Study on Smoking Cessation Strategies Among Canadian Adults who Smoke

Health Canada

Final Report

July 2023

Prepared for: Health Canada

Supplier name: Quorus Consulting Group Inc.
Contract award date: January 20, 2023
Delivery date: July 2023
Contract amount (incl. HST): $186,404.80
Contract #: CW2269609
POR number: 119-22

For more information, please contact: hc.cpab.por-rop.dgcap.sc@canada.ca

Ce rapport est aussi disponible en français.

Study on Smoking Cessation Strategies Among Canadians who Smoke

Final Report

Prepared for Health Canada
Supplier name: Quorus Consulting Group Inc.
July 2023

This public opinion research report presents the results of quantitative and qualitative research conducted by Quorus Consulting Group Inc. on behalf of Health Canada in April 2023. The qualitative portion consisted of 19 online focus groups with individuals aged 25 and older who smoke. Focus groups were conducted with participants from Eastern Canada, Western Canada and Quebec. The sessions were completed between April 5 and April 25, 2023. A total of 113 individuals participated in the focus groups. The quantitative portion of the study consisted of a national online survey of 2,548 respondents aged 25 or older in Canada who smoke. Survey data were collected from April 12 to April 28, 2023.

Cette publication est aussi disponible en français sous le titre : Étude sur les stratégies de renoncement au tabac chez les fumeurs d’âge adulte

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

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

Catalogue Number:
H14-450/2023E-PDF

International Standard Book Number (ISBN):
ISBN 978-0-660-67765-1

Related publications (registration number: POR 119-22):
Catalogue Number H14-450/2023F-PDF (Final Report, French)
ISBN 978-0-660-67766-8

^© 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:

June 15, 2023
Rick Nadeau, President
Quorus Consulting Group Inc.

Table of Contents

• Executive Summary
  • Qualitative research results
  • Quantitative research results
• Detailed Results
  • Research purpose and objectives
    • Qualitative research results
      • Journey to their current smoking experience
      • Confidence in and importance of quitting smoking
      • High and low prevalence discussion
      • Selecting a cessation method
    • Quantitative research results
      • Quality of life
      • Smoking use and history
      • Cessation - general awareness and opinions
      • Cessation history
      • Cessation strategies
      • Cessation plans
      • Risk perception and gaps in knowledge
      • Other substance use
      • Disposal
  • Methodology
    • Target audience and sample frame
    • Description of data collection procedures
• Appendices
  • Appendix A: Recruitment Screener
  • Appendix B: Moderation Guide
  • Appendix C: Online Survey Questionnaire
  • Appendix D: Nicotine dependence index calculation

Executive summary

Background and research objectives

Canada's Tobacco Strategy has set an ambitious goal of lowering tobacco use among Canadians to less than 5% by the year 2035. To realize this objective, Health Canada needs to prevent initiation of tobacco use as well as support cessation efforts to quit tobacco long-term.

According to the 2020 Canadian Community Health Survey, 13% of Canadians 15 years and older currently smoke. The majority of those who currently smoke have attempted to quit smoking in the past 12 months (58%) and/or are seriously considering quitting smoking within the next 6 months (63%). Adults (25 years of age and older) have a higher prevalence of current smoking (14%) than youth 15-19 (6%) but fewer report attempting to quit within the past year (60%) compared to youth 15-19 (84%) and young adults 20-24 (70%) who smoke. Additionally, some demographic groups have higher prevalence rates (e.g., 16% of men vs. 11% of women, 21% of those diagnosed with a mood and/or anxiety disorder vs. 12% of those not diagnosed with either, 18% of those with less than secondary education vs. 7% of those with a university degree or more). With the vast majority (91%) of current smoking occurring among Canadians 25 years and older, more needs to be done to explore the barriers around cessation faced by adults who currently smoke, notably among those within the higher prevalence rates.

This work will build upon previous adult smoking research conducted by the Tobacco Control Directorate but with a greater focus on the cessation tools and approaches, such as knowledge, use, alternatives to smoking, opinions, barriers, challenges, etc., to try to quit or reduce smoking.

Research objectives

The research objectives are as follows:

Quantitative Research

1. Gather details on attitudes, beliefs, knowledge, awareness, and use of cessation methods across Canada (e.g., nicotine replacement therapy, vaping with or without nicotine, 'cold turkey', reducing their smoking, etc.).
2. Investigate a range of experiences with those methods (e.g., challenges and advantages) and how those may impact future attempts.
3. Explore drivers of ongoing smoking, differentiating between those with or without a recent quit attempt.
4. Explore how other substance use may impact cessation (e.g., alcohol, cannabis).

Qualitative Research

1. The focus groups will be used to delve into individual quit methods, their experiences with them and barriers and facilitators of use, with an emphasis on population segments with high prevalence rates of current smoking.

Data from this research will inform the Tobacco Control Directorate's efforts to support Canadians smoking and nicotine cessation efforts.

Methodology

The qualitative portion consisted of 19 online focus groups with individuals aged 25 and older who smoke. Focus groups were conducted with participants from Eastern Canada, Western Canada and Quebec. The sessions were completed between April 5 and April 25, 2023. A total of 113 individuals participated in the focus groups.

The quantitative portion of the study consisted of a national online survey of 2,548 respondents aged 25 or older in Canada who smoke. Survey data were collected from April 12 to April 28, 2023.

Qualitative research results

Journey to their current smoking experience

Participants were asked to describe their "smoking journey," starting from the moment they first started smoking cigarettes to today. Some of the more common trends and patterns from this exercise included the following:

• Smoking cigarettes typically began either at high school or college/university. Most who started smoking cigarettes in high school did so either out of peer pressure, general curiosity, to "be cool" or to "fit in." Those who started in college or university did so because it was part of the social scene or to help them manage their academic stress.
• A number of participants started smoking due to high stress jobs or jobs where smoking was also more prevalent, such as the hospitality or construction industry.
• In the beginning, nearly all participants had someone, or often more than one person, in their life who also smoked cigarettes.
• Fast forwarding to today, adults who smoke explain they do so for four main reasons: out of habit, to help them manage their stress, as an activity when they are out with their friends, and for pleasure.
• Many who currently smoke cigarettes regularly explained that their circle of friends, coworkers and family members who also smoke cigarettes has shrunk considerably, to the point where some feel they are now the only ones who smoke cigarettes regularly. Those who smoke more casually or in social circumstances explain that they also have friends who smoke.
• The journey for many seems to involve an increase in smoking at some point, which tended to coincide either with a stressful time in their life, a particular line of work or an increase in social activity. Many also explained that they have tried to quit smoking entirely.

A few other notable findings pertaining to how smoking cigarettes fit into participants' lives include the following:

• Few seem to feel that they plan what they do or where they go based on whether they can smoke cigarettes.
• Many do feel that smoking isolates them from others.
• The cost of living was seen by all participants as getting more expensive and many had to make compromises and changes in their general household budget. The impact on cigarette use was mixed. Many explained how inflation in general but also the increase in the cost of cigarettes specifically has prompted them to adopt one or a combination of strategies (such as reduce how much they smoke, switch to a less expensive brand, etc.). Some who smoke more regularly and heavily explained that they will purchase their cigarettes no matter what. Some who smoke on a more casual or occasional basis felt that they did not change their use of cigarettes because they don't smoke enough for it to have a meaningful impact on their household budget.

Confidence in and importance of quitting smoking

Most participants would say that quitting smoking is at least somewhat important to them. Those who feel most strongly about this feel that it is long overdue, they understand the impact it is having on their health and their finances and, similarly, they understand the benefits of quitting. Those who feel less strongly about quitting were mostly individuals who smoke more casually or occasionally.

When asked how confident they would be that they would succeed if they tried to quit, most do feel confident they would succeed if they tried to quit. Those who tended to be the most confident were those who smoke occasionally and believe that the infrequent nature of their tobacco use would make it easy for them to quit, and those who have quit in the past (in some cases many times) and given that experience, they believe they can do it again if they put their minds to it. Those who felt less confident tended to be individuals who have never tried quitting in the past as well as some who have tried to quit, sometimes repeatedly and recognized the difficulty of this.

High and low prevalence discussion

Participants struggled to self-identify as fitting into a particular demographic or socio-economic profile which might make them more or less likely to smoke cigarettes. If anything, participants might propose that certain circumstances might make someone more likely to smoke cigarettes, among which the most common were rooted in the past rather than in the present. These included:

• parents, close friends and/or close family members smoked cigarettes,
• they grew up in a time when cigarette smoking was more common and popular, it was more widely permitted (e.g., in restaurants, in the workplace, etc.), less was known about the health impacts of smoking cigarettes, cigarette advertising was more prevalent, and smoking cigarettes was seen as "cool",
• they had or have a lot of stress in their life, and,
• the type of work they do or industry in which they work.

Participants reacted to patterns pertaining to prevalence in the following ways:

• Younger participants 25 to 44 were typically not surprised to learn that their age group was more likely to smoke compared to older individuals. Conversely, many of those over the age of 44 were surprised to learn that those 25 to 44 were more likely to smoke cigarettes. Many assumed that vaping was overtaking cigarette smoking, that cigarettes were more likely to be vilified, and that younger folks were more educated about the ill-effects of smoking cigarettes and that this would lead younger folks to be less inclined to smoke cigarettes compared to older individuals.
• Some men were not surprised to hear that they were more likely to smoke compared to women, mostly because of the kinds of sectors in which they work (such as construction, building maintenance, etc.). Some also explained that it is a more "macho" thing to do.
• Many explained that smoking helped them fit in when they were younger and that throughout their life, faced with varying forms of discrimination, they have needed to find ways to cope with stress, isolation or other forms of anxiety. For these individuals, smoking cigarettes was used as a coping mechanism.
• Many individuals in both lower and higher income households were not surprised to learn that individuals earning a lower income were more likely to smoke compared to higher income individuals. Proposed contributing factors included stress caused by financial duress, and the sectors in which low-income Canadians might work.
• Most individuals with a mood or anxiety disorder were not surprised to learn that they are more likely to smoke compared to individuals with neither type of disorder. Some explained that, faced with their disorder at a young age, smoking helped them "fit in" with others and it helped them manage their anxiety or just cope.
• Reactions among members of the LGBTQIA2S+ were mixed. Some did not understand why they might be more likely to smoke whereas for others, the reasons were quite clear. Those in the latter group explained that cigarettes helped them manage the social and personal challenges they endured growing up.
• Many individuals from Indigenous communities were also not surprised to learn that they might be more likely to smoke compared to individuals who do not identify as Indigenous. Some felt that smoking and tobacco are traditional in their community and as such smoking does not take on the same meaning as it might in other segments of society. Some also explained that smoking has been and continues to be quite prevalent among their friends who are Indigenous and among family members, which in turn normalizes and perpetuates the behaviour.

Selecting a cessation method

The research explored awareness and experiences with a variety of smoking cessation strategies and methods.

In terms of aided and unaided awareness, participants across all segments seemed fairly aware of a wide range of strategies. The methods of which participants were the least aware included: a 1-800 quitline helpline or smoker's helpline, an internet-based program or smartphone app, attending in-person group counselling, and using smoking cessation medications.

When specifically asked if there were any methods they had never tried and that they would also never likely consider in the future, the least popular strategies were: smoking cessation medications, a 1-800 quitline or smoker's helpline, vaping (with or without nicotine), in-person group counselling, and an internet-based program or smart phone app.

The discussion then focused on methods and strategies that participants had used in the past, irrespective of whether they helped. Some of the highlights from this line of questioning included:

• Nicotine replacement therapy (NRT), especially gum and patches, were often mentioned. Participants tended to see mixed results with these approaches. Use was typically triggered because these methods have been around for a long time and they were just aware of them, friends and family had seen success in their use, they were recommended by a pharmacist or their physician, and they were featured prominently at their pharmacy. Participants stopped using NRTs mostly because they did not feel they worked.
• Some had tried prescription medication and few felt it worked for them. The side-effects, especially vivid dreams, led them to abandon this method which, for most, had been recommended by their physician.
• Hypnosis was also used by some, although few believe it was helpful. This method tended to be a one-time experiment for participants, which had most likely been recommended by friends or through advertising.
• Vaping with nicotine was also a popular strategy, which was still being used by certain participants in these focus groups. This approach had been most often recommended by friends and was seeing some success among certain participants.
• Strategies such as managing one's stress, exercise, quitting "cold turkey" and gradually reducing the number of cigarettes smoked were also relatively common. Participants were typically led to consider these approaches on their own with no particular recommendation or consultation from other people.

While most participants generally agreed that the decision to quit has to come from them, many also agreed that some form of support from someone can be helpful. Most seemed to feel that support from someone in their circle of friends or family would be most helpful.

In terms of the types of "stars" that should align in their life to increase the odds of success when it comes to quitting, most agreed on three particular factors: having the right mindset, having less stress in their life, and having the right kind of support to keep them motivated.

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 probability quantitative research.

Quantitative research results

Smoking use and history

Nearly three quarters (73%) of respondents smoked cigarettes every day of the last month. Another 17% smoked at least once each week while 10% smoked at least once in the month.

Respondents' average age at the time of their first cigarette was just over 16 years old. Across all participants, the average number of years having smoked cigarettes was 30 years.

On average, respondents who smoke daily began to do so around the age of 18-19. These respondents smoke an average of 13 cigarettes per day. Roughly one quarter (26%) of those who smoke daily have a cigarette within 5 minutes of waking up while almost half (47%) smoke within 6-30 minutes of waking up.

Those who smoke occasionally smoke an average of 5 cigarettes on the days that they smoke. More than half of those who smoke occasionally have their first cigarette at least an hour after waking up (54%). A quarter of these respondents smoke within 6-30 minutes of waking up (25%) and a smaller proportion smoke within 31-60 minutes of waking up (15%).

Just under 6 in 10 respondents (59%) were considered "low" on the nicotine dependence index. More than one third (35%) were considered medium on the index and 6% of respondents would be classified as high on the nicotine dependence index. The vast majority of those who smoke occasionally were categorized as "low" on the nicotine dependence index (90% versus 48% of those who smoke daily) whereas more of those who smoke daily were in the "high" category (8% versus 1% of those who smoke occasionally).

Cessation - general awareness and opinions

Respondents were asked to provide their level of agreement with a series of statements.

• 64% agreed that they value quality of life over quantity of life.
• 49% would cut back on cigarettes before cutting back on other expenses.
• 47% would cut back on cigarettes before cutting back on hanging out with friends.
• 45% agreed that they value their individual rights over the rights of society.
• 43% agreed that they value their mental health over their physical health.
• 27% agreed that they value their social life more than time spent on their own.

Over half of respondents (53%) felt satisfied with their life currently. On the other hand, 14% reported being dissatisfied with their current life.

Smoking cessation aids or methods with the highest awareness included nicotine patches (46%) and nicotine gum (37%).

When asked how much various strategies would increase their chances of quitting smoking, the following were perceived to be the most successful:

• Reduce the number of cigarettes smoked (22%);
• Find better ways to manage stress (22%);
• Exercise (21%);
• Smoking cessation medication (20%);
• Nicotine replacement products (18%).

Most respondents (81%) were not aware of any subsidized smoking cessation options in their province or community. Of the options listed, awareness of subsidized options was highest for nicotine patches (10%) and nicotine gum (5%).

An even 1 in 5 (20%) respondents reported having insurance that covers all or part of the cost of smoking cessation medication.

Cessation history

More than 7 in 10 respondents (72%) reported that at some point in the past, they had stopped smoking for at least 24 hours because they were trying to quit. Of these respondents, 57% reported having tried to quit in the last 12 months.

Cessation plans

Respondents were presented with a list of smoking cessation strategies and asked whether they were currently using the strategy or if they had used the strategy in the past 12 months.

The strategies used more frequently included the following:

• 56% were currently reducing the number of cigarettes they smoke and another 32% reported having done so in the past 12 months (with 68% describing the method as useful).
• 35% were currently trying to quit smoking on their own and another 44% reported having done so in the past 12 months (with 60% describing the method as useful).

Cessation methods that were considered to be the most useful included the following:

• using a vape with nicotine (74% among the 21% currently using this method);
• making a deal with a friend or family member (73% among the 16% currently using this method);
• attending in-person group counselling (71% among the 12% currently using this method);
• using a 1-800 quit line or smoker's helpline (70% among the 8% currently using this method).

For those who had attempted to quit in the past 12 months, the main positive benefits experienced included:

• saving money (65%);
• breathing was easier (43%);
• home, car, breath and clothes smelled better (41%);
• less coughing and/or wheezing (41%).

Despite the positive benefits experienced, respondents reported that they continued to smoke due to too much stress (28%), too much difficulty quitting due to being around friends who smoke or when drinking alcohol (26%), smoking being too ingrained in their routine (25%), and enjoyment of smoking (25%).

Just under one third of respondents (32%) said they plan to quit sometime in the future (beyond 6 months). Another 23% reported that they plan on quitting within the next 6 months while 16% planned on quitting in the next month. On the other hand, 18% had no plans of quitting while another 11% were unsure.

Respondents were split when thinking about their confidence in their ability to quit smoking at the present time with 32% saying they were confident and 33% saying they were not confident. Half (50%) were confident that they could eventually quit for good while 17% were not confident.

Quitting smoking was deemed important by 60% of respondents while 13% did not feel quitting was important to them.

Respondents who had not made any previous quit attempts and did not have plans to quit mainly attributed this to their enjoyment of smoking (38%) or because smoking was too ingrained into their routine (34%).

The main reason that respondents would be compelled to quit smoking was to improve their health (34%), however 12% said they did not think about quitting.

Perceived value of various sources of information

Respondents were asked how much they would value various sources of information when it comes to quitting smoking. The following were considered the most valuable:

• A friend or family member who has successfully stopped smoking cigarettes (47%);
• Health care professionals (47%);
• Someone who has successfully stopped smoking (47%);
• Family members (41%);
• Individuals who do scientific research of smoking and/or smoking cessation (37%);
• Friends (36%).

Risk perception and gaps in knowledge

Respondents were presented with a list of statements and asked how much they agreed with each one. The following was observed:

• 26% agreed that exercise can undo most of the effects of smoking.
• 24% agreed that whether a person gets lung cancer depends more on genes than anything else.
• 17% agreed that vitamins can undo most of the effects of smoking.
• 15% agreed that there's no risk of getting cancer if someone only smokes for a few years.

Other substance use

Vaping

More than 2 in 5 respondents (42%) reported that they had ever used a vaping device with nicotine. When asked about the frequency of using a vaping device with nicotine within the past month, 19% had done so daily, 20% had used one at least once a week and 17% had used one about once in the past month.

Of respondents who vaped nicotine in the past 30 days, the most common level of nicotine was 10 milligrams (28%). Fewer used products containing 5 milligrams of nicotine (22%). Just over one-third used higher levels: 15 milligrams of nicotine (15%) or 20 milligrams of nicotine (20%).

Those who vaped nicotine in the past 30 days differed on how soon after waking up they used the device. Some did so within 5 minutes (16%), within 6 to 30 minutes of waking up (29%), within 31-60 minutes of waking up (20%) or more than an hour after waking up (29%).

These respondents also differed on the frequency at which they used their device, with the largest proportion reporting having vaped 5 or less times per day (32%).

Preferred product flavours among those who vape typically included fruit (36%), tobacco flavour (18%), mint (14%) or menthol (12%).

Roughly one quarter (24%) had used a vaping device without nicotine in the past 30 days. Of these respondents, 6% had used this type of product daily, 23% did so once a week and 28% had used one about once in the past month.

Of the respondents who used a vaping device (either with or without nicotine) in the past 30 days, 40% used a disposable device while 67% used a reusable device. Reusable vaping devices consisted of systems that use pre-filled cartridges or pods (43%) or devices that contained cartridges which can be manually refilled with e-liquid (64%).

Alcohol

In the past 30 days, 12% of respondents consumed alcohol daily, 29% did so weekly and another 25% consumed alcohol about once in the month.

Half (50%) of those who consume alcohol said they smoked about the same number of cigarettes on days that they drank alcohol while 40% reported smoking more on days that they consumed alcohol.

Disposal

Cigarette butts

The garbage was the most common method for disposing cigarette butts (22% always, 27% most of the time). Public ashtrays were also commonly used for disposal (17% always, 23% most of the time). Littering on the ground was less commonly reported (4% always, 14% most of the time).

Vaping products

Of those who have tried vaping either with or without nicotine, 40% had used a device until the battery died or until the e-liquid ran out.

The most common method of disposal for vaping devices was in the garbage (31% always discarding this way, 25% disposing this way most of the time). The recycling bin was used for disposal always for 9% of respondents while 15% used this method most of the time.

Of the respondents who had vaped, 51% had stopped using a reusable vaping device in the past. Of these respondents, 50% disposed of the device. The most common method of disposal was in the garbage (33% always used the garbage for disposal, 22% did so most of the time). Another way respondents disposed of these devices was at a specialized facility, which was done so always by 11% of respondents while 6% used this method most of the time.

More than one third (35%) of those who had vaped in the past had either replaced a prefilled cartridge or stopped using one. The most common method of disposal for these cartridges was in the garbage with 29% having always done so, and 24% having done so most of the time. Before disposing of the cartridge, 9% always rinsed it, 13% rinsed most of the time while 43% never rinsed the cartridge before disposal.

Of those who had tried vaping, 37% had finished a bottle of e-liquid or stopped using one. The most common method of disposal was in the garbage with 24% always doing this while 18% did this most of the time. The recycling bin was used for disposal always for 12% of respondents while 17% used this method most of the time.

Of the respondents who had disposed of a bottle of e-liquid either in the garbage or recycling bin in the past, 11% said they always rinse the bottle before disposing of it while 13% did so most of the time.

Batteries in vape devices

Of those who had disposed of a vaping device, 29% had removed the battery from the device.

These batteries were mainly disposed of in the garbage (36%), at a specialized facility (31%), or in the recycling bin (27%).

Supplier name: Quorus Consulting Group Inc.
Contract number: CW2269609
Contract award date: January 20, 2023
Contract amount (including HST): $186,404.80
For more information, please contact Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca

These results are presented and discussed in-depth throughout the detailed results section of the report.

Non-probability quantitative research disclaimer

This survey was conducting using a non-probability sample (i.e., a commercially available online panel). Thus, the results of this survey are not statistically projectable to the target population because the sampling method used does not ensure that the sample represents the target population with a known margin of sampling error. Reported percentages are not generalizable to any group other than the sample studied, and therefore no formal statistical inferences can be drawn between the sample results and the broader target population it may be intended to reflect. The sample data have been weighted to reflect the demographic composition as per the Methodology section.

Statistical projection is strictly the prerogative of probability quantitative research.

Detailed Results

Research purpose and objectives

Canada's Tobacco Strategy has set an ambitious goal of lowering tobacco use among Canadians to less than 5% by the year 2035. To realize this objective, Health Canada needs to prevent initiation of tobacco use as well as support cessation efforts to quit tobacco long-term.

According to the 2020 Canadian Community Health Survey, 13% of Canadians 15 years and older currently smoke. The majority of those who currently smoke have attempted to quit smoking in the past 12 months (58%) and/or are seriously considering quitting smoking within the next 6 months (63%). Adults (25 years of age and older) have a higher prevalence of current smoking (14%) than youth 15-19 (6%) but fewer report attempting to quit within the past year (60%) compared to youth 15-19 (84%) and young adults 20-24 (70%) who smoke. Additionally, some demographic groups have higher prevalence rates (e.g., 16% of men vs. 11% of women, 21% of those diagnosed with a mood and/or anxiety disorder vs. 12% of those not diagnosed with either, 18% of those with less than secondary education vs. 7% of those with a university degree or more). With the vast majority (91%) of current smoking occurring among Canadians 25 years and older, more needs to be done to explore the barriers around cessation faced by adults who currently smoke, notably among those within the higher prevalence rates.

This work will build upon previous adult smoking research conducted by the Tobacco Control Directorate but with a greater focus on the cessation tools and approaches, such as knowledge, use, alternatives to smoking, opinions, barriers, challenges, etc., to try to quit or reduce smoking.

This work will involve quantitative and qualitative research methods:

• Phase 1: Online Survey of Canadian adults aged 25 and older who smoke
  • The quantitative phase will gather data across Canada on cessation tools and approaches used by adults who currently smoke and who may or may not be currently trying to quit/reduce their smoking.
• Phase 2: Online Focus Groups with Canadian adults aged 25 and older who smoke
  • The qualitative phase will allow for a deeper dive into the challenges and ways to improve cessation rates among groups with high prevalence rates of current smoking.

Research objectives

The research objectives are as follows:

Quantitative Research

1. Gather details on attitudes, beliefs, knowledge, awareness, and use of cessation methods across Canada (e.g., nicotine replacement therapy, vaping with or without nicotine, 'cold turkey', reducing their smoking, etc.).
2. Investigate a range of experiences with those methods (e.g., challenges and advantages) and how those may impact future attempts.
3. Explore drivers of ongoing smoking, differentiating between those with or without a recent quit attempt.
4. Explore how other substance use may impact cessation (e.g., alcohol, cannabis).

Qualitative Research

1. The focus groups will be used to delve into individual quit methods, their experiences with them and barriers and facilitators of use, with an emphasis on population segments with high prevalence rates of current smoking.

Data from this research will inform the Tobacco Control Directorate's efforts to support Canadians smoking and nicotine cessation efforts.

Qualitative research results

Journey to their current smoking experience

Participants were asked to describe their "smoking journey," starting from the moment they first started smoking cigarettes to today. Some of the more common trends and patterns from this exercise included the following:

• Smoking cigarettes typically began either at high school or college/university.
• A few did start smoking around the house or in their neighbourhood, an activity that typically involved "sneaking" cigarettes from others in the household, and, for a few, finding cigarette butts on the streets.
• Most who started smoking cigarettes in high school did so either out of peer pressure, general curiosity, to "be cool" or to "fit in." A number recalled a sizable "smoking pit" in the high school yard which was the place to be or be seen. Those who started in college or university did so because it was part of the social scene or to help them manage their academic stress.
• A number of participants started smoking due to high stress jobs or jobs where smoking was also more prevalent, such as the hospitality or construction industry.
• In the beginning, nearly all participants had someone, or often more than one person, in their life who also smoked cigarettes. These were most often close friends, siblings or one or both of their parents.
• Fast forwarding to today, adults who smoke explain they do so for four main reasons: out of habit, to help them manage their stress, as an activity when they are out with their friends (especially if alcohol is involved), and for pleasure (i.e., they really enjoy smoking cigarettes).
• Many who currently smoke cigarettes explained that their circle of friends, coworkers and family members who also smoke cigarettes has shrunk considerably, to the point where some feel they are now the only ones who smoke cigarettes regularly. Participants described how there used to be a noticeable group outside their workplace congregating at breaks and lunch to smoke a cigarette whereas now, they are sometimes the only ones there. Similarly, at social gatherings, participants would describe how there would often be a group of people who smoke gathering outside or on the porch and that it was not difficult to find someone with whom they would go out "to have a smoke." Nowadays, many of these participants have noticed that they are often the only one who steps outside to smoke a cigarette. It was further explained that cigarette smoking used to be a way to bond or meet other people at work and at gatherings whereas now, stepping out to smoke a cigarette has become a lonely activity.
• Those who smoke more casually or in social circumstances explain that they also have friends who smoke occasionally.
• The journey for many seems to involve an increase in smoking at some point, which tended to coincide either with a stressful time in their life, a particular line of work (e.g., restaurants, bars, construction, etc.) or an increase in social activity. Many explained that they have tried, some for longer periods than others, to quit smoking entirely. Although some may have quit at least once in their lives, all of these participants continue to smoke at least occasionally with some believing they have reduced how much they smoke compared to at its peak.
• A common pattern in the smoking journey among older women was a pause in their use of tobacco during a pregnancy.

Few seem to feel that they plan what they do or where they go based on whether they can smoke cigarettes. Many explained that this may have been more common when smoking was permitted in certain places. However, since smoking is prohibited everywhere that is open to the public, they no longer feel they need to make this choice. Some participants noted that they are more likely to plan whether they smoke based on who they are going to meet rather than where they are going. For instance, participants explained that they will not smoke in places where there are going to be young children or babies. A few, especially in their 20's and 30's, noted that they will avoid smoking if one of their parents will be there.

Many do feel that smoking isolates them from others. Whereas smoking in groups was more common when they were younger, now they feel that only a few people congregate on sidewalks, porches and alleys to smoke cigarettes. When they need to leave their group to go out to smoke a cigarette, participants feel they are in some ways ostracized and "missing out." They feel bad themselves for stepping away and they are also made to feel bad by others in their group.

The cost of living was seen by all participants as getting more expensive and many had to make compromises and changes in their general household budget. The impact on cigarette use was mixed. A good number explained how inflation in general but also the increase in the cost of cigarettes specifically has prompted them to adopt one or a combination of the following strategies: reduce how much they smoke, switch to a less expensive brand, switch to hand rolled cigarettes, switch to contraband or cigarettes sold "on reserves" or switch to vaping. Some who smoke more regularly and heavily did not change how much or what they smoked - they explained that they will purchase their cigarettes no matter what. As well, some who smoke on a more casual or occasional basis felt that they did not change their use of cigarettes because they don't smoke enough for it to have a meaningful impact on their household budget. In fact, for a few of these individuals, they just smoke their friends' cigarettes.

Confidence in and importance of quitting smoking

Most participants would say that quitting smoking is at least somewhat important to them. Those who feel most strongly about this feel that it is long overdue, they understand the impact it is having on their health and their wallets and, similarly, they understand the benefits of quitting. There were also participants who said that quitting was quite important to them now because they had or were planning to have children, or because they had grandchildren.

A few are also motivated by the fact that someone in their family had died from a health condition related to smoking cigarettes. Older participants were more likely to point to specific impacts on their health from smoking cigarettes and that they are interested in living as long as possible. Those with young children at home were interested in setting the right example.

"Yeah, with two young kids running around, I kind of want to set a model citizen example here and I don't want to be sneaking out and smoking cigarettes from time to time. That's why it's kind of driving me to quit fully… So that's kind of the driving force for me, just for my own family. It's not a priority for me anymore." - Male, 31 years old, Ontario

Those who feel less strongly about quitting were mostly individuals who smoke more casually or occasionally. These participants feel that cigarettes do not control them, they have a clear understanding of when and how much they smoke in a given timeframe and they do not believe that the number of cigarettes they are smoking is having any negative impact on their health, or at least it is so minimal it is not worth worrying about. A few enjoyed smoking too much to consider quitting. Participants will also downplay the importance of quitting out of concern for the impact it would have on their social life. Some also feel that quitting would either add to an already stressful time in their life or it would impact their ability to manage the stress in their life.

When asked how confident they would be that they would succeed if they tried to quit, a range of responses were provided. Most do feel confident they would succeed if they tried to quit. Those who tended to be the most confident usually fell into one of two categories: those who smoke occasionally and believe that the infrequent nature of their tobacco use would make it easy for them to quit, and those who have quit in the past (in some cases many times) and given that experience, they believe they can do it again if they put their minds to it. Some also believe that they are "in control" and that if they wanted to quit, they could. Some of the more confident participants also explained that they recognize the impact it is having on their health and that this was sufficiently motivating and a few added that they hate that they smoke cigarettes and they really want to quit.

Those who felt less confident tended to be individuals who have never tried quitting in the past as well as some who have tried to quit, sometimes repeatedly and recognized the difficulty of this. Low confidence also stems from some feeling that quitting is a relatively low priority for them and, knowing that it takes significant commitment, don't feel they would be fully invested in the effort.

"I'd like to quit, but I'm in the mindset that something always comes up, and someday I will or someday it'll kill me. I'm not quite sure anymore, but I've tried a few times, and like I said, something always comes up, so it is important, but it's one of the lower priorities at the moment." - Male, 38 years old, Ontario

Finally, some do not feel confident because others around them, especially a spouse or close friends, also smoke.

The discussion related to the importance of quitting and confidence sometimes resulted in participants being at opposing ends of the "confidence" and "importance of quitting" spectrums. Common scenarios would include:

• Participants who do not smoke regularly who do not consider quitting important and also feel quite confident they could quit if they tried.
• Participants who consider quitting very important but who also recognize that quitting is easier said than done and have a low level of confidence that they would succeed in quitting if they tried.

High and low prevalence discussion

Participants struggled to self-identify as fitting into a particular demographic or socio-economic profile which might make them more or less likely to smoke cigarettes. Participants explained that when they look around them, they do not recognize any particular trend or any segment of society more likely or less likely to smoke than any other. If anything, participants might propose that certain circumstances might make someone more likely to smoke cigarettes, among which the most common were rooted in the past rather than in the present. These included:

• parents, close friends and/or close family members smoked cigarettes,
• they grew up in a time when cigarette smoking was more common and popular, it was more widely permitted (e.g., in restaurants, in the workplace, etc.), less was known about the health impact of smoking cigarettes, cigarette advertising was more prevalent, and smoking cigarettes was seen as "cool",
• they had or have a lot of stress in their life, and,
• the type of work they do or industry in which they work.

Because of how cigarettes were viewed when they were younger, some of the participants who were over the age of 45 tended to feel that they fit the profile of someone who smokes because of their age. Otherwise, a few felt that they were probably more likely to smoke because they were men, a few participants felt they were probably more likely to smoke because they are members of the LBGTQIA2S+ community or because they are Indigenous.

The manner in which participants reacted to certain findings or patterns pertaining to prevalence included the following:

• Younger participants 25 to 44 were typically not surprised to learn that their age group was more likely to smoke compared to older individuals. They sensed that fewer "life obligations", not having children or as many children, still feeling quite healthy and still having a fairly active social life all contributed to increasing the odds that their age group is more likely to smoke cigarettes than older individuals.
• Conversely, many of those over the age of 44 were surprised to learn that those 25 to 44 were more likely to smoke cigarettes. Many assumed that vaping was overtaking cigarette smoking, that cigarettes were more likely to be vilified, and that younger folks were more educated about the ill-effects of smoking cigarettes and that this would lead younger folks to be less inclined to smoke cigarettes compared to older individuals. Many also assumed older individuals would be more likely to smoke cigarettes for the various reasons listed earlier - that they grew up in a time when cigarette smoking was more common and popular, it was more widely permitted, less was known about the health impact of smoking cigarettes, cigarette advertising was more prevalent, and smoking cigarettes was seen as "cool."
• Some men were not surprised to hear that they were more likely to smoke compared to women, mostly because of the kinds of sectors in which they work (such as construction, building maintenance, etc.). Some also explained that it is a more "macho" thing to do.
• On a related note, many individuals in both lower and higher income households were not surprised to learn that individuals earning a lower income were more likely to smoke compared to higher income individuals. Most tended to hypothesize that given the stress caused by financial duress, this would likely lead to smoking cigarettes. Some also suspected that the sectors in which low-income Canadians work might see higher rates of smoking than others.
• Most individuals with a mood or anxiety disorder were not surprised to learn that they are more likely to smoke compared to individuals with neither type of disorder. Some explained that, faced with their disorder at a young age, smoking helped them "fit in" with others and it helped them manage their anxiety or just cope. Many continue to utilize cigarettes for the same reasons. A few also explained that cigarettes were a better and healthier alternative compared to other substances they have used or consumed in the past such as cannabis, hard drugs and alcohol.
• Reactions among members of the LGBTQIA2S+ were mixed. Some did not understand why they might be more likely to smoke whereas for others, the reasons were quite clear. Those in the latter group explained that cigarettes helped them manage the social and personal challenges they endured growing up, cigarettes were said to help them "fit in." Smoking also helped them manage the anxiety they felt around their sexual identity and preferences. Some also explained that in their community, it was and remains "the thing to do."

"For me, I'm LGBTQ. It's a huge part of the community. If you don't smoke it, you're seen as someone who is not cool, who's not fit to be within the community so there's a lot of pressure in that aspect. I think that's a huge part of it." Male, 32 years old, British Columbia

"Before I came out, so the act of just sort of being gay and living in this culture, I think predisposed me for sure to smoking a lot because a lot of my gay friends did the same. I noticed most of my gay male friends all smoke as opposed to the, you know, the straight counterparts. […] gay people were, you know, looked at very horribly and especially like during my time, there's the AIDS epidemic so I think there was a lot of stress being gay and hiding that from people, and so that translated into smoking." Non-Binary, 52 years old, Ontario

"[…] in Halifax, it was literally a metal door down at dark alley, no signs, no lights, and that's where we went to party because that was the only gay club in the city and you had to come out in groups because if not, you were attacked. So, it took me back to a very dark place, and you know, that is definitely when I look around at my group of friends back then and everybody, we all smoked, and I think it was just a stress reliever because you're being in the process of…you're in the middle of the AIDS epidemic. You're being disowned from family and friends. You are being beat up. You're being tracked and chased and all of these horrific things that typically don't happen and I think it was just part of a stress release…I don't know…but something for me to think about for sure." Female, 53 years old, Nova Scotia

• Many individuals from Indigenous communities were also not surprised to learn that they might be more likely to smoke compared to individuals who do not identify as Indigenous. A few factors seemed to contribute to this - some felt that smoking and tobacco serve certain traditional purposes in their community and as such smoking does not take on the same meaning as it might to non-Indigenous individuals. Some also explained that smoking has been and continues to be quite prevalent among their friends who are Indigenous and among family members, which in turn normalizes and perpetuates the behaviour. As well, some suspect that the lower cost that Indigenous people pay for cigarettes increases accessibility of the product and decreases the importance of cost as a driver for deciding to quit. Finally, a few suspect that Indigenous individuals may be more likely to earn lower incomes, face various types of discrimination and live with more stress in general, all of which might increase the odds of them smoking.

Selecting a cessation method

The research explored awareness and experiences with a variety of smoking cessation strategies and methods.

Without prompting with examples, participants across all segments seemed fairly aware of strategies such as various forms of nicotine replacement therapy (gum, patch, spray, inhaler), prescription medication (especially Champix and Zyban), "cold turkey" (or "willpower"), gradually reducing the quantity of cigarettes smoked, changing their habits or routine, vaping with nicotine, hypnosis, laser, keeping busy or keeping their hands busy, counseling, and exercise. In a few sessions, participants also mentioned literature/books, getting pregnant, acupuncture, sweets/candy, cannabis, and shock therapy.

When presented with a specific list of methods and strategies, the following trends emerged:

• By and large, participants were aware of nearly all methods presented. Those who smoked more casually or occasionally were more likely to be unaware of more items on the list.

  The methods of which participants were the least aware included: a 1-800 quitline helpline and an internet-based program or smartphone app. Awareness was somewhat low for attending in-person group counselling and using smoking cessation medications.

• When specifically asked if there were any methods they had never tried and that they would also never likely consider in the future, the following trends emerged:
  • Smoking cessation medications were the least popular with most of these participants explaining that they would prefer resorting to strategies that do not involve medication. Some had also heard through word-of-mouth that these medications have undesirable side-effects, especially vivid dreams. Those who only smoke occasionally were especially reluctant to consider medication since they saw this strategy as mostly an option for individuals who are "addicted," something which they did not see themselves as being.
  • Many also felt that they would not use a 1-800 quitline helpline. The general sense was that calling such a helpline is something someone would do in an emergency or who is in a crisis, which few felt applied to their situation. There was also an expectation that the person with whom they would speak on the helpline would only give them information they probably already knew. Finally, many who were not interested in a quitline were also not interested in talking to a stranger about their smoking.
  • Vaping, with or without nicotine, held limited appeal to many participants. These participants felt that switching from smoking cigarettes to vaping was equivalent to switching one bad habit for another. A good number seemed to believe that vaping might be worse than smoking cigarettes.
  • Interest for in-person group counselling was also weak, with many of these participants uncomfortable or reluctant to discuss their use of tobacco with others in a group environment.
  • Finally, interest was weak for the internet-based program or smart phone app. Participants could not imagine how this sort of tool could help them. There was also a sense that no app or internet-based program could motivate them or have an impact on their willpower, which was a key challenge for many.

The discussion then focused on methods and strategies that participants have used in the past, irrespective of whether it succeeded. Some of the highlights from this line of questioning included:

• Nicotine replacement therapy (NRT), especially gum and patches, were often mentioned. Participants tended to see mixed results with these approaches. They were led to try these approaches in a variety of different ways - for some, these methods have been around for a long time and they were just aware of them, for others, friends and family had seen success in their use, they were recommended by a pharmacist or their physician, or they were featured prominently at their pharmacy. Participants stopped using NRT mostly because they did not feel they worked - some would continue smoking while taking NRT while others felt the product was not reducing their cravings. Unpleasant taste, side-effects (especially for patches), and cost were also some of the challenges encountered with these products.

  "I think the most successful I tried was the patch. I quit for a couple of years. The downside to it was it made me sweat incredibly." - Male, 58 years old, Ontario

• Some had tried smoking cessation medication and few felt it worked for them. The side-effects, especially vivid dreams, led them to abandon this method which for most had been recommended by their physician.
• Hypnosis was also used by some, although few believed it was helpful. This method tended to be a one-time experiment for participants, which had most likely to been recommended by friends or through advertising.
• Vaping with nicotine was also a popular strategy, which was still being used by certain participants in these focus groups. This approach had been most often recommended by friends and was seeing some success among certain participants.
• Strategies such as managing one's stress, exercise, quitting "cold turkey" and gradually reducing the number of cigarettes smoked were also relatively common. Participants were typically led to consider these approaches on their own with no particular recommendation or consultation from other people. These participants tended to encounter challenges such as not having enough time to exercise, or not being able to manage one's stress.

  "I tried [to quit] a lot because, in that time, I was playing soccer with my friends then I started to smoke. I didn't have too much breath to play sports, that's why I tried to quit, but I couldn't because of the, as I said, the work [stress]." - Male, 41 years old, New Brunswick

• Many explained that in their efforts to quit or reduce their smoking, any reason was a good reason to start smoking again.

While most participants generally agreed that the decision to quit has to come from them, many also agreed that some form of support from someone can be helpful. Most seemed to feel that support from someone in their circle of friends or family would be most helpful.

"For myself, I would definitely need support. I thrive off of encouragement… My family and friends would mean the most, but if you don't have family and friends, you can get that from a doctor or a counsellor or pharmacist, anyone." - Female, 47 years old, Alberta

In terms of the types of "stars" that would need to align in their life to increase the odds of success when it comes to quitting, most agreed on three particular factors: having the right mindset, having less stress in their life, and having the right kind of support to keep them motivated. Some also said that a serious health diagnosis would be the trigger for them.

"Maybe getting a lung disease or something that probably will make me think about quitting smoking. But aside from that, no, I like it." - Female, 34 years old, Alberta

Those who were especially confident that they could quit (as discussed earlier in the session) believed all they needed was to put their minds to the task.

Quantitative research results

Notes for the reader:

• Throughout the report, notable subgroup findings are described as per t-test and z-test results (see Methodology).
• Subgroup findings were primarily focused on comparing results among adults aged 25-44 and those aged 45 and older, as well as a focus on individuals who smoke daily, compared to those who smoke occasionally. Additional subgroup findings were only highlighted throughout relevant areas of the report.
• Notable findings among subgroup sample sizes of less than 25 have been omitted throughout the report.
• The report features results for scale questions ranging from 0-10, with results grouped into positive (7-10), neutral (4-7), or negative ranges (0-3) for ease of reading.
• Subgroup findings for all questions are provided in a separate set of "banner tables." These tables are referenced by the survey question in the report.

Quality of life

More than half of respondents (53%) said they felt satisfied with their life right now (assigned a score of 7, 8, 9 or 10 on scale from 0-10). Another third of respondents (33%) responded neutrally and 14% of respondents reported being dissatisfied (score of 0, 1, 2, or 3) with their current life.

Adults aged 45 and older were more likely to report being dissatisfied with their life (16% versus 12% of those aged 25 to 44). Individuals who smoke daily were also more likely to report being dissatisfied with their life currently (16% versus 9% of those who smoke occasionally).

Respondents who reported having a disability reported lower life satisfaction (24% said they were dissatisfied compared to 11% of those with no reported disability).

Smoking use and history

Smoking frequency

Nearly three quarters of respondents (73%) reported that within the last month, they smoked cigarettes every day. A total of 27% smoked occasionally (17% smoked at least once in a week, and another 10% smoked at least once a month).

Respondents aged 45+ were more likely to have smoked daily (83%) compared to those in the 25-44 age category (62%).

Women were also more likely to report having smoked daily (79%) compared to men (68%).

Respondents from Quebec were more likely to smoke daily (81%) than those in Atlantic Canada (70%), Saskatchewan/Manitoba (60%), Alberta (72%) and British Columbia (61%).

There was also a relationship between household income and frequency of smoking. Those with a household income of less than $40k were most likely to smoke daily (81%) which decreases to 62% of respondents earning $100k and above.

Those with a high school education or less were more likely to report smoking daily (84%) compared to those with a college (76%) or university education (56%).

Respondents who reported having a disability were more likely to smoke daily (81% versus 71%).

Smoking history

Respondents' average age at the time of their first cigarette was just over 16 years old.

Those aged 45 and older were more likely than those aged 25-44 to report smoking a whole cigarette between the ages of 12-14 (30% versus 25%) or 15-17 (37% versus 27%). Younger respondents were more likely to smoke their first cigarette between the ages of 18-21 (30% versus 17% of older respondents).

Those who smoke daily were more likely to consume a whole cigarette for the first time between the ages of 12-14 (29% versus 23%) whereas occasional smokers were more likely to do so between the ages of 18-21 (30% versus 21%). This trend is also reflected when considering the average age at time of smoking a whole cigarette for the first time (17.2 versus 16.4).

Based on respondents' age and their reported age at the time they smoked their first cigarette, the number of years having smoked cigarettes was calculated. Across all participants, the average number of years having smoked cigarettes was 30 years.

Those who smoke occasionally were more likely to have smoked cigarettes for 30 years or less (73% vs. 45%) while individuals who smoke daily were more likely to have been smoking for more than 30 years (55% versus 27%).

Regionally, the average number of years having smoked was highest among individuals in Quebec at 33 years.

On average, respondents who smoke daily began to do so around the age of 18-19.

Those aged 45 and older were more likely to begin smoking daily between the ages of 15 and 17 (35% versus 26%) while those aged 25 to 44 were slightly more likely to begin smoking daily at the age of 22 or older (21% versus 16%).

On average, respondents who smoke daily smoke about 13 cigarettes per day. Of the respondents who smoke daily, those aged 25-44 were more likely to smoke between 1 to 5 cigarettes (26% versus 10%) while those aged 45 and older were more likely to report smoking 11-15 cigarettes (25% versus 17%) or 16-20 cigarettes (21% versus 12%).

Those who smoke occasionally, on average smoke about 5 cigarettes on the days that they smoke. Of these respondents, those 25-44 were more likely to smoke only 1-2 cigarettes on days that the smoke compared to older respondents (44% versus 34%).

Individuals who smoke were asked how soon after waking up they have their first cigarette.

For those who smoke daily, roughly one quarter (26%) have a cigarette within 5 minutes of waking up and just under half (47%) have a cigarette within 6-30 minutes of waking. A smaller proportion smoke within 31-60 minutes of waking up (15%) or after the first hour of waking up (13%).

On the other hand, just 6% of those who smoke occasionally reported having their first cigarette of the day within 5 minutes of waking up. A quarter smoke within 6-30 minutes of waking up (25%) and a smaller proportion smoke within 31-60 minutes of waking up (15%). More than half of those who smoke occasionally have their first cigarette after at least an hour after waking up (54%).

The nicotine dependence index categorizes respondents into a three-category variable: low (0-2), medium (3-4), and high (5-6) based on the number of cigarettes smoked each day as well as the duration of time between waking up and smoking. A more detailed explanation of how points were allocated can be found in Appendix D.

Just under 6 in 10 respondents (59%) were considered "low" on the nicotine dependence index earning a score of 0-2 based on their responses to survey questions. More than one third (35%) were considered medium on the index, scoring 3-4 points. Just 6% of respondents would be classified as high on the nicotine dependence index, scoring 5-6 points.

Respondents aged 25-44 were more likely to be categorized as low on the index (70% versus 50%) while those aged 45 and over were more likely to be categorized as either medium (43% versus 26%) or high (7% versus 4%). The vast majority of those who smoke occasionally were categorized as low (90% versus 48% of those who smoke daily) whereas more of those who smoke daily were in the high category (8% versus 1% of those who smoke occasionally).

Cessation - general awareness and opinions

Respondents were asked to provide their level of agreement with a series of statements.

Close to two thirds of respondents (64%) agreed that they value quality of life over quantity of life while just 4% disagreed.

Just under half of respondents (49%) agreed that they would cut back on cigarettes before cutting back on other expenses, while less than 1 in 5 (17%) disagreed. Younger respondents and those who smoke occasionally were more likely to agree with this statement (53% versus 46% and 68% versus 42% respectively).

Slightly less (47%) agreed that they would cut back on cigarettes before cutting back on hanging out with friends, however, 1 in 5 (22%) disagreed with this statement. Agreement was higher among respondents aged 25-44 (54% versus 41%). Those who smoke occasionally were more likely to agree with this statement (62% versus 41%).

A similar proportion (45%) agreed that they value their individual rights over the rights of society while 15% disagreed. Agreement was higher among respondents aged 25-44 (49% versus 41%), among those who smoke occasionally (49% versus 43%), and men (48% versus 41%).

More than 2 in 5 (43%) agreed that they value their mental health over their physical health. Close to half of respondents (47%) were neutral while just 7% disagreed. Agreement was higher among those aged 25-44 (48% versus 39%).

Lastly, more than a quarter of respondents (27%) agreed that they value their social life more than time spent on their own while almost one third (32%) disagreed with this statement. Agreement was higher among those aged 25-44 (34% versus 20%), men (32% versus 20%), and those who smoke occasionally (33% versus 24%).

Smoking cessation methods and aids

Smoking cessation aids or methods with the highest awareness included nicotine patches (46%), nicotine gum (37%), the "cold turkey" method (19%), prescription medication (15%), vaping devices (13%) and hypnosis (12%). Just under one quarter of respondents (24%) could not list any method or aids for quitting.

Respondents who smoke daily, those aged 45 and older, women, respondents with plans to quit, and respondents with previous quit attempts were more likely to provide examples of cessation methods or aids.

When asked how much various methods would increase their chances of quitting smoking, the following were perceived to be the most successful:

• Reduce the number of cigarettes you smoked (22%);
• Find better ways to manage stress (22%);
• Exercise (21%);
• Smoking cessation medication (20%);
• Nicotine replacement products (18%);
• Use vaping products with nicotine (12%);
• Make a deal with a friend of family member (10%);
• Use vaping products without nicotine (10%).

Cessation methods that were perceived to be successful by less than 1 in 10 respondents included the following:

• Brief counselling from a health care professional (9%);
• In-person group counselling (9%);
• Consume cannabis (7%);
• Drink alcohol (6%);
• Internet-based program or smart phone app (6%);
• A 1-800 quit line (5%);
• Socializing with friends who smoke (5%).

The following cessation methods were perceived to significantly increase the chances of quitting smoking among occasional smokers compared to daily smokers:

• Exercise (28% versus 18%);
• Find better ways to manage stress (27% versus 21%);
• Reduce the number of cigarettes you smoked (26% versus 21%);
• Use vaping products without nicotine (15% versus 7%);
• Use vaping products with nicotine (15% versus 10%);
• Make a deal with a friend or family member (13% versus 8%);
• Brief counseling from a health care professional (12% versus 8%);
• Socializing with friends who smoke (8% versus 3%).

Those aged 25-44 tended to perceive the following methods as successful compared to those 45 years or older:

• Exercise (26% versus 17%);
• Find better ways to manage stress (25% versus 20%)
• Use vaping products with nicotine (14% versus 9%);
• Use vaping products without nicotine (13% versus 6%);
• Make a deal with a friend or family member (13% versus 7%);
• Brief counselling from a health professional (12% versus 6%);
• In-person group counselling (12% versus 6%);
• Consume cannabis (10% versus 4%);
• Using a 1-800 quit line (8% versus 3%);
• Internet-based program or smart phone app (8% versus 4%);
• Drink alcohol (7% versus 4%);
• Socializing with friends who smoke (7% versus 3%).

Subsidization and insurance for smoking cessation aids

The majority of respondents (81%) were not aware of any smoking cessation aids that are subsidized in their province or community.

Of the options listed, awareness of subsidized options was highest for nicotine patches (10%) and nicotine gum (5%). Those who smoke daily were more likely to be aware of these options. Respondents aged 25-44 and females were also more likely to be aware that nicotine patches are subsidized by their province or community.

Exactly 1 in 5 (20%) respondents reported having insurance that covers all or part of the cost of smoking cessation medication. Just over half of respondents (51%) do not have this type of insurance while 3 in 10 were not sure (29%).

Respondents most likely to report having this type of insurance included women (22%), those who smoke daily (21%), and Indigenous respondents (32%).

Reading materials from doctors or pharmacies

Just 6% of respondents report that they need help when reading instructions, pamphlets, or other written material from their doctor or pharmacy either always (2%) or most of the time (4%) while another 13% say they need help sometimes.

Those aged 25-44 and those who smoke occasionally were more likely to report needing help reading these materials most of the time (7% versus 2% and 7% versus 3% respectively) or sometimes (17% versus 10% and 19% versus 11% respectively).

Respondents who identify as members of a racialized community or as Indigenous were more likely to report needing help reading these materials most of the time (8% versus 3% and 10% versus 4% respectively) or sometimes (23% versus 12% and 21% versus 13% respectively).

Cessation history

Previous attempts to quit smoking

More than 7 in 10 respondents (72%) reported that at some point in the past, they had stopped smoking for at least 24 hours because they were trying to quit, while one quarter (25%) had not done so.

The following sub-segments were more likely to report having attempted to quit in the past:

• Respondents aged 45+ (76% versus 67%);
• Women (75% versus 69%);
• Non-Indigenous respondents (72% versus 61%).

Of those who had stopped smoking for at least 24 hours in the past (n=1,885), more than half (57%) reported having done so in the last 12 months.

The following sub-segments were more likely to report having attempted to quit in the last 12 months:

• Respondents aged 25-44 (66% versus 49%);
• Those who smoke occasionally (86% versus 46% daily);
• Men (63% versus 50%);
• Those with a university education (71%);
• Those earning a household income of $80,000-$100,000 (64%) or more than $100,000 (67%);
• Indigenous respondents (70% versus 56%);
• Members of a racialized community (73% versus 54% not of a racialized community).

Of the respondents who had stopped smoking for at least 24 hours in the past 12 months (n=1,033), 17% had attempted to quit just once, close to half (48%) had made two or three quit attempts, and just under one third (32%) had made four or more quit attempts.

Those who smoke occasionally were more likely to have tried to quit four or more times (42% versus 24%), whereas those who smoke daily were more likely to have tried to quit two or three times (52% versus 42%) or just one time (20% versus 11%).

Cessation strategies

Current and past cessation strategies used

Respondents were presented with a list of smoking cessation strategies and asked whether they were currently using the strategy or if they had used the strategy in the past month.

The strategies used more frequently included the following:

• 56% were currently reducing the number of cigarettes they smoke and another 32% reported having done so in the past 12 months;
• 35% were currently trying to quit smoking on their own and another 44% reported having done so in the past 12 months;
• 21% were using a vaping device with nicotine in attempt to quit smoking and another 22% had done so in the past 12 months;
• 20% were currently using nicotine replacement products, and another 33% reported using these products in the past 12 months.

Other strategies used by fewer respondents included the following:

• 16% had made a deal with a friend or family member and another 23% had made a deal like this in the past 12 months;
• 16% of respondents were using a vaping device without nicotine in attempt to quit smoking while another 19% had done so in the past 12 months;
• 13% were currently using smoking cessation medication such as Zyban or Wellbutrin and another 18% reported using this type of medication in the past 12 months;
• 12% were attending brief counselling with a healthcare professional and another 18% had done so in the past 12 months;
• 10% were using an internet-based smartphone app to help with quitting and another 15% had tried this strategy in the past;
• 9% were attending in-person group counselling to help quit smoking and another 12% had done so in the past;
• 8% were currently using a 1-800 quit line or smokers helpline and another 13% had done so in the past.

Respondents aged 25-44 were more likely than those aged 45 and older and men were more likely than women to be currently using many of these strategies including:

• A vaping product with nicotine (28% versus 14% and 25% versus 16% respectively);
• Nicotine replacement products (26% versus 14% and 25% versus 12% respectively);
• A vaping product without nicotine (20% versus 11% and 19% versus 11% respectively);
• Making a deal with a friend or family member (22% versus 9% and 18% versus 13% respectively);
• Smoking cessation medication (18% versus 8% and 15% versus 9% respectively);
• Brief counselling from a healthcare professional (17% versus 6% and 15% versus 7% respectively);
• In-person group counselling (15% versus 3% and 12% versus 4% respectively);
• An internet-based program or smart phone app (15% versus 5% and 13% versus 6% respectively);
• A 1-800 quit line or helpline (13% versus 4% and 12% versus 3% respectively).

Perceived usefulness of various smoking cessation methods

Almost three quarters (74%) of respondents who reported currently using a vape with nicotine to help quit smoking (n=188) found this strategy useful.

Results were consistent across sub-segments.

Almost three quarters (73%) of respondents who reported making a deal with a friend or family member to help quit smoking (n=144) found this strategy useful.

Respondents aged 25-44 were more likely to find this strategy useful compared to those aged 45 and older (79% versus 57%).

Just over 7 in 10 (71%) of those who reported currently attending in-person group counselling to help quit smoking (n=71) found this strategy useful.

Results were consistent across sub-segments.

Exactly 7 in 10 (70%) of those who reported currently using a 1-800 quit line or smoker's helpline to help quit smoking (n=63) found this strategy useful.

Results were consistent across sub-segments.

Nearly 7 in 10 (68%) of those who reported currently reducing the number of cigarettes they smoked as a strategy to help quit smoking (n=578) found this method useful.

Those who smoke occasionally were more likely to find this strategy useful compared to those who smoke daily (75% versus 63%).

More than two thirds (68%) of those who reported currently using a vaping product without nicotine to help quit smoking (n=140) found this strategy useful.

Results were consistent across sub-segments.

Nearly two thirds (65%) of the respondents who reported currently using smoking cessation medications to help quit smoking (n=112) found this strategy useful.

Results were consistent across sub-segments.

Close to two thirds (65%) of the respondents who reported currently using an internet-based program or smartphone application to help quit smoking (n=84) found this strategy useful.

Results were consistent across sub-segments.

More than 3 in 5 (64%) of the respondents who reported currently using nicotine replacement products to help quit smoking (n=177) found this strategy useful.

Results were consistent across sub-segments.

An even 3 in 5 (60%) of those who reported currently trying to quit smoking without any special preparations (n=356) found this method to be useful.

Results were consistent across sub-segments.

Just under 3 in 5 (59%) of the respondents who reported currently receiving brief counselling from a health professional to help quit smoking (n=106) found this strategy useful.

Results were consistent across sub-segments.

Positive changes from cessation attempts

Respondents who had attempted to quit in the past 12 months were asked about any positive benefits they had experienced from their efforts to quit smoking.

The top benefits included the following:

• Over 3 in 5 (65%) reported having saved money;
• More than 2 in 5 (43%) said breathing was easier;
• Just over 2 in 5 reported that their home, car, breath and clothes smelled better (41%) and that they noticed less coughing and/or wheezing (41%).

Respondents aged 45 and older were more likely to report experiencing less coughing and/or wheezing (47% versus 35%). Those aged 25 to 44 were more likely to report more energy (41% versus 29%), improved quality of life (39% versus 26%), freedom from addiction (29% versus 18%), and setting a good example for children (29% versus 18%).

Those who smoke occasionally were more likely to report experiencing improved quality of life (38% versus 30%), freedom from addiction (31% versus 19%), setting a good example for children (28% versus 21%) and lower blood pressure (18% versus 12%).

Females were more likely to report saving money (69% versus 62%), better smelling home, car, breath and clothes (47% versus 36%), less coughing and/or wheezing (45% versus 38%), and setting a good example for children (28% versus 20%).

Men were more likely to report experiencing improved quality of life in their efforts to quit smoking (35% versus 28%).

Reasons for no longer using cessation strategies

Respondents who reporting having tried one of the presented quit methods within the past 12 months but were no longer using that strategy were asked why their attempt did not lead them to quit smoking long-term.

The main reasons included too much stress (28%), too much difficulty quitting due to being around friends who smoke or when drinking alcohol (26%), smoking was too ingrained in their routine (25%), and too much enjoyment of smoking (25%).

Other key reasons included craving cigarettes (19%), negative impacts on mood (16%), replacement of smoking with bad habits (15%), and that the cessation strategy did not replace the experience of smoking (14%).

Respondents aged 45 and older were more likely to say that they did not quit long-term because they enjoy smoking too much (29% versus 21%) whereas those 25-44 were more likely to indicate that the approach did not fit their schedule (10% versus 3%).

Those who smoke daily were more likely to report too much stress in their life to quit (32% versus 21%) and that smoking was too ingrained in their routine (28% versus 20%).

Females were more likely to say that their life was too stressful to quit (34% versus 24%).

Cessation plans

Future cessation intentions

When thinking about quitting smoking, just under one third of respondents (32%) said they plan to quit sometime in the future (beyond 6 months). A little under a quarter (23%) of respondents reported that they plan on quitting within the next 6 months while a smaller proportion (16%) had more immediate plans and planned on quitting in the next month.

Slightly less than 1 in 5 (18%) reported having no plans of quitting while another 11% were unsure.

Respondents aged 25-44 and those who smoke occasionally were more likely to intend on quitting smoking within the next month (19% versus 14% and 27% versus 13% respectively).

Those who smoke daily were more likely to see themselves quitting sometime in the future beyond 6 months (34% versus 27%) or to not plan on quitting (20% versus 11%). Those aged 45 years or older were more likely to not plan on quitting (21% versus 14%).

Steps taken towards smoking cessation

Just under half of respondents (49%) had started to think about a quit plan. Additionally, more than 1 in 5 had done some research (23%) or discussed their plans with family or friends (22%). A smaller proportion had taken steps towards their quit plan by talking to a healthcare professional (14%) or made detailed steps to handle any potential challenges (10%).

Just under one quarter of respondents had yet to develop a quit plan (23%).

Respondents aged 25-44 were more likely to report that they have done research to help develop their quit plan (27% versus 19%), discussed their plan with family or friends (25% versus 20%), and made detailed steps to handle challenges (12% versus 8%).

Those who smoke daily were more likely to say they thought about their quit plan (51% versus 45%) while those who smoke occasionally were more likely to report having done research (27% versus 21%), discussed their plans with friends or family (26% versus 20%), and made detailed steps to handle challenges (15% versus 9%).

Respondents aged 45 and older and those who smoke daily were more likely to report they had not begun to develop a quit plan (27% versus 20% and 25% versus 19% respectively).

Lastly, men were more likely to say they had done research (26% versus 18%) and made steps to handle challenges (12% versus 8%).

Confidence in ability to quit smoking

Respondents were split when thinking about their confidence in their ability to quit smoking at the present time. A very similar proportion of respondents were confident (32%), neutral (32%) and not confident (33%).

Respondents aged 25-44 and those who smoke occasionally were more likely to report being confident in their ability to quit smoking at the present time (39% versus 25% and 58% versus 22% respectively).

Men were more likely than women to be confident in their ability to quit at the present time (38% versus 25%).

Those earning a household income of $40,000 or more were more confident compared to those earning less than $40,000 (36% versus 24%).

Confidence increased when respondents were asked to think about their ability to eventually quit smoking for good, with the percentage of those confident increasing to half (50%). Still, a fair proportion of respondents were not confident in their ability to eventually quit (17%) while a higher proportion were neutral (29%) and another 4% were unsure.

Respondents aged 25-44 and those who smoke occasionally also reported more confidence in their ability to eventually quit smoking for good (56% versus 45% and 64% versus 45% respectively).

Men were more confident than women that they could eventually quit smoking cigarettes for good (53% versus 47%).

Those with a previous quit attempt were more confident in their ability to quit for good (55% versus 39%).

Perceived importance of smoking cessation

An even 3 in 5 (60%) perceived quitting smoking as important while another quarter (25%) were neutral and fewer (13%) did not feel quitting was important to them.

Results were consistent across age groups.

Respondents who smoke occasionally were more likely to consider quitting to be important (65% versus 59%).

Reasons for continuing to smoke

Respondents who had not made any previous quit attempts and did not have plans to quit (n=1,386) mainly attributed this to the following reasons:

• 38% said they enjoy smoking too much;
• 34% felt that smoking was too ingrained in their routine;
• 27% said their life was too stressful to quit;
• 26% felt that they did not have enough willpower to quit;
• 25% were concerned about the withdrawal symptoms;
• 21% were worried that their attempts to quit would not be successful.

Respondents aged 45 and older were more likely to provide the following reasons:

• they enjoy smoking too much (46% versus 30%);
• smoking was too ingrained in their routine (38% versus 30%);
• they did not have enough willpower to quit (31% versus 22%);
• they were concerned about the withdrawal symptoms (29% versus 22%);
• quitting smoking aids are too expensive (18% versus 13%).

Respondents aged 25-44 and older were more likely to provide the following reasons:

• everyone they know smokes cigarettes (17% versus 8%);
• they believe their health is good (14% versus 9%);
• they don't know where to get information on smoking aids (5% versus 2%);
• they don't know where to start the process of quitting smoking (10% versus 5%).

Those who smoke cigarettes daily were more likely to refer to the following factors that have affected their ability to quit smoking:

• they enjoy smoking too much (43% versus 23%);
• smoking was too ingrained in their routine (40% versus 15%);
• their life is too stressful to quit (30% versus 15%);
• they did not think they had enough willpower to quit (29% versus 16%);
• they were concerned about the withdrawal symptoms (28% versus 17%);
• they are afraid they will not succeed (23% versus 13%);
• their partner or spouse smoked cigarettes (18% versus 12%);
• quitting smoking aids are too expensive (17% versus 9%).

On the other hand, those who smoke occasionally were more likely to say that they believe their health is good (19% versus 9%).

Reasons to quit smoking

The main reason that respondents would be compelled to quit smoking was to improve their health (34%). Other reasons included taking responsibility for their health (18%) and the perception that quitting will be important for many aspects of their life (17%).

A smaller proportion of respondents claimed that they feel pressure from others to stop smoking (8%) or would feel guilt if they continued to smoke (5%).

Slightly more than 1 in 10 (12%) reported not thinking about stopping.

Respondents aged 25-44 were more likely to report feeling pressure from others not to smoke (10% versus 5%) or that they would feel guilty if they smoked (9% versus 2%).

Those aged 45 and older and those who smoke daily were more likely to report that they think quitting is the best thing for their health (38% versus 29% and 35% versus 30% respectively) or that they have not thought about quitting (16% versus 8% and 14% versus 6% respectively).

Respondents who smoke occasionally were more likely to report that they want to take responsibility for their own health (35% versus 30%) or that they would feel guilty if they smoked (9% versus 4%).

Perceived value of various sources of information

When someone is thinking about quitting smoking, there are many different sources of information. Respondents were asked how much they would value various sources of information when it comes to this topic. Respondents aged 25-44 tended to provide higher perceived value across sources of information compared to those 45 years or older. The same trend was observed among individuals who smoke occasionally compared to those who smoke daily.

A friend or family member who has successfully stopped smoking cigarettes was seen as the most valuable source of cessation information. Almost half (47%) considered this a valuable source while 1 in 5 (20%) felt it was not very valuable.

Respondents aged 25-44 and those who smoke occasionally were more likely to perceive a friend or family member who has stopped smoking as a valuable source of cessation information (52% versus 42% and 55% versus 43% respectively).

Health care professionals were considered a valuable resource for cessation information by close to half of respondents (47%).

Respondents aged 25-44 and those who smoke occasionally were more likely to perceive health care professionals as a valuable source of cessation information (52% versus 43% and 55% versus 44% respectively).

Someone who has successfully stopped smoking was considered a valuable resource for cessation information by close to half of respondents (47%).

Respondents aged 25-44 were more likely to perceive someone who has stopped smoking as a valuable source of cessation information (54% versus 40%).

Family members were considered a valuable resource for cessation information by roughly 2 in 5 respondents (41%).

Respondents aged 25-44 and those who smoke occasionally were more likely to perceive family members as a valuable source of cessation information (49% versus 33% and 49% versus 38% respectively).

Individuals who do scientific research of smoking and/or smoking cessation was perceived as a valuable source of cessation information by a little less than 2 in 5 respondents (37%).

Respondents aged 25-44 and those who smoke occasionally were more likely to consider someone that does scientific research on smoking and/or smoking cessation as a valuable source of cessation information (46% versus 28% and 47% versus 33% respectively).

Friends were considered to be a valuable source of cessation information by over one third of respondents (36%).

Respondents aged 25-44 and those who smoke occasionally were more likely to perceive friends as a valuable source of cessation information (46% versus 26% and 49% versus 31% respectively).

Just over one quarter of respondents (26%) perceived non-government organizations such as health charities to be a valuable source of cessation information while a higher proportion (32%) felt there was little value.

Respondents aged 25-44 and those who smoke occasionally were more likely to consider a non-government organization as a valuable source of cessation information (34% versus 19% and 34% versus 23% respectively).

Just under one quarter of respondents (24%) perceived the government to be a valuable source of cessation information, however more than one third (36%) felt the government was not very valuable as an information source on quitting smoking.

Respondents aged 25-44 and those who smoke occasionally were more likely to consider the government to be a valuable source of cessation information (32% versus 18% and 32% versus 22% respectively).

Businesses that sell smoking cessation products were seen as a valuable source of cessation information by a little over 1 in 5 respondents (22%). Close to 2 in 5 (39%) considered this source of information to be of little value.

Respondents aged 25-44 and those who smoke occasionally were more likely to perceive these businesses as a valuable source of cessation information (30% versus 14% and 29% versus 19% respectively).

Celebrities such as social media influences, actors or athletes, were perceived as a valuable source of cessation information by 14% of respondents. More than 3 in 5 (63%) considered celebrities to have little value as a source of information on smoking cessation.

Respondents aged 25-44 and those who smoke occasionally were more likely to consider celebrities to be a valuable source of cessation information (22% versus 7% and 24% versus 11% respectively).

Risk perception and gaps in knowledge

Respondents were presented with a list of statements and asked how much they agreed with each statement.

More than one quarter of respondents (26%) agreed that exercise can undo most of the effects of smoking, however one third (33%) disagreed.

• Respondents aged 25-44 and those who smoke occasionally were more likely to agree with this statement (35% versus 18% and 32% versus 24% respectively).
• Men were also more likely to agree with this statement (32% versus 19%).

Just under one quarter (24%) agreed that whether a person gets lung cancer depends more on genes than anything else while one third (33%) disagreed with this statement.

• Respondents aged 25-44 were more likely to agree with this statement (28% versus 21%).
• Men were also more likely to agree with this statement (28% versus 20%).

A little less than 2 in 5 (17%) agreed that vitamins can undo most of the effects of smoking while just under half (49%) disagreed.

• Respondents aged 25-44 and those who smoke occasionally were more likely to agree with this statement (27% versus 8% and 25% versus 14% respectively).
• Men were also more likely to agree with this statement (20% versus 8%).

Less than 1 in 5 (15%) agreed that there's no risk of getting cancer if someone only smokes for a few years, however more than 3 in 5 (61%) disagreed.

• Respondents aged 25-44 and those who smoke occasionally were more likely to agree with this statement (23% versus 8% and 20% versus 13% respectively).
• Men were also more likely to agree with this statement (24% versus 10%).

Other substance use

Vaping

More than 2 in 5 respondents (42%) reported that they had ever used a vaping device with nicotine and just under one quarter (24%) had used a vaping device without nicotine in the past.

Over 2 in 5 (43%) had not used either type of vaping device in the past. Respondents aged 45 and older as well as those who smoke daily were more likely to report having used neither type of vaping device (55% versus 30% and 46% versus 36% respectively).

Respondents aged 25-44 were more likely to have tried vaping nicotine (49% versus 35%) as well as vaping without nicotine (33% versus 15%).

Those who smoke occasionally were more likely to report using a vaping device without nicotine (33% versus 21%).

Those who had used a vaping product with nicotine in the past (n=1,051) were asked about the frequency of using this type of product within the last 30 days.

Roughly 1 in 5 (19%) had used a vaping product with nicotine daily and a similar proportion (20%) had used one at least once a week. Another 17% had used one about once in the past month.

More than 2 in 5 (43%) reported not using a vaping product with nicotine at all in the past 30 days.

Respondents who had used a vaping product without nicotine in the past (n=544) were asked about the frequency of using this type of product within the last 30 days.

Only 6% had used this type of product daily while less than a quarter (23%) did so once a week and another 28% had used one about once in the past month.

More than 2 in 5 (41%) reported not using a vaping product without nicotine at all in the past 30 days.

Of those who had used a vaping product with nicotine within the past 30 days (n=543), the vaping products differed in nicotine concentration.

More than 1 in 5 (22%) said the product they used contained up to 5 milligrams of nicotine while a higher proportion (28%) used a product with 5 to 10 milligrams of nicotine. Another 15% said the vaping product they used contained 10 to 15 milligrams of nicotine while 20% used a product with 15 to 20 milligrams of nicotine.

Just 3% used a vaping product that contained more than 20 milligrams of nicotine while 13% were unsure of the nicotine concentration in the product they used.

Results were consistent across age and frequency of smoking.

Frequency of vaping

Respondents who had used a vaping product with nicotine within the past 30 days (n=543) also differed on how soon they use the product after waking up.

For 16% of those who vaped nicotine in the past 30 days, their vape was used within 5 minutes of waking up. About 3 in 10 (29%) said they use their vaping product with nicotine within 6 to 30 minutes of waking up. Another 1 in 5 (20%) said they typically use this product within 31-60 minutes of waking up and 29% of respondents do so more than an hour after waking up.

Respondents aged 25 to 44 were more likely to use their vaping device within 5 minutes of waking up (20% versus 9%) while those aged 45 and older were more likely to do so after an hour of waking up (35% versus 26%).

Of those who had used a vaping product with nicotine within the past 30 days (n=543), about one third (32%) report using the device 5 times or less per day and a smaller proportion do so 6-10 times per day (21%). Fewer respondents use the device 11-15 times per day (13%), 16-20 times per day (7%), 21-25 times per day (7%), 26-30 times per day (4%) or 31 or more times per day (5%).

Another 8% did not provide a range but rather said they vape continuously throughout the day.

Results were consistent across age groups.

Those who smoke cigarettes occasionally were more likely to say that they use a vaping device with nicotine continuously throughout the day (14% versus 5%).

Vaping preferences

Preferred product flavours among those who vape typically included fruit (36%), tobacco flavour (18%), mint (14%) or menthol (12%). Fewer preferred candy (8%) or dessert (6%) flavours and 4% said their preferred vaping product is flavourless.

Results were consistent across age groups.

Those who smoke occasionally were more likely to say they prefer mint flavours (20% versus 11%) or no flavour (7% versus 2%).

Women were more likely to prefer fruit flavours (44% versus 31%) whereas men preferred mint flavours more often (18% versus 10%).

Of the respondents who used a vaping device (either with or without nicotine) in the past 30 days (n=711), 2 in 5 (40%) used a disposable device while close more than two thirds (67%) used a reusable device.

Respondents aged 25-44 were more likely to have used a disposable device (45% versus 30%) whereas those 45 and older were more likely to have used a reusable device (74% versus 64%).

Of those who used a reusable vaping device (n=479), more than 2 in 5 (43%) used a device that required a prefilled cartridge or pod. A higher proportion (64%) used a device which contained a cartridge that can be manually refilled with e-liquid.

Those who smoke daily were more likely to use a device containing pre-filled cartridges (49% versus 35%) whereas those who smoke occasionally were more likely to use a device which contains a cartridge that can be refilled with e-liquid (73% versus 59%).

Men were also more likely to use a device which contains a cartridge that can be refilled with e-liquid (68% versus 57%).

Alcohol

Frequency of alcohol consumption

In the past 30 days, a little more than 1 in 5 respondents (12%) reported drinking alcohol daily while 3 in 10 (29%) reported drinking alcohol weekly and another one quarter (25%) drank alcohol about once in the month.

Slightly under one quarter (23%) of respondents said they had not consumed alcohol in the past month and another 8% had never consumed alcohol before.

Respondents aged 45 and older were more likely to report that they drank alcohol daily (14% versus 11%) whereas those 25-44 were more likely to have consumed alcohol weekly (31% versus 26%) or at least once in the last month (29% versus 22%).

Those who smoke daily were more likely to report drinking every day in the last 30 days (14% versus 10%).

Men were more likely than women to have consumed alcohol daily (14% versus 10%) or weekly (31% versus 26%).

Impacts of consuming alcohol on number of cigarettes smoked

Exactly half (50%) of those who consumed alcohol (n=1,676) said they smoked about the same number of cigarettes on days that they drank while 2 in 5 (40%) reported smoking more on the days that they consumed alcohol. Just 6% reported smoking fewer cigarettes on the days that they consumed alcohol.

Respondents aged 45 and older and those who smoke daily were more likely to report having smoked the same number of cigarettes on days that they consumed alcohol (54% versus 46% and 52% versus 43% respectively).

Those who had stopped smoking for at least 24 hours in the past were more likely to report smoking more cigarettes on days when they consumed alcohol (44% versus 31%).

Disposal

Respondents were asked how they dispose various products including cigarettes, vaping devices, and vaping cartridges or e-liquid. The garbage was the most common method of disposal across the products and devices mentioned.

Cigarette butts

When it comes to disposing cigarette butts, the most common method was in the garbage with 22% always, 27% most of the time, and 19% sometimes using this disposal method.

Public ashtrays were used for disposal always for 17% of respondents while 23% used this method most of the time and 32% did so sometimes.

Other ways to dispose of cigarette butts included:

• On the ground (4% did so always while 14% did so most of the time);
• Flushed down a toilet (3% did so always while 7% did so most of the time);
• In the compost (3% did so always while 7% did so most of the time);
• Down a sewer (3% did so always while 6% did so most of the time).

Vaping products

Of those who had tried vaping either with or without nicotine (n=1,291), 2 in 5 (40%) had used a device until the battery died or until the e-liquid ran out while more than half (55%) had not.

Respondents aged 25-44 and those who smoke occasionally were more likely to have used a vaping device until the battery died or the e-liquid ran out (47% versus 30% and 47% versus 37% respectively).

When it comes to discarding disposable vaping devices, the most common method reported by respondents was in the garbage with 31% always discarding this way, 25% disposing of vaping devices this way most of the time, and 18% sometimes using his disposal method.

The recycling bin was used for disposal always for 9% of respondents while 15% used this method most of the time and 16% did so sometimes.

Other ways respondents discarded disposable vaping devices included:

• At a specialized facility (8% did so always while 10% did so most of the time);
• Lost or misplaced it (5% did so always while 11% did so most of the time);
• Gave it to someone else (4% did so always while 8% did so most of the time);
• Returned it to someone else (3% did so always while 8% did so most of the time);
• On the ground (3% did so always while 6% did so most of the time).

Respondents aged 25-44 tended to describe always disposing vaping devices in the recycling bin compared to those 45 years or older (11% versus 4%).

Daily smokers more commonly described always disposing vaping devices in the recycling bin compared to occasional smokers (11% versus 5%).

Of those who had tried vaping either with or without nicotine (n=1,291), half (51%) had stopped using a reusable vaping device while 2 in 5 (41%) had not.

Results were consistent across age groups and frequency of smoking.

Of the respondents who had stopped using a reusable vaping device (n=646), half (50%) disposed of the device while just under half (47%) still own the device. The remaining 3% could not remember.

Respondents aged 25-44 were more likely to have disposed of a reusable vaping device (57% versus 41%).

When it comes to disposing of reusable vaping devices, the most common method was in the garbage with 33% reporting that they always do this, 22% dispose these devices in the garbage most of the time, and 19% sometimes used this disposal method.

Another way to dispose of these devices is at a specialized facility, which is done so always by 11% of respondents while 6% used this method most of the time and 14% did so sometimes.

Other ways that participants disposed of reusable vaping devices included:

• In the recycling bin (10% did so always while 9% did so most of the time);
• Gave it to someone else (6% did so always while 8% did so most of the time);
• Returned it to the retailer (6% did so always while 7% did so most of the time);
• Lost or misplaced it (5% did so always while 10% did so most of the time);
• On the ground (3% did so always while 8% did so most of the time).

Daily smokers tended to report never disposing of a reusable vape in the recycling bin compared to occasional smokers (64% versus 43%).

Of those who had tried vaping either with or without nicotine (n=1,291), more than one third (35%) had either replaced a prefilled cartridge or stopped using the cartridge. More than half (56%) had not replaced or stopped using a prefilled cartridge and another 8% were unsure or could not remember.

Respondents aged 25-44 were more likely to have replaced a prefilled cartridge or disposed of one (38% versus 32%).

Those with a university education were also more likely to have replaced or disposed of a prefilled cartridge (45% versus 31-32%).

Members of a racialized community were also more likely to have replaced or discarded a prefilled cartridge (49% versus 32%).

When it comes to disposing vape cartridges, the most common method was in the garbage with 29% having always done so, 24% disposed of cartridges in the garbage most of the time, and 20% sometimes used this disposal method.

The recycling bin was used for disposal always for 9% of respondents while 15% used this method most of the time and 20% did so sometimes.

Other ways that participants reported discarding vape cartridges included:

• At a specialized facility (6% did so always while 12% did so most of the time);
• Lost or misplaced it (4% did so always while 13% did so most of the time);
• Returned it to the retailer (4% did so always while 11% did so most of the time);
• Gave it to someone else (4% did so always while 10% did so most of the time);
• On the ground (4% did so always while 8% did so most of the time).

Of the respondents who had disposed of or thrown out a prefilled vape cartridge in the garbage or recycling bin in the past (n=366), more than 2 in 5 (43%) reported that they never rinse the cartridge before discarding it. A smaller proportion said they always (9%), most of the time (13%) or sometimes (22%) rinse it before discarding while 11% did so rarely.

Respondents aged 45 and older were less likely to rinse these cartridges before discarding them (55% said they never do compared to 37% of those 25-44).

Those who smoke daily were also less likely to rinse their prefilled vape cartridges before disposal (49% said they never do compared to 32% of those who smoke occasionally).

Of those who had tried vaping either with or without nicotine (n=1,291), more than one third (37%) had finished a bottle of e-liquid or stopped using one while more than half (54%) had not. Another 8% were unsure or could not remember.

Results were consistent across age groups and frequency of smoking.

When it comes to disposal of e-liquid bottles, the most common method was in the garbage with 24% always, 18% most of the time, and 27% sometimes used this disposal method.

The recycling bin was used for disposal always for 12% of respondents while 17% used this method most of the time and 20% did so sometimes.

Other ways that participants reported disposing of e-liquid bottles included:

• Gave it to someone else (6% did so always while 10% did so most of the time);
• At a specialized facility (5% did so always while 8% did so most of the time);
• Lost or misplaced it (4% did so always while 9% did so most of the time);
• Returned it to the retailer (3% did so always while 10% did so most of the time);
• On the ground (3% did so always while 9% did so most of the time).

Of the respondents who had disposed of a bottle of e-liquid either in the garbage or recycling bin in the past (n=410), 1 in 10 (11%) said they always rinsed the bottle before disposing it while 13% did most of the time and 20% did so sometimes.

Another 1 in 10 said they rarely rinsed the bottle before disposing of it and more than 2 in 5 (43%) never did.

Respondents aged 45 and older were more likely to report that they had always rinsed the bottle before disposal (18% versus 7%).

Those who smoke daily were more likely to report that they had never rinsed the bottle before disposal (48% versus 34%).

Batteries in vape devices

Of those who had disposed of a vaping device (n=843), roughly 3 in 10 (29%) had removed the battery from the device.

Respondents aged 25-44 and those who smoke occasionally were more likely to have removed the battery from a vaping device (34% versus 21% and 37% versus 25% respectively).

Respondents who had removed batteries from vaping devices (n=215) mainly report disposing of the battery in the garbage (36%), at a specialized facility (31%), or in the recycling bin (27%).

Fewer respondents returned the battery to a retailer (11%), kept the battery or did not dispose of it (10%), gave it to someone else (9%), lost or misplaced it (5%), or disposed of it on the ground (4%).

Respondents aged 25-44 and men were more likely to return the battery to a retailer (15% versus 3% and 16% versus 2% respectively).

Those who smoke daily were more likely to bring the battery to a specialized facility (40% versus 19%) or dispose of it on the ground (7% versus 0%).

Methodology

Summary: The study consisted of two phases of research: first a series of online focus groups, followed by a national telephone and online survey with Canadian households.

Quorus was responsible for coordinating all aspects of the research project, including designing and translating the research instruments; coordinating all aspects of participant recruitment and related logistics; collecting the data; and delivering the required reports. The research approach is outlined in greater detail below.

Target audience and sample frame

Qualitative

The target audience for this research study consisted of individuals who smoke cigarettes from the following three regions:

• Eastern Canada (English);
• Western Canada (English);
• Quebec (French).

Groups were distributed among the following segments, which were selected due to the higher prevalence of smoking cigarettes (with the exception of racialized individuals which is a lower prevalence segment):

• Age;
• Individuals with low income (less than $40,000 personal income or less than $60,000 household income);
• Individuals with high income (personal income of $80,000 or higher or household income of $100,000 or more);
• Individuals who have been diagnosed with a mood and/or anxiety disorder;
• Individuals who are non-heterosexual;
• Indigenous persons;
• Racialized individuals.

In the design of the recruitment screener, specific questions were inserted to clearly identify whether participants qualified for the research program and to ensure, where applicable, a good representation by age, region, gender, education level, and ethnicity.

In addition to the general participant profiling criteria noted above, additional screening measures to ensure quality respondents include the following:

• No participant (nor anyone in their immediate family or household) was recruited who worked in related government departments/agencies, nor in advertising, marketing research, public relations, a tobacco or e-cigarette company, a smoking cessation company, a legal or law firm, a cannabis-related company, or the media (radio, television, newspaper, film/video production, etc.).
• No participant acquainted with another participant was knowingly recruited for the same study, unless they were recruited into separately scheduled sessions.
• No participant was recruited who had attended a qualitative research session within the past six months.
• No participant was recruited who had attended five or more qualitative research sessions in the past five years.
• No participant was recruited who had attended a qualitative research session on the same general topic as defined by the Researcher/Moderator in the past two years.

Description of data collection procedures

Data collection consisted of online focus groups with smokers aged 25 and older. Each focus group lasted approximately 90 minutes.

For each focus group, Quorus recruited 8 participants with the goal of achieving 6-8 participants per session. All focus group participants were offered an honorarium of $125 after their session.

Participants invited to participate in the focus groups were recruited by telephone through random digit dialing of the general public as well as through the use of a proprietary opt-in database.

The recruitment of participants followed the screening, recruiting and privacy considerations as set out in the Standards for the Conduct of Government of Canada Public Opinion Research-Qualitative Research. Furthermore, recruitment respected the following requirements:

• All recruitment was conducted in the participant's official language of choice, English and French, as appropriate.
• Upon request, participants were informed on how they can access the research findings.
• Upon request, participants were provided Quorus' privacy policy.
• Recruitment confirmed each participant had the ability to speak, understand, read and write in the language in which the session was to be conducted.
• Participants were informed of their rights under the Privacy and Access to Information Acts and ensure that those rights were protected throughout the research process. This included: informing participants of the purpose of the research, identifying both the sponsoring department or agency and research supplier, informing participants that the study will be made available to the public in 6 months after field completion through Library and Archives Canada, and informing participants that their participation in the study is voluntary and the information provided will be administered according to the requirements of the Privacy Act.

At the recruitment stage and at the beginning of each focus group, participants were informed that the research was being conducted for the Government of Canada/Health Canada. Participants were informed of the audio/video recording of their session and of the presence of Health Canada observers. Quorus ensured that prior consent was obtained at the recruitment stage and before participants began their focus group.

All online focus groups were conducted in the evening after regular business hours. The research team used the Zoom platform to host and record focus group sessions (through microphones and webcams connected to the moderator and participants electronic devices, such as their laptop, tablet or smartphone) enabling client remote viewing.

Online focus groups

A total of 19 online focus groups were conducted across Canada between April 5 and April 25, 2023. The details of these groups are outlined in the table below.

Quantitative

The research consisted of an online survey of individuals aged 25+ who smoke cigarettes, conducted through an online panel of households.

Quorus collaborated with Health Canada to finalize the survey instrument in English to meet the research objectives. Quorus translated the client-approved English version of the survey. Respondents had the choice to complete the survey in English or French.

All research work was conducted in accordance with the Standards for the Conduct of Government of Canada Public Opinion Research - Online Surveys. More specifically, Quorus informed participants of their rights under the Privacy and Access to Information Acts and ensure that those rights are protected throughout the research process. This includes: informing participants of the purpose of the research; identifying both the sponsoring department or agency and research supplier; informing participants that the study will be made available to the public in 6 months after field completion through Library and Archives Canada and informing participants that their participation in the study is voluntary and the information provided will be administered according to the requirements of the Privacy Act and the Personal Information Protection and Electronic Documents Act.

A total of 2,548 surveys were completed, with data collection occurring between April 12 and April 28, 2023. Data collection included a pretest of 18 surveys with English respondents and 16 with French respondents. The pretest helped to assess the flow of the survey, understanding of the questions, language, data integrity, and particularly the length of the survey. Upon review of the pretest findings, it was determined that no changes to the questionnaire were needed and as such, surveys completed as part of the pretest were kept as part of the final results.

The survey took on average 19 minutes to complete.

For this study, quotas were established for each province to ensure there was adequate representation to generate sufficient data regionally, which would allow for a more robust analysis. Data was monitored to aim for a 50/50 gender split in each province, and that no specific age cohort was under-represented. A margin of error could not be calculated for the online results due to the use of a non-probability sample, as respondents were only selected from those who had registered to participate in online surveys through a panel.

The online survey participation rate was approximately 85%.

Non-response bias is a possible issue since certain types of people may be more willing to respond to a survey request than others.

The data collected cannot be extrapolated to the overall population of Canadians. Further description of the non-probability sampling approach, including quotas and web panels, can be found here: https://www150.statcan.gc.ca/n1/edu/power-pouvoir/ch13/nonprob/5214898-eng.htm

Data were weighted by region, gender and age using a two-step process to ensure that the data was consistent with the Canadian population overall and then controlled for the incidence of individuals who smoke cigarettes. The two-step process involved the following:

• Step 1 - Obtain General Population Incidence Statistics of Individuals Who Smoke: The data collected from the screening questions in the questionnaire among both eligible and ineligible survey respondents was weighted using the latest general population Census data to obtain incidence statistics of individuals who smoke by age group, by gender and by region.
• Step 2 - Apply Incidence Weights to Eligible Survey Respondents: Respondents ineligible for the full survey were removed from the dataset and the incidence statistics obtained in Step 1 were used to calculate the weights for the updated dataset consisting exclusively of individuals who smoke. The tables below summarize the distribution of eligible respondents without any weights applied (in the column titled "Unweighted") and the distribution once weights are applied (in the "Weighted" column).

Respondent Profile

The following tables detail the demographic composition of the overall survey sample.