Youth and Young Adult Vaping Cessation Research

Executive Summary

Prepared for Health Canada

Supplier name: Earnscliffe Strategy Group

Contract number: HT372-202821/001/CY

Contract value: $124,963.64 (including HST)

Award date: July 29, 2020

Delivery date: December 7, 2020

Registration number: POR 020-20

Health Canada Project Number: POR 20-07

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.

Youth and Young Adult Vaping Cessation Research

Executive Summary

Prepared for Health Canada

Supplier name: Earnscliffe Strategy Group

December 2020

This public opinion research report presents the results of focus groups conducted by Earnscliffe Strategy Group on behalf of the Department of Health Canada. The qualitative research was conducted in November of 2020.

Cette publication est aussi disponible en français sous le titre : Recherche sur l'abandon du vapotage chez les jeunes et les jeunes adultes.

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

Catalogue Number: H14-359/2021E-PDF

International Standard Book Number (ISBN): 978-0-660-38273-9

Related publications (registration number: POR 020-20)

H14-359/2021F-PDF (Final Report, French)

978-0-660-38274-6

Executive summary

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of the qualitative research into vaping cessation among youth and young adults.

Recent data gathered by the Government of Canada has shown a substantial increase in the prevalence of vaping. The increase captured in the 2019 Canadian Tobacco and Nicotine Survey (CTNS) appears to be driven primarily by youth and young adult uptake. Through further research, the Government of Canada discovered that 60% of vapers would like to quit at some point, including 35% who reported wanting to quit within the next year. In terms of youth, cessation seems to be less of a priority; barriers as to why include withdrawal effects and peer pressure. Thus, while there is previous research examining vaping behaviour among Canadians, Health Canada would like to explore more deeply the motives youth and young adults hold towards trying to quit vaping. This research also aimed to help Health Canada understand the needs and support youth and young adults require with respect to vaping cessation. The research findings will be used to renew and update public awareness and commnunications materials developed for smoking cessation targeted at youth aged 12-18 to include vaping cessation content. Further, the research findings will be used to ensure youth and young adults have the best tools and resources at their disposal to quit vaping.

The specific objectives of the research were to understand what motivates youth and young adults to quit vaping, as well as determine which tools and resources are most useful to help youth and young adults quit vaping. The contract value for this project was $124,963.64 including HST.

To meet these objectives, Earnscliffe conducted a comprehensive wave of qualitative research involving a series of fourteen (14) online focus groups between November 17^th and 23^rd, 2020. The groups were conducted with residents of seven Canadian cities: St. John’s, NF; Moncton, NB; Montreal, QC; Toronto, ON; Regina, SK; Calgary, AB; and, Vancouver, BC. The groups were conducted with youth aged 15-19 and young adults aged 20-24. The groups with residents in Montreal and Moncton were conducted in French; the 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.

Overall Findings

The thrust of the findings across age and language were very consistent. Unless otherwise noted, findings in this report are common across all audiences and languages; only noteworthy differences are mentioned.

Current vaping habits varied although the majority of participants vaped daily, every other day or casually on weekends with friends in social settings.
While there was some variance in terms of motivation for vaping, the influence of peers and the predominance of vaping in social settings was significant. Participants indicated they vaped because it was: fun/enjoyable (including the appeal of the flavours); calming/stress relief; helped with focus; acceptable alternative to smoking cigarettes/help cut down on cigarette smoking; and, convenient (as you can do it anywhere, including indoors).
The downsides associated with vaping tended to revolve around: negative health effects (nausea for a few, sore throat and breathing challenges for some – particularly noticeable during exercise or sports, sore stomach and loss of appetite); cost; addiction; and, inconvenience (i.e., leaky devices, coil replacement, etc.).
When asked if they had ever tried to quit or reduce how often/much they vaped, several in each of the youth (15-19) groups and half or more young adults (20-24) raised their hands. It seemed that many did not perceive a need to reduce or quit, arguing that they were not vaping frequently enough, or that they were less susceptible to health problems given their age. But more important was the sense many participants had that it would be fairly easy to quit (easier to quit than smoking cigarettes); although more young adults (20-24) and/or those who vape more frequently, were a little more doubtful. More youth (15-19) and/or those who vape less frequently, felt that they could easily stop if they wanted to.
The reasons for trying to reduce how often/much they vaped or quit altogether were mixed including a desire to reduce expenses; feel better (especially those involved in sport); and, a desire to limit addiction.
The most common approach to quitting was ‘cold turkey’ with some indicating they had deliberately thrown away or hid their devices. Others spoke of purchasing replacement pods or juice less frequently or switching to disposable vapes.
The majority, especially young adults (20-24), can envision a future when they no longer vape. This was often attributed to a desire to reverse one or more of the specified downsides but also quite a few participants flagged the point in time when they want to start a family (or being pregnant) as a logical reason to quit.
Most felt capable of quitting on their own, although some suggested they may go to friends or family members for advice and/or support. While both audiences would go to friends before family, if anyone was to go to family first, more often than not it was young adults. Few, if any, volunteered relying on other sources such as quit lines, online counseling, mobile applications, etc.

Reactions to Cessation and Campaign Materials

Please refer to the Appendix for all of the tested campaign materials.

Reasons to quit smoking or vaping (Annex A & B)

When provided with a list of reasons to stop smoking or vaping, participants agreed that the reasons were clear and easy to understand and there was at least one reason that participants could relate to.
However, in terms of the presentation, some felt that if they had read the combined list, “Reasons to quit smoking and vaping” (Annex A), their assumption would be that it was aimed at people who smoke cigarettes and not at those who vape as many of the reasons (e.g., unpleasant odour) did not seem to apply to them. Most indicated they would prefer to have the reasons presented separately for each (Annex B).
When asked if there was anything missing, participants felt that the reasons provided were heavily focused on social aspects and neglected to portray the (objectively more important) health reasons to quit vaping.

How will you quit smoking or vaping (Annex C)

Reactions to the graphic, “How will you quit smoking or vaping?” (Annex C), were mixed. Some thought it was fun and liked following along to see where they would end up. Others felt it was busy and slightly confusing. However, the idea of customized plans based on your own circumstances was generally appealing.
All tended to like that there was a range of plans and it is worth noting that the plans presented were generally in line with the approaches used by those who had tried to reduce or quit before or would consider if they were interested in reducing/quitting.
Many volunteered that they would have liked more information about each approach although these concerns were assuaged when participants were provided with more detailed information for Plan #1 “Quit with a Friend’s Help” (Annex D) and Plan #2 “Cut Back First; Then Quit” (Annex E).
Unlike “Reasons to quit smoking and vaping” (Annex A), participants preferred to have one graphic (flow chart) for smoking and vaping as opposed to separate graphics because the paths were virtually the same.

Plan #1 Quit With a Friend’s Help (Annex D)

While not everyone agreed that this approach could work for them, most felt this level of detail was a step in the right direction.
Some called for more tips/ideas on how a friend might be able to distract someone who vaped from vaping. There was also some uncertainty and discomfort with the responsibility this approach places on others for their success. There was much discussion about what kind of friend this would require, including whether it would be a benefit or a drawback if the friend does not vape (or was not also contemplating quitting). Some felt this responsibility might be better placed on a group or counselor.
With regards to the tone and language used, participants in both the youth and young adults groups felt that it was a little too childish and that the Government of Canada was trying too hard to sound cool (e.g., cigs, high-fives). Participants suggested a more serious, not pointed or accusatory, tone and language.

Plan #2 Cut Back First; Then Quit (Annex E)

There was fairly widespread appreciation for this approach and the content. It was felt to be helpful, realistic and several participants volunteered it was the kind of thing they might try.
Some suggestions for improvement included different ways of measuring diminished use (i.e., counting the frequency of replacement pods/coils purchased) rather than every single puff or ‘session’ which seemed unrealistic to log. Some also indicated they would have preferred a little more prescription of concrete goals rather than the use of arbitrary terms such as ‘fewer’ and ‘even fewer’.

Tracking Card (Annex F)

Even among the few skeptical of using this approach themselves, reactions to the idea of logging and tracking behaviour made sense and the overwhelming majority felt this could be a useful tool.
A few pointed out that they found tracking “mood” intriguing, which for those who had tried to reduce or quit, was in line with their own experience. In addition to the suggestions mentioned above, some also suggested tracking the dollar amount spent which they argued would provide perspective on how much one could be saving.
In terms of format, most seemed to prefer a mobile application for tracking. They felt it would be easier to use, readily accessible, and possibly more discreet. A handful of participants (across all of the groups) felt it would be handy to have a paper tracking card as well as they felt it held them more accountable.

Program Title (Annex G)

Reactions to the two program titles, “Quit4Life (Vie100fumer/vapoter)” or “Quit4You (Mavie100fumer/vapoter)”, were generally lukewarm. Both youth and young adults, English and French speakers, described the use of the number 4 or 100 as “cheesy” and “gimmicky”. In French, some participants were confused by use of the number 100 and its relevance to the program.
Regardlesss of audience or language, in terms of the meaning of each title, there was some appreciation for the notion of “for life” because of the permanence it expressed; and, perhaps equal appreciation for the notion of “for you” because of the more personal sentiment and importance this placed on the person looking to quit.

Messages (Annex H)

Participants were presented with two series of messages that could be used in future vaping campaign materials. The first series related to cessation; the second to addiction.

In terms of the language used, all of the messages were clear and easy to understand for both English and French audiences.
In terms of the different communications approaches used, participants tended to both like and dislike all of the messages, which suggests that using different approaches may be effective to reach a broader audience.
Overall, both youth and young adults tended to prefer (and react more favourably) to the messages related to cessation (in both English and French). In fact, when asked to select a message that would most motivate them to do something, most tended to select a message from this series of messages.
The message, “Take charge of your future. Leave the vape behind.” was by far the most widely appreciated. Participants liked that it was brief, to-the-point, and empowering while managing to be an imperative statement that didn’t feel as bossy as some others.
Participants also reacted favourably to the message, “Are you worried about lung health? Make now the time to quit vaping.” as it focused on an important health risk related to vaping.
The message, “Challenge yourself to be vape-free for a day/week.” was often criticized but only for the fact that it seemed a rather easy goal. Changed to a month or simply, “Challenge yourself to be vape-free.” and views were more favourable.
The approach of messages like “What are you missing out on because you ‘need’ to vape?” “Why headrush into a nicotine addiction?”, and “Why risk nicotine addiction? The buzz isn’t worth it.” were somewhat off-putting for some participants. For some it harkened back to their view that the Government was trying too hard, while others felt the tone was somewhat belittling. At the same time, some appreciated some of these sentiments.

Research Firm:

Earnscliffe Strategy Group Inc. (Earnscliffe)

Contract Number: HT372-202821/001/CY

Contract award date: July 29, 2020

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: December 7, 2020

Stephanie Constable, Principal, Earnscliffe