There is growing concern over the consistency of youth tobacco use rates over the past few years across Canada. In Saskatchewan, this trend is particularly troubling, as tobacco use rates in the province are consistently greater than the national average. A popular hypothesis is that the availability of flavoured products is to blame.

1. April 28, 2015
Flavoured Tobacco:
The Impact on Saskatchewan

2. Interdisciplinary Research Team
Joanna
Jakubczyk,
B.Com.
Marketing,
MPH
Candidate
Jacob
Van Nest,
B.A.
Anthropology,
MPH
Candidate
Zach
Bouck,
B.HSc.
Biology,
MPH
Candidate
Dr. Yelena
Bird,
Assistant
Professor,
School of
Public Health,
University of
Saskatchewan
Dr. John
Moraros,
Assistant
Professor,
School of
Public Health,
University of
Saskatchewan
Jennifer
Miller,
VP Health
Promotion,
The Lung
Association of
Saskatchewan

3. Agenda
• Flavoured Tobacco Products
• Introduction
• Issue
• Relevance
• Marketing Influences
• Social Perceptions
• Direct and Indirect Costs
• Federal & Provincial Policies
• What Can Saskatchewan Do?

4. The Tobacco Epidemic
“Smoking is the leading cause of
preventable death worldwide (1).”
- World Health Organization (WHO), 2011
2011: 6 million deaths per year (1)
2030: 8 million deaths per year (1)

5. What are Flavoured Tobacco Products?
Definition of Flavoured Tobacco Products:
“Menthol cigarettes, flavoured cigarillos, cigars, shisha
(waterpipe tobacco), pipe tobacco, blunt wraps, bidis,
smokeless tobacco, and rolling papers.” (2)

6. Prevalence of Tobacco Use
Youth smoking prevalence in Saskatchewan almost
double the Canadian average!
0
5
10
15
20
25
11 to 14 15 to 19
Prevalence(%)
Age Group
Smoking Prevalence among Youth
Canada
Saskatchewan

7. Change in Prevalence
0
5
10
15
20
25
Canada Saskatchewan
Prevalence(%)
Change in Smoking Prevalence among
Youth aged 15 to 19 years old (4)
Year 2008
Year 2011

8. Flavoured Tobacco
0
10
20
30
40
50
60
Use Initiation
Saskatchewan Canada
Prevalence(%)

10. Current Provincial Policy
November 17th 2013
“We’re going to have to look really closely at what
Alberta and Ontario are proposing with their
legislation and regulations. But at this time, we don’t
have anything that we’re moving forward with.” (5)
– Honourable Dustin Duncan
Saskatchewan Minister of Health

11. Relevance
Saskatchewan Demographics
•In 2011, nearly 20% of the Province’s 1 million people are aged 15-19
(increase of 5.41% since 2006) (6)
•Average age is 40.9 years (6)
Aboriginal Population
•15.6% of SK pop is Aboriginal (average age is 22.6 years) (7)
•34.1% of aboriginals are 15 and under (7)
Tobacco Prevalence
– 33.1% prevalence of aboriginal youth smoke (7)
– 44.1% of aboriginal youth report use of flavoured cigarettes
(7)

13. Influence of Marketing
Although tobacco companies
say that they do not market their
products to youth, their brand
extensions that feature fun,
flavoured and scented tobacco
portray a different story.

14. Packaging and Promotion

15. Smoking Appeal
● Flavoured additives such as menthol contribute to
tobacco dependence by:
• Reducing smoke harshness (8)
• Creating a false perception that the cigarettes are less
harmful (8)
● The cool, minty taste of menthol acts as a
reinforcer of smoking behaviour (8)

16. Recruiting Youth
• Menthol and other flavoured products are used as
a starting point for youth (9)
• Youth smokers who initiate with mentholated cigarettes
nearly two times more likely to become established
smokers than youth who initiate with non-mentholated (10)
• Candy flavoured products mask the taste of
tobacco and are used to ‘sweeten the poison’(11)
• Getting someone to smoke is the first step,
producing a pack-a-day customer is the end goal
(11)

17. Social Acceptance
• The sweet aromas of
flavoured tobacco products
contributes to social
acceptance (12)
• Advertising for flavoured
products suggests that if you
smoke them, you will have
fun (13)
• Products that are promoted
as being “cool” may lead to
smoking initiation among
youth, who are subject to
social pressures (13)

18. Sensory Effects of Menthol
Cooling, analgesic effect
•Localized numbing (14)
•“Do you smoke when you have a sore throat or
bad cold?”
Decreased irritation
•Inhibits cough and inflammatory response (14)
Results:
•Less intention of quitting due to medical reasons
(10)

19. Exploitation of Effects
Age-appropriate formulas:
• Low menthol with nicotine = ideal impact and
sensation for inexperienced youth smokers
0
500
1000
1500
2000
2500
3000
Non-mentholated Mentholated
MentholConcentration(mg)
Type of Tobacco Product
0.01 mg

20. Economic and Human Costs
• There are serious physical, emotional, economic,
and environmental costs associated with
tobacco use (15)
• Direct: increased mortality, disability, healthcare
expenditure and disease
• Indirect: increased economic losses in
productivity
• To keep Saskatchewan strong it is important to
reduce tobacco initiation

21. Direct Costs to Saskatchewan
• 1 in 5 deaths can be attributed to tobacco use (15)
• Healthcare costs attributable to smoking: $154.9 million
in 2002 (15)
• Today, this would roughly equate to (16)
$197.8 million

22. Indirect Costs to Saskatchewan
• Tobacco related mortality and morbidity hinder
the workforce and strip society of income (15)
• Estimated total indirect cost in 2008: $535.2 million
(15
• Today, this would roughly equate to: (16)
$598.2 million

23. Employer Cost
Absenteeism, lost productivity, and insurance add
to the indirect costs of tobacco use
2012:
$4,256 per
employee
(17)
Today:
453,500
full-time
and
104,700
part-time
employees
(18)
2013:
smoking
rate of
22.8% (19)
Today:
estimated
employer
total cost
$490.8
million (16)

24. Total Costs
• This economic cost is preventable
• With a population of 1,132,640 (2015) (18) the
cost of tobacco use in Saskatchewan is
$1,122 per capita
$197.8 million + $598.2 million + $490.8 million
= $1.28 billion
Saskatchewan spends $0.34 per capita

25. Tobacco Control
Building a Healthier Saskatchewan:
A Strategy to Reduce Tobacco Use
• 2008 – 2011: $1.3 million annually
• Since 2011:
When tobacco reduction programs receive
adequate funding, they are proven to be successful.
$327,000 annually

26. Federal Government
Cracking Down on Tobacco Marketing
Aimed at Youth Act, 2009

27. Federal Government
cigarillos before
Bill C-32
“cigars” after
Bill C-32
Prime Time
peach, rum, raspberry
Prime Time Plus
peach, rum, cherry
1.4 grams 1.5 grams

28. Federal Government
Proposal to Amend Tobacco Act, 2014
•Aimed at closing the loophole and banning most
flavours in products weighing up to 6 grams
•Not including “adult” flavours: menthols, rum, port,
wine, and whiskey
Non-comprehensive scope and slow progress has
compelled many provinces to take action and show
leadership by introducing legislation that goes
above and beyond the federal proposal.

29. Current Provincial Policy
January 20th 2014
“Certainly we [the Provincial government] are
taking their [Canadian Cancer Society] advice into
consideration. We are looking into what other
provinces have introduced in terms of legislation.”
– Honourable Dustin Duncan
Saskatchewan Minister of Health

30. Provincial Governments
Alberta (Bill 206)
• Only province to have passed independent legislation
• Includes menthol products (as of May 31, 2015)
Manitoba (Bill 52)
• Excludes menthol products, snuff and chew
Nova Scotia (Bill 90)
• Includes menthol products, flavoured pipe tobacco and
smokeless tobacco
Unfortunately, all of the above exclude certain flavours
(port, rum, wine and whiskey)

31. The Example to Follow: Ontario
Ontario - Making Healthier Choices Act, 2014
• Bill 45 draft similar to the initial Alberta Bill 206
• Incremental ban for flavoured products
• Menthol sales permitted until 2016
• Also covers e-cigarettes (prohibits sales to minors)
As of March 3rd, 2014, second draft was
approved by all three political parties

32. Policy Recommendations
• Growing public and political awareness of the
threat that flavoured tobacco products pose.
• Ontario’s Bill 45 is the recommended model for
policy action in Saskatchewan
Having flavoured tobacco restrictions
that exclude menthol is “like having a
ban on soda pop but saying, ‘OK,
Pepsi and Coke, you’re exempted.’”
- David Hammond
Policy Expert in Ontario

33. Flavours: What Can Saskatchewan Do?
• The Tobacco Control Amendment Act or Bill 133
contains a provision to prohibit flavoured cigarillos.
• Sec 2 (b.2) SK has the regulatory authority to
prohibit “other” flavoured tobacco products.
A simple regulation could ban all flavoured products!

34. Thank You
Banning Flavoured Tobacco:
Why Not Saskatchewan?

35. References
• (1) World Health Organization. (2011). WHO Report on the Global Tobacco Epidemic, 2011. Geneva: World Health Organization.
• (2) Health Canada. (2013). Summary of the results of the Youth Smoking Survey 2012-2013. Retrieved from: http://www.hc-sc.gc.ca/hc-ps/tobac-
tabac/research-recherche/stat/_survey-sondage_2012-2013/result-eng.php
• (3) Propel Centre for Population Health Impact. (2013). Flavoured Tobacco Use among Canadian Youth: Evidence from Canada’s 2010/2011 Youth
Smoking Survey. University of Waterloo. Retrieved from:
https://uwaterloo.ca/propel/sites/ca.propel/files/uploads/files/flavoured_tobacco_use_yss_20131007.pdf
• (4) Propel Centre for Population Health Impact. (2013). Tobacco Use in Canada: Patterns and Trends 2013 Edition. University of Waterloo.
Retrieved from http://www.tobaccoreport.ca/2013/TobaccoUseinCanada_2013.pdf
• (5) Modjeski, M. (2013, November 17th). Saskatchewan government won’t ban flavoured tobacco. Metro News. Retrieved from:
http://metronews.ca/news/saskatoon/857076/saskatchewan-government-wont-ban-flavoured-tobacco/
• (6) Government of Saskatchewan. (2011). Saskatchewan Population Report: 2011 Census of Canada. Retrieved from:
http://www.stats.gov.sk.ca/stats/population/Censuspop2011.pdf
• (7) First Nations Information Governance Centre. (2012). First Nations Regional Health Survey (RHS) 2008/10: National report on adults, youth and
children living in First Nations communities. Retrieved from
http://fnigc.ca/sites/default/files/First%20Nations%20Regional%20Health%20Survey%20%28RHS%29%202008-10%20-%20National%20Report.pdf
• (8) Ahijevych, K., & Garret, B.E. (2010). The role of menthol in cigarettes as a reinforcer of smoking behavior. Nicotine & Tobacco Research 12(s2), p.
s110-s116. doi: 10.1093/ntr/ntq203
• (9) Kreslake, J.M., Wayne, G.F., Alpert, H.R., Koh, H.K., & Connolly, G.N. (2008). Tobacco industry control of menthol in cigarettes and targeting of
adolescents and young adults. American Journal of Public Health, 98(9), p. 1685-1692.
• (10) Nonnemaker, J., Hersey, J., Homsi, G/, & Busey, A. (2010). Menthol Cigarettes and Youth Smoking Uptake. Retrieved from:
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/TobaccoProductsScientificAdvisoryCommittee/UCM237551.p
df
• (11) Lewis, M.J., & Wackowski, O. (2006). Dealing with an innovative industry: A look at flavored cigarettes promoted by mainstream brands.
American Journal of Public Health, 96(2), 244-251.
• (12) Minaker, L.M., Ahmed, R., Hammond, D., & Manske, S. (2014) Flavored tobacco use among Canadian students in grades 9 through 12:
Prevalence and patterns from the 2010-2011 youth smoking survey. Preventing Chronic Disease, 11, 9pp. doi:
http://dx.doi.org/10.5888/pcd11.140094
• (13) Rising, J., & Alexander, L. (2011). Marketing of menthol cigarettes and consumer perceptions. Tobacco Induced Diseases, 9(s1), 8pp. doi:
10.1186/1617-9625-9-S1-S2

36. References
• (14) Federal Drug Administration (FDA). (2013). Chapter 3: The Physiological Effects of Menthol Cigarettes. Retrieved from:
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/TobaccoProductsScientificAdvisoryCommittee/UCM244975.p
df
• (15) Rhymes, J., Colman, R., & Ren, Z. (2009). The cost of tobacco use in Saskatchewan. Genuine Progress Index: Measuring Sustainable
Development, available from: http://www.cancer.ca/~/media/cancer.ca/SK/get%20involved/take%20action/tobacco%20control/costoftobacco-
tobaccofullreport-SK.pdf
• (16) Bank of Canada. (2015). Inflation calculator. Consumer Price Indexes for Canada, accessed from:
http://www.bankofcanada.ca/rates/related/inflation-calculator/
• (17) Conference Board of Canada, The. (2013). Up in smoke: Smokers cost their employers more than $4,000 each per year. News Release, 14(47),
available from: http://www.conferenceboard.ca/press/newsrelease/13-10-
29/up_in_smoke_smokers_cost_their_employers_more_than_4_000_each_per_year.aspx
• (18) Statistics Canada. (January 2015). Saskatchewan labour force statistics. Saskatchewan Bureau of Statistics, Ministry of Finance, available from:
http://www.stats.gov.sk.ca/stats/labour2015/lfsjan15.pdf
• (19) Statistics Canada. (2013). Community health survey: Smoking. Statistics Canada, available from: http://www.statcan.gc.ca/pub/82-625-
x/2014001/article/14025-eng.htm
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