W AVE 8 SURVEYS

ENVIRONICS

RESEARCH GROUP

W AVE 8 SURVEYS

THE HEALTH EFFECTS OF TOBACCO

AND HEALTH WARNING MESSAGES ON CIGARETTE PACKAGES

SURVEY OF YOUTH

Prepared for: Health Canada

POR-03-69

Prepared by: Environics Research Group Limited

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March 2004

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Environics Rcseurch Group Limi:cd

33 Bloor Screer East, Suite 900 Toromo, Ontario

Canada M4\X1 3H l

[el: 4l6.920.90l0 fax: 4l6.920- 3299 http://www.environics.nec

TABLE OF CONTENTS

1.0 INTRODUCTION

2.0 SMOKING STATUS . .. .. . . A. Smoking Behaviour and Brands . B. Quit Attempts and Poreriuai Quitters

3.0

HEAL TH EFFECTS OF SMOKING A.

B.

C

General and Top-of-mind Effects

Sources of Information about Health Effeets Specifie Health Effects Caused by Smoking

D. Specifie Health Effeets Caused by Second-hand Smoke E. Health Effects Caused by Hydrogen Cyanide

4.0 HEALTH WARNING MESSAGES A.

B.

c.

D.

Reeall and Reads Per Day . lm pact of Currenr Messages . Assessment of Currene Messages

Avoidanee of Messages .

5.0

SUDE AND INSERT . . A. Recall and Reads per Day ofSlide. . . B. Assessmene of Information on

C. The

6.0 _TOXIC SUBSTANCES .

A. Awareness of Toxic Substances .

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

ApPENDICES Survey Merhods Questionnaires

3

4 4 6

9 9 12 14 22 26

28 28 41 43 45

46 46 48

49

50 50 55

1.0 INTRODUCTION

Environies Researeh Group Limited was eommissioned by Health Canada to conducc a survey of Canadian yourh, including youth smokers and non-smokers. The main objective of the

Sl~~_s_to_ vide information (0 assise in che evaluation

of the impact of new health warnins. messages on to acco p~ onfôûtlïKiloWTedge and behaviours. The new health warning messages began appearing on the major robacco brands in Canada on approximate.y January l, 2001 and on ail brands as of approximately June 30.

The survey assessed sources of information about the effecrs of cobaeco, awar eness and knowledge of the health effecrs of tobacco, the extenr co which specific cliseases are believcd to be caused by tobacco and the nurnber of dearhs caused by smoking.

As weil, the sur vey looked at perceptions of the healrh effcci s of ehemicals or roxic substances in cigarettes, particularly hydrogcn cyan ide. The survey also measured awarencss and reeall of the new warning messages on borh the ex ter ior of the packages and on the package si ides and inser ts, the ir effcct on knowledge and behaviours, including behaviours intended tO avoid the new labels. Finally, the survey 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 aduits ancl aclult smokers was conduetecl separately ancl is diseussecl under separate coyer.

One goal of the new surveys was co concluct the sampling and questionnaire design to allow comparison with seven previous waves of su~eys:surveys conôuct"ëd- by En-vironic; in

J

^uly-and

August 2003: after the labels had been appearir.g on ail brands for appr oxirnarcly two years: surveys conducted in December 2002, afrer the labels had been appearing on most brands for alrnosr two years; surveys conclucced in July 2002, afrer the new labels hacl been appearing on ail brands for at least a year; in Novernber and December 2001, afrer the new labels hacl been appcaring on ali brands for at leasr six months; surveys inJuly 200 l , after the new labels hacl appeared on ail brands; surveys conducted in March and April 200 l, a few monrhs afrer the new health warning messages were introducecl inro the mar ketplace ; and baseline sur veys, which were eonductecl in November and December 2000, prior to the introduction of the new health warning nlessages inro the marketplace.

The survey of youth agecl 12 co 18 years, which included vouth srnokers and non-smokers, is based on a sam pie size of 11°00 ..

This survey was conducted between December 2 ancl 22, 2Q_Q3..

A survey based on a sam pie of 1,000 has a margin of error of approximatcly 3.1 percemage points, 19 times in 20.

This report summarizes the finclings of the research. In the tables incluclecl in this report, we present results for the general population CGP), srnokers CS) and porenrial smokers CPS). The sam pie sizes of these groups are:

General population:

Smokers:

Porenrial srnokers:

1,000 117 286

Appended to this report are copies of the English and French questionnaires and a description of the survey methods.

ENVIRONICS

HEALTI-I EFFECTS OF TOI3ACCO AND I-IEALTH \XIARNING MESSAGES - \XIAVE 8 3

2.0

SMOKING STATUS

A.

Smoking Behaviour and Brands

From the survev, seven percent of youth smoke cigarettes every day and five percent srnoke occasionally. Among youth srnokers, 60 percent smoke every day and 40 percent smoke occasionally.

Older youch, especially chose aged 17 CO 18 years, are more likely than younger teens CO say chey smoke cigarettes every day or occasionally.

Among non-smoking youth, about three in re n (28%) say they have at sorne cime rried cigarette smoking, which includes just having a few puff.s. Among non-smoking youth who have never cried smoking, not even a few puffs, six percent ,ay they have seriously thought abouc nying smoking. Among ail non-smoking youth, one percent say they might try smoking within the next monrh.

Cigarette Consumption Per Day

DEC 2000 MAR APR 2001 JULY 2001 NOV DEC 2001 JULY 2002 DEC 2002

GP PS GP PS GP PS GP PS GP PS GP PS

Every day Il 64 7 54 10 65 10 61 8 62 10 68

Occasionally (Iess Ihan every day) 6 36 6 46 5 35 39 5 38 5 32

Nol al ail 83 100 87 ^- 100 84 - 100 83 - 100 88 - 100 85 - 100

. Less Ihan one percent Q.l

Of the youth sam pie, 12 percent are smokers and 88 percent are non-smokers. Of ail yourh, 29 percent can be classified as porencial smokers; among non-smoking youth, 32 percent can be c1assified as potential smokers. Porential smokers include any youth who say they have nied smoking, have seriously thought about smoking or think they might try smoking wirhin the next month.

JULY·AUG 2003 DEC 2003

GP PS GP PS

63 4 37

89 100

60 40

88 99

AI the [rresent lime, do yo" ,i7l]nke ciy,or(!l1e.î (mClmtfm:{urecl 01" roil yOllr oum) et/el)! clay, occa.firma/ly or not al aff?

ENV! RON les

I-IEMTI-I EFFECTS or TOUACCO AND I-IEALTI-I WARNING MESSAGES _ \"(!AVE 8 4

About one in ten Canadian youth (12%) report having smoked at least 100 cigarettes in rheir life. This number is more than rwice as high among older yourh, aged 17 tO 18 years.

Among youch smokers who smoke every day, a rota! of 23 percent report smoking more than 15 cigarettes per day;

including two percent who report smoking more than 25 cigarettes per day. About one-rhird (34%) say they smoke between ten and 15 cigarettes per day, and about four in teri (42%) report smoking fewer rhan teri cigarettes per day.

Among yourh smokers who smoke occasionally, 1 more than eight in ten (84%) report smoking fewer than ren cigarectes per day on the days char they srnoke, six percent smoke berween ten and 15 cigarettes per day, and nine percent srnoke more than 15 cigarettes per day.

Among yourh srnokers, DuMaurier King Sile (Il %) and Du'Maur ier Regular Sile (11 %) are most often mentioned as their regular brands of cigarettes. Sm aller proportions mention Export "f'I.' Regular Sile (8%), Players Light Regular Sile (8%), DuMaurier Light King Sile (8%), No. 7 (6%), Export "A"

Medium Regular Sile (6%) and Belmont Milds brand name (5%). Twenty-nine percent mention sorne orher brand, and nine percent say they do not have a regular brancl.

When youth smokers are askecl if chey smoke any orher brancls of cigarettes, 52 percent say they do nor smoke an)' ether brancl.

Thcsc nurnbcrs should he inter pretee] wirh caution, duc co smalt samp!e size (N=4H).

Cigarette Consumption Per Day Everyday Smokers

'=>'-'.""'-" __ ''''='«''.'''''_'",,,w..w#>.,, __ , ... ___ ~ __ .... , ... , "--~~,--,-,"'-,-,=,-,-«''''''''~~=",.., .. -=-'''*'~'''' . -"'="~'«'-"'<~"""="'~'-<

OEC MAR-ApR JUlY NOV-OEC JULY OEC JUlY-AUG OEC

2000 2001 2001 2001 2002 2002 2003 2003

Less Ihan 10 cigarettes per day 31 35 25 40 20 29 37 42

10 10 15 cigarettes per day 41 40 49 39 49 48 43 34

16 10 20 cigarettes per day 12 12 12 9 13 9

21 1025 cigarettes per day 14 12 17 13 15 9 7 12

26 or more cigarel1es per day 2 2

Q.6

On (We1'ClKe, bou. mcmy rt~arelfeJ do Y0/( smolee per da)'?

Su/JJamjJ/e: Sm()ke eI/eIJ' day

Cigarette Consumption Per Day Occasional Smokers

JUlY Nov-DEG JULY DEC

2001 2001 2C02 2003

Less Ihan 10 cigarettes per day 92 89 89 85 85 82 88 84

1010 15 cigarelles per day 5 11 13 12 6

16 or more cigarettes per day 3

dk/na

Q.7

On the da)'.! tbûl yrm smolze, about bou. man)' cigarettes do yotl J7JJoke?

SUÙîamjJ!e: Smnke ocrclJùmalLv

ENVI RON ICS HE,\LTH EFFECTS OF TOBACCO AND HEilLTH \X/ARNING MESSAGES - \X/AVE 8

B.

Ouit Attempts and Potential Ouitters

More rhan six in ten youth srnokers (63%) report having rried co quit smoking; just under four in teri (37%) have not tried to quit.

Arnong youth srnokers who have tried co quit smoking,' more than nine in ten (96%) say they have stopped smoking for a period of 24 hours at least once in the past year, in an at ternpt ro quit. Four percent say they have not arrernpted co quit smoking in the past year.

Thcsc numbers shnuld oc inœrpr ctcd with caution, duc (0 smal l snmp!e sizes (N = 72).

Ouit Attempts Smokers

Yes No dklna

OEC

2000

66 33

68 32

JULY

2001

Nov- DEC .... IULY

2001 2J02 2002 ^DEC

65 35

... uLy-AUG

2003 2003 ^DEC

63 37 61

38

69 31

75 25

39 40

Q.9

Haoe );011 euer trica ln quit .rmokinr..?

Ssbsample. Smoeers

Number of Times Tried to Ouit Smoking Smokers

Nov-DEC JUlY DEC DEC

2001 2002 2002 2003

Once 21 15 25 21 29 20 23 23

Twice 15 26 19 19 20 34 16 20

Three limes 20 10 13 13 12 23 20

More Ihan Ihree limes 27 37 32 34 37 22 26 33

Nol in Ihe past year 15 12 10 13 11 11

dklna _{2 l'}

Q.1O

ln tbe /Ja.1'1 yeCl/; hou! mcmy times have )'Olt stopped J7noking!or at least 24 hours becarrse )'01/. uiere 11Jlin[? tc quit J7l7oking?

S!lIJJamjJ/e: Sn;nk(1)" tobo bave Iried 10 qllit .fmoking

ENVI RON ICS

I-IE,\LTI-I EFFECTS OF TOIJ,KCO AND I-IEALTI-I \XlA RNING MESSAGES _ WAVE 8 6

About six in ren yourb smokers (58%) report the y are now seriously thinking of quitting smoking; about four in teri (42%) sa y they are not.

Among youth smokers who are seriously thinking about quitting smoking,' more than [ive iCi ten (53%) say they will cry to quit within the next 30 days. Four in ten (39%) say they will cry to quit within the next six monrhs. Four percent say they will not try wirhin the nexr six months.

There has been no significant change sirice July-August 2003 in the number of youth smokers who have tried to quit or who say chey are seriouslv thinking of quitting. The current resulrs also suggest no significant change in the nurnber of porenrial quirters who think they will try to quit within 30 days."

Thcse number s should he inccrprcrcd wirh caution, duc (0 smal! samplc sizcs (N=(1:i).

4 The sam pic of potcnrinl quir tcrs is srnal l (N=<'iR); chis finding should he vico-cd wirh caution.

Potential Ouitters Smokers

DEC MAR-APR JULY Nov-DEC JlJlY DEC JULY-Auc DEC

2000 2001 2001 2001 2002 2002 2003 2003

Yes 57 50 56 63 60 64 62 58

No 42 49 44 36 ::9 36 36 42

dklna

• Less than one percent

Q.lla

Are J'rJ1l nou/ seriousl» thinking of quitting smoeing?

S"/;JtunjJ/e: Smoken"

Potential Ouitters Smokers

DEC MAR-ApR JULY Nov-DEC JULY DEC JULY-Auc DEC

2000 2001 2001 2001 2002 2002 2003 2003

Within the next 30 days 56 41 37 63 48 49 45 53

Within Ihe nexl 6 monlhs 28 50 49 28 43 42 44 39

Nol wilhin Ihe nexl 6 months 12 6 8 9 8

dk/na

ç.n»

Il/ben do yO!l ibint: yON u.il! 11J' tf) quit?

SIIIJJetmjJ!e: Smoeers who are Jerio/./J<JI thinking

0/

quitting smoking

ENVI RON ICS

HEALTH EFFECTS or TOBACCO AND HEALTH WARNING MESSAGES - WAVE 8 7

Among yourh smoker s who are seriously thinking about quitting smoking,' more than five in ten say they will use will power or go cold turkey (53%) tO try ro quit smoking. Smaller nurnbers say they would use the nicotine patch (24%), use nicotine gum (11 %), chew gum/candy/food (9%), eut back gradllally (5%), or avoid other smokers and situations involving smoking (4%).

Twelve percent mention sorne other ways or merhods, and eight percent offer no opinion.

Thcsc numbcrs should be incctprcted wuh camion, duc (0 small sa rnp]e sizcs (N = 68).

Ways to Ouit Smokers

Will power/cold Iurkey/jusi stop Nicotine patch

Nicotine gum Chew gum/candy/food Cut back gradually

Avoid other smokers/situations involving smoking Distract yourself

Zyban

Clinic or group program More exercise/gel physically fit Seek doctor/professional advice Sell-help program

Drink fluids Hypnosis Prescription drugs Don't star:

Olher None/nothing dk/na

DEe MAR-ApR JULY Ncv-Dsc ,_lULY DEe JULY-AUG DEe

2000 2001 2001 2001 2002 2002 2003 2003

54 46 54 53 52 42 46 53

9 18 7 9 16 19 17 24

8 9 23 Il

4 14 Il 20 17 9

10 16 8 8 13 8

2 3 4

2 2

Il 14

Q./ le

lf yo» uere 10 quit .rmoking (li sorne poin! in the fU/lire, wbat waYJ or met!:JocÙ do yn1/ think yOft wOllld use?

SII!J.ramjJ!e: Srnoken iobo are .îerùm.dy thinking of quittin[!. Jmoking

ENvrRONrcs

HEALTH EFFECTS OF TOGACCO AND HEALTH \XlAfu'JING MESSAGES _ WAVE 8 8

3 0 HEAL TH EFFECTS OF SMOKING

A.

General and Top-of-mind Effects

AbOLIt ni ne in ten yourh (88%) think thar cigarette smoking is a major heal rh problern in Canada. Eleven percent think ir is a minor problern. Only one percent think ir is not a health problern.

When asked what specifie human health effecrs or diseases can be caused by smoking cigarettes, youth are most likely ro mention ILlng cancer (59%). Smaller proportions mention cancer in general (37%), heart attack/disease/angina (15%), lung disease (14%), oral cancer - rongue, lips, mou th, rhroar (12%), emphysema (9%), gum disease/roorh loss/rnouth disease (6%), asthrna (6%), respirarory problerns/difficulry br earhing/shor t ness of br eat h (5 %) and yellow teeth/fingers/effect on appearance (5%). Thirty-one percent mention ether hurnan health effects or diseases.

There has been a slight increase since July-August 2003 in the proportion who mention cancer in general. The results of the current survey are sirnilar to rhose found in December 2000.

Older youth are more likely than or hers to mention ILlng cancer, oral cancer and ernphyscma.

The results of the cur rent survey are essentially the sarne as chose found in the previous sur veys.

The view thar smoking is a major health problem is slightll' lower among yourh srnokers and pore ntial youth srnokers.

Smoking as a Health Problem

DEC 2000 MAR-APR 2001 JULY 2001 . NOV-DEC 2001 JULY 2002 DEC 2002 JULY-AUG 2003 DEC 2003

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

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

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

dk/na

• Less than one percent

Q.12

ln genel'ttf, cio yOIl think ,hat Clj:,arette J7nokinJ!. if a mttjr)'/' bert/th problem, a rninor heafth jJro!J/em or not a hect/th pmblem in Canada?

ENVIRONICS HEI\LTH EFFECTS OF TOUM:CO AND HEALTH W'ARNING MESSAGES - WAVE 8

9

Health Effects of Smoking - Top-of-Mind

" """",,,,.,,,,.

Cancer - lung Cancer in general Hearl attackldisease/angina Lung disease/lurqs (unspecilied) Cancer - oral (tangue. lips, mouth, throat) Emphysema

Gum disease/tooth loss/rnouïh disease 4

Asthma 5

Respiratory probtems/diHiculty breatlling/

shortness 01 breath

Yellow teeth/lingers/effect on appearance Bronchitis/chronic bronchitis Bad breath

Stroke

Brain damage/disease

Btood circulation problems/blood clots Cancer - other

Death/premature death Addiction

Second-hand smoke Impotence/sexual dysfunction Liver damage/disease

Poor physical condilion/loss of energy Smaller babies/reduced growth of babies

during pregnancy

• Less than one percent

DEC 2000

GP PS

60 55 64

35 38 35

17 23 16

t 6 17 17

13 15 15

16

MAR-APR 2001 J U L y 2001 NOV-OEC 2001 JULY 2002 DEC 2002 JULY-AUG 2003 OEC 2003

GP PS GP PS GP PS GP PS GP PS GP PS GP PS

68 60 70 61 57 68 62 67 65 55 58 58 59 64 62 62 59 62 59 65 59

34 38 35 37 42 33 37 38 37 40 35 44 37 33 38 32 32 35 37 35 40

21 28 19 19 17 19 19 27 16 17 18 16 21 19 23 17 21 14 15 21 14

13 15 12 14 12 12 14 9 14 16 13 12 t 5 11 15 15 11 14 14 10 14

14 14 18 15 23 19 18 29 t8 12 17 13 15 17 20 12 19 14 12 18 15

10 t 6 11 10 19 10 14 11 20 10 11 14 15 10 15 12 9 12

6 8 5 6 7 8 6 6 6 9 11 6 8

6 10 3 5 4

10 14 11 9

2 3 3

4

5 3 3 7

2 3 3 3

5

Continued "

Q.13

\Fhal .Ijm:ific buman bèaùb e!JecJ.J or diseases, li cm)'! (cm yO/l think

oJ

tbai can be cauJed hy Jm()king cigC/ret/ô? Are tlzere any others?

ENVIRONICS

HEALTH EFFECTS OF T013A((~O AND HEALTH \XfAfu'JJNG MESSAGES - WlAVE 8 10

Health Effects 01 Smoking - Top-ol-Mind

Conlinued

PS

MAR APR 2001 GP S PS

1 1 1 Cançer - breast

Birlh defects/problems with pregnancy Skin irritations/conditions

Throat disease/problems Effect on the tetus/unborr child Kidney disease/problems Headaches

Preterm birth/premature birth Eye disease/problems Allergies High blood pressure Cougl1ing

Wrinkles/premature aging Diabetes

Immune system problems Gangrene

Dizz.ness/rausea

Osteoporosis/problems with bones Stomach problems

Air polfu'.on/env-rorrncntal damage Miscarriages/still births Other

None/nothing dk/na

• Less than one percent

DEe 2000 GP

1

JULY 2001

GP PS 1

PS 1

GP 1

PS GP

1

PS 1

GP S 1 1

PS 1

GP 1

PS GP

1 1

Q./J

\f/hal JJJe(:ific human heaLth eJJec/_î (JI' diseases, If an)', (cm yOIl think ofthat (an he cCllt.fed Il)' .ï?!loking cigarettes? Are tbere any otbers ?

ENVIRONICS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARJ'IING MESSAGES - IX'AVE 8 11

8.

Sources of Information about Health Effecs

\Vhen asked where they have recently seen or heard information thar talks about the health effects of smoking cigarettes, the largest proportions of youth mention television (51 %) and school/universiry (51 %). This is followed by mention of cigarette packages (20%), magazines (15%), word of mouth/family/friends (12%), newspapers (7%), bill boards (6%), radio (5%) and Internet/website (5%). Sixteen percent mention ether sources of information and five percent say nowhere.

The results of the current survey find thar the nurnber of youth who have seen or heard information about the health effecrs of smoking cigarettes on cigarette packages has decr eased by eight points from

J

uly-August 2003, but rernains a cotai of seven points higher than in December 2000. The nurnber who mention school/university is Il points higher than in j uiy- August 2003, but is similar co the nurnbers found in Novernber- December 2001 and December 2002.

Girls are more likely than boys to have seen this information in magazines. Older you th and youth smokers are more likely th an others co have seen this information on cigarette packages. Older youth are also more likely re mention magazines and television.

Youth aged 12 to 14 are more likely CO mention school/university and word of mou th. Among non-srnokers, potential youth smokers are more likely co mention cigarette packages, but they are less likely to mention school/university.

--- --- --- --- --- ---

ENVtRONICS

I-I::ALTH EFFECTS or TOUACUl ,\ND I-IEALTH WARNING MESSAGES - \X/AVE 8 12

Sources of Information A.bout Health Effects

OEC 2000 MAR-APR 2001 JULY 2001 NOV-DEC 2001 JULY 200, OEC 2002 JULY-AUG 2003 OEC 2003

GP S PS GP S PS GP S PS GP S PS GP S '5 GP 5 P5 GP 5 P5 GP 5 P5

49 54 52 56 54 61 48 44 49 53 59 56 54 53 57 56 73 60 55 64 54 51 55 56

48 39 46 44 21 40 40 24 39 49 28 53 37 23 33 47 24· 47 40 20 37 51 36 47

13 34 14 29 66 34 32 70 35 30 62 33 32 60 37 24 48 28 28 59 31 20 50 24

16 16 16 14 Il 17 Il Il 12 14 13 15 13 17 16 Il 21 15 14 18 15 15 16

Il Il 10 10 8 Il 14 14 15 14 8 15 15 12 14 15 13 15 12 14 13 12 10 12

6 7 8 7 6 6 6 3 5 6 8 10 8 8 9 8 4 7 Il

6 8 6 7 13 8 7

5 3 6

6 Television

School/universi1y Cigarelle packages Magazines

Ward of mouth/family/friends Newspapers

Billboards Radio Internel/webs ite Doctor/doctor's office Bus/public transportation Posters

News

Hospitals/medical clinics Store

Public areas and buildings Advertislng/media - general Books/scientiflc journals Movie theatre

Pa m phi et s/broc h u res/flye rs Other tobacco product packages Workplace

Health associations/aqencies Other

Nowhere dk/na

• l.ess than one percent

3

Q.14

ThinkiJ7l. genera/<y a/)(mt informati()n which ta!k.r a!J(}lIt the !Jet/llh ejJè({,f nf-,)nok.inf!, CJ~!!,flrefle.f, iobere have yOlt seen or beerd any 0/ ibis kind ni inform,-:ttùm recent/y? A nywhere elfe?

ENVI RON ICS HEALTH EFFECn OF TOBACCO ,IND HEALTH \XI,IR1\)ING MESSAGES - \XIAVE R

13

c. Specific Health Effects Caused by Smoking

ln rhis section of rhe survey, respondenrs were read a lisr of healrh effecrs and diseases, and were asked rhe exte nr (0 which they agreed or disagreed thar each can be caused by smoking Cigarettes.

An overwhelming majoriry of yourh srrongly agree rhar lung cancer (94%) can be caused by smoking cigarerres. Large majorities strongly agree that smoking can cause hearr disease (76%), gum or rnouth diseases (74%), rhroar cancer (72%), mourh cancer (71 %), asrhrna (70%) and premature dearh (63%).

About one-ha If of youth srrongly agree thar smoking can cause sm aller babies or reduced growrh of babies during pregnancy (53%), srroke (51 %), wrinkles and premature aging (49%), and chronic bronchiris (48%).

Fewer rhan half of you rh srrongly agree thar smoking can cause ernphyserna (39%), premarure bir th or prererm birrh (38%), blood clots (36%), miscarriages (36%), impotence in men (26%), stomach ulcers (23%) and infertility (23%). Fewer than rwo in teri each srrongly agree thar smoking can cause bladder cancer (17%), Mulriple Sclerosis (13%), Alzheirners Disease (13%), arrhriris (12%), acne (11 %), gangrene (11 %) and hepatiris 00%)

The resulrs of the current survey suggest rhat rhere have been slighr decreases from rhe July-August 2003 survey in rhe proportions of yourh who srrongly agree rhat impotence, and premature birrh can be caused by smoking. Cornparison wirh rhe baseline survey in December 2000 suggesrs rhar rhere have been increases in the nurnbers of Canadian yourh who srrongly agree rhar imporence in men, inferrility, rnouth cancer, gum or rnourh diseases, and srroke can be caused by smoking.

Among yourh, girls are more likely rhan boys ro srrongly agree thar smoking can cause many of these hurnan healrh condirions, including asrhma, emphysema, hearr disease, srroke, chronic bronchiris, gum and rnourh diseases, infer tilit y, impotence in men, miscarriages, smaller babies or reduced growrh of babies du ring pregnancy, premature birrh or prererm birth, and wrinkles and premature aging.

Older yourh are more likely ro strongly agree thar smoking can cause many of rhese human healrh conditions, including asthrna, emphysema, impotence in men, inferriliry, mouth cancer, rhroar cancer, gum and rnouth diseases, wrinkles and premature aging, miscarriages, smaller babies or reduced growrh of babies during pregnancy, premature birth, premature death and chronic bronchicis. They are less likely ta strongly agree that smoking can cause gangrene, ar thr ius, bladder cancer and acne.

Those who have seen, read or heard about rhe healrh warning messages now on cigarette packages, and those who have seen the messages on cigarette packages themselves, are more likely than those who have nor ta strongly agree thar smoking can cause emphysema, imporence in men and chronie bronchiris.

Those who have seen rhe messages on cigarette packages are also more inclined ta mention gum and rnouth diseases, and infertility.

Among non-smoking youth, poreritial smokers are more likely ro strongly agree thar smoking can cause impotence in men, rhroat cancer, gum and mou th diseases, and inferriliry, but they are more Iikely to strong ly disagree that smoking can cause bladder cancer. Yourh smokers are more likely than ethers ro strongly agree thar smoking can cause chronic bronchiris and impotence in men, but rhey are more likely to strongly disagree thar smoking can cause arthritis, gangrene, miscarriages, bladder cancer, hepatitis, acne, Multiple Sclerosis and Alzheirners Disease.

ENVJRONICS

HEALTH EFFECTS OF TOUACCO AND HEALTH \'(rARt'llNG IvfESSAGES - \'(rAVE 8 14

Specifie Health Effects Caused by Smoking

DEe 2000 MAR-APR 2001 JUL y 2001 NOV-DEe 2001 JULY 2002 OEe 2002 JULY-AUG 2003 OEe 2003

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

Lung cancer

Strongtyagree 95 93 96 97 94 98 95 90 96 95 96 94 95 89 95 95 91 95 94 92 94 94 92 94

Somewhat agree 10 5 5 6 5 5

Somewhat disagree Strongty disagree dk/na

Heart d isease

Strongtyagree 74 78 74 78 76 81 74 75 77 76 78 74 77 70 75 78 75 77 77 82 76 76 72 76

Somewhat agree 2 t 17 21 18 19 16 21 16 20 20 16 23 19 24 21 18 20 19 18 14 19 20 25 21

Somewhat disagree 2 2 3 4 2 3 2 2 3 2 3 2 2 2 2 2

Strongty disagree 2 3 2

dk/na

Gum or mouth diseases

Strongtyagree 66 64 68 73 73 76 72 68 74 73 75 71 75 65 76 75 75 76 75 82 75 74 68 79

Somewhat agree 23 24 21 19 21 17 19 t 7 19 20 19 23 18 23 18 19 17 19 19 14 19 20 21 16

Somewhat disaqree 5 3 2 5 2 10 3

Strongty disagree 2

dklna Throat cancer

Strongtyagree 75 76 75 77 78 81 72 72 79 75 82 75 73 70 75 73 79 74 74 83 78 72 74 76

Somewhal agree 18 18 19 17 17 14 21 22 18 20 16 21 20 22 19 21 15 21 21 16 20 23 21 20

Somewhat disagree 3 1 2 3 3 2 2 2 2 2 3 2 3 3 2 2

Strongty disagree 2

dklna

• Less than one percent

Q./5

1 am f,oing to read J'r)/{ Cl /ùl of hf/man health effect: and diseases ibat ma)' or mû} mn be caliJee! by .î1noking cigarettes. Based on what YOtt know or belieie, jJleaJe telL me zfyou strongl» agree, sometubat ûgree, JOmewhetf cliragn!e (JI" _îtron.f!/Y dùagree that J?Jloking cigarettes can cause eacb of the fol!owing .

ENVI RON ICS HôALTH EFFECTS OF TODACCO AND HEALTH \'(IARNING MESSAGES _ \'(IAVE 8

15

Specüic Health Effects Caused by Smoking

OEe 2000 MAR-APR 2001 JULY 2001 NOV-DEe 2001 JUL y 2002 OEe 2002 JULY-AUG 2003 DEe 2003

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

Moulh cancer

Sironglyagree 66 68 69 69 68 72 66 62 71 71 73 69 71 68 72 69 71 69 70 77 71 71 75 72

Somewhal agree 21 21 18 21 22 20 24 28 22 22 21 24 20 22 17 22 19 25 21 18 21 21 19 19

Somewhal disagree . 7

3 6 3 2 5 5 7

Sirongly disagree 4 5 2

dk/na 3

Aslhma

Sironglyagree 67 67 72 70 71 70 67 62 73 66 72 71 70 68 72 71 72 74 69 71 71 70 57 70

Somewhal agree 22 22 21 21 20 22 21 21 17 23 17 21 20 20 19 21 21 20 22 21 24 22 30 24

Somewhal disagree 5 4 6 5 5 3 2 3 2

Sirongly disagree 3 9 2 4

dk/na

2 Premalure dealh

Sironglyagree 63 63 61 67 58 66 64 61 61 64 64 63 65 55 62 61 55 61 66 69 61 63 57 60

Sornewhat agree 23 25 24 21 25 23 23 21 28 23 23 24 24 27 25 25 27 28 24 19 30 24 24 27

Somewhal disagree 5 8 5 6 11 5 5 7 9 6 5 8 13

Sirongly disagree 5 9 3 3

clk/na

Smaller babies or reduced growlh of babies during pregnancy

Sironglyagree 51 48 54 55 55 55 54 53 56 53 55 52 55 58 57 53 49 50 54 56 53 53 58 54

Somewhal agree 29 31 29 29 26 30 29 26 32 31 27 32 31 27 28 31 28 37 31 23 34 31 24 31

Somewhal disagree 10 7 6 7 10 8 10 .8

Sirongly disagree

5 3 5 2

dk/na 6

• Less Ihan one perce ni

---_ Q.15 -- -- --- --_

_--_

_--- ---

__

^--- --

__

^{--- --_-} --_

-_

^---_

1 am /!.oinf!. to read yon ct /ù! of bronan health elfectJ and aiseases that may or mû_)! no! be cal/Jed by J?l7oking cigarettes. /3a.îed on whal yOlt know or belieue, /JLeaJe tel! me t!Y()/I _)trrJngJ)' af!.ree, Jomewhat agree, sometuba: cli.faf,ree /)1' ,rtrong,ly clùClgree that .Î!rI(}king cigarettes can CaNJe each of the fol/mt/in/!. .

ENVI RON ICS

H~ALTH EFFECTS OF TOBACCO AND HEALTH \XfAfu'lING MESSAGES _ \'(lAVE 8

16

Specifie Health Effects Caused by Smoking

DEC 2000

GP S PS

Stroke Strongtyagree Somewhat agree Somewhat disagree Strongty disagree dk/na

44 37 41 30 23 33

Il 13 10

4 6

Il 20 10

Wrinktes and premature aging Strongtyagree Somewhat agree Somewhat disagree Strongly disagree dk/na

50 53 50

25 23 23

12 9 13

9 13 9

Chronic bronchitis Stronglyagree Somewhat agree Somewhat disagree Strongly disagree dk/na

51 56 57 30 31 29

5

10

Emphysema Stronglyagree Somewhat agree Somewhat disagree Strongly disagree dk/na

37 48 41

24 19 25

8

4 6 4

27 22 22

MAR-APR 2001 GP S PS

51 52 49 26 19 26

Il

4 7

12 11 13

52 44 52 25 24 25 12 12 13

9 16 8

52 64 54 28 23 32

5 3 11

42 48 43 21 23 20

5 28 22 28

JULY 2001

GP S PS

49 53 43 27 t 8 30 7 10

4 3

13 18 14

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

2

50 55 57 23 29 22

17 12

38 49 37 20 17 24

9 9 9

2 30 21 27

NOV-DEC 2001 GP S PS

49 48 45 27 19 29

8 8

4 4

13 20 12

48 46 48 25 26 25 12 12 12 9 10 10

51 55 52 30 27 32

12

36 43 34 21 27 23

8 9

32 27 31

JULY 2002

GP S PS

49 43 45 30 27 32

12 9 Il

50 44 50 25 22 25 Il 11 12

10 19 10

3

54 64 55 27 24 27

5 6

10

43 48 42 21 20 23 5 4 25 19 26

DEC 2002

GP S PS

JULY-AUG 2003

GP S PS

10

3 22 17 21

49 60 49 32 26 32 10

50 51 51 24 22 24

12 15

Il 6

50 59 56 28 26 30

6 2

14 9

38 46 37 22 18 20

9 6 13

4 28 26 25

DEC 2003

GP PS

51 49 49

32 27 33 10 14 Il

3 6

49 44 49

25 22 25 15 18 16

8 15 8

48 54 49

33 35 35

10

39 43 43 26 21 25

11 18 13

3 5 3

21 14 17 52 54 47

30 21 31 11 12 2

6 9

48 44 52 27 23 26

12 14 Il

17 8

2

53 64 55

30 24 31

5 2

4 6

42 50 48

25 25 20 7

Q

/5

1 am /!.oing tn reac! y(}!{ a fùt of h:lJJ7cm hecf;Ùh eJfe{:!.f and diseases tbat ma)' or may nos be cau.wei /;} .r7noking cigarettes. Based on what YOII know or l)elie1!e, Jl/ea.'Ie tell me ifyo/J, Jt1'()ng!y agree, someu/bat agree, .îOmewhat difap,ree or Jtron/f/)' di.\r:tf.{n:e that JJnoking cigarettes can car/se eûch of the flf/()wing .

ENV!RONICS

HEALTH EFFECTS OF TOBACCO AND HEALTH WARNING MESSAGES - WAVE 8 17

Specifie Health Effects Caused by Smoking

DEe 2000

GP S PS

Premature birth or preterm birth Stronglyagree

Somewhat agree Somewhat disagree Strongly disagree dklna

42 46 44 30 28 29

13 13 12

Blood clots Stronglyagree Somewhat agree Somewhat disagree Strongly disagree dklna

34 35 30

35 34 36

14 12 15

7 8 7

10 Il 12

Miscarriages Stronglyagree Somewhat agree Somewhat disagree Strongly disagree dklna

34 32 36

34 31 31

14 16 16

8 15 8

10 5

Impotence in men Stronglyagree Somewhat agree Somewhat disagree Strongly disagree dklna

14 18 13

29 27 33

18 19 20

15 21 16

24 14 17

MAR-APR 2001 GP S PS

41 36 43

34 32 36

Il 13

7 10 9

36 34 36

37 32 38 12 12 Il

5 13 9 10

35 29 37

31 28 32

13 19 13

8 14 9

12 9

27 35 28

27 31 28 16 14 16 Il 15 Il

19 17

JULY 2001 GP S PS

42 42 44 33 32 33

10 10

7 12 7

5

34 31 33 35 32 37 14 18 14

6 7 6

Il 12 9

35 29 38

32 31 35

12 17 12

8 13 7

14 9 8

27 34 31 26 31 28 15 12 15

9 15

23 16

NOV-DEe 2001 GP S PS

JUL y 2002 GP S PS

DEe 2002

GP S PS

JULY-AUG 2003

GP S PS

DEe 2003 GP S PS

38 40 41 37 36 37 14 17 Il

3 6

36 36 37

40 3,; 39

13 17 15

36 36 38 33 31 32 16 19 16

5 Il 7

1 0 ~,

26 40 32 32 2E, 34

18 20 17

6 9 6

18 5 Il 39 36 37

33 32 34 13 13 15

8 Il

7 9

37 37 36 38 34 38 Il Il 13

5 6

8 12

35 28 34 33 31 36 13 20 12

7 9

12 14

30 42 30 30 24 34

14 16 13

8 9 8

18 15

40 39 39 36 34 39 12 Il 12

6 Il 6

40 33 36 35 30 37 12 18 12

5 Il 5

8 10

37 29 36 33 35 35 14 15 14

7 15 7

10 5 7

28 38 29 30 25 33 14 9 15

9 19 8

19 14

39 42 42 36 31 36 12 12 13

9 6

36 33 35 39 32 40

12 16 15

14 5

36 32 37 34 32 34 13 12 17

9 16 8

6

26 41 30

31 27 29

15 12 17

13 9

20 14

43 45 44 33 37 33

Il 5 13

5

36 36 36

37 29 36

12 17 16

7 4

Il 10 8

36 34 34 33 32 35

13 15

7 18 7

Il 7

30 48 37 26 30 28

13 16

7

23 14

Q,15

/ am going 10 read yr)/! a lift of bN7?7an bealtb eJfec/J ami diseases !hû! may {)1' may 1701 be crJ,ltJed by smoking cigarettes. Based on what yOIl enmo or believe, jJ/ease tel! me iIJ'()//. slnmgly agl'ee, someu/bat agree, snmeiobat dùa/!.,'ee (JI' JtmnF/Y ciùagree tbat .f?JlOking cigorenes (an cause eacb of ibe fol/owing .

ENV1RON1CS

HEALTH EFFECTS OF TOll,ICCO AND HEALTH W'ARl'lING MESSAGES _ \'(lAVE 8 18

Specifie Health Effects Caused by Smoking

OEe 2000

GP S PS

Inferlilily Sironglyagree Somewhal agree Somewhal disagree Sirongly disagree dk/na

18 19 20

29 23 32 17 24 18

12 15 13

23 19 17 Siomach ulcers

Sironglyagree Samewhal agree Somewhal disagree Sirongly disagree dk/na

23 23 24 36 27 34

19 27 21

9 Il Il 13 11 10 BJadder cancer

Sironglyagree Samewhal agree Somewhal disagree Sirongly disagree dk/na

18 16 16

29 20 29 26 26 28 16 28 17 11 10 10 Mulliple Sclerosis

Sironglyagree Somewhal agree Somewhal disagree Sirongly disagree dk/na

14 13

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

MAR-APR 2001 GP S PS

23 20 24 31 31 34 18 24 18

9 Il 20 14 16

24 20 22 36 28 38 19 24 20

8 18 13 9 13

19 13 17 29 18 30 25 29 29 15 25 13 13 16 Il

13 12

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

JULY 2001 GP S PS

OEC 2002

GF S PS

OEC 2003

GP S PS

22 22 25

30 31 31 14 18 15

9 10 Il

25 18 17

22 23 23 33 21 37 18 24 20

9 19 17 13 12

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

11 5 11

27 22 30

18 20 20

15 24 15 29 29 24

NOV-OEC 2001 GP S PS

21 25 21 32 25 35 15 17 16

8 Il 9

23 22 18

22 17 20 39 32 40 18 24 18

9 16 10 13 11 12

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

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

JULY 2002 GP S PS

24 23 25

32 29 34 17 17 18

18 8

19 13 15

25 19 25 37 35 35 16 21 19

9 17 7

14 10 14

17 15 14 29 24 24 26 18 31

15 35 18

12 9 12

14 10 12 29 17 30 20 21 21 13 31 14 25 20 23

23 31 25

34 24 36 15 14 18

8 14 10

19 18 12

24 23 22 41 41 39 15 12 17

7 13 9

20 7

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

10 9

15 16 13 30 22 32

19 17 21

14 27 14 21 17 20

JULY-AUG 2003 GP S PS

23 29 24 31 31 34

16 8 17

6 7

25 24 19

23 22 25 40 37 41 15 15 17

11 7

15 15 10

18 9 17

30 29 31 28 29 29 13 22 15 12 11

13 9 10 31 28 33

19 24 23

10 13 12 27 27 22

23 25 28

37 34 36

16 21 20

10 17 10 11

23 29 20 40 28 45 19 29 21

15

11 8

17 10 16 23 25 31 28 35 30 14 24 17

8 6 6

13 10 16 31 32 30

24 25 25

12 22 Il

20 12 18

Q.15

1 am f!.oinf!. [0 reac/Y0lt ,ct /Ùf of bU!!lûn health effiClJ and diseases tha! ma.)' or may 1701 be c(lI!,œd /;)' .iJl7()kinK cig,tretteJ. /3ClJecl on robai yOIt enou. or be!ieve, plea.le teLl me lfYOll Jtrrmf(ly agree, someiuba:

agree, someiobat dùa;:,ree or .f/rang/y dùaf!.H!e that Jmoking cigarettes (an CClI/Je eac!;

r1

the !o!lowing "

ENV! RON ICS

HEALTH EFFECTS OF TOUACCO AND I-lEALTH WAfu'lING MESSAGES - \X/AVE 8 19

Specifie Health Effects Caused by Smoking

OEC 2000

GP S PS

Alzheimers Disease Sironglyagree Sornewhal agree Sornewhal disagree Sirongly disagree dklna

Il 9

27 20 29 27 28 29

22 33 23

13 Il

Ar'hritis Sironglyagree Sornewhal agree Somewhal disagree Sirongly disagree dk/na

12 Il 26 12 28

29 35 30

25 37 25 9 Acne

Sironglyagree Sornewhal agree Sornewhal disagree Sirongly disagree dk/na

Il

23 14 25 30 28 25 29 44 33

6 Gangrene

Sironglyagree Sornewhal agree Sornewhat disagree Sirongly clisagree dklna

9 10 19 14 19 19 21 22

20 31 23

32 24 30

MAR-APR 2001 GP S PS

JUL y 2001 GP S PS

12 10

25 14 25 28 36 30 20 30 21

15 Il 14

12 10

26 19 21 29 32 33 22 36 25

Il 10 Il

Il 10 7

24 14 22

30 28 32 26 39 39 9

20 16 18 19 31 19 20 24 24 31 24 29

Il 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

12 12

22 17 23 28 33 24 29 42 32 10 3

19 10 16

15 14 20

21 42 24 36 24 32

NOV-OEC 2001 GP S PS

JULY-AUG 2003

GP S PS

DEC 2003

GP S PS

Il 13 27 14 31 27 29 32 20 32 20

15 13 Il

Il

25 15 27 31 29 34 22 37 22 Il Il

Il Il

23 .12 26 30 29 28 26 43 29

9 9

20 13 22

18 17 22

17 29 18

36 33 29

JUL y 2002

GP S PS

DEC 2002

GP S PS

13 13 10

3D 20 30

27 21 29 19 37 20

il 9 Il

13 Il 13

29 21 31

30 29 31

13 29 18

10 10

Il Il 7

25 20 22 30 26 36

26 39 29

10 10

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

Il 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

12 9 10

25 22 25 28 29 33

23 32 25

Il Il

10 10

22 17 23

17 16 20

17 28 17

35 30 29

13 10 15

30 20 27

27 26 28

18 33 18

12 Il Il

12 10

30 19 31

28 31 31 20 34 19

10 9

Il Il

28 17 30

31 32 31

22 35 22

8

Il 10

26 20 32 21 24 21

15 28 16

26 19 21

12 10

26 13 26

26 27 27

21 39 24

14 15 13

12 12

27 20 23

29 25 30 20 38 21

12 14

13 7 10

22 20 18 29 27 32 27 41 28

10 12

12 Il

21 13 23 18 17 20

18 39 18

31 20 31

Q.!5

1 am J.;oing co rend yOIl ct /ùt 01 h!lltwn hea/tb ef!i'(f.I and diseases tbat ma)' ar ma)! '10/ he (amui hy .fI'l7oking cigan!ftI!J. IJa.œd on tubaI YO!! kJ70W (/1" belieie, /JÙ>(l,œ le!! me l!y(1!t ,ftrnngty agl'ee, J(}1newhat agree, sometubat clhag}"{!1! or .l/rrmgll' dùaglw tbai J!l7oking cigarettes (an (({f/.le eacb oflhe frdfowinf!. .

ENVI RON ICS

HEALTH EFFECr; OF TOUACCO AND HEALTH WlARNING MESSAGES _ \X/AVE R 20

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

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

Hepatitis

Stronglyagree 9

ID

8 9

ID Il ID Il

7

ID ID

Somewhal 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

Somewhal disagree 27 24 29 29 34 33 25 23 29 29 31 27 26 29 29 2~ 30 27 27 30 28 30 35 35

Sirongly 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

dk/na 15 13 14 15

ID

16 17 12 14 14 15 14 15

ID

13 2~ 22 25 18 18 14 12 12

Q.15

1 am [!.ojnf. to l'l'ad Jlr)/{ a list n! hnrnan bealtb effictJ and dùeaœJ tbat ma)' or may not he ransed hy ,flnoking cigaretres. Ra.let! (In whttl J'()1j knnw nr belieue, pleaie tell me z!y()// JtnJ11t/y agree, sometubat af',ree, sorneiubat dùay,ree or Jtrrmp.fJ' dùa[!,ree !ha! J1llnking ciK?llcelleJ can cau Je each

of

the fol/owirlf!..

ENVIRONICS l-lOALTH EFFE~T:; OF TOBACCCl AND I-IEALTH W,IRNING MESSAGES- W1AVE 8 21

D.

Specifie Heallh Effecls Caused by Second-hand Smoke

In this section of the survey, respondents were read a list of health effects in non-smokers, and were asked about the extent

to which they agreed or disagreed thar each can be caused by second-hand srnoke.

Majorities of yourh strongly agree rhar second-hand smoke can cause asthma attacks in children (67%), lung cancer in non- smokers (67%), and chest infections (56%) and bronchiris (52%) in children. Fewer than half strongly agree that second-hand smoke can cause heart disease (44%) and strokes (26%) in non- . smoking adul ts, and SIDS (Sudden Infant Death Syndrome) or crib deat h (23%). Only about one in ten each strongly agree char second-hand smoke can cause ear infections in children (13%), or Multiple Sclerosis (ll %), ar thriris (10%) and Alzheirners Disease (9%) in non-smoking adulrs.

The results of the current survey are similar to those found in July-August 2003. Comparison with the baseline survey ofDecember 2000 suggests thar there have been increases in the proportions of you th who srrongly agree thar second-hand smoke can cause lung cancer in non-sinokers, and heart disease and srrokes in non-smoking adulrs.

Among youth, girls are more likely th an boys to strongly agtee thar second-hand smoke can cause asthma anacks, chest infections and bronchitis in children, and heart disease in non- smoking adulrs. Older youth are more likely than ethers to

strongly agree thar second-hand smoke can cause asthrna, chesr infections and bronchitis in children, and lung cancer in non- srnokers. Younger youth, aged 12 to l4 years, are more likely rhan ethers to strongly agree rhar second-hand smoke ca n cause Alzbeirner's Disease, ar thritis and Multiple Sclerosis in non- smoking adulrs.

Those who have seen, read or heard about the health warning messages now appearing on cigarette packages or who have seen them on cigare ne packages themselves, are more likely tO strongly agree char second-hand smoke can cause chest infections and bronchitis in children. Those who have seen the messages on cigare ne packages are also more inclined co mention asrhrna in children.

Potential smokers among yourh are more likely ta strongly agree that second-hand smoke can cause bronchiris in children; they are, however, more likely to srrongly disagree thar second-hand srnoke can cause ear infections in children, and art hritis and Alzheimers Disease in non-smoking adulrs. Youth smokers are less likely to strongly agree thar second-hand smoke causes lung cancer in non-smokers; they are more likely ta strongly disagree thar second-hand smoke can cause ear infections in children, or arthritis, Multiple Sclerosis and Alzheirners Disease in non- smoking adu.ts.

ENVI RON les

I-IEALTH EFFEC:TS OF TOllACCO ,\ND HE/\LTH WARNING MESSAGES - WAVE 8 22

Specifie Health Effects Caused by Second-hand Smoke

OEC 2000 MAR-APR 2001 JULY 2001 NOV-OEC 2001 JULY 2002 OEC 2002 JULY-AUG 2003 OEC 2['03

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

Asthma attacks in children

Stronglyagree 64 66 66 64 61 63 62 58 64 61 64 61 65 64 69 67 69 63 68 71 68 67 67 67

Somewhat agree 25 23 24 27 33 28 27 39 26 31 28 30 25 22 23 27 26 31 26 25 29 25 27 26

Somewhat disagree 6 6 6 6 5 2

Strongly disagree 3

dk!na

Lung cancer in non-srnokers

Stronglyagree 56 62 56 60 55 63 52 42 53 54 51 57 55 52 55 64 63 63 67 58 66 67 57 68

Somewhat agree 31 23 33 28 31 26 33 35 32 33 36 33 30 31 32 28 26 29 26 30 28 25 31 24

Somewhat disagree 7 8 8 6 11 10 6 9 10 5 5

Strongly disagree 8 3 3

dk!na

Chest infections in children

Stronglyagr88 54 60 55 53 55 55 49 50 53 52 53 55 53 53 54 55 61 56 53 60 58 56 56 59

Somewhat agree 32 24 34 35 33 36 38 35 37 37 37 35 33 29 34 33 27 35 35 29 32 32 33 30

Somewhat disagree 5 6 10 . 6

Strongly disagree 4

dk!na 3

Bronchitis in children

Stronglyagree 49 58 50 50 52 50 46 48 49 47 54 48 49 50 52 52 59 50 49 50 54 52 52 56

Somewhat agree 34 29 34 35 36 37 35 35 32 36 32 37 34 33 33 35 31 38 33 35 32 33 32 32

Somewhat disagree 7 6 9 9 10 3 10

Strongly disagree 4 4 4 4 4 4 4

dk!na 7 5 3 8 3 3 2

• Less than one percent

Q.7ô

Here if ct lift of bealt]: eJJeC!J and diseases afficlinf!. non-smoeers that ma)' nr ma)' nol he cnnsed hy (;rea.tbing in second-band smol:e [rom cigm-etteJ thal otber J)en/de are .rmnkinf!... Baud on what yOIl èrmiu rn: belleie, please tell me lfY0!f Jtrûn!!/J' Clf!.ree, sometohat (lp,ree, _,-nmewha.1 diJagree rw.\"tnmgly dùay,ree {ha/. second-band smolze can C(""Je each of the following .

ENVtRON1CS HEALTH EFFECT;; OF TOIlACCO AND HEALTH \XfARNING MESSAGES - WIAVE 8

23

Specifie Health Effects Caused by Second-band Smoke

Heart disease in non-srnokmq adutts Stronglyagree

Somewhat agree Somewhat disagree Strongly disagree dk/na

Strokes in non-smoking adults Strongtyagree Somewhat agree Somewhat disagree Strongly disagree dklna

OEe 2000

GP S PS

38 42 39

38 35 38

13 12 12

8 8

20 18 19

37 28 36 21 19 24 12 20 12

10 16 9

SIDS (Sudden tnfant Death Syndrome) or Crib Death Stronglyagree

Somewhat agree Somewhat disagree Strongly disagree dklna

Ear infections in chitdren Stronglyagree Somewhat agree Somewhat disagree Strongly disagree dklna

23 21 24 3t 26 31 16 18 16 15 21 16

t 5 15 14

15 t5 15

24 21 22

28 27 29

24 28 27

9

MAR-APR 2001 GP S PS

JULY 2001 GP S PS

NOV-OEe 2001 GP S PS

36 32 39 42 42 41 12 12 Il 7 t 2 6 2 2

23 25 31 38 26 43 19 22 17 13 7

12 14 12

22 22 20 33 25 36 18 18 19 10 19 Il 16 15 13

Il 10 24 15 26 33 30 35 24 34 24

Il

JUL y 2002 GP S PS

OEe 2002

GP S PS

JULY-AUG 2003 GP S PS

40 35 41 39 44 38 12 9 14 7 10 6

3

24 2 t 20 38 32 38 19 20 21 9 19 .10 10 8 Il

24 21 25 30 24 32 19 20 20 11 20 13

15 16 10

14 13

26 26 25 30 23 33 23 38 22

37 37 39 40 34 37

14 14 14

6 13 6

3

22 20 18 33 29 34

22 19 23

10 15 10

t 3 17 14

18 18 19

33 30 32 17 19 19 13 20 13 20 12 17

13 15 12 27 21 29 26 21 28 26 37 25

37 31 38 40 39 38 14 17 15

7 9 8

23 22 19 38 30 40 19 19 21 Il 18 12

9 Il

22 25 20 32 24 33 18 20 18 12 18 14

16 13 15

12 12

24 15 26 32 27 32 23 42 22

9

4~ 45 43

3t 35 39

1[< 15 Il

5 5

3

26 25 21

39 28 38

19 19 24

21 10

7 8

24 26 24

34 28 35

le

17 19 Il 21 12

E 10 9

1 E· 21 16 2"· 21 23

3" 23 37

2" 31 20

43 35 44 40 46 40 9 12 3

27 29 27 40 30 42 18 18 19

8 12 Il

25 20 24 36 38 35 15 12 20 10 19 10 14 10 Il

12 14 10 26 21 24

32 27 34

22 27 25 8 10

OEe 2003 GP S PS

44 41 43

38 37 39 Il 10 13

5 10 2

26 26 27 39 42 35 21 15 28

8 14 3

23 19 24 35 36 37 20 23 22 14 10

13 8 8

13 8 14

28 22 26 32 31 31 21 34 23

Q.16

l-Ien' is a lùt 0/ bea/th ejJectJ and diseases aJJecting non-smobers that may or mClJl nat he call.ff!cI by hreathing in second-band smoee [mm cigarettes that ether people are J1)wking. BaJed on what yotl lsnocu or belieie, j;/ea.œ tell me l!}O!-l JtronY.LJI clJ!.1'ee, someu/hat clf!.1'ee, somnobeu dùagree or Jtrnngly dùagree that second-band smoee can caure each of the fol/nwing ..

ENV!RONICS l-IEALTH EFFECTS OF TOBACCO AND HE,\LTH WAfu'lING MESSAGES - WAVE R 24

Specifie Health Effects Caused by Second-hand Smoke

-,---=-,_..,....,-",'~,'~,~ .. ~ .. ~-", .. "~-"

OEC 2000 MAR-APR 2001 J U L y 2001 NOV-OEC 2001 JULY 2002 OEC 2002 JULY-AUG 2003 OEC 2003

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

Muillple Sclerosis in non-smoking aduus

Sironglyagree 10 4 Il 10 10 10 10 Il 13

Somewhal agree 25 17 28 26 18 24 25 25 26 25 14 26 28 16 22 26 13 24 27 26 27 33 27 31

Somewhal disagree 25 24 29 28 29 29 24 23 25 28 27 31 28 24 33 28 27 33 26 21 30 27 27 27

Sirongly disagree 22 35 23 18 32 20 19 31 20 19 33 19 17 37 19 19 39 20 15 20 17 13 28 15

dk/na 19 16 14 18 13 17 23 17 19 19 16 17 18 15 16 18 Il 15 22 25 17 16 10 14

Arlhrilis in non-smoking adults

Sironglyagree 10 Il 10 10 10 Il 8 10 10

Somewhal agree 20 Il 17 21 12 18 21 15 22 22 13 19 23 15 22 23 16 22 24 16 24 27 19 26

Somewhal disagree 34 34 35 31 29 34 31 25 34 32 23 37 31 21 33 33 27 35 31 29 32 33 28 34

Sirongly disagree 31 44 34 32 53 32 27 41 25 30 48 31 28 52 29 25 43 28 24 37 26 23 40 25

dk/na 7 Il 6 Il Il

Alzheimer's Disease in non-srnokinç adults

Sironglyagree 6 4 10 10 9 9 10 9 4

Somewhal agree 23 15 24 25 22 21 23 14 22 26 14 28 25 16 21 26 12 25 27 25 23 29 22 30

Somewhal disagree 30 28 33 29 29 36 28 24 31 28 30 29 29 20 32 29 22 31 30 29 34 32 30 32

Sirongly disaqree 27 40 30 27 38 28 26 46 27 26 40 28 26 50 29 26 50 29 20 28 26 21 38 24

dk/na Il Il Il 6 15 10 Il 12 13 10 13

Q 16

llere is a lùt of health e/fecH and diseases ajJee/in!_!, non-smoeers that mû)' or mr./J' nol be camed by lJ1wllhing in second-band smolze [rom cigarettes that otber peo/lle are smoeing, Based on whal yrill knOUJ or believe, p/I!C{.J(! tel! me IfY0{l Jtnm/!.!y ûgree, someu/ba: rl[!,1W .. ::mneu)haL dùagree or .îtrong!y dùc'gree !hat .îecond-hand smoee (an cause eacb of the !O!!OWÙlg .

ENV1RONICS HEALTH EFFECTS OF TOOACCO AND HEALTH WAlù'lING MESSAGES - \X/AVE 8 25

E.

Health Effects Caused by Hydrogen Cyanide

The survey finds rhat the number of yourh who say hydrogen cyanicle does not cause any healrh effects or diseases is clown slightly (by four points) from

J

uly-August 2003, and is a total of 20 points lower [han thar found in Dece mber 2000.

When askecl, rop-of-rnind, seven in te n youth (71 %) offer no specifie health cffects or diseases thar can be caused by hydrogen cyanide. Anor her four percent say hydrogen cyanicle does not cause any health effects or diseases. Thir tyfive percent mention specifie health effects or diseases, includiru; lung disease/cancer (6%) and cancer in general (5%).

Youth smokers are slightly more likely than ethers to mention specifie healrh effects or diseases in response to this question.

ENVI RON ICS HEALTH EFFECTS OF TOBACCO AND HEALTH \X/ARNING MESSAGES - \X/AVE 8 26

Health Effects Caused by Hydrogen Cyanide

~","""~""",~,~,,=,,,

DEe 2000 GP S PS

Lung disease/rancer Cancer - general Dealh

Respiralory problems/loss 01 brealh Hearl disease/allack

Brain damage/memory loss/strnke Headache

Moulh cancer/disease Dizziness Stornacf aches Throal cancer Lung damage Liver cancer/disease Weakness Poisoning

Pregnan cy/compl icalions

Verligo . Nausea

Damage 10 cells/arleries/blood Damage 10 neNOUS system Burning in body/organs Other

None dklna

24 27 25

66 64 64

• less than one percent

MAR-APR 2001 GP S PS

1 1

30 30 30 59 56 58

JULY 2001 GP S PS

12 14 12

76 70 72

NOV-OEe 2001 GP S PS

17 20 17 69 59 70

JULY 2002 GP S PS

70 62 68

OEe 2002

GP S PS

75 56 77 73 70 69

OEe 2003 GP S PS

4 4

71 64 70 JULY-AUG 2003

GP S PS

Q.39

lY/hat .\j)ecific hUllth eJfeC/_î or dùea.œJ, if an)', (an .l'nu name t!;at can lJi: ctlll.œd hy hydrogen cyanide? Are there an)' oihers?

ENVIRONICS

HEALTH EFFECTS OF TOI3ACCO AND HEALTH \VARNJNG MESSAGES - \X/AVE 8 27

4.0

HEALTH WARNING MESSAGES

A.

Recall and Reads Per Day

An overwhelming number of yourh (92%) say they have seen health warning messages on cigarette packages. Youth smokers (99%) express virtually unanimous recal!.

The number of youth who say they have seen healch warni[1g messages on cigarette packages is essentially unchanged from the previous surveys.

Recall of Health Warning Messages on Cigarette Packages

.. ~ .

Yes No

DEC 2000 GP S PS 91 98 96

9

93 100 MAR APR 2001

GP S PS

Q.17

1 lave _ynll ever seen tbe health 'Wclrning me.îJtlf,;e.Î on n'Kar!!!!/! fJac:kaf!.I!J?

Older youth and potenrial yourh smokers are more likely ta recall seeing the healch warning messages.

Seven in ten youth (70%) say the y have seen, read or heard about the health warning messages thar are now on cigarette packages in Canada, and another six percent say they may have. Just over two in ten (23%) say they have not.

It should be noted r hat in ail surveys conducted since the Oecember 2002 survev, when asked about "health warning messages thar are now on cigarette packages in Canada" in this question, respondents were proviccd with the additional explanarory phrase "thar is, the new messages thar began appearing on cigarette packages at the beginning of 200 1" in order to clarify the meaning of the question.

NOV·DEC 2001 GP S PS

DEC 2002 GP S PS

97 98 98

2

JULY AUG 2003 GP S PS 93 100 97

DEC 2003 GP S PS

92 99 98 J UL y 2001

GP S PS 93 99 96

JULY 2002 GP S PS 94 99

5

98 2

93 98 97 95

ENVIRON les

HEALTI-I EFFECT, OF TOBACCO AND HEALTH W',IR.c'lING MESSAGE, _ \X/AVE 8

28