Smoking Lived Experience Study

Executive Summary

Prepared for Health Canada

Supplier name: Earnscliffe Strategy Group

Contract number: HT372-204272/001/CY

Contract value: $227,293.62 (including HST)

Award date: January 19, 2021

Delivery date: April 19, 2021

Registration number: POR 103-20

For more information on this report, please contact Health Canada at:

hc.cpab.por-rop.dgcap.sc@canada.ca

Ce résumé du rapport est aussi disponible en français.

Smoking Lived Experience Study

Executive Summary

Prepared for Health Canada

Supplier name: Earnscliffe Strategy Group

April 2021

This public opinion research executive summary presents the results of ethnographic diaries and in-depth interviews conducted by Earnscliffe Strategy Group on behalf of the Department of Health Canada. The research was conducted from February to March of 2021.

Cette publication est aussi disponible en français sous le titre : Étude sur l'expérience vécue en matière de tabagisme

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 executive summary, please contact Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca

Catalogue Number: H14-368/2021E-PDF

International Standard Book Number (ISBN): 978-0-660-39313-1

Related publications (registration number: POR 103-20)

Étude sur l'expérience vécue en matière de tabagisme Rapport final (Final Report, French)

ISBN 978-0-660-39314-8

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

EXECUTIVE SUMMARY

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of the ethnographic and qualitative research exploring the lived experience of someone who smokes.

Health Canada sought to conduct this research as it continues to work towards the ambitious goal set out by Canada's Tobacco Strategy of lowering tobacco use among Canadians to 5% by the year 2035. Past research indicates that half of current smokers have made an attempt to quit in the past 12 months however this number decreases with age. There is significantly less research that has been conducted on real-time smoking behaviours. Therefore, in order to prevent the initiation of tobacco use, as well as support users in their cessation efforts to quit tobacco long-term, Health Canada contracted Earnscliffe to utilize a 'lived experience' approach. The specific objectives of the research were to gather information about smoking behaviours and feelings in real-time, with the overall goal of learning more about situations smokers typically find themselves in when smoking. Findings from the research will be used to help Health Canada develop new lines of messaging that focus on the experience of smoking. In addition, findings will also be used to provide program strategy and communications with a more fulsome understanding of smokers' patterns of behaviour to better meet their needs when they are ready to quit. The contract value for this project was $227,293.62 including HST.

To meet these objectives, Earnscliffe conducted a comprehensive two-phased research project. Phase 1 involved an ethnographic approach in order to understand participants' daily activities/lives. Participants were asked to journal about their daily lives on a daily basis for three weeks. While they were not provided with specific guidance to journal about their tobacco use, participants were aware of the focus of the study on smoking. Over the course of the engagement, participants were also asked to complete an initial introductory 'Getting to know you' activity and a 'Final thoughts' activity in addition to individual facilitator probing and discussion topics. This phase was comprised of a three-week diary exercise involving 110 participants across Canada. The diary exercise was conducted between February 19^th and March 12^th, 2021. Of the 110 participants, 21 participated in French and 89 participated in English. Participants were those who smoke daily with good representation across key demographics.

Following the initial diary exercise, we conducted a second wave of qualitative research, involving in-depth interviews with a select group of fifty (50) participants from the initial diary exercise. Participants were selected based on the thought and effort devoted to their diary reflections. Special attention was paid to ensure good representation of key demographics. The interviews were conducted by telephone between March 10^th and March 23^rd, 2021. Ten interviews were conducted in French, while the rest were conducted in English. The interviews were on average 30 minutes in length.

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 takeaways can be summarized as follows:

• Overall participation in the engagement was exemplary. Diary reflections were consistently detailed, thoughtful, personal, and sincere. Many participants were pleasantly surprised about how much they enjoyed maintaining a daily journal. In fact, maintaining a daily journal was a practice that several participants envisioned maintaining going forward.
  • When probed in the interviews whether maintaining a journal as part of a quit attempt would be a helpful exercise, several participants felt that it would, especially as a means to understand their tobacco use.
• Of the thousands of sentiments (thoughts, moods, feelings, etc.) expressed across all of the diary reflections, about half were expressions of a neutral (neither positive nor negative) feeling. Among the other half, positive feelings were expressed more than twice as often as negative feelings. And, while very few of the specific sentiments included variations of the words smoke or cigarette, when the terms came up, it was more often the case that the sentiment being expressed was positive in nature, rather than negative.
• Given this, it is perhaps not surprising to see that at a high level, participants tended to recount how they were feeling, as well as what they were doing and with whom over the course of their days.
• Having said that, almost all mentioned smoking at least once in their diary reflections; many mentioned it in at least half. A few participants did not mention smoking in any of their diary reflections.
• Participants expressed varying degrees of guilt and shame about their tobacco use in different ways over the course of the engagement. For most, smoking was not something they were particularly proud of or broadcast. In fact, but for a few participants who have no desire to quit, quitting smoking was raised in at least one diary reflection for the majority of participants.
• These mixed emotions and feelings related to their smoking behaviour perhaps explain why it did not figure prominently in ways one might have expected. For example, it did not figure prominently in reflections about what health (generally) and feeling good or great meant to them; what they would tell their five-year old self; or, where they go from here (after the diary exercise). It did, however, figure prominently in reflections about what three things they could give up that would give them more time, energy and peace.
• Observations of the diary reflections suggested that there were four primary roles of smoking as part of the lived experience of those who smoke daily: routine, coping mechanism (stress relief), reward and pleasure.
• The key themes that emerged related to smoking (some of which fall under the roles of smoking) included: the COVID-19 pandemic; a desire to quit or reduce smoking; stigma; and, use of other substances (alcohol or cannabis).
• Perhaps not surprising, the pandemic seemed to have had a profound impact on participants' lives. While there have been some positive impacts, most seemed to have been impacted adversely.
  • o Upon further probing in the interviews, many participants indicated that dealing with the pandemic had resulted in increased tobacco use which was mainly attributed to increased stress/anxiety, boredom and/or increased opportunity to smoke.
• A desire to quit or reduce smoking was a theme that was raised in at least one diary reflection for the majority of participants. It was reflected in a variety of different ways: desire/intentions to quit; past quit attempts (both successful and unsuccessful); efforts to reduce the number of cigarettes they smoke; resisting the urge to smoke cigarettes; and, conversely, a cohort who has no intention to ever quit smoking.
• While not one of the more common themes observed in the reflections, stigma did come up in a number of ways. Participants mentioned hiding their tobacco use from certain family members (i.e., parents, spouses/partners, and especially children) and choosing when and where they smoke in public spaces which speaks to the guilt and shame they feel about their tobacco use.
  • Probing in the interviews revealed that those who did hide their tobacco use seemed to do so for a few reasons: so as not to set a bad example, especially for children; so that their personal brand/image was not defined by their tobacco use; and, to avoid receiving stigmatizing comments that were either judgemental or guilt-inducing.
• With respect to the correlation between smoking and the use of other substances, there definitely appeared to be a much stronger correlation between smoking and alcohol consumption than there was between smoking and cannabis consumption.
  • In the interviews, those who drink alcohol tended to describe smoking and drinking as behaviours that go together and a noticeable increase in cigarette smoking while drinking. The opposite was true for those who consume cannabis in that they felt they smoked less (and fewer cigarettes) when consuming cannabis.

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: April 19, 2021

Stephanie Constable

Principal, Earnscliffe