In my role I have been involved in strategies that have been developed to respond to the population needs, particularly those living with chronic conditions. In the South West region this includes people living with multiple chronic conditions including Chronic Obstructive Pulmonary Disease (COPD), diabetes, Congestive Heart Failure (CHF), arthritis, asthma and mental health and addictions (SWLHIN, 2018).
To enhance my learning, I spent time exploring smoking, as smoking is one of the key determinants of COPD. Smoking cessation is a component of care delivery models when working with people living with COPD. During this unit focused on chronic disease we were asked to reflect on similarities or differences with another province. One of my classmates provided information on British Columbia’s approach to tobacco use. Exploring these two provinces has provided some interesting facts for comparison, which are highlighted below.
Quick Statistics
British Columbia in 2015 (from Reid et al (2018)
Smoking prevalence: 10.2% (399 000 smokers) compared to 11.4% in 2013 and below the national average of 13%, the lowest of all provinces
Males = 12.2% (236 00 smokers)
Females = 8.2% (163 000 smokers)
Average daily consumption = 14.8 CPD compared to 12.9 CPD in 2013
Males average consumption = 16.7 Cigarettes Per day (CPD)
Females average consumption = 12.0 CPD
Average price per carton (200 cig)= $104.96
Tobacco use also impacts B.C.’s economy each year by $2.3 billion for treating illness caused by smoking, sick time and lower productivity (Clean Air Coalition, 2014).
Tobacco-related illness is the leading cause of preventable death in BC. Approximately 6,000 British Columbians die each year from tobacco related illnesses, either caused by direct tobacco use and/or exposure to second-hand tobacco smoke (Clean Air Coalition, 2014).
Ontario in 2015 (from Reid et al (2018))
Smoking prevalence : 11.3% (1,303,000 smokers compared to 12.6% in 2013 and below the national average of 13%, the third lowest province)
Males= 13.3% (748 000 smokers)
Female = 9.4% (555 000 smokers)
Average daily cigarette consumption = 13.2 CPD compared to 13.0 CPD in 2013
Males average consumption = 15.7 CPD
Females average consumption = 10.5 CPD
Average price per carton (200 cig) = $88.86
Each year, tobacco claims 13,000 lives in Ontario — that equals 36 lives every day. Tobacco-related disease costs Ontario’s health care system an estimated $2.2 billion in direct health care costs and it also costs an extra $5.3 billion in indirect costs such as time off work(OTRU Evaluation Update, 2016).
Policy and Legislation
The BC Government (2018) under the Tobacco and Vapour Products Control Regulation has a number of components that respond to use. These include:
No tobacco products can be used within 6 metres of any doorways, air intakes, open windows to any public and work areas such as (stores, offices, entrances to condos/apartments, work vehicles, public transit, restaurants, pubs
There is also law against smoking or vaping in your vehicles if: One is operating a work vehicle and/or Someone is under the age of 16 is in the vehicle
There are limits on advertising, marketing and signage related to tobacco and vapour use
The Ontario Government (2018) also has legislation called the Smoke Free Ontario Act, 2017. This includes direction on:
Tobaccos sales restrictions based on age and visibility
Advertising and/or marketing restrictions
Smoke free spaces including outdoor patios, child care facilities, motor vehicles with children inside, enclosed workplaces, smoking shelters with more than 2 walls & roof, areas where home health care workers work, hospitals (9 meters from door), common areas of hotels, motels & inns, residential care facilities, schools, children’s playgrounds (20 meters) or publically owned sports fields (20 meters)
No smoking in car – age restriction (under 16 years of age)
Increased taxation
Smoking Cessation Interventions
British Columbia – Smoking Cessation Interventions:
The Government of BC (2018) through the BC Smoking Cessation Program helps people stop smoking or using other tobacco products by assisting them with the cost of 1) nicotine replacement therapy (NRT) products or 2) smoking cessation prescription drugs.
1) All residents with a valid provincial health card are eligible to receive 12 weeks annually of cost-free NRT through the BC Smoking Cessation Program; participants must register via telephone and choose to pick up their 4 week allocation of NRT at any community pharmacy or have it delivered by mail (no prescription is required).
2) BC Pharmacare reimburses eligible members for either bupropion or varenicline for 12 consecutive weeks per 12-month period. Under exceptional circumstances, PharmaCare may cover a course of NRTs in the same calendar year as a prescription drug by a Special Authority request.
Ontario – Smoking Cessation Interventions:
The Smoke-Free Ontario Strategy Monitoring Report (TOTRU, 2016) lists the components in place in Ontario to support smoking cessation. These include:
Aboriginal Tobacco Program
Hospital & Workplace based cessation demonstration projects
Leave the Pack Behind
ODB & Pharmacy Smoking Cessation Program
Ottawa Model for Smoking Cessation
Public Health Unit Programs and Services
Smokers Helpline
Smoking Cessation by Family Physicians
Smoking Treatment for Ontario Patients (STOP)
In Ontario the following is financially supported (Johnson & Johnson,2018):
· The Ontario Drug Benefit program provides reimbursement for bupropion and varenicline for smoking-cessation treatment, in conjunction with smoking-cessation counseling, for Ontario Drug Benefit-eligible recipients (i.e., Ontarians ≥65 years of age, recipients of Ontario Disability Support Program or Ontario Works, residents of long-term care homes or homes for special care, Ontarians receiving home care services, and Ontarians registered in the Trillium Drug Program). Treatment with each agent is limited to 12 weeks (168 tablets) of reimbursement per 365 days per patient.
· STOP Program: Ontarians can access limited NRT through workshops hosted across the province by CAMH in partnership with local community partners and sponsored by the Ministry of Health and Long Term Care, Smoke Free Ontario Branch. These partners include Family Health Teams, Family Health Organizations and some Community Health Centres and Public Health Units. Patients of these partners are eligible for the CAMH STOP programs, which provides free NRT as either monotherapy or combination therapy
Through my learning journey about tobacco use and smoking in Ontario and British Columbia, I can see many similarities and a few differences. It is interesting that these two provinces rank among the top provinces in Canada for reducing their smoking rates. Both provinces have focused programs, policies and legislation to support change in tobacco use. Progress has been made. However, I feel there is continued progress to be made at a provincial and national level to address tobacco use. With 1 in 5 of every Ontario adult resident using tobacco and given what is known about health implications and mortality rates, there is work to be done (TOTRU, 2016).
References
British Columbia Laws (2018) Tobacco Control Act 2007 Retrieved from http://www.bclaws.ca/civix/document/id/loo75/loo75/10_232_2007
Clean Air Coalition British Columbia (2014). Tobacco statistics. Retrieved from: https://www.cleanaircoalitionbc.com/newsroom/tobacco-statistics#tobacco-smoke-nicotine
Government of British Columbia (2018). BC Smoking Cessation Program. https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/what-we-cover/drug-coverage/bc-smoking-cessation-program
Government of British Columbia Government (2018) Tobacco and Vapour Free Places Retrieved from: https://www2.gov.bc.ca/gov/content/health/keeping-bc-healthy-safe/tobacco-vapour/requirements-under-tobacco-vapour-product-control-act-regulation/tobacco-vapour-free-places
HealthLink BC ( 2015) BC Smoking Cessation Program Retrieved from https://www.healthlinkbc.ca/health-feature/bc-smoking-cessation-program
Johnson & Johnson Inc. (2018) Help them quit. Retrieved from https://www.helpthemquit.ca/treatment/costs-coverage
Ontario Government (2018) Ontario Smoke-free facts Retrieved from https://www.ontario.ca/page/smoke-free-ontario#section-4
Ontario Government (2018) Smoke Free Ontario Retrieved from https://www.ontario.ca/page/smoke-free-ontario#section-2
Reid, J., Hammond, D., Rynard, V., Madill, C., & Burkhalter, R. (2018) Tobacco Use in Canada: Patterns and Trends, 2017 Edition. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo. Retrieved from https://uwaterloo.ca/tobacco-use-canada/adult-tobacco-use/smoking-provinces/british-columbia
The Ontario Tobacco Research Unit (2016) 2015 Smoke Free Ontario Strategy Monitoring Report Retrieved from https://otru.org/2015-smoke-free-ontario-strategy-monitoring-report/