VAPERS)] Which of the following statements best describes your use of e-cigarettes….?
I use e-cigarettes every day 1
I have used e-cigarettes at least once a week in the last 4 weeks 2
I have used e-cigarettes less than once a week in the last 4 weeks 3
I have tried an e-cigarette once 4
NOTE TO RECRUITER:
SMOKERS: IF Q4B=YES AND CODE 3 OR 4 IN Q5 GO TO Q8
VAPERS: IF Q4A=YES AND CODE 1 OR 2 IN Q5 - RECRUIT MIX IN GROUPS 1, 3, 5
IF Q4B=NO (NON-SMOKER) AND CODE 3 OR 4 IN Q5 SELECTED - THANK AND TERMINATE
[ASK IF Q4A=YES AND CODE 1 OR 2 IN Q5 (VAPE DAILY OR AT LEAST ONCE A WEEK IN PAST 4 WEEKS)] How long have you been using e-cigarettes?
Less than 1 year 1
1 to 3 years 2 Recruit mix for Groups 1, 3, 5
4 years or longer 3
[ASK IF Q4A=YES (VAPER) AND Q4B=NO (NON-SMOKER)] Have you ever smoked cigarettes?
Yes 1 Recruit mix for Groups 1, 3, 5
No 2
IF Q4B=YES (SMOKER)] Do you smoke cigarettes every day, frequently, or occasionally?
Every day 1 GO TO Q10
Frequently 2
Occasionally 3
[ASK IF Q8=FREQUENTLY OR OCCASIONALLY] In the past 4 weeks, did you smoke a cigarette at least once a week?
Yes 1 Recruit max 3 per group 2, 4, 6
No 2
IF Q4A=NO (NON-VAPER) AND Q9=NO (DOES NOT SMOKE AT LEAST ONCE A WEEK), THANK AND TERMINATE
[ASK IF Q4B=YES (SMOKER)] How long have you been smoking?
Less than 2 years 1
2-5 years 2
6-10 years 3 Recruit mix for Groups 2, 4, 6
11-20 years 4
Over 20 years 5
[ASK IF Q4B = YES (SMOKER) and IF Q4A=NO (NON-VAPER)] Have you ever tried an e-cigarette?
Yes 1 Recruit mix for Groups 2, 4, 6
No 2
The next few questions will ensure that we include a variety of participants in each group.
What is your employment status? Are you currently … ? READ RESPONSES IN ORDER-CODE ONE ONLY
Employed full-time 1
Employed part-time 2
Self-employed 3
Unemployed 4
Student 5
Stay at home parent 6 Max 5 per group
Retired 7
VOLUNTEERED
Refused 8
IF EMPLOYED, ASK: What is your current occupation?
_TERMINATE IF SIMILAR OCCUPATIONS AS IN Q2
IF RETIRED, ASK: What was your occupation before you retired?
_TERMINATE IF SIMILAR OCCUPATIONS AS IN Q2
We would like to invite a good cross section of people of different income levels. Which of the following best describes your total household income before taxes last year? Would you say…? READ RESPONSES IN ORDER-CODE ONE ONLY
Less than $30,000 1
At least $30,000 but less than $50,000 2
At least $50,000 but less than $75,000 3 Recruit a good mix in each group
At least $75,000 but less than $100,000 4
$100,000 or more 5
VOLUNTEERED
Refused 6
What is the highest level of education you have finished?
Elementary 1
Some High School/Professional Training 2
Completed High School 3
Some College / Technical Training 4 Recruit a good mix in each group
Completed College / Technical Training 5
Some University 6
Completed University 7
And finally, have you ever attended a small group discussion for which you received a sum of money?
Yes 1 CONTINUE - Max of 5 per group
No 2 Go To Invitation
How many group discussions have you attended in the past 5 years? _
What was the subject of all of the group discussions you have ever attended?_
When was the last time you attended a group discussion?_
INVITATION
Based on your responses, it looks like you have the profile we are looking for. I would like to invite you to participate in a small group discussion, called a focus group, we are conducting at _ PM, on. As you may know, focus groups are used to gather information on a particular subject matter; in this case, the discussion will be on health-related issues that affect Canadians. The discussion will consist of 8 to 10 people and will be very informal. It will last approximately two hours, refreshments will be served and you will receive $100 as a thank you for your time. Are you interested and available to attend?
Yes 1
No 2 THANK & TERMINATE
The discussion you will be participating in will be audio and video recorded for use by the research team only to analyze the findings. Please be assured your comments and responses are strictly confidential. Are you comfortable with the discussion being recorded?
Yes 1
No 2 THANK & TERMINATE
The discussion will take place in a room that is equipped with a one-way mirror for observation, allowing Government of Canada employees who are involved in this research to observe the discussion without disturbing it. Some people may also be observing the discussion remotely [SPECIFY ONLY IF ASKED: via web streaming, through the use of a secure online portal]. Your participation will be anonymous and only your first name will be given to these people. Would this be acceptable to you?
Yes 1
No 2 THANK & TERMINATE
During the group discussion, participants will be asked to read materials and write out short responses. Is it possible for you to take part in these activities in English without assistance?
Yes 1
No 2 THANK & TERMINATE
Terminate if person gives a reason such as verbal ability, sight, hearing, or related to reading/writing ability.
Since participants in focus groups are asked to express their thoughts and opinions freely in an informal setting with others, we'd like to know how comfortable you are with such an exercise. Would you say you are…?
Very comfortable 1
Comfortable 2
Not very comfortable 3 THANK & TERMINATE
Not at all comfortable 4 THANK & TERMINATE
To participate in the focus group, you will need to bring with you a signed copy of a consent form. May we have your email address to send you the consent form? Your participation in this research will not influence any interactions or day to day activities you have with the Government of Canada.
RECORD EMAIL: _
ONCE RECORDED - READ BACK TO CONFIRM
Thank you. Just a reminder that the group discussion will be held on [DATE] from [TIME] to [TIME]. To make sure that the discussion begins on time, we ask that you arrive 15 minutes before the start. We will not be able to include you if you arrive late and you will not receive the financial incentive.
Please bring your glasses if you need them to read, and anything else you need to take part in the group discussion. Also, everyone is asked to bring a piece of I.D, picture if possible.
Someone from our company will call you back one or two days before the group discussion. To do that, we will need your contact information. RECORD AT THE TOP OF THE SCREENER
As these are small groups and with even one person missing, the overall success of the group may be affected, I would ask that once you have decided to attend that you make every effort to do so. If something comes up and you are unable to attend, please call_____ (collect) at ________as soon as possible so we can find a replacement.
Thank you, and we look forward to hearing your thoughts during the group discussion.
Attention Recruiters
Confirming - ONE OR TWO DAYS BEFORE GROUP
Moderator's Guide
Phase I
Evaluation of Possible Labelling Elements for Vaping Products - Focus Groups
The goal of this research is to evaluate the expectations of Canadian vapers and smokers with respect to information on vaping products and to evaluate the effectiveness of proposed labelling requirements for vaping products. Specific research objectives include:
10 minutes
30 minutes
For the first part of our discussion, I'd like to learn more about your smoking/vaping preferences and what information you know about the products you use. As part of our discussion today, I'll be asking each of you to complete a few exercises. These will help me get your personal opinions, before our general discussion. I've put all the exercises in one document. [MODERATOR DISTRIBUTES PLACEMAT]
Exercise #1: For the first exercise, I'd like you to jot down what you consider to be the risks or health effects of smoking cigarettes and of vaping or using e-cigarettes. What you write can be based on what you know or what you have heard about it.
Exercise #2: For the second exercise, there is a list of statements about vaping and smoking. I'd like you to circle the scale number that represents the extent to which you agree or disagree with each statement.
Exercise #3: First - what questions do you currently have about vaping products, including e-cigarettes and their liquids - please write down things that you're curious about and don't have the answer to now.
Exercise #4: What information do you think should be available on vaping product labels?
NOTE TO MODERATOR: At this point in the discussion, we are interested in understanding their general information needs without passing out package or device. Later on, we will prompt specifically on certain vaping products.
After exercises are completed: I'd like to learn more about your smoking/vaping preferences…
[ASK TO VAPERS]
[ASK IF BOTH SMOKE AND VAPE]
[ASK ALL]
REVIEW EXERCISE #2 RESPONSES
Vaping/e-cigarettes 30 minutes
I'd like to talk a little more about e-cigarettes or vaping.
30 minutes
In today's world, we are bombarded with information; some are useful, others not. Considering that we need to make choices …
ASK TO NON-VAPERS
For those who do not use e-cigarettes right now…
ASK TO VAPERS
Now if you are using e-cigarettes right now…
Some of this information is found directly on the product label…
ASK ALL
PROMPTS IF NEEDED:
20 minutes
I would now like to focus on information that would be shown on the specific product. Health Canada is proposing new regulations that would require manufacturers to provide information on labels on e-cigarette products. I would now like to focus on your information needs for these labels. For this discussion, I would like to focus on labels on e-cigarette liquids.
Before we finish up, take a moment to jot down your recommendations for the government as it is looking at mandatory information on e-cigarette labels. What do you want them to keep in mind; what's most important. I will give you a few minutes to do so. MODERATOR TO CHECK BACK WITH CLIENTS TO CONFIRM IF THERE ARE ANY MORE QUESTIONS.
That ends our discussion. Thank you for your time and comments. Direct them to the hostess to receive the incentive
Focus Group Materials
Phase I
At the top of the page, there is a small icon of the torso of a person next to the word "group" and a line to write down the group number. The title below reads, "Number one. Risks and Health Effects". Below the title are two sections, side-by-side, allowing blank spaces to write down responses. Each section is identified with a small image: one consisting of cigarettes and the other consisting of vaping devices and e-cigarette. At the top of this page, there is a small icon of the torso of a person next to the word "group" and a line to write down the group number. The title below reads, "Number two. Statements". Below the title is a table with a list of nine statements in the left-hand side column and on the right-hand side column, next to each statement, there is a one to ten number scale, with one being "disagree" and ten being "agree". The nine statements include: "Smoking and vaping have the same risks and health effects"; "Vaping e-cigarettes poses less health risks than smoking cigarettes."; "Smoking cigarettes is more addictive than vaping e-cigarettes."; "Nicotine is a toxic chemical and should be avoided."; "Second-hand vape from e-cigarettes is as harmful as second-hand smoke from cigarettes."; "E-cigarettes always contain nicotine."; "E-cigarettes can help you quit cigarettes."; " The nicotine in e-cigarettes is just as addictive as nicotine in regular cigarettes."; and "You can't get addicted to e-cigarettes." At the top of the page, there is a small icon of the torso of a person next to the word "group" and a line to write down the group number. Below are two boxes. On the left-hand side, the box is titled "Number three. Questions" and includes lines to write down responses, numbered from one to five. The section on the right-hand side of the page is titled "Number four. Packaging" and includes five response line items numbered from one to five.
First page:
Second page:
Third page:
Vaping Products Labelling Study Screener: Phase 2 - FINAL
Name:
Daytime phone:
Evening phone:
Email:
Group 1 2 3 4 5 6
FOCUS GROUPS:
Toronto, ON (ENGLISH)
Date: Monday, June 25, 2018
Location: CRC Toronto
1867 Yonge Street
Suite 200
Time:
Group 1 - 6:00 pm - Vapers
Group 2 - 8:00pm - Smokers
Montreal, QC (FRENCH)
Date: Tuesday, June 26, 2018
Location: CRC Montreal
1610 Ste-Catherine St W
Bureau 411
Time:
Group 3 - 6:00 pm - Vapers
Group 4 - 8:00pm - Smokers
Vancouver, BC (ENGLISH)
Date: Thursday, June 28, 2018
Location:Vancouver Focus
1080 Howe Street
Suite 503
Time:
Group 5 - 6:00 pm - Vapers
Group 6 - 8:00pm - Smokers
Specification Summary |
|
|
|
Hello/Bonjour, my name is____ and I am with Corporate Research Associates, a market research company. We are conducting a study on behalf of the Government of Canada, specifically for Health Canada, and we are looking for people to take part in a small group discussion. We would like to speak with someone in your household who is at least 18 years old. Would that be you? IF NO, ASK TO SPEAK WITH SOMEONE ELSE AND REPEAT INTRO
Would you prefer that I continue in English or in French? Préférez-vous continuer en français ou en anglais? [IF FRENCH, CONTINUE IN FRENCH OR ARRANGE CALL BACK WITH FRENCH INTERVIEWER:] Nous vous rappellerons pour mener cette entrevue de recherche en français. Merci. Au revoir.
The purpose of the study and the small group discussions is to hear people's views on health-related issues that affect Canadians. Those who qualify and participate in the group discussion will receive $100 in appreciation for their effort.
May I ask you a few quick questions to see if you are the type of participant we are looking for to take part in this small group discussion? This will take about 6 or 7 minutes. The information you provide will remain completely confidential and you are free to opt out at any time. The information collected will be used for research purposes only and handled according the Privacy Act of Canada.*Thank you.
*IF ASKED: The personal information you provide is protected in accordance with the Privacy Act and is being collected under the authority of section 4 of the Department of Health Act. The information you provide will not be linked with your name on any document including the consent form or the discussion form. In addition to protecting your personal information, the Privacy Act gives you the right to request access to and correction of your personal information. You also have the right to file a complaint with the Office of the Privacy Commissioner if you feel your personal information has been handled improperly. For more information about these rights, or about our privacy practices, please contact Health Canada's Privacy Coordinator at 613-948-1219 or privacy-vie.privee@hc-sc.gc.ca.
THANK & TERMINATE WHERE REQUIRED IN THE SCREENER: Unfortunately, we will not be able to include you in this study. We already have enough participants who have a similar profile to yours. Thank you for your time today.
Gender (By Observation):
Female 1 Recruit 5 per group
Male 2 Recruit 5 per group
To begin, how many years have you been living in [MARKET]? [RECORD # of Years:__ ]
Less than 2 years 1 THANK AND TERMINATE
At least 2 years or more 2
Do you, or does anyone in your household currently work or have ever worked in any of the following areas?
Marketing/Market Research 1
Public relations, communications, graphic design, or creative agency 2
Advertising or media (TV, Radio, Newspaper) 4
Health sector 6
Government department, federal, provincial or municipal that is responsible for health or public health 7
An association, organization or company which activities relate in any way to tobacco, smoking or vaping 8
IF YES TO ANY OF THE ABOVE, THANK AND TERMINATE
In to which of the following age groups do you fall? Are you…?
Less than 18 1 THANK AND TERMINATE
18-29 2 Recruit 2-3 per group
30-39 3 Recruit 2-3 per group
40-49 4 Recruit 2-3 per group
50-59 5 Recruit 1-2 per group
60-69 6 Recruit 1-2 per group
Over 70 7 Recruit max 2 per group
At the present time, do you…
a. Use electronic cigarettes, also known as e-cigarettes or a vaping device?
b. Smoke cigarettes?
Yes 1
No 2
NOTE TO RECRUITER:
VAPER ONLY: IF Q4A=YES AND Q4B=NO - CONSIDER FOR GROUPS 1, 3, 5
SMOKER ONLY: IF Q4A=NO AND Q4B=YES - CONSIDER FOR GROUPS 2, 4, 6
COMBO SMOKER AND VAPER: IF Q4A=YES AND Q4B=YES - CONSIDER FOR GROUPS 1, 3, 5 first
IF Q4A=NO AND Q4B=NO, THANK AND TERMINATE
4a. [ASK IF Q4A=YES (VAPERS)] How often, if at all, do you use the following in your e-cigarette or vaping device? READ AND RANDOMIZE STATEMENTS A-C
a. Vape fluids containing nicotine
b. Nicotine-free vape fluids
c. Vape fluids containing marijuana/cannabis/THC
Would you say ?
Never 1
Sometimes; or 2
Always 3
VOLUNTEERED
Don't know 8
NOTE TO RECRUITER:
CONSIDER FOR VAPER GROUPS 1, 3, 5 IF:
CONSIDER FOR SMOKER GROUPS 2, 4, 6 IF:
[ASK IF Q4A=YES (VAPERS)] Which of the following statements best describes your use of e-cigarettes….?
I use e-cigarettes every day 1
I have used e-cigarettes at least once a week in the last 4 weeks... 2
I have used e-cigarettes less than once a week in the last 4 weeks 3
I have tried an e-cigarette once 4
NOTE TO RECRUITER:
SMOKERS: IF Q4B=YES AND CODE 3 OR 4 IN Q5 GO TO Q8
VAPERS: IF Q4A=YES AND CODE 1 OR 2 IN Q5 - RECRUIT MIX IN GROUPS 1, 3, 5
IF Q4B=NO (NON-SMOKER) AND CODE 3 OR 4 IN Q5 SELECTED - THANK AND TERMINATE
[ASK IF Q4A=YES AND CODE 1 OR 2 IN Q5 (VAPE DAILY OR AT LEAST ONCE A WEEK IN PAST 4 WEEKS)] How long have you been using e-cigarettes?
Less than 1 year 1
1 to 3 years 2 Recruit mix for Groups 1, 3, 5
4 years or longer 3
[ASK IF Q4A=YES (VAPER) AND Q4B=NO (NON-SMOKER)] Have you ever smoked cigarettes?
Yes 1 Recruit mix for Groups 1, 3, 5
No 2
[ASK IF Q4B=YES (SMOKER)] Do you smoke cigarettes every day, frequently, or occasionally?
Every day 1 GO TO Q10
Frequently 2
Occasionally 3
[ASK IF Q8=FREQUENTLY OR OCCASIONALLY] In the past 4 weeks, did you smoke a cigarette at least once a week?
Yes 1 Recruit max 3 per group 2, 4, 6
No 2
IF Q4A=NO (NON-VAPER) AND Q9=NO (DOES NOT SMOKE AT LEAST ONCE A WEEK), THANK AND TERMINATE
[ASK IF Q4B=YES (SMOKER)] How long have you been smoking?
Less than 2 years 1
2-5 years 2
6-10 years 3 Recruit mix for Groups 2, 4, 6
11-20 years 4
Over 20 years 5
[ASK IF Q4B = YES (SMOKER) and IF Q4A=NO (NON-VAPER)] Have you ever tried an e-cigarette?
Yes 1 Recruit mix for Groups 2, 4, 6
No 2
The next few questions will ensure that we include a variety of participants in each group.
What is your employment status? Are you currently ? READ RESPONSES IN ORDER-CODE ONE ONLY
Employed full-time 1
Employed part-time 2
Self-employed 3
Unemployed 4
Student 5
Stay at home parent 6 Max 5 per group
Retired 7
VOLUNTEERED
Refused 8
IF EMPLOYED, ASK: What is your current occupation?
_TERMINATE IF SIMILAR OCCUPATIONS AS IN Q2
IF RETIRED, ASK: What was your occupation before you retired?
_TERMINATE IF SIMILAR OCCUPATIONS AS IN Q2
We would like to invite a good cross section of people of different income levels. Which of the following best describes your total household income before taxes last year? Would you say ? READ RESPONSES IN ORDER-CODE ONE ONLY
Less than $30,000 1
At least $30,000 but less than $50,000 2
At least $50,000 but less than $75,000 3 Recruit a good mix in each group
At least $75,000 but less than $100,000 4
$100,000 or more 5
VOLUNTEERED
Refused 6
What is the highest level of education you have finished?
Elementary 1
Some High School/Professional Training 2
Completed High School 3
Some College / Technical Training 4 Recruit a good mix in each group
Completed College / Technical Training 5
Some University 6
Completed University 7
And finally, have you ever attended a small group discussion for which you received a sum of money?
Yes 1 CONTINUE - Max of 5 per group
No 2 Go To Invitation
How many group discussions have you attended in the past 5 years?_
What was the subject of all of the group discussions you have ever attended?_
When was the last time you attended a group discussion?_
IF THEY HAVE BEEN TO A GROUP IN THE PAST 6 MONTHS - THANK & TERMINATE,
IF THEY HAVE BEEN TO 3 OR MORE GROUPS IN THE PAST 5 YEARS - THANK & TERMINATE
IF PARTICIPATED IN A PAST GROUP ON SMOKING OR VAPING - THANK & TERMINATE
INVITATION
Based on your responses, it looks like you have the profile we are looking for. I would like to invite you to participate in a small group discussion, called a focus group, we are conducting at ___ PM, on. As you may know, focus groups are used to gather information on a particular subject matter; in this case, the discussion will be on health-related issues that affect Canadians. The discussion will consist of 8 to 10 people and will be very informal. It will last approximately two hours, refreshments will be served and you will receive $100 as a thank you for your time.
Are you interested and available to attend?
Yes 1
No 2 THANK & TERMINATE
The discussion you will be participating in will be audio and video recorded for use by the research team only to analyze the findings. Please be assured your comments and responses are strictly confidential. Are you comfortable with the discussion being recorded?
Yes 1
No 2 THANK & TERMINATE
The discussion will take place in a room that is equipped with a one-way mirror for observation, allowing Government of Canada employees who are involved in this research to observe the discussion without disturbing it. Some people may also be observing the discussion remotely [SPECIFY ONLY IF ASKED: via web streaming, through the use of a secure online portal]. Your participation will be anonymous and only your first name will be given to these people. Would this be acceptable to you?
Yes 1
No 2 THANK & TERMINATE
During the group discussion, participants will be asked to read materials and write out short responses. Is it possible for you to take part in these activities in English without assistance?
Yes 1
No 2 THANK & TERMINATE
Terminate if person gives a reason such as verbal ability, sight, hearing, or related to reading/writing ability.
Since participants in focus groups are asked to express their thoughts and opinions freely in an informal setting with others, we'd like to know how comfortable you are with such an exercise. Would you say you are…?
Very comfortable 1
Comfortable 2
Not very comfortable 3 THANK & TERMINATE
Not at all comfortable 4 THANK & TERMINATE
To participate in the focus group, you will need to bring with you a signed copy of a consent form. May we have your email address to send you the consent form? Your participation in this research will not influence any interactions or day to day activities you have with the Government of Canada.
RECORD EMAIL:_
ONCE RECORDED - READ BACK TO CONFIRM
Thank you. Just a reminder that the group discussion will be held on [DATE] from [TIME] to [TIME]. To make sure that the discussion begins on time, we ask that you arrive 15 minutes before the start. We will not be able to include you if you arrive late and you will not receive the financial incentive.
Please bring your glasses if you need them to read, and anything else you need to take part in the group discussion. Also, everyone is asked to bring a piece of I.D, picture if possible.
Someone from our company will call you back one or two days before the group discussion. To do that, we will need your contact information. RECORD AT THE TOP OF THE SCREENER
As these are small groups and with even one person missing, the overall success of the group may be affected, I would ask that once you have decided to attend that you make every effort to do so. If something comes up and you are unable to attend, please call _ (collect) at _ as soon as possible so we can find a replacement.
Thank you, and we look forward to hearing your thoughts during the group discussion.
Attention Recruiters
Confirming - ONE OR TWO DAYS BEFORE GROUP
Moderator's Guide - FINAL
Evaluation of Labelling Elements for Vaping Products - Focus Groups Phase 2
10 minutes
For the first part of our discussion, I'd like to learn more about your vaping choices. EXERCISE #1 WAS
EXERCISE #2 - Indicate where your opinion falls on the scale that compares vaping to smoking cigarettes.
AFTER THE EXERCISE: Put that aside for now; we'll come back to it later.
ALL:
If you currently vape or use e-cigarettes, I would like to understand a bit more about your choices of vaping liquids. For those who are former vapers or users of e-cigarettes, or who have never tried these devices, I'd like you to answer the questions as if you were considering using vaping devices or e-cigarettes going forward.
70 minutes
Until just recently, vaping products labelling was not regulated in Canada. As of May, certain vaping liquid containers require a hazard symbol, safety instructions and first aid statements, but other aspects of labelling are not regulated.
Health Canada is considering further labelling requirements for vaping products. We will look at some of those today. We will look at four different product examples, one at a time. We will focus on the information itself, how it's presented and where it is located rather than the overall label design. That's because each manufacturer would still be allowed to use their own package branding, and they would only need to incorporate the prescribed information with their own design. The bottles we are looking at are examples only - not any specific brand.
Here is how we will proceed. For each of the four products, I will give each of you a sample to look at, ask you to examine it on your own and answer a few questions individually before discussing your overall reactions together. We will do that for each product, one at a time. Please hold your thoughts as you first see each product.
EACH PRODUCT IS PRESENTED AND DISCUSSED ON ITS OWN BEFORE MOVING TO NEXT PRODUCT;
PRODUCTS ARE PRESENTED IN ORDER: A) 15ML BOTTLE; B) 30ML PACKAGE AND BOTTLE; C) 60ML BOTTLE; D) CARTRIDGE CARTON; DISTRIBUTE ONE SAMPLE PER PARTICIPANT - EXPLAIN LOREM IPSUM WHERE RELEVANT
EXERCISE #3A-D - Now take a few minutes to complete the exercise. First, place a checkmark in the box if this is the size of e-liquid bottles you typically buy. Then indicate to what extent you agree or disagree with each statement. I will give you a moment to do so.
FOLLOWING THE EXERCISE - FOR EACH LABEL, ASK:
Let's have a look at the next product label…REPEAT EXERCISE AND DISCUSSION FOR ALL FOUR PRODUCT SIZES
EXERCISE #4 - AFTER ALL PRODUCTS HAVE BEEN REVIEWED: Now that we have seen all of the products, take a moment to indicate the extent to which you agree or disagree with a number of statements that refer to the information found on these labels.
Let's talk about your overall reactions…
Now I'd like to discuss in greater detail the information on these labels.
"FIRST AID TREATMENT: IF SWALLOWED, SEEK MEDICAL ATTENTION IMMEDIATELY"
SKULL AND CROSSBONES SYMBOL:
"NICOTINE 6 MG/ML"
"INGREDIENTS: PROPYLENE GLYCOL, GLYCERINE, NICOTINE, FLAVOUR"
"CAUTION: NICOTINE IS HIGHLY ADDICTIVE - HEALTH CANADA" (OPTION 1)
I'd like to show you a couple of different options for this warning. SHOW ONE VERSION AT A TIME ROTATE PRESENTATION ORDER
OPTION 2: "THIS PRODUCT CONTAINS NICOTINE WHICH IS A HIGHLY ADDICTIVE SUBSTANCE - HEALTH CANADA"
OPTION 3: "WARNING: THIS PRODUCT CONTAINS NICOTINE. NICOTINE IS AN ADDICTIVE SUBSTANCE - HEALTH CANADA"
FOR EACH, ASK:
EXERCISE #5 - AFTER ALL VERSIONS HAVE BEEN DISCUSSED: Take a moment and jot down on your exercise sheet, which of the three statements is most compelling to you and why.
EXERCISE #6 - Now that we have looked at a number of labels, take a moment to answer another question individually. AFTER COMPLETION:We will come back to it later.
Based on the label information we have looked at, these products would contain nicotine, but some products do not have nicotine.
I'd like to show you statements that could be used on nicotine-free products. These products would still have the list of ingredients, but would not have the skull and crossbones, first aid statement and the warning on them. We will look at three different statements, one at a time. PRESENT EACH STATEMENT ONE AT A TIME - ROTATE PRESENTATION ORDER
OPTION 1: Nicotine free (Sans nicotine),
OPTION 2: Does not contain nicotine (Ne contient pas de nicotine)
OPTION 3: Zero nicotine, 0mg/mL
FOR EACH, ASK:
ONCE ALL SHOWN: Sometimes labels say a product is free of a certain substance even though there is a trace amount of that substance included. For example, "sugar-free" drinks still include a trace amount of sugar, or alcohol-free drinks still have trace amounts of alcohol.
AFTER ALL LABELS HAVE BEEN DISCUSSED:
Looking back at your responses to exercises 2 and 6…
EXERCISE #7 - Before we finish up, take a moment to jot down your recommendations for the government as it is looking at mandatory information on vaping product labels. What do you want them to keep in mind; what's most important. I will give you a few minutes to do so. MODERATOR TO CHECK BACK WITH CLIENTS TO CONFIRM IF THERE ARE ANY MORE QUESTIONS.
That ends our discussion. Thank you for your time and comments. Direct them to the hostess to receive the incentive
Focus Group Materials
Phase II
This page includes the words "first name" followed by a line to write down the response. Below is a table titled "Number two - Vaping or e-cigarettes…". The next row is divided into three sections, each titled "…are MORE harmful than smoking", "…are the SAME", and "…are LESS harmful than smoking". The row below is divided into eleven sections, each including a number on a scale from minus five to plus five. Below is a table with the instruction "why" and space for responses to be written down. This page includes four sections. The four section titles are as follows: "Number three A. Fifteen ml bottle", "Number three B. Thirty ml bottle", "Number three C. Sixty ml bottle", and "Number three D. Cartridge carton". Next to each title is the line "I normally buy this type of product" followed by a small white checkbox. In each of the four sections, there is a table with two statements in the left-hand side column and a one to ten numerical scale on the right-hand side column, with one meaning "disagree" and ten meaning "agree". The two statements include, "This label is easy to read." And "Information on this label is clearly presented." At the top of this page, there is a section titled, "Number four. Statements". Below is a table with five statements on the left-hand side column and a one to ten number scale on the right-hand side column next to each statement, where one means "disagree" and ten means "agree". Below the table is another section titled, "Number five. Choice". It includes a line preceded with "Which one?" and a section to write down comments titled, "Why?". This page includes the words "first name" followed by a line to write down the response. Below is a table titled "Number six - Vaping or e-cigarettes…". The next row is divided into three sections, each titled "…are MORE harmful than smoking", "…are the SAME", and "…are LESS harmful than smoking". The row below is divided into eleven sections, each including a number on a scale from minus five to plus five. Below is a table with the instruction "why" and space for responses to be written down. At the top of this page, there is a title that says "Number seven. Final Thoughts" with lines included below to capture participants' responses.
First page:
Second page:
Third page:
Fourth page:
Fifth page:
Materials Tested
Phase II
Note: All materials were tested on actual 3D bottles and boxes. Here are the labels and boxes in open view.
15 ml bottle The image shows a 15 ml e-liquid bottle label with the following text. On the left side: Premiers soins: En cas d'ingestion obtenir des soins médicaux immédiatement. The first aid treatment statement was presented in an area surrounded by a border. In the middle : Brand name. Flavour. E-liquid/e-liquide. Skull and crossbones symbol. Nicotine 6mg/ml. 15 ml. On the right side: Company Name, Mailing Address, First Aid Treatment: if swallowed, seek medical attention immediately. The first aid treatment statement was presented in an area surrounded by a border.
First page: 15 ml bottle
15 ml bottle tag This image shows additional statements label to be attached to 15 ml and 30 ml sized e-liquid bottles with the following text. On the outer left panel: Attention : la nicotine crée une forte dépendance. Santé Canada. On the outer right panel: Caution: Nicotine is highly addictive. Health Canada. On the inner left panel: Ingredients: Propylene glycol, glycerine, nicotine, flavour. On the inner right panel: Ingrédients : Propylène glycol, glycérine, nicotine, arôme.
First page: 15 ml bottle tag
30 ml bottle The image shows a 30 ml e-liquid bottle label with the following text. On the left side: Premiers soins: En cas d'ingestion obtenir des soins médicaux immédiatement. In the middle : Brand name. Flavour. E-liquid/e-liquide. Skull and crossbones symbol. Nicotine 6mg/ml. 30 ml.. On the right side: Company Name, Mailing Address, First Aid Treatment: if swallowed, seek medical attention immediately. The two first aid treatment statements (English and French) were presented in an area surrounded by a border.
Second page: 30 ml bottle
60 ml bottle The image shows a 60 ml e-liquid bottle label with the following text. On the left side: Premiers soins: En cas d'ingestion obtenir des soins médicaux immédiatement. Attention : la nicotine crée une forte dépendance. Santé Canada. Ingrédients : Propylène glycol, glycérine, nicotine, arôme. In the middle : Brand name. Flavour. E-liquid/e-liquide. Skull and crossbones symbol. Poison. Nicotine 6mg/ml. 60 ml. On the right side: First Aid Treatment: if swallowed, seek medical attention immediately. Caution: Nicotine is highly addictive. Health Canada. Ingredients: Propylene glycol, glycerine, nicotine, flavour. Company Name, Mailing Address. The two first aid treatment statements (English and French) were presented in an area surrounded by a border.
Second page: 60 ml bottle
30ml box This image shows the exterior box packaging for a 30 ml e-liquid bottle with the following text. On the left-side panel: Caution: Nicotine is highly addictive. Health Canada. Ingredients: Propylene glycol, glycerine, nicotine, flavour. Company Name, Mailing Address. On the front panel: Brand name. Flavour. E-liquid/e-liquide. Nicotine 6mg/ml. 30 ml. On the back panel: Attention : la nicotine crée une forte dépendance. Santé Canada. Ingrédients : Propylène glycol, glycérine, nicotine, arôme. On the right side panel: Extra information provided by company / Les informations supplémentaires fournies par l'entreprise. Placeholder text.
Third page: 30 ml box
5 cartridges box This image shows the exterior box packaging for 5 prefilled cartridges for vaping with the following text. On the left side panel: Ingredients: Propylene glycol, glycerine, nicotine, flavour. On the front panel: Brand name. Flavour. Prefilled Cartidges for Vaping / Cartouches pré-remplies pour le vapotage. Nicotine 6mg/ml. 5 cartridges / cartouches. Caution: Nicotine is highly addictive. Health Canada. Attention : la nicotine crée une forte dépendance. Santé Canada. On the right side panel : Ingrédients : Propylène glycol, glycérine, nicotine, arôme. On the back panel: Extra information provided by company / Les informations supplémentaires fournies par l'entreprise. Placeholder text. Company Name, Mailing Address.
Fourth page: 5 cartridges box
Phase 1 of the research was conducted prior to Bill S-5 receiving Royal Assent