Social Values and Psychographic Segmentation of Tobacco and Nicotine Users and Non-Users

Final Report

Prepared for Health Canada
Supplier name: Earnscliffe Strategy Group
Contract number: HT372-192982/001/CY
Contract value: $239,989.12
Award date: September 6, 2019
Delivery date: February 21, 2020

Registration number: POR 048-19
For more information on this report, please contact Health Canada at:
hc.cpab.por-rop.dgcap.sc@canada.ca

Ce rapport est aussi disponible en français.

Prepared for Health Canada
Supplier name: Earnscliffe Strategy Group
February 2020

This public opinion research report presents the results of an online survey and focus groups conducted by Earnscliffe Strategy Group on behalf of Health Canada. The research was conducted from September 2019 to February 2020.

Cette publication est aussi disponible en français sous le titre : Valeurs sociales et segmentation psychographique des utilisateurs et des non-utilisateurs de tabac et de nicotine

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca or at:

Health Canada, CPAB
200 Eglantine Driveway, Tunney's Pasture
Jeanne Mance Building, AL 1915C
Ottawa, Ontario K1A 0K9

Catalogue Number: H14-345/2020E-PDF

International Standard Book Number (ISBN): 978-0-660-34329-7

Related publications (registration number: POR 048-19)

H14-345/2020F-PDF (Final Report, French)
978-0-660-34330-3

© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2020

TABLE OF CONTENTS

• Executive summary
• Introduction
• Detailed findings
  • Section A: Understanding of vaping and nicotine
  • Section B: Current and past behaviours
  • Section C: Psychographic profile of survey sample
  • Section D: Psychographic indexing of nicotine behaviours
  • Section E: focus on youth 15-19 who only vape
• Conclusions
• Appendix A: Survey methodology report
• Appendix B: Survey instrument
• Appendix C: Focus group methodology report
• Appendix D: Screener
• Appendix E: Discussion guide
• Appendix F: Handout

Executive summary

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of the quantitative and qualitative research conducted to understand social values and psychographic segmentation of tobacco and nicotine users and non-users.

The Government of Canada made the commitment to reduce tobacco use to less than 5% by 2035 in order to help combat the prevalence of chronic diseases, such as cancer, respiratory ailments, and heart disease. In order to achieve this goal Health Canada created a robust surveillance program capable of pinpointing a variety of statistics related to smoking and vaping; from the number of cigarettes an individual smokes per day, to how old they were when they had their first cigarette or vape. While this data has provided a variety of insights and information with regards to demographics (age, gender, province, income, etc.) there is still limited understanding as to who people who smoke or vape are on a more personal level. The aim of this research was to understand their morals, values, belief systems, health views, etc. The specific objectives were to explore whether or not there are different segments within the smoking and vaping population with whom different messages would resonate stronger than those currently in use. The research focused on vaping, while youth smoking rates are at historic lows, youth vaping is currently increasing at an overwhelming rate particularly among youth 16 and 19, thus Health Canada wanted to further understand this phenomenon. Feedback from this research will help Health Canada understand how to maximize different policies to achieve their 2035 target. The total cost to conduct this research was $239,989.12 including HST.

In addition to the information objectives, Health Canada needed to ensure each of a variety of specific target audiences were adequately sampled in order to more clearly understand the nuance of opinion by target audience. Each target audience - some of which are not mutually exclusive - had the following target sample sizes:

• At least n=2,000 people aged 15-19;
• At least n=1,000 people aged 15 or older who smoke;
• At least n=1,000 people aged 15 or older who vape;
• At least n=500 people aged 15-19 who vape; and,
• At least n=700 people aged 20 or older who vape.

To meet all of these objectives, Earnscliffe conducted a two-phased research program.

The research began with a quantitative phase involving an online survey of 7,773 Canadians aged 15 and older. The online survey was conducted using our data collection partner, Leger's, proprietary online panel. To achieve the target sample sizes for all target audiences identified, Earnscliffe developed a data collection approach that began with a total of 6,071 interviews collected as a core sample of the general population aged 15 years and older. Subsequently, the following oversamples were collected among each of the audiences listed below in order to meet all of the target audience sample objectives:

• 1595 additional cases among youth aged 15-19; and
• 107 additional cases among people aged 20 years and older who vape.

In the end, each of the target audiences achieved the following sample sizes:

• n=2,013 people aged 15-19;
• n=1,420 people aged 15 or older who smoke;
• n=1,232 people aged 15 or older who vape;
• n=523 people aged 15-19 who vape; and,
• n=709 people aged 20 or older who vape.

The survey was conducted from December 24^th to January 21 ^st, 2020 in English and in French. The data was weighted to reflect the demographic composition of the Canadian population aged 15 and older, including the incidence of smoking. Because the online sample is based on those who initially self-selected for participation in the panel, no estimates of sampling error can be calculated, and the results cannot be described as statistically projectable to the target population. The treatment here of the non-probability sample is aligned with the Standards for the Conduct of Government of Canada Public Opinion Research for online surveys.

Additionally, due to the use of non-probability online opt-in panels for data collection, this survey should not be relied upon for incidence rates of behaviour. For statistical information on prevalence, refer to the Canadian Tobacco, Alcohol and Drugs Survey (CTADS, available at https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey.html).

The second phase of research involved a qualitative phase which included a series of fifteen focus groups with three segments of the Canadian population (18+): adults who currently vape but have never smoked, adults who currently vape but formerly smoked cigarettes, and adults who currently vape and smoke cigarettes (dual users). Three sessions were conducted in each of the following five cities: Halifax (February 3, 2020); Montreal (February 4, 2020); Toronto (February 5, 2020); Calgary (February 6, 2020); and Vancouver (February 8, 2020). All groups were 1.5 hours in length. The groups in Montreal were conducted in French, all others were conducted in English.

It is important to note that qualitative research is a form of scientific, social, policy and public opinion research. Focus group research is not designed to help a group reach a consensus or to make decisions, but rather to elicit the full range of ideas, attitudes, experiences and opinions of a selected sample of participants on a defined topic. Because of the small numbers involved the participants cannot be expected to be thoroughly representative in a statistical sense of the larger population from which they are drawn and findings cannot reliably be generalized beyond their number.

The key findings from the research are presented below. Bolded results indicate that the result of the demographic group mentioned is significantly higher (at the 95% confidence interval) than the result found in other subgroups discussed in same analysis.

Understanding of Vaping and Nicotine

• In terms of the perceptions of all respondents, the plurality (31%) feel that vaping products are most commonly associated with both recreational uses, and as something to help people quit smoking. This overlapping of motivations begins to separate somewhat when analyzed on the basis of behaviour. Among those who vape, there are two general categories of people: those who do so as a way to reduce or eliminate their use of cigarettes; and those for whom the activity provides some other benefit or benefits.
• The main reasons why people who vape choose to do so included to quit smoking (26%), to reduce stress/relax (13%), and because of peer pressure/social purposes (11%). The main reasons why people who do not vape with nicotine choose not to included health concerns (33%), to quit smoking or vaping with nicotine (22%), and because they are generally uninterested (17%). Focus group discussions with those who vape reinforced these survey findings and added some colour to the insights. Most described starting out of curiosity and with a friend or friends who already vaped and in nearly all cases, their first experience was using a device owned by someone else. Many participants described appreciating the social aspect and the stress relief vaping provides them. Contrastingly, participants who currently smoke or smoked in the past, were more inclined to describe their motivation as one of smoking cessation, typically as a substitute for some but not all of the cigarettes they would typically smoke each day. These people tended to more often cite particular aspects of vaping that they appreciated: that it more closely replicated the hand-to-mouth motion of smoking; and that it can provide a reasonably similar throat sensation that they seek when smoking. Most who vape started out of curiosity because a friend or acquaintance introduced them to it.
• In terms of health concerns, neither vaping nor smoking are top-of-mind concerns when asked to name the most pressing health issues presently facing Canada, with neither mentioned by more than 1% of respondents. When it comes to vaping specifically, respondents tend to describe their level of knowledge of health impacts as modest at best, but whether in spite of a lack of knowledge or because of it, the perception of harm is fairly widespread. Only 43% of respondents felt they were knowledgeable of the health impacts of vaping products containing nicotine. Even fewer (36%) considered themselves knowledgeable of the health impacts of vaping products containing cannabis, and even less (31%) considered themselves knowledgeable of the health impacts of vaping products containing flavours only. Nevertheless, the majority (69%) felt vaping products containing nicotine were extremely/very harmful. Half (50%) felt products containing cannabis were harmful, and roughly a third (38%) felt products containing only flavours were harmful. Over half (52%) of respondents felt that the health risk of vaping products is the same regardless of the level of nicotine.
• Overall, respondents are somewhat divided over the relative harms of vaping products containing nicotine as compared to cigarettes. When compared to cigarettes, 40% of respondents felt that vaping products containing flavours only were less harmful, while 30% felt the same about products containing cannabis, and 20% felt the same about products containing nicotine. In focus groups, participants tended to add that while the long-term health effects of smoking cigarettes are definitely negative, known and well-established, there is a degree of uncertainty due to a lack of history or evidence of long-term effects related to vaping. Those in groups who currently smoke or smoked in the past were much more adamant that the harms of vaping, whatever they may end up being, are unlikely to be as bad as the harms associated with smoking cigarettes.
• There are some differences of opinion based upon usage behaviours that are worth noting in terms of perceived health risks. Respondents who vape with higher concentrations of nicotine (2%+) are more likely to feel that vaping products containing nicotine are less harmful (a little harmful or not at all harmful) than those who vape with under 2% nicotine, or none at all (28% compared to 18% and 7% respectively). Similarly, people who vape once a month or less were significantly more likely to find vaping products containing nicotine extremely harmful (20%) compared to those who vape daily (5%).
• Much of the sense of fear over the health effects associated with vaping appears to have developed relatively recently. Half (47%) felt that their impression of harm associated with vaping products containing nicotine has worsened. Two in five (40%) reported the same of vaping products containing cannabis, and 39% felt the same about products containing flavours only. The main reason impressions of vaping products changed over time was media reports, followed by news of people dying/getting sick from vaping, and finally the idea that vaping causes lung damage/disease. Focus group discussions elicited a widespread sense that emerging stories about lung disease introduced new concerns about what they were putting in their lungs, although those who currently smoke were less inclined to describe themselves as discouraged by this same emerging health issue.
• In terms of addiction, both the quantitative and qualitative phases demonstrated that most understand the addictive nature of nicotine, whether in cigarettes or in vaping products that contain nicotine. That said, there are still many who believe that even vaping products that do not contain nicotine are addictive. Vaping products containing nicotine were seen by far as the most addictive (83%) followed by products containing cannabis (67%), and lastly products containing flavours only (50%). When people who vape were asked if they consider themselves addicted, half (50%) reported being either very or a little addicted. Respondents who self-assessed themselves as very addicted to vaping were much more likely than others to feel that vaping products containing flavours only (28%) or containing nicotine (62%) are extremely harmful. In the focus groups, it should be noted that virtually none said they were vaping products that do not contain nicotine. That noted, there were many participants who felt their vaping was an addiction, some described it as "already" being an addiction, since their tenure was a few years or less. Those in the groups who described themselves as addicted often resented that fact and felt that an addiction to nicotine was more problematic than being addicted to something like chocolate, given the physical discomfort of withdrawal that comes with attempting to quit nicotine and which they believe is not involved when quitting an addiction to something like chocolate.

Packaging

• While most focus group participants describe their initial contact with vaping as being in a social setting and not involving packaging, it was clear from the groups and is clear in the survey results, that there is fairly widespread exposure to packaging among those who vape. Three-quarters of respondents (75%) bought/received their vaping devices in a box. And two-thirds (65%) bought/received their pods/liquids in an original box. Roughly a third (30%) of respondents who vape keep their device in its original packaging. This number grows to 39% with pods/liquids. Majorities of all age groups discard packaging although those 25 years of age or older are slightly more likely to keep their product in its original packaging (34%).
• Respondents who vape daily were much more likely to say their vaping device (96%) or pods/liquid (79%) came in a box, compared to those who vape once a month or less (66% and 62% respectively). In focus group discussions, those who vape less frequently tended to include many who only vape socially and a few who still only vape products owned by others, thus limiting their exposure to packaging.

Current and Past Behaviours

• As this survey involves a non-probability sample, any results about behaviour are useful for identifying those who behave in one way or another and enabling comparison of groups of respondents based upon behaviour, but the incidence results are not reliable measures of the proportions who do so. For statistical information on prevalence, refer to the Canadian Tobacco, Alcohol and Drugs Survey (CTADS, available at https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey.html).
• Given the large survey sample and the oversampled populations, the subsets of respondents identified by behaviour provide ample cell sizes for detailed statistical examination. One in five respondents (19%) have smoked cigarettes in the past 30 days, one in ten (9%) have vaped with nicotine, 6% have vaped with flavours only or vaping products that they were unsure of the nicotine content, and 7% have vaped with cannabis.
• Frequency and duration of smoking are both much higher than for vaping. Of respondents who have smoked in the past 30 days, over half (53%) did so every day, and the majority have been smoking for over 10 years (56%). Of the respondents who have vaped with nicotine in the past 30 days, a quarter (24%) did so every day, and the plurality (37%) have been vaping with nicotine for less than a year. The plurality of respondents who vape do so once per day (17%), however 13% vape more than 10 sessions per day.
• Among those who currently neither smoke nor vape, there is a significant group with experience with cigarettes, but much fewer with experience vaping. Of respondents who have not smoked or vaped with nicotine in the past 30 days, two out of five (39%) have smoked in the past, and 8% have vaped with nicotine in the past. Given the years that each behaviour has been possible, it should be expected that the behaviour that has a longer history has a greater proportion with experience.
• In terms of what it is that people are vaping, nearly all who vape are vaping flavours (93%) and most are vaping products that contain nicotine (67% of those who solely vape, and 84% of dual users). With regards to vaping devices used, the most common device was the one with a tank that you refill with liquid; 70% of respondents have used this device before. The second most used was the device with pre-filled pods/cartridges (50%), followed by disposable devices (36%). Over half of those who vape do so with 2% or higher nicotine concentration (58%), and a third (32%) do so with more than 20mg/ml nicotine concentration. A third of respondents have used nicotine salts before (30%), and a fifth (19%) have heard of them but never used them. Of those who have used nicotine salts, opinions are split; 34% prefer nicotine salts, while 33% prefer vaping with nicotine but not nicotine salts.
• The use of flavours is extremely common and for many, a key factor influencing their behaviour. Of all respondents who vape at all, only 2% say they vape an unflavoured product, whether it contains nicotine or not. The most popular flavour is fruit (30%) followed by mint/menthol (17%), and tobacco (11%). In focus groups, participants described the flavours as appealing, that they tended to have developed an affinity to one or more. Some participants said they would not vape at all if there were no flavours and several of the focus group participants who smoke indicated some discomfort with the concept of vaping without flavours. A few of these individuals offered that the flavour is one of the aspects that helps them choose to vape instead of smoke a cigarette.
• Of those who have tried to quit smoking, equal proportions (19% in each case) have tried vaping with nicotine or using a nicotine replacement therapy (e.g., nicotine gum, nicotine patch, nicotine inhaler, etc.). Slightly fewer (12%) indicated having tried vaping without nicotine. One in four (26%) said they tried other ways of quitting smoking. For those who have tried vaping in an attempt quit smoking but ultimately returned to smoking, the most common reasons they went back to cigarettes is because it is hard to quit (17%), that vaping not working/satisfying needs/not getting the same feeling (16%), or they desired the effects they got from cigarettes (i.e. stress reduce/relaxation) (9%). For those who attempted to quit by using vaping products but have gone back to smoking, when asked what method they would use to quit smoking in the future, the majority of survey respondents opted for other ways (63%), though roughly half (48%) said they would try a nicotine replacement therapy, and less than a third (30%) would try vaping with nicotine. The focus groups demonstrated fairly clearly that people who currently smoke and formerly smoked who vape now are largely doing so as a means to reduce or eliminate their use of cigarettes. The impact it has had on their smoking varies with some crediting vaping with helping them quit, others with helping them cut down on smoking and others indicating that vaping nicotine has added to their behaviours without reducing any cigarette consumption.

Psychographic Indexing of Nicotine Behaviours

• The survey contained numerous variables specifically designed to enable psychographic analysis behaviours. These included self-identification of personality traits, values, life goals and activities that people enjoy in their spare time. Comparing the propensity for one behaviour or another among those who self-identify with a particular psychographic characteristic with the overall propensity for that behaviour, index scores were created to identify linkages between behaviours such as smoking and vaping and each psychographic characteristic. The results demonstrate there are clearly linkages relating psychographics to each of four behaviour categories: exclusively smoking; exclusively vaping; dual use; and, doing neither. The dataset allows for any number of behaviours or subsets of the population to be profiled in this way.
• The people who are more likely to be only smoking include:
  • Those not satisfied with their life, feel like they are not making progress financially and describe themselves as depressed;
  • Those who value loyalty and respect tradition;
  • Those who fail to identify a life goal; and
  • Those who identify hunting/fishing and drinking as things they like to do.
• The people who are more likely to be a dual user include:
  • Those not satisfied with their life, feel like they are falling behind financially, and those who have an optimistic outlook;
  • People describe themselves as being fashionable, trendy, hedonistic, experimental, depressed, excitable, lazy, moody, neurotic and a follower;
  • People who value being adventurous or creative;
  • Those who want to be famous and want to have a clear career path; and
  • Those who identify drinking, texting, performing, gaming, and hunting/fishing as things they like to do.
• The people who are more likely to be vaping only include:
  • Those who have an optimistic outlook and are neither satisfied nor dissatisfied with their life;
  • Those who pay little or no attention to current events;
  • People describe themselves as being hedonistic, trendy, fashionable, lazy, experimental, neurotic, bubbly, moody, modern, anxious, stressed, depressed and a follower;
  • Those who value being adventurous and successful;
  • Those who want to be famous, want to have a clear career path, who want peer recognition, want a full-time steady job and want to get married or have a life partner; and
  • Those who identify texting, drinking, shopping, gaming visual arts, social media, performing and playing sports as things they like to do.

Research Firm:
Earnscliffe Strategy Group Inc. (Earnscliffe)
Contract Number: HT372-192982/001/CY
Contract award date: September 6, 2019

I hereby certify as a Representative of Earnscliffe Strategy Group that the final deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not 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: Date: February 24, 2020

Doug Anderson
Principal, Earnscliffe

Introduction

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of the quantitative and qualitative research conducted to understand social values and psychographic segmentation of tobacco and nicotine users and non-users.

Health Canada would like to understand tobacco and vaping use on a different level in order to discover new ways to communicate with audiences who currently use tobacco and vaping products. The overall objective of the research was to investigate social values, psychographic characteristics and values in order to better understand the segments of Canadians.

The specific objectives of the research included:

• Gather secondary information on Canadians' motivations to engage, core values, interests including smoking/vaping behaviours, including cessation, and knowledge, etc.;
• Seek a better understanding of Canadians' views and understanding on this issue (including stigma related to tobacco and vaping use);
• Segment the Canadian population into distinct segments based on their psychographic and behaviour characteristics in a context of smoking/vaping behaviours and knowledge; and,
• To understand the specific attitudes and behaviours among youth who vape.

The research will help Health Canada facilitate the development and refinement of alternative messaging approaches; including the potential use of messages that address social values.

In addition to the information objectives, Health Canada needed to ensure each of a variety of specific target audiences were adequately sampled in order to more clearly understand the nuance of opinion by target audience. Each target audience - some of which are not mutually exclusive - had the following target sample sizes:

• At least n=2,000 people aged 15-19;
• At least n=1,000 people aged 15 or older who smoke;
• At least n=1,000 people aged 15 or older who vape;
• At least n=500 people aged 15-19 who vape; and,
• At least n=700 people aged 20 or older who vape.

To meet all of these objectives, Earnscliffe conducted a two-phased research program.

The research began with a quantitative phase involving an online survey of 7,773 Canadians aged 15 and older. The online survey was conducted using our data collection partner, Leger's, proprietary online panel. To achieve the target sample sizes for all target audiences identified, Earnscliffe developed a data collection approach that began with a total of 6,071 interviews conducted collected as a core sample of the general population aged 15 years and older. Subsequently, the following oversamples were collected among each of the audiences listed below I order to meet all of the target audience sample objectives:

• 1595 additional cases among youth aged 15-19; and
• 107 additional cases among people aged 20 years and older who vape.

In the end, each of the target audiences achieved the following sample sizes:

• n=2,013 people aged 15-19;
• n=1,420 people aged 15 or older who smoke;
• n=1,232 people aged 15 or older who vape;
• n=523 people aged 15-19 who vape; and,
• n=709 people aged 20 or older who vape.

The quantitative study was designed to shed light on how psychographic characteristics relate to vaping and smoking behaviours. Throughout this report, analysis has focused on those who smoke, those who are dual users and those who vape - including analysis of the 15+ sample overall, as well as among three different age groups.

For the tables, wherever the terms smokes or vapes are used, it refers to people who have done this in the past 30 days. The term dual refers to individuals who both smoke and vape. The results of the 2017 Canadian Tobacco, Alcohol and Drugs Survey (2017) were used in the weighting scheme to ensure the results reflect appropriate relative proportions by behaviour (https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey/2017-summary/2017-detailed-tables.html#t9).

The tables below indicate the total number of cases both overall and by region, for the final total sample of 7,773 cases, which includes the base sample of 6,071 Canadians aged 15 years and older and each of the oversamples.

The surveys were conducted from December 24^th to January 21 ^st, 2020 in English and in French. The data was weighted to reflect the demographic composition of the Canadian population aged 15 and older. Because the online sample is based on those who initially self-selected for participation in the panel, no estimates of sampling error can be calculated, and the results cannot be described as statistically projectable to the target population. The treatment here of the non-probability sample is aligned with the Standards for the Conduct of Government of Canada Public Opinion Research for online surveys. Additionally, due to the use of non-probability online opt-in panels for data collection, this survey should not be relied upon for incidence rates of behaviour. For statistical information on prevalence, refer to the Canadian Tobacco, Alcohol and Drugs Survey (CTADS, available at https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey.html). For more details on the methodology of the survey, please see Appendix D.

The second phase of research involved a qualitative phase which included a series of fifteen focus groups with three segments of the Canadian population (18+): adults who currently vape but have never smoked, adults who currently vape but formerly smoked cigarettes, and adults who currently vape and smoke cigarettes (dual users). For each group, a maximum of ten (10) individuals were recruited as participants. In total, 113 people participated in this phase of focus group discussions. Three sessions were conducted in each of the following five cities: Halifax (February 3, 2020); Montreal (February 4, 2020); Toronto (February 5, 2020); Calgary (February 6, 2020); and Vancouver (February 8, 2020). All groups were 1.5 hours in length. The groups in Montreal were conducted in French whereas all other locations were conducted in English. Please refer to the Recruitment Screener in the Appendix of this report for all relevant screening and qualifications criteria.

In each city, the groups with adults who currently vape but have never smoked began at 5:00 pm (10:00 AM in Vancouver), the groups with adults who currently vape but formerly smoked cigarettes began at 6:30 pm (11:30 AM in Vancouver) and the groups with adults who currently vape and smoke cigarettes (dual users) began at 8:00 pm (1:00 PM in Vancouver). The sessions were approximately 1.5 hours in length. Focus group participants were given an honorarium of $100 as a token of appreciation for their time. Refer to Appendix A and C for the methodology breakdown of each respective phase. Appendix B includes the survey instrument used in the quantitative phase. Finally, Appendix D, E and F provide greater detail on how the groups were recruited, the discussion guides used in the focus groups, and the handouts used in the focus groups.

Bolded results presented in this report indicate that the difference between the demographic groups analysed are significantly higher than results found in other columns in same demographic analysis. Unless otherwise noted, differences highlighted are statistically significant at the 95% confidence level. The statistical test used to determine the significance of the results was the Z-test. Due to rounding, results may not add to 100%.

The qualitative findings of the second phase of research are woven throughout the report. The second phase of focus groups was conducted with three key audiences: adults who currently vape but have never smoked, adults who currently vape but formerly smoked cigarettes, and adults who currently vape and smoke cigarettes (dual users). Except where specifically identified, the qualitative findings in this report represent the combined results for all audiences, as the findings were very consistent.

For the tabular results selected for highlighting in the body of the report, the "Total" column always includes all respondents answering a particular question, but in the interest of brevity, not all subset categories are necessarily compared with each other. For example, in many cases specific age breaks under 25 years of age are displayed, but not the responses of older age categories, although the "Total" column includes respondents from all age categories.

It is important to note that qualitative research is a form of scientific, social, policy and public opinion research. Focus group research is not designed to help a group reach a consensus or to make decisions, but rather to elicit the full range of ideas, attitudes, experiences and opinions of a selected sample of participants on a defined topic. Because of the small numbers involved the participants cannot be expected to be thoroughly representative in a statistical sense of the larger population from which they are drawn, and findings cannot reliably be generalized beyond their number.

Detailed findings

The following report is divided into five sections: understanding of vaping, nicotine, and packaging; current and past behaviours; psychographic profiling; sample profile: nicotine behaviours; and, sample profile: demographics. Results from the qualitative phase of research are woven in throughout the report where applicable. Details about the survey design, methodology, sampling approach, and weighting of the results may be found in the Survey Methodology Report in Appendix D. Percentages may not add up to 100% due to rounding. Bolded results indicate that the result of the demographic group mentioned is significantly higher (at the 95% confidence interval) than the result found in other subgroups discussed in same analysis. Throughout the report, the term youth refers to those 15-19 years of age, young adults refers to those 20-24 years of age, and the term adults refers to those aged 25 and older. Except where specifically identified, the qualitative findings represent the combined results across the various audiences and for both English and French. The quantitative findings focus primarily on the differences across the target segments: the two oversamples and the general population as a whole. Appended data tables provide results of findings across a much broader range of characteristics, behaviours and attitudes.

The final data were weighted to replicate actual distribution of population aged 15 and older by region, age and gender according to the most recent Census (2016) data available and by the 2017 Canadian Tobacco, Alcohol and Drugs Survey (CTADS) to reflect the actual distribution of people by smoking and vaping behaviours. For the purposes of reporting, when examining the quantitative results among people who smoke, the sample combines the people who smoke (who indicate having smoked in the past 30 days) found in the general population sample and both oversamples. Thus, the data on people who smoke or vape is reflective of the population as defined by the proportion who have done so in the past 30 days.

Section A: understanding of vaping and nicotine

Throughout this section of the report and in subsequent chapters, results among certain key subsets are examined (e.g., people who smoke; people who vape; dual users, etc.). The identification of these subsets was made through a series of questions on current, past and potential behaviours related to cigarettes, and vaping. For a full examination of the results of that line of questioning, please see Section B: Current and Past Behaviours. Please note that "smokes" means people who identified as having smoked in the past 30 days and did not identify as having vaped in the past 30 days. Similarly, "vapes" means people who identified as having vaped in the past 30 days and did not identify as having smoked in the past 30 days. "Dual" means people who identified as having both smoked and vaped in the past 30 days. The total of each of the groups identified on the basis of usage does not equal the total number of respondents because respondents who refused to answer were not always resolved. They are included in the total sample, but not necessarily identified for a target audience.

This chapter focuses on people's general understanding of vaping and nicotine, motivations as to why people would or would not choose to vape, as well as perceived harmfulness of vaping and respondents' views on how addictive vaping is or can be. The chapter also explores packaging preferences and habits.

Motivations for Vaping

Roughly a third of respondents (31%) feel that vaping is both for recreational use and something to help people quit smoking. Over half of youth who vape (54%) feel that vaping is mostly for recreational use/for fun, which is much higher compared to young adults who vape ( 45%), or adults who vape (23%). Looking specifically at people who smoke, young adults were more than six times as likely to feel that vaping is more for recreational use (39%) than for helping people to quit smoking (6%).

There are a few differences between other demographic groups:

• Youth are significantly more likely to think of vaping products as recreational (36%) whereas older adults 55+ are the least likely (13%). Older adults (18%) and adults 35-54 ( 19%) were most likely to think of vaping products as cessation tools. Whereas, adults 25-34 (34%) and young adults (37%) are most likely to associate vaping products as both recreational and cessation tools.
• Respondents living in BC (24%), Alberta ( 22%), Manitoba/Saskatchewan (21%), and Ontario (24%), are significantly more likely than those living in Quebec (14%) or Atlantic Canada (19%) to associate vaping products with recreational use. On the other hand, those living in Atlantic Canada (22%) and Quebec (26%) are significantly more likely to associate vaping with cessation tools.
• People with household incomes of over $100k are most likely to associate vaping with recreational use (23%), those making between $20k and $40k are the least likely (15%).
• Students are the most likely to associate vaping with recreational use (35%), while people who are self-employed (21%) or working full-time or part-time ( 19%) are most likely to associate vaping as a cessation tool.

Qualitative Insights: Purpose of Vaping

Those who only vape often tended to think of vaping as something to do recreationally; to fit in, especially among younger participants; and, as a stress reliever. These participants were often inclined to describe it as fun. Most started vaping out of curiosity because a friend or acquaintance introduced them to it. And, it appeared, perhaps given their lack of experience with smoking cigarettes, that they were a little more uncertain (than those in the other groups) about whether what they vape contains nicotine. Perhaps most important, given the combination of all of these factors, most seemed to think that they could very easily stop vaping if they were so inclined.

In their own words:

"It's social. I now have a reason to be a joiner."

"I only vape with friends."

"It's a good way to relax."

Those who formerly smoked cigarettes or currently smoke cigarettes, on the other hand, tended to view vaping as predominantly a cessation tool. For most of these participants, it was one of the reasons they began vaping, although they may have been encouraged by others in their social circle or by seeing that vaping is more accepted in their social circles or environments. They also seemed to be much more aware of the nicotine levels they were vaping, mostly because they were actively trying to reduce the amount of nicotine they were consuming in an effort to become less addicted to vaping. Vaping was, at least initially, a part of their smoking cessation plan.

In their own words:

"I saw it as a way to get healthier."

"I'm a creature of habit and it helped replace the hand-to-mouth movement I have when I smoke."

"It doesn't make me smell like cigarettes do."

"It's something I can do when smoking a cigarette is not allowed."

Primary reasons as to why people chose to vape differed significantly between the different audiences. Overall, a quarter of respondents (26%) who vape do so to quit smoking. This was also the main reason why a third of adults 25 or older who vape solely choose to vape (35%). However, for youth and young adults who solely vape the main reason is pressure from their peers and social purposes (24% and 24% respectively). Effects of the product (vaping is relaxing, and reduces stress) are also big reasons why people chose to vape, more so for youth (19%) than for young adults (16%) or adults (10%).

Notable demographic differences include:

• Youth are the most likely to vape because of peer pressure ( 20%) or because it is fun (13%). While those aged 55+ are the most likely to vape in order to quit smoking ( 57%). Important to note, less than 10% of youth (9%) vape with the goal of quitting smoking.
• Women are more likely to vape with the goal of quitting smoking ( 31%) compared to men (22%), whereas men are more likely to vape because they enjoy it (11%) compared to women (3%).
• Alberta residents are the most likely to vape because they enjoy it ( 15%), while Quebec residents are most likely to vape because it is fun (12%). Respondents living in Atlantic Canada are the most likely to vape with the goal of quitting smoking ( 32%).
• Respondents with household incomes of less than $20k ( 35%) and between $20k and $40k (36%) are most likely to vape to quit smoking. Those making between $60k and $80k are most likely to vape because they enjoy it (21%).
• Respondents not in the workforce are significantly more likely to vape in order to quit smoking (43%), students are significantly more likely to vape because of peer pressure (27%), and people working full-time are most likely to vape because they enjoy it (12%).

People who vape because they enjoy it are significantly more likely to feel that vaping products containing flavour only are extremely harmful ( 25%). Further, those who vape for the taste or flavours are the most likely to feel that vaping products containing only flavours are not at all harmful (24%). Among those who vape because it is healthier than smoking the plurality (34%) feel that vaping with flavours only isa little harmful.

In terms of vaping products containing nicotine, those who vape because they enjoy it (25%) or because it is fun ( 22%) are the most likely to feel that these products are extremely harmful. Among those who vape for the taste or flavours (35%), the effects of the product (38%), or because it is healthier than smoking (42%) the plurality believe vaping with nicotine is moderately harmful.

Qualitative Insights: Reasons for Vaping

What we detected in some of the groups, particularly with dual users, was that vaping had become a secondary habit for many. While these participants admitted that they initially tried vaping out of curiosity and in the hopes of quitting smoking, they described vaping as a different experience, that they liked for different reasons. They elaborated that while it helped reduce some of the cigarettes they consumed, it did not seem to curb all of their cravings for cigarettes. In fact, some participants, in Montreal for example, described vaping and smoking cigarettes as lifestyle choices that they did not want to give up necessarily.

Throughout the groups, the flavours emerged as something that people appreciate about vaping. As well, nearly all indicated that they vape products containing nicotine, and many do so exclusively. For many of those vaping products containing nicotine, the effect of nicotine itself is something they seek. For those who smoke, the nicotine is essential, as they see this largely as an alternative delivery mechanism for their nicotine.

Some who smoke indicated having specifically sought out a particular throat feeling that they feel is a key sensation they link to smoking and tested multiple devices or settings in order to most closely replicate this feeling.

In their own words:

"The flavours? That's the beauty of it."

"It's an alternative nicotine delivery system."

"Now that I smoke less, I can run a lot farther and without coughing."

"C'est plus pratique au travail."

Respondents who do not vape with products containing nicotine do not do so primarily because of health concerns (33%), because they quit smoking/vaping (22%), or out of general lack of interest (17%). Significantly more young adults (29%) who used to solely vape, and adults (20%) who used to solely vape choose not to as they consider it an addictive product, compared to those who used to smoke (3%), or previous dual users (11%).

The majority of people who vape do so to help cope with stress or anxiety (65%), the price (64%), potential health harms (63%), or the presence of nicotine in the product (61%). Among youth, significantly more dual users vape to cope with anxiety (71%), because of the presence of nicotine (67%), potential health benefits (50%), and because the device has smart features (41%), compared to youth who solely vape (57%, 45%, 37%, and 19% respectively). In terms of adults, significantly more dual users vape for the device's smart features (37%), or to help fit in (36%), compared to adults who solely vape (26% and 23% respectively).

Most prominent reasons why people choose not to vape include the potential health harms (67%), advice from physicians or healthcare professionals (42%), or the presence of nicotine in the product (41%). Youth were more likely than the total sample to report not wanting to vape because of potential health harms (70%), which is slightly less among young adults and adults (68% and 67% respectively).

Perceived Harmfulness of Vaping

In terms of top-of-mind health concerns presently facing Canada, vaping and smoking only surfaced for 1% of respondents. The most prevalent health concerns are cancer (18%), accessibility (13%), and wait times (10%). Interestingly, youth are much more likely to offer vaping (6%) as a health concern compared to young adults (2%), or adults (1%). The three groups did not differ much in their volunteering of smoking as a health concern (2%, 2%, 1% respectively). Looking specifically at youth, dual users are significantly more likely to respond with addiction (22%) compared to people who solely smoke, solely vape, or non-users. Further, youth who solely vape are significantly more likely to offer cancer asa response (24%) compared to those who solely smoke, dual users and non-users.

When asked specifically about the health risks of vaping products relative to the amount of nicotine in the product, one in two respondents (52%) feel that the health risks are the same regardless of the level of nicotine in the product. Less than a third (31%) feel that vaping products with higher levels of nicotine have more health risks. However, when looking specifically at youth, the plurality (46%) feel that vaping products with higher levels of nicotine have more health risks and half of young adults (50%) feel the same. Whereas, over half (55%) of adults feel that nicotine levels have no effect on the amount of health risks of a vaping product. Looking at youth, those who solely vape (54%), and dual users (59%) are more likely to feel that nicotine has an effect on the level of health risks in a vaping product compared to those who solely smoke (45%) and non-users (43%). In terms of young adults, those who solely vape (62%) are more likely than dual users (52%), those who solely smoke (36%), and non-users (49%) to feel the same. This trend continues, though to a lesser degree, when looking at adults who solely vape (43%) and their counter parts (dual users, 38%; non-users, 28%; and, those who solely smoke, 22%).

Overall, respondents feel they are most knowledgeable about the health impacts of vaping products that contain nicotine (43%), slightly less so about the health impacts of vaping products that contain cannabis (36%), and least about the health impact of vaping products that contain flavours only (31%). In each instance, regardless of age, those who vape solely, or dual users are more knowledgeable (or claim to be) than those who smoke solely, when it comes to the health impacts of vaping products that contain nicotine. Of the three age categories, youth feel the most knowledgeable about the health impacts of vaping products containing nicotine (53%), containing cannabis (41%), and containing flavours only (41%).

There are a few differences between other demographic groups:

• Men are more likely than women to consider themselves knowledgeable about the health impacts of vaping products containing nicotine (44% vs. 41%), vaping products containing cannabis ( 38% vs. 33%), and vaping products containing only flavours (34% vs. 29%).
• Post-graduates are more likely than all other education categories to consider themselves knowledgeable about the health impacts of vaping products containing nicotine (53%), cannabis ( 43%), and flavours (37%).
• Students are more likely than their counterparts to consider themselves knowledgeable of the health impacts of vaping products containing nicotine (49%), cannabis (42%), or flavours only ( 39%).

In terms of harmfulness of vaping products over two-thirds (69%) of respondents feel that vaping products that contain nicotine are either extremely or very harmful. One in two (50%) feel that vaping products that contain cannabis are extremely or very harmful, and roughly a third (38%) feel that vaping products containing flavour only were either extremely or very harmful. Non-users and those who solely smoke were significantly more likely to feel that vaping products were extremely or very harmful, regardless of the contents. Over three-quarters (77%) of adult non-users feel that vaping products that contain nicotine are extremely or very harmful, compared to 64% of young adults, or 74% of youth. Further, more adults (61%) who solely smoke feel that vaping products that contain nicotine are extremely or very harmful compared to young adults (48%) who solely smoke and youth (57%) who solely smoke.

Other demographic differences include:

• Women consider vaping products containing nicotine (73%) and cannabis (53%) to be more harmful than men (64% and 47% respectively).
• Respondents aged 55+ are the most likely to find vaping products containing nicotine (76%), cannabis (58%), or flavours only (43%) to be harmful.
• Those with household incomes greater than $100k are the most likely to find vaping products containing nicotine (73%), or flavours only (41%) to be harmful.
• Respondents not in the workforce are significantly more likely to consider vaping products containing nicotine (74%), cannabis (56%), or flavours only (41%) to be harmful.

When comparing vaping products to smoking in terms of harmfulness, two in five (40%) respondents feel that vaping products containing flavours only are much less or somewhat less harmful than smoking cigarettes. Slightly fewer (30%) feel that vaping products containing cannabis are much/somewhat less harmful than smoking cigarettes, and half as many (20%) feel the same about vaping products containing nicotine. People who solely vape are roughly twice as likely (67%) to find vaping products (regardless of contents) to be harmful, compared to non-users (39%). Youth who solely vape are much more likely to find vaping products containing flavours only (73%), cannabis (51%), or nicotine (50%) to be much less or somewhat less harmful than non-users (48%, 30%, and 21% respectively). The same is true for young adults who solely vape about vaping products containing flavours only (74%), cannabis ( 57%), and nicotine (56%), compared to non-users (60%, 51%, and 33% respectively). As well as adults who vape solely in terms of vaping products containing flavours only (61%), cannabis ( 50%), and nicotine (56%), compared to non-users (36%, 26%, and 14% respectively).

There are a few differences between other demographic groups:

• Men are more likely than women to consider vaping products containing cannabis (20%) or flavours only (14%) to be more harmful than cigarettes (18% and 12% respectively).
• Those aged 55+ are most likely to find vaping products containing nicotine (22%), cannabis (23%), or flavours only (14%) more harmful than cigarettes.

Qualitative Insights: Vaping Compared to Cigarettes

For the most part, participants described vaping as less harmful than smoking cigarettes, but many - particularly those who do not smoke- clearly indicated having concerns about potential harms related to vaping. Those who smoke were more uniformly adamant that it is healthier than smoking cigarettes and some would passionately defend vaping against what they saw as inaccurate or misinformed criticisms of the harms. Nevertheless, many felt the harms are, at best, not yet fully understood and at worst, it may mean putting things in one's lungs that shouldn't be inhaled and may eventually result in serious health problems.

In their own words:

"It's gotta be better than smoking cigarettes."

"There are lots of carcinogens in cigarettes that are simply not in vaping."

"I wouldn't even compare it to cigarettes. I'd say it's just as safe as alcohol."

"It's just a new addiction."

"Initially, I thought it was fine, but now I don't feel certain."

"J'etais déçu parce que je crois que je vapote plus que je fumais avant."

When respondents were asked to think about their perception of the harmfulness of vaping products now, compared to a year ago, products containing nicotine (47%) increased the most in terms of harmfulness, while views of products containing cannabis (40%) or flavours only (39%) did not change as much. Significantly more youth non-users feel that their impression of products containing nicotine (46%), cannabis (39%), and flavours only (36%) was much/a little more harmful than it was a year ago compared to those who vape solely (45%, 30%, and 28% respectively). When looking at young adults we see a different trend, whereby those who solely smoke held significantly higher opinions in terms of change in perception of harm of products containing nicotine (58%), cannabis (49%), and flavours only (48%), compared to non-users (38%, 30%, and 31% respectively).

There are a few differences between other demographic groups:

• Respondents aged 55+ are the most likely to feel vaping products containing nicotine (52%), cannabis (46%), or flavours only (44%) to be more harmful than they did a year ago.
• Those with household incomes greater than $100k are significantly more likely than those with lower household incomes to consider vaping products containing nicotine (54%), cannabis (46%), or flavours only (48%), to be more harmful than they did a year ago.

When asked what the main reason their impression of harm associated with vaping products not containing nicotine or cannabis (containing flavours only) has changed the plurality (28%) cited media reports, while 20% have heard about people dying or getting sick from vaping, and 15% heard that vaping causes lung damage/disease. However, these results are nearly identical to the responses given for why impressions have changed of vaping products containing nicotine (media reports, 27%; people are dying/getting sick, 20%; vaping causes lung damage/disease, 10%). Which points towards the notion that respondents do not feel that nicotine has an effect on the harmfulness of vaping products.

Qualitative Insights: Information Sources About Vaping

One of the more compelling findings was the degree of influence of the unknown around vaping on participants' views, particularly among those who used to smoke in the past and those who are dual users. Those who did not see vaping as a cessation tool often pointed out the fact that little is known about the potential effects of vaping. And, views of vaping seemed to have shifted more recently as a result of the media attention around vaping in the US and what they thought was a death in Ontario, despite the fact that that was related to the vaping of cannabis. The net effect for this audience was a tendency to disassociate vaping as a cessation tool, which seemed to give participants permission to be dependent on another habit.

In terms of sources of information, very few volunteered Health Canada asa source they have relied on, but most indicated feeling information Health Canada might provide on health effects would be credible. There were some who expect that even though the information Health Canada would provide would be accurate and credible, the government may have a particular direction in which they would like behaviour to be pushed and therefore might not be as inclined to tell of benefits or reduce fears of harms associated with vaping.

When looking at addiction, responses are much more concrete. The vast majority (83%) feel vaping products containing nicotine are either very or somewhat addictive. Over two-thirds (67%) feel the same is true about vaping products containing cannabis, and slightly fewer (50%) feel the same is true about products containing flavours only. That said, more non-users feel that the level of addictiveness of vaping products was high compared to those who solely vape. Youth non-users feel that products containing nicotine (84%), cannabis (73%) and flavours only (52%) are either very or somewhat addictive, which is much higher than perceptions of those who vape solely (73%, 50%, and 25% respectively). Young adult non-users are also more likely than young adults who solely vape to find products containing nicotine (87% and 73%), cannabis (65% and 59%), and flavours only ( 48% and 33%). Finally, the same can be said for adult non-users (87%, 71%, and 54% respectively) compared to adults who vape solely (74%, 45%, and 33% respectively) about vaping products containing nicotine, cannabis, and flavours only.

Notable demographic differences include:

• Respondents aged 55+ are the most likely to find vaping products containing nicotine (86%), cannabis (72%) or flavours only (53%) to be somewhat or very addictive.
• Residents of Quebec are more likely to find vaping products containing nicotine (87%) or cannabis ( 78%) to be addictive.
• Post-graduates are the most likely to find vaping products containing nicotine (89%), cannabis (71%) or flavours only (52%) to be addictive.
• Those with household incomes of over $100k are more likely to find vaping products containing nicotine (89%), cannabis ( 71%), or flavours only (53%) to be addictive.

One in two respondents who vape (50%) feel that they are either very ora little addicted to vaping. Young adults feel they are the least addicted to vaping, with 44% saying very or a little, compared to 47% among youth and 53% among adults. There are also unique differences among dual users and people who vape solely. 42% of youth who vape solely reported feeling at least a little addicted, compared to 57% of dual users. Similarly, 37% of young adults who vape solely reported feeling at leasta little addicted to vaping compared to 53% of dual users. However, this is not the case for adults, where 59% of those who vape solely reported feeling at least a little addicted, compared to 50% of dual users.

Respondents who self-assessed themselves as very addicted to vaping are much more likely to feel that vaping products containing flavours only (28%) or containing nicotine (62%) are very addictive. Among those who consider themselves not at all addicted to vaping one in ten (9%) feel that vaping products containing flavours only are extremely addictive, this number grows to 41% when considering vaping products that containing nicotine.

Qualitative Insights: Vaping/Nicotine Addiction

Participants throughout the groups understood that nicotine is addictive and the general nature of addiction. There were many who felt that their vaping was already an addiction (due to the nicotine) and some- particularly those who only vape in social situations - who felt that they were not addicted. The participants who smoked currently or in the past tended to see vaping as a way to help meet their addictive need, but the view about their nicotine addiction tended to be noticeably more negative. Since many who smoke indicated vaping as a way to help quit or reduce their cigarette use, vaping often was compared to other nicotine replacement therapies as being among the tools available to try to deal with nicotine addiction in a healthier way, either through reducing cigarette smoking or weaning off of nicotine.

Comparing nicotine addiction to other types of addictions elicited many comments about how nicotine is a "real" addiction, unlike someone havinga chocolate "habit." These participants tended to cite the physical discomfort of withdrawal as being present with a nicotine addiction and not with an addiction to something like chocolate.

In their own words:

"I hate that nicotine has control over me."

"I only vape a few times a week at clubs or parties, so I don't think I'm addicted."

Packaging

When respondents were asked about packaging the majority reported that their device (75%) came in a box, slightly fewer (65%) reported that their liquid or pod came in a box. Results were similar regardless of age, or smoking habits (dual users compared to people who vape solely). Though important to note that in each instance roughly 1 in 10 report they do not know whether their device or liquid came in a box or not.

Packaging preferences varies by demographic group:

• Men are more likely than women to carry their vaping device ( 34% vs. 23%) in its original packaging.
• Respondents aged 25-34 are the most likely of any age category to carry their vaping device (42%) or pod/liquid ( 51%) in its original packaging.
• Alberta residents (74%) and Quebec residents ( 71%) are more likely to report that they bought/received their pod/liquid in the original box.
• Post-graduates are more likely to carry their vaping device ( 40%) or pod/liquid (45%) in its original packaging.

A little under a third (30%) of people who vape keep their device in its original packaging, whereas three in five (59%) discard the packaging it comes in. Adults who vape are more likely (34%) to keep their device in its original packaging compared to youth (24%) or young adults (18%). Respondents are more likely to keep their pod/liquid in its original packaging (39%) compared to their device (30%). As with the device, adults are more likely to keep the liquid/pod in its original package (44%) compared to youth (35%), or young adults (25%).

Respondents who vape daily are much more likely to say their vaping device (97%) or pods/liquid (80%) came in a box, compared to those who vape oncea month or less (63% and 62% respectively).

Respondents who classify vaping products containing nicotine to be a little harmful are much more likely to report their device (81%) or pods/liquid (70%) came in a box, than those who classified the products containing nicotine as not at all harmful (66% and 48% respectively).