1. Tobacco use and
exposure workshop
Anne Meloche
Program Training and Consultation Centre

2. Program Training & ConsultationProgram Training & Consultation
Centre (PTCC)Centre (PTCC)
• Lead Ontario provincial tobacco control
resource centre
• Responsible for leading & coordinating tobacco
control capacity building & knowledge exchange
in support of the Smoke Free Ontario Strategy
• Partnership of:
• Cancer Care Ontario
• Region of Waterloo Public Health
• Sudbury and District Health Unit
• Propel Centre for Population Health Impact
2

3. Question:
What was the prevalence of tobacco in
Ontario in 1965?
41.4%
(Ontarians 15 years of age and over who smoke)
Source: A Report for the Ontario Council of Health.
Smoking and Health in Ontario: A Need for Balance.
Report of the Task Force on Smoking, Submitted to the Ontario Council of Health, May 1982.

4. Question:
What is the prevalence of tobacco
in Ontario in 2007-2008
19% currently smoke
22% use tobacco
Source: 2007-2008 Canadian Community Health Survey

5. The Burden of Tobacco Use In
Ontario
 Leading preventable cause of disease & death
 Over 13,000 deaths in Ontario each year1
 In 2002, 17% of all deaths in Canada were attributed to
tobacco use1
 $6.1 billion in direct health care costs & lost
productivity2
1
Baliunas et al. (2007) Smoking- attributed mortality and expected years of life lost in Canada 2002: Conclusions
for prevention and policy
2
Rehm, J et al. The Costs of Substance Abuse in Canada 2002. retrieved from:
http:www.ccsa/Eng/Priorities/Research/CostStudy/Pages/default.aspx

6. Health Consequences of Tobacco Use
“Smoking harms nearly every health
organ of the body, causing many
diseases, and reducing the health of
smokers in general”3
Smoking causes a variety of cancers
including lung cancer, oral cancers,
pancreatic cancer, renal cancers, bladder
cancer, cervical cancer
3
USDHHS. (2004). The health consequences of smoking: A report of the Surgeon
General.

7. Health Consequences of Tobacco Use
Smoking causes cardiovascular diseases,
including atherosclerosis, coronary heart
disease, stroke, & respiratory diseases
including acute respiratory illnesses (e.g.
pneumonia, etc), & chronic obstructive
pulmonary disease (COPD)

8. Exposure to Second-hand Smoke
Over 50 carcinogens have been identified in
SHS and no safe level of exposure has been
identified4
Exposure to SHS causes lung cancer, coronary
heart disease, and respiratory problems4
Exposure during childhood increases the risk
of SIDS, acute respiratory infections, middle ear
disease, and asthma4
4
USDHHS. (2006). The health consequences of involuntary exposure to tobacco smoke: A
report of the Surgeon General.

9. Current tobacco use in Ontario

10. Tobacco Use in OntarioTobacco Use in Ontario
Ages 12+ 2007-2008Ages 12+ 2007-2008
22% of Ontarians use tobacco
19% currently smoke cigarettes
Numbers:
2.3 millio of 12.9 million Ontarians use some
form of tobacco
2.1 million smoke cigarettes
Source: 2007-2008 Canadian Community Health Survey
10

12. Current Smoking (%) by Age andCurrent Smoking (%) by Age and
Sex Ages 15+, Ontario 2007-2008Sex Ages 15+, Ontario 2007-2008
0
10
20
30
40
50
15-17 18-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70+
Female
Male

13. Youth SmokingYouth Smoking
The prevalence rate of current
smoking among youth aged 15-17
was 10% (about 0.1 million youth)
13

14. Young Adults – SmokingYoung Adults – Smoking
PrevalencePrevalence
Young
adults aged
20-24 years
reported
the highest
prevalence
of smoking
at 27%
14

15. Current Smokers: Age and SexCurrent Smokers: Age and Sex
Highest Prevalence
–Males aged 25-29 years (37%)
–Females aged 25-29 years (24%)
Greatest number
–Males aged 40 to 44: 173,300 of 1.2
million male smokers (15%)
–Females aged 25-29 years: 109,100 of
892,300 female smokers (12%)
15

16. Prevalence (%) and Number ofPrevalence (%) and Number of
Current Smokers by ImmigrationCurrent Smokers by Immigration
Status, Ages 12+, 2007-2008Status, Ages 12+, 2007-2008
13
22
0
20
40
60
80
100
Immigrant Non-Immigrant
442,600
1,582,600
0
500,000
1,000,000
1,500,000
2,000,000
Immigrant Non-Immigrant
16

17. Ethnicity and Current SmokingEthnicity and Current Smoking
Ages 12+, 2007-2008Ages 12+, 2007-2008
Aboriginal respondents:
–40% smoking prevalence
–106,500 or 5% of all Ontario smokers
White respondents
–21% smoking prevalence
–1.6 million or 79% of all smokers
Black (8%) South Asian (9%) and
Chinese (10%) respondents reported
lower rates of smoking
17
17

18. Other populationsOther populations
People with mental health
issues (schizophrenia) 70%
Aboriginal community 40%
Gay and bisexual community
(aged 18-59) 33%
Francophones 27%
People whose first language
is neither English nor French 14%

19. Francophones in Ontario
41.5%
28.7%
5.9%
1.4%
22.5%
Ontario's francophone
community numbers
582,690, i.e. 4.8% of
the province's total
population (according to
Statistics Canada 2006
census)
Source: website
of the Office of
Francophone
Affairs, Ontario

20. 2006 Census data indicated
that about 242 490 people
reported being Aborginal in
Ontario i.e. 2.0% of the
province's total population
* Regional numbers are estimates
Central East & West: 18.9%
South West: 11.5%
North East: 9.2%
Northern: 31.7%
Aboriginal Population in Ontario
About 28.7% of Aboriginal communities reside in other parts of Ontario
http://www.trilliumfoundation.org/User/Docs/PDFs/research/InfoNote_Aboriginal.pdf

21. Sexual Orientation in Ontario
Ontario is home to between 400,000 and 1.25
million people who self-identify as lesbian, gay,
bisexual, transsexual, transgender, Two-Spirit,
intersex, queer, or questioning (LGBTTTIQQ).
Making up five to ten per cent of Ontario's
population, those who are members of sexual or
gender minority communities routinely experience
threats to their health and well-being because of
their sexual orientation and/or gender identity.
 RNAO Position Statement: Respecting Sexual Orientation and
Gender Identity, June 2007

22. Current Smoking (%) by EducationCurrent Smoking (%) by Education
Ages 18+, 2007-2008Ages 18+, 2007-2008
27
25 24
17
21
0
5
10
15
20
25
30
Less than
High School
Completed
High School
Some Post-
secondary
School
Completed
Post-
secondary
School
ON

23. Current Smoking (%) byCurrent Smoking (%) by
Household Income, Ages 18+,Household Income, Ages 18+,
2007-20082007-2008
18
16
20
22
24
25
32
33
26
24
22
13
0 10 20 30 40 50
Not Stated
$100,000 or more
$80,000-$99,999
$60,000-$79,999
$50,000-$59,999
$40,000-$49,999
$30,000-$39,999
$20,000-$29,999
$15,000-$19,999
$10,000-$14,999
$5,000-$9,999
Less than $5,000

24. ReferencesReferences
Health Canada. (2008). CTUMS.
Ottawa, ON. Health Canada.
Retrieved on January 27, 2010
From: http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/resea
OTRU. (2009). Who Are Ontario
Smokers? Toronto, ON. OTRU.
24

26. Smoke-free Ontario Strategy (SFO)
2005: Government announced SFO Strategy
Comprehensive tobacco control
initiative aimed at decreasing tobacco
use in order to reduce chronic
disease & tobacco related deaths

27. Smoke-free Ontario Strategy (SFO)
3 Pillars of strategy:
o Prevention – prevent children, youth &
young adults from starting to use
tobacco
o Cessation – motivate & support tobacco
users to quit
o Protection – eliminate exposure to
second-hand smoke (SHS)

28. 6 keys to Success for Community
Action for a Smoke-Free Ontario
1. Work Together
2. Keeping your eye on the ball
3. Identify and Capitalize on Synergies
4. Coordinate with Provincial, National
and International Initiatives
5. Respond to community needs
6. Have a plan

29. 1) Working in Partnership
Community based tobacco control involves many
partners, including:
 36 PHUs – leadership & coordination of tobacco
control at the local level
 7 Tobacco Control Area Networks (TCANs) –
regional planning & coordination
 CHCs
 Hospitals
 Smoke-free Coalitions/Councils
 Health practitioner organizations
 Sport & Recreation organizations
 School Boards
 NGOs & their community chapter offices
 Social Services
 Others

30. 2) Keeping your eye on the ball
Comprehensive Planning and Action
Community-based action required within each
pillar (cessation, protection, prevention)
Reinforcement through integrated approach
(linkages) with regional & provincial supports
(e.g. coordination with provincial media
campaigns, referral to provincial Smokers’
Helpline, etc)
Effectiveness requires mix of policy, program &
public education across multiple settings,
partners & target audiences

31. 3) Identify and Capitalize on Synergies
 Identify programs or initiatives that are
known to impact positively on more
than one tobacco control issue.
Examples:
1) Using stop smoking medication in
conjunction with behavioural support
2) There is strong evidence that smoke-
free environments serve a double
purpose: provide protection from
second-hand smoke and promote
smoking cessation

32. 4) Coordinate with Provincial, National and
International Initiatives
To be able to coordinate activities
and achieve maximum effect, local
practitionners need to know what is
happening at all levels.
Example:
National-Non Smoking Week – third
week of January (including weedless
Wednesday)

33. 5) Respond to Community Needs
Importance of identifying community
needs by:
Needs Assessment
Service Gap Assessment

34. 6) Having a Plan
 Under SFO, plans needed to take account of
seven strategic components:
1. Leadership, coordination and collaboration
2. Capacity building and infrastructure
development
3. Monitoring, evaluation and research
4. Program Interventions
5. Public Education
6. Tobacco Industry Denormalization
7. Policy and action

35. Community-based Actions To Reduce
Tobacco Use & Increase Cessation
Cessation Pillar Policy Program/Service Public Education
Provide smoking
cessation referral to
SHL & other resources
X
Promote smoking
cessation & motivate
smokers to quit
through contests,
campaigns, etc
X
Facilitate training of
practitioners on
smoking cessation
X
Provide cessation
services to priority
populations (e.g. blue
collar, Aboriginal,
Francophone, etc)
X

36. Community-based Actions To Reduce
Exposure to Second-hand Smoke
Protection Pillar Policy Program/Service Public Education
Educate decision
makers about the
need for specific
changes to policy
X
Develop & promote
by-laws –SHS
exposure, e.g. TF
outdoor recreational
areas (parks,
beaches,
playground, etc.)
X
Promote compliance
with SF vehicle laws
X
Encourage
voluntary adoption
of policies that
promote SF homes
(single and multi-
unit)
X

37. Community-based Actions To Prevent
Smoking Initiation
Prevention
Pillar
Policy Program/Service Public Education
Limit the
number of
tobacco retail
outlets through
zoning &
licensing,
especially in
proximity to
schools
X
Develop/facilitate
youth-led
prevention
activities &
actively engage
youth in
implementing
school &
community-
based policies &
programming
X

38. Community-based Actions To Prevent
Smoking Initiation
Prevention
Pillar
Policy Program/Service Public Education
Promote TC as
a priority within
comprehensive
school
programming
X

39. Integrating tobacco
control with other risk
factors

41. Case Example #1
Tobacco Free Sports and Recreation
NW Youth Coalition organized 13 events to gather
community support for TF parks & beaches
 Summer – regional education campaign to change social
norms around tobacco use
– Events included community marches, rallies, butt
litter clean ups, etc
– Significant earned media
– Post card campaign – part of municipal council lobby
strategy
 Presented to Thunder Bay City Council (Oct 2008)
 By-law approved supporting TF parks & beaches (spring
2009)

42. Play, Live, Be Tobacco Free Ontario –
Creating healthy public policy
The target audience for this
intervention is decision-makers and
others with influence over policies
within sport and recreation
organizations and municipalities.

43. Play, Live, Be Tobacco Free Ontario –
Creating healthy public policy
The collaborative was formed to secure funding
and to develop the strategy.
The major activities planned include:
Local and regional social marketing campaigns,
including the mobilization of youth
Grants for local sport and recreation
organizations
Capacity building supports including a website,
policy database and map
A policy model to support action within sports
and recreation organizations on other CDP risk
factors

44. Case Example #2 – Partnerships
Partnership with 3 community mental health
agencies & York Region Community and
Health Services
Comprehensive, evidence-based cessation plan
designed, implemented & evaluated:
– Training of mental staff (brief contact
intervention) & understanding of tobacco
addiction as it relates to mental health clients
– Policy development – to enhance staff
implementation of BCI, documentations,
accessibility to self-help resources for clients

45. Case Example #2 – Partnerships
– Champion model – champions identified to obtain
intensive cessation training, act as best practices
resource, to deliver the counselling & to collaborate
through a community of practice
– Group smoking cessation program – offered to
clients along with access to no cost nicotine
replacement therapy

46. The case made for smoking cessation
Question:
Within the context of
a smoking
cessation program,
what are the issues
you would discuss
with a person who
would like to quit
smoking?

47. Risk factors discussed in smoking
cessation intervention
Physical activity

48. Risk factors discussed in smoking
cessation intervention
Healthy Eating

49. Risk factors discussed in smoking
cessation intervention
Alcohol « use »

50. Risk factors discussed in smoking
cessation intervention
Drinking lots of water!

51. From the industry that
« doesn’t » quit!

52. Cigarillos

54. « Cigarillos are the new cigarettes for
kids. »
Physicians for Smoke-Free Canada
« Young canadians use cigarellos 3
times the rate of adults. »
Health Canada

56. Smoking in movies
Film is better than any commercial
that has been run on television or
any magazine, because the
audience is totally unaware of any
sponsor involvement.” –
Robert Richards, president of Productions, Inc.
in a 1972 letter to the president of RJ Reynolds

57. Provincial Supports
PTCC – lead provincial TC resource centre
(ptcc-cfc.on.ca)
• responsible for leading & coordinating TC
capacity building & knowledge exchange
programs in support of the SFO Strategy
• PTCC-Media Network: media advocacy expertise
& training to increase positive media coverage
around TC issues
Training Enhancement in Applied Cessation
Counselling and Health (teachproject.ca)
• Training for health care professionals –
cessation counselling

58. Provincial Supports
ATP - Aboriginal Tobacco Program (tobaccowise.com)
• Engage Aboriginal communities in the creation of HP
strategies to decrease & prevent the misuse of tobacco
& to develop “tobacco-wise” communities
Youth Advocacy Training Instituted (YATI) (yationlung.ca)
• Training & assistance to support the development &
implementation of youth tobacco use prevention
programs
SHAF (nsra-adnf.ca)
• Responsible for conducting public policy research and
education designed to reduce tobacco-related disease &
death

59. Provincial Supports
Ontario Tobacco Research Unit (otru.org)
Tobacco control research,
monitoringevaluation and training

60. ….in conclusion

61. How would you complete the
following sentence:
Smoking is…….

62. World Health
Organization
Although tobacco deaths rarely make
headlines, tobacco kills one person every
six seconds.

63. In the 20th century the tobacco
epidemic killed 100 million
people worldwide.

64. In the 21st century
it could kill one billion.

65. Reversing this entirely preventable
epidemic must now rank as a top
priority for public health and for
political leaders in every country of
the world.
Dr Margaret Chan, WHO Director-General