Public Opinion Research on Noticeability of Health Information Messages and effectiveness of Health Warnings for Tobacco Labelling - Executive summary

Prepared for Health Canada

Supplier Name: Environics Research
Call-up number: HT372-183473/001/CY
POR Registration Number: POR 058-18
Contract Value: $110,925.04 (HST included).
Award Date: 2018-10-18
Delivery Date: May 2019

Registration Number: POR 058-18

For more information on this report, please contact Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca

Ce rapport est aussi disponible en français.

Public Opinion Research on Noticeability of Health Information Messages and effectiveness of Health Warnings for Tobacco Labelling
Executive summary

Prepared for Health Canada by Environics Research

March 2019

This public opinion research report presents the results of an online survey conducted by Environics Research on behalf of Health Canada. The research was conducted with 3,000 Canadians aged 16 and older who are daily or occasional smokers between January 28 and March 5, 2019.

Permission to reproduce
This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at:
hc.cpab.por-rop.dgcap.sc@canada.ca

©Her Majesty the Queen in Right of Canada, as represented by the Minister of Public Services and Procurement Canada, 2019.

Cat. No. H21-310/2019E-PDF

ISBN 978-0-660-30325-3

Related publications (registration number : POR 058-18)
Catalogue number : H21-310/2019F-PDF (Executive summary, French)
ISBN : 978-0-660-30326-0

Cette publication est aussi disponible en français sous le titre Recherche sur l'opinion publique concernant la visibilité des messages d'information sur la santé et l'efficacité des avertissements de santé pour l'étiquetage du tabac.

Executive summary

Background and objectives

Previous research has demonstrated that health-related information on tobacco product packaging is effective at raising awareness of the health hazards and effects of tobacco use, particularly through both loss-framed (negative consequences) and gain-framed (encouraging) messages on the same package. In Canada, legislation requires Health Warnings (HW) on the outside of tobacco packaging, Health Information Messages (HIM) on the inside, and Toxic Emissions Statements (TS) on the side.

The research objectives are as follows:

1. Health Information Messages: To gather national, quantitative information from smokers about their views of current HIM placement and suggestions on how to improve this component of tobacco labeling which informs Canadians on the health effects of smoking and the health benefits of quitting/provides tips to help people quit tobacco.
2. Health Warnings: To provide quantitative information on draft HW to gauge the clarity and understanding of the HW in conveying the health hazards and health effects of tobacco use. Also, to inform label design and gauge the viability of testing tobacco labeling using an on-line survey tool (as opposed to focus groups).

Methodology

To address the research objectives, an online survey was conducted between January 28 and March 5, 2019 with 3,000 Canadians aged 16 or older who are daily or occasional smokers. Quotas were used to ensure that a sizeable number of surveys were completed by respondents in four different age groups (16-19, 20-24, 25-44 and 45+) across the country. A quota was also included to ensure that at least 1,000 surveys were completed in French which included an oversample in Quebec and the targeting of panellists from areas outside Quebec with sizeable French-speaking populations. The final sample was weighted to reflect the regional and demographic composition of current smokers according to the 2017 Canadian Tobacco Alcohol and Drugs (CTADS) survey.

Survey respondents were drawn from among panels of individuals who have agreed to participate in online surveys. Because the sample is based on those who initially self-selected for participation in the panel, no estimates of sampling error can be calculated, and the results cannot be described as statistically projectable to the target population.

Cost of research

The cost of this research was $110,925.04 (HST included).

Key findings

The findings of this research shed light on how smokers interact with the mandated HIM and HW on cigarette packaging. Recall was measured for a total of 10 HIM, including eight current and two uncirculated HIM. Each respondent then evaluated two of the current HIM in greater detail. In addition, a total of 24 HW that have never appeared on cigarette packages were tested for noticeability. Each respondent completed a detailed evaluation of two HW.

Health Information Messages (HIM)

Respondents are generally aware of the health topics addressed by HIM: 89% of those reporting reading HIM at least rarely recall a current HIM health topic from a list provided. They also have reasonably good recall of existing HIM (six in ten respondents overall recalled at least one current HIM from a set of four images shown), well above the levels of recall for HIM which do not currently appear on cigarette packaging that were provided as a control (and thus they could not have been exposed to). The majority of respondents notice and read HIM at least sometimes and are reading them just as often as a year ago, in large part because they consider them very prominent and hard to miss or ignore. Non-readers cite the lack of new stimuli as the main reason they don't read HIM.

Overall, HIM are judged to be interesting, credible, and in most cases, the right length. Although there is some connection between interest and recall, the connection is weak – the best recalled HIM are not necessarily the ones that score the highest on the various dimensions, (e.g. interest, credibility) nor is there a clear pattern between HIM recall and the element that first catches the eye (e.g. the colour, the headline, the image, etc.). In other words, the most noticeable HIM are not necessarily the ones where the image (or any other element) catches the eye first.

Package type is a main factor in how respondents interact with HIM. Flip-top package users are more likely than slide and shell users to notice HIM, because they are included as an insert, whereas the HIM is found on the backside of the slide of a slide and shell package. However, because flip-top users tend to discard the inserts, slide and shell users are more likely to read HIM. When asked where to place new HIM on slide and shell packages specifically to promote noticeability, the most common suggestion is an insert, which is mentioned more often than the inside flap on the slide or on either side of the shell. This location, however, raises the possibility fewer people would read new HIM, similar to current flip-top inserts.

HIM also appear to resonate more strongly among those who are planning or intending to quit in the next three or six months. Those who are more serious about quitting and are more likely to say the information is interesting, helpful and relevant to them (and to read HIM more often and read more of the content when they do). They are also more likely to express interest in most types of health information, including how to end tobacco addiction, how health improves after quitting and how to reverse the negative effects of smoking, as well as cessation information related to managing cravings and withdrawal symptoms.

Health Warnings (HW)

Respondents were shown five randomly selected HW from the total of 24 tested and asked to rank them in terms of noticeability. They were then given a series of follow up questions about two of them: the one which they chose as the most noticeable and another randomly selected HW.

The detailed evaluations provided information about the noticeability, clarity and comprehension of the HW. The HW with images that were clearly identified as the most eye-catching element also had high noticeability scores. Examples include the HW showing decayed teeth/mouth, neck cancer and oral cancer. The majority of respondents feel that each of the HW tested here clearly communicate the intended health message through the use of images and text. Respondents believe that what the HW are saying about the health effects of smoking is true, would not want to see the image presented again and would remember the health warning in one month's time.

Ratings for believability/credibility were higher for testimonial-style HW (one that tells a true personal story from a real person about how tobacco use has affected their health and lives) and those where health concerns are better known (e.g., pregnancy, impact on babies, lung cancer, throat cancer, heart disease).

Political neutrality statement and contact information

I hereby certify as a Senior Officer of Environics Research that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not contain any reference to electoral voting intentions, political party preferences, standings with the electorate, or ratings of the performance of a political party or its leader.

Sarah Roberton
Vice President, Corporate and Public Affairs
sarah.roberton@environics.ca
613-793-2229
Supplier name: Environics Research Group
PWGSC contract number: HT372-183473/001/CY
Original contract date: 2018-10-18