Parliamentary Research Branch

PRB 98-8E

At the federal level, efforts to control tobacco use involve many different federal departments and agencies, including those working on health, finance, agriculture and anti-smuggling endeavours. Measures employed include legislation, taxation, and public education.

This section focuses primarily on the actions of Health Canada and on its policies and programs aimed at tobacco-related research, education, prevention and cessation. Legislative and taxation efforts are described in separate units.

The federal government’s roles in relation to health-oriented policies and tobacco use programs arose from both constitutional powers and historical and practical considerations. They encompass:

• delivery of health care services to specific groups under federal jurisdiction (such as First Nations people on reserves) as well as to the RCMP, Correctional Services, the Armed Forces and veterans;

• actions to protect the health of Canadians, directly and in co-operation with other federal agencies and provincial governments, such as legislating the Tobacco Act and the Food and Drugs Act;

• support for the health care system through the Canada Health and Social Transfer and research funding;

• strategies to improve the health of the population through general education and specific initiatives such as the former Tobacco Demand Reduction Strategy and the current Tobacco Control Initiative.

In 1994, the federal government announced a Tobacco Demand Reduction Strategy as part of its National Action Plan to Combat Smuggling in Canada. The strategy was to be funded by a health promotion surtax on profits from tobacco manufacturing. The amount allocated to the three-year initiative was to be about $60 million annually.

In 1996, the Tobacco Control Initiative was to allocate $50 million over five years for a comprehensive strategy combining research, policy and program development, public education, information dissemination and enforcement of legislation. An additional $50 million was pledged in the 1998 Speech from the Throne. The following sections describe federal support for anti-tobacco initiatives aimed at certain target groups, workplaces, product decisions, and health professionals.

Under the Tobacco Demand Reduction Strategy, efforts were made to develop prevention and cessation programs for groups with a higher prevalence of smoking or with a low responsiveness to previous programs. Priority groups included: youth, women, Francophones, Aboriginal people, certain ethnic and immigrant populations, the heavily addicted, and low income and low literacy groups. The current Tobacco Control Initiative continues to emphasize particular groups and the need for a multi-pronged approach.

Much of the federal action has been directed to the development and dissemination of research findings with respect to these groups. Since 1985, social marketing, particularly anti-tobacco advertising, has been a major part of federal government efforts to reduce tobacco use. In addition, Health Canada has designed the Community Action Initiatives Program (CAIP) to provide funding for projects supporting and encouraging the development and implementation of community-based anti-tobacco programs. Examples of federal initiatives for vulnerable groups are described below.

i) Youth

The 1994 Youth Smoking Survey provided information on young people’s attitudes to and knowledge of smoking.(1) Among other things, the survey found that 70% of 15 to 19 year olds cited peer influence as the most common reason for starting to smoke and that 85% of smokers and 83% of non-smokers consider tobacco company sponsorships on billboards and event promotions to be advertising. Detailed analysis of the results concluded that programs and policies should be directed to younger age groups of both sexes and should be supported by schools, youth organizations, and young people’s workplaces.(2)

One of the first of such programs aimed at youth was the "Break Free" campaign in place from 1987 to 1993.(3) Current efforts include the "Challenge to Youth" campaign whose advertisements aired in Cineplex Odeon theatres during summer 1997 and on television in winter 1998. A post-test analysis found that the "convincing value" of the ads was lower for boys than girls, for smokers than non-smokers, and for French audiences than English ones.(4)

Smoking cessation programs for teens were found to require several specific components. Thus, teens prefer programs that have high levels of success and offer methods that can be used on an individual basis, are affordable, and minimize the side effects of withdrawal. Health Canada’s Quit-4-Life self-help kit can be used individually or in groups. A 1995 evaluation found that 77% of teens using the kit were able to reduce their cigarette consumption and about 20% had been able to quit for at least three months.(5)

ii) Women

A 1995 survey found that 25% of females smoked, compared to 29% of males. However, in the 15 to 19-year age group, the percentage for females was higher than that for males.(6)

The recognition that women and men start or stop smoking for different reasons led Health Canada in 1988 to support the first National Workshop on Women and Tobacco. This led to special programs for young girls and for pregnant and low-income women as well as to educational campaigns and cessation programs for women. In 1995, background work for another Women and Tobacco Workshop saw the publication of a framework for action that provided an overview of research, programs, public policy, and social marketing literature.(7)

Within the Tobacco Demand Reduction Strategy, both the Women and Tobacco Initiative and the Pre- and Post-Natal Tobacco Initiative developed special programs for adolescent and adult women. These included research on the design and delivery of effective tobacco cessation programming, a "Back Talk Guide" to help young women aged 12 to15 years to respond to media messages in an informed way, and development of booklets to be used by health care professionals when advising on the dangers of tobacco use during pregnancy.(8)

iii) Francophones

Data collected by Health Canada suggest that Francophones are a high-risk group in terms of smoking. A 1995 survey found that 36% of male Francophones in Canada smoke and 35% of female Francophones do so. This compares to the Canadian average of 29% for males and 25% for females over 15 years of age.(9)

Information collected by the Health Promotion and Programs Branch led to proposals for the development of programs with characteristics that appeal to Francophones. Some proposals focused on programs that are culturally sensitive and emphasize freedom of individual choice, that are visual and interactive, that propose replacing cigarettes with other pleasurable activities, and that involve professionals such as physicians, nurses and teachers.(10)

iv) Aboriginal People

Responsibility for the delivery of programs and services to Aboriginal people is divided between the federal and the provincial/territorial governments according to whether recipients are status Indians, on or off reserve; non-status Indians; recognized or unrecognized Inuit; or Metis. Thus, the health of First Nations people on reserve and recognized Inuit people comes under the Medical Service Branch of Health Canada, while the Metis and other groups have access to federal programs for the general population.

Studies conducted by Health Canada reveal that smoking rates among Aboriginal people are much higher than among the Canadian population as a whole. A 1991 survey found that 56% of Indians, 57% of Metis and 72% of Inuit were currently smokers, compared to 32% of the overall Canadian population.(11) Additional information on smoking habits was gathered through the 1996 First Nations Youth Smoking Survey and through the regional health surveys carried out by First Nations organizations.

Efforts carried out under the Tobacco Demand Reduction Strategy to reduce these high smoking rates included tobacco prevention workshops run by the National First Nations and Inuit Working Group on the Non-Traditional Use of Tobacco, training Aboriginal community health workers, and designing a smoking prevention/cessation model for Aboriginal women called "Helping You Quit: A Smoking Cessation Guide for Aboriginal Women in Canada." Additional activities are expected under the Tobacco Control Initiative.

For Aboriginal people, tobacco has traditionally had a spiritual significance and has been used in ceremonies and for trading purposes. It has been suggested that acknowledgement of and support for the historical and spiritual context of tobacco use can provide a strong base for prevention and cessation programs. Programs must recognize, however, that Aboriginal Canadians are not a homogeneous group and that there are significant cultural differences in Indian Nations, Metis communities, and Inuit peoples.

Since the late 1980s, the federal government has developed various measures to discourage tobacco smoking in workplaces under its jurisdiction; that is, in industries or enterprises considered to be federal undertakings or businesses. The affected workers are primarily federal public servants and employees in such areas as interprovincial or international transportation, telecommunications, banking, and broadcasting.

The measures are linked primarily to the Non-smokers’ Health Act and its Regulations. Although the Act permits smoking in designated areas within workplaces, many federally regulated workplaces have developed policies to clarify the application of the legislation. The following sections provide a brief overview of some of these policies.

i) Public Service Departments

Treasury Board has developed a policy to assist departments in the application of the non-smoking legislation.(12) The policy applies to indoor or enclosed spaces under the employer’s control. Smoking rooms can be designated in consultation with the safety and health committee and can include motor vehicles, hospitality rooms, and a portion of any living accommodation or recreational facilities provided for employees.

Several additional concerns have arisen from the development and administration of this policy. For example, there is now more intensive smoking in areas seen as non-workplace, such as the areas around the entrances to the work site. Since commercially leased space for cafeterias is not considered to be under the employer’s control, workers in older buildings that have contracted cafeterias or adjoining restaurants continue to face heavy concentrations of smoke in these areas. Although departments may provide smoking cessation programs for employees, there is no obligation for them to do so and the serious problem of addiction can be overlooked.

ii) Transportation Sector

Smoking is prohibited or limited on trains, airplanes and buses that operate interprovincially or internationally. For example, VIA trains prohibit smoking in the Quebec City-Windsor corridor and in all cars where meals are served. In trains outside this corridor, smoking is permitted only in designated sections and cars.

Attempts to control smoking on aircraft began shortly after the Non-smokers’ Health Act was introduced in the House of Commons. What started as a smoking ban during flights of two hours or less in 1987 had within a year been expanded to all North American flights. In 1994, Canada became the first country to ban smoking on both domestic and international flights over its territory. By 1998, all domestic and trans-border lounges prohibited smoking and Vancouver had become the first international lounge to do so.(13)

iii) Parliament: House of Commons and Senate

All buildings occupied by the House of Commons and the Senate (including all offices, lobbies, committee rooms, washrooms, freight entrances, etc.) are covered by the Non-smokers’ Health Act. So far, however, only the House of Commons has developed a policy for the application of the legislation.(14) The Senate has no policy and no internal person with monitoring responsibility, a situation that makes enforcement of the legislation more difficult.

The House of Commons policy covers issues such as signage, counselling, disciplinary action, and visitors’ compliance. It also notes that employees who smoke will not receive extended break periods and that smoking cessation programs are offered from time to time. By January 1996, after continued complaints, it was agreed that the Act would be more strictly enforced; the Manager of the Occupational Health, Wellness and Safety Division was authorized to report any alleged breaches to the Minister of Labour.

iv) Correctional Services Institutions

In 1990, in response to the federal Non-smokers’ Health Act, Correctional Services Canada developed a policy for its application within federal correctional institutions, which include penitentiaries, correctional residential centres, and psychiatric centres. The policy prohibits smoking by staff and offenders in all administrative areas, gymnasiums, dining rooms, kitchens and health centres.

In 1997, the Executive Committee of CSC agreed to continue work toward the goal of prohibiting smoking in all indoor and enclosed spaces.(15) Individual institutions were to have some discretion in designating smoking and non-smoking areas based on assessments of architectural design and consultations with warden, union and inmate representatives. Because many penitentiaries are built of solid stone and because almost 75% of inmates are smokers, particular problems arise with regard to ventilation and the location of smoking areas. Cellblocks and ranges meet the definition of "living accommodation" as defined by the Nonsmokers’ Health Regulations and can thus be designated as smoking rooms or areas. However, each institution is to take reasonable and practical measures to minimize the effects of tobacco smoke; for example, by grouping smokers together and ensuring airflow away from non-smokers.

Tobacco products are controlled primarily by the provisions of the Tobacco Act. However, there are several areas where the federal government has undertaken additional research initiatives for increasing understanding of how product packaging and product promotion affect the consumption of tobacco products.

i) Plain Packaging

In March 1994, following the suggestion of the Minister of Health, the House of Commons Standing Committee on Health began a study of plain or generic packaging of tobacco products. During the two months of hearings, the Committee members received evidence about the potential effects of plain packaging on tobacco consumption, on contraband and smuggled products, on the tobacco industry (manufacturing, growers, packagers, wholesalers, retailers) and on health costs. In their report, the Committee members concluded that legislating plain or generic packaging could be a reasonable step in the overall strategy for reducing tobacco consumption and called for the development of a legislative framework to proceed in this direction.(16)

In response to considerable questioning about the constitutional and trade implications of legislating requirements for plain packages in Canada, the Minister of Health subsequently commissioned a study by a panel of experts. Its report acknowledged the difficulty of proving conclusively that plain packaging would persuade smokers to quit or young people to defer consumption; however, it did conclude that there was substantive evidence that such packaging would reduce tobacco use.(17)

The federal government has support from provincial and territorial health ministers and international resolutions for requiring generic packages as one means of reducing tobacco smoking. It has not yet produced regulations on this issue, although it has legislative authority under the Tobacco Act to do so.

ii) Labelling

The focus on packaging includes labelling and in particular the requirement for labels to carry strong health messages and adequate toxic constituent information. Provisions in both the 1989 Tobacco Products Control Act and the 1997 Tobacco Act deal with these issues. However, as the Health Canada 1995 Blueprint document made clear, the existing provisions could be enhanced.(18) Research commissioned by the Office of Tobacco at Health Canada has focused on these areas; for example, a 1997 report by the Environics Research Group found significant public support for placing additional messages on packaging.(19) Expanding the list of toxic constituents from three (nicotine, tar, carbon monoxide) to include the more than 50 different chemical compounds, together with the addition of new messages, is expected to increase smokers’ and non-smokers’ knowledge of the product and ultimately to decrease consumption.

The provinces are the primary deliverers of health care through various health professionals. Such professionals can be very effective in counselling their clients against smoking. A 1995 survey by Health Canada indicated that 77% of current smokers had seen a doctor and 55% had seen a dentist within the previous year, suggesting that there had been opportunities for these health professionals to intervene.(20) Federal government action in delivering health care services to specific groups, financing health research, and supporting national approaches render it an active partner with the provinces and practitioners in advancing changes with respect to tobacco use.

i) Education

The education of health professionals is important to this issue, as is their role in educating others about tobacco use. Health Canada, through its support of school-based health promotion, has identified a role for physicians in neighbourhood and community efforts to prevent and reduce tobacco use. For example, they can be volunteer speakers or advocates of adolescent cessation programs. Research funded by Health Canada suggests, however, that all health professionals, including physicians, are ill-prepared for these roles. A survey of professional faculties, funded by the Office of Tobacco Reduction Programs within the Health Promotion and Programs Branch and co-ordinated by the Physicians for a Smoke-Free Canada, found that few schools for medicine, nursing, pharmacy or psychology included information on counselling against smoking on their health education curricula.(21)

ii) Practice

Much of the current emphasis on health practices has been directed at physicians. As part of the Tobacco Demand Reduction Strategy, Health Canada provided partial funding for a physician-directed publication called "Guide Your Patients to a Smoke Free Future," prepared by the Canadian Council on Smoking and Health (now called the Canadian Council on Tobacco Control).(22) "Mobilizing Physicians for Clinical Tobacco Intervention" is a joint effort involving the Canadian Medical Association and Physicians for a Smoke-Free Canada.(23)

Federally funded research is credited with increasing knowledge about how health professionals can influence tobacco use. For example, a departmental survey of about 3,817 physicians revealed that only 32% of Canada’s family physicians were aware that they could bill most provincial or territorial health plans for providing smoking-cessation advice to patients not diagnosed as having a smoking-related illness.(24)