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The Smoke-Free Ontario Act's First Anniversary

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I    Smoke-Free Ontario Strategy: Background

May 31, 2007, marked the first anniversary of a Smoke-Free Ontario (SFO).

In 2005, the Ministry of Health and Long-Term Care (MOHLTC) fully funded tobacco control programs in public health units across the province. This funding is part of a comprehensive and province-wide strategy, called the Smoke-Free Ontario Strategy, that brings together many organizations (a list is provided in the related resources for this article) and has three goals:
    * Prevention (helping youth remain smoke-free)
    * Protection (helping Ontarians avoid second-hand smoke exposure)
    * Cessation (helping smokers quit)

A key component of this comprehensive strategy is the Smoke-Free Ontario Act. As of May 31, 2006, this legislation protects the health of all Ontarians by prohibiting smoking in all enclosed workplaces and enclosed public places. The Smoke-Free Ontario Act (SFOA) replaces the Tobacco Control Act (1994) and standardizes a patchwork of local municipal by-laws. The legislation strengthens measures to ensure that only those 19 years of age and older can buy tobacco products and will phase out the display of tobacco products, with a complete ban beginning May 31, 2008.

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II    Strategy Infrastructure

The overall strategy has a prescribed infrastructure, developed in 2005, that supports multi-level (i.e., local, regional, and provincial) program planning, coordination, and communication.

The Smoke-Free Ontario Program Unit at the Ministry of Health Promotion is responsible for the overall management of the strategy and the development of the infrastructure.

The Community Action Work Group (CAWG) and the Tobacco Control Area Networks (TCANs) are the centralized and regional hubs for communication, capacity building, and planning.

The CAWG is a provincial-level committee, chaired by the Chief Medical Officer of Health or designate. One of the CAWG's functions is to provide a venue for integrated communication and planning related to the Smoke-Free Ontario Strategy. Each TCAN is represented at the CAWG. Other members of the CAWG include partners and stakeholder organizations in the Smoke-Free Ontario Strategy.

TCANs are networks of public health units (PHU) organized by geography, with one to nine PHUs per TCAN. Each TCAN is lead by one PHU in the region, which is called the Coordinating Public Health Unit (CPHU). Each CPHU has a TCAN Coordinator and a Youth Development Specialist.

The TCAN Coordinator leads this network of PHUs and is funded to develop their respective TCAN networks and steering and subcommittees and to assist with area-wide planning, communication, and collaboration. To date, the TCANs have facilitated a wide variety of collaborative public education, public relations, and training activities.

Finally, the overall strategy has a strong monitoring, research, and evaluation component, which is conducted independently by the Ontario Tobacco Research Unit (OTRU).

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III    Success Stories

The SFO Strategy has experienced many successes to date, including (but not limited to) the following list of highlights:

  • There is increased momentum around tobacco control. Provincial networks have expanded and key partners are collaborating on efforts.
  • The SFOA came into effect one year ago and has been met with a high level of compliance. Compliance with the SFOA is being measured through a compliance study done before and after the SFOA implementation. A one-year, post-legislation compliance study will also be done.
  • Youth are engaged in tobacco control initiatives and are highly motivated to take action.
  • There is a multi-media campaign (Stupid.ca), high school grants, and Youth Action Alliances, as well as other partnership programs for youth.
  • The Ontario Tobacco Control conference in December 2006 had record attendance.
  • The Driven to Quit Challenge had more entries than ever before.
  • The number of calls to Smokers' Helpline has increased and the service hours have been expanded.
  • A mass distribution phase of nicotine replacement therapy (NRT) in the Smoking Treatment for Ontario Patients (STOP) Study was introduced in January 2006 and is the first of its kind in Canada. The study involved an unprecedented 13,000 participants who received free nicotine replacement therapy such as nicotine gum or patches to help them to quit smoking and their effectiveness was monitored for six months.

Prevention

The prevention component of the strategy includes a multi-media campaign (Stupid.ca), high school grants program (high schools apply for a grant for prevention activities in their school), and Youth Action Alliances (YAAs) as well as other partnership programs for youth.

The YAAs, in particular, have been a very active part of the prevention strategy. In 2006, all 36 public health units were funded to start at least one Youth Action Alliance (YAA). To date there are over 50 YAAs in the province. The YAA program provides an opportunity for high school age youth--Peer Leaders--to create and implement innovative and unique tobacco control programs for youth by youth. The activities and events developed and implemented by the YAAs vary and are based on the needs of a particular community and the youths' interest and creativity. YAA activities include public education, Tobacco Industry Denormalization (a term used to describe activities and work to expose the tobacco industry and its tactics), earned media attention (media that is promoted or earned through events, etc., rather than through purchased advertising), and advocacy for public policy change.

Reasons for Success

The SFO strategy has been successful for a number of reasons. A primary reason for its success is the strong public support for smoke-free public places and the desire to have SFO legislation. A secondary reason is the SFO strategic framework of the SFO strategy, which is widely comprehensive and includes public education, healthy environments, policy change, educational resources, and consistent legislation across the province and a large prevention component for youth.

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XII    Support for Tobacco Control: Facts and Figures

Smoking is the number one preventable cause of premature death and illness in Ontario and accounts for the premature and preventable deaths of approximately 16,000 Ontarians each year (Illing, E.M.M. & Kaiserman, M.J., 2004). Currently 20% of all Ontarians smoke (Health Canada, 2002). Tobacco-related disease costs $1.7 billion in healthcare annually and $4.4 billion in lost productivity (Jha, P. & Chaloupka, F.J., 1999) These diseases account for at least half a million hospital days each year (Ontario Medial Association, 2003). Second-hand smoke poses a health risk to non-smokers and smokers alike.

Ontarians support tobacco control. Two out of three Ontarians support increased taxes on cigarettes. Three in four would support a tax increase to fund tobacco control initiatives. Eighty-one percent support increased spending on tobacco control initiatives, and 68% support provincial intervention for smoke-free by-laws (Ipsos Reid Poll, 2004). Public support for tobacco control helps to make public health efforts a priority.

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XIII    Looking Forward, Looking Back

Our one-year anniversary is certainly a good time to reflect about how far we have come and what our future direction is.

What are the next steps? The next phase is preparing for the final component of the SFOA: the retail display ban in May 2008. There are certainly many issues on the horizon: contraband tobacco products ( illegal tobacco products ranging from incorrectly taxed or labelled to imported products that do not meet legislated standards), drifting smoke in multi-unit dwellings, and smoking in vehicles, to name a few.

Tobacco control--is it done? Certainly not! As important as it is to keep track of emerging issues, it is just as important to maintain what has already been achieved. So as we recognize this one-year anniversary of the SFOA, it is imperative to look back and appreciate all the hard work and dedication that has gone into making SFO and Tobacco Control a success.