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
Executive Summary
Prepared by:
Corporate Research Associates Inc.
Prepared for:
Health Canada
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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.