Smokers and Recent Quitters' Awareness and Perceptions of Options to Minimize Harms from Nicotine and Tobacco Products

Final Report

Prepared for Health Canada

Supplier Name: Phoenix SPI
Contract Number: HT372-183932-001-CY
Contract Value: $146,648.24 (including HST)
Award Date: 2018-12-17
Delivery Date: 2019-06-11

Registration Number: POR 093-18

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

Smokers and Recent Quitters' Awareness and Perceptions of Options to Minimize Harms from Nicotine and Tobacco Products

Final Report

Prepared for Health Canada
Supplier name: Phoenix Strategic Perspectives Inc.
June 2019

This public opinion research report presents the results of an online survey conducted with 3,006 current and former smokers aged 18 and older between February 22 and March 14, 2019.

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 or at:

Communications and Public Affairs Branch
Health Canada
200 Eglantine Driveway, Jeanne Mance Building
AL 1915C, Tunney's Pasture
Ottawa, Ontario K1A 0K9

Catalogue number:
H21-311/2019E-PDF
International Standard Book Number (ISBN):
978-0-660-30327-7
Related publications (registration number: POR 093-18):
Catalogue number H21-311/2019F-PDF (Final report, French)
ISBN 978-0-660-30328-4

^© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2019

Cette publication est aussi disponible en français sous le titre : Sensibilisation et perception des fumeurs et des personnes ayant récemment cessé de fumer sur les options visant à réduire les méfaits des produits du tabac

Table of Contents

• Executive Summary
• Introduction
  • 1. Background and Objectives
  • 2. Methodology
  • 3. Notes to Reader
• Detailed Findings
  • 1. Smoker Profile + Behaviours
  • 2. Views on Smoking and Cessation Attitudes
  • 3. Awareness and Use of Nicotine and Tobacco Products
  • 4. Nicotine and Tobacco Products vs. Cigarettes
  • 5. Perceptions of Nicotine and Tobacco Products
  • 6. Motivation to Quit Smoking
  • 7. Quit Experience
  • 8. Stress and Smoking
  • 9. Sources of Information
  • 10. Descriptions of Potentially Harm Reduced Nicotine Products
  • 11. Profile of Survey Respondents
  • 12. Conclusions and Observations
• Appendix
  • 1. Technical Specifications
  • 2. Survey Questionnaire

Figures

• Figure 1: Smoking status
• Figure 2: Length of time since last cigarette
• Figure 3: Cigarettes smoked in the last 30 days
• Figure 4: Length of time smoking
• Figure 5: Number of cigarettes smoked
• Figure 6: Length of time before having first cigarette
• Figure 7: Social Circle [current smokers]
• Figure 8: Social Circle [former smokers]
• Figure 9: Views on smoking and cessation [current smokers]
• Figure 10: Views on smoking and cessation [former smokers]
• Figure 11: Awareness of nicotine and tobacco products [current smokers]
• Figure 12: Awareness of nicotine and tobacco products [former smokers]
• Figure 13: Use of nicotine and tobacco products [current smokers]
• Figure 14: Use of nicotine and tobacco products [former smokers]
• Figure 15: Factors affecting willingness to try nicotine and tobacco products [current smokers]
• Figure 16: Factors affecting willingness to try nicotine and tobacco products [former smokers]
• Figure 17: Reasons for not trying nicotine and tobacco products [current smokers]
• Figure 18: Reasons for not trying nicotine and tobacco products [former smokers]
• Figure 19: Reasons for trying nicotine and tobacco products [current smokers]
• Figure 20: Reasons for trying nicotine and tobacco products [former smokers]
• Figure 21: Nicotine and tobacco products versus cigarettes: experience [current smokers]
• Figure 22: Nicotine and tobacco products versus cigarettes: experience [former smokers]
• Figure 23: Nicotine and tobacco products versus cigarettes: taste [current smokers]
• Figure 24: Nicotine and tobacco products versus cigarettes: taste [former smokers]
• Figure 25: Nicotine products versus cigarettes: nicotine delivery [current smokers]
• Figure 26: Nicotine products versus cigarettes: nicotine delivery [former smokers]
• Figure 27: Friends and family members' view nicotine and tobacco products [current smokers]
• Figure 28: Friends and family members' view nicotine and tobacco products [former smokers]
• Figure 29: Perceived harm of nicotine and tobacco products [current smokers]
• Figure 30: Perceived harm of nicotine products [former smokers]
• Figure 31: Smokeless tobacco products are less harmful than…
• Figure 32: Heated tobacco products are less harmful than…
• Figure 33: Nicotine replacement therapies are less harmful than…
• Figure 34: E-cigarettes with nicotine are less harmful than…
• Figure 35: E-cigarettes without nicotine are less harmful than…
• Figure 36: Cigars/little cigars are less harmful than…
• Figure 37: Water-pipes with tobacco are less harmful than…
• Figure 38: Perceived harm of e-cig devices [current smokers]
• Figure 39: Perceived harm of e-cig devices [current smokers by age]
• Figure 40: Perceived harm of e-cig devices [former smokers]
• Figure 41: Switching to e-cigarettes and health [current smokers]
• Figure 42: Switching to e-cigarettes and health [former smokers]
• Figure 43: Quit attempts [current smokers]
• Figure 44: Readiness to quit [current smokers]
• Figure 45: Actions taken to quit [current smokers]
• Figure 46: Reasons for not quitting [current smokers]
• Figure 47: Confidence in ability to quit
• Figure 48: Quit attempts [former smokers]
• Figure 49: Actions taken to quit [former smokers]
• Figure 50: Use of nicotine products to help quit [former smokers]
• Figure 51: Usefulness of nicotine products in helping one quit [former smokers]
• Figure 52: Stress events [current smokers]
• Figure 53: Stress events [former smokers]
• Figure 54: Stress index
• Figure 55: Stress and quitting smoking
• Figure 56: Thinking about quitting smoking [current smokers]
• Figure 57: Sources of information
• Figure 58: Early adopters [current smokers]
• Figure 59: Early adopters [former smokers]
• Figure 60: Words used to Describe Potentially Harm Reduced Nicotine Products [current smokers]
• Figure 61: Words used to Describe Potentially Harm Reduced Nicotine Products [former smokers]

Executive Summary

Tobacco use is the leading cause of preventable death in Canada. It is a contributing factor to serious chronic diseases, such as cancer, respiratory ailments, and heart disease. Canada's Tobacco Strategy recognizes the health potential of helping those who cannot or will not quit smoking by identifying less harmful products than cigarettes. Though scientific knowledge is still emerging, Health Canada recognizes that providing people who smoke access to less harmful products could provide public health benefits if they reduce tobacco-related death and disease by helping smokers quit or switch completely, even if the product may also bring public health harms.

The objective of the research was to gather information on the attitudes and behaviours of Canadian cigarette smokers and recent quitters (i.e., those who quit smoking within the 12 months preceding the research) with respect to potentially less harmful tobacco and nicotine products. Potentially less harmful tobacco and nicotine products include, but are not limited to, electronic cigarettes, smokeless tobacco, heated tobacco, and nicotine replacement therapies. This research will help Health Canada gain an initial understanding of less harmful tobacco and nicotine products and will help inform policy and public health communications to Canadians.

An online survey was administered to 3,006 current (n=2,500) and former (n=506) cigarette smokers aged 18 and older between February 22 and March 14, 2019. The design targeted former smokers who had quit smoking less than a year prior to the survey (i.e., "recent quitters"); however during the fieldwork, the incidence of eligible recent quitters was lower than anticipated. As a result, eligibility was extended to include former smokers who had quit up to five years ago. The sample was drawn from a panel of online Canadians. Surveys that use samples drawn from online panels cannot be described as statistically projectable to the target population. No estimates of sampling error can be calculated because the sample is based on those who initially self-selected for participation in the panel.

Key findings include:

• Awareness of different tobacco and nicotine products available in Canada is fairly low among current and former smokers.
  • Familiarity tended to be higher for nicotine patches (38% of current smokers know them well or a fair amount and 33% of former smokers), gums (35% of current smokers and 38% of former smokers), and e-cigarettes (31% and 30% respectively), and lower for inhalers (16% and 13% respectively), sprays (16% and 11% respectively), and heated tobacco products (11% and 4% of former respectively).
  • Relatively few respondents know a great deal about any of these products, with most current and former smokers reporting that they know only a little or that they have only heard of the product but know nothing about it. Current and former smokers were most likely to have not heard of heated tobacco products (45% of current smokers compared to 64% of former smokers).
• Use of selected nicotine and tobacco products is fairly low.
  • Current smokers familiar with the products were more likely than former smokers to have at least tried e-cigarettes with nicotine (65%) and without nicotine (52%), nicotine gums (60%), patches (57%), heated tobacco products (56%), and less likely than former smokers to have tried smokeless tobacco products (36%) and nicotine sprays (37%).
  • Half or more of former smokers have never tried any of these products (from 50% who have never tried e-cigarettes with nicotine to 77% who have never tried smokeless tobacco products). Formers smokers who are familiar with the product were more likely to have tried e-cigarettes with nicotine (50%), nicotine gums (44%), and patches (41%).
• Price is the main factor affecting willingness to try nicotine and tobacco products.
  • Respondents familiar with any of these nicotine and tobacco products (i.e., know at least a little about the product) were asked what would affect their willingness to try the products. For current smokers, price (53%) stood out as a factor, followed by potential health benefits (38%), taste (36%), and advice from a healthcare professional or physician (32%).
  • For former smokers, lack of interest topped the list at 50%. This was followed by price (31%), advice from a healthcare professional or physician (27%), and potential health harms (24%).
• Use of nicotine and tobacco products other than cigarettes tends to be less satisfying than smoking cigarettes.
  • Current smokers' experiences using nicotine and tobacco products were usually described as less satisfying than smoking regular cigarettes. This was especially the case regarding nicotine gums and patches, with each described as somewhat or much less satisfying than smoking regular cigarettes by approximately two-thirds of current smokers (68% said this about patches and 65% said this about gums). The exception was heated tobacco products. It was the only product whose use was more likely to be described as somewhat or much more satisfying (37%) in comparison with smoking cigarettes.
  • Former smokers were more likely than current smokers to describe their use of nicotine and tobacco products as less satisfying than smoking regular cigarettes. The majority of former smokers described their experiences with most of these products as somewhat or much less satisfying than smoking regular cigarettes: 77% said this about gums, 75% about lozenges, 71% about patches, 70% about sprays, 69% about inhalers, and 63% about smokeless tobacco products.
• Taste of nicotine and tobacco products tend to be viewed as less satisfying compared to taste of cigarettes.
  • The majority of current smokers described the taste of nicotine gums (59%) and lozenges (52%) as somewhat or much less satisfying than that of regular cigarettes. E-cigarettes with nicotine and heated tobacco products were the only products more likely to be viewed as somewhat or much more satisfying than the taste of regular cigarettes: 40% of current smokers said e-cigarettes with nicotine are more satisfying compared to 36% who said they are less satisfying and 36% of current smokers said this about heated tobacco products compared to 32% who said they are less satisfying. The taste of all other products was considered to be somewhat or much less satisfying than the taste of regular cigarettes.
  • Former smokers were more likely than current smokers to say the taste of these nicotine and tobacco products was somewhat or much less satisfying than the taste of regular cigarettes. This was the case for five products: nicotine inhalers (70%), nicotine gums (66%), nicotine sprays (62%), nicotine lozenges (58%), and smokeless tobacco products (52%). In only two cases, that of e-cigarettes with and without nicotine, were former smokers more likely than current smokers to describe the taste of the product as somewhat or much more satisfying than that of cigarettes (47% and 55% respectively).
• Assessments of the nicotine delivery of nicotine and tobacco products compared to the nicotine delivery provided by regular cigarettes varied by product.
  • Approximately two-thirds of current smokers rated gums (67%) and patches (64%) as less satisfying than cigarettes, and many (55%) provided a similar assessment of lozenges. Similarly, e-cigarettes with nicotine and nicotine inhalers were reported by similar proportions (44% and 43% respectively) as having less satisfying nicotine delivery as compared to cigarettes. Heated tobacco products were the only product more likely to compare favourably (i.e., to be rated as somewhat or much more satisfying) than unfavourably (i.e., somewhat or much less satisfying) with regular cigarettes in this regard. Specifically, 40% of current smokers considered them somewhat or much more satisfying versus 26% who considered them somewhat or much less satisfying. Use of heated tobacco products was low, however, with just 5% of current smokers using these products daily and 12% using them at least weekly.
  • More former smokers rated gums (82% of former smokers compared to 67% of current smokers), lozenges (76% and 55% respectively), inhalers (74% and 43% respectively), and sprays (67% and 36% respectively) as somewhat or much less satisfying in terms of nicotine delivery. Only in the case of e-cigarettes with nicotine did assessments of current and former smokers tend to be similar (27% of current and 24% of former smokers rated the delivery of nicotine using e-cigarettes as somewhat or much more satisfying than the nicotine delivery of regular cigarettes).
• All nicotine and tobacco products, including different types of e-cigarettes, were viewed as at least a little harmful.
  • Most current smokers thought each of the nicotine and tobacco products listed cause some degree of harm to the person using them. That being said, the perceived extent of harm posed by each product varied. Cigarettes and cigars/little cigars were viewed as the most harmful, with the majority of current and former smokers rating them as very or extremely harmful (current smokers: 67% and 58% respectively; and former smokers: 87% and 69% respectively).
  • Current and former smokers' perceptions of the degree of harm caused by e-cigarettes did not tend to vary much by type of e-cigarette device. Between one in five (21%) and one-quarter (25%) of current smokers considered each type of e-cigarette device as causing serious harm (i.e., very or extremely harmful). Similar proportions of former smokers rated each type of e-cigarette as very or extremely harmful to a person's general health: rechargeable e-cigarettes (31%), disposable e-cigarettes (30%), vape pens (31%), tank and mod vape systems (30%), pod vape systems (29%), and mini mode vape systems (28%).
  • Common reasons selected to explain why some nicotine and tobacco products are less harmful than others were the lack of second-hand smoke, the perception that the product does not contain nicotine, and perception that the product does not contain as many chemicals.
• Current and former smokers believe that switching to e-cigarettes improves health.
  • A large proportion of current smokers believe that quitting smoking cigarettes and switching to e-cigarettes would improve one's health, though they were more likely to think this to be the case when switching to e-cigarettes without nicotine (50%) than to e-cigarettes with nicotine (43%).
  • Perceptions among former smokers were very similar to those of current smokers, with the main difference being an even larger proportion of former smokers who said that health would improve 'a lot' if one switches to nicotine-free e-cigarettes. Twenty-two percent think that the health of a smoker would improve 'a lot' if one switches to e-cigarettes without nicotine compared to e-cigarettes with nicotine (9%).
• Four in 10 former smokers used e-cigarettes to help them quit.
  • Former smokers were most likely to have used e-cigarettes (41%) as a cessation method. Three in 10 (30%) said they used nicotine replacement therapies, while approximately one-quarter said they used smokeless tobacco products (23%) to help quit smoking.
  • In terms of the impact of these products on smoking cessation, former smokers were most likely to attribute a big role to e-cigarettes, with three in 10 (29%) saying they had a moderate to big role in helping them quit smoking. In contrast, just over half (51%) of former smokers described smokeless tobacco products as playing no role at all in helping them quit smoking and staying quit and 38% said this about nicotine replacement therapies.
• Health professionals are the top sources of information about switching from cigarettes to another product.
  • Former smokers were more likely to identify health/health care-related sources when asked where they would you go to get more information about switching from cigarettes to another product containing nicotine, one that is potentially less harmful to their health. This included a physician/family doctor/nurse practitioner (55% of former smokers versus 48% of current smokers), a health counsellor (27% of former smokers versus 19% of current smokers), and a municipal public health unit (12% of former smokers versus 7% of current smokers).

The contract value was $146,648.24 (including HST).

Political Neutrality Certification

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

Signed:

Alethea Woods, President Phoenix Strategic Perspectives Inc.

Introduction

Phoenix Strategic Perspectives (Phoenix SPI) was commissioned by Health Canada to conduct an online survey of Canadians who currently smoke and who have recently quit smoking.

1. Background and Objectives

Tobacco use is the leading cause of preventable death in Canada. It is a contributing factor to serious chronic diseases such as cancer, respiratory ailments, and heart disease. Approximately fifty percent of long-term smokers die prematurely from smoking-related diseases, amounting to over 45,000 deaths attributable to smoking in Canada each year.

In order to reduce the burden of disease and disability, the Government of Canada announced a target of less than 5% tobacco use by 2035. ¹ The Strategy will feature broad, population-based approaches needed to achieve the ambitious target, and targeted approaches focussed on specific populations with high levels of tobacco use. To realize this objective, Health Canada needs to prevent initiation of tobacco use as well as support smoking cessation.

Canada's Tobacco Strategy recognizes the health potential of helping those who cannot or will not quit smoking by identifying less harmful products than cigarettes. Though scientific knowledge is still emerging, Health Canada recognizes that less harmful products could provide public health benefits if they reduce tobacco-related death and disease by helping smokers quit or switch completely, even if the product may also bring public health harms. Potentially less harmful tobacco and nicotine products include, but are not limited to, electronic cigarettes, smokeless tobacco, heated tobacco, and nicotine replacement therapies.

Data is limited on Canadian cigarette smokers' and recent quitters' awareness, perceptions, beliefs, attitudes, knowledge and behaviours regarding potentially less harmful nicotine and tobacco products, their health risks, and their use as aids to reduce or quit smoking. The primary objective of the study, therefore, was to gather information on the attitudes and behaviours of Canadian cigarette smokers and recent quitters with respect to potentially less harmful nicotine and tobacco products. Specific research objectives included the following:

• Measuring current smokers' and recent quitters' level of awareness and knowledge of potentially less harmful nicotine and tobacco products;
• Gathering information on current smokers' and recent quitters' attitudes and behaviours with respect to potentially less harmful nicotine and tobacco products; and
• Measuring the perceptions of current smokers and recent quitters regarding the relative preference of these potentially less harmful nicotine and tobacco products.

This research will help Health Canada gain an initial understanding of less harmful tobacco and nicotine products and will help inform policy and public health communications to Canadians.

2. Methodology

An online survey was administered to 3,006 current (n=2,500) and former (n=506) cigarette smokers aged 18 and older between February 22 and March 14, 2019. Current smokers included daily and non-daily (i.e., occasional) smokers who had smoked in the 30 days prior to the survey. Former smokers were smokers who had quit in the five years prior to the survey. The design targeted former smokers who had quit smoking less than a year prior to the survey (i.e., "recent quitters"); however during the fieldwork, the incidence of eligible recent quitters was lower than anticipated. As a result, eligibility was extended to include former smokers who had quit up to five years ago.

The survey averaged 15 minutes to complete. The sample was drawn from Dynata's panel of online Canadians. Panellists were invited to participate in the survey through an email invitation which contained a password-protected URL to access the survey. Survey data was weighted by region, age and gender to reflect the demographic composition of the target population. Surveys that use samples drawn from online panels cannot be described as statistically projectable to the target population. No estimates of sampling error can be calculated because the sample is based on those who initially self-selected for participation in the panel.

More information on the methodology can be found in the Appendix of this report: Technical Specifications of Research.

3. Notes to Reader

• In the report, "current smokers" refers to daily and occasional smokers who had smoked cigarettes in the 30 days preceding the survey. "Former smokers" refers to smokers who had quit smoking in the five years prior to the survey. This includes those who had quit within the last year (i.e., "recent quitters") and those who had quit smoking between one and five years ago (i.e., "longer-term quitters").
• The current smoker and former smoker survey data were kept separate for the analysis. As such, the results are presented separately in the detailed findings, typically first for current smokers, and then for former smokers.
• All results are expressed as percentages, unless otherwise noted. Throughout the report, percentages may not always add to 100 due to rounding and/or multiple responses being offered by respondents.
• At times, the number of respondents changes in the report because questions were asked of sub-samples of the survey population. Accordingly, readers should be aware of this and exercise caution when interpreting results based on smaller numbers of respondents. In particular, caution should be exercised in interpreting results for former smokers who have tried heated tobacco products because of the very small sample size (n=16).
• Where base sizes are reported in tables and graphs, they reflect the actual number of respondents who were asked the question.
• Demographic and other subgroup differences are identified in the report. When reporting subgroup variations, only differences that are significant at the 95% confidence level and that pertain to a subgroup sample size of more than n=30 are discussed in the report. If one or more categories in a subgroup are not mentioned in a discussion of subgroup differences (for example, if two out of four age groups are compared), it can be assumed that significant differences were found only among the categories reported.
• The survey questionnaire can be found in Appendix along with more information about the technical specifications of research.

Detailed Findings

1. Smoker Profile + Behaviours

Smoking status of survey respondents A total of 3,006 respondents were surveyed for this study. Of those respondents, 58% were daily smokers, 25% were occasional smokers and 17% were former smokers.

Figure 1 - Text Equivalent

Smoking status

Q6. At the present time, do you smoke cigarettes every day, occasionally or not at all?	All respondents (n= 3,006)
Daily smoker	58%
Occasional smoker	25%
Former smoker	17%

Base: n=3,006; all respondents Q6. At the present time, do you smoke cigarettes every day, occasionally or not at all?

The likelihood of smoking daily was higher among smokers aged 65 and older (80%) than smokers aged 18 to 34 years (51%). It also increased with the number of years a respondent has been smoking (from 22% of those who have been smoking for less than a year to 82% of those who have been smoking for over 20 years).

University graduates (64%) were less likely to be daily smokers than smokers with high school or less (75%) or a college level education (70%). Daily smokers were more likely to come from lower income households (74% reported a household income of under $40,000 compared to 63% who reported a household income of $80,000 to just under $100,000 and 65% who reported a household income of $100,000 to just under $150,000).

Two-thirds of former smokers quit between 1 and 5 years ago Of the 506 respondents who identified as former smokers, 65% quit smoking between one and five years ago and 35% quit smoking within the last year. Specifically, 8% last smoked a cigarette less than one month ago, 9% between one and three months ago, 10% between four and six months ago, and 8% between seven and 12 months ago.

Figure 2 - Text Equivalent

Length of time since last cigarette

Q8. When did you last smoke a cigarette?	Former smoker (n= 506)
Less than 1 month	8%
1 month	2%
2 months	3%
3 months	4%
4-6 months	10%
7 months to just under 1 year	8%
1-5 years	65%

Base: n=506; former smokers Q8. When did you last smoke a cigarette? Q9. How many months has it been since you last smoked a cigarette?

One in 10 occasional smokers smoked a whole cigarette every day in the past 30 days One in 10 (10%) self-identified occasional smokers (n=858) said they smoked at least one whole cigarette every day over the past 30 days. Similar proportions smoked only on weekends (36%) or on weekends and weekdays (but not daily) (38%). Six percent of occasional smokers smoked a whole cigarette on weekdays only over the past 30 days.

Figure 3 - Text Equivalent

Cigarettes smoked in the last 30 days

Q11. Thinking back over the past 30 days, which days did you smoke at least one whole cigarette?	>Occasional smokers (n= 858)
Every day	10%
Weekdays only	36%
Weekends only	6%
Weekdays + weekends (but not daily)	38%
Can't recall	10%

Base: n=858; occasional smokers Q11. Thinking back over the past 30 days, which days did you smoke at least one whole cigarette?

Daily smokers have smoked longer than former and occasional smokers When asked how long they have been smoking cigarettes (or had smoked cigarettes in the case of former smokers), the majority of all respondents reported smoking cigarettes for over 20 years. This included 63% of daily smokers, 47% of former smokers, and 33% of occasional smokers.

Figure 4 - Text Equivalent

Length of time smoking

Q12. How long have you been smoking cigarettes / did you smoke cigarettes before you quit?	All Respondents (n=3,006)
	Former smoker	Occasional smoker	Daily smokers
Less than 1 year	14%	7%	1%
1-5 years	14%	28%	10%
6-10 years	11%	18%	11%
11-20 years	12%	10%	14%
Over 20 years	47%	33%	63%

Base: n=3,006; all respondents [Dk/nr: 2%]. Q12. How long have you been smoking cigarettes / did you smoke cigarettes before you quit?

Number of cigarettes smoked by current and former smokers varies All respondents were asked about their smoking habits-specifically, on average, how many cigarettes they smoke (or smoked) per day. Former smokers were more likely to have smoked 25+ cigarettes, on average, per day when they did smoke compared to current smokers (18% of former smokers versus 10% of current smokers).

Time between waking up and having first cigarette varies considerably Most (69%) daily smokers said they have their first cigarette within 30 minutes of waking up (including 21% who have their first cigarette within 5 minutes). Almost half (49%) of former smokers said they also used to have their first cigarette within 30 minutes of waking up when they were smoking. The majority (56%) of occasional smokers smoke their first cigarette more than an hour after waking up, while one in five (21%) smoke within 30 minutes of waking up.

Figure 6 - Text Equivalent

Length of time before having first cigarette

Q14. How soon after you wake up do you smoke your first cigarette? / When you were smoking, how soon after you woke up would you smoke your first cigarette?	All Respondents (n=3,006)
	Former smoker	Occasional smoker	Daily smokers
Within 5 minutes	17%	3%	21%
6 to 30 minutes	32%	18%	48%
31 to 60 minutes	23%	15%	18%
More than 1 hour	24%	56%	13%

Base: n=3,006; all respondents [Dk/nr: 4%].
Q14. How soon after you wake up do you smoke your first cigarette? / When you were smoking, how soon after you woke up would you smoke your first cigarette?

Half of current and former smokers have friends who smoke
Many current and former smokers reported having someone in their social circle who smokes cigarettes. Half have friends who smoke cigarettes (49% of current smokers and 52% of former smokers), while approximately four in 10 have family members (41%, 42% respectively) or co-workers (41%, 43% respectively) who smoke. Current smokers were more likely than former smokers to report having a partner or spouse who smokes (36% versus 26% of former smokers).

Twenty-eight percent (28%) of current smokers and 20% of former smokers have co-workers who smoke cigarettes and use e-cigarettes, 25% of current smokers and 18% of former smokers have friends who smoke cigarettes and use e-cigarettes, and 23% of current smokers and 19% of former smokers have classmates who smoke cigarettes and use e-cigarettes.

2. Views on Smoking and Cessation Attitudes

Survey respondents were asked to rate their level of agreement with a number of statements about smoking and smoking cessation. The majority of current smokers agreed (or strongly agreed) ² that the cravings for nicotine will get weaker over time after quitting smoking (67%), that former smokers can expect to live longer than those who continue to smoke (60%), that there is no safe way to consume nicotine (60%), and that nicotine causes cancer (59%). In each case, agreement was more likely to be moderate than strong, suggesting that smokers are not entirely confident in their knowledge in these areas. In addition, six in 10 (61%) disagreed (or strongly disagreed) ³ with the statement: There is no health benefit from quitting smoking for people who already have a smoking-related disease.

Current smokers were more divided when it came to whether or not some tobacco products are less harmful than others (34% agreed or strongly agreed, 22% were neutral and 37% disagreed or strongly disagreed) and whether it is better to keep smoking than risk the stress of quitting for some smokers (26% agreed or strongly agreed, 27% were neutral, and 44% disagreed or strongly disagreed).

Compared to current smokers, former smokers were more likely to agree or strongly agree that cravings for nicotine will get weaker over time (81% of former smokers compared to 67% of current smokers), that former smokers can expect to live longer than those who continue to smoke (73% of former smokers compared to 60% of current smokers), and that there is no safe way to consume nicotine (68% of former smokers compared to 60% of current smokers).

In addition, former smokers were more likely than current smokers to disagree or strongly disagree that there is no health benefit from quitting smoking for people who already have a smoking-related disease (75% of former smokers compared to 61% of current smokers), that it is better for some smokers to keep smoking than risk the stress of quitting (70% of former smokers compared to 44% of current smokers), that some tobacco products are less harmful than other tobacco products (50% of former smokers compared to 37% of current smokers), and that nicotine causes cancer (18% of former smokers compared to 12% of current smokers).

3. Awareness and Use of Nicotine and Tobacco Products

Awareness of different tobacco and nicotine products is fairly low
Nearly all respondents were at least somewhat familiar with the different nicotine and tobacco products available in Canada. Familiarity tended to be higher for nicotine patches and gums, e-cigarettes, and smokeless tobacco products, and lower for nicotine lozenges, inhalers and sprays, as well as for heated tobacco products. With that said, relatively few know a great deal about any of these products, with most current and former smokers reporting that they know only a little or that they have only heard of the product but know nothing about it.

Current smokers were more likely than former smokers to know many of the products a fair amount or well: nicotine gums (35% of current smokers compared to 28% of former smokers), nicotine lozenges (22%, 13% respectively), smokeless tobacco products (20%, 15% respectively), nicotine sprays (16%, 11% respectively), and heated tobacco products (11%, 4% respectively).

Notably, there were no significant differences between current and former smokers in familiarity with nicotine patches (38% of current smokers and 33% of former smokers) or e-cigarettes (31%, 30% respectively).

Compared to occasional smokers, daily smokers were more likely to know a fair amount or well the following products: nicotine patches (41% of daily smokers compared to 32% of occasional smokers) and nicotine gums (37% of daily smokers compared to 30% of occasional smokers).

Use of selected nicotine and tobacco products is fairly low
All respondents who were familiar with a nicotine and tobacco product (i.e., know at least a little about the product) were asked to describe their current use of the product. Use of these products was fairly low, with many saying they have never tried them.

Current smokers who are familiar with the product were more likely to have tried e-cigarettes with nicotine (65%) and without nicotine (52%), nicotine gums (60%) and patches (56%), as well as heated tobacco products (56%). Current smokers were less likely to have tried lozenges (44%), smokeless tobacco products (36%) and nicotine sprays (37%). Daily or weekly use of these products ranged from a low of 7% to 8% for the nicotine replacement therapies and smokeless tobacco products to a high of 17% for heated tobacco products and 18% for e-cigarettes with nicotine.

Half or more of former smokers have never tried any of these products (from 50% who have never tried e-cigarettes with nicotine to 77% who have never tried smokeless tobacco products). Formers smokers who are familiar with the product were more likely to have tried e-cigarettes with nicotine (50%), nicotine gums (44%), and patches (41%). Former smokers includes smokers who have quit within the last five years and may not need to use these products, regularly or at all.

Price is the main factor affecting willingness to try nicotine and tobacco products
Respondents familiar with at least one of these nicotine and tobacco products (i.e., know at least a little about the product) were asked what would affect their willingness to try the products.

For current smokers, price (53%) was the most commonly reported factor, followed by potential health benefits (38%), taste (36%), and advice from a healthcare professional or physician (32%). Sixteen percent (16%) of current smokers expressed no interest in trying any of these nicotine and tobacco products.

The likelihood of saying price affects their willingness to try these products was higher among 18 to 34 year olds (56%) and 55 to 64 years (57%) compared to smokers aged 65 and older (45%) and among those living in households with an annual income of under $40,000 (60%) compared to those living in households with an annual income $40,000 or more (51%). Taste and smell were more likely to be mentioned by 18 to 34 year olds (45%, 34% respectively) and 35 to 54 year olds (42%, 27% respectively) compared to smokers aged 65 and older (24%, 13% respectively).

Compared to smokers aged 65 and older, smokers 18 to 34 years of age were more likely to say that advice from family or friends (27% of 18 to 34 year olds and 13 of those aged 65+), availability (32%, 14% respectively), and potential health harms (27%, 20% respectively) would affect their willingness to try these products.

Figure 15 - Text Equivalent

Factors affecting willingness to try nicotine and tobacco products [current smokers]

Q19. Which of the following factors would affect your willingness to try these products?	Current smokers who heard about a product (n=2,325)
Price	52%
Potential health benefits	38%
Taste	36%
Advice from physician/health care professionals	32%
Potential health harms	24%
Smell	24%
Availability	21%
Advice from family/friends	19%
I'm not interested in these products	16%
Other	1%

Q19. Which of the following factors would affect your willingness to try these products? Base: n=2,325; current smokers who heard of a product. (Multiple responses accepted).

For former smokers, lack of interest was the most commonly reported factor (50%) followed by price (31%), advice from a healthcare professional or physician (27%), and potential health harms (24%).

Figure 16 - Text Equivalent

Factors affecting willingness to try nicotine and tobacco products [former smokers]

Q19. Which of the following factors would affect your willingness to try these products?	Former smokers who heard about a product (n= 454)
I'm not interested in these products	50%
Price	31%
Advice from physician/health care professionals	27%
Potential health harms	24%
Potential health benefits	22%
Taste	21%
Smell	20%
Availability	12%
Advice from family/friends	12%
Other	1%

Q19. Which of the following factors would affect your willingness to try these products? Base: n=454; former smokers who heard of a product. (Multiple responses accepted).

Compared to former smokers, current smokers were more likely to point to the following as factors affecting their willingness to try these products: price (53% of current smokers compared to 31% of former smokers), potential health benefits (38%, 24% respectively), taste (36%, 21% respectively), availability (21%, 12% respectively), as well as advice from friends and family (19%, 12% of former smokers respectively).

Reasons for not trying nicotine and tobacco products
Various reasons were cited by respondents who were aware of the product to explain why they have not tried these nicotine and tobacco products. Among current smokers, reasons relating to the perceived effectiveness of the product to help them quit smoking, the perceived price of these products, and the belief that the product will be less satisfying than a regular cigarette tended to be the top reasons selected for not trying them.

The top reason for not trying nicotine replacement therapies or e-cigarettes without nicotine was the perception that these products will not help them quit smoking: 31% of current smokers said this about e-cigarettes without nicotine, 36% said it about lozenges, 29% about patches, 29% about gums, 28% about sprays and 24% about inhalers. Cost (i.e., the product is expensive) was the top reason for not trying e-cigarettes with nicotine (30%) or heated tobacco products (28%), while the belief that the product will be less satisfying than a regular cigarette was the top reason for not trying smokeless tobacco products (30%). Current smokers were more likely to say they have not tried e-cigarettes with nicotine (28%) or smokeless tobacco products (27%) because they felt it would be trading one addiction for another.

Figure 17 - Text Equivalent

Reasons for not trying nicotine and tobacco products [current smokers]

Reasons	Patches	Gum	Lozenges	Inhalers	Sprays	Heated tobacco products	E- cigarettes WITH nicotine	E- cigarettes WITHOUT nicotine	Smokeless tobacco products
n	n=847	n=754	n=780	n=695	n=733	n=386	n=582	n=796	n=932
I don't think it will help me quit smoking	29%	29%	36%	24%	28%	18%	23%	31%	26%
This product is expensive	26%	21%	21%	23%	24%	28%	30%	22%	13%
I don't want to stop smoking cigarettes	25%	21%	18%	14%	17%	6%	15%	16%	15%
It will be less satisfying than regular cigarettes	20%	26%	25%	15%	15%	13%	20%	26%	30%
It's trading one addiction for another	17%	13%	13%	14%	14%	15%	28%	21%	27%
No one has suggested I use it	14%	11%	18%	19%	20%	17%	9%	9%	10%
Not enough information about long-term health effects	9%	6%	11%	10%	13%	19%	24%	21%	11%
I don't know how to use it	8%	3%	5%	9%	9%	19%	8%	8%	10%
It's not convenient to use this product	7%	5%	6%	9%	9%	8%	8%	6%	16%
I'm concerned I'll become addicted to this product	6%	5%	3%	7%	10%	16%	14%	9%	11%
I don't know where to buy this product	4%	4%	6%	10%	9%	12%	5%	6%	7%
It's not convenient to buy this product	4%	5%	6%	9%	7%	8%	5%	7%	6%
I don't need it	3%	2%	2%	2%	2%	2%	1%	2%	4%
Other	3%	1%	1%	1%	1%	0%	1%	2%	1%

Q20. Which of the following are reasons why you haven't tried [INSERT PRODUCT]? Base; current smokers who haven't tried nicotine and tobacco products. (Multiple responses accepted).

Former smokers were more likely to say they have not tried these nicotine and tobacco products because they felt it would be trading one addiction for another or because they felt these products were not needed.⁴

Figure 18 - Text Equivalent

Reasons for not trying nicotine and tobacco products [former smokers]

Reasons	Patches	Gum	Lozenges	Inhalers	Sprays	Heated tobacco products	E- cigarettes WITH nicotine	E- cigarettes WITHOUT nicotine	Smokeless tobacco products
n	n=250	n=217	n=175	n=134	n=150	n=38	n=167	n=216	n=219
I didn't need it	37%	34%	30%	25%	25%	32%	26%	27%	23%
It's trading one addiction for another	24%	22%	17%	21%	15%	17%	28%	18%	28%
This product is expensive	16%	9%	13%	17%	12%	11%	16%	15%	3%
I quit cold turkey	14%	14%	14%	18%	17%	11%	19%	14%	14%
It wasn't convenient to use this product	7%	8%	6%	11%	7%	9%	5%	8%	11%
Not enough information about long-term health effects	5%	4%	4%	7%	13%	24%	17%	16%	14%
No one has suggested I use it	5%	10%	16%	16%	15%	7%	7%	7%	4%
It wasn't convenient to buy this product	3%	4%	7%	7%	4%	19%	8%	7%	3%
I didn't know how to use it	2%	2%	2%	3%	5%	4%	2%	5%	8%
I didn't think it would help me quit smoking	2%	7%	9%	12%	9%	0%	5%	7%	3%
I didn't know where to buy this product	2%	1%	4%	7%	6%	0%	4%	4%	4%
I was concerned I'd become addicted	2%	2%	1%	3%	1%	1%	3%	2%	3%
I didn't want to stop smoking cigarettes	1%	2%	<0.5%	0%	0%	0%	0%	0%	5%
It will be less satisfying than regular cigarettes	0%	2%	3%	0%	1%	4%	2%	1%	11%
Other	6%	2%	1%	1%	3%	0%	3%	7%	5%

Q20. Which of the following are reasons why you haven't tried [INSERT PRODUCT]? Base; former smokers who haven't tried nicotine and tobacco products. (Multiple responses accepted).

Like current smokers, the top reason for not trying many of these products was that former smokers did not need them: 37% of former smokers said this about patches, 34% about gums, 32% about heated tobacco products, 30% about lozenges, 27% about e-cigarettes without nicotine, 25% about inhalers, and 25% about sprays. Trading one addiction for another was the top reason selected for not trying e-cigarettes with nicotine (28%) or smokeless tobacco products (28%).

Reasons for using nicotine and tobacco products
When asked why they have used these nicotine and tobacco products, current and former smokers tended to mention that the product is easy to use, that it helps with cravings or in situations where smoking is not permitted, and that the product would eventually (or did) help them quit smoking cigarettes.

Among current smokers who tried a product, the top reason for trying many of these products was the perception that they will help them quit smoking: 50% of current smokers said this about patches, 41% about gums, 33% about lozenges, 32% about inhalers, 31% about e-cigarettes with nicotine, and 25% about e-cigarettes without nicotine. Notably, this was the not the top reason for trying smokeless tobacco products (cited by 14% of current smokers, it was tied for sixth in terms of rank) or heated tobacco products (cited by 22% of current smokers, it ranked as the second most cited reason for trying the product along with enjoying it).

Advice from a physician, healthcare professional or pharmacist was most likely to be mentioned in relation to patches: 29% of current smokers selected this as a reason for trying patches compared to gums (16%), inhalers (16%), sprays (16%), lozenges (15%), heated tobacco products (9%), smokeless tobacco products (8%), and e-cigarettes without (7%) or with (6%) nicotine.

Being offered the product by friends ranked among the top reasons selected for trying smokeless tobacco products (26%; the reason selected with the greatest frequency), e-cigarettes with nicotine (25%; tied for third in terms of rank), and e-cigarettes without nicotine (23%; third in terms of rank).

Figure 19 - Text Equivalent

Reasons for trying nicotine and tobacco products [current smokers]

Reasons	Patches	Gum	Lozenges	Inhalers	Sprays	Heated tobacco products	E- cigarettes WITH nicotine	E- cigarettes WITHOUT nicotine	Smokeless tobacco products
n	n=1,131	n=1,199	n=660	n=547	n=490	n=545	n=1,320	n=1,106	n=665
To help me eventually quit smoking cigarettes	50%	41%	33%	32%	21%	22%	31%	25%	14%
Advice from physician/health care professional/pharmacist	29%	16%	15%	16%	16%	9%	6%	7%	8%
Easy to use	29%	33%	29%	29%	21%	23%	24%	24%	16%
To deal with cravings in situations/places where I can't smoke	29%	33%	30%	22%	20%	14%	21%	16%	12%
I am addicted to nicotine	25%	21%	22%	25%	16%	12%	18%	12%	13%
It's less harmful than cigarettes	24%	27%	19%	18%	18%	14%	25%	22%	11%
Easy to buy	18%	22%	20%	14%	15%	15%	15%	14%	15%
It's socially acceptable to use in public	11%	18%	20%	13%	14%	11%	15%	13%	10%
To save money	11%	9%	11%	14%	10%	14%	15%	10%	12%
Advice from friends/family	11%	13%	12%	12%	11%	11%	15%	11%	10%
I was offered by friends	8%	12%	14%	12%	13%	20%	25%	23%	26%
To reduce exposure of chemicals to others around me	8%	10%	10%	11%	11%	10%	13%	12%	11%
To be in social settings where others are smoking cigarettes	7%	8%	9%	10%	10%	11%	10%	10%	8%
I like to try new products	7%	9%	15%	14%	19%	17%	15%	17%	18%
I enjoy it	6%	9%	12%	12%	11%	22%	20%	17%	16%
I like the flavours they come in	5%	10%	14%	11%	11%	15%	22%	22%	14%
Other	1%	2%	0%	1%	2%	1%	1%	2%	2%

Q21. Why have you used [INSERT PRODUCT]? Base: current smokers who tried these nicotine and tobacco products. (Multiple responses accepted).

Among former smokers who tried a product, the top reason for trying many of these products was to help them quit smoking: 62% of former smokers said this about patches, 57% about inhalers, 54% about gums, 47% about e-cigarettes with nicotine, 39% about sprays, 38% about lozenges, and 29% about e-cigarettes without nicotine. Being offered it by friends was the top reason for trying smokeless tobacco products (31%) and heated tobacco products (38%).⁵

Advice from a physician, healthcare professional or pharmacist was most likely to be mentioned in relation to patches (39%). Ease of use was also an important factor for patches; cited by 31% of former smokers. Ease of use ranked among the top three reasons for trying lozenges (24%) and sprays (25%), but this was not the case for inhalers (10%).

The perception that the product is less harmful than cigarettes ranked second as a reason for trying e-cigarettes with nicotine (38%; just ahead of liking the flavours which was selected by 31% of former smokers) and without nicotine (26%; just ahead of liking the flavours which was selected by 24% of former smokers). It was also among the top five reasons for using a number of the nicotine replacement therapies: patches (15%), gums (24%), lozenges (23%), and inhalers 24%).

Dealing with cravings in situations/places where it is not possible to smoke was the top reason selected for trying lozenges (46%), and it was among the top reasons mentioned for trying gums (ranked second at 34%), inhalers (ranked second at 40%), sprays (ranked second at 36%), and smokeless tobacco products (tied for second at 17% along with liking to try new products).

Figure 20 - Text Equivalent

Reasons for trying nicotine and tobacco products [former smokers]

Reasons	Patches	Gum	Lozenges	Inhalers	Sprays	Heated tobacco products	E- cigarettes WITH nicotine	E- cigarettes WITHOUT nicotine	Smokeless tobacco products
n	n=146	n=167	n=53	n=49	n=38	n=16	n=185	n=138	n=63
To help me eventually quit smoking cigarettes	62%	54%	38%	57%	39%	17%	47%	29%	5%
Advice from physician/health care professional/pharmacist	39%	16%	15%	15%	23%	0%	3%	0%	2%
Easy to use	31%	29%	24%	10%	25%	23%	21%	12%	12%
To deal with cravings in situations/places where I can't smoke	23%	34%	46%	40%	36%	9%	23%	19%	17%
I am addicted to nicotine	11%	12%	18%	6%	8%	22%	15%	3%	10%
It's less harmful than cigarettes	15%	24%	23%	24%	4%	12%	38%	26%	8%
Easy to buy	9%	17%	8%	8%	13%	12%	11%	3%	4%
It's socially acceptable to use in public	7%	12%	17%	2%	9%	3%	16%	5%	12%
To save money	13%	7%	10%	0%	1%	9%	14%	9%	2%
Advice from friends/family	10%	4%	4%	5%	5%	12%	11%	9%	7%
I was offered by friends	2%	6%	12%	9%	1%	38%	23%	22%	31%
To reduce exposure of chemicals to others around me	5%	3%	10%	1%	1%	5%	7%	10%	2%
To be in social settings where others are smoking cigarettes	3%	8%	8%	11%	2%	0%	16%	8%	2%
I like to try new products	1%	8%	9%	9%	12%	18%	13%	13%	17%
I enjoy it	3%	3%	7%	2%	13%	6%	20%	19%	13%
I like the flavours they come in	0%	3%	5%	12%	9%	12%	31%	24%	6%
Other	2%	4%	3%	0%	8%	0%	2%	9%	7%

Q21. Why have you used [INSERT PRODUCT]? Base: former smokers who tried these nicotine and tobacco products. (Multiple responses accepted).

4. Nicotine and Tobacco Products vs. Cigarettes

Use of nicotine and tobacco products tends to be less satisfying than smoking cigarettes
Current smokers' experiences using nicotine and tobacco products were usually described as less satisfying than smoking regular cigarettes. This was especially the case regarding nicotine gums and patches, with each described as somewhat or much less satisfying than smoking regular cigarettes by approximately two-thirds of current smokers (68% of current smokers said this about patches and 65% said this about gums). A majority (57%) also described their experience using nicotine lozenges as somewhat or much less satisfying than smoking regular cigarettes, while nearly half responded the same way for e-cigarettes with nicotine (48%) and without nicotine (49%).

The proportion of current smokers describing their use of the remaining products as somewhat or much less satisfying than smoking regular cigarettes ranged from 28% for heated tobacco products to 43% for smokeless tobacco products and nicotine inhalers.

The proportion of current smokers describing their use of nicotine and tobacco products as somewhat or much more satisfying than smoking regular cigarettes ranged from 13% for nicotine patches to 37% for heated tobacco products. The latter was the only product whose use was more likely to be described favourably (i.e., as somewhat or much more satisfying) (37%) than unfavourably (28%) (i.e., as somewhat or much less satisfying) in comparison with smoking cigarettes.

Former smokers were more likely than current smokers to describe their use of nicotine and tobacco products as less satisfying than smoking regular cigarettes. The majority of former smokers described their experiences with most of these products as somewhat or much less satisfying than smoking regular cigarettes: 77% said this about gums, 75% about lozenges, 71% about patches, 70% about sprays, 69% about inhalers, and 63% about smokeless tobacco products.

Former smokers were more likely to describe their use of e-cigarettes with nicotine (36%) and without nicotine (37%) as somewhat or much more satisfying than smoking regular cigarettes. However, even in the case of these two products, larger proportions of former smokers described their use of e-cigarettes with nicotine (44%) and without nicotine (45%) as somewhat or much less satisfying rather than somewhat or much more satisfying than smoking cigarettes.

Taste of nicotine and tobacco products tend to be viewed as less satisfying compared to taste of cigarettes

Current smokers' views on the taste of most nicotine and tobacco products compared to that of cigarettes were mixed. The majority of current smokers described the taste of nicotine gums (59%) and lozenges (52%) as somewhat or much less satisfying than that of regular cigarettes. E-cigarettes with nicotine (37%) and heated tobacco products (36%) were the only products more likely to be viewed as somewhat or much more satisfying than the taste of regular cigarettes. All other products were considered to be somewhat or much less satisfying than the taste of regular cigarettes.

Former smokers were more likely than current smokers to say the taste of many of these nicotine and tobacco products was somewhat or much less satisfying than the taste of regular cigarettes. This was the case for five products: nicotine inhalers (70%), nicotine gums (66%), nicotine sprays (62%), nicotine lozenges (58%), and smokeless tobacco products (52%).

In only two cases, that of e-cigarettes with and without nicotine, were former smokers more likely than current smokers to describe the taste of the product as somewhat or much more satisfying than that of cigarettes (47% and 55% respectively). Views on the taste of heated tobacco products ⁷ were mixed, but the single largest proportion (32%) described the taste as no different than the taste of regular cigarettes (31% of former smokers described these products as somewhat or much more satisfying and 37% described them as somewhat or much less satisfying).

Views on delivery of nicotine
Current smokers' assessments of the nicotine delivery of nicotine and tobacco products compared to that provided by regular cigarettes varied by product.

Nicotine gums (67%), patches (64%), and lozenges (55%) were most likely to be rated as somewhat or much less satisfying than regular cigarettes in this regard. E-cigarettes with nicotine (44%) and nicotine inhalers (43%) were also more likely to compare negatively in this regard, with similar proportions reporting these products as somewhat or much less satisfying than cigarettes.

Assessments of smokeless tobacco products and nicotine sprays were mixed. One-third (33%) of current smokers rated smokeless tobacco products as somewhat or much more satisfying than regular cigarettes, 28% said there is no difference, and 35% said they are somewhat or much less satisfying. Similarly, one-third (33%) rated sprays as somewhat or much more satisfying than regular cigarettes, 27% said there is no difference, and 36% said they are somewhat or much less satisfying.

Heated tobacco products were the only product more likely to compare favourably (i.e., to be rated as somewhat or much more satisfying) than unfavourably (i.e., somewhat or much less satisfying) with regular cigarettes in this regard. Specifically, 40% of current smokers considered them somewhat or much more satisfying versus 26% who considered them somewhat or much less satisfying.

More former smokers rated gums (82% of former smokers compared to 67% of current smokers), lozenges (76%, 55% respectively), inhalers (74%, 43% respectively), and sprays (67%, 36% respectively) as somewhat or much less satisfying in terms of nicotine delivery compared to current smokers. Moreover, where current smokers' assessments of smokeless tobacco products were mixed, former smokers were more likely to rate these products as somewhat or much less satisfying (49%) than somewhat or much more satisfying (18%).

Only in the case of e-cigarettes with nicotine did assessments of current and former smokers tend to be similar. ⁹ Specifically, 27% of current and 24% of former smokers rated the delivery of nicotine using e-cigarettes as somewhat or much more satisfying than the nicotine delivery of regular cigarettes.

5. Perceptions of Nicotine and Tobacco Products

Friends and family members view nicotine products as somewhat acceptable
With one exception, the majority of current smokers said their friends and family members view the use of these nicotine and tobacco products as at least somewhat acceptable. Specifically, 63% said their friends and family think nicotine lozenges are somewhat or completely acceptable, 59% said this about nicotine gums, 58% about patches, 56% about inhalers, 56% about e-cigarettes without nicotine, 55% about heated tobacco products, and 54% about nicotine sprays. In each case, smokers who did not describe these products as either somewhat or completely acceptable to their friends and family were more likely to describe their assessments as indifferent ("neither" at the mid-point of the scale) than as somewhat or completely unacceptable.

The exception related to smokeless tobacco products. While the largest proportion of smokers (43%) said their friends and family view the use of this product as at least somewhat acceptable, just over one-quarter (28%) said it was at least somewhat unacceptable to them. The rest (25%) said their friends and family were indifferent about the use of smokeless tobacco products.

Current smokers aged 65 and older were less likely than younger smokers to say that their friends and family view as completely or somewhat acceptable nicotine gums (43% versus 61% of smokers under 35 years of age and 67% of smokers between the ages of 35 and 64) and e-cigarettes without nicotine (30% versus 59% of smokers between the ages of 18 and 64).

With two exceptions, the majority of former smokers also said their friends and family view the use of these nicotine and tobacco products as at least somewhat acceptable. The exceptions were smokeless tobacco products (16% of former smokers said their friends or family view these products as somewhat or completely acceptable) and e-cigarettes with nicotine (48% of former smokers said their friends and family view these products as somewhat or completely acceptable).

Former smokers were most likely to say that their friends or family view the use of nicotine lozenges (72%) and inhalers (72%), followed by patches (69%) and gums (69%) as somewhat or completely acceptable. Smaller majorities indicated that their friends or family view as somewhat or completely acceptable the use of nicotine sprays (58%), heated tobacco products (57%), and e-cigarettes without nicotine (54%).

Former smokers were more likely than current smokers to say that their friends or family consider the use of nicotine patches to be somewhat or completely acceptable (69% of former smokers compared to 58% of current smokers) and to say that the use of smokeless tobacco products is somewhat or completely unacceptable (52% and 28% respectively).

All nicotine and tobacco products viewed as at least a little harmful
Most current smokers think each of these products is at least a little harmful to the health of the person using them. Cigarettes and cigars/little cigars were viewed as most harmful, with the majority of current smokers rating them as very or extremely harmful (67% and 58% respectively).

Four in 10 (40%) indicated that smokeless tobacco products are very or extremely harmful, while smaller proportions said this about water-pipes with tobacco (33%), e-cigarettes with nicotine (28%), heated tobacco products (26%), and e-cigarettes without nicotine (20%). Nicotine replacement therapies (12%) were least likely to be seen as very or extremely harmful. Notably, the proportion of current smokers who were unable to assess the potential harm of these products ranged from a low of 9% for cigarettes to a high of 39% for heated tobacco products.

Similar views were expressed by former smokers, with the main difference being that they were even more likely than current smokers to consider these products harmful. Once again, cigarettes and cigars/little cigars were most likely to be described as causing serious harm (87% rated cigarettes as very or extremely harmful and 69% rated cigars/little cigars as very or extremely harmful). This was followed by smokeless tobacco products (52%), water-pipes with tobacco (44%), e-cigarettes with nicotine (38%), heated tobacco products (33%), and e-cigarettes without nicotine (23%).

Nicotine replacement therapies were again least likely to be seen as causing serious harm (11% rated them as not at all harmful). Notably, the proportion of former smokers who were unable to assess the potential harm of these products ranged from a low of 3% for cigarettes to a high of 50% for heated tobacco products.

With the exception of e-cigarettes without nicotine and nicotine replacement therapies (where no statistically significant differences between current and former smokers were observed), former smokers were more likely than current smokers to rate all of these nicotine and tobacco products as very or extremely harmful.

Reasons for viewing nicotine and tobacco products as less harmful
Respondents who rated a nicotine and tobacco product as less harmful than another product were asked to select a reason why. Specifically, respondents were randomly presented with two pairings, each of which included a product they rated as less harmful and one they rated as harmful. No pairings included cigarettes.

Common reasons selected to explain why some nicotine and tobacco products are less harmful than others were the lack of second-hand smoke, the perception that the product does not contain nicotine, and perception that the product does not contain as many chemicals.

The figures below present the top three reasons offered for each pairing, first for current smokers and then for former smokers. Exercise caution when interpreting the results for former smokers given the very small sample sizes.

Virtually all current and former smokers aware of e-cigarettes perceive them to be at least a little harmful
Current smokers' perceptions of the degree of harm caused by e-cigarettes do not tend to vary much by type of e-cigarette device. Between one in five (21%) and one-quarter (25%) of current smokers consider each type of e-cigarette device as very or extremely harmful to a person's general health. When 'moderately' harmful is factored in, the gap widens, ranging from 52% who consider disposable e-cigarettes to be at least moderately harmful to 42% who attribute the same extent of harm to pod vape systems. That said, overall, the largest proportion of respondents views these devices as a little or moderately harmful.

The proportion of current smokers unable to assess the harm caused by the various types of e-cigarettes because they are not familiar with them ranges from 8% to 18% and is highest in relation to mini mod (16%) and pod vape (18%) systems.

Younger smokers were more likely than older smokers to rate vape pens, tank and mod vape systems, mini mod vape systems, and pod vape systems as a little harmful or not at all harmful:

Similar proportions of former smokers (28% to 31%) consider each type of e-cigarette device to be very or extremely harmful to a person's general health. The proportion of former smokers unable to assess the harm caused by the various types of e-cigarette devices ranges from 9% to 24% and, as was the case with current smokers, is highest in relation to pod vape (24%) systems.

Compared to current smokers, former smokers were significantly more likely to assess most of the devices as very or extremely harmful to a person's general health: rechargeable e-cigarettes (31% of former smokers said they are very or extremely harmful compared to 22% of current smokers), vape pens (31% and 22% respectively), tank and mode vape systems (30% and 21% respectively), pod vape systems (29% and 21% respectively), and mini mod vape systems (28% and 21% respectively).

Current and former smokers believe that quitting smoking cigarettes and switching to e-cigarettes improves health
A large proportion of current smokers believe that quitting smoking cigarettes and switching to e-cigarettes improves health a little or a lot, though they were more likely to think this to be the case when switching to e-cigarettes without nicotine (50%) than to e-cigarettes with nicotine (43%). While almost identical proportions (33% if switching to e-cigarettes without nicotine and 35% if switching to e-cigarettes with nicotine) think health will improve 'a little' regardless of the type of e-cigarettes, smokers are twice as likely to think health will improve 'a lot' if one switches to e-cigarettes without nicotine (17%) rather than e-cigarettes with nicotine (8%).

Current smokers who did not think switching to e-cigarettes would improve one's health were more likely to think it would have no effect on health (27% said this about e-cigarettes with nicotine and 21% about e-cigarettes without nicotine) than to think it would worsen one's health (11% of smokers said this about nicotine e-cigarettes and 11% said it about e-cigarettes without nicotine).

Almost one in five smokers were uncertain about the effect of switching to e-cigarettes with nicotine (19%) or without nicotine (19%).

Current smokers who have at least tried e-cigarettes were more likely than those who have not to say that switching from cigarettes to e-cigarettes with nicotine would improve one's health a little or a lot. Forty-eight percent (48%) of current smokers who tried e-cigarettes said that the switch from cigarettes to e-cigarettes with nicotine would improve one's health a little or a lot compared to 38% of current smokers who have never tried e-cigarettes. When asked about e-cigarettes without nicotine, 64% of current smokers who have tried e-cigarettes said that the switch would improve one's health (either a little or a lot) compared to 52% of current smokers who have never tried e-cigarettes.

In addition, those who have tried to quit smoking and have tried e-cigarettes (61%) were more likely than those who have tried e-cigarettes, but who have not tried to quit smoking (48%), to say that switching to e-cigarettes with nicotine would improve one's health a little or a lot. Smokers 18 to 34 years of age (48%) were more likely than older smokers (43% of 35 to 54 year olds and 39% of 55 to 64 year olds) to say that quitting smoking cigarettes completely and switching to using e-cigarettes with nicotine would improve one's health a little or a lot.

Figure 41 - Text Equivalent

Switching to e-cigarettes and health [current smokers]

30A/B. How do you think it would affect the health of a smoker if they quit smoking cigarettes completely and switched to using e-cigarettes with with/without nicotine?	Current smokers (n= 2,500)
	Nicotine	No Nicotine
Improve health a lot	8%	17%
Improve health a little	35%	33%
No effect on health	27%	21%
Make health a little worse	9%	9%
Make health a lot worse	2%	2%
Don't know how it will affect health	19%	19%

30A/B. How do you think it would affect the health of a smoker if they quit smoking cigarettes completely and switched to using e-cigarettes with with/without nicotine? Base: n= 2,500; current smokers.

Perceptions among former smokers regarding the health effects of quitting smoking and switching to e-cigarettes were very similar to those of smokers. More than one in five (22%) former smokers think that the health of a smoker will improve 'a lot' if one switches to e e-cigarettes without nicotine (9% think this will be the case if switching to e-cigarettes with nicotine). Similar proportions said that the health of a smoker will improve 'a little' if switching to e-cigarettes with (38%) or without (35%) nicotine.

Few think that switching completely from smoking cigarettes to using e-cigarettes with nicotine (11%) or without nicotine (11%) will make a smoker's health a little or a lot worse. Notably, one in five were uncertain about the effect of switching to e-cigarettes with nicotine (22%) or without nicotine (21%).

Figure 42 - Text Equivalent

Switching to e-cigarettes and health [former smokers]

30A/B. How do you think it would affect the health of a smoker if they quit smoking cigarettes completely and switched to using e-cigarettes with with/without nicotine?	Former smokers (n=506)
	Nicotine	No Nicotine
Improve health a lot	9%	22%
Improve health a little	38%	35%
No effect on health	19%	11%
Make health a little worse	7%	7%
Make health a lot worse	4%	4%
Don't know how it will affect health	22%	21%

30A/B. How do you think it would affect the health of a smoker if they quit smoking cigarettes completely and switched to using e-cigarettes with/without nicotine? Base: n= 506; former smokers.

6. Motivation to Quit Smoking

Most current smokers have tried to quit at some point
Just over three-quarters (78%) of current smokers said they have tried to quit smoking at some point in their lives. Among those who have tried, approximately one-third (36%) said they have tried to quit once over the past 12 months ⁵⁴, while nearly half (46%) said they have tried more than once during this period.

Approximately one in five (18%) could not recall how many times they have tried to quit over the past 12 months.

Figure 43 - Text Equivalent

Switching to e-cigarettes and health [current smokers]

Q31. Have you ever tried to quit smoking?	Current smokers (n= 2,500)
Yes	78%
No	22%

Q32. How many times have you tried to quit smoking over the last 12 months? Only include times that you went a day or more without smoking cigarettes because you were trying to quit.	Current smokers who tried to quit smoking (n= 1,865)
One	36%
Two	22%
Three	10%
Four	5%
Five or more	9%
I can't recall	18%

[Left] Q31. Have you ever tried to quit smoking? Base: n=2,500; current smokers.
[Right] Q32. How many times have you tried to quit smoking over the last 12 months? Only include times that you went a day or more without smoking cigarettes because you were trying to quit. Base: n=1,865; current smokers who tried to quit smoking.

Six in 10 smokers want to quit
Current smokers were asked what best describes how they feel right now about their smoking.
The majority (62%) of current smokers said they want to quit smoking ⁵⁵, while a sizeable minority (39%) said they do not. Among the latter, one-quarter (26%) said they think they should stop smoking, despite the fact that they do not want to, while the rest were categorical that they do not want to stop. Among those who want to quit, nearly half (47%) have no definite plans or intentions in this regard, while 15% said they intend to try to quit within the next six months (8% within the next month and 7% within the next 6 months).

Figure 44 - Text Equivalent

Readiness to quit [current smokers]

Q33. Which of the following statements best describes how you feel right now about your smoking?	Current smokers (n= 2,500)
I don't want to stop smoking	13%
I think I should stop smoking, but don't really want to	26%
I want to stop smoking, but I haven't thought about when	15%
I really want to stop smoking, but I don't know when I will	16%
I want to stop smoking and hope to soon	16%
I really want to stop smoking and intend to in next 6 months	7%
I really want to stop smoking and intend to in the next month	8%

Q33. Which of the following statements best describes how you feel right now about your smoking? Base: n=2,500; current smokers.

Cutting back on the number of cigarettes smoked is the most common action taken by current smokers to support cessation
Current smokers identified a variety of actions taken in the last six months related to smoking cessation. The single most commonly taken action, identified by just over one-third of smokers (35%), was to cut back on the number of cigarettes smoked. Other measures tended to fall into distinct types or categories of action which included the following:

• Replacement techniques (i.e. replacing smoking with a substitute) such as e-cigarettes with nicotine (25%), nicotine gums (23%), nicotine patches (21%), e-cigarettes without nicotine (16%), cannabis/cannabis products (11%), nicotine lozenges (10%), nicotine inhalers (7%), and nicotine sprays (5%), smokeless tobacco, and heated tobacco products (3% each).
• Steps including the following: telling someone about their intention to quit (14%), trying to avoid triggers (12%), speaking to a health professional (12%), changing routine/behaviour (11%), looking for information about quitting smoking (10%), starting a new hobby (8%), setting a quit date (7%), making a deal with a friend of family member to quit smoking together and buying a self-help book (4% each), and calling the Quitline (1%).
• Therapies such as medications (5%), counselling (4%), acupuncture (3%), and hypnosis (2%).

Nearly one in five (18%) said they have done none of the above in the past six months.

Figure 45 - Text Equivalent

Actions taken to quit [current smokers]

Q34. Have you done any of the following in the last six months?	Current smokers (n= 2,500)
Cut back on the number of cigarettes smoked	35%
Tried E-cigarettes WITH nicotine	25%
Tried nicotine gums	23%
Tried nicotine patches	21%
Tried E-cigarettes WITHOUT nicotine	16%
Told friends/family my intent to quit smoking	14%
Tried to avoid triggers	12%
Spoke to a family doctor/pharmacist/health professional about quitting	12%
Used cannabis or cannabis products	11%
Changed my routine/behaviour	11%
Tried nicotine lozenges	10%
Looked for information about quitting smoking	10%
Started a new hobby	8%
Set a quit date	7%
Tried nicotine inhalers	7%
Tried nicotine sprays	5%
Tried medication (e.g., Zyban, Champix)	5%
Made a deal with a friend or family member to quit smoking together	4%
Tried self-help books	4%
Tried counselling	4%
Tried smokeless tobacco	3%
Tried heated tobacco products	3%
Tried acupuncture	3%
Tried hypnosis	2%
Called the quitline	1%
Other	1%
Done none of these in last 6 months	18%

Q34. Have you done any of the following in the last six months? Base: n=1,865; current daily and occasional smokers. (Multiple responses accepted).

Enjoyment tops list of factors affecting current smokers' ability to stop smoking
Current smokers were asked if any factors have affected their ability to quit smoking cigarettes.

The most frequently identified factors were the enjoyment derived from smoking (42%), followed by a perceived lack of willpower (31%), a stressful life (29%), potential withdrawal symptoms (28%), and fear of not succeeding (22%). Other factors identified with some frequency included the cost of quit smoking aids (16%), having a partner/spouse who smokes (16%), living among smokers (11%), and not knowing where to start the quit process (8%). Factors less frequently identified included lack of information about quit smoking aids (4%) and not knowing where to go for such information (2%).

Figure 46 - Text Equivalent

Reasons for not quitting [current smokers]

Q35. Quitting smoking is hard. Have any of the following factors affected your ability to quit smoking cigarettes?	Current smokers (n= 2,500)
I enjoy smoking too much	42%
I don't think I have the willpower to quit	31%
Life is too stressful to quit	29%
The potential withdrawal symptoms	28%
I am afraid that I will not succeed	22%
Quit smoking aids are too expensive	16%
My partner or spouse smokes cigarettes	16%
Everyone I know smokes cigarettes	11%
Don't know where to start the process	8%
Don't have enough info about quit smoking aids	4%
Don't know where to get info about quit smoking aids	2%
Other	2%

Q35. Quitting smoking is hard. Have any of the following factors affected your ability to quit smoking cigarettes? Base: n=2,500; current smokers. [Dk/nr:<0.5%] (Multiple responses accepted).

7. Quit Experience

Former smokers were confident in ability to quit smoking
Former smokers (84%) were more likely to express confidence in their ability to quit smoking once they had taken the decision to do so than were current smokers (70%) on the assumption that they would try to do so in the next six months. Specifically, a majority of former smokers (52%) described themselves as extremely or very sure about their success (once they had taken the decision to quit) compared to only 18% of current smokers. Correspondingly, current smokers were more than twice as likely as former smokers to express little or no confidence in their ability to quit (44% are slightly or not at all sure compared to versus 21% of former smokers).

Figure 47 - Text Equivalent

Confidence in ability to quit

Q36. If you decided to give up smoking completely in the next 6 months, how sure are you that you would succeed? / Q41. When you decided to give up smoking completely, how sure were you that you would succeed?	Current smokers (n= 2,500)	Former smokers (n= 506)
Extremely sure	7%	30%
Very	11%	22%
Moderately	31%	24%
Slightly	21%	8%
Not at all sure	23%	13%
Don't know	7%	3%

Q36. If you decided to give up smoking completely in the next 6 months, how sure are you that you would succeed? Base: n=2,500; current smokers. [Dk/nr:7%].

Q41. When you decided to give up smoking completely, how sure were you that you would succeed? Base: n= 506; former smokers. [Dk/nr:3%].

Most former smokers tried multiple times to quit prior to success
Just over two-thirds (68%) of former smokers said that they tried to quit smoking more than once before they succeeded. One-third (33%) said they tried two to three times, 19% said they tried four to five times, and 16% said they tried more than five times before they were successful. Twenty-two percent (22%) said they succeeded on their first attempt, while 9% said they could not recall.

Figure 48 - Text Equivalent

Quit attempts [former smokers]

Q37. How many times did you try to quit smoking before you were successful?	Former smokers (n= 506)
One	22%
2 to 3	33%
4 to 5	19%
6 to 10	8%
More than 10	8%
I can't recall	9%

Q37. How many times did you try to quit smoking before you were successful? Base: n=506; former smokers.

Various products/methods used by former smokers to quit smoking
Former smokers took a variety of actions or measures in the course of their successful quit attempt. Just over one in five (22%) former smokers said they changed their routine or behaviour in the last year. Other steps or initiatives included the following: cutting back on the number of cigarettes smoked (16%), avoiding triggers (16%), setting a quit date (16%), telling someone about their intention to quit (14%), speaking to a health professional (12%), starting a new hobby (8%), looking for information about quitting smoking and making a deal with a friend of family member to quit smoking together (6% each), using a self-help book (2%) and calling the Quitline (1%).

A host of replacement techniques were also tried (i.e. replacing smoking with a substitute). These included the following: nicotine patches (17%), e-cigarettes with nicotine (15%), nicotine gums (13%), e-cigarettes without nicotine (8%), cannabis/ cannabis products (8%), nicotine lozenges (5%), nicotine sprays (4%), nicotine inhalers (3%), and smokeless tobacco (1%).

Some tried various therapies including medications (8%), counselling and acupuncture (2% each), and hypnosis (1%).

Figure 49 - Text Equivalent

Actions taken to quit [current smokers]

Q38. You successfully quit smoking in the last year. Which, if any, of the following did you do?	Current smokers (n= 506)
I changed my routine/behaviour	22%
I used nicotine patches	17%
I cut back on the number of cigarettes smoked	16%
Tried to avoid triggers	16%
I set a quit date for when I wanted to quit smoking	16%
I used E-cigarettes WITH nicotine	15%
I told friends/family my intent to quit smoking	14%
I used nicotine gums	13%
Spoke to a doctor/pharmacist/health professional	12%
I quit cold turkey	11%
I used E-cigarettes WITHOUT nicotine	8%
I started a new hobby	8%
I used medication (e.g., Zyban, Champix)	8%
I used cannabis/marijuana/THC/CBD	8%
I looked for information about quitting smoking	6%
I made a deal to quit smoking with someone	6%
I used nicotine lozenges	5%
I used nicotine sprays	4%
I used nicotine inhalers	3%
I used self-help books	2%
I used counselling	2%
I used acupuncture	2%
I was diagnosed with an illness/hospitalized	2%
I used smokeless tobacco	1%
I called the quitline	1%
I used hypnosis	1%
I used heated tobacco products	<0.5%
Other	9%

Q38. You successfully quit smoking in the last year. Which, if any, of the following did you do? Base: n=506; former smokers. [Dk/nr: 1%] (Multiple responses accepted).

Former smokers more likely to have used e-cigarettes to help them quit
Four in 10 (41%) former smokers who have used e-cigarettes said they used them as a way to quit smoking. Three in 10 (30%) who have used nicotine replacement therapies said they used them to quit smoking, while approximately one-quarter who have used heated (24% ⁵⁶) or smokeless (23%) tobacco products said they used them as a way to help them quit smoking.

Figure 50 - Text Equivalent

Use of nicotine products to help quit [former smokers]

Q39. Did you use [INSERT: e-cigarettes / smokeless tobacco products / heated tobacco products / nicotine replacement therapies] as a way to help you quit smoking?	Former smokers who used a product (n= 16 - 218)
E-cigarettes	41%
Nicotine replacement therapies	30%
Heated tobacco products	24%
Smokeless tobacco products	23%

Q39. Did you use [INSERT: e-cigarettes / smokeless tobacco products / heated tobacco products / nicotine replacement therapies] as a way to help you quit smoking? Multiple responses accepted. Base: n=16-218; former smokers who used a product.

Mixed views on impact of e-cigarettes, NRTs, heated and smokeless tobacco products
Former smokers provided varying assessments of the perceived impact of these products as smoking cessation devices. They were most likely to attribute a big role to e-cigarettes, with three in 10 (29%) saying they had a moderate (6%) to big (23%) role in helping them quit smoking. Twenty-nine percent (29%) also describe heated tobacco products ⁵⁷ as having a moderate or big role in helping them quit smoking; however, the impact of heated tobacco products was far more likely to be viewed as moderate (27%) than big (2%).

Nicotine replacement therapies and smokeless tobacco products were less likely to be described as at least moderately important in this regard (18% and 15% respectively). Just over half (51%) of former smokers described smokeless tobacco products as playing no role at all in helping them quit smoking and staying quit and 38% said this about nicotine replacement therapies.

The proportion of former smokers unable to assess the impact of these products on their cessation journey ranged from 10% to 27% and was highest in relation to nicotine replacement therapies.

8. Stress and Smoking

Two-thirds of current and former smokers have moderate levels of personal stress
Most current smokers said they have experienced selected events or situations at least sometimes over the past month, but fewer than half indicated they experienced any of these often (i.e., fairly or very often). Current smokers were most likely to report feeling confident about their ability to handle their personal problems fairly or very often (46%), to never or almost never have felt difficulties were piling up so high that they could not overcome them (42%), to fairly or very often have felt that they were on top of things (41%), and to fairly or very often been able to control irritations in their life (39%). In addition, 37% said they often or fairly often felt nervous or stressed over the last month.

The most notable and consistent difference between current and former smokers was the higher proportion of current smokers who said they often experienced negative feelings, particularly, finding they could not cope with all the things they had to do (21% of current smokers compared to 15% of former smokers), feeling difficulties were piling up so high they could not overcome them (21% and 14% respectively), and being upset because of something that happened unexpectedly (24% and 14% respectively).

In addition, former smokers were more likely than current smokers to never or almost never have felt that they were unable to control the important things in their life (47% of former smokers compared to 38% of current smokers), to have felt stressed or nervous (30% and 23% respectively), or to have been angered because of things that happened that were outside of their control (38% and 30% respectively).

When these individual measures of personal stress are aggregated, roughly one-quarter (23%) of current smokers are considered to have low stress, two-thirds (68%) moderate stress, and one in 10 (9%) high stress. Notably, former smokers (36%) were significantly more likely than current smokers (23%) to have a low amount of personal stress, and the likelihood of having low stress was higher among longer-term quitters (39%) than more recent quitters (29%).

More smokers anticipate facing stress if they quit smoking than former smokers who reported actual stress

Feedback from former smokers on the degree of stress they have felt since quitting smoking mirrors the general pattern of feedback from current smokers on the degree of stress they expect to feel if they quit smoking. The most notable difference is the much higher proportion of current smokers (27%) who anticipate facing more stress if they quit smoking as compared to former smokers (7%).

Figure 55 - Text Equivalent

Stress and quitting smoking

Q43. Since you quit smoking, do you feel you have more, the same, or less stress in your life? "Former smokers' perceptions of stress after quitting smoking"	Former smokers (n= 506)
More stress	7%
About the same	57%
Less stress	29%
Don't know	6%

Q43. Since you quit smoking, do you feel you have more, the same, or less stress in your life? "Current smokers' perceptions of stress after quitting smoking IF they quit"	Current smokers (n= 2,500)
More stress	27%
About the same	51%
Less stress	13%
Don't know	9%

[Left] Q43. Since you quit smoking, do you feel you have more, the same, or less stress in your life? Base: n=506; former smokers.

[Right] Q44. If you quit smoking, do you feel you would have more, the same, or less stress in your life? Base: n=2,500; current smokers.

Current smokers were more likely to agree (44%) than disagree (17%) with the statement 'Thinking about quitting smoking makes me feel anxious and stressed out'. Agreement with the statement was much more likely to be moderate (32%) than strong (12%). Just over one-third (35%) neither agreed nor disagreed.

Figure 56 - Text Equivalent

Thinking about quitting smoking [current smokers]

Q45. To what extent do you agree or disagree with the following statement? "Thinking about quitting smoking makes me feel anxious and stressed out"	Current smokers (n= 2,500)
Strongly agree	12%
Agree	32%
Neither	35%
Disagree	11%
Strongly disagree	6%

Q45. To what extent do you agree or disagree with the following statement? Base: n=2,500; current smokers.

The following subgroups were more likely to agree that thinking about quitting smoking makes them feel anxious and stressed out: daily smokers (49%) compared to occasional smokers (33%); and smokers who are slightly or not at all sure that they can successfully quit smoking (54%) compared to smokers who are moderately (40%) or very (33%) sure they will be able to quit.

9. Sources of Information

Sources of information about switching from cigarettes to another product
For the most part, current and former smokers are similarly likely to identify potential sources of information about switching from cigarettes to another product containing nicotine that is potentially less harmful to their health. The only noticeable difference is that former smokers are more likely to identify sources associated specifically with personal health and health care. This includes a physician/family doctor/nurse practitioner (55% of former smokers versus 48% of current smokers), a health counsellor (27% of former smokers versus 19% of current smokers), and a municipal public health unit (12% versus 7% of current smokers). Former smokers were also more likely to identify online forums (24% versus 18% of current smokers).

Figure 57 - Text Equivalent

Sources of information

Q47. Where would you go to get more information about switching from cigarettes to another product containing nicotine, one that is potentially less harmful to your health?	All respondents (n=3,006)
	Current smokers	Former smokers
Physician/family doctor/nurse practitioner	48%	54%
Pharmacist/pharmacy	34%	34%
Friends	25%	23%
A health counsellor	19%	27%
Online forums	18%	24%
Family	18%	15%
Government of Canada	14%	15%
Co-workers/classmates	8%	7%
Mental heath counsellor	7%	4%
City/municipal public health unit	7%	12%
From a hospital	7%	9%
Counsellor	6%	8%
Psychologist	5%	2%
People I follow on social media	4%	3%
Dentist	3%	3%
Internet/online resources	1%	2%
Other	6%	11%

Q47. Where would you go to get more information about switching from cigarettes to another product containing nicotine, one that is potentially less harmful to your health? Base: n=3,006; all respondents. [Dk/nr: 4%-6%]. (Multiple responses accepted).

Willingness to try new products

A majority of current smokers expressed some degree of agreement with each of these statements, though they were more likely to agree 'somewhat' with each one than to agree 'a lot' or 'completely'. Specifically, 70% of current smokers agreed at least somewhat that, when they shop, they look for what is new (4% agreed completely), 58% of current smokers agreed at least somewhat that they usually try new products before other people (4% agreed completely), and 56% of current smokers agreed at least somewhat that they like to be the first to try something new (5% agreed completely).

A similar pattern of response was evident among former smokers, though they were less likely to agree 'completely' with each statement, and a majority (52%) said they do not at all agree with the statement 'I like to be the first among my friends and family to try something new'. Nearly three-quarters (73%) of former smokers agreed at least somewhat that, when they shop, they look for what is new, 57% agreed at least somewhat that they usually try new products before other people, and 48% agreed at least somewhat that they like to be the first to try something new.

10. Descriptions of Potentially Harm Reduced Nicotine Product

At the end of the survey, respondents were asked in an open-end manner what words they would use to describe to their friends and family completely switching from smoking cigarettes to using another product containing nicotine, one that is potentially less harmful to their health. More than half the current (57%) and former (61%) smokers elected to provide a response.

Those who did respond offered a wide variety of descriptions, from "trying to quit smoking" (8% of current smokers and 2% of former smokers), to "making a healthy or healthier choice" (7% and 3% respectively), to "switching to an alternative" (5% and 3% respectively).

Other respondents characterized the switch as making a less harmful choice (4% of current smokers and 6% of former smokers) or "making a better choice" (3% and 4% respectively), while some mentioned specific actions, such as "stopping smoking cigarettes" (3% of current smokers and 3% of former smokers), "cutting back on smoking" (1% and 1% respectively), switching to e-cigarettes (1% and 1% respectively), and switching to the patch (1% and 2% respectively), among others.

The full range of responses can be found in figures 60 and 61.

Figure 60 - Text Equivalent

Figure 60: Words used to Describe Potentially Harm Reduced Nicotine Products [current smokers]

The image shows a visual representation (word cloud) of the words used when respondents were asked in an open-end manner what words they would use to describe to their friends and family completely switching from smoking cigarettes to using another product containing nicotine, one that is potentially less harmful to their health. Words have different sizes indicating their relative frequencies.

Q46. If you completely switched from smoking cigarettes to using another product containing nicotine, one that is potentially less harmful to your health, what words would you use to describe this switch to your friends and family? Base: n=2,500; current smokers. [Dk/nr: 57%]

Figure 61 - Text Equivalent

Figure 61: Words used to Describe Potentially Harm Reduced Nicotine Products [former smokers]

The image shows a visual representation (word cloud) of the words used when respondents were asked in an open-end manner what words they would use to describe to their friends and family completely switching from smoking cigarettes to using another product containing nicotine, one that is potentially less harmful to their health. Words have different sizes indicating their relative frequencies.

Q46. If you completely switched from smoking cigarettes to using another product containing nicotine, one that is potentially less harmful to your health, what words would you use to describe this switch to your friends and family? Base: n=506; former smokers. [Dk/nr: 61%]

11. Profile of Survey Respondents

% of survey sample (weighted)

12. Conclusions and Observations

This research yielded some interesting conclusions concerning the attitudes and behaviours of current and former smokers with respect to potentially less harmful tobacco and nicotine products.

• Communication may be needed to address attitudes toward potentially less harmful tobacco and nicotine products. Most current and former smokers do not believe there is a safe way to consume nicotine, and some do not differentiate between less harmful and more harmful tobacco products. Many current and former smokers were unable to assess the potential harm of these products-this was particularly noticeable when it came to heated tobacco products.
• Awareness of potentially less harmful tobacco and nicotine products is fairly low among current and former smokers. Relatively few current and former smokers know a great deal about any of these products, and many have never heard of heated tobacco products. The products they were more likely to know about were nicotine patches, nicotine gums and e-cigarettes.
• Use of selected nicotine and tobacco products is also fairly low, but it was generally higher for e-cigarettes among both current and former smokers. Among current and former smokers who tried a product, the top reason for trying many of these products was to help them quit smoking. Notably, this was the not the top reason for trying smokeless tobacco products or heated tobacco products-being offered the product by a friend was the most frequently selected reason. Perhaps not surprisingly, among those who tried nicotine patches, one of the top reasons for doing so was advice from a physician, healthcare professional or pharmacist.
• Current and former smokers who have tried these nicotine and tobacco products tended to rate them as somewhat or much less satisfying than regular cigarettes when it comes to experience, taste and nicotine delivery. Notable exceptions include the following: 1) When it came to experience and nicotine delivery, heated tobacco products were the only product whose use was more likely to be described as somewhat or much more satisfying in comparison with smoking cigarettes; and 2) On taste, e-cigarettes with nicotine and heated tobacco products were the only products more likely to be viewed as somewhat or much more satisfying than the taste of regular cigarettes.
• Current and former smokers believe that quitting smoking cigarettes and switching to e-cigarettes improves health. In addition to improving health, many former smokers said that e-cigarettes had a moderate to big role in helping them quit smoking (more so than nicotine replacement therapies, heated tobacco products, and smokeless tobacco products). Moreover, perceptions of the degree of harm caused by e-cigarettes do not tend to vary much by type of e-cigarette device. Notably, however, younger smokers were more likely than older smokers aware of e-cigarettes to rate vape pens, tank and mod vape systems, mini mod vape systems, and pod vape systems as a little harmful or not at all harmful.

Appendix

1. Technical Specifications

• An online survey was administered to 3,006 Canadians aged 18 and older who are current smokers or who had recently quit smoking. Current smokers included daily and non-daily smokers. Recent quitters were former smokers who had quit smoking in the last five years. The design targeted former smokers who had quit smoking less than a year prior to the survey; however during the fieldwork, the incidence of eligible recent quitters was lower than anticipated. As a result, eligibility was extended to include former smokers who had quit up to five years ago.
• The sample quotas were as follows:

• In addition to broadening the eligibility requirements for former smokers from one to five years, an additional change to the screening of panellists was introduced at the mid-point of the data collection. The Standards for the Conduct of Government of Canada Public Opinion Research stipulate that panel members may not have participated in any Government of Canada survey in the previous 30 days. This eligibility requirement works well when the research audience is a high incidence population, such as Canadians aged 18 and older. However, the target population of the research was very low incidence (1% to 19%) and too many eligible panellists were being screened out of the survey at this question. To balance the need to respect the Standards and meet the sample quotas, the screening question was changed to exclude panellists who participated in a Health Canada survey is the previous 30 days (rather than a Government of Canada survey). This small change reduced the number of panellists terminated as part of the screening process.
• The survey averaged 15 minutes to complete, and the fieldwork was conducted between February 22 and March 14, 2019.
• The survey questionnaire was programmed using computer-assisted web interviewing (CAWI) technology. The programming was tested for skip logic by the initial programmer, as well as by a second senior programmer. Following this, the script was tested through random data generation.
• Following survey best practices, the questionnaire was pre-tested in advance of the fieldwork to ensure that it measured what it was intended to measure. There were 10 completions in each official language. No issues or concerns arose during the pre-test. In addition to the pre-test, the survey programming was tested using a random number generator and the output verified prior to the launch of the fieldwork. Following the fieldwork, the data were cleaned and checked using SPSS syntax. The review assessed response ranges and the length of time taken to complete the survey to identify any respondent who took an unreasonably short time answering, who "straightlined" responses. Any cases flagged for data quality were replaced prior to the weighting and tabulation of the data.
• The sample was drawn from Dynata's panel of online Canadians. Surveys that use samples drawn from online panels cannot be described as statistically projectable to the target population.
• Panellists were rewarded for taking part in the survey per the panel's incentive program, which is structured to reflect the length of survey and the nature of the sample.
• Survey data were weighted by region, age and gender to reflect the demographic composition of the target population using data from the 2016 Census and the 2017 Canadian Tobacco, Alcohol and Drugs Survey (CTADS). Specifically, census data was used to weight the former smokers by region, age and gender, while CTADS data were used to weight the current smokers by type (daily and occasional). For the regional, age and gender component of the weight, a combination of CTADS and census data was used (because some of the CTADS sample cells contained no data and could not be used to develop weights).
• Because the sample is based on those who initially self-selected for participation in the panel, no estimates of sampling error can be calculated.
• All survey respondents were informed that their participation was voluntary, and that information collected was protected under the authority of privacy legislation.
• Sponsorship of the study was revealed (i.e., the Government of Canada).
• The response rate was 60%, calculated using the formula outlined in the Standards for the Conduct of Government of Canada Public Opinion Research (Online Surveys).

2. Survey Questionnaire

Landing Page
Please select the language in which you wish to complete the survey.

• English
• French

[NEXT]

Survey Intro Page
Thank you for agreeing to take part in this short survey. We anticipate that the survey will take up to 15 minutes to complete.

Background information
This research is being conducted by Phoenix Strategic Perspectives (Phoenix SPI), a Canadian public opinion research firm, on behalf of Health Canada.

The purpose of this online survey is to collect opinions and feedback on a variety of tobacco and nicotine products, including cigarettes and e-cigarettes.

How does the online survey work?

• Your participation in the survey is completely voluntary and confidential.
• Your decision on whether or not to participate will not affect any dealings you may have with the Government of Canada, now or in future.

What about your personal information?

• Please be assured that all opinions will remain anonymous and will not be attributed to you personally in any way.
• The personal information you will provide to Health Canada is governed in accordance with the Privacy Act and is being collected under the authority of section 4 of the Department of Health Act in accordance with the Treasury Board Directive on Privacy Practices. For more information, click here.
• Your personal information will be collected by Phoenix SPI in accordance with the applicable provincial privacy legislation or the Personal Information Protection and Electronic Documents Act (PIPEDA).

What happens after the online survey?
The final report written by Phoenix SPI will be available to the public through Library and Archives Canada (www.bac-lac.gc.ca/).

If you have any questions about the survey, you may contact Phoenix SPI at research@phoenixspi.ca.

Your help is greatly appreciated, and we look forward to receiving your feedback.

Screening

1. What is your age?
   [TEXT BOX]
   • Prefer not to answer [ASK Q1a]
     

     TERMINATE IF UNDER 18

     TERMINATION MESSAGE:
     Thank you very much for your interest in completing this survey. Unfortunately you must be at least 18 years of age to take part in this survey.

   • 1a. Would you be willing to indicate in which of the following age categories you belong?
   • Under 18
   • 18 to 34
   • 35 to 49
   • 50 to 54
   • 55 to 64
   • 65 or older
   • Prefer not to answer [TERMINATE]
     

     TERMINATE IF UNDER 18

     TERMINATION MESSAGE:
     Thank you very much for your interest in completing this survey. Unfortunately you must be at least 18 years of age to take part in this survey.

2. In the previous 30 days, in which, if any, of the following have you participated?
   

   Select all that apply

   • A Health Canada survey TERMINATE
   • A survey about smoking cigarettes TERMINATE
   • A survey on vaping/electronic cigarettes TERMINATE
   • A survey on smoking cessation TERMINATE
   • A survey on nicotine products TERMINATE
   • None of the above
     

     TERMINATION MESSAGE:
     Thank you very much for your interest in completing this survey. Unfortunately you are not eligible for this survey.

3. Do you, or any member of your immediate family, work for…?
   Select all that apply
   • A marketing research firm
   • A magazine or newspaper
   • A radio or television station
   • A public relations company
   • The government, whether federal, provincial, territorial or municipal
   • An advertising agency or graphic design firm
   • Tobacco or e-cigarette company TERMINATE
   • Company that produces smoking cessation aids TERMINATE
   • Legal or law firm TERMINATE
4. How do you identify your gender? (This may be different from the information noted on your birth certificate or other official documents)
   • Male
   • Female
   • Other
   • Prefer not to answer
     
5. Where do you live?
   • Alberta
   • British Columbia
   • Manitoba
   • New Brunswick
   • Newfoundland and Labrador
   • Northwest Territories
   • Nova Scotia
   • Nunavut
   • Ontario
   • Prince Edward Island
   • Quebec
   • Saskatchewan
   • Yukon

Smoking Profile

6. At the present time, do you smoke cigarettes every day, occasionally or not at all? This includes cigarettes that are bought ready-made, as well as cigarettes that people make themselves. This does not include cannabis cigarettes or joints.
   • Every day SMOKER, GO TO Q12
   • Occasionally GO TO Q11
   • Not at all CONTINUE
7. Have you ever smoked cigarettes?
   • Yes CONTINUE
   • No TERMINATE
8. When did you last smoke a cigarette?
   • Less than a year ago RECENT QUITTER; ASK Q9-10, THEN GO TO Q12
   • 1 to 5 years ago LONG-TERM QUITTER; GO TO Q12
   • More 5 years ago TERMINATE
   • Don't know TERMINATE
9. How many months has it been since you last smoked a cigarette?

   Number of months: [TEXT] CONTINUE TO Q12

   • Less than 1 month ASK Q10
   • Don't know TERMINATE
     [IF Q9=LESS THAN1 MONTH]
10. How many days has it been since you last smoked a cigarette?
    

    Number of days: [TEXT]

    • Don't know
11. [OCCASIONAL SMOKERS]Thinking back over the past 30 days, which days did you smoke at least one whole cigarette?
    • I did not smoke in the past 30 days TERMINATE
    • I smoked every day
    • I smoked on weekends only (Friday night, Saturday, Sunday)
    • I smoked weekdays only (Monday to Friday)
    • I smoked on weekdays and weekend days, but not every day
    • I can't recall
12. How long [SMOKERS] have you been smoking cigarettes / [RECENT QUITTERS] did you smoke cigarettes before you quit?
    • Less than 1 year
    • 1-5 years
    • 6-10 years
    • 11-20 year
    • Over 20 years
    • Don't know
13. [SMOKERS] On average, how many cigarettes do you smoke per day? / [RECENT QUITTERS] When you were smoking, on average, how many cigarettes did you smoke per day? [OCCASIONAL SMOKERS] On the days that you do smoke, how many cigarettes do you smoke per day?

    [TEXT]

    • Don't know
14. [SMOKERS ⁵⁹] How soon after you wake up do you smoke your first cigarette? / [RECENT QUITTERS] When you were smoking, how soon after you woke up would you smoke your first cigarette?
    • Within 5 minutes
    • 6 to 30 mintues
    • 31 to 60 minutes
    • More than 60 minutes
    • Don't know
15. Do any of the following people in your life smoke cigarettes or use e-cigarettes*? This does not include cannabis cigarettes, joints or vaping with cannabis/marijuana/THC /CBD.
    

    [GRID FORMAT; RANDOMIZE ROW ITEMS]

    [ROWS]

    • Friends
    • Classmates
    • Co-workers
    • Spouse/partner
    • Family members
    • Parents or guardians

    [COLUMNS]

    • Smoke cigarettes
    • Use e-cigarettes
    • Both
    • Neither
    • Don't know
    • Not applicable

Attitudes
[EVERYONE]

16. To what extent do you agree or disagree with the following statements?

[GRID FORMAT]

[ROWS; RANDOMIZE ROW ITEMS]

1. Former smokers can expect to live longer than those who continue to smoke.
2. There is no health benefit from quitting smoking for people who already have a smoking-related disease.
3. Nicotine causes cancer.
4. There is no safe way to consume nicotine.
5. After quitting smoking, the cravings for nicotine will get weaker over time.
6. Some tobacco products are less harmful than other tobacco products.
7. For some smokers, it is better to keep smoking than risk the stress of quitting.

[COLUMNS]

• Strongly disagree
• Disagree
• Neither agree nor disagree
• Agree
• Strongly agree
• Don't know

Awareness + Knowledge of Nicotine Products
[EVERYONE]

17. How familiar are you with the following products?

[GRID FORMAT; RANDOMIZE ROW ITEMS]

[ROWS]

1. Nicotine patches
2. Nicotine gums
3. Nicotine lozenges
4. Nicotine inhalers
5. Nicotine sprays
6. Heated tobacco products (iQOSTM, PLOOM TechTM GloTM)
7. E-cigarettes (vape, vape pen, tank, pod, mod, & mini mod) (e.g., JUUL, Vype, Aspire, Eleaf, Joyetech, SMOK etc.)
8. Smokeless tobacco products (e.g., chewing tobacco, snuff, snus, dip, chew)

[COLUMNS]

• Never heard of it
• Heard of it but know nothing about it
• Know a little
• Know a fair amount
• Know it well

[EVERYONE AWARE OF AT LEAST ONE PRODUCT AT Q17 - KNOW A LITTLE, A FAIR AMOUNT OR WELL]

18. Which of the following describes your current use of [INSERT PRODUCT]?

[GRID FORMAT]

[ROWS] [PRODUCTS RESPONDENTS ARE AWARE OF - KNOW A LITTLE, A FAIR AMOUNT OR WELL AT Q17]

1. Nicotine patches
2. Nicotine gums
3. Nicotine lozenges
4. Nicotine inhalers
5. Nicotine sprays
6. Heated tobacco products (iQOSTM or GloTM)
7. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine (This does not include use with cannabis/marijuana/THC/CBD)
8. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITHOUT nicotine (This does not include use with cannabis/marijuana/THC/CBD)
9. Smokeless tobacco products (e.g., chewing tobacco, snuff, pouches, dip, chew)

[COLUMNS]

• Daily or almost daily
• Less than daily, but at least once a week
• Less than weekly, but at least once in the last 30 days
• Used regularly in the past (daily or occasionally) but not in the last 30 days
• Tried once or twice, but haven't used in the last 30 days
• Never tried it

19. Which of the following factors would affect your willingness to try these products (i.e., e-cigarettes, smokeless tobacco products, heated tobacco products, or nicotine replacement therapies, e.g., nicotine patches, nicotine sprays, nicotine lozenges, nicotine gum and nicotine inhalers)?

Select all that apply

[ROTATE ITEMS]

• Price
• Availability
• Taste
• Potential health benefits
• Potential health harms
• Smell
• Advice from physician/health care professionals
• Advice from friends/family
• Other: Specify [TEXT]
• Nothing; I'm not interested in these products

[THOSE WHO HAVEN'T USED ANY PRODUCTS AT Q18, BUT ARE AWARE BASED ON Q17-know a little, a fair amount, well); USERS SKIP TO NEXT QUESTION]

20. Which of the following are reasons why you haven't tried [INSERT PRODUCT]?
    

    Select all that apply

    [ROTATE ITEMS]: [SMOKERS]

• I don't want to stop smoking cigarettes
• It will be less satisfying than regular cigarettes
• I don't think it will help me quit smoking
• I'm concerned I'll become addicted to this product
• It's trading one addiction for another
• There's not enough information about the long-term health effects of this product
• I don't know where to buy this product
• It's not convenient to buy this product
• It's not convenient to use this product
• This product is expensive
• I don't know how to use it
• No one has suggested I use it
• Other: Specify [TEXT]

[ROTATE ITEMS]: [RECENT QUITTERS]

• I don't/didn't need it
• I quit cold turkey
• I didn't think it would help me quit smoking
• I was concerned I'd become addicted to this product
• It's trading one addiction for another
• There's not enough information about the long-term health effects of this product
• I don't/didn't know where to buy this product
• It's not/wasn't convenient to buy this product
• It's not/wasn't convenient to use this product
• This product is expensive
• I don't/didn't know how to use it
• No one has suggested I use it
• Other: Specify [TEXT]

PRODUCTS:

1. Nicotine patches
2. Nicotine gums
3. Nicotine lozenges
4. Nicotine inhalers
5. Nicotine sprays
6. Heated tobacco products (iQOSTM or GloTM)
7. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine
8. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITHOUT nicotine
9. Smokeless tobacco products (e.g., chewing tobacco, snuff, pouches, dip, chew)

[SEND NON-USERS-THOSE WHO HAVE NEVER USED A PRODUCT AT Q18 TO Q26]

[IF EVER USED PRODUCTS AT Q18]

21. Why have you used [INSERT PRODUCT]?
    

    Select all that apply

    • To deal with cravings in situations/places where I can't smoke
    • To help me eventually quit smoking cigarettes
    • It's socially acceptable to use in public
    • To save money
    • It's less harmful than cigarettes
    • Advice from physician/health care professional/pharmacist
    • Advice from friends/family
    • To be in social settings where others are smoking cigarettes
    • Easy to buy
    • Easy to use
    • I was offered by friends
    • To reduce exposure of chemicals to others around me
    • I enjoy it
    • I like the flavours they come in
    • I like to try new products
    • I am addicted to nicotine
    • Other. Specify: [TEXT]

    PRODUCTS:

    1. Nicotine patches
    2. Nicotine gums
    3. Nicotine lozenges
    4. Nicotine inhalers
    5. Nicotine sprays
    6. Heated tobacco products (iQOSTM or GloTM)
    7. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine
    8. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITHOUT nicotine
    9. Smokeless tobacco products (e.g., chewing tobacco, pinch, dip, snuff)
22. Overall, how does the experience of using [INSERT PRODUCT USED] compare to smoking regular cigarettes?
    • Much less satisfying than smoking
    • Somewhat less satisfying
    • No difference
    • Somewhat more satisfying
    • Much more satisfying than smoking
    • Don't know

    PRODUCTS:

    1. Nicotine patches
    2. Nicotine gums
    3. Nicotine lozenges
    4. Nicotine inhalers
    5. Nicotine sprays
    6. Heated tobacco products (iQOSTM or GloTM)
    7. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine
    8. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITHOUT nicotine
    9. Smokeless tobacco products (e.g., chewing tobacco, snuff, pouches, dip, chew)

PROGRAMMING NOTE: Use a grid format for respondents who have used more than one product. The question will read: How do each of these products compare to smoking regular cigarettes?

23. How does the taste of [INSERT PRODUCT USED] compare to the taste of regular cigarettes?
    • Much less satisfying than cigarettes
    • Somewhat less satisfying
    • No difference
    • Somewhat more satisfying
    • Much more satisfying than cigarettes
    • Don't know

    PRODUCTS:

    1. Nicotine gums
    2. Nicotine lozenges
    3. Nicotine inhalers
    4. Nicotine sprays
    5. Heated tobacco products (iQOSTM or GloTM)
    6. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine
    7. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITHOUT nicotine
    8. Smokeless tobacco products (e.g., chewing tobacco, snuff, pouches, dip, chew)

PROGRAMMING NOTE: Use a grid format for respondents who have used more than one product. The question will read: How does the taste of each of these products compare to the taste of regular cigarettes?

24. The way nicotine is delivered depends on the type of product you use. For example, you absorb nicotine through the skin when using a patch and you inhale it when using an e-cigarette. How does the delivery of nicotine using [INSERT PRODUCT USED] compare to smoking a regular cigarette?
    • Much less satisfying than smoking a cigarette
    • Somewhat less satisfying
    • No difference
    • Somewhat more satisfying
    • Much more satisfying than smoking a cigarette
    • Don't know

    PRODUCTS:

    1. Nicotine patches
    2. Nicotine gums
    3. Nicotine lozenges
    4. Nicotine inhalers
    5. Nicotine sprays
    6. Heated tobacco products (iQOSTM or GloTM)
    7. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine
    8. Smokeless tobacco products (e.g., chewing tobacco, snuff, pouches, dip, chew)

PROGRAMMING NOTE: Use a grid format for respondents who have used more than one product. The question will read: The way nicotine is delivered depends on the type of product you use. For example, you absorb nicotine through the skin when using a patch versus and you inhale it when using an e-cigarette. How does the delivery of nicotine using each of these products compare to smoking a regular cigarette?

25. How do your friends or family view the use of [INSERT PRODUCT]? Do they view it as…
    • …completely unacceptable?
    • …somewhat unacceptable?
    • …neither unacceptable nor acceptable?
    • …somewhat acceptable?
    • …completely acceptable?
    • Don't know
      

      PRODUCTS:

    1. Nicotine patches
    2. Nicotine gums
    3. Nicotine lozenges
    4. Nicotine inhalers
    5. Nicotine sprays
    6. Heated tobacco products (iQOSTM or GloTM)
    7. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine
    8. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITHOUT nicotine
    9. Smokeless tobacco products (e.g., chewing tobacco, snuff, pouches, dip, chew)
    10. Cigarettes

[EVERYONE]

26. Cut during pre-testing
27. In your opinion, how harmful, if at all, do you think each of the following are to the health of the person using them?

[GRID FORMAT]

[ROWS]

1. Smokeless tobacco products (e.g., chewing tobacco, pinch, dip, snuff)
2. Heated tobacco products (iQOSTM or GloTM)
3. Nicotine replacement therapies (e.g., gums, lozenges, inhalers, sprays, patches)
4. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine
5. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITHOUT nicotine
6. Cigars/Little cigars
7. Water-pipes with tobacco (also known as hookah, sheesha, narg-eelay, hubble-bubble, or gouza)
8. Cigarettes

[COLUMNS]

• Extremely harmful
• Very harmful
• Moderately harmful
• A little harmful
• Not at all harmful
• Don't know

[PRESENT RESPONDENTS TWO MOST/LEAST PAIRINGS-TO BE SELECTED RANDOMLY-AND ASK THE NEXT QUESTION FOR EACH PAIR. EXCLUDE PAIRINGS INCLUDING CIGARETTES.]

28. What is the main reason you think that [INSERT PRODUCT] are less harmful than [INSERT PRODUCT]?

    [ROTATE ITEMS]

    • There is no second-hand smoke
    • This product doesn't contain as many chemicals
    • This product won't cause cancer
    • This product doesn't contain nicotine
    • This product is easier to quit when you want to
    • This product isn't burnt
    • This product doesn't contain tobacco
    • Other. Specify: [TEXT]

    [PRODUCTS]

    1. Smokeless tobacco products (e.g., chewing tobacco, pinch, dip, snuff)
    2. Nicotine replacement therapies (e.g., gums, lozenges, inhalers, sprays, patches)
    3. Heated tobacco products (iQOSTM or GloTM)
    4. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine
    5. E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITHOUT nicotine
    6. Cigars/Little cigars
    7. Water-pipes with tobacco (also known as hookah, sheesha, narg-eelay, hubble-bubble, or gouza)

    [THOSE AWARE OF E-CIGARETTES AT Q17; EVERYONE ELSE GOES TO Q30]

29. As you may know, there are different types of e-cigarettes available. In your opinion, how harmful, if at all, do you think each of the following are to a person's general health? This does not include use with cannabis/marijuana/THC/CBD.

    [GRID FORMAT]
    
    [ROWS]

    1. Disposable e-cigarettes
    2. Rechargeable e-cigarettes
    3. Vape pens
    4. Tank and mod vape systems
    5. Mini Mod vape systems
    6. Pod or (Pod Mod) vape systems

    [COLUMNS]

    • Extremely harmful
    • Very harmful
    • Moderately harmful
    • A little harmful
    • Not at all harmful
    • Don't know
    • Not familiar with that type of device
30. How do you think it would affect the health of a smoker if they quit smoking cigarettes completely and switched to using e-cigarettes?
    
    • Improve their health a lot
    • Improve their health a little
    • No effect on their health
    • Make their health a little worse
    • Make their health a lot worse
    • Don't know

    Motivation to Quit [SMOKERS]
    [SMOKERS BASED ON Q6]

31. Have you ever tried to quit smoking?
    
    • Yes
    • No

    [IF Q31=NO, GO TO Q33 AND THEN SKIP TO Q35]

32. How many times have you tried to quit smoking over the last 12 months? Only include times that you went a day or more without smoking cigarettes because you were trying to quit.
    
    • Once
    • Twice
    • 3 times
    • 4 times
    • 5 times or more
    • I can't recall
33. Which of the following statements best describes how you feel right now about your smoking?
    
    • I don't want to stop smoking
    • I think I should stop smoking but don't really want to
    • I want to stop smoking but haven't thought about when
    • I really want to stop smoking but I don't know when I will
    • I want to stop smoking and hope to soon
    • I really want to stop smoking and intend to in the next 6 months
    • I really want to stop smoking and intend to in the next month
34. Have you done any of the following in the last six months?

    Select all that apply

    [ROTATE ITEMS]

    • I tried E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) with nicotine
    • I tried E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) without nicotine
    • I tried Nicotine patches
    • I tried Nicotine gums
    • I tried Nicotine lozenges
    • I tried Nicotine inhalers
    • I tried Nicotine sprays
    • I tried Smokeless tobacco (e.g., chewing tobacco, pinch, dip, snuff)
    • I tried Heated tobacco products (iQOSTM or GloTM)
    • I tried Medication (e.g., Zyban, Champix)
    • I tried Counselling
    • I tried Acupuncture
    • I tried Hypnosis
    • I tried Self-help books
    • I called the pan-Canadian, toll-free quitline (1-866-366-3667)
    • I set a quit date for when I wanted to quit smoking
    • I spoke to a family doctor, pharmacist, or other health professional about quitting smoking
    • I told friends/family my intent to quit smoking
    • I made a deal with a friend or family member to quit smoking together
    • I cut back on the number of cigarettes I smoke
    • I looked for information about quitting smoking
    • I used cannabis or cannabis products/marijuana/THC/CBD
    • I tried to avoid situations that triggered my urge to smoke
    • I changed my routine/behaviour
    • I started a new hobby
    • Other: Specify [TEXT]
    • None of these
35. Quitting smoking is hard. Have any of the following factors affected your ability to quit smoking cigarettes?

    Select all that apply

    [ROTATE ITEMS]

    • My life is too stressful to quit
    • I enjoy smoking too much
    • Everyone I know smokes cigarettes
    • My partner or spouse smokes cigarettes
    • I don't think I have the willpower to quit
    • I don't have enough information about quit smoking aids
    • I don't know where to get information about quit smoking aids
    • Quit smoking aids are too expensive
    • I don't know where to start the process of quitting smoking
    • The potential withdrawal symptoms
    • I am afraid that I will not succeed
    • Other: Specify [TEXT]
36. If you decided to give up smoking completely in the next 6 months, how sure are you that you would succeed?
    
    • Not at all sure
    • Slightly sure
    • Moderately sure
    • Very sure
    • Extremely sure
    • Don't know

    You're almost finished the survey.

    Quit Experience: [RECENT QUITTERS]
    [RECENT QUITTERS BASED ON Q8]

37. How many times did you try to quit smoking before you were successful?
    
    • Once
    • 2-3 times
    • 4-5 times
    • 6-10 times
    • More than 10 times
    • I can't recall
38. You successfully quit smoking in the last year. Which, if any, of the following did you do?

    Select all that apply

    [ROTATE ITEMS]

    • I used E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) with nicotine
    • I used E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) without nicotine
    • I used Nicotine patches
    • I used Nicotine gums
    • I used Nicotine lozenges
    • I used Nicotine inhalers
    • I used Nicotine sprays
    • I used Smokeless tobacco (e.g., chewing tobacco, pinch, dip, snuff)
    • I used Heated tobacco products (iQOSTM or GloTM)
    • I used Medication (e.g., Zyban, Champix)
    • I used Counselling
    • I used Acupuncture
    • I used Hypnosis
    • I used Self-help books
    • I called the pan-Canadian, toll-free quitline (1-866-366-3667)
    • I set a quit date for when I wanted to quit smoking
    • I spoke to a family doctor, pharmacist, or other health professional about quitting smoking
    • I told friends/family my intent to quit smoking
    • I made a deal with a friend or family member to quit smoking together
    • I cut back on the number of cigarettes I smoke
    • I looked for information about quitting smoking
    • I tried to avoid situations that triggered my urge to smoke
    • I changed my routine/behaviour
    • I started a new hobby
    • I used cannabis/marijuana/THC/CBD
    • Other: Specify [TEXT]

    [IF EVER USED PRODUCTS AT Q18]

39. Did you use [INSERT: e-cigarettes / smokeless tobacco products / heated tobacco products / nicotine replacement therapies] as a way to help you quit smoking?
    
    • Yes
    • No

    E-cigarettes=
    E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITH nicotine
    E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) WITHOUT nicotine

    SMOKELESS=Smokeless tobacco products (e.g., chewing tobacco, pinch, dip, snuff)

    HEATED=
    Heated tobacco products (iQOSTM or GloTM)

    NRT=
    Nicotine patches
    Nicotine gums
    Nicotine lozenges
    Nicotine inhalers
    Nicotine sprays

    PROGRAMMING NOTE: Use a grid format for respondents who have used more than one product. Products=rows; response options=columns.

40. What role, if any, did [INSERT: e-cigarettes / smokeless tobacco products / heated tobacco products / nicotine replacement therapies] play in helping you quit smoking and stay quit?
    
    • No role at all
    • A small role
    • A moderate role
    • A big role
    • Don't know

    E-Cigarettes=
    E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) with nicotine
    E-cigarettes (vape, vape pen, pod, tank, mod & mini mod) without nicotine

    SMOKELESS=
    Smokeless tobacco products (e.g., chewing tobacco, pinch, dip, snuff)

    HEATED=
    Heated tobacco products (iQOSTM or GloTM)

    NRT=
    Nicotine patches
    Nicotine gums
    Nicotine lozenges
    Nicotine inhalers
    Nicotine sprays

    PROGRAMMING NOTE: Use a grid format for respondents who have used more than one product. Products=rows; response options=columns.

41. When you decided to give up smoking completely, how sure were you that you would succeed?
    
    • Not at all sure
    • Slightly sure
    • Moderately sure
    • Very sure
    • Extremely sure
    • Don't know

    You're almost finished the survey.

    Stress + Smoking

    We have just a few final questions for you.

42. In the last month, how often have you….

    [GRID FORMAT]

    [ROWS; ROTATE ITEMS]

    1. been upset because of something that happened unexpectedly?
    2. felt that you were unable to control the important things in your life?
    3. felt nervous and stressed?
    4. felt confident about your ability to handle your personal problems?
    5. felt that things were going your way?
    6. found that you could not cope with all the things that you had to do?
    7. been able to control irritations in your life?
    8. felt that you were on top of things?
    9. been angered because of things that happened that were outside of your control?
    10. felt difficulties were piling up so high that you could not overcome them?

    [COLUMNS]

    • Never
    • Almost never
    • Sometimes
    • Fairly often
    • Very often

    [RECENT QUITTERS]

43. Since you quit smoking, do you feel you have more, the same, or less stress in your life?
    
    • More stress
    • About the same amount of stress
    • Less stress
    • Don't know

    [SMOKERS]

44. If you quit smoking, do you feel you would have more, the same, or less stress in your life?
    • More stress
    • About the same amount of stress
    • Less stress
    • Don't know

    [SMOKERS]

45. To what extent do you agree or disagree with the following statement?

    Thinking about quitting smoking makes me feel anxious and stressed out

    • Strongly disagree
    • Disagree
    • Neither agree nor disagree
    • Agree
    • Strongly agree
    • Don't know

    Related Issues

46. If you completely switched from smoking cigarettes to using another product containing nicotine, one that is potentially less harmful to your health, what words would you use to describe this switch to your friends and family?

    [TEXT BOX]

    • Don't know
47. Where would you go to get more information about switching from cigarettes to another product containing nicotine, one that is potentially less harmful to your health?

    Select all that apply

    [ROTATE ITEMS]

    • Physician/family doctor/nurse practitioner
    • Dentist
    • Friends
    • Family
    • Co-workers/classmates
    • Online forums
    • Pharmacist/pharmacy
    • City/municipal public health unit
    • From a hospital
    • People I follow on social media
    • Government of Canada
    • Counsellor
    • Psychologist
    • Mental health counsellor
    • A health organization
    • Other: Specify [TEXT]
48. To what extent do you agree with the following statements?

    [GRID FORMAT]

    [ROWS]

    1. I usually try new products before other people do.
    2. When I shop, I look for what is new.
    3. I like to be the first among my friends and family to try something new.

    [COLUMNS]

    • Not at all
    • Somewhat
    • A lot
    • Completely

    Demographics
    These last questions will help us group your answers with others that we will receive in this survey.

49. What is the highest level of formal education that you have completed?
    • Less than high school (no certificate, diploma or degree)
    • High School diploma or equivalent
    • Registered Apprenticeship or other trades certificate or diploma
    • College, CEGEP or other non-university certificate or diploma
    • University certificate or diploma below bachelor's level
    • Bachelor's degree
    • Post graduate degree above bachelor's level
    • Prefer not to answer
50. What language do you speak most often at home?
    • English
    • French
    • Other
    • Prefer not to answer
51. Which of the following categories best describes your current employment status? Are you…
    • Working full-time, that is, 35 or more hours per week?
    • Working part-time, that is, less than 35 hours per week?
    • Self-employed?
    • Unemployed, but looking for work?
    • A student attending school full-time?
    • Retired?
    • Not in the workforce? [Full-time homemaker, unemployed, not looking for work]
    • Other
    • Prefer not to answer

    [IF WORKING]

52. In which industry or field do you work? Please select the one that best describes your work.
    • Agriculture, Forestry, Fishing and Hunting
    • Mining and oil and gas extraction
    • Construction
    • Manufacturing
    • Wholesale Trade
    • Retail Trade
    • Transportation and warehousing
    • Information and cultural industries
    • Finance and Insurance
    • Real estate and rental and leasing
    • Professional, scientific and technical services
    • Management of companies and enterprises
    • Administrative and support, waste management and remediation services
    • Education services
    • Utilities
    • Health care and social assistance
    • Arts, entertainment and recreation
    • Accommodation and food services
    • Public administration
    • Other: Specify [TEXT]
    • Prefer not to answer
53. Which of the following categories best describes your total household income? That is, the total income of all persons in your household combined, before taxes?
    • Under $20,000
    • $20,000 to just under $40,000
    • $40,000 to just under $60,000
    • $60,000 to just under $80,000
    • $80,000 to just under $100,000
    • $100,000 to just under $150,000
    • $150,000 and above
    • Prefer not to answer
54. Including yourself, how many people usually live in your household?

    [TEXT]

    • Prefer not to answer

    Completion Page

    That concludes the survey. Thank you very much for your thoughtful feedback. It is much appreciated. The results will be available at the Library and Archives Canada website in the coming months.