The Evaluation of Canada’s Health Warning Messages: 18 Month Follow-Up Murrray Kaiserman 1, Eva M....
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Transcript of The Evaluation of Canada’s Health Warning Messages: 18 Month Follow-Up Murrray Kaiserman 1, Eva M....
The Evaluation of Canada’s Health Warning Messages: 18 Month Follow-UpMurrray Kaiserman1, Eva M. Makomaski Illing1, Donna Dasko2
1 Tobacco Control Programme, Health Canada2 Environics Research Group
12th World Conference on Tobacco or Health, August 2003, Helsinki, Finland
Overview
Health Warning Messages in Canada• Purpose• As Health Intervention• Examples
Evaluation of Health Warning Messages• Data Collection• Results
Conclusions
Health Warning Messages in Canada
1994-2000 Post 2000
Two phase introduction:
Dec 23, 2000 & June 26, 2001
Purpose of Health Warning Messages
To inform consumers of the hazards of tobacco use
Secondary Effects:
To encourage cessation
To reduce consumption
To encourage avoidance of the use of tobacco products where they can harm others
Health Warning Messages as a Health Intervention
Frequency of exposure – 74 million hits per day
Target audience – the smoker, including the potential quitter & the potential smoker
Intervention – delivered at time of smoking behaviour
Examples of New Health Warning Messages in Canada
“Canadian warnings are the most vivid in the world and serve as the model for other countries” [The Tobacco Atlas, 2002]
Evaluation of the New Health Warning
Messages –
MAIN OBJECTIVE of SURVEYS –
to provide information to assist in evaluation of the new health warning messages and their effect on public & consumer knowledge & behaviours
Data Collection – ADULTS (Ages 18+)General Population & Smokers Telephone Surveys
Wave 1 (Baseline - prior): November-December 2000
•N=1,502 (1,000 smokers, 502 non-smokers)
Wave 2 (3 months - post): March-April 2001
•N=1,532 (1,015 smokers, 517 non-smokers)
Wave 3 (6 months - post): July 2001
•N=1,543 (1,029 smokers, 514 non-smokers)
Wave 4 (12 months - post): November-December 2001
•N=1,518 (1,007 smokers, 511 non-smokers)
Wave 5 (18 months - post): July 2002
•N=1,500 (1,000 smokers, 500 non-smokers)
Data Collection – YOUTH (Ages 12-18)Youth Telephone Surveys
Wave 1 (Baseline - prior): December 2000
•N=1,015 (168 smokers, 847 non-smokers) [N=363 potential]
Wave 2 (3 months - post): March-April 2001
•N=1,003 (135 smokers, 868 non-smokers) [N=365 potential]
Wave 3 (6 months - post): July 2001
•N=1,006 (162 smokers, 844 non-smokers) [N=338 potential]
Wave 4 (12 months - post): November-December 2001
•N=1,001 (159 smokers, 842 non-smokers) [N=340 potential]
Wave 5 (18 months - post): July 2002
•N=1,000 (131 smokers, 869 non-smokers) [N=338 potential]
Smoking Behaviour
30%
17%
36%
28%
13%
36%
31%
15%
33%
25%
17%
36%
28%
13%
32%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Adult Smokers Youth Smokers Potential Smokers (Youth)
Wave 1 (Baseline) Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Number of Times Tried to Quit
20%
14%
10%
16%
40%
24%
16%
9%
18%
33%
21%
15%
20%
27%
15%
29%
20%
6%
37%
8%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
Once Tw ice Three > Three Not in Past Year
Adults (Wave1) Adults (Wave 5) Youth (Wave 1) Youth (Wave 5)
Q7/Q10 In the past year, how many times have you stopped smoking for at least 24 hours because you were trying to quit smoking? (W5 - Adults: 79%; W5 - Youth: 59%)
Methods Used to Quit
0%
10%
20%
30%
40%
50%
60%
Will Power Patch Zyban Nicotine Gum Gradually Candy Other
Adults (Wave1) Adults (Wave 5) Youth (Wave 1) Youth (Wave 5)
Q8c/Q11c If you were to quit smoking at some point in the future, what ways or methods do you think that you would use?
Sources of Information About the Health Effects of Smoking
0%
10%
20%
30%
40%
50%
60%
70%
Television CIGARETTEPACKAGES
New spapers Magazines Radio School/University Word of Mouth
Adult Smokers - W1 Adult Smokers - W5 Youth Smokers - W1 Youth Smokers - W5
Youth, Potential - W1 Youth, Potential - W5
Q11/Q14 Thinking generally about information which talks about the health effects of smoking cigarettes, where have you seen or heard any of this kind of information recently? Anywhere else?
Sources of Information About the Health Effects of Smoking – Cigarette Packages
33% 34%
14%
57%
66%
34%
57%
70%
35%
60%62%
33%
58%60%
37%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Adult Smokers Youth Smokers Potential Smokers (Youth)
Wave 1 (Baseline) Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q11/Q14 Thinking generally about information which talks about the health effects of smoking cigarettes, where have you seen or heard any of this kind of information recently? Anywhere else?
Health Effects of Smoking – Top of Mind Responses – Gum or Mouth Diseases
1%
4%
5%
2%
9%
5%
4%
6% 6%
4%
7%
6%
4%
8%
7%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
Adult Smokers Youth Smokers Potential Smokers (Youth)
Wave 1 (Baseline) Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q10/Q13 What specific health effects or diseases, if any, can you think of that can be caused by smoking cigarettes? Are there any others?
Health Effects of Smoking – Aided Responses - Gum or Mouth Diseases – ADULTS
49% 53% 48%54% 50% 53%
29%29%
29%
31%28% 26%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Adult Smokers -W1
Adult Smokers -W5
Male Smokers -W1
Male Smokers -W5
Female Smokers -W1
Female Smokers -W5
% A
gre
e
Strongly agree Somewhat agree
Q12/Q15 I am going to read you a list of human health effects and diseases that may or may not be caused by smoking cigarettes. Based upon what you know or believe, please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that smoking can cause each of the following?
Health Effects of Smoking – Aided Responses - Gum or Mouth Diseases – YOUTH
64% 65% 65%73%
66%78%
24% 23% 23%19%
23%
17%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Youth Smokers -W1
Youth Smokers -W5
Male Youth - W1 Male Youth - W5 Female Youth -W1
Female Youth -W5
% A
gre
ee
Strongly agree Somewhat agree
Q12/Q15 I am going to read you a list of human health effects and diseases that may or may not be caused by smoking cigarettes. Based upon what you know or believe, please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that smoking can cause each of the following?
Health Effects of Smoking – Top of Mind Responses – Impotence
3%
9%
4%
2%
4%
1%
2%
4%
2%2%
6%
1%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
Adult Smokers Youth Smokers Potential Smokers (Youth)
Wave 1 (Baseline) Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q10/Q13 What specific health effects or diseases, if any, can you think of that can be caused by smoking cigarettes? Are there any others?
Health Effects of Smoking – Aided Responses - Impotence – ADULTS
14%19% 16% 18%
13%20%
23%
29%
26%
32%
19%
24%
0%
10%
20%
30%
40%
50%
60%
70%
Adult Smokers -W1
Adult Smokers -W5
Male Smokers -W1
Male Smokers -W5
Female Smokers -W1
Female Smokers -W5
% A
gre
e
Strongly agree Somewhat agree
Q12/Q15 I am going to read you a list of human health effects and diseases that may or may not be caused y smoking cigarettes. Based upon what you know or believe, please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that smoking can cause each of the following?
Health Effects of Smoking – Aided Responses - Impotence – YOUTH
18%
38%
14%
28%
15%
27%
27%
25%
29%
31%
28%
29%
0%
10%
20%
30%
40%
50%
60%
70%
Youth Smokers -W1
Youth Smokers -W5
Male Youth - W1 Male Youth - W5 Female Youth -W1
Female Youth -W5
% A
gre
e
Strongly agree Somewhat agree
Q12/Q15 I am going to read you a list of human health effects and diseases that may or may not be caused by smoking cigarettes. Based upon what you know or believe, please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that smoking can cause each of the following?
Specific Health Effects Caused by Smoking
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LUNGCANCER
Emphysema GUM/MOUTHDISEASE
Blood clots IMPOTENCE Infertility Acne
% Agree
Adult Smokers-W1 Adult Smokers-W5 Youth-W1 Youth-W5
Q12/Q15 I am going to read you a list of human health effects and diseases that may or may not be caused by smoking cigarettes. Based upon what you know or believe, please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that smoking can cause each of the following?
Specific Health Effects Caused by Second-Hand Smoke
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LUNG CANCERIN NON-
SMOKERS
Chest infectionsin children
Strokes in non-smoking adults
Sudden InfantDeath Syndrome
Multiple Sclerosisin non-smoking
adults
Arthritis in non-smoking adults
% Agree
Adult Smokers-W1 Adult Smokers-W5 Youth-W1 Youth-W5
Q13/Q16 Here is a list of human health effects and diseases that may or may not be caused by breathing in second-hand smoke from cigarettes. Based on what you know or believe, please tell me if you strongly agree, somewhat agree, somewhat disagree, or strongly disagree that smoking can cause each of the following?
Smoking Attributable Mortality – 45,000 Deaths
16%15%
18%19%
24% 24%23%
28%
21%
26%28%
24%
27%
36%
27%
0%
5%
10%
15%
20%
25%
30%
35%
40%
Adults Smokers Youth Smokers Potential Smokers (Youth)
Wave 1 (Baseline) Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q15/Q18 Which of the following do you think is the closest approximation of the number of Canadians who die each year as a result of tobacco use? Is it closest to ….?
Looking at the Health Warning Messages
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Several times a day About once a day Once every two orthree days
About once a week Less than once aweek
Never
Adult Smokers - W1 Adult Smokers - W5 Youth Smokers - W1 Youth Smokers - W5Youth, Potential - W1 Youth, Potential - W5
Q21a/Q24a About how often do you find yourself looking at, or reading health warning messageson cigarette packages? Would it be …..?
Recall of Specific Health Warning Messages on Cigarette Packages – Adult Smokers
19%
16% 16%17%
9%
18%
16%15%
17%
8%
17%16%
20%
22%
9%
23%
18%
24%
18%
11%
0%
5%
10%
15%
20%
25%
30%
Harmful duringpregnancies
Causes lungcancer
IMPOTENCE Harmful toothers/children
MOUTH/GUMDISEASE
Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q23 Without looking at a cigarette package, when it comes to the new health warning messages on cigarette packages, what specific health warning messages can you remember? Are there any others?
Recall of Specific Health Warning Messages on Cigarette Packages – Youth Smokers
15%
20%
29%
27%
11%
20%
22% 22%
26%
8%
14%
21%
32% 32%
7%
17%18%
30%
27%
8%
0%
5%
10%
15%
20%
25%
30%
35%
Harmful duringpregnancies
Causes lungcancer
IMPOTENCE Harmful toothers/children
MOUTH/GUMDISEASE
Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q26 Without looking at a cigarette package, when it comes to the new health warning messages on cigarette packages, what specific health warning messages can you remember? Are there any others?
Impact of the Health Warning Messages - Informing
54%
74%
64%
79%
69%
84%
68%
83%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Adult Smokers Youth Smokers
% E
ffec
tive
Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q27/Q30 Thinking about the new health warning messages you have seen on cigarette packages, have these messages been very effective, somewhat effective, not very effective or not at all effective in each of the following ways ….?
Impact of the Health Warning Messages – Getting you to try quitting
36%
50%
38%
51%
43%
55%
45% 44%
0%
10%
20%
30%
40%
50%
60%
Adult Smokers Youth Smokers
% E
ffec
tive
Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q27/Q30 Thinking about the new health warning messages you have seen on cigarette packages, have these messages been very effective, somewhat effective, not very effective or not at all effective in each of the following ways ….?
Assessment of the Health Warning Messages - Accurate
78%
88%93%
77%
85% 87%82%
90%94%
80% 82%
95%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Adult Smokers Youth Smokers Potential Smokers (Youth)
% A
gre
e
Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q25/Q28 Thinking generally about new health warning messages on cigarette packages in Canada, do you strongly agree, somewhat agree, somewhat disagree or strongly disagree with each of the following statements….
Assessment of the Health Warning Messages – Provide Important Information
78%
95% 94%
78%
90%93%
81%
96% 96%
80%
85%
94%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Adult Smokers Youth Smokers Potential Smokers (Youth)
% A
gre
e
Wave 2 (3 Months) Wave 3 (6 Months) Wave 4 (12 Months) Wave 5 (18 Months)
Q25/Q28 Thinking generally about new health warning messages on cigarette packages in Canada, do you strongly agree, somewhat agree, somewhat disagree or strongly disagree with each of the following statements…
Toxic Substances in Cigarettes
0%
10%
20%
30%
40%
50%
60%
Nicotine Tar Carbon monoxide Benzene Hydrogen cyanide Formaldehyde
Adult Smokers-W1 Adult Smokers-W5 Youth Smokers-W1 Youth Smokers-W5Youth,Potential-W1 Youth,Potential-W5
Q32/Q35 Without looking at anything, what if any, chemicals or toxic substances can you name that are in cigarettes or cigarette smoke? Are there any others?
Conclusions
Smokers’ awareness of the health outcomes of smoking remains high
Smokers continue to strongly support and approve the new health warning messages
Smokers continue to read the messages
Conclusions After 18 months, messages continue to be noticed
• with a trend away from general mention of pictures and towards reference to specific images (e.g. pictures/diseases of mouth/teeth), design elements or messages
After 18 months, smokers’ learning is continuing to show definite signs of growth
After 18 months, health warning messages are not demonstrating any indication of wear out