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

Executive Summary

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: 2019-06-03

Registration Number: POR 093-18

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

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).

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.

Alethea Woods
President
Phoenix Strategic Perspectives Inc.