The National Strategy's goals--prevention, cessation, protection, and denormalization--are interconnected, so that many tobacco control initiatives have overlapping impacts even when they are designed to address a single goal. For example, legislation that establishes smoke-free environments protects people from the effects of second-hand smoke and supports those who are trying to quit. It also encourages denormalization. In another example, legal action in British Columbia has for many years drawn the public's attention to the health hazards associated with tobacco use and how the industry has strategically worked to deceive them. British Columbia's efforts have encouraged other provinces to pursue cost-recovery legislation. This results in a coordinated and unified approach that reduces duplication. Because of these overlapping impacts, it is easier to group initiatives by strategic direction.
The five strategic directions are:
The information in Progress in Strategic Directions represents only a very small number of the tobacco control initiatives and activities taking place in Canada.
Canada is internationally recognized for its success in legislating the tobacco industry. At all levels--federal, provincial, territorial, and municipal--successful tobacco control laws, bylaws, and regulations have been implemented. Each year, laws are added or refined. Developing policies and strategies also play a critical role in tobacco control.
The first session of the Conference of the Parties to the World Health Organization's Framework Convention on Tobacco Control took place in February 2006. Since its entry into force on February 27, 2005, the Convention has become one of the most widely embraced treaties in the history of the United Nations, with 168 signatories. At the 2006 conference, a reporting instrument for assessing progress under the Convention was designed. Three reporting timeframes were established, and signatory countries were assigned to one of three groups for reporting. Canada, which is among the first group of countries designated to use the reporting instrument, is required to submit its first report no later than February 2007.
In 1998, British Columbia became the first jurisdiction in Canada to launch a lawsuit against the tobacco industry for the recovery of tobacco-related health care costs. The tobacco industry challenged the province's right to do so. In September 2005, the Supreme Court of Canada unanimously upheld the province's right to sue the tobacco industry and concluded that the Tobacco Damages and Health Care Costs Recovery Act is constitutional.
In Alberta, the Smoke-Free Places Act was passed in May 2005 and became law on January 1, 2006. In its amended form, the Act restricts smoking in any public place and workplace where minors are allowed. Municipalities are encouraged to continue to implement policies that complement this regulation and that protect all of the community. Bylaws that already restrict smoking in all public places and workplaces are not affected.
Improvements to British Columbia's Tobacco Sales Act establish an administrative process to manage retailer compliance, specify what types of identification are acceptable to determine the age of cigarette purchasers, and provide systems for updating lists of tobacco retailers.
In March 2006, the legislative assembly of the Northwest Territories passed The Tobacco Control Act. The Act will complement Workplace Compensation Board regulations already in effect by eliminating tobacco use in other public places, and banning the sale of tobacco in pharmacies, in recreation facilities, and from vending machines. It will also prohibit retailers from displaying tobacco products or tobacco advertising. Tobacco retailers will also be required to post health warning signs at the point of purchase.
Five provinces now have health care cost recovery legislation. In 2005, Nova Scotia passed the Tobacco Damages and Health-care Costs Recovery Act and New Brunswick introduced the Tobacco Damages and Health Care Costs Recovery Act. In 2006, Manitoba introduced its Tobacco Damages and Health Care Costs Recovery Act. They join British Columbia (1998) and Newfoundland and Labrador (2000) in being able to sue the tobacco industry for damages caused by their products.
In October 2005, Nova Scotia introduced amendments to its Smoke-free Places Act. These amendments will eliminate designated smoking rooms in all work places, including bars and restaurants. They will also disallow smoking on licensed patios and outdoor areas.
In May 2006, the Smoke-Free Ontario Act went into effect. New provisions within the Act prohibit smoking in all enclosed workplaces, enclosed public places, and certain specified places, such as covered patios associated with eating and drinking establishments. The Act does not address smoking in residences, but does restrict indoor smoking in residential care facilities to a controlled smoking area that meets prescribed criteria. Restrictions on smoking do not apply to an Aboriginal person who uses tobacco for traditional Aboriginal cultural or spiritual purposes. The Act elaborates on previous restrictions on the sale of tobacco to minors; sets out a limited ban on retail display of tobacco products, with a complete display ban going into effect in May 2008; and bans the promotion of tobacco products at retail and wholesale outlets. Enforcement support for the new Act is a key component of Ontario's tobacco control strategy. As of May 2006, approximately 250 public health unit staff had received comprehensive training on the Act and on enforcement protocols.
In June 2005, Quebec strengthened its Tobacco Act by adopting amendments, the majority of which took effect May 31, 2006. These new measures mark the start of a new era in Quebec. The new provisions of the Tobacco Act govern smoking in public places such as bars, pubs, taverns, restaurants, bingo halls, and shopping malls. The amendments to the Act cover three components: smoking in public places, sales of tobacco, and the promotion and advertising of tobacco products.
In 1997, three of Canada's tobacco manufacturers launched a constitutional challenge of Canada's Tobacco Act. They amended their challenge in 2000 to include the Tobacco Reporting Regulations and the Tobacco Products Information Regulations. In 2002, the Quebec Superior Court upheld the validity of the Act and its regulations. The decision was appealed, and in 2005, the Quebec Court of Appeal maintained the validity of the regulations and of most of the Act. Its ruling invalidated some parts of the prohibitions on sponsorship promotion.
Given the importance of the Act to the Federal Tobacco Control Strategy and the fact that the Act was drafted in accordance with guidelines set out by the Supreme Court of Canada, the Government felt that it was necessary to appeal the decision. The Government applied for leave to appeal the Quebec Superior Court of Appeal's decision regarding ss. 18(2), 20, 24, and 25 of the Tobacco Act. These provisions concern promotion disguised as scientific works, promotion "likely to create an erroneous impression," and the use of a manufacturer's name for sponsorship purposes.
On March 23, 2006, the Supreme Court of Canada announced that it would grant the leave application by the Attorney General of Canada. The Supreme Court also granted the cross-appeal application by the tobacco manufacturers and granted the status of intervener to the Canadian Cancer Society.
In June 2005, the Cigarette Ignition Propensity Regulations, as well as the accompanying Regulations Amending the Tobacco Reporting Regulations, became law. All cigarettes manufactured or imported for sale in Canada must now meet the new national standard for ignition propensity. Canada is now the first country to have a national standard to reduce fire risks from cigarettes. According to the Canadian Association of Fire Chiefs, between 1995 and 1999 at least 14,030 fires were started from smoking materials. These fires killed 356 people, injured another 1,615 people, and cost more than $200 million in property damage. The victims are often children and the elderly. These regulations apply to cigarettes manufactured or imported on or after October 1, 2005. Therefore, it could take time for cigarettes that meet the new standard to replace existing stock. Health Canada will monitor the marketplace and will take appropriate action where violations occur.
When the Newfoundland and Labrador Department of Health and Community Services launched its Provincial Wellness Plan in March 2006, it challenged Newfoundlanders and Labradorians to "Go Healthy." The Plan promotes good health through eight areas, one of which is tobacco control. This reaffirms the province's Tobacco Reduction Strategy. Each of the eight areas is addressed by four key activities: strengthening partnerships and collaborations, developing and expanding wellness initiatives, increasing public awareness, and enhancing capacity for health promotion. The Plan is supported by a website and promotional material.
In January 2006, New Brunswick introduced its multi-year Wellness Strategy, which identifies four priority areas for action: Mental Fitness/Resilience, Tobacco Reduction, Healthy Eating, and Physical Activity. This strategy builds on efforts and partnerships established to date. The New Brunswick Anti-Tobacco Coalition, which has supported coordinated implementation of the province's Anti-Tobacco Strategy since 2001, is a key partner in advancing the broader Wellness Strategy. The Wellness Strategy is funded by an annual budget of $2 million.
In May 2006, Quebec launched its new tobacco control strategy, Plan québécois de lutte contre le tabagisme 2006-2010.
In Newfoundland and Labrador, the Alliance for the Control of Tobacco (ACT) commissioned a survey of school administrators. Approximately 18 per cent of the schools surveyed allowed smoking on school grounds, and of those, 89 per cent had a designated smoking area. Following the release of the survey, ACT met with the ministers of Education, and Health and Community Services, and with school boards, teacher associations, and school council groups to discuss the results. As a consequence, both the Labrador School District and the Nova-Central School District have introduced policies that prohibit smoking on school grounds.
To ensure a harmonious and successful implementation of its strengthened Tobacco Act, Quebec produced and distributed several publicatisons targeted to various audiences affected by the new measures. Of particular note are Guide to Implementing a Tobacco-free School Strategy and Trousse du détaillant.
Increased Support for Smoke-free Spaces
In 2005, Health Canada hired a public opinion research firm to survey the general public--including smokers and non-smokers--in Saskatchewan, New Brunswick, and Manitoba. More people reported that they would likely visit bars and restaurants if they are smoke-free than the number who would stay away because of a smoking ban.
Support for smoke-free legislation continues to be very high, with 83 per cent of Saskatchewan residents, 86 per cent of New Brunswick residents, and 82 per cent of Manitoba residents supporting their respective provincial smoking ban legislation.
Among smokers in each province, support for the legislative ban on smoking has increased noticeably since a 2004 survey: 57 per cent of Saskatchewan smokers (up 10 points), 68 per cent of New Brunswick smokers (up 11 points), and 57 per cent of Manitoba smokers (up 6 points) now support the legislative ban.
The intent of this strategic direction is to ensure that Canadians have access to information about tobacco and about services that foster prevention, cessation, protection, and denormalization.
In March 2006, the Alberta Alcohol and Drug Abuse Commission launched a television and poster campaign targeted to young adults. The theme of the "Firepit" commercial was "One cigarette never killed anyone. But who ever smoked just one?" Directed at young adult occasional smokers, the theme points out that smoking quickly adds up. The campaign directed this population to Alberta's new web cessation program, www.albertaquits.ca.
The second phase of British Columbia's mass media campaign kicked off in 2006. It targets young adults with the highest smoking prevalence--blue-collar workers between 20 and 30 years old. Instead of emphasizing quitting smoking and the dangers of smoking, the message is You Can Get Better--a positive, hopeful message that says "start living." Television and radio ads, and three posters, all reinforcing the "you can get better" message, highlight the benefits of quitting.
The Canadian Cancer Society-Manitoba Division partnered with the Interlake, Winnipeg and Brandon Regional Health Authorities, the Manitoba Lung Association and Cancer Care Manitoba to produce "Quit Now Manitoba," a social marketing campaign. The main goal of the six-week campaign was to increase the number of calls to the Smokers' Helpline, and it was targeted to adults between 25 and 55 from lower socio-economic backgrounds. Pre- and post-campaign telephone surveys were used to measure results. Overall there was a significant increase in the number of calls to the Smokers Helpline during the campaign.
Northwest Territories conducted the second phase of its "Don't Be a Butthead" campaign and expanded it by adding a creative contest for youth encouraging them to express their opinions about tobacco. Also new in 2005 was a special initiative to target the campaign to athletes. The goal is to keep youth between 8 and 14 smoke free.
For the third consecutive year, Northwest Territories, Yukon, and Nunavut produced Smoke Screening, a pan-territorial project that reaches 4,500 students across the Canadian North. Students watch 12 anti-tobacco ads and vote for the ad that they feel would be most effective in getting youth to reduce tobacco use, quit, or never start. Seventy-nine of a possible 98 schools participated across the three territories. The program continues to receive excellent evaluations from participating teachers.
Nova Scotia launched the follow-up to the "Great Reasons to Smoke" campaign. The current print and broadcast campaign profiles real tobacco users, their stories and rituals, and what they do to conceal their smoking. The campaign is aimed at young adults and is intended to hold up a mirror to smokers, showing the practices they have acquired from smoking. The provincial Smokers, Helpline is featured at the end of each profile. The website sickofsmoke.com has been updated to include testimonials from smokers.
Using feedback from focus groups, Yukon designed an innovative Young Adult Mass Media Tobacco Campaign. In October 2005, 12 young adults who were either current or former smokers became the public faces for the campaign, appearing on posters, postcards, bus shelters, buses, and t-shirts. The campaign draws an analogy between quitting smoking and breaking up by using the logo "I love you but ... (I'm) moving on smoke-free." Twelve distinct reasons for becoming smoke free--relevant to young adults--were used. A unique feature of the campaign were songs written by Yukon youth. Finally, Quitpacks were distributed to smokers who were ready to go smoke free. The Quitpacks were slingback packs, highly appealing to young adults, filled with cessation tools and resources.
The Prince Edward Island Fax Referral Program links health care practitioners directly to counselling services offered through the Smokers' Helpline. Physicians, pharmacists, and dentists who identify a patient who wants to quit smoking can fax the information to the Smokers' Helpline. Trained counsellors then contact the individual. During its first year, referrals by health professionals increased from 19 per cent to 30 per cent. Physicians were the most frequent participants in the Fax Referral Program, with 18 physicians referring patients in the first six months.
Health Canada, in collaboration with provincial and territorial officials, hosted the National Youth and Young Adult Forum on Tobacco Control in Ottawa. The forum attracted 142 participants, who shared experiences, expanded their knowledge, and learned new skills, all related to tobacco control. In addition, they had the opportunity to discuss a possible National Youth and Young Adult Framework for Action on Tobacco Control. Youth (16 through 18 years of age) and young adults (19 through 29 years of age) played key roles throughout the forum as presenters, moderators, note takers, and very active participants.
Manitoba completed its second Review and Rate Program, which asked 30,000 grade 6 through grade 12 students to review 12 anti-tobacco television ads. Students voted for the ad most likely to keep them from starting to smoke, or to encourage them to quit if they already smoke. The winning ad, "Relaxed as Can Be," was aired in March 2006. The success of this program stems from its ability to engage youth in tobacco control and to stimulate a great deal of in-class discussion about tobacco use and its consequences.
The New Brunswick Anti-Tobacco Coalition, with the Canadian Cancer Society-New Brunswick Division as lead organization, continued to encourage and support a comprehensive school health approach through a wide variety of Tobacco-Free Schools activities and initiatives. Among their many activities and initiatives, with support from Health Canada, they
In addition, the Tobacco-Free Schools Grant Program was funded for an additional year through the province's Wellness Strategy. As a result, the quality and quantity of comprehensive anti-tobacco awareness activities with school-community partners increased.
As a member of the New Brunswick Anti-Tobacco Coalition, Sport New Brunswick developed the Tobacco-Free Sport initiative (Everyone is a Role Model, Keep Tobacco Away from the Game) to encourage member provincial sport organizations to develop, communicate, and reinforce tobacco-free (including smokeless tobacco) policies as part of their sport or recreation program. The focus of these efforts is to create more supportive physical and social environments for Tobacco-Free Sport. A handbook was developed in collaboration with various partners, including the Centre for Coaching Education of New Brunswick, Recreation New Brunswick, and the New Brunswick Interscholastic Athletic Association. Banners, posters, temporary tattoos and other promotional material on Tobacco-Free Sport were developed for distribution at tournaments, annual general meetings, and other events to support these efforts. Ongoing distribution has been integrated into core activities of the organization. The outcome of these efforts is increased collaboration between provincial sport organizations and the Coalition.
In Nunavut, the Minister's Youth Action Team on Tobacco sent 20 grade 9 through grade 12 students to Iqaluit for a week. In addition to learning about tobacco-use issues and practising leadership and presentation skills, they learned how to plan their own tobacco reduction projects. After doing community demonstrations and presentations in Iqaluit, they returned to their home communities prepared to complete their own projects.
Ontario provided $3.3 million in new funding for youth tobacco control and extended its $500,000 high school grant program to support student-led activities. Funds flowed to 18 Youth Action Alliances, which are peer leadership programs that teach youth aged 14 to 17 the skills needed to work on policy-related tobacco control issues and to engage youth in local action to prevent smoking, reduce second-hand smoke exposure, and increase awareness of tobacco issues. Also, in 2006, the Government of Ontario launched Phase 2 of the " Stupid.ca" campaign, as a component of the Smoke-Free Ontario Strategy, under the prevention component. This phase included a revised website, which built on the successes of the first, providing a stronger emphasis on encouraging youth to become local non-smoking advocates. During the first 18 months of the campaign, the Stupid.ca ads attracted over 1.2 million unique visitors to the site.
Youth-centred activities hit a new high in Yukon, with youth participating in the 2005 National Youth and Young Adult Forum on Tobacco Control in Ottawa, and teams from two schools attending the BLAST youth tobacco leadership conference in Yellowknife. One high school, in partnership with the Yukon Government, turned its smoking pit into a beach volleyball court and stage for music, with grass and picnic tables. For the first time, smoking cessation programs were offered at two high schools. School staff were trained to run these programs.
In October 2005, the Alberta Alcohol and Drug Abuse Commission and its partners The Lung Association AB/NWT and the Canadian Cancer Society AB/NWT launched a web-based cessation service, www.albertaquits.ca. This service is available 24 hours a day, seven days a week. Between its launch and March 31, 2006, 6610 people registered.
The Cessation Working Group of the New Brunswick Anti-Tobacco Coalition is supported by a broadly based partnership that includes the New Brunswick Medical Society, the Nurses Association of New Brunswick, the New Brunswick Pharmacists Association, the New Brunswick Dental Hygienists Association, the Canadian Cancer Society-New Brunswick Division, the Heart and Stroke Foundation of New Brunswick, the VON Healthy Baby & Me Program, the Regional Health Authorities, and the Department of Wellness, Culture and Sport. While these efforts with a wide range of provider groups continue, this year efforts have shifted to promote development of an environment to ensure that providers systematically intervene with smokers through a systems approach within Regional Health Authorities (RHAs).
Workshops to support RHAs' efforts to build cessation interventions into all RHA clinical care practices have been provided, including a two-day workshop by the Ottawa Health Institute, for senior leaders and administrators from all eight RHAs.
These workshops support RHA efforts to address cessation in a systematic, coordinated and comprehensive way, which in turn maximizes the reach of available resources (self help and Smokers' Helpline).
In November 2005, the Newfoundland and Labrador Smokers' Helpline expanded its Community Action and Referral Effort (CARE) to 500 registered nurses as a pilot program. The CARE program allows physicians to connect consenting clients to smoking cessation services by faxing a referral form. Referred clients are contacted by phone within 72 hours. By including nurses in the program, the Smokers' Helpline can reach clients in remote locations where physician services are often unavailable.
In Nunavut, all community health representatives and prenatal nutrition program workers were trained in minimal-contact (that is, very brief) interventions. Since the majority of these workers speak Inuktitut and are based in local communities, tobacco reduction information will be dispersed throughout the territory and will be available from Inuktitut speakers.
In its first year of operation, the Ontario Lung Association's Youth Advocacy Training Institute implemented three curricula to build knowledge, skills, and capacity among 300 peer leaders, 238 youth volunteers, 55 adult staff, and 34 youth advisors. The Institute receives funding through the Smoke-Free Ontario Strategy.
In 2005, Saskatchewan Health provided its Regional Health Authorities with a variety of resources to enforce The Tobacco Control Act and to support tobacco reduction initiatives. It also provided support and education to Tobacco Enforcement Officers to assist them in enforcing tobacco control legislation.
As of August 2005, Manitoba began enforcing restrictions on the display, advertising, and promotion of tobacco and tobacco-related products. These restrictions mean that power walls are not permitted, nor can tobacco products be displayed, advertised, or promoted if visible to children. This prohibition includes outdoor signs.
In preparation for a ban on the display of tobacco products at retail outlets, Prince Edward Island Department of Health inspectors visited all tobacco retail outlets to inform proprietors of their obligations under the ban. The ban went into effect in June 2006. Although the legislation permits tobacconist stores to be categorized as such, an outlet must devote more than 50 per cent of all retail space--that includes floor, wall, and ceiling space--to the sale of tobacco products, individuals must be 19 years of age or older to enter, and tobacco products cannot be visible from the exterior of the store.
In 2005, the British Columbia Ministry of Health and the Centre for Addictions Research of British Columbia (CARBC) formed a new research relationship. With research partnerships with the province's five public universities, CARBC is able to advise on health and addiction issues and to incorporate the tobacco resource centre into the Substance Information Link ( www.silink.ca). Furthermore, the Ministry of Health and BC Stats are learning more about tobacco use by tracking and profiling smokers' behaviour and attitudes. Information is available for the entire province and by health authority, and is updated three times a year.
The Canadian Tobacco Control Research Initiative (CTCRI) is a collaboration between a group of Canadian agencies and government departments. Current major funding partners are the six Canadian Institutes of Health Research, the National Cancer Institute of Canada, the
Canadian Cancer Society, and Health Canada. In 2005, CTCRI awarded $1,663,532 to tobacco control and nicotine addiction research programs, including a small international policy grants program aimed at building capacity for the ratification and implementation of the World Health Organization's Framework Convention on Tobacco Control in low- to middle-income countries. In addition, new funding of over $1.9 million was awarded to innovative multi-year community-based research programs. Aboriginal communities are a particular target for this program.
With Health Canada funding, the effectiveness of SWITCH clubs in reducing tobacco use among youth was evaluated in spring 2006. SWITCH (Students Working in Tobacco Can Help) is an important element of the Prince Edward Island Tobacco Reduction Alliance's (PETRA) comprehensive tobacco reduction strategy. SWITCH clubs promote tobacco control in high schools, junior high schools, and the broader community by engaging youth in the design and delivery of youth-targeted programs. The Canadian Cancer Society-Prince Edward Island Division, the primary sponsor of SWITCH, works closely with PETRA partners to coordinate and support SWITCH clubs throughout the Island. The survey used a number of data-gathering methods, including a web-based student survey. According to the survey, 95 per cent of respondents reported that they had gained knowledge about tobacco issues, and 95 per cent reported that they had learned how tobacco companies target youth.
The Ontario Tobacco Research Unit (OTRU) conducts independent evaluation and monitoring of the Smoke-Free Ontario Strategy. On an annual basis, the OTRU produces a monitoring and evaluation report series. In June 2006, the OTRU released its most recent report, documenting indicators of Ontario Tobacco Strategy progress for 2004-2005. The report indicates that significant progress has occurred in all three strategy goal areas (i.e., protection, prevention, and cessation). Of particular note is the fact that in 2004, smoking prevalence among Ontario students reached its lowest level since 1977. Between 1999 and 2004 there was also a 30-per cent decline in per capita cigarettes sales in Ontario.
In fall 2005, Yukon released the results of the Yukon Youth Smoking Survey, which surveyed every Yukon student in grades 5 through 12. The survey provided invaluable information about what influences Yukon youth to take up or avoid tobacco use. It was also a vehicle for anti-tobacco education; after each class completed the survey, students discussed a tobacco-related topic.