Qualitative Testing of Health Messages for Tobacco Promotions

Health Canada

Executive Summary

July 2023

Prepared for:
Health Canada
Supplier name: Quorus Consulting Group Inc.
Contract award date: January 6, 2023
Delivery date: July 2023
Contract amount (incl. HST): $89,925.40
Contract #: CW2267531
POR number: 089-22

For more information, please contact:
cpab_por-rop_dgcap@hc-sc.gc.ca
Ce rapport est aussi disponible en français.

Qualitative Testing of Health Messages for Tobacco Promotions
Executive Summary
Prepared for Health Canada
Supplier name: Quorus Consulting Group Inc.
July 2023

This public opinion research report is based on 15 online focus groups that Quorus completed between April 24 and May 4, 2023. Sessions were held with individuals who smoke aged 18 to 24 and 25 or older and individuals who do not smoke and who are at least 18 years of age. Focus groups spanned the country and lasted approximately 90 minutes. All participants were informed the research was for the Government of Canada. A total of 96 individuals participated in this study.

Cette publication est aussi disponible en français sous le titre : Test qualitatif des messages liés à la santé sur les promotions du tabac

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: cpab_por-rop_dgcap@hc-sc.gc.ca

Department of Health
200 Eglantine Driveway
A.L. 1915C
Ottawa, Ontario
K1A 0K9

Catalogue Number:
H14-451/2023E-PDF

International Standard Book Number (ISBN):
ISBN 978-0-660-67767-5

Related publications (registration number: POR 089-22):
Catalogue Number H14-451/2023F-PDF (Final Report, French)
ISBN 978-0-660-67768-2

© His Majesty the King in Right of Canada, as represented by the Minister of Health, 2023

Political Neutrality Statement

I hereby certify as Senior Officer of Quorus Consulting Group Inc. that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Policy on Communications and Federal Identity and the Directive on the Management of Communications - Appendix C.

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:

May 29, 2023
Rick Nadeau, President
Quorus Consulting Group Inc.

Executive summary

Background and research objectives

Tobacco use continues to be the leading preventable cause of illness and premature death in Canada. While tobacco use has decreased, a significant number of Canadians still use tobacco. Approximately 48,000 Canadians die each year from tobacco use. The health and economic costs associated with tobacco use in Canada were estimated at $12.3 billion in 2017, with direct health care costs of $6.1 billion.

Under the Tobacco and Vaping Products Act (TVPA), tobacco promotion is restricted, but not prohibited. Some tobacco companies voluntarily apply health-related messages, but are not required to do so. Since 2020, a health warning must be conveyed on vaping product advertisements under the TVPA’s Vaping Products Promotion Regulations.

Canada is a Party to the World Health Organization Framework Convention on Tobacco Control (FCTC), an international treaty that addresses a wide range of tobacco issues. Canada is not yet fully compliant with its obligations relating to tobacco advertising, promotion and sponsorship, as it does not “require that health or other appropriate warnings or messages accompany all tobacco advertising and, as appropriate, promotion and sponsorship”, contrary to Article 13, paragraph 4, of the FCTC.

To inform future direction, Health Canada was interested in exploring the following elements for health-related messages that could appear on tobacco promotions:

• Message Size (percentage of the total surface area of the advertisement and promotion)
• Message Placement (location of the health message on the advertisement and promotion)
• Typography of Message (typeface and point sizes)
• Message Colours
• Message Content

Research objectives

The objective of the research was to gather feedback on a variety of draft health-related messages that could appear on tobacco promotions.

Specifically, to explore reactions to, and further the understanding of the impact of 6 draft health-related messages to determine if the concepts are:

• noticeable;
• credible and relevant for the target audiences;
• in plain language and understood (in the intended way) by the target audiences;
• culturally appropriate for the target audiences;
• effective at informing and educating Canadians about the health hazards and health effects of tobacco use; and
• memorable.

The research also gathered feedback assessing the impact of size and placement of the health-related messages on tobacco promotions.

Methodology

The research methodology consisted of 15 online focus groups with people who smoke as well as those who do not smoke in Canada. The focus groups were held between April 24 and May 4, 2023, and included individuals from across the country. Focus groups were segmented by age group and smoking status: young adults who smoke (aged 18-24), adults who smoke (aged 25 and older), and adult who do not smoke (aged 18 and older). Each focus group session lasted approximately 90 minutes. Participants were informed upfront that the research was being conducted on behalf of Health Canada and they each received an honorarium of $125 for their participation. In total, 96 individuals participated in the research.

Qualitative research results

Tobacco promotions – general discussion

At the beginning of each session, participants were asked if they had any personal experience where they recalled seeing promotions for tobacco products in the recent past. Overall, very few participants recalled seeing any sort of advertising for a tobacco product over the past few years. Among the very few who did recall seeing advertisements for tobacco products, they included the following:

• Advertising for “natural tobacco” on public transportation in the Vancouver area
• Online advertising for “knock off versions” of name brand cigarettes
• Online advertising for cigarette products available from Indigenous reserves

These advertisements were described by participants as ordinary, featuring mostly an image of the product. As well, they did not seem to recall seeing a health message or warning on the advertisement.

Health Warning/ Message Concepts

Participants were presented with six draft concepts developed by Health Canada. The draft concepts can be found in the detailed results section of the full report.

Each concept was presented and discussed individually. The order in which the concepts were shown changed from one session to the next.

Feedback and reactions were very consistent across regions and across the three target segments. The key strengths and weaknesses of each concept are presented below.

Concept 1 – Wondering about vaping?

Key strengths:

• The yellow background was eye-catching
• Effective formatting and visibility of “Wondering about vaping?”
• Considered relevant among a few participants who had used vaping to help them reduce their use of tobacco

Key weaknesses:

• The concept was considered to contain too much text
• The message lacked credibility – many participants believed that there wasn’t enough research on the health effects of vaping to make any conclusions, and few seemed to believe that vaping is genuinely less harmful than smoking cigarettes
• The message seemed contradictory – on the one hand the message encourages vaping while on the other it discourages vaping
• Too many font variations were used
• The concept was perceived to be lacking an effective image, or that the image used (a large white question mark) is weak

Concept 2 – Impotence

Key strengths:

• Effective at capturing attention, the image was particularly effective at drawing attention
• Effective use of colour, including an impactful use of “Warning”
• Short text with a simple message was seen as effective
• The message was considered informative for some
• The concept was considered humourous by many. The approach was considered to be refreshing coming from a Government department and for a tobacco health warning

Key weaknesses:

• The concept has a narrow target audience – the concept only focuses on men’s health
• The concept lacked some credibility among men who have not experienced what the message conveys
• Some participants felt the humourous approach to relay a serious message weakens the overall intent of the message
• A few participants felt there are probably more serious health impacts related to tobacco use that should be prioritized

Concept 3 – Quitting can help you get closer.

Key strengths:

• Participants appreciated an approach that uses positive reinforcement in an effort to reduce tobacco use
• Participants liked the approach as a reminder of how using tobacco can also impact the health of others. This connected with people who smoke, in particular with older participants

Key weaknesses:

• The visual appeal was considered moderate to weak overall
• Many participants did not understand or were not clear what the tag line “Quitting can help you get closer meant.
• Many did not understand the connection between the two sentences in the message. Most recommended removing the tagline “Quitting can help you get closer” entirely.
• The image was not well received – some felt using an image of an adult/ grandparent playing in the park with their child/grandchild would be more appropriate.
• Some participants who smoke did not believe that smoking hindered their ability to get close with others.

Concept 4 – Protect your baby

Key strengths:

• Effective use of image and colour to draw attention
• Strong layout and formatting of text which consisted of a short, impactful title, followed by a short and simple health-related message accompanied by a clear and an image that generated an emotional response
• Considered the best formatting approach for the contact / quit line information
• Resonated with participants even if they are not pregnant

Key weaknesses:

• A few felt it was focused on a very narrow target audience: pregnant women
• Seemed by some to be communicating information that should be well known
• Some confusion around whether the message also applied to health effects related to second-hand smoke exposure. Making this clear could make the concept more impactful since it broadens overall relevance.

Concept 5 – Difficulty concentrating?

Key strengths:

• Message on mental health was seen by many to be very relevant
• The message about impact of smoking on concentration was considered new information for some participants

Key weaknesses:

• Not effective from a visual standpoint, including a poor image selection
• The concept was not perceived to be effective at appearing as a warning
• The concept was considered to be more like an ad completely unrelated to harms related to smoking cigarettes (for instance, a tutoring service)
• The concept was not considered believable by most participants who smoke – in their opinion, smoking actually helps them concentrate
• The link to concentration was not seen as a sufficiently serious subject to be part of a health warning related to tobacco use

Concept 6 – Cigarettes aren’t attractive as you think

Key strengths:

• Very effective at capturing attention
• Many participants were immediately drawn to the image, especially the mouth
• The approach to use a “checklist” was seen as effective

Key weaknesses:

• Image was perceived as fake or exaggerated by several participants, which weakened the credibility of the message
• The second sentence was considered unnecessary
• Few seemed to believe that there are people who consider cigarettes “attractive”, which weakens the impact of the first sentence
• Many participants who smoke and some who do not smoke felt they recognized this concept and felt that something new would be needed to get their attention or have a meaningful impact
• Some felt the message should refer to more serious health impacts of tobacco use

At the end of review of concepts, participants were asked which concepts were most effective at drawing their attention and effective at informing them of the health impacts of tobacco use. Participants almost always selected concepts 2, 4 and 6 as the ones that were the most effective at drawing their attention away from the tobacco ad and as the ones that had the most impact on them.

The quit line information included on each of the concepts was noticed by most participants. While few would see themselves calling the quit line or accessing the cessation web site, most felt the information was important to include. The approach could be further improved by adding a QR code.

Almost all participants felt that including an image in the concept was an important factor in its effectiveness at catching their attention and making them want to read the content of a health warning.

Health Warning / Message Size

Participants were quickly shown three versions of the same concept one at a time, with the size of the health warning/message increasing each time. The sizes of health warning/messages took up 30%, 35%, and 40% of the space of the advertisement. The presentation of the three approaches was always the same, starting with the smallest footprint and ending with the largest of the three. These mock-ups can be found in the detailed results section of the full report.

Many did not feel that the health warning/message with the larger size have a significant impact on the noticeability or ease of reading of the concept. However, if they were to choose, the largest health warning/message approach was considered by most to be the most noticeable and the easiest to read.

Health Warning / Message Placement

Participants were quickly shown two versions of a concept one at a time, each with a different placement of the health warning/message. One with the health warning displayed at the top of the advertisement and another with the health warning displayed within and at the right side of the advertisement. The order of presentation of the two approaches alternated from session to session. These mock-ups can be found in the detailed results section of the full report.

Reactions to the two approaches were mixed with most gravitating to the approach with the health warning/message displayed at the top of the advertisement as the more effective approach. Those who preferred this approach felt it looked more like a “warning” and, because they are naturally inclined to read from top-to-bottom, this approach had them notice the warning before the tobacco advertisement portion. They also felt that the approach with the health warning/message imbedded within the advertisement seemed to make it look like the tobacco warning was a sticker or an afterthought whereas the vertical approach clearly shows the warning as a separate and distinct element at the top.

Those who preferred the health warning/message imbedded within the advertisement felt like that the warning appeared larger in that format and made it both more noticeable and easier to read. They also liked that the warning appears to overtake the visual elements of the tobacco advertisement.

Qualitative research disclaimer

Qualitative research seeks to develop insight and direction rather than quantitatively projectable measures. The purpose is not to generate “statistics” but to hear the full range of opinions on a topic, understand the language participants use, gauge degrees of passion and engagement and to leverage the power of the group to inspire ideas. Participants are encouraged to voice their opinions, irrespective of whether or not that view is shared by others.

Due to the sample size, the special recruitment methods used, and the study objectives themselves, it is clearly understood that the work under discussion is exploratory in nature. The findings are not, nor were they intended to be, projectable to a larger population.

Specifically, it is inappropriate to suggest or to infer that few (or many) real world users would behave in one way simply because few (or many) participants behaved in this way during the sessions. This kind of projection is strictly the prerogative of quantitative research.

Supplier name: Quorus Consulting Group Inc.
Contract number: CW2267531
Contract award date: January 6, 2023
Contract amount (including HST): $89,925.40
For more information, please contact Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca