1. TOBACCO Control: Progress and Priorities Charles Gardner, MD, CCFP, MHSc, FRCPC MOH, Simcoe Muskoka District Health Unit March, 2014

2. Tobacco Control System Committee

3. Smoke Free Ontario Strategy: Tobacco Control System Committee

4. Expert Advice for Ontario: Tobacco Strategy Advisory Group (TSAG)  BUILDING ON OUR GAINS, TAKING ACTION NOW: ONTARIO’S TOBACCO CONTROL STRATEGY FOR 2011 – 2016  Based on EVIDENCE TO GUIDE ACTION – PHO  Advice to government: Tobacco Control System Committee to advise the province on SFO renewal implementation  Targets to be achieved by 2016 5% reduction in tobacco use (490,000 fewer users) Reduce ETS – ban smoking on restaurant and bar patios, and allow smoke-free leases in the Residential Tenancies Act Increase quitting rates and reduce reuptake rates Ban new tobacco products Reduce tobacco disease by 6.5% MOHLTC target – Ontario to have lowest rate of smoking in Canada

5. OTRU 2014 Report: Smoking rates over time in Ontario

6. The Impact of Smoke-Free Public / Work Places (and the need for smoke- free patios)

7. Successes in Smoking Prevention Past-Year Smoking, by grades 7-12, Ontario, 1977-2011 Source: 2014 Smoke Free Ontario Strategy Evaluation Report. The Ontario Tobacco Research Unit. January 2014

8. Priority Populations Source: 2014 Smoke Free Ontario Strategy Evaluation Report. The Ontario Tobacco Research Unit. January 2014.

9. TSAG Implementation Highlights of Strategies Commenced:  Whole of government approach Ministry of Health Action Plan: to have the lowest smoking rate in the country Min of Finance re contraband - engagement of first nations re contraband  Tobacco growing: Raw leaf regulation commenced in January, 2014  Cessation: Need to double annual quit rate from 1.6% in order to achieve TSAG target of 5% reduction over 5 years (OTRU 2014 report) Coordinated tobacco cessation services –hospital-based and workplace-based smoking cessation demonstration grants –increased access to counseling and pharmacotherapy through primary care –Provincial cessation supports reaching 5% of smokers (OTRU 2014 report) ODB coverage for prescription cessation products

10. TSAG Implementation Strategies commenced:  Research Provincial and local research, surveillance and monitoring – re initiatives, programs, policies, disparities, youth and young adult prevention  Reduce disparities Engage First Nations (Min of Finance)  Social marketing Social smoking provincial commercial (movies and internet re social smoking – Cannes award for creativity) TCANs – regional social marketing events (ex. CE – social supply awareness videos) OPHEA school-based tobacco prevention pilot

11. TSAG Implementation Strategies commenced: Youth Smoking Prevention Act if passed, will:  Products: prohibit new products (ban flavored tobacco products targeted at youth), restrict water pipes (enhanced testing for tobacco content)  Prohibit smoking on playgrounds, sport fields, and restaurant and bar patios (local public health action re bylaws – 75+ outdoor smoking amendments)  Prohibit tobacco sales on post-secondary education campuses and specified provincial government properties Federal Budget 2014:  Price: Increase price / tax ( $4 per carton)

12. TSAG Implementation Strategies awaiting commencement / uncertain status:  Sufficient resources (at least $100 M would be within the CDC recommendations) –Current strategy funding is $47.8 million (this includes the $5M enhancement in 2011) –Dedicated funding from tobacco taxes to tobacco control –Public health funding from tobacco settlements  Divestment of investments  Products: plain packaging  Price: Anti-contraband public education  Promotion: Adult ratings for movies and video games with tobacco imagery

13. TSAG Implementation Strategies awaiting commencement / uncertain status:  Tobacco Growing: Work with partners to reduce tobacco production over time (licenses, acreage, ceilings)  Protection Smoke-free Multiunit Dwellings: –Amend Residential Tenancies Act to allow smoke-free MUDs a material term of leases (local municipal initiatives – now 75 + smoke-free community housing buildings in Ontario) –Tax credits for smoke-free affordable housing

14. Final Thoughts (OTRU 2014) “Strong scientific evidence supports further prohibitions on smoking in public spaces, restricting retail availability of cigarettes and increased funding for intensive public education and media campaigns.” Robert Schwartz, Executive Director of OTRU, Associate Professor at the Dalla Lana School of Public Health and Senior Scientist at CAMH. Proposed new legislation and changes in regulations about outdoor smoking and flavored cigarettes together with renewed investments in social marketing and cessation system development indicate that the Ontario Government is attuned to the need to do more. Source: 2014 Smoke Free Ontario Strategy Evaluation Report. The Ontario Tobacco Research Unit. January 2014