2000 - 2002 Report on Tobacco Control - Update

Health Canada's Role In Tobacco Control

Health Canada's Tobacco Control Programme (TCP) plays a leadership role in the implementation of the Strategy; and Health Canada's First Nations and Inuit Health Branch (FNIHB) assumes particular responsibility for First Nations and Inuit tobacco control programmes. This document outlines Health Canada's - as well as its partners' - activities in tobacco control from 2000 to 2002.

When It Comes To Legislation

Unquestionably, one of the highlights in Canadian tobacco control was the successful defence in 2002 of the Tobacco Act and its regulations. In 1997 the three major tobacco manufacturers in Canada - JTI-Macdonald Corp. (formerly RJR-Macdonald Inc.), Rothmans, Benson & Hedges Inc. and Imperial Tobacco Canada Ltd. - launched a constitutional court challenge of those sections of the Act and its regulations which impose restrictions on advertising and sponsorship, and require tobacco manufacturers to print pictorial health warning messages on cigarette packages.

Officials from Health Canada, together with lawyers representing the Attorney General of Canada, participated in the preparation for trial as well as the hearings (from January through September of 2002). There were roughly 1000 exhibits at trial and 81 days of transcribed testimony. Twenty-six sections of the Act were challenged; four different sections of the Canadian Charter of Rights and Freedoms were invoked; there were additional arguments based on federal/provincial powers and other legal issues.

In its December 2002 decision, the Quebec Superior Court fully upheld the constitutionality of the Tobacco Act and its regulations. Some excerpts from the ruling included,'The tobacco companies are in a particularly difficult position. They sell a harmful product and know it. They have the right to sell it because outright prohibition would be unrealistic. ... They offer no evidence to rebut the claimed ill effects of cigarettes because there is none. ... Their evidence respecting the effects of advertising was unconvincing. They are trying to save an industry in inevitable decline. They have every right to do so. Their rights, however, cannot be given the same legitimacy as the government's duty to protect public health.' (The three manufacturers are appealing this decision.)

"On behalf of the Canadian Cancer Society, I commend the Government of Canada for its vigorous and successful defence of the 'Tobacco Act' and its regulations. ... This historic judgement is extremely important for public health in Canada and abroad."

- Carol Hiscock, President, Canadian Cancer Society

When It Comes To Regulating Tobacco Products Compelling Tobacco Health Warning Messages - A World Class Precedent

A significant achievement involved the enactment of regulations around tobacco package labelling. In 2000, Health Canada instituted a series of 16 pictorial and textual health warning messages which must be displayed across at least 50 percent of the principal surfaces of cigarette packaging, as well as health information messages which must be provided inside each package.

This was unprecedented. Canada was the first country in the world to implement pictures relating to tobacco's health effects and hazards, as well as additional information about tobacco-related diseases and quitting. A number of countries have followed Canada's lead - including Brazil, Thailand and members of the European Union.

Furthermore, the warning labels have had substantial impact. In 2001 Health Canada studied responses to the health warning messages, and smokers' perceptions of the ability of the messages to inform, to discourage smoking, to encourage quitting and to alter self-image (as well as brand image). The research showed that the majority of adult smokers used the cigarette package as a source of information and that the cigarette package is an effective means of reaching smokers - hence a successful public education tool.

Reaching Further Still

In 2002, Health Canada again studied response to the health warning messages; data confirmed they continue to resonate with Canadians. Health Canada is aware, nonetheless, that many forms of intervention have a limited shelf life, and is taking steps to address potential 'wear-out' of the messages. One area of research Health Canada is actively pursuing (in connection with health warning messages) is appropriate communication with Canadians who demonstrate lower literacy skills. Health Canada has partnered with another federal government department, Communication Canada, in this regard.

Reducing The Fire Risks From Cigarettes

Health Canada is also exploring ways to reduce public health and safety hazards by mandating changes to cigarettes. Fire statistics between 1995 and 1999 indicate that at least 14,030 fires in Canada were started by smokers' materials. These fires killed 356 people, injured another 1,615 and caused more than $200 million in property damage during the same period. Research has shown that design modifications to cigarettes may make them less likely to cause fires.

Health Canada is actively working towards the development of regulations concerning reduced ignition propensity (RIP) cigarettes, which would lower the tendency of cigarettes to ignite upholstered furniture, mattresses and bedding - thus reducing associated fatalities. To this end, a consultation paper - Regulatory Proposal for Reducing Fire Risks from Cigarettes - was initiated in December of 2002.

Light And Mild - Deceptive And Deadly

Health Canada aims to reduce the use of tobacco products by ensuring that misleading information is not provided to consumers, whether via tobacco product packaging, or by promotional means. One area of particular concern is the labelling of tobacco products as 'light' or 'mild'.

Despite a consensus among scientists that there is no conclusive evidence that cigarettes labelled 'light' or 'mild' reduce the death rate from smoking, about 18 percent of Canadians (nearly one in five) continue to believe that they are less harmful. Health Canada has been working to educate the public through mass media advertising (i.e., its 'Light & Mild - Deceptive & Deadly' campaign) and public education.

Health Canada also sought public input in December 2001 regarding the possible development of regulations that would ban these terms from tobacco packaging. Health Canada continues to work to gather the information needed to move ahead. Any future decision in this respect will be based on solid information and sound legal reasoning.

When It Comes To Taxing Tobacco

The taxation of tobacco products is an important element of the government's comprehensive Strategy. Evidence demonstrates that effective and sustainable tobacco tax policies can significantly contribute to reducing the consumption of tobacco products, particularly among youth. The current tobacco tax framework, introduced in April 2001, is designed to enable the federal government to achieve its objective of discouraging smoking through higher tobacco prices, while taking appropriate complementary measures to minimize the risks associated with the potential for increased levels of contraband tobacco sales in the domestic market.

Key elements of the new framework create additional disincentives for consumption and reduce the incentive to smuggle Canadian-produced tobacco products back into Canada. The new structure includes a two-tier export tax-refund mechanism applicable to tobacco products manufactured in Canada; and new taxes on Canadian tobacco products delivered to duty-free shops, sold as ships' stores (both in Canada and abroad), and on imported tobacco products delivered to Canadian duty-free shops. Federal excise tax also now applies to tobacco products imported by Canadian resident travelers.

In addition to these measures, increased funding was provided to federal departments and agencies to improve their ability to monitor and assess the effectiveness of these measures in reducing tobacco smuggling. The federal government also announced an increase in the surtax on the profits of tobacco manufacturers to 50 percent of corporate income tax payable, from 40 percent.

In November of 2001 and June of 2002 respectively, second and third rounds of tobacco tax increases were introduced. Federal taxes were increased in all provinces and territories, ultimately re-establishing a uniform federal excise tax rate on cigarettes across the country. Taxes were also increased on fine-cut tobacco, tobacco sticks, exported tobacco products, and on tobacco products delivered to duty-free shops, sold as ships' stores, or imported by Canadian residents returning to Canada.

When It Comes To Communicating With Canadians

Provision of accurate, consistent health information over time is Health Canada's responsibility; and all Canadians have a right to this information. Under the Strategy this responsibility is incorporated within a framework defined by integrated, comprehensive and sustained measures to reduce tobacco consumption and exposure to tobacco smoke.

Messages delivered with the support of pertinent tobacco control policies, as well as educational and regulatory measures, will have more resonance. Tobacco control measures that are supported by strategic messaging will have greater impact. Combining mass media and multi-media messaging with other tobacco control initiatives is the optimal means, ultimately, to a more powerful tobacco control initiative.

Sending The Right Messages

We know that generating and maintaining awareness is consistent with the iterative process in attitudinal change and, eventually, changes in behaviour. Health Canada has been producing mass media advertising campaigns designed to provide information that is accurate, consistent and available over time.

Although it is too early to evaluate the overall effectiveness of these campaigns, there are indications that Health Canada's mass media initiatives have been making Canadians more aware of the consequences of smoking.

One of the advertising campaigns which generated considerable response since the enactment of the Strategy was 'Numbers', launched in early 2002 via television, radio and print. It featured bodies in a morgue, each bearing a toe tag with numbers incrementing to 45,000 - the number of Canadians who die each year as a result of tobacco. Almost 80 percent of Canadians recalled the ad when prompted, and approximately 65 percent indicated an understanding of its message: 'Tobacco. We can live without it.'

Second-hand smoke was the issue in Health Canada's 'Couch' ad, a television and print campaign for both mainstream and Aboriginal audiences which explored the subject of second-hand smoke as it pertains to Canadian youth. It featured young people being exposed to tobacco smoke in a party setting, and encouraged young Canadians to protect their families and friends from second-hand smoke diseases. More than 80 percent of Canadian youth recalled seeing this ad when prompted; of those, close to 80 percent remembered the phrase, 'second-hand smoke diseases'.

Health Canada has also conducted campaigns around: second-hand smoke in Canadian workplaces ('Heather') [see details about this campaign, pg. 9]; second-hand smoke in the home ('Target'); secondhand smoke in Aboriginal communities ('Labels'); healthy lifestyle choices ('Doctors' and 'Athlete'); the toxic constituents in tobacco ('Cocktail'); and misleading tobacco product labelling ('Light & Mild - Deceptive & Deadly').

Health Canada recognizes that changes in opinions usually take time to root and grow, and changes in behaviour normally come about over a period of time. As part of the Strategy's comprehensive approach, Health Canada will mount mass media campaigns on an ongoing basis, delivering messages that assist in the shift towards a smoke free society. In the immediate future, these campaigns will bring further attention to issues around second-hand smoke, and will engage Canadians in a journey towards smoking cessation.

Sending The Right Signals

The Strategy has also been supported by Health Canada's tobacco control website - www.GoSmokefree.ca - launched in 2002. Consisting of roughly 1000 pages, the site garnered approximately half a million hits in 2002, and generated 2500 subscribers to a variety of e-mail updates and newsletters. In addition to providing a wealth of tobacco control information and resources, the site contains links to various other helpful sites - such as the National Clearinghouse on Tobacco or Health.

My twin sons were doing a project on smoking and alcohol. The youth smoking section was excellent, written in their language, fun to read, and easy to understand. GREAT JOB!

- Name withheld

When It Comes to Quitting

Quitting smoking represents the single most important step that smokers can take to enhance the quality and length of their lives. There is no question that smokers can quit - more than 7 million Canadians (over half of Canadians who have ever smoked) have done so. There are now more former smokers in Canada than there are smokers.

Furthermore, whenever one person quits smoking, many others benefit. Workplace productivity can increase; insurance and maintenance costs can be reduced. And evidence shows that as the number of people who quit goes up (resulting in fewer models for smoking behaviour), the number of people who start goes down. Plus, fewer smokers means less second-hand smoke.

An essential component of the Strategy is the earliest possible delivery of the most effective cessation programming, in order to ward off disease, disability and premature death. Provision of appropriate smoking cessation programming has two facets to it.

On the one hand, Health Canada and its partners undertake 'better practices' reviews on an ongoing basis, in order to identify needs, carry on relevant research, and be sure that the most suitable assistance (for example, for pregnant and post-partum women) is provided to Canadians. On the other hand, it is critical that programmes to help smokers quit are easily and universally accessible. Health Canada has taken several steps to ensure that the most effective cessation programming is made available to Canadians in a direct and timely fashion.

On Paper

In 2001 the Y2Quit Newsletter was initiated by Health Canada. The newsletter was the result of a collaboration between Family Physicians of Canada, the Canadian Council for Tobacco Control, Physicians for a Smoke-Free Canada, and Health Canada. The role of physicians in helping Canadians to stop smoking is the newsletter's focus; it provides up-to-date tobacco control news and information to health professionals and to their patients across Canada.

On The Telephone

In 2002 Health Canada oversaw the development of a National Network of Quitlines to provide a framework for sharing resources, identifying research and training needs and providing cost-efficient cessation counselling across Canada. Health Canada is also providing funding for training, resources and information dissemination, as well as the establishment of a national standardized approach to quitline monitoring and evaluation.

Also in 2002 Health Canada partnered with the provinces, as well as with the Canadian Cancer Society, the Canadian Lung Association, the Heart & Stroke Foundation of Canada and others, to pilot/evaluate 1-800 quit lines in six provinces.

On The Web

Forty-five percent of visitors to Health Canada's www.GoSmokefree.ca website access cessation information, tapping into a variety of online smoking cessation tools.In addition to exploring a new inventory of Canadian tobacco cessation programmes and resources, visitors can now sign up for E-Quit, a 30-day series of free e-mail messages which will help them through the cessation process. Approximately 10,000 people had signed up for this series as of the end of 2002.

On the Road to Quitting is another interactive self help web-based resource (also available in print format) that motivates smokers to quit and supports them at every step along the way. This programme helps people to deal with temptations, stress, withdrawal symptoms and relapse; it assists in building motivation and self-confidence; and it answers questions about nicotine replacement therapies and other stop-smoking strategies.

When it Comes To The Young

Bringing down Canada's smoking rate over the long term will depend upon changing smoking behaviour among young persons. Given that 85 percent of current smokers start smoking by the age of 19, and that the average smoker smokes for 34 years, there is significant impetus for programming activities targeted to youth. Studies have also confirmed that young people are becoming hooked on nicotine more quickly and at a younger age than previously thought. The period of adolescence presents a unique challenge - and a unique opportunity -where prevention and cessation programming are concerned.

Engaging Them

From a health perspective, when youth engage in decision-making, they often gain a sense of empowerment, a sense of belonging to their community, and they form healthy connections to others. The community benefits from the energy, ideas, perspectives and values that youth bring to organizations, activities, and their relationships with adults.

Meaningful youth engagement produces benefits not only to youth and to their communities, but also to the organizations and 'systems' that work to engage them. Health Canada knows that youth involvement is key to developing strategies that help young people remain or become smoke-free. To this end, Health Canada has created a Youth Action Committee (YAC). YAC is a nationally represented team of 20 smoking and non-smoking members (ages 14 to 19) from across Canada, reflecting the diversity of Canadian society. Members are active as a national group; and they are involved in health and tobacco control groups in their own provinces and territories, as well as within their own communities and schools. Health Canada benefits from their input in the design and implementation of tobacco control programmes for youth, as well as on ways to reach out to a young audience and engage them in tobacco issues.

Empowering Them

In 2002 Health Canada brought a diverse group of young Canadians (both smokers and non-smokers) together for the Smokefree Spaces National Youth Conference. The conference focussed on developing action plans for generating awareness of secondhand smoke issues in the delegates' own communities. Smokefree Spaces generated a wealth of ideas by youth for youth, and was instrumental in the compilation of Health Canada's Smokefree Spaces Activist Toolkit. The toolkit provides information, ready-to-use resources and tips for working with local community leaders, parents, teachers and the media to plan and implement smoke free personal and public spaces.

A number of other youth-oriented activities generated enthusiastic participation. In 2001 Health Canada embraced an idea from students at Hugh Boyd Secondary School in Richmond, British Columbia, by promoting their Blue Ribbon campaign via the web, in published materials and within public venues. Canada's Blue Ribbon campaign is about people working together to clear the air of second-hand tobacco smoke. Dealing with second-hand smoke starts with positive, constructive dialogue, identifying the issue publicly, and wearing one's convictions for all to see - hence the blue ribbon. Blue Ribbon publications deliver advice and information on the various ways to help clear the air together - smokers and non-smokers - "you and me, smokefree".

In 2000 Health Canada conducted a national How to Help a Friend Quit Smoking poster contest for youth aged 10 - 17. Then in 2001 Health Canada held a contest inviting youth to design tobacco control television advertisements; the contest and winning entries were promoted on MuchMusic and MusiquePlus. In 2002, MuchMusic and MusiquePlus were the venues for youth forums on second-hand smoke. These activities, which promote youth participation on a national level, also help to raise awareness among youth as to their peers' points of view.

Enabling Them

In 2002 a youth specific section was added to Health Canada's tobacco control website www.GoSmokefree.ca - generating a 25 percent increase in visits from youth under 19 years of age.

Health Canada also introduced an interactive resource called Science,Tobacco and You! in 2002.The programme, which originated in Florida, was developed in consultation with students, science and health educators, physicians and teachers. Aimed at students in grades 4 to 6, it encourages students to explore the effects of tobacco on the body. A Canadian teachers' resource guide accompanies the adapted CD ROM. Science, Tobacco and You! is an excellent example of how highly successful programmes can be built upon and adapted for new audiences.

Also in 2002 Health Canada partnered with the Canadian Lung Association to expand and update a Quit4Life cessation programme for youth who smoke. This programme is based on cognitive behavioural principles that teach youth to practice being non-smokers. Focus is also given to building the motivation to quit and to socially supportive environments. The programme is now available on the Health Canada web site and is being piloted in communities across the country.

Protecting Them

The Tobacco Act forbids the furnishing of tobacco persons in a public place. One of approaches to monitoring the Tobacco Act has been to employ test shoppers to gauge a retailer's them tobacco products. Health inspectors work with such young of provinces and territories. In Prince Edward Island, Nova Scotia, New Brunswick, Manitoba and British Columbia, provincial inspectors carry out this work under the terms of federal-provincial agreements.

A 2002 survey of retailers' behaviour regarding the furnishing of cigarettes to teens, conducted by ACNielsen, indicated that only 71.2 percent of retailers were unwilling to sell to youth. These results were similar to those derived from a previous survey. There remain thousands of retailers who have yet to recognize that cigarettes will addict most young people who use them, with deadly and debilitating health consequences.

To inform and educate retailers about federal youth access restrictions and - it is hoped -improve their behaviour, Health Canada developed a Retailer Toolkit for Tobacco Sales in 2001 - 2002. The kit provides guidelines, training materials, forms and signage that will inform and educate retailers about federal youth access restrictions. It has been distributed in Manitoba and Saskatchewan, and is being adapted for use in the other provinces and territories.

When It Comes To Research

Health Canada is watchful, and continually learning. Health Canada surveys general consumer knowledge, attitudes and behaviour, in order to derive information about smoking initiation, prevalence and quitting -as well as locations where young people purchase tobacco products, and other factors related to tobacco consumption. Health Canada also regularly monitors medical and scientific information concerning tobacco. One of the largest surveillance undertakings for Health Canada is the Canadian Tobacco Use Monitoring Survey (CTUMS), conducted under the auspices of Statistics Canada. CTUMS continually tracks changes in smoking status and consumption, and is Canada's most comprehensive indicator of trends in tobacco prevalence.

In 2002 Health Canada conducted the Youth Smoking Survey, querying 20,000 Canadian youth in grades 5 to 9 about their attitudes and behaviours pertaining to tobacco. Results are pending.

In 2002 Health Canada also established a federal / provincial / territorial working group on tobacco specific research, in order to discuss and ameliorate development and dissemination of tobacco research within Canada.

When It Comes To Collaborating

Tobacco control is everyone's business. From individual to global action, it must be a collaborative and truly collective effort. Health Canada knows that working with the provinces, territories and NGOs, as well as the international health community, is vital.

Upon the Strategy's implementation, Health Canada moved to initiate and consolidate relationships and to deploy innovative programmes, in order to ensure that the Strategy would move forward from a strong footing. The idea was to build on current networks and enhance the ability of communities to take action. These approaches have borne fruit across the full range of key Strategy areas.

For example, formalized tobacco control strategies are now in place in all of the provinces and in the Yukon and the Northwest Territories; development is underway for a co-ordinated approach to regulatory frameworks around tobacco; several partnership agreements around prevention and cessation programmes, as well as mass media communications initiatives, have been signed; and investments in educational and support projects at national and regional levels have increased significantly.

In 2002, opportunities for collaboration and funding for local projects included: a smoke free homes social marketing and community engagement intervention conducted by the Prince Edward Island Tobacco Reduction Alliance; cessation initiatives aimed at smokers with diabetes and chronic lung and heart diseases, as well as recent mothers who smoke, under the auspices of the Heart and Stroke Foundation of B.C. and Yukon; and piloting and evaluation of the Smokefree Places: You Can Get There toolkit in selected communities across the country by the Federation of Canadian Municipalities. Health Canada's regional offices are catalysts for these collaborations. They play a key role in establishing partnerships with community organizations for purposes of identifying and addressing regional priorities for action in tobacco control.

On The World Stage

We must react to the millions of people dying each year around the world from tobacco use. Those most impacted are increasingly in developing countries. It is essential for public health that we move to limit the enormous toll tobacco exacts across the globe.

To support capacity-building external to Canada, Health Canada yearly donates grant monies to the World Health Organization and the Pan American Health Organization. It also actively participates in internationally-oriented symposia and conferences on tobacco control.

Since 2000, Canada has assumed a leadership role in the development of the first international public health treaty, the international Framework Convention on Tobacco Control (FCTC).

The treaty will commit signatory countries to collective action and co-operation in tobacco control, and covers numerous issues - from tobacco packaging, labelling, advertising and sponsorship, to illicit trade, taxes, sales to youth, surveillance and research. Canada has taken a leadership role in the development and negotiation of the FCTC.

From within this venue and outside of it, Canada has shared expertise and advice, and provided assistance in tobacco control to several countries.