Canada’s recent progress in tobacco control under threat due to complacency, economic growth, and tobacco industry marketing strategies
* Long term study in Canada proves that public health strategies need to be refined over time to reinforce and build upon previous improvements*
*The affordability of cigarettes increased between 2002 and 2010*
*After 10 years of exposure to the same pictorial health warnings, the study found significant declines in smokers’ noticing (55% to 39%), and reading or looking closely (27% to 17%) at the warnings*
(Wednesday, 27 November 2013, Waterloo, Ontario, Canada): A report released today at the Canadian National Conference on Tobacco or Health in Ottawa reveals that Canada, traditionally seen as a global leader in tobacco control, is at risk of stagnating or even losing ground in its efforts to reduce tobacco use. The report, entitled “ITC Canada National Report: Findings from the Wave 1 to Wave 8 Surveys (2002-11)” was produced by the International Tobacco Control Policy Evaluation Project (the ITC Project), centered at the University of Waterloo, as part of a large international research collaboration across 22 countries throughout the world. The ITC Canada Report summarizes the findings of the ITC Canada Survey, a 9-year cohort survey of 1500-2000 smokers and quitters across Canada, designed to evaluate the effectiveness of Canada’s tobacco control policies.
The Report finds that Canada has been successful in implementing policies described in the WHO Framework Convention on Tobacco Control (FCTC). However, as the tobacco industry continues to introduce innovative products, packaging, and marketing strategies to dodge current restrictions, new and stronger policies are needed.
The ITC Canada Survey was conducted among a nationally representative sample of smokers between 2002 and 2011. While overall smoking prevalence among Canadian adults (aged 15 and older) has decreased dramatically from about 50% in 1965 to less than 20% in 2011, there has been a levelling off in this decline in recent years. Researchers found that:
Point of sale display bans have been successful – to a point
The percentage of smokers who noticed cigarette packs being displayed in shops or stores decreased from 76% in 2006-07 to 6% in 2011 after the ban on point of sale retail displays of tobacco products. However, smokers continue to be exposed to tobacco promotion through venues not currently covered by tobacco advertising, promotion, and sponsorship bans including entertainment media (18%) and special price offers (22%). In addition, there are exemptions on point of sale display bans for venues not accessible by minors in British Columbia, Manitoba, Saskatchewan, and Northwest Territories.
Cigarettes have become more affordable for Canadians
High prices are a key strategy to deter smoking. Between 2002 and 2010, cigarettes in Canada became substantially more affordable. Affordability increased by 1.4% per year, amounting to a total increase of about 12% over 8 years. More than three-quarters (79%) of smokers who had switched brands stated that price was a reason for their current brand choice. First Nations reserves are a primary source for the purchase of low or untaxed cigarettes. Although 40% of smokers in Ontario (and 21% in Atlantic Canada, 20% in Quebec, 16% in the Prairie provinces, and 11% in British Columbia) report having purchased cigarettes from First Nations Reserves once or more times in the past 6 months, less than 10% reported that their last purchase was from a First Nations Reserve. Increased enforcement action has resulted in a levelling off or reduction of purchasing from reserves between 2008 and 2011.
Smoke-free laws have led to a dramatic reduction in smoking in workplaces and public places
Smoke-free laws have been very effective in reducing exposure to second-hand smoke in indoor public places and workplaces. Between 2005 and 2011 there were significant reductions in the percentage of smokers who noticed smoking in workplaces (from 28% to 11%), restaurants (from 20% to 1%), and bars or pubs (from 45% to 2%). The percentage of smokers who have smoke-free homes increased from about a quarter (27%) in 2002 to almost half (43%) in 2011. Although support among smokers for complete bans on smoking in outdoor eating areas of restaurants and cafes (21%) and smoke-free patios at bars and pubs (12%) is low, ITC findings in Canada and in more than 20 countries show that smokers’ support for smoke-free policies increases after the policies are implemented.
Smokers support stronger restrictions on cigarette pack design
In 2001, Canada became the first country to implement large, pictorial warnings on 50% of the front and back of cigarette packs. A recent ITC study found that these warnings reduced smoking rates in Canada by 12 to 20 percent between 2000 and 2009. However, the ITC Canada Report found that repeated exposure to the same pictorial warnings reduces their impact. The same warnings were on packs for 10 years before they were replaced in 2012; during this period smokers became less likely to notice the warnings, and think about the health risks of smoking and quitting. Smokers are supportive of further restrictions on cigarette packaging. In 2011, support for cigarette plain packaging, as adopted in Australia in 2012, ranged from about a third (32%) of smokers in British Columbia to more than half (55%) of smokers in Quebec.
There is growing awareness and experimentation with e-cigarettes among adult smokers in Canada
Electronic cigarettes are readily available in Canadian retail outlets. There are many uncertainties about the impact of e-cigarettes on public health; although it is almost certain that e-cigarettes are less harmful than tobacco cigarettes, the degree to which e-cigarettes may be of benefit to public health will depend on whether these products promote dual use with cigarettes rather than serving as an aid to quitting and whether they encourage youth to start smoking cigarettes. Currently, there are few studies that have been conducted to address these critical questions. The ITC Canada Survey measured awareness and use of electronic cigarettes use among adult smokers and perceptions of their safety. The Survey found that 39% of smokers had heard of e-cigarettes. One-tenth (11%) of smokers who have heard of e-cigarettes have tried an e-cigarette (4% of all smokers) and 13% of smokers who have tried an e-cigarette currently use them at least once a month. Nearly all (89%) of those who have heard of e-cigarettes believe that they are less harmful than regular cigarettes.
Smokers support further flavour restrictions on cigarettes
In 2010, Canada banned flavours except menthol in cigarettes, little cigars, and blunt wraps. The ITC Canada Survey found that smokers support further restrictions. In 2011, two-thirds (66%) of smokers said they would “support” or “strongly support” a law to ban additives and flavourings that make cigarettes seem less harsh. Only 5% of smokers in the ITC Canada Survey smoke menthol flavour cigarettes, but the 2010-2011 Youth Smoking Survey conducted by the University of Waterloo and the Canadian Cancer Society found that a third (32%) of Canadian youth who smoked cigarettes in the last 30 days had smoked menthol cigarettes.
Smokers want to quit and support stronger actions by the Canadian government on tobacco
More than 86% of smokers in 2011 reported that they have tried to quit and more than a third plan to quit in the next six months. However, only about a third (32%) of smokers who visited a health professional in the last 6 months were advised to quit. In addition, smokers have noticed a significant decrease in anti-tobacco campaigns. The percentage of smokers who “often” or “very often” noticed advertising or information in the last 6 months on the dangers of smoking or that encourage quitting decreased from 52% in 2002 to 21% in 2011.
More than half of smokers “agreed” or “strongly agreed” that the government should do more to tackle the harm done by smoking. A third (34%) of smokers reported that they would “support” or “strongly support” a law that banned tobacco products completely. Almost half (47%) of smokers said they would “support” or “strongly support” a law that restricted the number of places where cigarettes could be purchased.
The report recommends the following strategies to strengthen tobacco control in Canada:
1. Increase prices and taxes on tobacco products and control price and price promotions, to reduce demand, particularly in Ontario and Quebec where total prices are much lower than in other provinces/territories.
2. Implement legislation for plain and standardized packaging.
3. Implement new pictorial warnings on packs by June 2015.
4. Conduct research to understand how e-cigarettes are being used among smokers, former smokers, and especially among youth and young people to inform regulations and legislation.
5. Strengthen point of sale display ban legislation in British Columbia, Manitoba, Saskatchewan, and Northwest Territories by removing exemptions for venues that are not accessible by minors.
6. Regulate smoking in movies and television programming.
7. Provide sustained funding for mass media campaigns on the health effects of tobacco use.
8. Implement a ban on menthol and other flavourings in tobacco products.
Professor Geoffrey T. Fong of the University of Waterloo in Canada, Chief Principal Investigator of the ITC Project, the international research collaboration that is evaluating the impact of the Framework Convention on Tobacco Control policies in 22 countries, said: “The tobacco industry never rests in its efforts to encourage people to initiate smoking or to smoke more. In addition, we can see from the ITC Canada Survey that health messages and tax and price initiatives become less effective over time if they are not refreshed and updated. These two factors suggest that legislators can never assume that their job is done when it comes to tobacco control; measures need to be under constant review and new initiatives need to be introduced in order to make further progress. We look forward to measuring the impact of the new graphic warnings introduced in 2012 to see if their impact increases once again. If so, that will underscore the recommendation in the Framework Convention on Tobacco Control that warnings should be refreshed every two to three years.”
Melodie Tilson, Director of Policy, the Non-Smokers’ Rights Association, commented: “The availability of robust data on the effectiveness of tobacco control policies is critical to our ongoing efforts to influence decision-makers to implement stronger tobacco control policies both in Canada and around the world. The ITC Canada Report provides evidence of Canada’s leadership in tobacco control and guidance on areas where we need to advocate for stronger policies, including stronger measures to control tobacco price incentives and the promotion of smoking in the entertainment media. The report identifies the need for sustained funding for campaigns to raise awareness of the harms of second-hand smoke and the need to expand smoke-free policies to outdoor public places. The findings also confirm that Canada’s delay in implementing new pictorial health warnings resulted in the declining effectiveness of the warnings as a tool to educate smokers and promote behaviours that lead to quitting. We are encouraged by the findings that the majority of smokers are supportive of stronger tobacco control policies and will continue to advocate strongly for these measures to be implemented. Finally, evidence of increasing awareness of and experimentation with e-cigarettes suggests that the current regulatory status quo on e-cigarettes is not working.”
Pamela C. Fralick, ICD.D, President and CEO, Canadian Cancer Society, concluded: “In Canada, smoking causes 30% of all cancer deaths and about 85% of all lung cancer cases. And although there have been significant reductions in smoking rates in Canada, as in most high-income countries, smoking still remains by far the single most important preventable cause of cancer and premature death. This is why any efforts to prevent cancer in Canada must include tobacco control. The ITC Canada Report provides strong evidence that we can improve tobacco control further – and save more people from death by cancer.”
The ITC Canada Wave 1 to 8 (2002-2011) National Report is available in English.
Notes for editors:
About the ITC Canada Survey
In 2002, researchers in Canada (University of Waterloo) partnered with an international team of researchers in Australia (The Cancer Council of Victoria), the United Kingdom (University of Strathclyde), and the United States (Roswell Park Cancer Institute and University of Illinois at Chicago) to create the ITC Four Country Project. The ITC Four Country Project conducts nationally-representative longitudinal cohort surveys of adult smokers aged 18 years or older in Canada, Australia, the United Kingdom, and the United States. The main objectives of the ITC Canada Survey are:
1) To examine patterns of smoking behaviour and opinions associated with smoking among adults in Canada.
2) To examine the impact of specific tobacco control policies implemented in Canada.
3) To compare the behaviour of smokers and the impact of policies between Canada and other ITC countries.
Data for Waves 1 to 6 (2001 to 2008) were collected using computer-assisted telephone interviewing (CATI) software. Data for Waves 7 and 8 (2008 to 2011) were collected using online web-based surveys, with respondents who did not complete the web survey within a set time frame being re-routed back into the telephone calling queue to complete the survey by CATI.
About The ITC Project
The International Tobacco Control Policy Evaluation Project (the ITC Project) is an international research collaboration involving over 100 tobacco control researchers and experts from 22 countries (Canada, United States, United Kingdom, Australia, Ireland, Thailand, Malaysia, China, South Korea, New Zealand, Mexico, Uruguay, France, Germany, The Netherlands, Brazil, Mauritius, Bangladesh, Bhutan, India, Kenya, and Zambia) who have come together to conduct research to evaluate the impact of tobacco control policies of the WHO Framework Convention on Tobacco Control (FCTC), the world's first health treaty. These policies include more prominent warning labels (including graphic images), comprehensive smoke-free laws, restrictions or bans on tobacco advertising, promotion, and sponsorship, higher taxes on tobacco products, removal of potentially deceptive labelling (e.g., "light" and "mild" and packaging design that lead consumers to the misperception that certain brands may be less harmful), promotion of cessation, education of public on the harms of tobacco, reduction of illicit trade, reduction of youth access, and product regulation. In each country, the ITC Project team conducts longitudinal cohort surveys and capitalizes on natural experiments to evaluate the impact of these policies over time. ITC Surveys contain over 150 measures of tobacco policy impact and have been conducted in countries inhabited by over 50 percent of the world's population, 60 percent of the world's smokers, and 70 percent of the world's tobacco users. Reports can be downloaded at www.itcproject.org
For more information, please contact:
Tracey Johnston, on behalf of the ITC Project, London, UK
Professor Geoffrey T. Fong
Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada