SURVEY OF YOUTH

(1)

ENVIRONICS

RES E ARC H G ~ 0 U P

WAVE 12 SURVEYS

THE HEALTH EFFECTS OF T OBACCO AND HEALTH

W

ARNING MESSAGES

ON CIGARETTE PACKAGES

SURVEY OF YOUTH

FINAL REPORT

Prepared for: Health Canada

POR#119-06 HC-POR-06-17 Conrracc# H4133-060545/001/CY

Prepared by: Environics Research Group Limited

January 2007

pn5999

Environics Research Group Limired 33 Bloor Street East, Suite 900 .

Toronto, Ontario CanadaM4W 3Hl

tel: 416;920.9010 fax; 416.920.3299 http://www.environics.net

(2)

T ABLE OF CONTENTS

l.0 INTRODUCTION AND EXECUTIVE SUMMARY 3

2.0 SMOKING STATUS .. .

A. Smoking Behaviour and Brands ..

B. Quit Attempts and Potenrial Quitters . 7

3.0 HEALTH EFFECTS OF SMOKING .. .. ..

A. General and Top-of-mmd Effects . .. ..

B. Sources of Information about Healrh Effects .. .

C. Specifie Health Effects Caused by Smoking .. ..

D.

E.

Specifie Healrh Effects Caused by Second-hand Smoke ..

Health Effects Caused by Hydrogen Cyan ide

10 10 13 15 23 27

4.0 HEALTH WARNING MESSAGES.. 29

A. Recall and Reads Per Day... 29

B. Impact of Current Messages... 41 C.

D.

Assessment of Current Messages 44

Avoidance of Messages.... 46

5.0

SUDE AND INSERT... 47

A. Recall and Reads per Day of Siide ..

B. Assessment of Information on Slide ..

C. The Insert.... .. ..

47

49

50

6.0 TOXIC SUBSTANCES 51

A. Awareness of Toxic Substances 51

B. Reads per Day and Impact of Information about Toxic Substances 57

_ApPENDICES Survey Merhods Questionnaires

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l.0 INTRODUCTION AND EXECUTIVE SUMMARY

Environies Researeh Group Limited was commissioned by Health Canada ro conduct a survey of Canadian youth, including yourh smokers and non-smokers. The main objective of the survey was to rovide information to assis

~

'H-th~

the impact of healt warning messages on robacco packaging on youth knowledge and behaviours. These healrh warning messages began appearing on the major tobacco brands in Canada on approximately J anuary l, 2001 and on ail brands by approximately June 30.

The survey assessed sources of informarion about the effecrs of robacco, awareness and knowledge of the healrh effecrs of tobacco, rhe extenc co which specifie diseases are believed co be caused by tobacco and the number of deaths caused by smoking. As well.. ir looked at perceptions of the healrh effecrs of chemicals or roxic substances in cigarettes, particularly hydrogen cyanide.

The survey also measured awareness and recall of the warning messages on borh the exrerior of the packages and on the package slides and inseres, rheir effecr on knowledge and behaviours, including behaviours intended ro avoid the labels. Finally, ir examined awareness of chemicals or toxic substances present in cigarettes, and recall of the information on toxic chemicals printed on the side of cigarette packages.

A survey of adults and adule smokers, aged 18 years and over, was conducted separarely and is discussed.under separare coyer.

One g~l~u~, conducted in December of 2006, was to conduct the sampling and quesrionnaire design in such a mariner as ro allow cornparison with Il previous waves of surveys conducred by Environics: baseline surveys, which were conducted in November and December 2000 prior co the introduction of new healrh warning messages into the marketplace; surveys conducted in March and April2001;a few rnonths afrer new healrh warning messages were firsr introduced inro the marketplace; surveys conducted in July 2001, afrer new labels

had appeared on ail brands; and cracking surveys eonducted in November and December 2001, July 2002, Decernber 2002, July and Augusr 2003, December 2003,.November and December 2004, July and August 2005, and February-March 2006.

The survey of youth aged 12 ro 18 years, which included youth smokers and non-smokers, is based on a sam ple size of 1,000. This survey was conducted from December 6 to December 27, 2006.

A survey based on a sam ple of 1,000 has a margin of error of approximately 3.1 percentage points, 19 rimes in 20.

This report summarizes the findings of the research. In the rables included in this report, we present results for the general population (GP), smokers (5) and potential smokers (PS).

Porenrial smokers include non-smoking youth who say they have tried smoking, have seriously rhoughr about smoking or think they might cry smoking wirhin the nexr month. The sarnple sizes of these groups are:

N M argin of Error (MOE)

General population: 1,000 ±3.1

Srnokers: 85 ± 10.6

Porential smokers: 215 ±6.7

Appended to the report are copies of the English and French questionnaires and a description of the survey merhods, Among the findings of the survey are:

About nine in ren yourh (87%) rhink char cigarette smoking is a major he al rh problem in Canada and 11 percent rhink ir is a miner problem.

When asked top-of-mind what specifie human healrh effecrs or dise as es can be caused by smoking cigarettes, youth are

î

most likely ro mention lung cancer (59%) and cancer in general (37%). Smaller proportions mention lung disease 05%), heart attack/disease/angina (12%), oral cancer - rongue, lips, mouth, thrcar (9%), gum disease/roorh loss/

mourh disease (7%), emphysema (6%), yellow reerh/fingers/

effecr on appearance (6%), asrhma (6%), and respirarory problems/difficulry brearhing/shorrness of brearh (5%).

When asked where they have recencly seen or heard information thar talks about rhe healrh .effecrs of smoking cigarettes, rhe large st proportions of yourh mention school/

university (54%) and television (48%). This is followed by menrion of cigarerre packages (12%), word-of-mourh/family/

friends (11 %), magazines (9%), newspapers (8%), Internet/

website (7%) and billboards (6%).

An overwhelming rnajoricy of youth srrongly agree thar lung cancer (94%) can be caused by smoking cigarettes. Large majorities strongly agree rhar smoking can cause gum or mouth diseases (79%), asthrna (77%), hearr disease (76%), rhroat cancer (76%), rnourh cancer (73%) and premature dearh (70%). More chan one-half of youthstrongly agree char smoking can cause stroke (56%), smaller babies or reduced growrh of babies du ring pregnancy (55%), wrinkles and premature aging (55%), and chronic bronchiris (54%).

Majorities of yourh strongly agree thar second-hand smoke can cause asthma attacks in children (71 %) and lung cancer in non-smokers (68%). About one-half scrongly agree ir can cause chest infections (55%) and bronchiris (54%) in children.

When asked, cop-of-mind, a total of eighr in ren yourh mention no specific healrh effeCcs or diseases thar can be caused by hydcogen cyanide (51 %), or say hydrogen cyanide does not cause any healrh effects or diseases (30%).

ENVIRONICS

HEALTH EPFECTS OF TOBACCO AND HEALTH WARNING MESSAGES _ WAVE 12

3

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An overwhelming number of yourh (90%) say they have seen healrh warning messages on cigarette packages. Youth srnokers (96%) express virtually unanimous recall.

Seven percent of youth report thar they look at or read he al th warning messages on cigarette packages several times a day and nine percent do this about once a day. Over six in ten (63%) look at or read rhese healrh warning messages less frequently, including 31 percent who say the y do this l'ess rhan once a week. Twenry-rwo percent say the y never look at or read these healrh warning messages.

A1most ail youth agree thar that the healrh warning messages are accu rate (94%) and thar the messages provide them with important information about the health effects of smoking cigarettes (92%). Eighr in ten yourh agree thar the health warning messages make smoking seem less attractive (82%).

86 percent of yourh smokers say the messages now on cigarette packages have been effective overall in informing them about the healrh effects of cigarette smoking; sm aller proportions say they have been effective in getting them to

cry to quit smoking (70%), increasing their desire to quit smoking (66%), getting them to smoke less around others rhan they used to (56%) and getting them ro smoke less (53%). These results should be interprered with caution due to the srnall sam pie size of yourh smokers.

When asked, top-of-rnind, what specifie health warning messages they can remember seeing on cigarerre packages in Canada (without looking at a cigarette package), the largesc proportion of yourh recall the messages mentioning lung cancer (21 %). Ocher recalled messages include harmful during pregnancies, harrnfulro fetus or low birrh rate (9%), harmful to others/children (9%), cancer in general (9%), heart disease (7%), second-hand smoke is harmful/dangerous (7%), lung disease (7%), rnouth or gum disease (6%), yellow fingers, gums or ceeth (5 %), impotence (5 %), and dearh/

premature dearh (5%).

When asked, rop-of-rnind, what pictures, images or graphies they can rernernber seeing on the health warning messages now on cigarette packages in Canada (withour looking at a cigarette package), the largest proportion of youth recall

lungs or diseased lungs (32%). Other recalled images include bad, rotten or big teeth (19%), pregnant wornen/with cigarettes (16%), rnouth or diseased mou th (10%), hearr or diseased heart (10%), children, kids or babies (9%), gums or diseased gums (6%), parenrs/morn/dad smoking (6%), lung cancer (5%), pictures of kids watching (5%) and baby/

premature baby (5%).

When yourh are asked, top-of-mind, what, if any, chemicals or roxic substances they can name thar are in cigarettes or cigarette smoke, the largesr proportions mention nicotine (38%) and tar (34%). Sm aller proportions mention tobacco (8%), poison/rat poison/strychnine/cyanide (6%) and carbon monoxide (6%). Twenry-seven percent mention other toxic substances and 14 petcent say there are no chemicals or roxic substances C'none/norhing"). Fourreen percent offer no opinion.

Two-thirds of yourh (67%) think thar chemicals are added tO tobacco when cigarettes are being manufactured.

To obtain a PDF version of the complete report, please contact the Tobacco Control Programme:

Mail: Tobacco Control Programme, Healrh Canada ru, 3507A1

Ottawa, Ontario, Canada K1A OK9

Telephone: 1-866-318-1116 Fax: (613) 954-2284

E-mail: [email protected]

ENVIRONICS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES _ WAVE l2 4

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2.0 SMOKING STATUS

A.

Smoking Behaviour and Brands

Among non-smoking youth, two in ten 09%) say they have at sorne rime tried cigarette smoking, which includes just having a few puffs. Among non-smoking yourh who have never tried smoking, not even a few puffs, five percenc say rhey have seriously thoughtabour trying smoking. Among aIl non-smoking youth, rwo percenc say they mighr rry smoking wichin rhe next rnonth.

Of the youth sampIe, eight percent are smokers and 92 percent are non-smokers. Of aIl yourh, 22 percent can be classified as potenciai smokers; among non-smoking youth, 23 percent cao be classified as porenrial smokers. Pocenciai smokers include non- smoking youch who say chey have rried smoking, have seriously thought about smoking or think they might try smoking withi~

the next month.

From the survey, four percent of youth smoke cigarettes every day and four percent smoke occasionally, Among yourh smokers, 51 percent smoke every day and 49 percent smoke occasionally.

Oider yourh, especially chose aged 17 to 18 years, are more likely rhan younger teens to say they smoke cigarettes every day or occasionally.

Cigarette Consumption

DEC 2000 MAR-APR 2001 JULY 2001 NOV-DEC 2001 JULY2002 DEC 2002 JULY-AUG 2003 DEC 2003 NOV-DEC 2004 JULY-AUG 2005 FEB-MAR 2006 OEC 2006 GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS

Every day 11 64 54 10 65 10 61 62 10 68 63 60 62 63 4 59 4 51

Occasionally (Iess than every day) 36 46 35 39 5 38 5 32 4 37 5 40 4 38 4 37 41 49

Not al ail 83 - 100 87 - 100 84 - 100 83 - 100 88 - 100 85 - 100 89 - 100 88 99 89 - 100 90 - 100 92 - 100 92 100

• Less than one percent

Q.I

At the pruent lime, do )'011. smoee cigar~ttes (manufrtctul'ed or roll your oum} eve,'y da)', oaasionally 0,. nol at ait?

ENVIRONICS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES _ WAVE 12

5

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One in cen Canadian yourh (8%) report having smoked at least

Cigarette Consumption Per Day

100 ci garer tes in rheir life. This number is more rhan twice as Everyday Smokers high among older youth, aged 17 to 18 years.

OEC MAR-MR JUlY NOV-OEC JULY OEC JUlY-AUG OEC NOV-OEC JULY-AUG FEB-MAR

---

OEC

2000 2001 2001 2001 2002 2002 2003 2003 2004 2005 2006 2006

Among yourh smokers who srnoke every day;' a total of 21

percent report smoking more chan 15 cigarettes per day; two Less than 10 cigarettes per day 31 35 25 40 20 29 37 42 31 35 36 35 percent report smoking more than 25 cigarettes per clay. More 10 to 15 cigarettes per day 41 40 49 39 49 48 43 34 42 43 37 44 than four in ten (44%) say rhey smoke between 10 and 15

16 to 20 cigarettes per day 12 12 6 12 9 13 9 13 12 20 6

cigarettes per clay, and about one-rhird (35%) report smoking

21 to 25 ciparettes per day 14 12 17 13 15 7 12 9 10 13

fewer rhan 10 cigarettes per day.

26 or more cigarettes per day 2 4 2 2

Among yourh smokers who smoke occasionally,' 97 percent Q.6

report smoking fewer rhan 10 cigarettes per day on the days thar On average, boto many cigarettes do )'0/1 smoèe per day?

they smoke; the remaining rhree percent smoke more chan 15 Subst1ll1ple: Smoee every day cigarettes per day.

Among youth srnokers, No. 7 (10%) and DuMaurier King Size (9%) are most ofren mentioned as their regular brand of cigarettes, followed by Export "li' Lighr Regular Size (8%),

Cigarette Consumption Per Day

DuMaurier Regular Size (8%), Player's Light Regular Size (6%),

Occasional Smokers Export "li' Medium Regular Size (6%), Canadian Classic Brand

(6%) and Export ''A'' Regular Size (5%). Thirry-two percent OEC MAR-MR JULY NOV-OEC JULY OEC JULy-AUG OEC NOV-OEC JULy-AUû FEB-MAR OEC

mention sorne ether brand, and nine percent say they do not have 2000 2001 2001 2001 2002 2002 2003 2003 2004 2005 2006 2006

a regular brand.

Less than 10 cigarettes per day 92 89 89 85 85 82 88 84 90 97 81 97

10 to 15 cigarettes per day 11 6 13 12 6 6 11

When yourh smokers are asked if they smoke any ether brands of

16 or more cigarettes per day 1 2 3 9 8

cigarettes, 47 percent say they do not smoke any other brand.

dlv'na 2 2

.Q.7

011 tb, days tbas YOIl smoee, about how m.my cigarettes do you smoke?

Subsnmple: Smoèe O{cdsionally

These numbers should be interprered wirh camion, due ra che small sample size (N=44, MOE= ± 14.8 perccnrage points).

Thèse numbers should be incerpreted wirh caution, due ro small sample size (N=41, MOE= ± 15.3 percentage points).

ENVIR:ONICS HEALTH EFFECTS OP TOBACCO AND HEALTH WARNING MESSAGES - WAVE l2 6,

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B.

Ouit Attempts and Potential Ouitters Ouit Attempts

Smokers

Six in ten youth smokers (62%) report having tried to quit smoking; four in ten (38%) have not tried ra quit.

_____ , .~m •

=~- , ~~ __

DEC JULY·AUG DEC Nov·DEC JULY-AuG FEE-MAR DEC

2002 2003 2003 2004 2005 2006 2006

DEC

2000 MAR-APR 2001 2001 ^JULY

Nov-DEC

2001

JUlY

2002

Among yourh smokers who have tried to quit smoking,' more rhan eight in ten (85%) say they have srappedsmoking for a period of 24 hours at least once in the past year, in an attempt to quit. Eleven percent say they have not attempted to quit smoking in the past year.

Yes 66

No 33

dk/na

51 38

69 31

75 25

59 40

55 35

68 32

63 37

69 31

56 44

64 35

62 38

Q.9

Have you ,ve'·lried 10 quit smoking?

Subjample: Smoeer:

Number of Times Tried to Ouit Smoking

Smokers

DEC MAR-APR JULY Nov-DEC JUlY DEC JULY-AUG DEC Nov-DEC JULY-AuG FEE-MAR OEC

2000 2001 2001 2001 2002 2002 2003 2003 2004 2005 2006 2006

Once 21 15 25 21 29 20 23 23 28 19 19 29

Twice 15 25 19 19 20 34 16 20 15 24 26 17

Three times 20 10 13 13 6 12 23 20 15 13 11 12

More than three times 27 37 32 34 37 22 25 33 33 30 35 27

Not in the past year 15 12 10 13 11 11 8 14 11

dk/na 2 1 4

Q.IO

ln tbe pari year; how man)' times have )'OU Itopped Jlnoking/or at least 24 hours becasse you were trying 10 quit jmoking?

Subrample: Smoèers who have tried 10 quit smoking

Thèse numbers should be incerprered wirh caution, duc co small sarnple size (N=53, MOE= ± 13.5 percencage peines).

ENVIRONICS HEALTH EFFEŒS OF TOBACCO AND HEALTH WARNING MESSAGES - WAVE 12 7

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More than five in ren yourh smokers (55 %) report they are now

Potential Ou itters

seriouslythinking of quitting smoking; more th an four in ten Smokers (43%) say they are not,

JUlY-AUG FEB-MAR Die

oEC MAR-APR JUlY NOV-oEC JUlY oEC JUlY-AUG oEC NOV-oEC

2000 2001 2001 2001 2002 2002 2003 2003 2004 2005 2006 2006

Among youth smokers who are seriously thinking about quitting

smoking," six in ten (58%) say they will rry co quit wirhin the Yes 57 50 56 63 60 64 62 58 62 55 55 55

next 30 days. Three in ten (32%) say they will try to quit within No 42 49 44 36 39 36 36 42 38 45 44 43

the nexr six rnonrhs. Eighr percent say they will not try wirhin the

dklna 1 3

next six months,

• less than one percent Survey results since December 2000 have tended ro follow a

ç.n:

seasonal pattern; the proporrion of youth smokers who think

Afe JOU mn" Jeriom/y Ihil1king ofquitting smoking?

they will rry to quit wirhin the nexr 30 days rends to be higher Subsampk: Smoèers in surveys conducred in November and Decernber, and lower

in surveys conducted at other times of year, The resulrs of the current survey follow this pattern,

Potential Ouitters

Smokers

oEC MAR-APR JUlY NOV-oEC JUlY oEC JUlY-AUG oEC NOV-oEC JUlY-AUG FEB-MAR oEC

2000 2001 2001 2001 2002 2002 2003 2003 2004 2005 2006 2006

Wilhin the next 30 days 56 41 37 63 48 49 45 53 46 47 36 58

Within the next 6 months 28 50 49 28 43 42 44 39 45 42 53 32

Not within the next 6 months 12 8 8 4 9 8 10

dklna 2 3 3 2

Q,]]!J

Whell do JOU think .JOU ioil! tly 10 quit?

Subsample: Smokers who are sel'ious/y thinking of qJlùting smoking

4 Thèse numbers should be incerprered wirh caution, due co small sample size{N=45, MOE= ± 14.6 percent age points).

ENVIRONICS HEALTH EFPECTS OF TOBACCO AND HEALTI-I WARNING MESSAGES _ WAVE 12 8

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Among yourh smokers who are seriously thinking about quitting

Ways to Quit

smoking,' chree in <en (32%) say they will use wiU power or go

Smokers

cold curkey to try to quit smoking. Smaller nurnbers say they

wou Id chew gum/candy/food (14%), use nicotine gum (14%), use DEC MAR-hR JULY Nov-DEC JULY DEe . JULY-AUG DEe Nov-Drc JULY-AUG FEB-MAR DEe

2000 2001 2001 2001 2002 2002 2003 2003 2004 2005 2006 2006

.the nicotine patch (13%), eut back gradually (13%), avoid other

Will power/cold turkey/just stop 54 46 54 53 52 42 46 53 47 51 26 32

srnokers or smoking situations (12%), gee more exercise (5%)

or distract thernselves (5 %). Eleven percent mention sorne other Chew gunVcandy/food 4 3 14 11 20 8 17 9 20 19 15 14

ways oc rnerhods, and four percent offer no opinion. Nicotine gum 6 8 6 9 7 23 6 11 12 11 13 14

Nicotine patch 18 7 16 19 17 24 13 13 26 13

The resulrs of the survey suggest inereases sirice February-Mareh Cut back gradually 10 16 8 13 3 8 9 7 13

2006 in the nurnbers of youth smokers who are seriously thinking Avoid other srnokers/sltuatlons

of quitring who would avoid ether smokers or smoking situations, involvingsmoking 8 9 4 7 8 12

use will power/go eold turkey or eut back gradually; they also More exercise/get physically fit 5 1 6 1 3 2 5

suggest a deerease in the nurnber who would use the nicotine Distract yourself 3 2 2 5

patch.

Self-help program 2 3

Drink fluids 2

Zyban 2 2

Mouthwash/spray

Clinlc or group program 2

Seek doctor/prolessional advice Hypnosis

Prescription drugs 2

Oon't start

Other 2 3 4 6

None/nothing

dk/na 11 14 8 10 17

ç.n.

If you uere to quit Jmoking at some point in the [uture, tuba: ways or metbods do you think you would /JJe?

S1/bsampk: Smoèers who di" J,riollsly thù/king of quitting Jmoking

5 These numbers should be incerpreted wirh caution, due co small sample size (N=45, MOE= ± 14.6 perl..:enrage points),

ENVIRONICS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES _ WAVE 12

9

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3.0

HEALTH EFFECTS OF SMOKING

A.

General and Top-of-mind Effects

When asked top-of-mind what specifie human healrh effects or diseases can be caused by smoking cigarettes, yourh are most likely to mention lung cancer (59%) and cancer in general (37 %), Smalier proportions mention lung disease (15 %), hearr arrack/

disease/angina (12%), oral cancer - tongue, lips, rnouth, rhroar (9%), gum disease/rooth loss/mouth disease (7%), emphysema (6%), yellow teeth/fingers/effecr on appearance (6%), asrhrna (6%), and respiratory problems/difficulty brearhing/shortness of breath (5%). Thirry-five percent mention ether hurnan healrh effects or diseases.

About ni ne in ten youth (87%) rhink thar cigarette smoking is a major healrh problem in Canada, Eleven percent think ir is a miner problern. Only one percent rhink it is not a healrh problern.

The results of the currenr survey are essentially the same as chose found in the previous surveys.

Smoking as a Health Problem

There has been a slighc decrease sirice February-March 2006 in the number of youth who mention heart arrack/disease/angina. The resulrs of the current survey are for the most part sirnilar to chose found in December 2000; there has.been a slighr increase in the nurnber who mention yellow reech/fingers/effecc on appearance, and slrghr decreases in the nurnbers who mention oral cancer and hearr attack/disease/angina.

Girls are slightly more likely th an boys to mention cancer in general.

DEC 2000 MAR-APR 2001 JULY 2001 NOV-DEC ?001 JULY2002 DEC 2002 JULY-AUG 2003 DEC 2003 NOV-DEC 2004 JULY-AUG 2005 FEB-MAR 2006 DEC 2006

GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS GP S PS

Major 84 72 84 87 77 88 85 70 84 86 80 82 84 67 83 85 70 84 87 83 85 88 82 84 88 88 85 88 83 86 89 79 89 87 72 87

Minor 13 22 14 Il 19 10 13 24 15 12 16 15 14 22 15 13 23 15 12 16 14 11 15 15 Il 11 14 10 15 12 9 15 11 23 11

Not a problem 2 2 1 3 5 2 2 2 2 1 1 2 2 1 2 2 5 1 2

dklna

• Less tIlan one percent

Q,12

ln gel1eral, do yOli tbin]: that cigarette smoking if a major h",llh problem, a miner b,altbproblem or 110/ a bea/tb problem i;; Canada?

ENVIRONICS HEALTH EFFECTS OP TOBACCO AND HEALTH WARNING MESSAGES - WAVE 12 10

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Health Effects 01 Smoking - Iop-ot-rnind

Cancer -Iung Cancer in general.

Lung disease/lungs (unspecified) Heart attack/disease/angina

Cancer - oral (tongue,.lips, mouth, throat) 13 OEC 2000 GP S PS 60 55 64 35 38 35 16 17 Gum disease/tooth loss/mouth disease 5

Emphysema 9 16 9

Yellow teeth/fingers/elfect on appearance 2 4 Asthma

Respiratory problems/difficulty breathing/

shortness of breath Stroke

Bronchitis/chronic bronchitis Bad breath

Blood circulation problems/blood clots Brain damage/disease

Death/premalure death Addiction

Cancer - breast Second-hand smoke Liver damage/disease

Cancer - ether

Impotence/sexual dysfunction Smaller babies/reduced growth of babies

du ring pregnancy Wrinkles/premature aging

• Less nan one percent

17 17 23 16 15 15

2

68 60 70 34 38 35 13 15 12 21 28 19 14 14 18

6 8 10 16 11

4 4

2 3

2

JULY 2001

GP S PS GP ^DEC²⁰⁰⁶S PS

4 1 2 2 2

4'

NOV-DEC 2001 GP S PS 62 67 65 37 38 37 14 9 14 19 27 16 18 29 18

5 10

3 9

14 2

2

3

JULY 2002 GP S PS

55 58 58 40 35 44 16 13 12 17 18 16 12 17 13

8 11 20 10

6 6 6 10 6

2 3 2

2 4 3 14

DEC 2002 GP S PS 59 64 62 37 33 38 15 11 15 21 19 23 15 17 20

6 6 11 14 15

4 1 8 5

3 4 3

2 2

2

5 11 3 4 4 3 2 2 2

2 1.

OEC 2003 GP S PS 59 65 59 37 35 40 14 10 14 15 21 14 12 18 15 6 12

5 3

6 6

4 2 2 2 2 5 2 2 3

NOV-OEC 2004 GP S PS 57 57 58 38 43 40 17 15 16 17 17 14 12 20 11

6 11 8 11 10

4 6 8 6

6 6

2 4 1 2

2

1.

2 4

2 1

3 2

2 2 4 . 3

fEB-MAR 2006 GP S PS 55 57 58 39 29 40 13 12 11 17 30 17 12 15 15

12 6 9 9 9

1 2 2 1

3 3 2 2

2 11 6

2

3 2 2 2

59 53 58 37 42 37 15 18 13 12 14 12

9 13 5 15 6

6 6 6

9 3 6 3 5 1

5 3

2 2 1 1 MAR-APR 2001

GP S PS

1 2

2

61 57 68 37 42 33 14 12 12 19 17 19 15 23 19

5 10 19 10

5 3 6 6 5 2

JULY-AUG 2003 GP S PS 62 59 62 32 32 35 15 11 14 17 21 14 12 19 14

11 8 10 15 12

434

5 5

2

JULY-AUG 2005 GP S PS 58 50 56 41 43 45

16 20

18 20 19 12 11 12 13 8 15 11 6 2

10 6 11

3 5 4

2 2 - 2

Continued ..

Q.13

What specifie buman health e!ferts or diseases, if any. ca"you tbink oflhat can be caused by smoëing ciga,-etteJ.' Are tbere any otbers?

ENVIRONIGS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES·- WAVE l2 11

(12)

Health Effects 01 Smoking - Top-ol-mind

Continued

DEC 2000 GP S PS

JUl Y-AUG 2003 DEC 2003

GP S PS GP S PS

Poor physical conition/loss of energy Throat disease/problems Coughing

High blood pressure Headaches

Air pollution/environrnemal damage Skin irritations/conditions Preterm birtlVpremature birth Birth defects/problems with pregnaney Elleet on the fetus/unborn child Kidney disease/problerns Eye disease/problems Allergies

Immune system problems Gangrene

Arthritis Stomach problems Diabetes

Osteoporosis/problerns with bones Dizzness/aausca

Fire accidents/burns Misearriages/still births Other

None/nothing dk/na

3

• less than one percent

MAR-APR 2001 JUlY 2001

GP S PS GP S PS

2

DEC 2002 GP S PS

1 2

2

NOV-DEC 2004 JUl Y-AUG 2005 FES-MAR 2006 DEC 2006

GP S PS GP S PS GP S PS GP S PS

2

4 2

2 1

2. 3

2

NOV-DEC 2001 JUlY 2002 GP S PS GP S PS

6 1 2

1.

3

3 4 3 3

Q.13

Wbal Jpecific buman beeùb ifftCIS or disesses,

if

any, can yOIl tbint: oflhat can be caused by JllIoking rigdreftes! Ar' tbere any otbers?

ENVIRONICS

HEALTH EFFECrS OF TOBACCO AND HEALTH WARNING MESSAGES - WAVE 12 12

(13)

B.

Sources of Information about Health Effects

When asked where they have recently seen or heard information thar talks about the healrh effects of smoking cigarettes, the largest proportions of youth mention school/university (54%) and television (48%). This is followed by mention of cigarette packages (12%), word-of-mourh/family/friends (l1 %), magazines (9%), newspapers (8%), Internet/website (7%) and billboards (6%). Fourteen percent mention other sources of information and nine percent say nowhere.

The results of the current survey find chat the number of youth who have seen information about the healrh effecrs of smoking cigarettes on cigarerre packages is essenrially the same as rhar found in February-March 2006 and in rhe baseline survey conducted in December 2000.

Girls are more likely than boys CO have seen or heard this informarion in school/universiry. Older yourh and yourh smokers are more likely rhan orhers to have seen this information on

cigarette packages. Older youch are al 50 more likely to mention newspapers, magazines and television. Yourh aged 12 to 16 are more likely to mention school/university and word-of-rnouth.

Among ,non-smokers, porential yourh srnokers are more likely ro mention cigarette packages. Smoking yourh are less likely ro

mention school/universiry. .

ENVIRONICS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES _ WAVE I2

13

(14)

Sources of Information about Health Effects

DEC 2000 MAR-APR 2001 JULY 2001 NOV-DEC 2001 JULY 2002 DEC 2002 JULY-AUG 2003 DEC 2003 NOV-DEC 2004 JULY·AUG 2005 fEB-MAR 2006 DEC 2006

School!university 48 39 45 44 21 40 40 24 39 49 28 53 37 23 33 47 24 47 40 20 37 51 35 47 54 28 50 42 21 35 57 44 52 54 35 50

Television 49 54 52 56 54 51 48 44 49 53 59 56 54 53 57 56 73 50 55 64 54 51 55 56 45 48 45 55 61 57 48 46 54 48 56 49

Cigarette packages 13 34 14 29 56 34 32 70 35 30 62 33 32 50 37 24 48 28 28 59 31 20 50 24 19 42 23 22 44 29 15 38 21 12 47 14

Word-of-mouthlfamily/friends 11 11 10 10 8 11 14 14 15 14 8 15 15 12 14 15 13 15 12 14 13 12 10 12 15 15 16 16 14 16 12 16 15 Il 15

Magazines 16 16 16 14 11 17 11 9 11 12 14 13 15 13 17 16 Il 21 15 14 18 .15 15 15 8 Il 11 12 19 13 5 13 9 Il Il

Newspapers 6 7 8 7 6 5 6 8 6 4 8 10 9 5 4 Il 6 6 8 9 7 9 8 9

InterneVwebsite 2 3 2 2 2 2 4 4 2 4 6 6 9

Billboards 5 6 5 5 7 8 7 13 8 6 4 4 7 7 4 10 4

Radio 2 5 5 5 4 5 5 3 5 6 5 2 4 6 9 5 4 5 3

Doctor/doctor's office 4 3 2 3 4 5 2 4 2 2

News 2 1 2 2 3 3 4

Bus/public transportation 2. 2 2 3 1

Posters 2

Store 1 2

Books/scientific journals 2

Other tobacco product packages 5

Workplace

-Hospitals/rredical clinics Pamphlets/brochures/flyers Public areas and buildings Home

Advertising/media - general 3

Health associations/agencies Movie theatre

Science Centre

Other 1 3

Nowhere 4 4 4 8 10

dklna 3 3 2

• less !han one percent

Q.14

Thinking general/y aboli! informauon tobicb htlks "bollt tbe !Jeallb effict.r ofJlI1oking cigawteJ, tubere have )'011 seen orbeard any ofibis kin" of information recently? Anyu/bere else?

ENVIRONICS HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES - WAVE l2 14

(15)

C.

Specifie Health Ettects Caused by Smoking

In this section of the survey, respondenrs were read a list of healrh effects and diseases, and were asked the extenr to which they agreed or disagreed thar each can be caused by smoking cigarettes.

An overwhelming majority of youth strongly agree that lung cancer (94%) can be caused by smoking cigarettes. Large majorities strongly agree thar smoking can cause gum or mouth diseases (79%), asthrna (77%), heart disease (76%), throar cancer (76%), mourh cancer (73%) and premature death (70%).

More than one-half of yourh strongly agree thar smoking can cause stroke (56%), smaller babies or reduced growrh of babies during pregnancy (55%), wrinkles and premature aging (55%), and chronic bronchitis (54%)-.

Fewer th an half of yourh strongly agree thar smoking can cause blood clots (42%), premature birrh or prererrn birrh (40%), emphysema (38%), miscarriages (36%), stomach ulcers (28%) and impotence in men (27%). Two in cen Ot fewer strongly agree thar smoking can cause inferriliry (24%), bladder cancer (22%), acne (19%), Multiple Sclerosis (18%), Alzheimer's Disease (18%), arrhriris (17%), gangrene (17%) and hepatitis (14%).

The results of the current survey suggest thar rhere have been increases since February-March 2006 in the proportions of yourh who strongly agree thar almost ail of rhese health effects and diseases can be caused by smoking cigarettes, with the exception of lung cancer, heart disease, rnourh cancer, blood clots, emrhysema, sromach ulcers, impotence, infert ility and bladder cancer, where the proportions are essentially unchanged.

Comparison wirh the baseline survey in December 2000 suggests thar there have been increases in the numbers of Canadian youth who strongly agree thac asthma, premature deach, wrinkles and premature aging, stomach ulcers, infertility, bladder cancer, acne, Multiple Sclerosis, Alzheimer's Disease, arthritis, gangrene, heparitis, blood clots, impotence in men, mourh cancer, gum or rnourh diseases, srnaller babies or reduced growrh of babies du ring pregnancy, and stroke can be caused by smoking.

Among yourh, girls are more likely th an boys to strongly agree chat smoking can cause emphysema, gangrene, acne, gum or mou th diseases, miscatriages, sm aller babies or reduced growrh of babies during pregnancy, premature birth or preterrn birrh, wrinkles and premature aging, throat cancer, asrhrna, rnourh cancer and chronic bronchitis. Boys are more likely to srrongly agree thar smoking can cause heparicis.

Older yourh are more likely ro strongly agree thar smoking

- can cause many of these human health conditions, including

emphysema, impotence in men, asthrna, inferrility, mourh cancer, throat cancer, premarure birth, wrinkles and premature aging, and chronic bronchitis. Younger teens are more likely ro strongly agree thar smoking can cause heart disease, stroke, arrhriris, bladder cancer, heparicis, acne and Alzheimer's Disease.

Those who have seen, read or heard abouc che healrh warning messages now on cigarette packages, and chose who have seen the messages on cigarette packages thernselves, are more likely than those who have not to strongly agree thar smoking can cause wrinkles and premature aging, throat cancer, impotence and infertility. Those who have seen, read or heard about the messages are also more likely to strongly agree thar smoking can cause chronic bronchiris, ernphysema, and gum and rnourh diseuses, while chose who have seen the messages on cigarette packages themselves are more likely ro say the same about premature dearh.

Youth smokers are more likely rhan ethers to srrongly agree that smoking can cause impotence, but chey are more likely co srrongly disagree that smoking can cause arrhriris, bladder cancer, hepariris, Alzheimer's Disease, gangrene and acne. Among non- smoking youth, porential smokers are less likely to srrongly agree thar smoking can cause stroke and sromach ulcers; they are more likely ro srrongly agree thar smoking can cause impotence, mouth cancer, throar cancer, prernarure birth ~nd chronic bronchicis.

ENVIRONICS

HEALTH EFFECfS OF TOBACCO AND HEALTH WARNlNG MESSAGES - WAVE 12 15

(16)

Specifie Health Effects Causee by Smoking

DEC 2000 GP S PS

Lung cancer Sirongly agree Somewhal agree Somewhal disagree Sirongly disagree dk,lna

95 93 96

Gum or moulh diseases Sirongly agree Somewhal agree Somewhal disagree Sirongly disagree dk,lna Aslhma

Sirongly agree Somewhal agree Somewhal disagree Sirongly disagree dk,lna

66 64 68 23 24 21

67 67 72 22 22 21

5

Heart disease Sirongly agree Somewhal agree Somewhal disagree Strongly disagree dk,lna

74 78 74 21 17 21

2

• less !han one percent

MAR-APR 2001 JULY 2001 GP S PS GP S PS

97 94 98 2 5

73 73 76 19 21 17

3

70 71 70 21 20 22

78 76 81 18 19 16

2 3

'95 90 96

72 68 74 19 17 19

8

67 62 73 21 21 17 5

4 3

2

74 75 77 21 16 20

3 3

NOV-DEC 2001 JULY 2002 GP S PS GP S PS

95 96 94

73 75 71 20 19 23

66 72 71 23 17 21

6 5

3

76 78 74 20 16 23 3 2

95 89 95 4 10

75 65 76 18 23 18

3

70 68 72 20 20 19 3 4 2

77 70 75 19 24 21 2 3 1 2

DEC 2002 GP S PS

95 91 95 5

75 75 76 19 17 19

3 5

'71 72 74 21 21 20

4 2

3

78 75 77 18 20 19

2

JULY-AUG 2003 DEC 2003 GP S PS GP S PS

94 92 94 6

75 82 75 19 14 19 4

69 71 71 22 21 24

4 4 2 2

77 82 76 18 14 19

2 2 2

94 92 94 8

74 68 79 20 21 16

10 3

70 57 70 22 30 24 2

76 72 76 20 25 21 2

NOV-DEC 2004 JULY-AUG 2005 FES-MAR 2006 DEC 2006

96 94 97 3 3

77 73 76 17 19 19

3

70 70 69 22 23 23

2 3

77 83 74 18 10 22

2 3

94 93 96 3

79 76 82 15 20 14

3

72 71 78 20 20 18

3 2

2

74 69 73 21 22 22

92 89 90 9

72 70 73 23 22 23

70 74 70 25 21 26

2 1 3 1

2

74 67 71 22 24 22

3 6 1,

94 84 96 10

4 2

79 74 81 16 18 15

4 1 3 3

77 78 76 16 12 16

334 2 5

76 71 76 19 21 17

254

Q,/5

l am going to "ad you a lirt of huma" bealtb effem and diseases tbat may or lIIay nOI he caused by smoking cigarelles, Based on what yOll know or believe, please tell me if you strollg/y agr,c, sometobat ,Igree, someu/bat disagm or .rtrong/y disagree that smoking cigarette: can cali" escb of the fol!owùtg "

ENVIRONICS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES - WAVE 12 16

(17)

DEC 2000

GP S PS

Specifie Health Effects Caused by Smoking

'---~----.---

Throat cancer Strongly agree . Somewhat agree Somewhat disagree . Strongly disagree

dklna

75 76 75 18 18 19 3 1 2 2

Mouth cancer Strongly agree Somewhat agree Somewhat disagree Strongly disagree dklna

66 68 69 21 21 18 6 5 7

4 3 5

3 Premature death

Strongly agree Somewhat agree Somewhat disagree Strongly disagree dklna

63 63 61 23 25' 24 8

Stroke Strongly agree Somewhat agree Somewhat disagree Strongly disagree dklna

44 37 41 30 23 33 11 13 10

4 6 4

11 20 10

• Less than one percent

MAR-APR 2001 JULY 2001

GP S PS GP S PS

3

77 78 81 17 17 14 3 3 2

2 2

69 68 72 21 22 20

67 58 66 21 25 23 7 6 3 2

51 52 49 26 19 26

11 4 12 11 13

72 72 79 21 22 18 3 3 2 3 2

66 62 71 24 28 22 3 2

64 61 61 23 21 28

11 5 4 2

49 53 43 27 18 30

8 10

4 3 13 18 14

75 82 75 20 16 21

222

1 '

71 73 69 22 21 24

334 2 2

64 64 63 23 23 24

6 5

4

49 48 45 27 19 29 8 4 4 13 20 12

73 70 75 20 22 19 2

71 68 72 20 22 17 6

65 55 62 24 27 '25

5 7

9 4

2 2

49 43 45 30 27 32

12 11

7 10

DEC 2002 JULY-AUG 2003 DEC 2003 GP S PS GP S PS GP S PS

73 79 74 21 15 21 3 3 2

3

69 71 69 22 19 25

4 6

61 55 61 25 27 28

6 9 6

3 4

52 54 47 30 21 31 11 12 2

9

74 83 78 21 16 20

2 1 2

70 77 71 21 18 21

5 2 2

66 69 61 24 19 30

4 2

4 3

49 60 49 32 26 32 10

72 74 76 23 21 20

4

71 75 72 21 19 19

5 4 7

63 57 60 24 24 27 13 7

3

51 49 49 32 27 33 10 14 11

3 6 4

3

49 51 45 33 28 33

9 13

10 5 5

NOV-DEC 2004 JULY-AUG 2005 FES-MAR 2006 DEC 2006

GP S PS GP S PS' GP S PS GP S PS

72 81 72 22 13 22

2 3 1 2

73 78 77 19 17 15 3 4

67 64 64 21 18 23

5 9 4 5

55 58 56 27 19 27

7 11 9

75 75 79 20 22 17

1 3 1-

74 76 77 19 17 17 5 2

67 62 64 22 28 22

4 3

51 53 49 31 31 30

7 9

4 7

70 68 68 24 28 27

3 2

72 81 71 22 11 22

3 8

66 67 62 24 18 29 5 8 6

76 75 82 18 15 14

2 7 1 2

73 71 78 21 19 16

3 8

2 3

70 65 -68 19 19 22

4 4 9 432

56 61 51 30 25 33 5 9 5 5 4 3

Q.15

1 am gaing to read yOIt cl list of hllman hcrdth ejftfts and diseases thcJl "M.Y 0,. "lf~Y Ilot be cdltsed hy smoking cigare/u.r. Based on what )'011 ènou. or beiieoe, please tell me if YOII stmngly agree, someiobat agree, somewhrtt dùagree or strang/y diIagree that .i1ll0kirlg cigarettes can ÛlUSf eacb of the followillg ...

ENVIRONICS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES - WAVE 12 17

(18)

DEC 2000 GP S PS

Specifie Heallh Effecls Caused by Smoking

,---~----~---~---~---

Smaller babies or reduced growlh 01 babies during pregnancy

Sironglyagree 51 48. 54

Somewhal agree 29 31 29

Somewhat disagree 7

Strongly disagree dk/na

Wrinkles and premature aging Sirongly agree Somewhal agree Somewhat disaçree Slrongly disagree dk/na

50 53 50 25 23 23 12 9 13 9 13 9

4 2

Chronic bronchilis Stronglyagree Somewhal agree Somewhal disagree Strongly disagree dk/na Blood clots

Sirongly agree Somewhal agree Somewhat disagree Sirongly disagree dk/na

51 56 57 30 31 29

10

34 35 30 35 34 36 14 12 15

7 8 10 11 12

55 55 55 29 26 30 10 7 4 7 4

52 44 52 25 24 25 12 12 13 9 16 8

3

52 64 54 28 23 32

11

36 34 36 37 32 38 12 12 11

13 9 10

54 53 56 29 26 32

50 47 54 22 24 22 13 11 11 10 16 10

50 55 57 23 29 22

17 12

34 31 33 35 32 37 14 18 14 6 7 6 11 12

4 3

37 37 36 38 34 38 11 11 13

566 8 12

DEC 2002 JULY-AUG 2003 DEC 2003 GP S PS GP S PS GP S PS

53 49 50 31 28 37

7 6

5 5

48 44 52 27 23 26 12 14 11

17 8 3

53 64 55 30 24 31

5 2 2 4 6

36 33 35 39 32 40 12 16 15 14 3

5 6

54 56 53 31 23 34

7 10 3 5

50 51 51 24 22 24

12 15

8 11 6 7

50 59 56 28 26 30

6 6 3

2 2

14 . 9

36 36 36 37 29 36 12 17 16

7 4 11 10 8

53 58 54 31 24 31 8 10 .8 2 3 6

49 44 49 25 22 25 15 18 16 8 15 8 2

48 54 49 33 35 35

7 3

10 6

36 36 37 40 33 39 13 17 15

7

4

41 41 44 37 38 37 11 9 10 3 6 2

5 53 56 54

30 29 29 9

·3 4

51 48 52 25 29 24 11 13 11 9 8 9

4 4

49 55 51 31 31 30

6

12 10

42 41 44 36 29 36 10 16 9

4 7

54 59 57 31 26 30

7 7

51 45 55 24 21 2S 13 17 9 8 15 9 4 .

53 58 60 27 27 28

10 2 12 4

40 44 41 37 29 39 10 14

8 4

NOV-DEC 2004 JULY-AUG 2005 FEB-MAR 2006

GP S PS GP S PS GP S PS

4

42 35 39 37 40 37 11 12 15

5 9 53 55 52

31 27 32

6

48 46 48 25 26 25 12 12 12 10 10 5

51 55 52 30 27 32

8 2 12

55 58 57 31 27 28

7 3 5

50 44 50 25 22 25 11 11 12 10 19 10

3

54 64 55 27 24 27

6

10

40 33 36 35 30 37 12 18 12

11 8 10

49 63 48 34 24 33

7 6

47 48 47 29 21 30 15 19 14' 6 13 6

49 54 51 32 35 33

6 2 11

DEC 2006 GP S PS

55 56 58 29 24 28

13 4 3 2 3

55 46 58 25 23 24

9 19 10 2

54 52 60 29 32 24

4 3

10 9

Q.15

1 am going la "ead you a list of buman health effects and diseases thal may or may not be caused. by smoking cigarelW. Based on tubai )'011 know or belieoe, please tell /II'

if

yo« strongly agree, JOIlUWhal agree, someu/ba: disagree 01' Jl1'ongly di.ragree that smoking cigarenes tan canse eacb of tbe follo-wùzg .

ENVIRONICS ^HEALTHEFFEC.TS OF TOBACCO AND HEALTH WARNING MESSAGES _ WAVE 12 18

(19)

Specific Health Effects Caused by Smoking

Premature birth or preterm birth Strongly agree Somèwhat agree Somewhat disagree Strongly disagree dk/na Emphysema

Strongly agree Somewhat agree Somewhat disagree Strongly disagree dk/na

Miscarriages Strongly agree Somewhat agree Somewhat disagree Strongly disagree dk/na Stomach ulcers

Strongly agree Somewhat agree Somewhat disagree Stronqly disagree dk/na

OEC 2000 GP S PS

42 46 44 30 28 29 13 13 12

8

37 48 41 24 19 25

7 5 8

4 4

27 22 22

34 32 36 34 31 31 14 16 16 15 8

10 8

23 23 24 36 27 34 19 27 21 Il Il

13 Il 10

41 36 43 34 32 36 Il 13 9 7 10 6

9

42 48 43 21 23 20

8 8

2 28 22 28

35 29 37 31 28 32 13 19 13

14 12 9

24 20 22 36 28 38 19 24 20

8 18 13 '9 13

42 42 44 33 32 33

10 10

12 7 5 6

38 49 37 20 17 24 9 9 9 2 30 21 27

35 29 38 32 31 35 12 17 12

13 14 9

22 23 23 33 21 37 18 24. 20

9 19 17 1·3 12

NOV-OEC 2001 JULY 2002

GPSPS GPSPS

39 36 37 33 32 34 13 13 15

8 Il 8 9 6

36 43 34 21 27 23

889 3 32 27 31

35 28 34 33 31 36 13 20 12

7 9

12 14 9

22 17 20 39 32 40 18 24 18

9 16 10 13 Il 12

40 39 39 36 34 39 12 Il 12

Il 6

43 48 42 21 20 23

7 4 25 19 26

37 29 36 33 35 35 14 15 14

15 10 5

25 19 25 37 35 35 16 21 19 17 7 14 10 14

OEC 2002 JULY-AUG 2003 OEC 2003 GP S PS GP S PS GP S PS

39. 42 42 36 31 36 12 12 13

42 50 48 25 25 20

8 7

2 22 17 21

36 32 37 34 32 34 13 12 17

9 16 6

24 23 22 41 41 39 15 12 17 7 13 9 20 7

43 45 44 33 37 33

Il 13

5 4

6

38 46 37 22 18 20 6 13 4 28 26 25

36 34 34 33 32 35 13 9 15

18 Il 7

23 22 25 40 37 41 15 15 17

Il 15 15 10

38 40 41 37 36 37 14 17 Il 6

39 43 43 26 21 25 Il 18 13

5 21 14 17

36 36 38 33 31 32 16 19 16

Il 10 3

23 29 20 40 28 45 19 29 21 1-5 6 Il 8

NOV-OEC 2004 JULY-AUG 2005 FEB-MAR 2006 OEC 2006

40 50 42 35 28 32 Il Il 13 6 5 8

38 39 42 23 21 21 10 Il 10

3 4 5 27 25 22

36 35 35 31 24 32 16 27 18 7 10 8

10 8

26 23 21 37 30 41 19 26 22

6 12 15

42 52 47 32 22 31 13 12 12

6 6

4 '

37 60 40 24 15 24

9 8 3

27 15 24

37 36 37 33 32 33 14 13 14 6 12 8 9

25 22 28 37 33 39 19 24 18 8 12 8 Il

36 45 38 35 25 36 18 17 18

5 8 6

35 34 39 26 29 27 10 15 10

3 3

25 18 21

32 39 36 35 31 34 14 13 15 , 6 12 6

12

25 16 22 43 42 50 17 21 16

10 10 Il 6

40 47 44 35 24 33 12 18 Il

566 8

38 40 40 25 19 24 10 16 12

484

23 17 20

36 35 35 36 31 32 12 20 12 6 9 12 10 5 9

28 27 24 40 33 46 15 20 15 6 14 9 Il 6

Q,15

1 am going la t: ead yotl a list of buman health efJém and' diseuses that 1II"Y or !!Iay not be caused by JlllOking cigarettes. Based on wh"t J'ail know (Ir believe, please tell sne

if

yOIl .rIFongly "gree, .romewhal agm, someu/bat diJagree Oy.rt,'ongly diJagree Ihal smoking cigarettes can ceuse eucb of ibe following ",

ENVIRONICS

HEALTH EFFECrS OF TOBACCO AND HEALTH WARNING MESSAGES _ WAVE 12 19

(20)

Specifie Health Effects Caused by Smoking

DEC 2000 GP S PS Impotence in men

Strongly agree Somewhat agree Somewhat disagree Strongly disagree dk'na Infertility

Strongly agree Somewhal agree Somewhat disagree Strongly disagree dk'na

14 18 13 29 27 33 18 19 20 15 21 15 24 14 17

18 19 20 29 23 32 17 24 18 12 15 13 23 19 17

Bladder cancer Stronglyagree Somewhat agree Somewhat disagree Strongly disagree dk'na

18 16 15 29 20 29 26 26 28 16 28 17 Il 10 10 Acne

Strongly agree Somewhat aeree Somewhat disagree Strongly disagree dklna

11 23 14 25 30 28 25·

29 44 33 6 9

27 35 28 27 31 28 16 14 16 Il 15 Il 19 6 17

23 20 24 31 31 34 18 24 18

9 Il 7 20 14 16

19 13 17 29 18 30 25 29 29 15 25 13

13 16 Il

Il 10 24 14 22 30 28 32 26 39 39

27 34 31 26 31. 28 15 12 15 15 9 23 8 15

. 22 22 25

30 31 31 14 18 15

9 10 Il 25 18 17

16 12 16 28 17 27 26 30 28 16 26 17 14 15 13

12 12

22 17 23 28 33 24 29 42 32 10 3 9

30 42 30 30 24 34 14 16 13

8 9

18 15

21 25 21 32 25 35 15 17 16 8 Il 9 23 22 18

)

17 14 15 27 18 24 29 30 33 14 25 15 13 14 12

Il Il

23 12 26 30 29 28 26 43 29

9 9

28 38 29 30 25 33

14 15

9 19 8 19 9 14

24 23 25 32 29 34 17 17 18 8 18 8 19 13 15

17 15 14 29 24 24 26 18 31 15 35 18

12 12

13 10

22 20 18 29 27 32 27 41 28 10 4 12

DEC 2002 GP S PS

26 41 30 31 27 29 15 12 17 7 13 9

20 14

23 31 25 34 24 36 15 14 18 8 14 10 19 18 12

19 19 15 29 23 28 27 25 29 16 26 18

10 9

Il Il 25 20 22 30 26 36 26 39 29 6

JULY-AUG 2003 DEC 2003 GP S PS GP S PS

30 48 37 26 30 28

13 16

7

23 14

23 29 24 31 31 34 16 8 17

6 9 25 24 19

18 17

30 29 31 28 29 29 13 22 15 12 Il 8

12 10

25 22 25 28 29 33 23 32 25 Il Il

26 40 32

32 26 34 18 20 17

6 6

18 Il

23 25 28 37 34 36 16 21 20

10 17 10 Il

17 10 15 23 25 31 28 35 30 14 24 17

8 6

Il Il

28 17 30 31 32 31 22 35 22

8

NOV-DEC 2004 JULY-AUG 2005 FEB-MAR 2006

GP S PS GP S PS GP S PS

29 43 33 28 30 28

13 16

8

21 15

24 33 23 35 32 38 13 13 16

8 Il 5 20 12 15

20 15 21 33 28 29 24 27 28 13 18 13 10 12 9

14 18 10 28 25 24 29 27 30 22 25 26

8 9

27 39 33 28 33 32 15 Il 15 9 Il 9 21 5 10

24 28 30 31 35 30 17 13 .14 8 14 9 20 8 15

18 18 14 32 24 33 24 22 28 15 28 18

9 8 7

15 10 15 27 24 26 26 20 30 24 40 24

5

24 43 25

30 24 31 18 15 18

7 12 22 6 19

21 23 25 35 32 33 18 27 21

6 5

20 13 15

19 10 19 33 24 31 28 36 30 Il 22 13

9 6

12 8 Il 31 23 29 32 32 36 17 27 17 7 9 6

DEC 2006 GP S PS

27 40 35 30 23 25 15 19 16 Il

20 13

24 32 26 34 34 33 15 16 13

7 Il

19 12 17

22 18 21 30 15 29 24 28 26 15 33 15

968

19 20 17 29 20 24 26 26 29 19 31 25

7 5

Q./5

1 am going la read you a list of buman health effects and diseases that IlIay or may nol /Je caused by smoking cigarettes. Based on u·hat yotl know 01- beliet», please "" me

if

you Jtrongly agree, someu/bat agm, someuibat diragree or Jlro/lKly diragree thal.rmoking cigarette: can came esrb of tbe following ...

ENVIRONICS

HEALTH EFFECfS OF TOBACCO AND HEALTH WARNING MESSAGES - WAVE 12 20

(21)

Specifie Health Effects Caused by Smoking

DEC 2000 MAR-APR 2001 JULY 2"001 GP S PS GP S PS GR S PS

Multiple Sclerosis Strongly agree Somewhat agree Somewhat disagree Strongly disagree dk/na

14 13

27 18 29 21 24 24 '16 29 14 22 20 19

Alzheimer's Disease Strongly agree Somewhat agree Somewhat disagree Strongly dlsaçree dk/na

11 8 9 27 20 29 27 28 29 22 33 23

13 11 8

Arthritis Strongly agree Somewhat agree Somewhat disagree Strongly disagree dk/na

12 11 26 12 28 29 35 30 25 37 25 6 9

Gangrene Strongly agree Somewhat agree Somewhat disagree Strongly disagree dk/na

9 10 19 14 19

19 21 22

20 31 23 32 24 30

13 12

29 25 29 21 27 21 13 18 15 24 22 23

12 10

25 14 25 28 36. 30 20 30 21 15 11 14

12 10

26 19 21 29 32 33 22 36 25 11 . 10 11

5 9 20 16 18 19 31 19 20 24 24 31 24 29

11 11

27 22 30 18 20 20 15 24 15 29 29 24

11 10

25 14 27 24 25 26 22 39 22 18 13 15

11 13

26 13 25 30 34 30 21 38 20 13 10 12

19 10 16 15 14 20 21 42 24 36 24 32

NOV-DEC 2001 JULY 2002

GPSPS GPSPS

13 11 28 23 29 20 22 23 15 19 16 24 26 24

11 13 27 14 31 27 29 32 20 32 20 15 13 11

11 8

25 15 27 31 29 34 22 37 22 11 11

8 20 13 22 18 17 22 17 29 18 36 33 29

14 10 12

29 17 30

20 21 21

13 31 14

25 20 23

12 6 10 26 13 26 26 27 27 21 39 24

14 15 13

12 9 12 27 20 23 29 25 30 20 38 21

12 14

12 11

21 13 23

18 17 20 18 39 18 31 20 31

DEC 2002 JULY-AUG 2003 OEC 2003 GP S PS GP S PS GP S PS

15 16 13 30 22 32 19 17 21 14 27 14 21 17 20

13 13 10 30 20 30 27 21 29 19 37 20

12 11

13 11 13 29 21 31 30 29 31 18 29 18 10 10 7

10 10

22 15 20 20 14 24 20 42 20 29 22 25

13 9 10 31 28 33 19 24 23 10 13 12 27 27 22

11 8 32 31 31 25 26 26 17 23 22 16 12 12

12 10

29 22 30 25 23 33 19 27 19 14 19 9

10 10

22 17 23 17 16 20 17 28 17 35 30 29

13 10 16 31 32 30 24 25 25 12 22 11 20 12 18

13 10 15 30 20 27 27 26 28 18 33 18 12 11 11

12 10

30 19 31 28 31 31 20 34 19

10 9

11 9 10 26 20 32 21 24 21 15 28 16 26 19 21

NOV-OEC 2004 JULY-AUG 2005 FEB-MAR 2006 OEC -2006 GP S PS GP S PS GP S PS GP S PS

14 15 12 33 28 35 18 21 19 10 15 10 25 21 24

13 10

30 25 27 27 31 33 18 25 17 12 10 13

12 6 10 28 21 26 30 32 33 21 36 24 10 5

11 10 24 19 23 18 19 21 16 25 19 31 27 29

16 10 14 30 25 28 20 20 26 12 28 14 23 17 18

12 14

33 21 35 24 31 24 18 33 20 12 10

13 12

27 13 27 31 41 30 21 35 25 8 3 6

11 10 8

23 16 28

19 24 16 17 28 23 30 23 25

12 6 11 31 26 26 22 27 28

10 17 12

25 25 23

10 33 21 30 29 36 33 17 28 18 12 9 12

11 11

29 17 26 30 40 32 19 30 21

11 9 10

11 7

26 28 23

20 17 25

12 21 15

32 28 29

18 20 18 35 26 32

17 23 20

11 18 12 20. 13 18

18 12 21 30 18 26 25 33 26 15 27 17 11 10 10

17 12 18 30 16 28 28 37 23 18 32 25

8

17 16 18 26 10 25

17 28 15

14 34 20 26 12 22

Q.15

1 am going to resd vo« a liss of buman bealtb elfect.r and diseases that may or ma)' not be ruused by smoking cigareues. Baud on what yOIl knl1W (W belùve, pùese tell me

if

yOIl st"ongly agree, sometuha:

agree, someuibat disagree or m'ongly diragm that smoking cigarettes can callSe eecb of the following _ ..

ENVIRONICS

HEALTH EFFECfS OF TOBACCO AND HEALTH WARNING MESSAGES - WAVE 12 21

(22)

Specifie Health Effects Caused by Smoking

...

,._"---_,,,----

DEC 2000 MAR-APR 2001 JULY 2001 NOV-DEC 2001 JULY 2002 DEC 2002 JULY-AUG 2003 DEC 2003 NDV-DEC 2004 JULY-AUG 2005 FEB-MAR 2006 DEC 2006

Hépatitis

Strongly agree 10 8 9 10 9 Il 10 Il 7 10 10 10 7 10 6 10 14 14 12

Sornewhat agree 23 14 22 20 14 16 23 18 25 21 15 23 26 20 24 25 Il 23 25 17 27 27 24 24 25 22 23 26 19 30 26 18 26 26 12 25

Somewhat disagree 27 24 29 29 34 33 25 23 29 29 31 27 26 29 29 29 30 27 27 30 28 30 35 35 31 27 31 28 24 28 32 30 33 26 33 26

Strongly disagree 26 40 26 25 35 27 26 42 27 26 34 28 23 32 28 23 36 30 22 29 25 20 33 19 22 34 25 23 44 26 21 34 22 23 37 27

dklna 15 13 14 15 10 16 17 12 14 14 15 14 15 10 13 29 22 25 18 18 14 12 12 12 10 12 13 10 10 13 8 12 12

Q.15

1"," going ta read yolt a list of bumnn beattb efficts and diseases that ma)' or ma)' Ilot be cawed hy smoki71g cigare/w. Based on what vou know or belieue, pleaJ' tell me lfyoli Jtrongly agree, sometuba!

agree, someu/hat dùagrl!e or Jtrong!y dùrJ.gree that smoking cigarette: fan Cause each of the follo'wing ."

ENVIRONICS HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES - WAVE 12 22

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D.

Specific Health Effects Caused by Second-hand Smoke

. In this section of the survey, respondents were read a list of healrh effecrs in non-srnokers, and were asked about rhe extent to which they agreed or disagreed thar each can be caused by second-hand smoke.

Majorities of yourh strongly agree thar second-hand smoke can cause asrhrna artacks in children (71 %) and lung cancer in non-smokers (68%). Abour one-half srrongly agree ir can cause chesr infections (55%) and btonchitis (54%) in children. Sm aller proportions srrongly agree thar second-hand smoke can cause heart disease (46%) and strokes (31%) in non-smoking adults, SIDS (Sudden Infant Dearh Syndrome) or crib dearh (29%), ear infections in children (16%), and Alzheimer's Disease (15%), Multiple Sclerosis (14%) and arthritis (14%) in non-smoking adults.

The results of the current survey suggest thar there have been increases since February-March 2006 in the proportions of . yourh who srrongly agree thar second-hand smoke can cause

ail of these healrh effecrs in non-smokers. Comparison wirh the baseline survey of December 2000 suggesrs chat rhere have been increases in the proportions of yourh who srrongly agree thar second-hand smoke can cause lung cancer in non-srnokers, hearr disease, srrokes, Multiple Sclerosis and Alzheirner's Disease in non-smoking adulrs, and asthma attacks, bronchiris and SrDS in .children.

Among youth, girls are more likely rhan boys ro srrangly agree thar second-hand smoke can cause SIDS, chesr infections, bronchiris and asrhma atracks in children, hearr disease and arthritis in non-smoking adults, and lung cancer in non-smokers.

Older yourh are more likely than orhers co srrongly agree rhat second-band smoke cari cause chest infections and bronchitis in children, and lung cancer in non-srnokers; younger yourh are , more likely to agree chat ir can cause arrhritis in non-smoking

adules and ear infections in children.

Those who have seen, read or heard about the health warning messages now appearing on cigarette packages, and rhose who have seen the messages on cigarerre packages themselves, are more likely [û srrongly agree thar second-hand smoke can cause asthrna and bronchitis in children, and lung cancer in non- srnokers.

Porenrial smokers among yourh are less likely, to strangly agree thar second-hand smoke causes lung cancer in non-smokers, Yourh srookers are more likely to srrongly disagree char second- hand srooke can cause arthritis, Multiple Sclerosis and Alzheimer's Disease in non-smoking adulrs, and SIDS and ear infections in children.

ENVIRONICS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES _ WAVE l2 23