The Evaluation of Canada

1
The Evaluation of Canadas Health Warning
Messages 18 Month Follow-UpMurrray Kaiserman1,
Eva M. Makomaski Illing1, Donna Dasko21
Tobacco Control Programme, Health Canada2
Environics Research Group12th World Conference
on Tobacco or Health, August 2003, Helsinki,
Finland
2
Overview

• Health Warning Messages in Canada
• Purpose
• As Health Intervention
• Examples
• Evaluation of Health Warning Messages
• Data Collection
• Results
• Conclusions

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Health Warning Messages in Canada
1994-2000
Post 2000

• Two phase introduction
• Dec 23, 2000 June 26, 2001

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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

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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

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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
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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

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Data Collection ADULTS (Ages 18)General
Population Smokers Telephone Surveys

• Wave 1 (Baseline - prior) November-December
  2000
• N1,502 (1,000 smokers, 502 non-smokers)
• Wave 2 (3 months - post) March-April 2001
• N1,532 (1,015 smokers, 517 non-smokers)
• Wave 3 (6 months - post) July 2001
• N1,543 (1,029 smokers, 514 non-smokers)
• Wave 4 (12 months - post) November-December
  2001
• N1,518 (1,007 smokers, 511 non-smokers)
• Wave 5 (18 months - post) July 2002
• N1,500 (1,000 smokers, 500 non-smokers)

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Data Collection YOUTH (Ages 12-18)Youth
Telephone Surveys

• Wave 1 (Baseline - prior) December 2000
• N1,015 (168 smokers, 847 non-smokers) N363
  potential
• Wave 2 (3 months - post) March-April 2001
• N1,003 (135 smokers, 868 non-smokers) N365
  potential
• Wave 3 (6 months - post) July 2001
• N1,006 (162 smokers, 844 non-smokers) N338
  potential
• Wave 4 (12 months - post) November-December
  2001
• N1,001 (159 smokers, 842 non-smokers) N340
  potential
• Wave 5 (18 months - post) July 2002
• N1,000 (131 smokers, 869 non-smokers) N338
  potential

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RESULTS - SMOKING BEHAVIOUR
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Smoking Behaviour
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Number of Times Tried to Quit
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)
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Methods Used to Quit
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?
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RESULTS - HEALTH EFFECTS OF SMOKING
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Sources of Information About the Health Effects
of Smoking
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?
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Sources of Information About the Health Effects
of Smoking Cigarette Packages
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?
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Health Effects of Smoking Top of Mind Responses
Gum or Mouth Diseases
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?
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Health Effects of Smoking Aided Responses - Gum
or Mouth Diseases ADULTS
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?
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Health Effects of Smoking Aided Responses - Gum
or Mouth Diseases YOUTH
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?
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Health Effects of Smoking Top of Mind Responses
Impotence
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?
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Health Effects of Smoking Aided Responses -
Impotence ADULTS
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?
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Health Effects of Smoking Aided Responses -
Impotence YOUTH
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?
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Specific Health Effects Caused by Smoking
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?
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Specific Health Effects Caused by Second-Hand
Smoke
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?
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RESULTS DEATHS FROM TOBACCO USE
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Smoking Attributable Mortality 45,000 Deaths
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 .?
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RESULTS HEALTH WARNING MESSAGES
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Looking at the Health Warning Messages
Q21a/Q24a About how often do you find yourself
looking at, or reading health warning messages on
cigarette packages? Would it be ..?
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Recall of Specific Health Warning Messages on
Cigarette Packages Adult Smokers
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?
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Recall of Specific Health Warning Messages on
Cigarette Packages Youth Smokers
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?
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Impact of the Health Warning Messages - Informing
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 .?
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Impact of the Health Warning Messages Getting
you to try quitting
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 .?
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Assessment of the Health Warning Messages -
Accurate
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.
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Assessment of the Health Warning Messages
Provide Important Information
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
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RESULTS TOXIC SUBSTANCES
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Toxic Substances in Cigarettes
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?
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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

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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