Tobacco Use

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  • 10:12-10:13- 1 minute- PTCC
  • 10:29-10:39 – Anne -
    Anne Meloche Presenting
    Definitions: Tobacco use: (i.e., currently smoked cigarettes, cigars, pipe, or used snuff or chewing tobacco in past 30 days)
    Current smoker: Individual who has smoked a cigarette in the past 30 days and has smoked at least 100 cigarettes in his/her
    lifetime.
    Canadian prevalence: Twenty percent (20%) of Canadians aged 12 years or over were current smokers in 2007–2008, representing approximately 5.7 million Canadians
  • 10:29-10:39 – Anne -
    Anne Meloche Presenting
    2007-2008 Canadian Community Health Survey
    -
    Prevalence of current smoking varied substantially by age and sex
    -Steep increase through adolescence (especially late adolescence) with decline around middle age
  • 10:29-10:39 – Anne -
    Anne Meloche Presenting
  • 10:29-10:39 – Anne -
    Anne Meloche Presenting
  • 10:29-10:39 – Anne -
    -Males between ages 25-49 years had significantly higher smoking prevalence than female counterparts
  • -Immigrants represent 21% of Ontario smokers
    Non-immigrants represent 76% of Ontario smokers
    Recent study from the University of Montreal says that young immigrant children in Canada are at increased risk for smoking with increasing lengthe of residence in Canada. ((Journal of Adolescent Health – Dr. Jennifer O’Loughlin)
  • 10:29-10:39 – Anne -
    From website of OFA
    Anne Meloche Presenting
  • 10:29-10:39 – Anne -
    http://www.trilliumfoundation.org/User/Docs/PDFs/research/InfoNote_Aboriginal.pdf
    Anne Meloche Presenting
  • 10:29-10:39 – Anne -
    Anne Meloche Presenting
    http://www.gaydata.org/02_Data_Sources/ds026_CCHS/ds026_CCHS_Report_2003.pdf
    RNAO Position Statement: Respecting Sexual Orientation and Gender Identity
    http://www.rainbowhealthontario.ca/resources/searchResults.cfm?mode=3&resourceID=fa169ded-3048-8bc6-e898-ef2cd468c948
    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.
  • 10:39 – 10-47 – Anne -
    Presenter: Anne Meloche-
    Completed post-secondary education had largest number of smokers (986,100 of the 2.0 million smokers aged 18 years and over or 48% of all smokers)
  • 10:39 – 10-47 – Anne -
    - BUT, greatest number of current smokers observed in the $100,000 or more income group (408,300 of smokers 18 years and over or 20% of all smokers in Ontario)
  • 10:39 – 10-47 – Anne -
    So, when we hear about the growing incidence of chronic disease and the need to modify our individual behaviour, and adopt healthy lifestyles, this is not taking account of the social determinants that are impacting our health, as represented by this diagram.
    The WHO commission on the sdoh – lots of reports and studies, final report in June 2008.
    The causes of the causes
  • PTCC – lead provincial TC resource centre
    Partnership: CCO, Propel Centre for Population Health Impact, Regional of Waterloo Public Health, Sudbury & district Health Unit
    Programs targeted to TC staff working in PH and their community partners
    Variety of programs and services:
    -technical assistance, training and resource development
    -Knowledge development, exchange and programming to increase the use of research and practice-based evidence
    -Media relations training and consultation services
    MN – unique program established in 2000 to increase positive media coverage tobacco issues at local and provincial levels
    Services – media relations/advocacy training, media monitoring, analysis of trends in the media and strategic communications consultation and support
    YATI – youth Advocacy Training Institute
    TEACH – Training Enhancement in Applied Cessation Counseling and Health (specializes in intensive cessation training)
    SHAF – Smoking and Health action Foundation
  • PTCC – lead provincial TC resource centre
    Partnership: CCO, Propel Centre for Population Health Impact, Regional of Waterloo Public Health, Sudbury & district Health Unit
    Programs targeted to TC staff working in PH and their community partners
    MN – unique program established in 2000 to increase positive media coverage tobacco issues at local and provincial levels
    Services – media relations/advocacy training, media monitoring, analysis of trends in the media and strategic communications consultation and support
    YATI – youth Advocacy Training Institute
    TEACH – Training Enhancement in Applied Cessation Counselling and Health (specializes in intensive cessation training)
    SHAF – Smoking and Health action Foundation
  • Tobacco Use

    1. 1. Tobacco use and exposure workshop Anne Meloche Program Training and Consultation Centre
    2. 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. 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. 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. 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. 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. 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. 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. 9. Current tobacco use in Ontario
    10. 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
    11. 11. 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
    12. 12. Youth SmokingYouth Smoking The prevalence rate of current smoking among youth aged 15-17 was 10% (about 0.1 million youth) 13
    13. 13. Young Adults – SmokingYoung Adults – Smoking PrevalencePrevalence Young adults aged 20-24 years reported the highest prevalence of smoking at 27% 14
    14. 14. 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
    15. 15. 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
    16. 16. 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
    17. 17. 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%
    18. 18. 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
    19. 19. 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
    20. 20. 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
    21. 21. 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
    22. 22. 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
    23. 23. 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
    24. 24. 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
    25. 25. 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)
    26. 26. 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
    27. 27. 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
    28. 28. 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
    29. 29. 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
    30. 30. 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)
    31. 31. 5) Respond to Community Needs Importance of identifying community needs by: Needs Assessment Service Gap Assessment
    32. 32. 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
    33. 33. 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
    34. 34. 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
    35. 35. 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
    36. 36. Community-based Actions To Prevent Smoking Initiation Prevention Pillar Policy Program/Service Public Education Promote TC as a priority within comprehensive school programming X
    37. 37. Integrating tobacco control with other risk factors
    38. 38. 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)
    39. 39. 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.
    40. 40. 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
    41. 41. 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
    42. 42. 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
    43. 43. 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?
    44. 44. Risk factors discussed in smoking cessation intervention Physical activity
    45. 45. Risk factors discussed in smoking cessation intervention Healthy Eating
    46. 46. Risk factors discussed in smoking cessation intervention Alcohol « use »
    47. 47. Risk factors discussed in smoking cessation intervention Drinking lots of water!
    48. 48. From the industry that « doesn’t » quit!
    49. 49. Cigarillos
    50. 50. « Cigarillos are the new cigarettes for  kids. » Physicians for Smoke-Free Canada « Young canadians use cigarellos 3  times the rate of adults. » Health Canada
    51. 51. 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 
    52. 52. 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 
    53. 53. 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
    54. 54. Provincial Supports Ontario Tobacco Research Unit (otru.org) Tobacco control research,  monitoringevaluation and training
    55. 55. ….in conclusion
    56. 56. How would you complete the following sentence: Smoking is…….
    57. 57. World Health Organization Although tobacco deaths rarely make headlines, tobacco kills one person every six seconds.
    58. 58. In the 20th century the tobacco epidemic killed 100 million people worldwide.
    59. 59. In the 21st century it could kill one billion.
    60. 60. 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

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