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
Online Qualitative Testing of Draft Health Warnings for Cigars, Pipe Tobacco, Smokeless Tobacco and Toxic Statements for Smokeless Product Packaging - 2019
Executive Summary
Prepared for Health Canada
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
©Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2019
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
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.
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
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