Prepared by: Corporate Research Associates Inc.
Prepared for: Health Canada
POR Registration Number: 126-18
PSPC Contract Number: HT372-184423
Contract Award Date: February 21, 2019
Delivery Date: May 3, 2019
Contracted Cost: $228,966.25
Ce rapport est aussi disponible en français.
For more information on this report, please email: hc.cpab.por-rop.dgcap.sc@canada.ca
CRA Corporate Research Associates
Suite 5001, 7071 Bayers Road
Halifax NS B3L 2C2
www.cra.ca
1-888-414-1336
Supplier Name: Corporate Research Associates Inc.
April 2019
This public opinion research report presents the results of focus groups conducted by Corporate Research Associates Inc. on behalf of Health Canada. The research study was done using qualitative focus groups. The research entailed a total of forty focus groups comprised of four categories. Ten groups were conducted with each of the following audiences: youth non-smokers ages 15-19; youth smokers ages 15-19; young adult smokers ages 20-24; and adult smokers ages 25 and older. The research was conducted between March 18 and 29, 2019.
Cette publication est aussi disponible en français sous le titre : Évaluation qualitative des avertissements relatifs à la santé révisés pour les paquets de cigarettes et sur les cigarettes.
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.
Catalogue Number:
H14-325/2019E-PDF
International Standard Book Number (ISBN):
978-0-660-30858-6
Related publications (registration number: POR-037-18):
Catalogue Number H14-325/2019F-PDF (Final Report, French)
978-0-66030859-3
© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2019
Tobacco use is the leading preventable cause of premature death and disease in Canada. Pictorial health warnings have been determined to be effective in broadening awareness of the hazards associated with tobacco use. Health Canada has created several refreshed pictorial health warnings, and was interested in assessing reactions to the concepts being considered, including new pictorial health warnings, as well as warning text directly onto individual cigarettes. Research was needed to determine whether the concepts would be effective in informing and educating Canadians about the health hazards and health effects of tobacco use.
To achieve these objectives, a qualitative research approach was undertaken. This entailed a total of forty in-person focus groups conducted from March 18 to 29, 2019 in Toronto, Vancouver, Halifax and Montreal. Ten focus groups were conducted for each of four audiences: youth non-smokers ages 15-19; youth smokers ages 15-19; young adult smokers ages 20-24; and adult smokers ages 25 and older. Participants in the research included a mix of gender and ages within each age group.
The Montreal focus groups were conducted in French, while discussions in all other locations were conducted in English. Each focus group lasted approximately 2 hours and participants each received $100 (Monday-Thursday) or $125 (Friday-Saturday) in appreciation for their time. A total of twelve (12) participants were recruited per group (with a goal of 10 attending the discussion). Across locations, 369 participants actually attended the discussions.
All participants were recruited per the recruitment specifications for the Government of Canada. Recruitment was conducted through qualitative panels stored on Canadian servers, with follow up calls to confirm the details provided and to ensure quotas were met. This report presents the findings from the study. Caution must be exercised when interpreting the results from this study, as qualitative research is directional only. Results cannot be attributed to the overall population under study, with any degree of confidence.
I hereby certify as a Representative of Corporate Research Associates Inc. that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Directive on the Management of Communications. Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate or ratings of the performance of a political party or its leaders.
Signed
Margaret Brigley, President & COO | Corporate Research Associates
Date: May 3, 2019
Findings from the Qualitative Testing of Revised Health Warnings for Cigarette Packages and on Cigarette – 2019 reveal that a number of elements related to the imagery, the messaging, and the layout are important in determining the impact of health warnings for cigarette packages. These conclusions are drawn from the review of reactions to a total of 44 health warnings (consisting of the review of 11 health warnings per group on a rotation schedule), and a total of 52 on-cigarette health warnings (with 13 reviewed per group on a rotation schedule).
Results confirm that messaging that is short, unexpected and serious in its potential personal impact garnered attention. Further, messaging that presents one specific health effect of smoking was generally considered clearer, easier to understand and more compelling than messaging that introduces multiple topics and lengthier explanations.
Feedback received in the focus groups suggests that imagery plays an important role in attracting initial attention on the health warning and greatly influences a message’s impact and credibility. Images that are meaningful and have the ability to clearly communicate the health effect of smoking without the assistance of the text were generally considered most impactful. Likewise, health warnings that feature a realistic image were generally considered more believable. As might be expected, unusual images or those never having been seen before were most likely to elicit attention. At the same time, imagery targeted at specific segments of the population was considered most relevant to the target audience.
While graphic and gruesome imagery effectively grab attention, they appear to sometimes lessen a health warning’s impact. Specifically, reactions varied during the focus groups from ignoring the warning for being accustomed to seeing these types of labels on cigarette packages, to avoiding looking at it altogether if it was felt to be too gruesome.
While the image plays an important role in the initial attention paid to the health warning, the accompanying text is also of importance in establishing the message’s relevance and credibility. A short message using plain language that identifies the health effect of smoking upfront, followed by a short explanation or rationale, was considered of interest. Moreover, attention was more acute for new or less-known information, as long as it is clearly explained in a simple manner. Health Canada endorsement also contributed to enhancing the message’s credibility on the health warnings reviewed.
Health warnings about nicotine addiction and the effects of second-hand smoke were considered less compelling by the target audience, as participants believed that both of those topics have been heavily promoted in recent years in various public education campaigns. Finally, health consequences that were not seen as potentially life-threatening (e.g., impotence, ear infections, asthma, pneumonia) were considered less likely to make someone think about their smoking. By comparisons, health warnings that present serious health effects on babies and fetuses elicited attention.
Further, realism, personal relevance, definitive statements and the use of statistics are key in generating credibility in a health warning. Having personally experienced a health effect of smoking or knowing someone who has enhances the perceived credibility of a health warning. Briefly explaining less-known health effects, as well as providing meaningful statistics helped improve the health warning’s credibility. Qualifying words were also questioned (e.g., preference expressed for “smoking causes cancer” rather than “smoking may cause cancer”) and introduced some doubt regarding the credibility of the claim.
In the case of health warnings that showed a health effect of smoking that could occur in the future, it was most important to young people to see the impact on a person’s health or lifestyle when they are in their forties (considered mid-life) rather than when they are in their sixties or later in life (considered closer to the end of life). Implying a reduced or dramatically changed lifestyle as a result of a health consequence, or suffering, grabbed young people’s attention, as long as the effects are considered realistic and common consequences of smoking, and not unique or extreme situations.
Testimonials were generally seen as ineffective at grabbing attention and eliciting interest. This may be due to the situation described being seen as unique to the person featured and people’s general inability to imagine themselves in those situations. Further, the imagery on those health warnings did not adequately convey the health consequences discussed in the text and generally lacked emotional appeal. Credibility was also lessened by the use of uncommon and perceived unrealistic names (e.g., Tarbox1).
In terms of the design and layout of a health warnings for cigarette packages, findings show that the preferred placement of elements depends on how individuals process information (e.g., reading from left to right or top to bottom) and what design elements they are drawn to (e.g., image or text). Further, contrasting red and yellow colours appear to have the strongest visual impact, and were most commonly associated with the implied intent of a warning (i.e., stop, danger). Black text on yellow background stood out, as did yellow text on a dark background. Positioning the warning banner at the top of the health warning spanning the entire width of the design was considered most visible. That said, the right justification of the word “warning” was questioned, with most expecting it to be centered. On the French health warnings, the term “avertissement” was considered more appropriate than “attention” for a health warning, for being formal and commonly associated with the ideal of prevention.
The quitline section of the health warning was generally noticed and highly appreciated. In terms of format, capitalizing and bolding the letters gave the message more prominence, while black lettering on a white background was considered most visible, eye-catching, and easier to read than white lettering on a blue background.
Once the review of health warnings for cigarette packages was completed, a short discussion regarding on-cigarette health warnings ensued. Reactions to having health warnings printed directly on cigarettes were viscerally negative among people who smoke, as they are considered unnecessary to warn those who smoke and a costly approach. However, the presence of on-cigarette health warnings made smoking less attractive to people who smoke and less frequent smokers expressed mixed opinion regarding its potential to impact awareness of health hazards.
Across groups, participants reviewed a total of 52 on-cigarette health warnings, with each group reviewing 13 different versions. In general, short on-cigarette messages and those that highlight the health impact of each puff were most noticed and considered most memorable. Health warnings that spoke of a broad health effect, those that identified death as the ultimate consequence of smoking, and those that suggested suffering were also considered most compelling. Versions with quitline information were also often selected among the most memorable. Addiction-related statements also held appeal among English-speaking participants. On-cigarette health warnings were generally considered credible, although those that presented health effects on body parts not readily associated with smoking (e.g., eyes), claims considered too vague or that provides limited explanation were considered less credible. New or less-known information about the health effects of smoking included the potential for stomach, bladder, kidney or lip cancer, damages on the eyes, impotence, and the large number of chemicals contained in cigarette smoke. Apart from the use of the acronym “COPD/MPOC”, the claim that smoking damages the eyes and the lack of clear consequence of having tar in every puff, the on-cigarette health warnings were considered clear and easy to understand.
Finally, in terms of how the health warning would appear on the cigarette, designs that included icons or red text were considered most eye-catching. In addition, having a health warning printed on the cigarette filter was considered most effective in ensuring the message remains visible and top-of-mind for people who smoke. The use of the colour yellow was also considered effective at grabbing attention.