Qualitative Research on Adult Smoking Cessation

Executive Summary

Prepared for Health Canada

Supplier name: Earnscliffe Strategy Group
Contract number: HT372-203701/001/CY
Contract value: $106,787.37 (including HST)
Award date: November 17, 2020

Delivery date: March 5, 2021

Registration number: POR 061-20
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.

Qualitative Research on Adult Smoking Cessation

Executive Summary

Prepared for Health Canada
Supplier name: Earnscliffe Strategy Group
March 2021

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 February of 2021.

Cette publication est aussi disponible en français sous le titre : Recherche qualitative sur le renoncement au tabac chez les adultes – Rapport final

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: H14-367/2021E-PDF
International Standard Book Number (ISBN): 978-0-660-39130-4

Related publications (registration number: POR 061-20)

H14-367/2021F-PDF (Final Report, French)
978-0-660-39131-1

© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2021

TABLE OF CONTENTS

• EXECUTIVE SUMMARY

EXECUTIVE SUMMARY

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of the qualitative research on adult smoking cessation communication themes and concepts.

Though tobacco use has been decreasing, it continues to be the leading preventable cause of premature death in Canada. In order to reduce the staggering death and disease burden of tobacco use, as well as reduce the costs of tobacco use towards society, Health Canada continues to work towards its commitment to reduce tobacco use to less than 5% by 2035. Looking at 2019 CCHS data from Canada, Health Canada can attribute a third of all daily smoking to adults aged 50-64; adults 35-49 are the second largest group of those who smoke daily. Thus, Health Canada sought to better understand the platforms, types of messaging, tools and resources that would help facilitate these audience’s journey to quit smoking. Findings from the research will be used to create targeted messages for this audience, as well as support a more robust understanding of how Health Canada can support smoking cessation needs for the two largest demographic segments of those who smoke in Canada.

The specific objectives of the research were to understand from those in the targeted age ranges, the types of messaging that will resonate with them. More specifically, the focus groups explored reactions towards five creative themes and two possible advertisement approaches. The contract value for this project was $106,787.37 including HST.

To meet these objectives, Earnscliffe conducted a comprehensive wave of qualitative research involving a series of sixteen (16) online focus groups between February 16^th and 22^nd, 2021. The groups were conducted with residents (both urban and rural) of eight Canadian cities: Halifax, NS; Montreal, QC (in French); Ottawa and Toronto, ON; Winnipeg, MB; Saskatoon, SK; Calgary, AB; and, Vancouver, BC. The groups were conducted with 138 adults 40-49 and 50-64 who smoke regularly; defined as daily or almost daily use. The first focus group age range was selected to begin at 40 versus 35 years old in order to group participants in more similar stage of life categories. In addition, recent public opinion research we (Earnscliffe) conducted suggests that there are few broad differences between the 40-49 and 50-64 age ranges for this target audience. More focus group sessions were conducted for the 50-64 age range to account for a greater population of smokers in this age category. The groups with residents in Montreal were conducted in French; the others were conducted in English.

Consistent with the results of our past research with these target audiences, the findings across age group and location were remarkably consistent. Except where specifically identified, the findings represent the combined results regardless of audience, location or language (English and French).

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.

Views about Smoking and Smoking Behaviours

The focus groups began with an initial warm-up discussion in which participants shared their views on smoking as well as their smoking behaviours.

• Smoking was not the same for all.
  There were several patterns of responses in terms of what smoking means to them and how they felt about smoking also varied. The most common reasons for smoking tended to revolve around: routine, addiction, a form of relaxation or stress relief, or an enabler of enjoyable moments (e.g., “me time”).
• Cessation seemed to be top of mind for most.
  Most participants have either quit smoking in the past or tried to quit smoking for one reason or another (i.e., pregnancy, sports, health, etc.). In fact, many have cessation in the backs of their minds at all times or set as a goal for the near future.
• There was no limit to tools/approaches smokers have used to quit smoking.
  Many have tried a number of different tools and resources to help quit with varying degrees of success. Some talked of having tried traditional NRT’s such as nicotine patches and gum, as well as, vaping, prescription medication, a web or mobile application, laser therapy and more therapeutic supports such as meditation and hypnotherapy.

Reactions to Communications Themes

Participants were asked to review different communications themes that could be used to encourage people to quit smoking. For each theme, two creative samples were shown to illustrate how that theme could be used in a communications campaign. The order in which the themes were presented in each group was randomized to reduce ordering effect.

While each theme generated a variety of specific reactions, there were two key overall takeaways worth noting:

• Diverse perspectives require a diversity of approaches.
  It is very common for qualitative research on advertising concepts to conclude that “there is no one-size-fits-all approach that works for everyone,” but these groups demonstrated that this may be particularly true when it comes to advertising about smoking cessation. From group to group, participants demonstrated widely varying receptivity to messaging and themes.
• Respect intelligence and choice.
  Regardless of the range of participant reactions to messaging and themes, one of the more consistent findings was the recommendation to respect the knowledge/intelligence of the target audience. Anything tested in the groups that implied the audience might still be unaware of the harms associated with smoking was usually met with negative reaction.

The following highlights the overall reaction to each of the five different themes:

THEME A: Health Consequences

• Mixed reactions, but aspirational messages have potential.
  This theme met with generally mixed reactions. Those who liked it offered that it was refreshing to hear positive messages about the health benefits associated with smoking cessation to the frightening, negative messages to which they have become accustomed (and overlook). However, discussions about this theme highlighted the need to focus strictly on the positive as participants pointed out that even while most of the content might be positive, a headline or image that references – or is even assumed to reference – a negative health effect of smoking, can erode the overall effectiveness of the approach.

THEME B: Tools and supports are effective

• Broad receptivity, helpful information.
  This theme was well received by virtually all participants. The discussions suggested that this theme meets some of them where they are in terms of smoking cessation – most are interested in quitting and looking for support. This theme was offering hope and options that someone interested in quitting smoking could try.

THEME C: Hard hitting factual health consequences

• Mixed and resisted by many.
  The hard hitting theme was the one participants were most inclined to criticize for its relentless negativity, its discomforting effect, and for overexposure. While some suggested that the jarring images was an immediate trigger to contemplate quitting; many felt this approach was overdone and claimed to be completely immune to it.

THEME D: Testimonials

• Potentially powerful when relevant and seen as authentic.
  While most felt the testimonial theme was one they had seen executed many times, it seemed to be quite powerful, memorable and able to connect with viewers on an emotional level. However, as with the hard hitting theme, cynicism over authenticity, repetitiveness and overexposure were often cited as reasons this theme has little effect on some participants now; particularly testimonials highlighting the negative aspects (and health consequences) of smoking. Indeed, most tended to react more favourably to the testimonial about the positive outcomes (health benefits) of quitting smoking; participants felt this would be welcome, encouraging and different from traditional communications approaches.

THEME E: Engagement

• Narrow appeal.
  The reactions to the engagement theme tended to depend upon the participants’ social media habits. Those who describe themselves as light users of social media felt there was little chance they would see something like this, let alone respond to the call to action in any way. Among more regular users of social media, there were a few whose immediate reaction was positive particularly in the sense of rallying support and shared experience. However, many participants were reticent and uncomfortable (due to stigma) to engage in a public forum that would draw attention to the fact they smoke; and, also the potential to fail in a public way.

Reactions to Creative Concepts

Participants were asked to review two draft creative concepts in storyboard format that are currently in development. Again, the order in which the concepts were presented in each group was rotated to reduce ordering effect. As these creative concepts were not the primary objective of the focus groups, the depth of discussions of each differed across each group dependent on the remaining time in each group.

• It’s Never Too Late was well received. Participants really liked the positive tone and message of encouragement that this concept implied. They also appreciated the bright colours, the interesting/appealing activities, and the fact the people in the ads were people like them (i.e., similar age). It was applauded for managing to convey a smoking cessation message without the irritating and constant finger-wagging about their tobacco use. Several pointed out that this helps them by recommending constructive and realistic activities to replace their smoking, with some saying, “I can do these things.”
• The Smoke from Cigarettes was underwhelming. Participants typically offered negative comments or indicated disinterest. They were less able to identify with this concept, felt it was neither very memorable nor attention grabbing, and unlike the hard hitting theme, it failed to shock. A few participants commented that the bright visuals at the end of the ad seemed incongruous with the rest of the concept although some appreciated that it ended on a positive note.

Research Firm:

Earnscliffe Strategy Group Inc. (Earnscliffe)
Contract Number: HT372-203701/001/CY
Contract award date: November 17, 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: March 5, 2021

Stephanie Constable
Principal, Earnscliffe