Online Qualitative Testing of Draft Health Warnings for Cigars, Pipe Tobacco, Smokeless Tobacco and Toxic Statements for Smokeless Product Packaging - 2019
Final Report
Prepared for Health Canada
Prepared by Narrative Research
PSPC Contract Number: HT372-192562/001/CY
Contracted Value: $86,320.70
Contract Date: June 18, 2019
Delivery Date: August 13, 2019
POR number: 026-19
For more information, please contact: hc.cpab.por-rop.dgcap.sc@canada.ca
Ce rapport est aussi disponible en français
Supplier Name: Narrative Research
August 2019
This public opinion research report presents the results of focus groups conducted by Narrative Research on behalf of Health Canada. The research study was done using qualitative focus groups. The research entailed a total of 15 online focus groups conducted with cigar, pipe tobacco and smokeless tobacco users from across Canada. More specifically, nine (9) groups were conducted with cigar and/or pipe tobacco users, while six (6) groups were conducted with smokeless tobacco users. All participants were 18 years of age or older, with a mix of gender and ages within each group. The research was conducted between July 15th and July 22nd, 2019.
Cette publication est aussi disponible en français sous le titre :
Évaluation qualitative en ligne d'ébauches d'avertissements de santé provisoires pour les cigares, les pipes à tabac et le tabac sans fumée et les énoncés toxiques pour l'emballage des produits sans fumée - 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
Catalogue Number:
H14-337/2020E-PDF
International Standard Book Number (ISBN):
978-0-660-32515-6
Related publications (registration number: POR-026-19):
Catalogue Number H14-337/2020F-PDF (Final Report, French)
ISBN 978-0-660-32516-3
Narrative Research Inc.
Contract Number: HT372-192562/001/CY
POR Registration Number: 026-19
Contract Award Date: June 18, 2019
Contracted Cost: $86,320.70
Background and Research Methodology
Tobacco use is the leading preventable cause of premature death and disease in Canada. Pictorial Health Warnings have been determined to be effective at raising awareness of the health hazards associated with tobacco use. Health Warnings on tobacco products are intended to inform Canadians, both tobacco users and potential users, about the health hazards and health effects arising from the use of tobacco products or its emissions. The Health Warnings are also intended to raise awareness of the pan-Canadian quitline which offers cessation advice to tobacco users. Health Canada has developed 13 draft Health Warnings for cigars and pipe tobacco, as well as 9 draft Health Warnings for smokeless tobacco. Moreover, Health Canada has also created 18 draft Toxic Statements for smokeless tobacco products. The Health Warnings and Toxic Statements are intended to focus on four key themes, namely: addiction, health impacts or diseases (as a result of using cigars, pipe tobacco and smokeless tobacco), how these products are not a safe alternative to cigarettes, and the harmful emissions or constituents in tobacco smoke and tobacco products.
Following development of these draft Health Warnings and Toxic Statements, Health Canada was interested in assessing reactions and understanding impressions to the concepts as a tool to communicate health-related information on tobacco packages, as well as assessing smokeless tobacco product users' reactions to draft textual Toxic Statements for smokeless tobacco. Ultimately, research was needed to determine whether the concepts would be effective at informing and educating Canadians about the health hazards and health effects of cigars, pipe tobacco and smokeless tobacco use.
To achieve these objectives, a qualitative research approach was undertaken. This entailed a total of 15 online focus groups conducted from July 15 to 22, 2019 with cigar, pipe tobacco and smokeless tobacco users from across the country. Specifically, nine (9) groups were conducted with cigar and/or pipe tobacco users, while six (6) groups were conducted with smokeless tobacco users. All participants were 18 years of age or older, and all had smoked cigars/pipe tobacco or used smokeless tobacco in the past. Each group included a mix of gender and ages, where possible.
Overall, eleven (11) groups were conducted in English with participants from British Columbia, Alberta, Manitoba, Ontario, New Brunswick, Prince Edward Island, Nova Scotia, and Newfoundland and Labrador. In addition, five (5) groups were conducted in French, with participants from the province of Quebec. Each online group lasted approximately 1.5 to 2 hours with participants each receiving $125 in appreciation of their time. A total of 10 participants were recruited per group (including 2 stand-by respondents). Across all groups, 111 participants attended the discussions, with an additional six (6) participants incentivized as stand-by respondents who did not take part in 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.
Political Neutrality Certification
I hereby certify as a Representative of Narrative Research 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, CEO & Partner | Narrative Research
Date: August 13, 2019
Key Findings and Conclusions
Findings from the Online Qualitative Testing of Draft Health Warnings for Cigars, Pipe Tobacco, Smokeless Tobacco and Toxic Statements for Smokeless Product Packaging reveal that a number of elements related to the imagery, the messaging, and the design are important in determining the impact of Health Warnings for packages. These conclusions are drawn from the review of reactions to a total of 22 Health Warnings (consisting of the review of 13 Health Warnings for cigar / pipe tobacco packaging and nine (9) Health Warnings for smokeless tobacco packaging), and a total of 18 Toxic Statements for smokeless product packaging.
Feedback received in the focus groups suggests that imagery plays an important role in attracting initial attention to a 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 / tobacco use without the assistance of the text were generally considered most impactful. Likewise, Health Warnings that feature a realistic image were generally considered more believable than those featuring drawings.
The research findings show that gruesome or graphic visuals grab attention. That said, for some, the more graphic images are sometimes ignored or avoided because they are considered so repulsive. By contrast, less graphic imagery was generally easier to ignore for those who smoke cigars / pipe tobacco or use smokeless tobacco. Unusual or unfamiliar images are most likely to elicit attention provided they are able to understand what is being shown.
Messaging that is short, introduces less common information, and is serious in its potential personal impact garners greatest attention, while longer text can be a deterrent to read the Health Warning. Participants considered that having a Health Warning highlight serious consequence to their health as a result of product usage are most apt to grab their attention. Further, messaging that presents one specific health effect of smoking cigars / pipe tobacco or using smokeless tobacco was generally considered clearer, easier to understand and more compelling than messaging that introduces multiple topics or lengthier explanations. In addition, realism, personal relevance, definitive statements and the use of statistics are key in generating credibility in a Health Warning. Participants who have personally experienced a health effect of smoking tobacco, or know someone who has, enhances the perceived credibility of a Health Warning.
Misconceptions regarding the health harms related to the use of these tobacco products were evident across all focus groups. There is a perception that smoking cigars / pipe tobacco and using smokeless tobacco products is less harmful to one's health than smoking cigarettes. It is worth noting that many of those using these products also smoke / have smoked cigarettes. Many participants cited using smokeless tobacco or cigars / pipe tobacco as a means to quit or wean themselves off cigarettes.
People who smoke cigars and pipe tobacco also perceived that if they do not inhale when smoking, the health effects are minimized and limited to the mouth / tongue and teeth. Those using smokeless tobacco are also under the impression that tobacco products that are not burned for consumption and don't produce smoke (ie. Smokeless tobacco) are less harmful. Further, a number of people who smoke cigars daily reported that they felt they have not personally experienced the signs or symptoms of addiction, and thus perceive cigars to be less addictive than cigarettes. Across groups, addiction was generally not considered a health effect of smoking cigars / pipe tobacco or using smokeless tobacco. Rather, it is considered a minor consequence that could be overcome.
Findings confirm that the inclusion of the Health Canada attribution on Health Warnings adds credibility to a Health Warning message and creates a sense of validation and trustworthiness in the message.
In terms of Health Warning design elements, findings show that 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 also stood out, as did yellow text on a dark background. The quitline section of the Health Warning was generally noticed and considered important and valuable information to include. In terms of format, capitalizing and bolding words gave the message more prominence.
When reviewing reactions to the 18 toxic statements being considered for smokeless tobacco packaging, findings suggest there is potential for such statements to further educate users on specific risks associated with smokeless tobacco. Of the three broad theme categories, results highlight key distinctions. When considering the 'cancer' themed statements, messaging that is brief, clear and provides quantitative facts was generally seen as effective and considered more alarming. Users also considered statements that provide descriptive and potentially visual consequences of product usage to be most effective.
Within the 'specific chemicals' themed statements, familiarity with the specified chemicals clearly makes a difference. Across groups, participants generally concurred that naming chemicals they are familiar with makes a statement more effective, as they can immediately relate to a potential danger associated with product usage. In contrast, vague statements, or those including chemicals they are unfamiliar with (i.e. nitrosamines) result in a lack of personal relevance and minimized impact of the statement. Chemicals that are understood (i.e. arsenic, lead and cadmium) provide greater shock value and effect.
Finally, when considering the 'nicotine / addiction' themed statements, participants believed that phrases that are short and clearly outline what nicotine does or what is happening when using smokeless tobacco are most effective at grabbing their attention. Mention of brain altering, and absorption in blood suggests serious consequences and grabs attention.
Introduction
Tobacco use is the leading preventable cause of premature death and disease in Canada. Tobacco use contributes to serious chronic diseases such as cancer, heart disease and respiratory illnesses. Approximately, one-half of people who have smoked for a long time die prematurely from smoking-related diseases, resulting in over 45,000 deaths in Canada annually.
The Tobacco Products Labelling Regulations (Cigarettes and Little Cigars) (TPLR-CLC) mandate the Health Warnings, Health Information Messages, and Toxic Emission Statements (TS) that are applied to cigarettes and little cigars (C/LC). The Tobacco Products Information Regulations (TPIR) stipulates the labelling requirements for smokeless tobacco, pipe tobacco and cigars, as well as other tobacco products. TPIR stipulates that labelling of these products consists of a combination of Health Warnings, Health Information Message, and Toxic Emissions/Constituents Information. While the TPLR-CLC requires pictorial HW to appear on at least 75% of the space on the front and back panels of C/LC packages, the TPIR requires pictorial Health Warnings of up to 50% of the principal display panels of cigar, pipe tobacco and smokeless tobacco product packages. The TPIR also requires that Toxic Constituents Information be displayed on any side or the bottom of packages of smokeless tobacco.
Health-related information on tobacco product packaging is recognized as one of the best approaches to raise awareness of the health hazards and health effects associated with tobacco use. Moreover, past research has shown the effectiveness of including both 'loss-framed' (negative consequences of tobacco use) and 'gain-framed' (benefits of quitting) messaging on the same package as a means of conveying the health effects and health hazards of smoking. Currently, Health Warnings are predominantly loss-framed messages that provide information in relation to the health effects and health hazards of tobacco use, testimonials from people who smoke on the effects of smoking, or about tobacco products and their harmful emissions and constituents. Health Warnings on C/LC also include gain-framed messaging in the form of information about cessation support services (quitline information). Research also demonstrates that frequent renewal of health-related labels on tobacco products helps maintain their effectiveness.
Health Canada is in the process of developing a draft suite of Health Warnings, HIM and Toxic Statements for tobacco products to update the health-related information currently displayed on tobacco packages, including labels specifically for cigars, pipe tobacco and smokeless tobacco. Moreover, Health Warnings for cigars, pipe tobacco and smokeless tobacco and Toxic Statements for smokeless tobacco will focus on four key themes, namely: addiction, health impacts or diseases caused by cigar, pipe tobacco and smokeless tobacco use; how these products are not a safe alternative to cigarettes; and the harmful emissions and constituents found in tobacco smoke and tobacco products. New labels on tobacco packages will also be complemented by the implementation of plain and standardized appearance measures for all tobacco product packaging in Canada (standardizing the colour and appearance of tobacco products and their packages).
Among its purposes, the newly designed draft Health Warnings for cigars, pipe tobacco and smokeless tobacco are intended to:
inform Canadians, both tobacco users and potential users, about the health hazards and health effects associated with tobacco use and from its emissions; and
raise awareness of the pan-Canadian quitline and web address.
In order to assess the draft designs for cigars, pipe tobacco and smokeless tobacco product packaging, Health Canada required a qualitative study to assess the reactions of Canadians who are consumers of these products. Specifically, there was a need to assess users' reactions towards the draft Health Warnings, and reactions towards the draft Toxic Statements for smokeless tobacco packages.
As a result of these research needs, a total of 15 online focus groups were conducted across two key audiences, namely people who smoke cigars/pipe tobacco, and users of smokeless tobacco products. Overall, ten groups were conducted in English, while five groups were conducted in French. Feedback was obtained from across the country on the concepts, messaging and effectiveness of the draft pictorial Health Warnings and the draft textual Toxic Statements.
Objectives
The qualitative research objectives were to explore reactions to 13 draft Health Warnings designed for cigars and pipe tobacco packaging, and 9 draft Health Warnings designed for smokeless tobacco packaging. Specifically, this research sought:
To determine if the factual information provided is noticeable and relevant, and whether the source is considered to be a reliable source of information;
To evaluate if the text written is in plain language and understood (in the intended way) by the target audience;
To determine if each Health Warning is engaging for cigar, pipe tobacco and/or smokeless tobacco users in order to encourage tobacco users to read the information;
To determine if each Health Warning informs and educates Canadians about the health hazards and health effects of tobacco use and encourages cessation;
To gather feedback on whether participants believe the Health Warnings would be memorable; and,
To gather participants' views of design elements of the Health Warnings, including the impact of different formats, placements and colours (i.e., background, border, certain text).
Moreover, specific research objectives to explore reactions to 18 draft Toxic Statements for smokeless tobacco products were:
To assess the statements noticeability, believability and relevance;
To assess whether the statements are understood in the intended way by the target audience; and,
To assess whether the statements inform and educate Canadians about the health hazards; and effects associated with smokeless tobacco use, and the specific toxic chemicals found in smokeless tobacco products.
This report presents the findings of the research. It includes a high-level executive summary, the description of the detailed methodology used, the detailed findings of the focus group discussions, and considerations derived from the analysis of research findings. The working documents are appended to the report, including the recruitment screener (Appendix A), the moderator's guide (Appendix B), and the schedule of rotation (Appendix C).
Research Methodology
Target Audience
There were two target audiences for this study, namely:
Adult users of cigars (i.e. cigars weighing over 1.4 grams and without a cigarette filter) and pipe tobacco (18+ years old); and
Adult users of smokeless tobacco products (such as chewing tobacco, moist snuff, smokeless pouches and snus) (18+ years old).
For the context of this project, "users" of cigars/pipe tobacco and/or smokeless tobacco products included those who have used these products within the last 30 days or who have ever used these products.
Research Approach
The study included a total of 15 in-person focus groups; nine (9) groups were conducted with cigar and/or pipe tobacco users, and six (6) groups were conducted with smokeless tobacco users. Additionally, 10 groups were conducted in English (6 groups with cigar/pipe tobacco users, and 4 groups with smokeless tobacco users), and five (5) groups were conducted in French (3 groups with cigar/pipe tobacco users, and 2 groups with smokeless tobacco users).
Participants in the research included those 18 years of age or older, with a mix of gender and ages within each age group. All had smoked cigars/pipe tobacco or used smokeless tobacco in the past (based on the relevant group). Groups included a mix of participants based on their tobacco use status (everyday, occasionally or rarely), and when they had last used the tobacco product with at least one-third having used the tobacco product within the past 30 days. The focus groups were conducted from July 15 to July 22, 2019. A total of ten (10) participants were recruited per group (including 2 stand-by respondents). Across groups, 111 participants attended the discussions (see summary table by location that follows), with an additional six (6) participants incentivised as stand-by respondents who did not take part in 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. An additional confirmation call was done approximately one day prior to each focus group. Those who took part in the discussion each received a compensation of $125 as a token of appreciation for their time, as per market standards. Group discussions each lasted up to two hours.
The following provides a summary of the user groups in each location:
Date & Time
Audience
Market
Language
# of participants
Monday, July 15, 2019
Group 1: 5:30 pm ADT/4:30pm EDT
Cigar/Pipe Tobacco Smokers
Atlantic
English
8
Group 2: 8:00pm ADT/7:00pm EDT/6:00pm CDT
Cigar/Pipe Tobacco Smokers
Central
English
7
Tuesday, July 16, 2019
Group 3: 6:30pm ADT/5:30pm EDT
Cigar/Pipe Tobacco Smokers
Atlantic
English
8
Group 4: 9:00pm ADT/8:00pm EDT/6:00pm MDT/5:00pm PDT
Cigar/Pipe Tobacco Smokers
West
English
7
Wednesday, July 17, 2019
Group 5: 6:30pm ADT/5:30pm EDT
Cigar/Pipe Tobacco Smokers
Quebec
French
8
Group 6: 7:00pm ADT/6:00pm EDT
Smokeless Tobacco Users
Atlantic/Central
English
8
Group 7: 9:30pm ADT/8:30pm EDT/6:30pm MDT/5:30pm PDT
Cigar/Pipe Tobacco Smokers
West
English
6
Thursday, July 18, 2019
Group 8: 6:30pm ADT/5:30pm EDT
Cigar/Pipe Tobacco Smokers
Quebec
French
8
Group 9: 7:30pm ADT/6:30pm EDT/5:30pm CDT
Cigar/Pipe Tobacco Smokers
Central
English
7
Group 10: 9:00pm ADT/8:00pm EDT
Smokeless Tobacco Users
Quebec
French
8
Group 11: 10:00pm ADT/9:00pm EDT/7:00pm MDT/6:00pm PDT
Smokeless Tobacco Users
West
English
5
Monday, July 22, 2019
Group 12: 6:30pm ADT/5:30pm EDT
Cigar/Pipe Tobacco Smokers
Quebec
French
8
Group 13: 7:00pm ADT/6:00pm EDT
Smokeless Tobacco Users
Atlantic/Central
English
8
Group 14: 9:00pm ADT/8:00pm EDT
Smokeless Tobacco Users
Quebec
French
7
Group 15: 9:30pm ADT/8:30pm EDT/6:30pm MDT/5:30pm PDT
Smokeless Tobacco Users
West
English
8
The following provides a breakdown of participants based on region, language and audience:
15 groups
Region
Language
Users of cigar and pipe tobacco (Aged 18+)
Users of smokeless tobacco (Aged 18+)
Total
Quebec / NB / Ontario
French
3
2
5
West (NWT, BC, AB, SK)
English
2
2
4
Central (MB, ON)
English
2
2
6
Atlantic (NB, PE, NS, NL)
English
2
TOTAL # SESSIONS:
9
6
15
Approach to Concept Review
To eliminate presentation biases, the presentation order of Health Warnings was changed across groups. The schedule of rotation is included in Appendix C.
Context of Qualitative Research
Qualitative discussions are intended as moderator-directed, informal, non-threatening discussions with participants whose characteristics, habits and attitudes are considered relevant to the topic of discussion. The primary benefits of individual or group qualitative discussions are that they allow for in-depth probing with qualifying participants on behavioural habits, usage patterns, perceptions and attitudes related to the subject matter. This type of discussion allows for flexibility in exploring other areas that may be pertinent to the investigation. Qualitative research allows for more complete understanding of the segment in that the thoughts or feelings are expressed in the participants' "own language" and at their "own levels of passion." Qualitative techniques are used in marketing research as a means of developing insight and direction, rather than collecting quantitatively precise data or absolute measures. As such, results are directional only and cannot be projected to the overall population under study.
Detailed Analysis
Heath Warning Testing - Cigars and Pipe Tobacco
Prior to discussing the Health Warnings, participants were shown an example of where the Health Warning may appear on cigar/pipe tobacco packages, as illustrated below:
Figure a. Sample CigarFigure a - Text description
Cigar package with drab brown color
First image: Brand Name, 5 cigars
Second image, the text reads:
Warning
Tobacco smoke hurts children
Tobacco smoke can trigger asthma attaches in children
Health Canada
Brand Name. Bar code.
Figure a1. Sample PipeFigure a1 - Text description
Pipe tobacco package with drab brown color
First image: Brand Name, Pipe tobacco, 10 g
Second image, the text reads:
Warning
Tobacco smoke hurts children
Tobacco smoke can trigger asthma attaches in children
Health Canada
Name and address of manufacturer. Bar code.
The following section presents, in numeric order, reactions to each of the 13 Health Warnings tested for cigars and pipe tobacco. The order of Health Warning presentation in the online group discussions was varied by group to avoid order bias. Of note, there were three instances where an image was applicable for both cigars and pipe tobacco and, in those cases, participants were presented both Health Warnings simultaneously. All other Health Warnings were presented individually.
NHWC01 - Cigars cause lung cancer even if you don't inhale./
NHWP01 - Smoking pipe tobacco causes lung cancer even if you don't inhale.
Figure 1. NHWCO1Figure NHWC01 - Text description
A man in a morgue with his chest cut open showing his infected lungs. Portrait view
Red and yellow colour combination
The text reads:
WARNING
Cigars cause lung cancer even if you don't inhale.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 1a. NHWPO1Figure 1. NHWP01 - Text description
A man in a morgue with his chest cut open showing his infected lungs. Portrait view
Red and yellow colour combination
The text reads:
WARNING
Cigars cause lung cancer even if you don't inhale.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 1b. NHWCO1Figure NHWC01 - Text description
Un homme dans une morgue avec la poitrine ouverte, montrant ses poumons infectés. Orientation Portrait
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Même si vous n'aspirez pas, fumer le tabac à pipe cause le cancer des poumons.
Across locations, this Health Warning was generally deemed attention-grabbing, credible, clear, easy to understand, and communicated a health effect of smoking.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning's red warning banner, graphic picture, yellow text box and brief text effectively grabbed attention. The image was considered disturbing, gross and shocking to most and across locations. Many participants felt that with such a graphic image, there was often less attention focused on the text.
That said, having 'pipe tobacco' and 'lung cancer' bolded effectively drew readers' attention and encouraged them to read the text. It was generally felt that this was a label that people who smoke pipe tobacco/cigars would prefer to avoid.
Credibility
Participants generally believed what the Health Warning said and the text was considered pointed, clear and accurate to most. Saying smoking cigars or pipe tobacco causes lung cancer 'even if you don't inhale' was concerning to many, while others considered it scare tactics and a message that is not necessarily believable. Indeed, across locations, some participants felt that if people who smoke do not inhale, they are not getting smoke in their lungs, and therefore have a diminished risk of developing lung cancer. While for some participants the Health Warnings made them reconsider this conviction, it was not the case for others who considered the health risk did not apply to them given that they did not inhale the smoke.
Clarity / Ease of Understanding
The Health Warning was considered clear and easy to understand, and most concurred that the image clearly portrayed lung disease. A few, however, questioned if it was showing an unhealthy or cancerous lung given that they were not familiar with what a healthy lung looks like.
The text was considered clear and direct in its messaging and was felt to work well together with the image.
Ability to Communicate a Health Effect
This Health Warning clearly communicated a health effect of smoking cigars / pipe tobacco, namely lung cancer.
Participants' Suggestions
Participants offered limited changes to enhance this Health Warning, including:
Show a side by side image (healthy lung vs. unhealthy lung) to help clarify that the lung shown is a cancerous lung / an unhealthy lung
Show a more realistic image, or more clearly indicate that the black parts are diseased lungs
Specify that the individual shown in the image is/was a person who smokes cigars or pipe tobacco
Reword the statement in the English version to suggest that tobacco "may" or "can" cause cancer
Replace the term "aspirez" with "inhalez" in the French cigar version
Add a statement near the quitline section to invite those who smoke not to wait to seek help until it is too late
Lungs outside of the body showing one healthy pink lung and one black deseased lung. Portrait view
Red and yellow colour combination
The text reads:
WARNING
Cigar smoking causes lung cancer.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 2. NHWP02Figure 2. NHWP02 - Text description
Lungs outside of the body showing one healthy pink lung and one black deseased lung. Landscape view
Red and yellow colour combination
The text reads:
WARNING
Cigar smoking causes lung cancer.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 2b. NHWC02Figure 2b - Text description
Poumons à l'extérieur du corps montrant un poumon rose en bonne santé et un poumon noir atteint. Orientation Portrait
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Les cigares causent le cancer des poumons.
Santé Canada
Figure 2c. NHWP02Figure 2c. NHWP02 - Text description
Poumons à l'extérieur du corps montrant un poumon rose en bonne santé et un poumon noir atteint. Orientation paysage
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Les cigares causent le cancer des poumons.
Santé Canada
This Health Warning was considered attention-grabbing primarily because of the bright colours, vivid image and brief text. The Health Warning was widely seen as believable and communicating a health effect of smoking, with the visual clearly portraying a negative health effect.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning effectively grabbed participants' attention with its clear, eye-opening graphic and simplistic text. For many, the use of a life-like illustration (rather showing real lungs) that clearly portrayed the impact of smoking cigars / pipe tobacco effectively grabbed participant's attention. The red warning banner and yellow text box also successfully grabbed attention, and having bolded text drew their eyes to the words that mattered most (pipe tobacco / lung cancer).
Those who felt the Health Warning did not grab their attention considered it too familiar and indicated that they have seen similar imagery on cigarette packages. Accordingly, they described themselves as desensitized to the visual and considered it something they personally find easy to overlook.
Credibility
Participants generally believed what the Health Warning said and the text was considered pointed, clear and accurate in its portrayal.
In a number of locations, however, a few participants did not realize that the image was not real and questioned how it is possible that someone could only have one lung in poor condition. For them, it was felt that having an image of a real unhealthy lung (as an autopsy) would increase the Health Warning's relevance, shock value, and make it more realistic.
Clarity / Ease of Understanding
Participants felt the Health Warning was clear and easy to understand, with its brief and simplistic text. For most, the visual also clearly portrayed the negative impact that smoking cigars or pipe tobacco has on the lungs and the image worked effectively with the text.
Ability to Communicate a Health Effect
In general, this Health Warning was believed to effectively communicate a health effect of smoking cigars or pipe tobacco, namely that it causes lung cancer. Participants did not, however, believe the Health Warning taught them something they did not already know.
Participants' Suggestions
Participants offered minimal suggestions on how to enhance the Health Warning, including:
Include real lungs (versus a mock visual) to be more realistic
Show two images side-by-side, including a healthy lung and an unhealthy lung
Add a label below each lung to indicate the "before" and "after" condition
In both the English and French versions, say that it "can cause" ("peut/peuvent causer") rather than that it "causes" or in the English version, "in this case, smoking cigars/pipe tobacco has caused lung cancer" or say that tobacco smoking is one of the causes of lung cancer (thus suggesting there are others)
NHWC05 - Cigar smoking causes throat cancer.
Figure 5. NHWC05Figure 5 - Text description
Man with his head tilted back showing an animation of an infected vocal cord. Portrait view
Red and yellow colour combination
The text reads:
WARNING
Cigar smoking causes throat cancer.
Throat cancer may lead to the removal of your vocal cords.
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Health Canada
Figure 5a. NHWC05Figure 5a - Text description
L'homme avec sa tête penchée en arrière montre une animation d'une corde vocale infectée. Orientation Portrait
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Les cigares causent le cancer de la gorge.
Le cancer de la gorge peut rendre nécessaire l'ablation de vos cordes vocales.
This Health Warning was consistently considered to communicate a health effect of cigar smoking and was generally deemed believable. Although its text was seen as clear and easy to understand, the Health Warning was not always considered effective at grabbing attention because most participants considered the image confusing and unclear.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
While this Health Warning's red warning banner, yellow text box, and bolded text initially grabbed attention, it was generally not considered overly effective at being attention-getting. Although the visual elicited curiosity for some, most considered it confusing and unclear, and accordingly, disregarded the Health Warning and felt it had limited impact.
Many participants felt that the image on its own did not grab their attention, nor did it connect with them personally. Since it was not a real image and did not clearly show any graphic effect of smoking cigars, participants' eyes were not effectively engaged to read the warning.
Credibility
Participants generally believed what the Health Warning said and the text was considered pointed, clear and accurate in its portrayal.
While the concept was deemed credible for showing the image of a real person, and for illustrating a real condition, some felt the image lacked clarity in identifying what vocal cords are or what throat cancer actually looks like. To improve credibility and clarity, it was felt a more realistic and graphic image of throat cancer should be shown.
Clarity / Ease of Understanding
While the Health Warning's text was considered clear and easy to understand, some confusion was evident with the visual. Participants were often not able to readily recognize what they were looking at and felt that more interpretation was needed. Some wondered if it showed a tumor on the vocal cords, while others felt it looked like someone had swallowed a child's toy. The illustration superimposed over a real photo was considered cartoonish and confusing to many.
Although the text and image worked well together, the text was seen as repetitive and unnecessarily long given its double mention of throat cancer.
Ability to Communicate a Health Effect
In general, the Health Warning was believed to communicate a health effect of cigar smoking, namely throat cancer. Most participants felt it did not teach them something new (i.e. that smoking causes throat cancer). The health effect of throat cancer was clearly communicated in the text of the Health Warning, and the graphic further supported the potential outcome, albeit not as clearly as the text. Questions were raised regarding what the risk of throat cancer actually was among people who smoke cigars versus people who smoke cigarettes, particularly given that many indicated they do not inhale when smoking a cigar.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Increase font size of the warning banner
Shorten the text by removing double mention of 'throat cancer'. In English this would become: "Cigar smoking causes throat cancer which may lead to the removal of your vocal cords".
Reword the French version to read: "le cigare cause le cancer de la gorge et peut rendre nécessaire l'ablation des cordes vocales"
Reword the French version to read: "Le cancer de la gorge peut causer l'ablation de vos cordes vocales"
Reword the French version to read: "Les cigars causent le cancer de la gorge"
Have all text in bold
In the English version, correct spelling of vocal cords (versus chords)
Include a more graphic picture related to the vocal cords (e.g. petri dish with removed vocal cords, removal of vocal cords or tracheotomy)
Include a more graphic (and more disturbing) image of throat cancer
Label the tumor in the image to ensure clarity
NHWC07 - Tobacco use causes oral cancer. /
NHWP03- Smoking pipe tobacco causes cancer of the mouth, lip and tongue.
Figure 6. NHWC07Figure 6 NHWC07 - Text description
A man showing a cancerous lump on his tongue. Portrait view
Black and yellow colour combination
The text reads:
WARNING
Tobacco use causes oral cancer.
This can lead to tumours on your tongue and cheeks.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 6a. NHWP03Figure 6a. NHWP03 - Text description
A man showing a cancerous lump on his tongue. Landscape view
Black and yellow colour combination
The text reads:
WARNING
Tobacco use causes oral cancer.
This can lead to tumours on your tongue and cheeks.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Overall Reactions
This Health Warning was considered highly effective at grabbing attention primarily because of the impactful image, having the Health Warning and dialogue in the same colour, and its brief headline / text. The Health Warning effectively communicated a health effect of using tobacco and was considered believable.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
The graphic and disturbing image on this Health Warning was largely attributed to it being considered highly impactful in grabbing attention. For many the realism of the visual was disturbing to look at, resulting in it being a Health Warning that they would instinctively try to avoid.
Across locations, some participants suggested that having the warning banner in red (rather than yellow) would increase the gravity of the warning given that red was considered more impactful and more serious.
Credibility
Participants consistently believed what the Health Warning said, with the impactful visual and text being considered clear and accurate in its portrayal. The Health Warning was deemed very credible for illustrating a real condition. That said, some considered the Health Warning to be very familiar and something they were used to seeing on cigarette packages. Accordingly, they described themselves as desensitized to the image and disregarded the Health Warning's message.
Clarity / Ease of Understanding
This Health Warning's realistic visual spoke volumes on its own. The Health Warning was considered clear and easy to understand, leaving no room for confusion. Although the text and image worked very well together, some felt the second paragraph 'this can lead to tumors on your tongue and cheeks' was unnecessary and did not increase the effectiveness of the Health Warning.
Ability to Communicate a Health Effect
This Health Warning was considered highly effective at communicating a health effect of smoking pipe tobacco or using tobacco, namely that doing so causes oral cancer or cancer of the mouth, lip and tongue. The health effect of cancer was undoubtedly portrayed in the shocking and realistic graphic, and clearly communicated in the text of the Health Warning. For many, the cancer-causing message was something they knew already. For others, however, the visual helped them to educate them on what oral cancer might look like.
Participants' Suggestions
Participants suggested the following changes to enhance the effectiveness of this Health Warning:
Have the warning banner in red to further grab attention, and to better demonstrate the seriousness of the Health Warning
Make it more personal by including 'this could be you' in the English version
For added credibility, ensure that the text is the same for both versions
NHWC08 - Cigars cause oral cancer.
Figure 7 NHWC08. TitleFigure 7 NHWC08 - Text description
Partial jaw removed from a person. Portrait view
Black and yellow colour combination
The text reads:
WARNING
Cigars cause oral cancer.
This can lead to the removal of part of your jaw bone.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 7a NHWC08. TitleFigure 7 NHWC08 - Text description
Mâchoire partielle retirée d'une personne. Orientation Portrait
Combinaison de couleurs noir et jaune
Le texte est le suivant :
AVERTISSEMENT
Les cigares causent le cancer de la bouche.
Une partie de l'os de la mâchoire pourrait être enlevée.
The gross and jarring picture on this Health Warning, together with its bold headline and concise text, clearly grabbed attention and was easy to understand. That said, this was less impactful when considering its believability.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
Across locations, this Health Warning effectively grabbed attention primarily because of its disturbing visual and bold headline. The yellow warning banner and yellow headline in the black box were also attributed to this Health Warning's effective design.
It was generally felt that graphic and gross pictures effectively grab consumers' attention and that this grotesque image will elicit discussion. Having the text say 'this can lead to…' provoked participants to consider why they should take the chance. While most felt the Health Warning grabbed and held their attention, some felt that its disturbing nature would cause them to turn away and avoid the Health Warning.
Credibility
While the Health Warning was considered to effectively communicate a health effect of smoking cigars and deemed believable to most, some felt that showing only part of a jaw makes it less believable and less personally relevant. For some, the image was confusing and resembled a piece of meat. They felt that not showing a person made the message unclear as it was not what they envisioned cancer would look like. Participants questioned whether the removal of part of a jaw bone actually was common effect of this cancer and some felt the Health Warning was over embellishing an unlikely situation.
Clarity / Ease of Understanding
While the Health Warning's headline and text were considered clear and easy to understand, the visual lacked relevance to some. Participants were not easily able to equate a piece of jaw to oral cancer and felt that showing a person would help them to better put it in perspective.
Although the text and image generally worked well together, it was felt that showing a real person would accentuate what the Health Warning was trying to communicate
Ability to Communicate a Health Effect
In general, the Health Warning was believed to communicate a health effect of cigar smoking, namely that it causes oral cancer. While most were aware of the link cigar smoking had to oral cancer, many were less familiar with the fact that cigar smoking can lead to the removal of part of the jaw bone. Questions were raised regarding what the risk of jaw bone removal actually was among people who smoke cigars versus people who smoke cigarettes, particularly given that many indicated they do not inhale when smoking a cigar.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Show a person with a jaw bone removed
Include statistics on the percentage of people who smoke cigars who get this type of cancer from smoking
Increase the focus on the quitline information
Consider a red warning banner
NHWC09- Like a cigarette, every cigar contains addictive nicotine.
Figure 8. NHWC09Figure 8 NHWC09 - Text description
Smoked cigarettes in the ashtray. Portrait view
Red and yellow colour combination
The text reads:
WARNING
Like a cigarette, every cigar contains addictive nicotine.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 8a. NHWC09Figure 8 NHWC09 - Text description
Des cigarettes fumées dans le cendrier. Orientation Portrait
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Comme une cigarette, chaque cigare contient de la nicotine, une substance qui crée une dépendance.
Vous pourriez devoir utiliser un sac au lieu d'une toilette pour le reste de votre vie.
This Health Warning was considered clear and easy to understand with a believable message; however, its image rendered the Health Warning less effective at grabbing attention and communicating a health effect of cigar smoking.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
The Health Warning's red warning banner, yellow text box, and bolded text grabbed attention, but this Health Warning was not especially effective at holding attention, primarily because of its image. The visual of an ashtray was considered commonplace and pointless to many, simply suggesting that it is time to empty the ashtray. The benign or lack of disturbing imagery further resulted in the image being ineffective. Participants consistently considered this to be a Health Warning they wouldn't mind having on their cigar packaging as it was not offensive and easy to disregard.
Credibility
Participants generally believed what the Health Warning said and the text was considered to the point, clear and accurate in its portrayal. As mentioned, the visual and text were not considered to work well together and the image did not add credibility to the Health Warning. To improve credibility and clarity, it was felt a more impactful picture that better depicted addiction should be included.
Clarity / Ease of Understanding
While the Health Warning's text was considered clear and easy to understand, the picture did not effectively support or reinforce its message.
Ability to Communicate a Health Effect
In general, the Health Warning was not considered effective at communicating a health effect of cigar smoking, (i.e. addiction). To some, the presence of numerous brands / types of cigars in the ashtray suggested that multiple people were smoking rather than a single person, and looked more like an ashtray of someone who smokes casually. This lessened the message of addiction and reinforced the social aspect of smoking cigars.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Replace the visual / include a more disturbing visual, such as showing someone with a tumor who is holding a cigar or smoking to show addiction as a health condition
Consider showing burn marks in the table, and an obviously addicted person
Show only one brand of cigars in the ashtray so it doesn't look like multiple people's cigars
Add a cigarette or two to the ashtray to better align with the text and reinforce the harmful nature of cigars
Increase the number of cigar butts in the ashtray to stress high consumption
Bold the words "addiction" and "nicotine"
NHWC10- Cigar smoking is addictive.
Figure 9. NHWC10Figure 9 NHWC10 - Text description
Woman smoking a cigar showing her yellow teeth. Portrait view
Red and yellow colour combination
The text reads:
WARNING
Cigar smoking is addictive.
Even if you don't inhale, nicotine is absorbed through the lining of the mouth.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 9a. NHWC10Figure 9a NHWC10 - Text description
Une femme fumant un cigare montrant ses dents jaunes. Orientation Portrait
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Fumer les cigares crée une dépendance. Même si vous n'aspirez pas, la nicotine est absorbée par les parois de la bouche.
This Health Warning received a moderate reaction in terms of being considered attention-getting, clear and easy to understand, believable and effectively communicating a health effect of smoking cigars. Across locations, the more modest impact was primarily attributed to the visual.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
While this Health Warning's red warning banner, yellow text box, and bolded text grabbed attention, participants voiced a mixed reaction to the visual's attention-grabbing ability. For some who were not accustomed to seeing women smoking cigars the picture grabbed attention, while others felt it did not make smoking a cigar unappealing since the woman looked as though she was enjoying a cigar. Indeed, having a picture of someone apparently enjoying a cigar did little to portray addiction and did not encourage them to read the text.
Credibility
This Health Warning lacked credibility to many. In a number of locations, multiple participants indicated that they did not consider cigar smoking as addictive as cigarette smoking. Some, in fact, indicated that they had turned to cigars as a way to wean themselves off cigarettes.
In numerous instances, participants felt the Health Warning's image lacked credibility, as the woman is not holding a cigar the way a person who smokes heavily would and many expected that someone with this level of tooth decay would have noticeable skin issues. Others, however, considered the woman's teeth to be too white and her complexion too pretty to suggest a problem. As mentioned, the visual was generally considered an appealing image of someone smiling and enjoying a social cigar.
Clarity / Ease of Understanding
The Health Warning's text was considered clear and easy to understand although it was not deemed to be effectively aligned with the visual. Participants appreciated reading that cigar smoking is addictive even if you don't inhale, and considered that information a common fallacy shared by people who are newly smoking cigars. That said, the descriptive text (nicotine absorption through the lining of the mouth) was considered more clinical than what was depicted in the visual, thus the image and text were not aligned.
Ability to Communicate a Health Effect
In general, the Health Warning's text was believed to communicate a health effect of cigar smoking, namely that cigar smoking is addictive and that nicotine can be absorbed through the lining of the mouth even if you don't inhale. That said, the text was considered overly wordy which made it easy to ignore. It was felt that shorter, more direct text would be more impactful. The visual was not considered to effectively portray a serious or threatening health effect of smoking cigars.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Change the image to make the woman less appealing / 'less pretty'
Change her facial expression / show her eyes to demonstrate if she is laughing or in pain
Include more yellow of the teeth / show unhealthier skin
Change the way she holds the cigar to be more realistic
Better align the text with the visual
Shorten the text (e.g., Cigar smoking is addictive, even if you don't inhale)
NHWC12- Cigars are addictive.
Figure 10. NHWC12Figure NHWC12 - Text description
A man standing in the rain smoking a cigar. Portrait view
Red and yellow colour combination
The text reads:
WARNING
Cigars are addictive.
It's not just a habit.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 10a. NHWC12Figure NHWC12 - Text description
Un homme debout sous la pluie fumant un cigare. Orientation Portrait
Combinaison de couleurs rouge et jaune
This Health Warning's red warning banner and yellow text box effectively grabbed attention, and was considered clear and easy to understand. That said, the Health Warning's image was not perceived to successfully communicate the danger of smoking nor did it effectively demonstrate a problem with addiction.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
While this Health Warning's red warning banner, yellow text box, and bolded text initially grabbed attention, the visual was considered less effective as being attention-getting. For most the Health Warning's image does not communicate or suggest a danger of smoking cigars and does not portray addiction. To many participants, the image simply looked like someone caught in the rain, and the man did not look especially uncomfortable or inconvenienced.
Participants generally concurred that the image on its own did not grab their attention, and did not resonate with them personally. Participants' eyes were not effectively engaged to read the warning.
Credibility
Overall, a good number of participants challenged the credibility of this Health Warning's message and felt it lacked personal relevance to them. Although the message of addiction is considered believable, many consider addiction to be a danger or disease, but not necessarily a health effect of smoking. Across locations, participants spoke of many types of addiction (caffeine, alcohol, etc.) and discounted cigar smoking as a serious addiction problem. In fact, many questioned if cigars are actually addictive, and some did not consider that to be the case.
More so, for some, the man did not look overly uncomfortable, concerned, or addicted, but rather the image simply depicted a man smoking in the rain. To improve credibility and clarity, it was felt a more realistic image of addiction should be considered, although participants were not able to readily identify what type of visual better demonstrates addiction other than showing a more desperate weather situation.
Clarity / Ease of Understanding
While the Health Warning's text was considered clear and easy to understand, it was generally felt that the picture did not coincide with the text. More specifically, participants did not believe that the picture portrayed a danger of smoking, nor did it show someone who appeared to be addicted. Some participants commented that it was not clear that the man was smoking a cigar.
Ability to Communicate a Health Effect
In general, the Health Warning was not deemed to effectively communicate that addiction is a health effect of cigar smoking. While the message itself (nicotine addiction) was clear and believable to some, the image did not effectively demonstrate a corresponding health effect through addiction. Indeed, nicotine addiction was not commonly seen as a health effect of smoking.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Change the image
Show worse weather / no umbrella
Show a person smoking who is more obviously uncomfortable
Consider using a different image to speak of addiction: a skeleton smoking a cigar; many people smoking outside, together; someone smoking in a snowstorm
Feature the cigar more prominently in the image for added clarity
Enlarge the text/use larger font to make the text more visible
NHWP04- Smoking pipe tobacco causes oral cancer.
Figure 11. NHWP04Figure 11 NHWP04 - Text description
A cancerous tongue. Landscape view
Red and yellow colour combination
The text reads:
WARNING
Smoking pipe tobacco causes oral cancer.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 11a. NHWP04Figure 11a NHWP04 - Text description
Une langue cancéreuse. Orientation paysage
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Ce produit cause la dépendance et des cancers mortels.
This Health Warning's graphic / grotesque image and short, concise text effectively grabbed attention, and it was considered clear and easy to understand and believable. Across locations, the Health Warning clearly communicated a health effect of smoking pipe tobacco by showing the possible consequences.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning's gross visual effectively grabbed attention, together with the red warning banner, yellow text box, and bolded text. It was generally felt that the more graphic the image, the more attention-getting or compelling the Health Warning would be. Participants appreciated that the image clearly showed a corresponding effect of smoking pipe tobacco and oral cancer; although some felt the image would perhaps be more appropriate for smokeless tobacco or chewing tobacco.
Credibility
Participants generally believed what the Health Warning said and the text was considered clear and accurate in its portrayal.
The condition shown was generally deemed more fitting for chewing tobacco and participants imagined that this condition would be something experienced by baseball players as a result of using 'chew' rather than by people who smoke pipe tobacco. Across locations, some participants questioned if this is what oral cancer looked like given that they had never seen it before.
Clarity / Ease of Understanding
The Health Warning's text was considered clear and easy to understand. While the concept was deemed credible by showing the image of a real person, and for illustrating a real condition, some felt it would be clearer to have a more distant shot of the mouth so viewers could more easily distinguish that it was a mouth. Further, to improve credibility and clarity, it was suggested that a pipe be shown in the person's mouth and that the text more clearly communicate that this could happen to them.
Ability to Communicate a Health Effect
In general, the Health Warning was believed to communicate a health effect of smoking pipe tobacco, namely oral cancer, although most felt it did not teach them something new (i.e. that smoking causes oral cancer). More so, as mentioned, participants generally believed this to be a condition more appropriate for smokeless tobacco given that they had typically never seen this type of condition in the mouth of a person who smokes pipe tobacco.
Participants' Suggestions
Participants offered limited suggestions to enhance the Health Warning, including:
Make it more personal / personally relevant (e.g. include 'this could be you' in the English version)
Clarify that this this what oral cancer looks like
Extend the warning banner the length of the Health Warning
Show more of the tongue / mouth
NHWP05- Smoking pipe tobacco causes cancer of the mouth, lips and tongue.
Figure 12. TitleFigure 12 - Text description
Medical instruments opening a mouth which contains cancer. Landscape view
Red and yellow colour combination
The text reads:
Smoking pipe tobacco causes cancer of the mouth lips and tongue.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 12a. TitleFigure 12a - Text description
Instruments médicaux ouvrant une bouche qui contient un cancer. Orientation paysage
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
Fumer le tabac à pipe cause le cancer de la bouche, des lèvres et de la langue.
This Health Warning was considered highly effective in terms of grabbing attention, being clear to understand, believable and in communicating a health risk of smoking pipe tobacco. Its' horrific, realistic picture and clear messaging left nothing to the imagination and were clearly aligned with the text.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning's dramatic and grotesque image, together with the red warning banner, yellow text box, and bolded text effectively grabbed attention. The visual and text were closely aligned and provided a clear warning to people who smoke pipe tobacco. Participants appreciated the brevity of the text and its concise messaging.
For many, the disgusting nature of the image was considered repulsive and some indicated that they would likely bypass or avoid the Health Warning altogether.
Credibility
Participants generally believed what the Health Warning said and the text was considered pointed, clear and accurate in its portrayal. Showing a real image added credibility to the Health Warning.
Some, however, considered the visual to be an over embellishment of an unlikely circumstance and questioned how likely it was for such a condition to occur. Others felt the image was more reflective of poor dental hygiene in general, which was likely a more credible cause of the displayed condition.
Clarity / Ease of Understanding
This Health Warning's text was considered clear and easy to understand, and the visual closely aligned with the text. Participants were able to recognize that they were looking at a mouth and assumed the visual accurately depicted what cancer in the mouth, lips or tongue would look like.
Ability to Communicate a Health Effect
In general, this Health Warning effectively communicated that a health effect of smoking pipe tobacco was cancer of the mouth, lips or tongue. Such health effects were clearly represented in the supporting graphic image.
Participants' Suggestions
Participants offered very few suggestions on how to enhance the Health Warning, with improvements generally including:
Bold all text
Use a less gruesome image
Show comparative images of a healthy mouth and a cancerous mouth, side-by-side
Show three different cancer images: lips, mouth, and tongue or consider mentioning only the type of cancer shown
NHWP06- Pipe tobacco smoke contains the same cancer causing chemicals…
Figure 13. NHWP06Figure 13 NHWP06 - Text description
A pipe on a table with smoke coming out of it in the shape of a skull. Landscape view
Black and yellow colour combination
The text reads:
WARNING
Pipe tobacco smoke contains the same cancer causing chemicals as cigarettes.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 13a. NHWP06Figure 13a NHWP06 - Text description
Une pipe sur une table avec de la fumée en forme de crâne. Orientation paysage
Combinaison de couleurs noir et jaune
Le texte est le suivant :
AVERTISSEMENT
La fumée de tabac à pipe contient les mêmes substances cancérogènes qu'on trouve dans les cigarettes.
This Health Warning was generally considered clear, easy to understand and believable. While it was deemed to effectively communicate a health effect of smoking pipe tobacco, participants considered it slightly less effective in its ability to grab attention. While some believed the visual to be clever and attention-getting, others felt it was bland, too fabricated or unrealistic, and that the smoke shaped like a skull could be easily missed.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning received moderate reactions in terms of its ability to grab attention. While participants appreciated the bold yellow warning and the yellow text on black, opinions of the image were mixed. Some were intrigued by the visual and considered it interesting, mysterious, clever and suspenseful, encouraging them to read the Health Warning text. For them, the skull imagery implied death, and made the Health Warning interesting. Other participants felt the visual looked contrived or fabricated and unrealistic, causing skepticism in the messaging. Further, some felt the image was bland and boring, with the skull being somewhat undistinguishable and potentially easily missed by consumers.
Credibility
Participants generally believed what the Health Warning said and the text was considered pointed, clear and accurate in its portrayal. While the text was credible, the contrived visual was not, and its lack of realism and edgy artistic design detracted from the Health Warning's believability for some. Showing the pipe standing on its own (versus in a pipe stand) added to the lack of realism in the photo and some participants were confused as to whether the visual spoke of second hand smoke or the danger of smoking.
Clarity / Ease of Understanding
The Health Warning's text was considered clear and easy to understand, although a good number of participants across locations felt that consideration should be given to shorten the length of the text. Once again, there were some mixed opinions of the visual's clarity. As discussed, some were able to quickly align the visual with the text, while for others, the image diminished the text's believability and did not effectively demonstrate a relationship between pipe tobacco and cigarettes.
Ability to Communicate a Health Effect
In general, the Health Warning was believed to communicate a health effect of smoking pipe tobacco, and many were surprised to read that pipe tobacco is potentially as deadly as cigarettes. Generally, participants did not believe that to be the case, especially given that when smoking pipe tobacco, they often did not inhale.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Make the skull more pronounced
Show the pipe in a holder, not standing on its own
Show a cigarette and pipe side by side to better depict the relationship / make a link
List the chemicals
Add a red warning banner/ change the colour of the warning banner to red
Replace the word "trouvé" by "retrouvé" in the French version
Use the term "danger" instead of "avertissement" in the French version
NHWP07: Like cigarettes, pipe tobacco contains highly addictive nicotine.
Figure 14. NHWP07 TitleFigure 14. NHWP07 - Text description
A young man sitting on the floor holding his legs with one arm and his head with his hand. Landscape view
Red and yellow colour combination
The text reads:
WARNING
Like cigarettes, pipe tobacco contains highly addictive nicotine.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 14a. NHWP07 TitleFigure 14a. NHWP07 - Text description
Un jeune homme assis sur le sol tenant ses jambes avec un bras et sa tête avec sa main. Orientation paysage
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Comme les cigarettes, le tabac à pipe contient de la nicotine, qui crée une forte dépendance.
This Health Warning was generally considered ineffective at communicating a health effect, holding users' attention and being credible. While its red and yellow colouring initially grabbed attention, the picture was perceived to be out of place and lacked relevance to the topic, as it did not suggest any relationship to smoking.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
While the red warning banner and yellow text box initially grabbed attention, this Health Warning was generally considered ineffective at grabbing attention because of its visual. Across locations, the visual was considered out of place and not at all associated with pipe tobacco.
Many saw the image as a picture of a homeless youth or someone suffering from a migraine / mental illness, rather than demonstrating nicotine addiction. It was also suggested that the age of the youth did not align with perceived profiles of a person who smokes pipe tobacco, but rather would be more representative of someone vaping.
Credibility
While participants generally believed what the Health Warning said (i.e. that pipe tobacco is addictive), the visual did not effectively support the text and did not clearly depict a health condition or have anything to do with smoking. The relationship between the text and image was considered confusing and unclear and accordingly, most disregarded the Health Warning and felt it had limited impact.
In addition, it was generally felt that it was not realistic to suggest that a young adult (e.g. someone 18-20 years of age) would be addicted to smoking pipe tobacco since participants did not consider that age group to be representative of people who frequently smoke pipe tobacco.
Clarity / Ease of Understanding
While the Health Warning's text on its own was considered clear and easy to understand, the visual did not align with the text. As mentioned, the visual was considered out of place and participants felt the youth more accurately depicted hard-core drug addiction, homelessness, depression or another mental health condition.
Ability to Communicate a Health Effect
In general, the Health Warning did not effectively communicate a health effect of smoking pipe tobacco, nor did it accurately depict tobacco addiction or a relationship / similarity between cigarettes and pipe tobacco.
Participants' Suggestions
Participants offered limited suggestions on how to enhance the Health Warning, with suggestions primarily including:
Change the image to one that better reflects a relationship with smoking pipe tobacco
Show cigarettes alongside a pipe / include tobacco product in image
Include a vaping device / consider for a vaping Health Warning
Reconsider the use of the expression "highly addictive" in the English version
NHWP08- Smoking pipe tobacco can become a deadly addiction even…
Figure 15. NHWP08 TitleFigure 15. NHWP08 - Text description
A man outside in the winter smoking a pipe. Landscape view
Black and yellow colour combination
The text reads:
WARNING
Smoking pipe tobacco can become a deadly addiction even if you smoke occassionally.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 15a. NHWP08 TitleFigure 15a. NHWP08 - Text description
Un homme dehors en hiver fumant une pipe. Orientation paysage
Combinaison de couleurs noir et jaune
Le texte est le suivant :
AVERTISSEMENT
Fumer occasionnellement le tabac à piple peut entraîner une dépendance mortelle.
While this Health Warning was considered clear, easy to understand and somewhat believable, it was deemed less effective at communicating a health effect of smoking pipe tobacco or grabbing attention. The picture was described as boring, bland and simply a photo of a guy enjoying his pipe.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
While this Health Warning's yellow warning banner and bolded yellow text on black initially grabbed attention, the uninteresting visual and lengthy text did not encourage consumers to read on. The visual was generally disregarded as simply a photo of a man smoking a pipe and accordingly, the Health Warning held limited impact.
This Health Warning did not suggest a negative consequence of smoking pipe tobacco and as such the image was considered misaligned with the text. Most participants indicated that they would not likely read the text if they saw this Health Warning on their pipe tobacco package. Further, many considered this Health Warning to be a one they would prefer to have on their product as it was not bothersome and could be easily ignored.
Credibility
For most this Health Warning lacked credibility and was not considered believable as presented. Overall, many people who smoke pipe tobacco do not consider smoking pipe tobacco to be nearly as addictive as smoking cigarettes. Contrary to what the text said, most did not consider smoking pipe tobacco to be addictive if you only smoke occasionally, since that had not been their personal experience.
While participants liked seeing an image of a real person, the visual shown did not suggest a deadly addiction, or even a less serious health condition. Rather, it simply displayed a thoughtful man enjoying his pipe.
Clarity / Ease of Understanding
While the Health Warning's text was considered clear and easy to understand, it was deemed too long and not compelling. Shorter, more direct text was suggested to enhance clarity.
Aside from the text, the visual did not effectively align with or support the intended message. It did not accurately depict an addiction, discomfort or unhealthy situation.
Ability to Communicate a Health Effect
In general, this Health Warning only moderately communicated a health effect of smoking pipe tobacco and most participants were not convinced that occasional pipe tobacco smoking results in a potential health effect given the comfortable or unthreatening image shown and their own personal experience.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Make the warning banner red
Include a different image that better aligns with the visual and implies a more deadly relationship with smoking pipe tobacco and your health
Shorten the text
Highlight the word "deadly" in the English version text
Include statistics to add credibility
Health Warning Testing - Smokeless Tobacco
Prior to discussion, participants were shown an example of where the Health Warning could appear on a smokeless tobacco package. See illustration below:
Figure 15a. Sample Smokeless tobaccoFigure 15a - Text description
Smokeless tobacco round can
Image shows 3 round cans
The text reads:
This product is hightly addictive
Health Canada
Brand Name
25g smokeless tobacco
The following section presents, in numeric order, reactions to each of the 9 Heath Warnings tested for smokeless tobacco. Note the order of Health Warnings presentation in the online group discussions varied by group to avoid order bias.
NHWS01 - This product causes oral cancer
Figure 16. NHWS01Figure 16 - Text description
An older man with half his cancerous jaw removed. Circle
Black and yellow colour combination
The text reads:
WARNING
This product causes oral cancer.
Health Canada
Brand Name
Smokeless Tobacco
Overall Reactions
This Health Warning was generally considered attention-getting, clear and easy to understand, believable and effective at communicating a health effect of using smokeless tobacco. While the picture generally grabbed attention and was considered clear and scary, some questioned if it actually showed oral cancer /jaw removal or if it was an older person with dentures removed. Accordingly, some participants felt the image could be easily overlooked.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning's yellow warning banner and succinct text, together with the dramatic picture effectively grabbed attention. For most, it was easy to understand that the man had had surgery, and having a real-life picture encouraged participants to read the text to learn more about it. The short message in all capitals was considered strong and impactful, immediately getting to the point.
Many participants believed that the image didn't connect with them personally given that the man in the picture appeared to be old.
Credibility
Participants generally believed what the Health Warning said and its text was considered pointed, clear and accurate in its portrayal. The image was considered dramatic, powerful and realistic to many, with numerous participants across locations indicating that they have actually seen or known people in real life with similar conditions. Others, however, were unsure what the image represented and did not consider it to represent oral cancer. Some did not readily identify the scars and wondered if it was a man with his dentures removed.
To improve credibility and clarity, it was felt the image should include more pronounced scarring and that a younger person should be featured to establish increased personal relevance.
Clarity / Ease of Understanding
This Health Warning's text was considered clear, straight forward and easy to understand. Participants appreciated the brevity of the text, especially given that the lid of the tobacco can is small. Showing a real person in the photo and the consequences of oral cancer further accentuated the Health Warning's message. As mentioned, the only confusion associated with this Health Warning was the fact that some did not consider the image to visually represent oral cancer, and they were unsure as to what the image was actually was showing.
Ability to Communicate a Health Effect
In general, the Health Warning effectively communicated a health effect of using smokeless tobacco, namely oral cancer, although most felt it did not teach them something new. The health effect of oral cancer was clearly communicated in the text of the Health Warning, and the graphic further supported the potential outcome, albeit not as clearly as the text.
Participants' Suggestions
Participants' suggestions for improving this Health Warning included:
Enhance the image to more effectively demonstrate the consequence of oral cancer / jaw removal
Show a before and after image
Show a more pronounced scar so it is not easily overlooked
Show a younger person
Include a red warning banner to better grab attention
NHWS02- This product causes mouth infections and cancer.
Figure 17. NHWS02 TitleFigure 17 - Text description
Teeth that are infected and cancerous. Circle
Black and yellow colour combination
The text reads:
WARNING
This product causes mouth infections and cancer.
R Dr. Martin T Tyler
Brand Name
Smokeless Tobacco
Overall Reactions
This Health Warning clearly grabbed attention with its graphic and disturbing image, yellow colour and bold headline. The image was considered realistic and believable, and the text and image were considered well matched, clear and concise. The Health Warning was seen as effectively communicating a health effect of using smokeless tobacco.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
The graphic, gross image on this Health Warning, together with its bold headline, effectively grabbed attention. Most considered the image to be disturbing but realistic, given that they could clearly see the inflamed gums and poor teeth. Having a single, real-life image that was relevant to those using smokeless tobacco was deemed effective in grabbing their attention.
Across groups some participants believed that using the colour red for the warning banner would better grab attention given that red was more reflective of something that is urgent or an emergency.
Credibility
Participants generally believed what the Health Warning said and the text was considered pointed, clear and accurate in its portrayal. Some took note of the doctor's name on the side of the image and this added credibility and legitimacy to the photo to most, validating that it was real.
Some smokeless tobacco users questioned how realistic such a condition actually was, describing it as extreme and the mouth of someone with poor dental hygiene. Others, however, felt the image accurately portrayed what a mouth looked like after chewing tobacco.
Clarity / Ease of Understanding
The Health Warning's text and visual were considered clear and easy to understand, with no confusion evident. Participants deemed the text relevant, clear and to the point and appreciated its brevity. As mentioned, the text and image worked well together.
Ability to Communicate a Health Effect
This Health Warning effectively communicated a health effect of using smokeless tobacco, namely that using the product caused mouth infections and cancer. Across locations, it was generally felt that the Health Warning did not communicate something that they didn't know already.
Participants' Suggestions
Participants offered minimal changes to enhance this Health Warning:
Include red warning banner
Provide the age of the person shown in the image
NHWS03 - This product is highly addictive.
Figure 18. NHWS03 TitleFigure 18 - Text description
A young man desperately reaching for a can of smokeless tobacco. Circle
Black and yellow colour combination
The text reads:
WARNING
This product is heighly addicttive.
Health Canada
Brand Name
Smokeless Tobacco
Overall Reactions
This Health Warning was deemed ineffective at grabbing users' attention, although the yellow warning banner did initially attract attention. For most, the image proved problematic in that it was not relevant to smokeless tobacco, and was considered silly, unbelievable and not reflective of what would happen with someone of that age. The image's lack of relevance to the text (i.e. does not effectively demonstrate addiction) was further attributed to the Health Warning's apparent ineffectiveness.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
While this Health Warning's yellow warning banner initially grabbed attention, the image was ineffective at grabbing and holding most participants' attention. While some appreciated the Health Warning's simplistic and straightforward message, and that it included a younger generation, most participants considered it overly dramatic, exaggerated and likely worthy of mocking.
A good number of participants liked having an image that was not gross and disturbing and felt that they would look to buy a product with this label because it was not offensive and easy to ignore.
Credibility
While participants generally believed what the Health Warning said (namely that the product is highly addictive), the image lacked relevance to the text and was not considered effective at demonstrating addiction. Further, the use of a teenager to depict addiction for a product that was considered more commonly used among older people further attributed to the Health Warning's perceived ineffectiveness. The visual was believed to be too conceptual and dramatic in its design, resulting in it being considered unbelievable.
It was felt that the Health Warning needed to better demonstrate a real struggle with addiction, perhaps showing something that a person would give up for an addictive product or showing a bad choice. The Health Warning was criticized for not showing a health effect of addiction.
Clarity / Ease of Understanding
While the Health Warning's brief text was clear and easy to understand, the visual did not properly reflect the intended message and caused confusion. As mentioned, the visual was deemed overly dramatic and silly, and was not considered relevant to users of smokeless tobacco. Participants questioned why the youth was crawling and felt the image did not clearly show what he was crawling after. Some felt he looked mildly unhappy perhaps, but did not look in clear distress or as though he was suffering.
Ability to Communicate a Health Effect
In general, the Health Warning was not believed to communicate a health effect of using smokeless tobacco. Across locations, many believed that addiction is not a health effect or a consequence of using smokeless tobacco, but rather is a disease that can impact an individual's product usage. In addition, the visual as presented was not considered to effectively portray addiction in a way that was deemed relevant to users of smokeless tobacco.
Participants' Suggestions
Participants suggested a variety of changes to enhance this Health Warning:
Include a red warning banner
Replace the image with one that shows health consequences of using smokeless tobacco
Use an image that shows a more realistic struggle with addiction
Include a visual that shows making a choice
Include a slightly older person in the photo to establish greater personal relevance to users of smokeless tobacco
NHWS04 - Nicotine Changes Your Brain
Figure 19. NHWS04 TitleFigure 19 - Text description
Creative image of a man holding his brain. Circle
Red and yellow colour combination
The text reads:
WARNING
Nicotine changes your brain making it difficult to stop using tobacco.
Health Canada
Brand Name
Smokeless Tobacco
Overall Reactions
This Health Warning received a mixed reaction. While some felt the Health Warning effectively grabbed attention with its red headline and intriguing, bright image, others found the image confusing, better reflecting a migraine or headache. This Health Warning was not perceived to effectively communicate a health effect of using smokeless tobacco, especially given its reference to tobacco solely.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning's red warning banner, yellow text box, and bolded text initially grabbed attention, and for some, the animated brain image also caught attention. Some participants felt the image piqued their curiosity and made them ponder how tobacco usage affected their brain. For most, however, the image was confusing given that it combined a real photo with a computer-generated image.
Across most locations, the animated brain image was considered unbelievable and unrealistic to many and did not effectively link with the Health Warning's text. The glowing brain was considered ridiculous to some. More so, the text was considered too long, vague and confusing to some, with users questioning what 'changes' referred to.
A good number of participants felt that the image on its own did not grab their attention, nor did it connect with them personally.
Credibility
Participants generally did not believe what the Health Warning said and the visual was not deemed reflective of how nicotine changes a brain. It was felt that such an image is not an accurate representation of what happens with addiction. To improve credibility and clarity, it was felt a more realistic and appropriate image is required with a more succinct message.
Clarity / Ease of Understanding
Both the text and the image proved problematic to some. For many, it was unclear what the image was trying to portray and participants felt that it better represented a migraine, headache or memory challenges rather than addiction. The cartoony appearance of the brain visual did not convince participants of the impact or seriousness of nicotine on the brain as it did not instill fear or concern.
Aside from being perceived as too long, the text was considered vague in its content. The word 'change' was deemed problematic and some participants felt that saying nicotine 'changes' the brain rather than 'affects' the brain are very different matters, with the word 'change' perhaps overstating its impact.
Ability to Communicate a Health Effect
In general, the Health Warning did not effectively communicate a health effect of using smokeless tobacco. It was considered too broad and vague, with lack of clear messaging. Participants questioned if the text was intending to say simply that nicotine is addictive.
Participants' Suggestions
Participants' suggestions to improve the effectiveness of this Health Warning included:
Change the image (include a better photo / image, show real brain)
Consider showing an MRI image of how the brain is affected by nicotine
Use a visual that reflects consequences of addiction
Simplify / shorten the text
In English, use 'affect' rather than 'change'
In English, include 'makes chemical changes to your brain'
NHWS05 - This product is highly addictive and causes harm to your health.
Figure 20. NHWS05 TitleFigure 20 - Text description
A hand with strings attached to a human like a puppet. Circle
Red and yellow colour combination
The text reads:
WARNING
This product is highly addictive and causes harm to your health.
Health Canada
Brand Name
Smokeless Tobacco
Overall Reactions
This Health Warning was considered somewhat effective at grabbing attention and was a warning users could easily ignore. While the image was deemed powerful and thoughtful to some, others were confused by what it was trying to show and felt 'a cartoon' did not best demonstrate addiction or harm to your health. Users questioned if addiction is a health issue and felt the warning should better demonstrate the harm the product causes.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning was rated moderately in terms of its ability to grab users' attention. While the red warning banner, yellow text box, and bolded text initially grabbed attention through its vibrant colour combination, the visual received a mixed reaction. Some considered the black image on yellow to be powerful and highly impactful, clearly communicating that users are a slave to nicotine. For others, the visual was confusing and unclear, and accordingly, they disregarded the Health Warning and felt it had limited impact.
At a glance, some participants felt the lengthy text and more complex visual created a Health Warning that was too busy and difficult to comprehend. For them the image and text did not complement each other. These users were unsure what the visual was trying to represent and some questioned if it was a better depiction of suicide or bullying. Numerous participants felt this was a label they could easily ignore.
The yellow / black colour combination was criticized by some participants for its close association to 'yield', 'school buses', 'slow down' or 'bumble bees'. This colouring expressed a lessened sense of urgency to some.
Credibility
Participants generally felt the Health Warning was not overly credible. It was generally felt that addiction is not a result of using the product, as implied, but rather is a disease. To improve credibility and clarity, it was felt a more realistic or impactful image should be included.
Clarity / Ease of Understanding
While the Health Warning's text was considered clear and easy to understand, some confusion was evident with the visual. As mentioned, the marionette depicted a lack of control to some, but to others it lacked relevance to the Health Warning.
Ability to Communicate a Health Effect
In general, the Health Warning was not considered to communicate a clear health effect of using smokeless tobacco. Across locations, there was notable discussion relating to addiction being a disease (similar to gambling, drugs or caffeine) and not a health issue. As a result, many participants did not believe this Health Warning suggests using smokeless tobacco is harmful to your health.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Replace the image with a real photo
Consider including a ball and chain visual
Remove the yellow background colour
Show a more direct consequence or impact of using the product
Shorten the text
NHWS06 - This product is not a safe alternative to cigarettes.
Figure 21. NHWS06Figure 21 - Text description
Cigarette butts in and around a full smokeless tobacco can. Circle
Black and yellow colour combination
The text reads:
WARNING
This product is not a safe alternative to cigarettes.
Health Canada
Brand Name
Smokeless Tobacco
Overall Reactions
This Health Warning received a moderate reaction in terms of grabbing attention. The message was considered highly believable, realistic, clear and easy to understand, and effectively addressed what was considered a huge misconception (i.e. that non-combustible tobacco products are significantly less risk than cigarettes). However, the Health Warning's plain / bland image was seen as resembling an ashtray and considered a 'soft' warning that is easy to avoid / ignore. Users questioned whether the text 'not a safe alternative' referenced addiction or other health effects of using the product.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning generally grabbed attention with its realistic image and bold yellow Health Warning banner. Although the visual elicited curiosity for most, some questioned why anyone would choose to put out a cigarette in 'snuff'. The visual, though appreciated for its personal relevance, was criticized for its plain colouring.
Credibility
Participants generally believed what this Health Warning said and the text was considered educational, clear and accurate in its portrayal. There was general consensus across locations that there is a huge misconception that smokeless or non-combustible tobacco is notably less risky that cigarette smoking. The image and the text were considered personally relevant and realistic and put doubt in some participants mind as to the perceived reduced risk associated with smokeless tobacco.
Clarity / Ease of Understanding
While the Health Warning's text was considered clear and easy to understand, some confusion was evident. The text and the image worked well together to demonstrate a similar relationship between smokeless tobacco and cigarettes, but participants were often unsure what was meant by 'not a safe alternative', wondering if that was referencing addiction or health effects. Some participants took the image literally and found it confusing as to why the smokeless tobacco package would be shown as an ashtray.
Ability to Communicate a Health Effect
In general, the Health Warning did not effectively communicate a perceived health effect of using smokeless tobacco. It was generally felt that more information was required to understand why it is not a safe alternative to cigarettes, as the general perception (or misconception) was that cigarettes are more harmful to your health.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Add a red warning banner
Make the image less appealing (grosser - including tar)
Include some colour contrast between the image and white background
Adjust the message to indicate whether it is referencing addiction or other health consequences (e.g. cancer)
Make the message clearer (i.e. what does 'a safe alternative' mean?)
Include statistics to show number of people who die from cancer due to tobacco
NHWS07 - This product contains many of the same toxic chemicals as cigarettes.
Figure 22. NHWS07Figure 22 - Text description
Rubber gloves holding a container with toxic written on it. Circle
Red and yellow colour combination
The text reads:
WARNING
This product contains many of the same toxic chemicals as cigarettes.
Health Canada
Brand Name
Smokeless Tobacco
Overall Reactions
While this Health Warning proved moderately effective at grabbing attention of most users due to its red warning banner and toxic symbol, some felt the image was 'over the top' and the text vague in its presentation. Although the Health Warning explains that smokeless tobacco includes toxic chemicals, users want to better understand what 'many of the same' references in the text, and what impact those chemicals might have on them personally.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning's red warning banner, yellow text box, and beaker displaying the toxic symbol generally grabbed attention. While the visual elicited curiosity for some, others found it blatantly obvious and silly in its design and lacking any shock factor that would grab and hold their attention. Showing a science-related image lacked personal relevance to many. In addition, the text was considered too generic and vague given its ambiguous claim of containing 'many of the same toxic chemicals as cigarettes'.
Credibility
While participants did not dispute the information shown in the Health Warning, the vagueness of the text diminished the Health Warning's credibility. Saying that the 'product contains many of the same toxic chemicals as cigarettes' begged the question as to what specific chemicals were the same. As such, across groups, participants expressed a desire for a more explicit Health Warning. To improve credibility and clarity, it was felt the various chemicals in each should be listed and that more personally relevant visuals should be included, perhaps showing what the personal consequences of product usage would be.
Clarity / Ease of Understanding
The Health Warning's text was generally considered easy to understand, and the toxic symbol on the beaker clearly positioned the chemicals as hazardous to health. That said, the lack of clarity in terms of what types of toxic chemicals are included in the products caused some confusion. Making such a generic, non-descriptive statement was considered almost over the top or unbelievable. Participants consistently suggested including a listing of appropriate chemicals.
Similarly, while the toxic label implied danger, having a skull and cross bone symbol on the beaker was suggested to more clearly communicate the implied danger.
Although the text and image generally worked well together, having more specific information provided, either in the text or as a listing on the visual was considered helpful to ease users' understanding.
Ability to Communicate a Health Effect
In general, the Health Warning was not considered especially effective at communicating a health effect of using smokeless tobacco. While it demonstrates that the product contains toxic chemicals, it does not suggest the actual health outcomes or effects of the toxic chemicals. Showing a more direct causal relationship between using smokeless tobacco and a health condition was suggested.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Add the skull and cross bone icon on the beaker (instead of the toxic symbol)
Show a consequence of using the product
Add a more relevant image that includes a person / health effect and is less scientific
Be more specific by including a list of the toxic chemicals
NHWS08 - Smokeless tobacco causes oral disease.
Figure 23. NHWS08Figure 23 - Text description
A tongue with hairy mouth disease. Circle
Black and yellow colour combination
The text reads:
WARNING
Smokeless tobacco causes oral disease.
Health Canada
Brand Name
Smokeless Tobacco
Overall Reactions
This Health Warning was generally considered attention-getting, believable and effective at communicating a health effect of using smokeless tobacco. This Health Warning's clarity, however, proved a little problematic. While the picture grabbed attention given its graphic nature, many were confused as to what body part they were looking at. Most commented that they were unsure as to what oral disease would look like, but would expect it to look more horrific. Participants spontaneously referred to oral cancer when discussing this HW, rather than oral disease as specified in the HW.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning's yellow warning banner and gross picture initially grabbed attention. That said, while the picture grabbed attention given its graphic nature, many were confused as to what body part they were looking at. Participants questioned if it was gums, the inside of a cheek, or a tongue. Further, some thought it showed a person with food (e.g. oregano) on their tongue. That said, the bolded text drew attention and helped participants better understand what they might be looking at. Some, however, felt the grey background did not provide sufficient contrast for ease of reading.
Credibility
As mentioned, while participants didn't dispute that smokeless tobacco causes oral disease, most commented that they are unsure what oral disease would look like, but would have expected it to look more horrific.
While the concept was deemed credible for showing a real image, and for illustrating a real condition, some felt the lack of clarity in the image was problematic. To improve credibility and clarity, it was felt the image needed to zoom out and clearly show that it is a tongue by showing lips, teeth or a nose.
Clarity / Ease of Understanding
While the Health Warning's text was considered clear and easy to understand, some confusion was evident with the visual. As mentioned, participants' inability to clearly distinguish what body part they were looking at in the image caused confusion, particularly when they were unsure as to what oral disease would actually look like. It was felt that with increased clarity in the image, the text and image would work well together. It was not clear to participants that this HW was about oral disease and not oral cancer.
Ability to Communicate a Health Effect
In general, the Health Warning was believed to communicate a health effect of using smokeless tobacco, namely oral disease, and while that was something they already knew, most felt the visual educated them on what oral disease looks like. It should be noted that some participants confused oral disease with oral cancer, often citing the latter when referring to the health effect communicated through this Health Warning.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Ensure the image better demonstrates what it is (pull back the shot to show lips / teeth or nose so it can be put in clearer context)
Label the tongue
Include a red warning banner
Lighten the grey background to provide greater colour contrast
NHWS09 - Smokeless tobacco causes oral disease which can lead to cancer.
Figure 24. NHWS09Figure 24 - Text description
A tongue with oral disease. Circle
Red and yellow colour combination
The text reads:
WARNING
Smokeless tobacco causes oral disease which can lead to cancer.
Health Canada
Brand Name
Smokeless Tobacco
Overall Reactions
This Health Warning was considered attention-getting, clear and easy to understand, believable and effectively communicating a health effect of using smokeless tobacco. While the picture grabbed attention, many felt it did not present a dramatic consequence. While the text and the image worked well together, it was felt that the amount of text should be reduced.
The following provides a more detailed description of reactions to this Health Warning.
Ability to Grab Attention
This Health Warning effectively grabbed attention with its graphic image, red warning banner and clear text. The yellow text box also grabbed attention. The text and image worked well together and were closely related. While participants appreciated being able to clearly identify what they were looking at (i.e. a tongue), there was some confusion as to what was being shown on the tongue.
Given the context of the text, some questioned whether the visual was showing oral disease or cancer.
Credibility
Participants generally believed what the Health Warning said and the text was considered clear and accurate in its portrayal. That said, as mentioned, a number of participants questioned what was on the tongue and didn't consider the image to be 'gross enough'. As a result, they found it easy to ignore. For some participants, the person's teeth were 'too perfect' or 'too white' and accordingly, they questioned if the image was touched up to be more dramatic. If that was the case, they felt the substance on the tongue might be embellished. Further, because it didn't look painful, it was deemed to be fake or unbelievable.
Clarity / Ease of Understanding
While the Health Warning's text was easy to understand, participants questioned if the visual was showing oral disease or cancer and felt the text would be more impactful if it was more direct and to the point. The white substance on the tongue did not look concerning to some, and was described as some kind of white powder or food. The substance on the tongue was often misinterpreted as something that is not a health risk, with participants wondering if it was sugar, yeast, paste, candy, powder or something like Alka Seltzer™.
The person's teeth were also considered too white for someone with a serious health condition, contributing to the fact that this looked contrived and not concerning.
Ability to Communicate a Health Effect
In general, the Health Warning was believed to effectively communicate a health effect of using smokeless tobacco, although as mentioned, participants were unsure if the visual depicted oral disease or cancer. Regardless, the visual did not instill fear of using smokeless tobacco because the condition shown did not look severe. While the text on the Health Warning did not communicate something new, it did educate participants on what a condition that they were not familiar with might look like.
Participants' Suggestions
Participants suggested the following changes to enhance the Health Warning:
Improve the image: zoom in to show a closer picture (remove nose, but leave lips / teeth)
Make the visual more graphic (not white foam-like), and looking more painful
Include more yellow teeth
Shorten and adjust the text (replace 'which' with 'and' in the English version)
Say only 'smokeless tobacco causes oral disease', or 'smokeless tobacco can cause cancer' to remove confusion
Health Canada Attribution
While reviewing the draft Health Warning designs for cigar and pipe tobacco and for smokeless tobacco, participants were asked what, if anything, the inclusion of the Health Canada attribution on the Health Warning suggested.
Regardless of audience and location, participants consistently agreed that attributing a Health Warning to Health Canada validated or legitimized the Health Warning. Most felt that a Health Canada attribution provides assurance that the statement has been tested or researched and is factual.
Some participants felt Health Canada attribution demonstrates that the federal government is trying to be proactive and provide citizens with information to help them make important choices concerning their health and wellbeing. In particular, it suggested that the government is trying to help people who smoke or people who use smokeless tobacco to stop smoking / using.
Health Warning Design Elements
Colour Templates for Cigar and Pipe Tobacco
For the cigar/pipe tobacco groups, once participants had an opportunity to provide feedback on each of the 13 Health Warnings being considered, participants were then asked to provide feedback on the two different template colour styles being considered. These included one with a black and yellow colour combination and another with a red and yellow colour combination, as shown below.
Figure 25. TitleFigure 25 - Text description
A man showing a cancerous lump on his tongue. Portrait view
Black and yellow colour combination
The text reads:
WARNING
Tobacco use causes oral cancer.
This can lead to tumours on your tongue and cheeks.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 25a. TitleFigure 25 - Text description
Un homme montrant une masse cancéreuse sur sa langue. Orientation Portrait
Combinaison de couleurs noir et jaune
Le texte est le suivant :
AVERTISSEMENT
L'usage du tabac cause le cancer de la bouche.
Ce cancer peut causer des tumeurs sur la langue ainsi que dans les joues.
Lungs outside of the body showing one healthy pink lung and one black deseased lung. Portrait view
Red and yellow colour combination
The text reads:
WARNING
Cigar smoking causes lung cancer.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 25a. TitleFigure 25 - Text description
Poumons à l'extérieur du corps montrant un poumon rose en bonne santé et un poumon noir atteint. Orientation Portrait
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Les cigares causent le cancer des poumons.
Santé Canada
Overall, regardless of colour preference, both designs were deemed effective in communicating health warning information, with participants finding the messaging easily readable due to the colour contrast of the text and background irrespective of colour combination. That said, findings showed that red and yellow are the strongest colours both in grabbing attention and implying danger / stop or warning, with French speaking participants being most likely to express a preference for this colour combination. The colour red was consistently described as suggesting a greater sense of urgency. By contrast, having black text on a yellow background was generally deemed less eye catching.
Once selecting their preferred colour combination, participants were then shown four different HW layout formats, as presented below. Specifically, for each colour combination participants were presented with four different layout options, namely two English or French options (based on the language of the group) and two bilingual options, with the HWs presented in both a portrait orientation and a landscape option for each.
Figure 25x. TitleFigure 25 - Text description
A man showing a cancerous lump on his tongue. Portrait view
Black and yellow colour combination
The text reads:
WARNING
Tobacco use causes oral cancer.
This can lead to tumours on your tongue and cheeks.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 25y. TitleFigure 25 - Text description
Un homme montrant une masse cancéreuse sur sa langue. Orientation Portrait
Combinaison de couleurs noir et jaune
Le texte est le suivant :
AVERTISSEMENT
L'usage du tabac cause le cancer de la bouche.
Ce cancer peut causer des tumeurs sur la langue ainsi que dans les joues.
Figure 6a. NHWP03Figure 6z. NHWP03 - Text description
A man showing a cancerous lump on his tongue. Landscape view
Black and yellow colour combination
The text reads:
WARNING
Tobacco use causes oral cancer.
This can lead to tumours on your tongue and cheeks.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 6. NHWC07Figure 6 NHWC07 - Text description
A man showing a cancerous lump on his tongue. Portrait view
Black and yellow colour combination
The text reads:
WARNING
Tobacco use causes oral cancer.
This can lead to tumours on your tongue and cheeks.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 2. NHWC02Figure 1b - Text description
Lungs outside of the body showing one healthy pink lung and one black deseased lung. Portrait view
Red and yellow colour combination
The text reads:
WARNING
Cigar smoking causes lung cancer.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 2b. NHWC02Figure 2b - Text description
Poumons à l'extérieur du corps montrant un poumon rose en bonne santé et un poumon noir atteint. Orientation Portrait
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Les cigares causent le cancer des poumons.
Santé Canada
Figure 2. NHWC02Figure 2. NHWC02 - Text description
Lungs outside of the body showing one healthy pink lung and one black deseased lung. Landscape view
Red and yellow colour combination
The text reads:
WARNING
Cigar smoking causes lung cancer.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 2c. NHWC02Figure 2c. NHWC02 - Text description
Poumons à l'extérieur du corps montrant un poumon rose en bonne santé et un poumon noir atteint. Orientation paysage
Combinaison de couleurs rouge et jaune
Le texte est le suivant :
AVERTISSEMENT
Les cigares causent le cancer des poumons.
Santé Canada
Lungs outside of the body showing one healthy pink lung and one black deseased lung. Portrait view
Red and yellow colour combination
Text is shown in English and French. The English text reads:
WARNING
Cigar smoking causes lung cancer.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
Figure 2c. NHWP02Figure 2c. NHWP02 - Text description
Lungs outside of the body showing one healthy pink lung and one black deseased lung. Landscape view
Red and yellow colour combination
Text is shown in English and French. The English text reads:
WARNING
Cigar smoking causes lung cancer.
Health Canada
You can quit. We can help.
1-866-366-3667
gosmokefree.gc.ca
All options were generally deemed clear and easy to read.
Also, participants noted that having only one language included in the Health Warning was preferred in most locations, as only one language was personally relevant to them. When including both languages, some participants felt the Health Warning appeared almost daunting, with the Health Warning appearing overly crowded. Across locations it was generally perceived that including a single language makes the Health Warning appear much less cluttered and that a Health Warning is more impactful when fewer elements are included. Further, some participants appreciated the fact that having only one language allowed for larger text or a larger image to be used, making the message easier to read.
Cigar and Pipe Tobacco - Quitline Preference
Overall, users found the various quitline designs easy to read, and appreciated the use of short and simple sentences. Across groups participants generally found that having the text bolded and in all capitalized lettering made the message stand out from the rest of the Health Warning. Some appreciated the blue border around the quitline section of the yellow and black colour combination, and suggested that having a red border around the quitline section of the red and yellow colour combination design would further draw attention to the quitline message.
Throughout the review of the HW, participants expressed appreciation for having the quitline information included on the tobacco packages, and found it an important component of a Health Warning.
Colour Templates for Smokeless Tobacco
For the smokeless tobacco groups, once participants had an opportunity to provide feedback on each of the nine (9) Health Warnings being considered, participants were then asked to provide feedback on the three different template colour styles being considered, as shown below.
Text description
An older man with half his cancerous jaw removed. Circle
Black and yellow colour combination
The text reads:
WARNING
This product causes oral cancer.
Health Canada
Brand Name
Smokeless Tobacco
Text description
Teeth that are infected and cancerous. Circle
Black and yellow colour combination
The text reads:
WARNING
This product causes mouth infections and cancer.
R Dr. Martin T Tyler
Brand Name
Smokeless Tobacco
Text description
Rubber gloves holding a container with toxic written on it. Circle
Red and yellow colour combination
The text reads:
WARNING
This product contains many of the same toxic chemicals as cigarettes.
Health Canada
Brand Name
Smokeless Tobacco
Participants generally considered all presented templates effective at communicating health warning information. That said, across most locations, there was a clear preference for the option including the red warning banner and preference was largely attributed to including the colour red for the warning banner. Red was considered a well-accepted descriptive of alarm or danger and deemed more attention-getting than the colour yellow. In comparison, the colour yellow was more closely associated with 'caution', depicting a lesser sense of urgency.
Despite the clear preference, some participants preferred having a more prominent visual as was the case in both other options, as well as having a more natural appearance of having the text overlaying the image rather than appearing within a separate box. Many suggested that consideration should be given to using other layouts, but with the red warning banner at top.
Smokeless Tobacco - Quitline Sections
Smokeless tobacco users were generally receptive to the idea of having a quitline section (i.e. an area that shows a tagline, a quitline phone number and a web address) with tobacco cessation information on smokeless tobacco packages. While many felt a quitline phone number would not likely be something they personally would reference, having the information available to those who may need or want it, was deemed important. Displaying such information on the inside of the can's lid or on the side of the package, (rather than on the top where much information is provided) was deemed most suitable. Adding the information on the top of the package would make it too cluttered and the information may not be as easily noticed.
Toxic Statements - Smokeless Tobacco
A series of 18 Toxic Statements that are being considered for display possibly on the side of smokeless tobacco product packages were shared with participants of the smokeless tobacco groups. These statements were grouped by theme with three sets of six statements, with the presentation of themes being rotated across groups. The following provides an overview of all of the statements reviewed by theme. Note that the schedule of rotation is included in Appendix C.
Theme: Nicotine/Addiction
English Statements:
Nicotine in smokeless tobacco is absorbed through mouth tissues and causes addiction.
This product contains nicotine, a highly addictive, brain altering chemical.
Highly addictive nicotine found in this product is absorbed through your mouth.
Nicotine is the highly addictive drug found in this product.
You are exposed to nicotine, a highly addictive substance when you use this product.
You absorb highly addictive nicotine into your blood when you use this product.
French Statements:
La nicotine présente dans le tabac sans fumée est absorbée par les muqueuses de la bouche et crée une dépendance.
Ce produit contient de la nicotine, une substance qui crée une forte dépendance et qui nuit au fonctionnement du cerveau.
La nicotine présente dans ce produit est une substance qui crée une forte dépendance et qui est absorbée par votre bouche.
La nicotine contenue dans ce produit est une drogue qui crée une forte dépendance.
Lorsque vous utilisez ce produit, vous êtes exposé à la nicotine, une substance qui crée une forte dépendance.
Lorsque vous utilisez ce produit, vous absorbez de la nicotine dans votre sang, une substance qui crée une forte dépendance.
Theme: Cancer
English Statements:
This product contains dozens of cancer-causing chemicals.
Toxic chemicals found in this product cause cancer inside your mouth.
Cancer-causing chemicals found in this product are absorbed through your mouth.
You are exposed to 28 cancer-causing chemicals every time you use this product.
Smokeless tobacco contains toxic chemicals that cause cancer.
Toxic chemicals found in this product are absorbed through your gums and cause oral cancer.
French Statements:
Ce produit contient des dizaines de substances chimiques cancérogènes.
Les substances toxiques contenues dans ce produit causent le cancer dans votre bouche.
Les substances cancérogènes contenues dans ce produit sont absorbées par votre bouche.
À chaque fois que vous utilisez ce produit, vous êtes exposé à 28 substances cancérogènes.
Le tabac sans fumée contient des substances chimiques qui causent le cancer.
Les substances toxiques contenues dans ce produit sont absorbées par vos gencives et causent le cancer de la bouche.
Theme: Specific Chemicals
English Statements:
Nitrosamines are toxic chemicals found in smokeless tobacco that cause cancer.
Cancer-causing arsenic, nickel and cadmium are chemicals found in this product.
Using this product exposes you to toxic metals.
You absorb cancer-causing nitrosamines through your mouth when you use this product.
This product contains toxic metals, including arsenic, cadmium and lead.
This product contains cadmium which is also found in battery acid.
French Statements:
Le tabac sans fumée contient des nitrosamines qui sont des substances toxiques et cancérogènes.
Ce produit contient de l'arsenic, du nickel et du cadmium, tous des substances cancérogènes.
L'utilisation de ce produit vous expose à des métaux toxiques.
Lorsque vous utilisez ce produit, vous absorbez par votre bouche des nitrosamines qui sont cancérogènes.
Ce produit contient des métaux toxiques, dont l'arsenic, le cadmium et le plomb.
Ce produit contient du cadmium que l'on trouve aussi dans l'acide de batterie.
In general, reactions to the Toxic Statements suggest that there is potential for such statements to further educate users on specific risks associated with smokeless tobacco and its toxic constituents. The following provides initial reactions to each group of statements.
When reviewing 'cancer' themed statements, messages that are brief, clear and provide quantitative facts were generally considered effective to communicate health hazards. In particular, statements that spoke of '28 cancer-causing chemicals' or 'dozens' of chemicals grabbed attention and were considered more alarming. Consistently, the statement with more specific details (28 cancer-causing chemicals) was deemed strongest of the two. Users also considered statements that provide descriptive and potentially visual outcomes of product usage to be effective. Further, a good number of participants felt having the statements written in first person in the English statements (e.g. inclusion of 'you' or 'your') was a more direct and effective way of messaging. It was also felt that statements would be more impactful if the words 'found in this product' or 'this product' were replaced with 'smokeless tobacco' to ensure it was not interpreted as generic to tobacco overall. None of the statements under this theme caused confusion or lacked credibility.
The Toxic Statements in the cancer-themed set that were considered most effective across languages were:
This product contains dozens of cancer-causing chemicals / Ce produit contient des dizaines de substances chimiques cancérogènes
You are exposed to 28 cancer-causing chemicals every time you use this product / À chaque fois que vous utilisez ce produit, vous êtes exposé à 28 substances cancérogènes
Smokeless tobacco contains toxic chemicals that cause cancer / Le tabac sans fumée contient des substances chimiques qui causent le cancer
In addition, the following statement stood out among English-speaking participants:
Toxic chemicals found in this product cause cancer inside your mouth / Les substances toxiques contenues dans ce produit causent le cancer dans votre bouche
By comparison, the following statement grabbed French-speaking participants' attention, in addition to the three mentioned above:
Toxic chemicals found in this product are absorbed through your gums and cause oral cancer / Les substances toxiques contenues dans ce produit sont absorbées par vos gencives et causent le cancer de la bouche
When considering the 'specific chemicals' themed statements, familiarity clearly makes a difference. Across groups, participants generally concurred that naming chemicals that they are familiar with makes a statement more effective, as they can immediately relate to a potential danger associated with product usage. By contrast, vague statements, or those including chemicals they are unfamiliar with (i.e. nitrosamines) result in a lack of personal relevance and minimized impact. Compounds that are understood (i.e. arsenic, lead and cadmium (found in battery acid)) provide greater shock value and effect.
Once again, it was suggested that statements should reference 'smokeless tobacco' rather than 'this product' for greater clarity. It was noted that there was a spelling mistake in the French version of the statement H, whereby the word "tous" should be replaced by "toutes".
The Toxic Statements in the specific chemical-themed set that were considered most effective across languages were:
Cancer-causing arsenic, nickel and cadmium are chemicals found in this product / Ce produit contient de l'arsenic, du nickel et du cadmium, tous des substances cancérogènes
This product contains cadmium which is also found in battery acid / Ce produit contient du cadmium que l'on trouve aussi dans l'acide de batterie
In addition, English-speaking participants identified the following statement:
This product contains toxic metals, including arsenic, cadmium and lead / Ce produit contient des métaux toxiques, dont l'arsenic, le cadmium et le plomb
In comparison, the following statement was cited in French-speaking groups as being among the most attention-grabbing:
Nitrosamines are toxic chemicals found in smokeless tobacco that cause cancer / Le tabac sans fumée contient des nitrosamines qui sont des substances toxiques et cancérogènes
Some of the 'specific chemicals' themed statements caused confusion, although among only a few participants. Specifically, cadmium and nitrosamines were not known by a few participants although they believed that identifying those substances lends credibility and weight to the Toxic Statements. A couple of participants also noted that the statement "Using this product exposes you to toxic chemicals" was too vague to elicit an emotional reaction.
When considering the 'nicotine / addiction' themed statements, participants expressed a preference for phrases that are short and clearly outline what nicotine does or what is happening when using smokeless tobacco. Mention of brain altering, and absorption in blood suggested serious consequences and grabbed attention. Once again first-person language in the English statements (i.e. you, your) was considered more impactful than generic statements and made the statements more personally relevant. A few participants commented that the word 'drug' is more impactful than 'substance'.
The Toxic Statements in the nicotine / addiction-themed set that were generally considered most effective across languages were:
This product contains nicotine, a highly addictive, brain altering chemical / Ce produit contient de la nicotine, une substance qui crée une forte dépendance et qui nuit au fonctionnement du cerveau
Highly addictive nicotine found in this product is absorbed through your mouth / La nicotine présente dans ce produit est une substance qui crée une forte dépendance et qui est absorbée par votre bouche
You absorb highly addictive nicotine into your blood when you use this product / Lorsque vous utilisez ce produit, vous absorbez de la nicotine dans votre sang, une substance qui crée une forte dépendance
In addition, English-speaking participants were drawn to the following statement:
You are exposed to nicotine, a highly addictive substance when you use this product / Lorsque vous utilisez ce produit, vous êtes exposé à la nicotine, une substance qui crée une forte dépendance
By contrast, French-speaking participants identified the following statements as being of interest in addition to the three identified above:
Nicotine in smokeless tobacco is absorbed through mouth tissues and causes addiction / La nicotine présente dans le tabac sans fumée est absorbée par les muqueuses de la bouche et crée une dépendance
Nicotine is the highly addictive drug found in this product / La nicotine contenue dans ce produit est une drogue qui crée une forte dépendance
Although none of the 'nicotine / addiction' themed statements were considered problematic, some elicited questions. For example, stating that nicotine is a brain altering chemical made a few participants question how this could be the case.
Appendix A: Recruitment Screener
Health Warnings Testing - Cigars, Pipe Tobacco, Smokeless Tobacco
Screener - FINAL
Name:
Daytime phone:
Evening phone:
Email:
Group 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
NETFOCUS GROUPS:
Date:
Monday, July 15, 2019
Audience:
Market
Time:
Group 1: 5:30 pm ADT/4:30pm EDT
Cigar/Pipe Smokers
Atlantic (EN)
Group 2: 8:00pm ADT/7:00pm EDT/6:00pm CDT
Cigar/Pipe Smokers
Central (EN)
Date:
Tuesday, July 16, 2019
Time:
Group 3: 6:30pm ADT/5:30pm EDT
Cigar/Pipe Smokers
Atlantic (EN)
Group 4: 9:00pm ADT/8:00pm EDT/6:00pm MDT/5:00pm PDT
Cigar/Pipe Smokers
West (EN)
Date:
Wednesday, July 17, 2019
Time:
Group 5: 6:30pm ADT/5:30pm EDT
Cigar/Pipe Smokers
Quebec/NB/ON (FR)
Group 6: 7:00pm ADT/6:00pm EDT
Smokeless Tobacco Users
Atlantic/Central (EN)
Group 7: 9:30pm ADT/8:30pm EDT/6:30pm MDT/5:30pm PDT
Cigar/Pipe Smokers
West (EN)
Date:
Thursday, July 18, 2019
Time:
Group 8: 6:30pm ADT/5:30pm EDT
Cigar/Pipe Smokers
Quebec/NB/ON (FR)
Group 9: 7:30pm ADT/6:30pm EDT/5:30pm CDT
Cigar/Pipe Smokers
Central (EN)
Group 10: 9:00pm ADT/8:00pm EDT
Smokeless Tobacco Users
Quebec/NB/ON (FR)
Group 11: 10:00pm ADT/9:00pm EDT/7:00pm MDT/6:00pm PDT
Smokeless Tobacco Users
West (EN)
Date:
Monday, July 22, 2019
Time:
Group 12: 6:30pm ADT/5:30pm EDT
Cigar/Pipe Smokers
Quebec/NB/ON (FR)
Group 13: 7:00pm ADT/6:00pm EDT
Smokeless Tobacco Users
Atlantic/Central (EN)
Group 14: 9:00pm ADT/8:00pm EDT
Smokeless Tobacco Users
Quebec/NB/ON (FR)
Group 15: 9:30pm ADT/8:30pm EDT/6:30pm MDT/5:30pm PDT
Groups 6, 10, 11, 13, 14 & 15: Smokeless tobacco users (18 years +)
All must have smoked cigar/pipe OR used smokeless tobacco in the past - aim for 6 per group within the past 30 days
Recruit 10 per group including 2 stand-by respondents
Aim for mix of age and gender, if possible, however should not be turned away if a mix is not achieved.
Length of discussion: 2 hours
Exclude sensitive occupations
Incentive: $125 per participant
Hello/Bonjour, my name is [Name Here] and I am with Narrative Research (formerly Corporate Research Associates), a market research company. We are conducting a study on behalf of the Government of Canada, specifically for Health Canada, and we are looking for people to take part in a small group discussion. We would like to speak with someone in your household who is at least 18 years old. Would that be you? IF NO, ASK TO SPEAK WITH SOMEONE ELSE AND REPEAT INTRO
Would you prefer that I continue in English or in French? Préférez-vous continuer en français ou en anglais? [IF FRENCH, CONTINUE IN FRENCH OR ARRANGE CALL BACK WITH FRENCH INTERVIEWER: Nous vous rappellerons pour mener cette entrevue de recherche en français. Merci. Au revoir.]
The purpose of the study and the small group discussions is to hear people's views on materials currently being developed by Health Canada. Those who qualify and participate in the group discussion will receive $125 in appreciation for their effort.
May I ask you a few quick questions to see if you are the type of participant we are looking for to take part in this small group discussion? This will take about 6 or 7 minutes. The information you provide will remain completely confidential and you are free to opt out at any time. The information collected will be used for research purposes only and handled according the Privacy Act of Canada.*Thank you.
*IF ASKED: The personal information you provide is protected in accordance with the Privacy Act and is being collected under the authority of section 4 of the Department of Health Act. The information you provide will not be linked with your name on any document including the consent form or the discussion form. In addition to protecting your personal information, the Privacy Act gives you the right to request access to and correction of your personal information. You also have the right to file a complaint with the Office of the Privacy Commissioner if you feel your personal information has been handled improperly. For more information about these rights, or about our privacy practices, please contact Health Canada's Privacy Coordinator at 613-948-1219 or hc. privacy-vie.privee.sc@canada.ca.
THANK & TERMINATE WHERE REQUIRED IN THE SCREENER: Unfortunately, we will not be able to include you in this study. We already have enough participants who have a similar profile to yours. Thank you for your time today.
Gender (By Observation):
Female - 1
Male - 2
AIM FOR A MIX OF GENDER, IF POSSIBLE - WILL SKEW MALES
Do you, or does anyone in your household currently work or have ever worked in any of the following areas?
Marketing/Market Research - 1
Public relations, communications, graphic design, or creative agency - 2
Advertising or media (TV, Radio, Newspaper) - 4
Health sector - 5
Government department, federal, provincial or municipal that is
responsible for health or public health - 6
An association, organization or company which activities relate in any way
to tobacco, smoking or vaping - 7
IF YES TO ANY OF THE ABOVE, THANK AND TERMINATE
In which of the following age groups do you fall? Are you…?
Less than 18 - 1 Thank & Terminate
18-24 - 2
25-34 - 3
35-44 - 4
45-54 - 5
55-64 - 6
65 years or older - 7
MUST BE AT LEAST 18 YEARS OR OLDER. AIM FOR A MIX OF AGES, IF POSSIBLE
A) In what city and province do you live?
RECORD CITY NAME:
RECORD PROVINCE:
3. B) How many years have you been living in [province]?
[RECORD # of Years: ]
Do you currently, or have you ever smoked cigars in the past?
Yes - 1 CONTINUE TO Q4a
No - 2 SKIP TO Q5
Were the cigars you smoke or smoked with or without a filter?
I only smoke(d) cigars with a filter - 1 SKIP TO Q5
I only smoke(d) cigars without a filter - 2 CONTINUE TO Q4b
I smoke(d) both cigars with and without a filter... 3 CONTINUE TO Q4b
Would you say you smoke cigars (not including cigars with a filter)… [READ IN ORDER]?
Everyday - 1 SKIP TO Q5
ccasionally; or - 2
Rarely - 3
When was the last time you smoked a cigar (not including cigars with a filter)?
Within the past 30 days - 1
At least 1 month, but less than 6 months ago - 2
At least 6 months but less than 1 year ago - 3
At least 1 year but less than 5 years ago - 4
At least 5 years ago or longer - 5
Do you currently, or have you ever smoked a pipe tobacco (not including waterpipe tobacco)?
Yes - 1 CONTINUE TO Q5a
No - 2 SKIP TO Q6
Would you say you smoke a pipe tobacco … [READ IN ORDER]?
Everyday - 1 SKIP TO Q6
ccasionally; or - 2
Rarely - 3
When was the last time you smoked a pipe tobacco?
Within the past 30 days - 1
At least 1 month, but less than 6 months ago - 2
At least 6 months but less than 1 year ago - 3
At least 1 year but less than 5 years ago - 4
At least 5 years ago or longer - 5
CONSIDER FOR GROUPS 1, 2, 3, 4, 5, 7, 8, 9, & 12:
ALL MUST EITHER SMOKE A CIGAR OR A PIPE TOBACCO, CURRENTLY OR HAVE SMOKED IN THE PAST (YES TO Q4 AND/OR Q5)
RECRUIT 4 PIPE TOBACCO SMOKERS AND 6 CIGAR SMOKERS PER GROUP (INCLUDING ONE SPEAR FOR EACH)
AIM FOR 6 PER GROUP WHO HAVE LAST SMOKED WITHIN THE PAST 30 DAYS
Do you currently use smokeless tobacco products such as chewing tobacco, moist snuff, smokeless pouches and snus, or have you ever used these products in the past?
Yes - 1 CONTINUE TO Q6a.
No - 2 SKIP TO Q7
Would you say you use smokeless tobacco products … [READ IN ORDER]?
Everyday - 1 SKIP TO Q7
ccasionally; or - 2
Rarely - 3
When was the last time you used a smokeless tobacco product?
Within the past 30 days - 1
At least 1 month, but less than 6 months ago - 2
At least 6 months but less than 1 year ago - 3
At least 1 year but less than 5 years ago - 4
At least 5 years ago or longer - 5
CONSIDER FOR GROUPS 6, 10, 11, 13, 14 & 15:
ALL MUST HAVE USED SMOKELESS TOBACCO PRODUCTS IN THE PAST (YES TO Q6)
AIM FOR 6 PER GROUP WHO HAVE LAST USED SMOKELESS TOBACCO PRODUCTS WITHIN THE PAST 30 DAYS
IF "NO" TO Q4, Q5, AND Q6 (ALL THREE) - THANK & TERMINATE
The discussion groups for this project will be conducted over the phone and online and will require the use of a laptop or desktop computer. The use of a tablet or smartphone is not permitted. Do you have access to a laptop or desktop computer with high-speed Internet to take part in this focus group?
Yes - 1
No - 2 THANK AND TERMINATE
How comfortable are you with using a computer? Are you…
Very comfortable - 1
Somewhat comfortable - 2
Somewhat uncomfortable - 3 THANK AND TERMINATE
Very uncomfortable - 4 THANK AND TERMINATE
Once you are online for the actual group you will also be required to join a telephone conference call to be connected to the discussion. Will you have access to a dedicated telephone (separate from your computer) for the 2-hour discussion?
Yes - 1
No - 2 THANK AND TERMINATE
I just have a few more questions…
Have you ever attended a small group discussion for which you received a sum of money?
Yes - 1 CONTINUE - Max of 6 per group
No - 2 Go To Invitation
How many group discussions have you attended in the past 5 years?
What was the subject of all of the group discussions you have ever attended?
When was the last time you attended a group discussion?
IF THEY HAVE BEEN TO A GROUP IN THE PAST 6 MONTHS - THANK & TERMINATE,
IF THEY HAVE BEEN TO 5 OR MORE GROUPS IN THE PAST 5 YEARS - THANK & TERMINATE
IF PARTICIPATED IN A PAST GROUP ON SMOKING, VAPING OR ADVERTISING - THANK & TERMINATE
INVITATION
I would like to invite you to participate in a small group discussion that will be conducted over the telephone and on the Internet on [INSERT DATE] from [INSERT TIME] to [INSERT TIME]. This session will be used to gather your thoughts and opinions on materials currently being developed by Health Canada. You would simply log on to a secure website from your computer either from home or work and at the same time join in a group discussion on the phone, via conference call. The discussion will consist of 8 to 10 people and will be very informal. It will last 2 hours and you will receive $125 in appreciation for your time. You will be asked to logon about 15 minutes before the beginning of the session, so around [INSERT TIME].
Are you interested and available to participate?
Yes - 1
No - 2 THANK AND TERMINATE
The discussion in which you will be participating will be audio recorded. The recordings are used to help with analysing the findings and writing the report. The results from the discussions will be grouped together in the research report, which means that individuals will not be identified in any way. Neither your name nor your specific comments will appear in the research report. Are you comfortable with the discussion being recorded?
Yes - 1
No - 2 THANK AND TERMINATE
There may also be some people from Health Canada and other observers involved in the project who have been involved in this project listening in on the session. They will not take part in the discussion and they will not know your last name. Are you comfortable with having these observers?
Yes - 1
No - 2 THANK AND TERMINATE
During the session, participants will be asked to read materials on the computer screen and type short responses. Is it possible for you to take part in these activities in English (French) without assistance?
Yes - 1
No - 2 THANK AND TERMINATE
TERMINATE IF RESPONDENT OFFERS ANY REASON SUCH AS SIGHT OR HEARING PROBLEM, A WRITTEN OR VERBAL LANGUAGE PROBLEM, A CONCERN WITH NOT BEING ABLE TO COMMUNICATE EFFECTIVELY OR IF YOU HAVE A CONCERN.
Could we please confirm the email address where we can send you the detailed instructions for logging in to the online focus group?
Record email address (and verify):.
We will send you the instructions at least 1 day in advance of the group. When joining the discussion, please call in 15 minutes before the beginning of the session to allow time to install any computer plug in or application that are required. If you arrive late, we will not be able to include you in the discussion, and will not provide you with the incentive.
As mentioned, we will be pleased to provide everyone who participates with $125 and you can choose to receive your incentive by cheque or through PayPal. Please note it takes approximately 2-3 weeks following your participation to receive an incentive by cheque and 5-7 days to receive an incentive through PayPal. If you do choose to receive your incentive through PayPal you will need to have a PayPal account.
[IF REQUIRED: To learn more about PayPal or to setup a PayPal account you can visit their website at www.paypal.ca]. Would you prefer to receive your incentive through PayPal or by cheque?
PayPal - 1
Cheque - 2
IF INCENTIVE BY PAYPAL:
A few days after the group discussion you will receive an email from Narrative Research indicating that your incentive is ready. You will simply need to log in to your PayPal account and the incentive will go into your PayPal balance. Once you're logged into your account you can click "Withdraw" to view your withdrawal options.
IF INCENTIVE BY CHEQUE:
Could I have the mailing address where you would like the cheque mailed to following your participation?
Mailing address:
City:
Province:
Postal Code:
And please confirm the spelling of your name:
SPARES: You have been recruited as an additional participant for this research, or a "spare", which means that you may or may not be able to take part in the session. So, we ask that you log in into the session at the scheduled time. If all other participants are present, the moderator will ask you to leave the session at the beginning, but you will receive the $125 incentive. If there is a participant missing, the moderator will ask you to stay for the 2-hour session and to participate in the discussion. Are you ok with being a "spare"?
Yes - 1
No - 2 THANK AND TERMINATE
ALL:
As these are very small groups and with even one person missing, the overall success of the group may be affected, I would ask that once you have decided to attend that you make every effort to do so. If you are unable to take part in the group discussion, please call [Phone Number] (collect) at ##### as soon as possible so we can find a replacement.
Thank you for your interest in our study. We look forward to hearing your thoughts and opinions!
ATTENTION RECRUITERS
Recruit 10 participants for each focus group (2 will be recruited as "spares")
Confirm that they have access to a desktop or laptop computer for the focus group and NOT a tablet or smartphone
Do not put names on profile sheet unless you have a firm commitment.
Repeat the date, time and email address before hanging up.
CONFIRMING
Confirm at the beginning of the day prior to the day of the groups
Verify date and time
Confirm they received the email detailed login instructions
Confirm responses to Q4, Q5 and Q6 (all points under these questions)
REMIND participants that the groups will be over the phone AND online and that they need to use a laptop or desktop computer (and NOT a tablet or smartphone)
Remind them to log into the discussion 15 minutes prior to the start time
Remind "spares" that they will need to logon to the session to receive the incentive and that they may or may not be able to take part
Appendix B:
Moderator's Guide
Moderator's Guide - FINAL
ONLINE QUALITATIVE TESTING OF NEW HEALTH WARNINGS FOR CIGARS, PIPE TOBACCO,
SMOKELESS TOBACCO AND TOXIC STATEMENTS FOR SMOKELESS PRODUCT PACKAGING
Study Objectives (do not share with participants)
The research aims to assess reactions to approximately 14-15 new health warning mock-ups for each of three product types: cigars, pipe tobacco, and smokeless tobacco, on their own, without comparisons. More specific objectives include:
To assess the noticeability of each HW;
To determine if each HW is relevant;
To determine if each HW is believable;
To evaluate if the text is clear and is understood (in the intended way) by the target audience;
To determine if each HW informs and educates Canadians about the health hazards and health effects of using these tobacco products and available cessation information; and
To gather participants' views of design elements of HW, including different layouts, placements and colours (i.e., for background, border, certain text)
The research also aims to assess top-of-mind reactions to approximately 18 toxic statements (TS) for smokeless tobacco products, notably in achieving the following objectives:
To assess the statements' noticeability, believability and relevance;
To assess whether the statements are understood in the intended way by the target audience; and
To assess whether the statements inform and educate Canadians about the health hazards and effects associated with smokeless tobacco use, and the specific toxic chemicals found in smokeless tobacco products.
Introduction 10 minutes
[SLIDE 1] Welcome: Introduce self & research firm & role as moderator (keep on time/on topic)
Sponsor: Groups on behalf of the Government of Canada
Length: Our discussion should last about 2 hours without a break
Topic: Look at proposed new (draft) health warnings for [cigars and pipe tobacco / smokeless tobacco] product packaging
Your Role: Share your opinions freely and honestly; no prep needed; not testing your knowledge
Process: All opinions are important; looking for your opinions (not what you think others might think); want to understand minority/majority of opinions; talk one at a time; interested in hearing from everyone
Netfocus: online, real-time; share feedback verbally and via online polls; will show you HWs on the screen
Logistics: Recording for reporting; observers representing the government and other observers involved in the project
Confidentiality: Your comments are anonymous; no names in reports; answers will not affect dealings with Government of Canada; Once finalized, the report can be accessed through the Library and Archives Canada.
[SLIDE 2] Participant Introduction: First name, who they live with, and how long have you been [smoking cigars/pipe tobacco / using smokeless tobacco], and how often do you [smoke/use], if you also smoke cigarettes and if so, how often.
Health Warnings for Tobacco Product Packaging
CIGARS/PIPE TOBACCO GROUPS (15 HW - 6 MIN PER HW) 100 minutes
SMOKELESS TOBACCO GROUPS (9 HW - 5 MIN PER HW) 45 minutes
[SLIDE 3]
Tonight, I would like to get your opinions about health warnings that are being considered for [cigar and pipe tobacco / smokeless tobacco] product packaging. The focus of the discussion will be the health warnings themselves; which tobacco companies will be required by law to put on all packages. We are only focussing on the health warnings today. I'll warn you that some of the visuals I will be showing you are graphic in nature.
You may know that plain packaging will be required for all tobacco products and you will start seeing this type of packaging later this year. Plain packaging means all tobacco product packages will have the same plain colour, without any design features, such as company logos or slogans.
[SLIDE 4] I'd like to show you an example so you can have a better idea of where the health warnings we will discuss today would appear on the packaging. We will not be discussing these plain packaging measures, only the health warnings themselves. Again, we are only asking for your feedback on the health warning; not the plain package colours or design. Is this clear to everyone? In total, we'll be looking at (First two groups: 15 - all other groups: 13 (cigars and pipe groups)/ 9 (smokeless groups) proposed health warnings.
Let's begin with the first one…
[SLIDES 5-6 (A THROUGH O) - 2 SLIDES PER HW - ROTATE PRESENTATION ORDER]
FOR EACH HEALTH WARNING, ASK (1-2 minutes per HW):
POLLS 1-15: Take a minute to look at the HW on the screen and then, complete a quick poll to answer (yes or no) to the following four questions:
This health warning grabs my attention
This health warning is clear and easy to understand
This health warning is believable
This health warning communicates a health effect of [smoking cigars and/or pipe tobacco / using smokeless tobacco]
Now let's talk about this health warning as a group.
FOR EACH HEALTH WARNING, ASK (4-5 minutes per HW) - ASK BASED ON RESPONSES FROM POLLS:
Attention/Noticeability/Engagement:
IF TIME PERMITS ONLY AND IF YES TO POLL A: What specifically grabs your attention; what stands out?
IF NO TO POLL A: If it did not grab your attention, why not?
Clarity:
IF TIME PERMITS ONLY AND IF YES TO POLL B: Do the text and image work well together?
IF NO TO POLL B: What, if anything, is unclear or confusing?
Is the text easy to read? Ask for comments on font size and contrast.
Is the image clear?
Credibility:
IF YES TO POLL C: Why do you find this believable?
IF NO TO POLL C: Why isn't it believable?
Comprehension:
IF YES TO POLL D: What is this health warning communicating? Is the information relevant to you? Did you learn anything new?
IF NO TO POLL D: What is this health warning communicating? Why isn't it relevant to you?
Any other suggestions to improve this HW?
If they say text is too long, probe:
How would you suggest shortening it?
If they said the image/text don't go well together or image is confusing, probe:
What would improve the ima ge?
Prompt on the last HW: only if it hasn't already come up:
Did you notice that Health Canada is mentioned on the Health warnings? What if anything does that suggest to you?
Now let's have a look at another health warning. Again, remember that we are not comparing health warnings, so I will ask that you comment on the next one on its own, and not compare it to those previously discussed. REPEAT POLL & QUESTIONS FOR EACH OF THE HEALTH WARNINGS
Health Warnings Design Elements 10 minutes
[SLIDE 7]
[CIGARS/PIPE TOBACCO GROUPS ONLY] You have seen two different template styles with different colours. You will see the two examples [A and B] on your computer screen.
[SMOKELESS TOBACCO GROUPS ONLY] You have seen three different template styles with different colours. You will see the three examples [A, B and C] on your computer screen.
POLL 16: Which colour combination is most eye-catching? Only pick one. [SHARE POLL RESULTS]
Which colour combinations are the most eye-catching? Why?
Overall, are both of these templates effective at communicating the information? Any suggestions to improve them?
IF NOT MENTIONED: Does one of the quitline sections (the area that shows a tagline, a quitline phone number and a website) grab your attention more than the other? Is one more noticeable? Easier to read? Easier to understand? Any other comments on the quitline section? Any suggestions to improve it?
[SMOKELESS TOBACCO GROUPS ONLY] Some tobacco products, like cigarettes, have a quitline section (an area that shows a tagline, a quitline phone number and a website) with tobacco cessation information. Should this information appear on smokeless tobacco packages? If so, where should this information appear? If not, why not?
So far, all of the HW you have seen have been in (English or French only), and in a portrait orientation. But packages for cigars and pipe tobacco come in many different shapes and sizes. I'm now going to show you 4 different layout options - some of them are oriented in portrait format, some in landscape, and some have both English and French text in the same HW. The messages are the same across all of these layouts.
Looking at these 4 different layouts:
Is the text easy to read across all of them? If not, why not?
Is there anything unclear or confusing?
Is the image clear?
Do you have any suggestions to improve any of these layouts?
[SMOKELESS TOBACCO GROUPS ONLY] Toxic Statements 15 minutes
The Government of Canada is also considering displaying statements, possibly on the sides of packages, that inform users about the toxic chemicals found in smokeless tobacco products, in addition to the health warnings we just saw. [SHOW EXAMPLE ON SCREEN OF WHERE THEY WOULD APPEAR]
I'd like to get your initial reactions to these 18 statements. They have been grouped by theme, with 6 statements in each group. Let's have a look at the first set.
Noticeability: Which ones grab your attention the most? Why?
Comprehension: Are any statements unclear or difficult to understand? Why?
[If too long]: How do you think it should be shortened?
Message Effectiveness: Which ones are best at informing you about the health effects and health hazards of smokeless tobacco products, and the specific toxic chemicals found in them?
Credibility: Are there any statements you do not believe? Why?
If so: Would mentioning Health Canada in the statement make it more believable?
Now let's have a look at the next set of statements. REPEAT QUESTIONS FOR EACH OF THE OTHER SETS
[SLIDE 11]
Before we finish, any additional thoughts you would like to share about what we have seen tonight?
Thanks & Closure
That concludes our discussion. On behalf of the Government of Canada, thank you for your time and input.
Appendix C:
Schedule of Rotation
Schedule of Rotation - Health Warnings
The following presents the schedule of rotation used during the focus groups to present the Health Warning. The schedule was designed to minimize any presentation order biases.
Pipe/Cigar HW
The two focus groups scheduled on the first night were presented with 15 Health Warnings, while all of the other groups were shown only 13 Health Warnings. The decision to remove NHWC03 and NHWC04 from the rotation was made to maximize the time spent reviewing the other Health Warnings. The table below illustrates the presentation order of Health Warnings in each of the focus groups consisting of participants who smoke pipe tobacco and/or cigars.
Group 1
Group 2
Group 3
Group 4
Group 5
NHWC08
NHWC04
NHWC01/NHWP01
NHWC03
NHWC12
NHWC10
NHWP04
NHWP08
NHWC02/NHWP02
NHWC09
NHWP06
NHWP07
NHWC05
NHWC07/NHWP03
NHWP05
NHWC05
NHWP07
NHWC10
NHWP06
NHWC07/NHWP03
NHWC12
NHWC01/NHWP01
NHWP04
NHWC04
NHWP08
NHWC02/NHWP02
NHWP05
NHWC09
NHWC03
NHWC08
NHWP07
NHWC12
NHWP04
NHWC10
NHWC08
NHWC07/NHWP03
NHWC09
NHWC01/NHWP01
NHWP08
NHWC02/NHWP02
NHWP05
NHWC05
NHWP06
NHWC12
NHWC10
NHWC01/NHWP01
NHWC08
NHWP04
NHWC05
NHWP08
NHWC02/NHWP02
NHWP06
NHWC09
NHWP07
NHWP05
NHWC07/NHWP03
NHWC09
NHWC07/NHWP03
NHWP07
NHWP08
NHWP04
NHWC10
NHWC05
NHWP05
NHWC08
NHWC02/NHWP02
NHWP06
NHWC01/NHWP01
NHWC12
Group 7
Group 8
Group 9
Group 12
NHWP04
NHWC08
NHWP08
NHWP05
NHWC01/NHWP01
NHWC05
NHWC09
NHWC10
NHWC07/NHWP03
NHWC12
NHWP07
NHWC02/NHWP02
NHWP06
NHWP05
NHWP08
NHWC05
NHWC02/NHWP02
NHWP07
NHWP04
NHWC09
NHWC08
NHWC01/NHWP01
NHWC10
NHWP06
NHWC07/NHWP03
NHWC12
NHWC05
NHWC10
NHWP05
NHWP06
NHWC08
NHWC01/NHWP01
NHWC02/NHWP02
NHWC12
NHWP08
NHWP04
NHWP07
NHWC09
NHWC07/NHWP03
NHWC09
NHWP08
NHWC12
NHWC08
NHWC05
NHWC01/NHWP01
NHWP07
NHWC02/NHWP02
NHWP06
NHWP04
NHWP05
NHWC07/NHWP03
NHWC10
Smokeless Tobacco HW
The table below illustrates the presentation order of Health Warnings in each of the focus groups consisting of participants who use smokeless tobacco.
Group 6
Group 10
Group 11
Group 13
Group 14
Group 15
NHWS08
NHWS02
NHWS05
NHWS03
NHWS06
NHWS07
NHWS01
NHWS09
NHWS04
NHWS03
NHWS01
NHWS07
NHWS04
NHWS08
NHWS02
NHWS09
NHWS05
NHWS06
NHWS05
NHWS08
NHWS04
NHWS03
NHWS09
NHWS06
NHWS01
NHWS02
NHWS07
NHWS07
NHWS02
NHWS05
NHWS01
NHWS03
NHWS08
NHWS09
NHWS04
NHWS06
NHWS03
NHWS07
NHWS08
NHWS06
NHWS04
NHWS05
NHWS02
NHWS09
NHWS01
NHWS03
NHWS07
NHWS08
NHWS06
NHWS04
NHWS05
NHWS02
NHWS09
NHWS01
Schedule of Rotation - Toxic Statements
The table below illustrates the presentation order of Toxic Statements by theme during each of the focus groups consisting of participants who use smokeless tobacco.
18 - Text description
