Ministerial Advisory Council on Tobacco Control - Biennial Report 2004-2006

Strategic Issues

In 2004/05 and 2005/06, Health Canada's Tobacco Control Programme asked the Council to consider and advise on several strategic issues related to the Federal Tobacco Control Strategy (FTCS), including:

• Priority areas for long-term goals and future directions for FTCS
  
• Discussion of regulatory proposals for issues such as reduced ignition propensity, 'Light & Mild' descriptors, warnings in tobacco ads, and simplified wording for warnings on tobacco products to meet the needs of people with low literacy
  
• Point-of-sale, the retail environment, and youth access to tobacco
  
• Factors that impact youth and young adults and their decisions regarding tobacco use
  
• Factors that impact Aboriginal people and their decisions regarding tobacco use
  
• Harm reduction and future modification of tobacco products

The Federal Tobacco Control Strategy (FTCS)

In April 2001, the Government of Canada announced its commitment to the FTCS. Complete details of the Strategy may be viewed at
http://www.hc-sc.gc.ca/hecs-sesc/tobacco/policy/ index.html#federal

The FTCS is now at the midpoint of its planned ten-year duration (2001-11). The first phase of the Strategy has been successful in reaching many of the established targets. Over 2006-2007, Health Canada's Tobacco Control Programme has undertaken a process to update the objectives and targets of the Strategy. Information on the consultative process can be found at: http://hc-sc.gc.ca/hc-ps/tobac-tabac/commun/consultation/ current-actuelle/ftcs-ii-tfsc/ index_e.html

Over the course of meetings in 2004/05 and 2005/06, the Council considered many of the above issues in detail.

1. Future Directions of Tobacco Control Efforts in Canada

As part of an ongoing effort, a substantial amount of meeting time in 2004/05 and 2005/06 was dedicated to strategic discussions with Health Canada on the future direction of federal tobacco control efforts.

The recent Canadian Tobacco Use Monitoring Survey (CTUMS 2005) showed that the trend in current smoking rates in Canada continues to decline. Results from this survey revealed that:

• slightly fewer than 5 million Canadians, representing 19% of the population aged 15 years and over, were current smokers;
  
  
• smoking among youth aged 15-19 years remained unchanged from last year at 18%, with 11% reporting daily smoking;
  
  
• prevalence of smoking among young adults 20-24 years of age continued to drop, with 26% of this group reporting smoking in 2005.

Smoking among the Aboriginal population continues to be a concern, particularly given that this is coupled with a generally greater overall incidence of health problems in this population. According to the 2004 NWT Northern Tobacco Use Monitoring Survey, NWT Department of Health and Social Services, young adults between 20 and 24 years of age have the highest smoking rate of any age group, at 53%. Meanwhile, 43% of youth between 15 and 19 years of age and 41% of adults between 25 and 44 years of age indicated they smoke cigarettes. Smoking rates also remain high among older adults, at 36%. The majority of NWT residents who currently smoke do so daily (70%). It is essential that we provide assistance with quitting for all smokers, but particularly for older, 'hard core' smokers who have the most compelling health reasons to quit, but who have the most difficulty doing so.

The four pillars of Health Canada's Tobacco Control Programme are protection, prevention, cessation, and harm reduction. Council carefully considered these elements in providing advice on future directions for federal tobacco control efforts around the following themes:

a) Reducing exposure to tobacco products at the retail level
- Retail stores are visited every day by young people who are exposed to large displays of tobacco products. Several provinces have taken the initiative to ban retail displays of tobacco products, reducing the potential for youth to be exposed to tobacco marketing efforts. This also removes tobacco products from the view of those who are trying to quit smoking, making it easier for them to successfully quit. It is the Council's position that banning retail tobacco product displays is a positive strategy that should be encouraged, in order to ensure that youth are not targeted by these displays.

Health Canada is studying issues relating to the retail environment, namely those relating to placement and promotion, as well as the prohibition to furnish tobacco to youth. The work has included research on international retail environments, retailer surveys and surveys of the general population about their knowledge and attitudes. Given that tobacco sales in the retail environment are a shared jurisdiction, governments at all levels should be involved in identifying acceptable solutions.

b) Social Sources of Supply
- As the level of retail compliance climbs in Canada to upwards of 80%, young people are turning more and more to social sources of supply. This means obtaining cigarettes from friends, parents, or even strangers. It is the Council's position that this is an important area to explore, in order to see what can be done about reducing youth access to tobacco products from social sources, especially from parents and other adults.

Health Canada continues to research the issues around non-retail sources of tobacco products accessed by youth. In addition to analyzing survey results, the department has undertaken a literature review to determine the level of information available and examined possible best practices connected to this issue. It is anticipated that a panel of experts will be convened to review past Canadian interventions in this area.

c) Reducing exposure to second-hand smoke
- Many provinces and municipalities have enacted laws to eliminate exposure to second-hand smoke in both public places and workplaces, thereby protecting the health of both workers and the general public. While there has been significant progress at the provincial, territorial and municipal levels, the current federal legislation (Non-Smokers' Health Act) still permits the existence of designated smoking rooms (DSRs) in workplaces under federal jurisdiction. The Council applauds efforts to date in this area, and encourages the continuation and expansion of smoke-free spaces.

As of May 31, 2006, nine Canadian provinces and territories had banned smoking in indoor public places and seven provinces and territories had enacted comprehensive smoke-free public places and workplaces legislation.

TCP is working to assist and support provinces, territories, municipalities and employers in the implementation of smoke-free public places and workplaces through the development of resource materials and the provision of programming and mass media contribution funding.

d) Encouraging smoke-free homes and cars
- Exposure to second-hand smoke in the home is still an issue for some children. The result is that children suffer ill health due to the effects of second-hand smoke. The Council would like to encourage the implementation of campaigns to encourage families to keep their homes and cars smoke-free, in order to protect the health of their children and loved ones.

Since 2004, TCP has led a national integrated public education and social marketing strategy on the implementation of smoke-free homes and cars, which targets parents 20-54 with children living in the home.

Progressive campaign messages through the phased strategy lead the target audience from awareness and education to behaviour change regarding the implementation of smoke-free homes and cars.

Regional mass media and programming contribution funding has also supported targeted and localized home and car campaigns across Canada, including local, targeted campaigns that find innovative ways of reaching First Nations families. Visit the First Nations and Inuit Health website for more information: http://www.hc-sc.gc.ca/fnih-spni/substan/tobac-tabac/media/index_e.html

2. Harm Reduction and Tobacco Control

Harm reduction was an important item on the agenda of Council in 2004/05, including discussions about the potential for future modification of tobacco products. Among the potential avenues for modifying products are using less tobacco in existing products (e.g., expanded tobacco, low circumference cigarettes), novel products (e.g., smokeless cigarettes, Swedish snus), and nicotine substitutes.

Council spent considerable time discussing these issues. While the current smoking rate is still declining, there is some concern that there may ultimately be a point below which the smoking rate will not be able to go. Whether that point is a 15%, 10%, 5% smoking prevalence, or some other figure, no one knows. What seems certain, however, is that for many years to come there may be some small segment of the population that is unable to break its dependence on nicotine.

For this small segment of the population, it would be desirable to be able to offer a product that could offer reduced harm, compared to current cigarette products. A variety of options are possible, and this is an area where substantial research is required. Council's recommendations are as follows:

a) Changes in existing tobacco products
- Changes in existing tobacco products need to be closely monitored. The tobacco industry has a history of introducing products, such as 'light' cigarettes, that have not turned out to be less harmful than regular cigarettes. Council recommends that any product modifications must be monitored very closely to understand the potential impact on overall public health.

Monitoring of changes in tobacco products is done through the review of product information that the tobacco industry is to provide under the Tobacco Reporting Regulations.

b) Nicotine and other substitutes
- A variety of nicotine substitutes, such as nicotine gum or the patch, could play a role in weaning smokers off of cigarettes. Little is currently known about the long-term viability of these methods as a substitute for smoking, since they are usually intended to ultimately wean smokers off of nicotine. Council recommends that this area be investigated, since it presents a potential method for reducing smoking prevalence. However, this should not detract from overall efforts to reduce smoking prevalence.

The availability and use of these products is being monitored through a variety of mechanisms, including public opinion research and CTUMS.

Regulations have gone forward to require Canadian cigarettes to have a reduced ignition propensity. This is expected to reduce fires caused by careless smoking, and ultimately reduce the harm associated with smoking. Further information is available from the Tobacco Control Programme's Web site at http://hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/reg/ignition-alllumage/ index_e.html

Council applauds the introduction of regulations for reduced ignition propensity cigarettes, since this will undoubtedly save lives that would otherwise be lost due to fire.

3. Disadvantaged Populations and First Nations, Inuit and Métis Peoples

a) Disadvantaged Populations

Disadvantaged populations in Canada generally seem to have a higher propensity to use tobacco. It is well documented that tobacco use is correlated with lower socioeconomic status and lower educational attainment. An unfortunate result of this is that those who can financially least afford to smoke are often the most likely to be dependent on tobacco.

It is essential that efforts be made to ensure that disadvantaged populations receive the support they need to reduce smoking prevalence. Groups that are already marginalized should not suffer the additional burden of tobacco dependence.

b) First Nations, Inuit and Métis Peoples

First Nations, Inuit and Métis peoples have disproportionately high levels of tobacco use, and suffer higher levels of tobacco-related illness as a result. The burden of ill health that falls on this group needs to be addressed by effective and culturally sensitive tobacco control measures that are introduced and embraced at the grassroots level.

Some key themes emerged in this area:

a) Traditional teachings
- It is important to take into account the context in which people live, and to understand their lives and the role of tobacco in their lives. Tobacco has a 'good' or 'sacred' role to play in Aboriginal culture. The non-traditional use of tobacco presents just one of the many problems that Aboriginal communities are struggling with. Council recommends that any tobacco control efforts in these communities must acknowledge the 'sacred' role of tobacco, while discouraging non-traditional tobacco usage.

The First Nations and Inuit Health Branch, in partnership with First Nations on-reserve and First Nations organizations incorporate traditional teachings and the role of sacred tobacco in the implementation of the First Nations and Inuit Tobacco Control Strategy (FNITCS). Prevention and promotion activities include references to the role of traditional tobacco and emphasize the harms of tobacco misuse. Elders' statements and experiences are also used to illustrate the difference between traditional tobacco use and tobacco misuse.

b) Community-based Initiatives
- The most effective tobacco control initiatives in First Nations, Inuit and Métis communities appear to be those that are linked to overall wellness. In other words, tobacco is only one part of the picture, and needs to be considered in the context of other community issues.Furthermore, local community-led initiatives appear to be most effective, since they are most likely to deal with the real needs of the local community. It is Council's recommendation that tobacco control efforts in First Nations, Inuit and Métis communities be linked to overall wellness initiatives, focusing on community-based and community-led initiatives.

Approximately 80% of funding under the FNITCS is directed to community projects and the development of community capacity. Projects are reflective of the needs of communities and tobacco control initiatives are linked to other community-based programs such as the National Native Alcohol and Drug Abuse Program and the Maternal-Child Development Program.

A significant number of community-based projects funded by the FNITCS are focussed on youth and pregnant women.

Numerous community-based organizations are funded under the FNITCS to develop and run mass media campaigns tailored to the unique needs of each population.