Public and Workplace Public and Workplace Smoking PoliciesSmoking Policies

Created by the Registered Nurses’ Association of Ontario

World Health International World Health International Framework on Tobacco Framework on Tobacco

World Health Organization (WHO) developed the International Framework Convention on Tobacco Control

Encourages countries to set legislation that:• Controls tobacco companies’ operations within

their borders• Educates smokers about health risks• Protects people from second-hand smoke

MPOWERMPOWER• MPOWER Policy Package

• WHO Report on the Global Tobacco Epidemic, 2008• Policies to provide guidelines for worldwide reduction

of tobacco use

• Monitor tobacco use and prevention policies• Protect people from tobacco smoke• Offer help to quit tobacco use• Warn about the dangers of tobacco• Enforce bans on tobacco advertising,

promotion and sponsorship• Raise taxes on tobacco

National Tobacco ControlNational Tobacco Control• Health Canada’s Federal Tobacco Control

Strategy: A Framework for Action• Current goal to reduce overall smoking

from 19% to 12% (by 2011)

• Objectives include: • Reduce prevalence of youth smokers • Increase number of adults who quit smoking• Reduce prevalence of second-hand smoke

exposure• Contribute to implementation of WHO’s

Framework Convention on Tobacco Control• Monitor and assess contraband tobacco

National Tobacco Control (cont.)National Tobacco Control (cont.)

Federal government regulates aspects of the sale of tobacco:

Requirements for health messages Importation of tobacco products Control of advertising and sponsorship by tobacco

companies

National Tobacco Control (cont.)National Tobacco Control (cont.)

Ingredient Emission levels for a cigarette sold in CanadaPrevious Current *

Tar 8 mg 8 – 29 mgNicotine 1 mg 1 – 2.6 mgCarbon Monoxide 9 mg 9 – 27 mgFormaldehyde n/a 0.035 – 0.13 mgHydrogen cyanide n/a 0.073 – 0.25 mgBenzene n/a 0.034 – 0.08 mg

• Latest initiative oblige tobacco companies to list more of cigarettes’ toxic ingredients on the package

(Health Canada, 2009b)

Provincial/Territorial Tobacco Provincial/Territorial Tobacco ControlControl

Each province/territory has jurisdiction over tobacco products and their regulation

Youth smoking Ventilated smoking rooms Designated smoking area, etc.

Information about federal and provincial/territorial tobacco control legislation is available from the Canadian Council for Tobacco Controlwww.cctc.ca

Smoke-Free Ontario (SFO)Smoke-Free Ontario (SFO)• Administered through the Ministry of Health Promotion and

Sport under the Chronic Disease Prevention division• SFO’s Tobacco Control Act

• Regulates smoking in public spaces and workplaces• Regulates the conditions of sale of tobacco products• Prohibits the sale of tobacco to people under 19 years• Protects children from second-hand smoke when in daycare

programs• Restricts smoking in an around health-care facilities• Bans the use of point-of-sale advertising such as retail power

walls• Bans smoking in vehicles when children under 16 years are

present

SFOSFO• Supports awareness and prevention programs

through:–Public health programs (e.g. high school programs)–Monitoring access of minors to tobacco products–Cessation programs :• Smoker’s Helpline• Leave the Pack Behind - campus program• Driven to Quit Challenge - provincial contest• Stop Smoking Treatment for Ontario Patients (STOP) –

research study examining the effectiveness of NRT• Training Enhancement in Applied Cessation Counselling

and Health (TEACH) – certified training course for health-care professionals

SFO StrategySFO Strategy

Prevention Child/youth programs Restricted access to tobacco

Protection Legislation Smoke-free public spaces, workplaces etc.

Cessation Cessation programs Education for health-care professionals

Tobacco Industry TacticsTobacco Industry Tactics

Marketing◦In Canada marketing/advertising of tobacco has been highly restricted (federally & provincially) especially in regards to marketing towards youth

◦See www.cctc.ca for specific marketing legislation (federal and provincial/territorial)

Tobacco Industry TacticsTobacco Industry TacticsDespite the restrictions on tobacco

advertising, many Canadians report seeing tobacco ads. 

In March 2006, Health Canada commissioned a survey of Canadians' recall of tobacco advertising. ◦"One in five (19%) Canadians recall seeing tobacco

advertising in the past few months." ◦"More than a third (36%) of those younger than 24

recall seeing ads”◦Among those who have seen ads, they are most

likely to recall seeing ads in magazines.

MarketingMarketing

In other countries: ◦Sponsorship by

cigarette companies for artsand sporting events

◦Targeted packaging

Ottawa ModelOttawa Model• A systematic approach to tobacco dependence

treatment for hospitalized smokers• Designed an implemented at the University of

Ottawa Heart Institute• Adopted by a number of hospitals in Ontario & other

provinces/territories

• Uses 5As Protocol (Ask, Advise, Assess, Assist & Arrange)

• Smokers are more likely to be hospitalized than non-smokers• Opportunity to help smokers quit smoking

Ottawa Model:Ottawa Model: On Admission On Admission1. Ask

• Ask about client/patient tobacco use in the past 6 months

• Document smoking status & quitting history

2. Advise• Advise client/patient to quit

3. Assess• Assess the smoker’s interest in quitting (during

hospital stay, within 30 days, within 6 months?”

4. Assist• Brief counselling (includes pharmacotherapy

options)

Ottawa Model: Ottawa Model: During During HospitalizationHospitalizationfor people who for people who wantwant to quit smoking to quit smoking• Counselling focuses on: –Managing withdrawal symptoms–Planning how to remain smoke-free following

discharge

• Pharmacotherapy –Offered during the hospital stay–Prescribed for 10 – 12 weeks after discharge

• Self-help materials for smokers wanting to quit are provided

Ottawa Model: Ottawa Model: During HospitalizationDuring Hospitalizationfor people who for people who DO NOT want DO NOT want to quit smokingto quit smoking

• Counselling focuses on: –Pros and cons of smoking• ie. ‘what do you see as some of the advantages

and disadvantages of smoking?’• Pharmacotherapy is offered during the

hospital stay to help patients remain comfortable in the smoke-free environment

• Self-help materials tailored to smokers who do not want to quit are provided

• Information about community cessation services is provided

Ottawa Model: Ottawa Model: On DischargeOn Discharge

5. Arrange Offer follow up to all smokers

Interactive, voice response (IVR) – mediated telephony system & database

Automated calls inquiring about smoking Results can be scanned by a nurse Clients/patients receive a telephone call form

a nurse if they appear to need more support

Ottawa Model: Best PracticesOttawa Model: Best Practices1. Document smoking status2. Designate staff to provide treatment 3. Include tobacco dependence treatment in

clinical pathways, care maps, or Kardex systems used for quality management

4. Ensure pharmacotherapy for smoking5. Track tobacco users for more than 30 days

after discharge, provide counselling6. Ensure training for health-care professionals7. Provide self-help material8. Establish referral links9. Evaluate the provisions of tobacco dependence

treatment10. Provide feedback to health-care professionals

Importance of Hospital Smoking Importance of Hospital Smoking PoliciesPolicies

Policies that restrict smoking:

◦ Help people quit smoking is made less convenient encourages the use of NRT

◦Regulate second-hand smoke staff patients visitors

Standard of careStandard of care

All smokers have the right to the best care

No tradition of providing training in nursing curriculum (we’re changing that now!)

Smoking PoliciesSmoking Policies

Many smokers mention that ‘no smoking’ policies help them to quit or limit smoking

These policies:◦Stimulate motivation to quit◦Facilitate quitting by avoiding triggers

What nurses can doWhat nurses can do

What nurses can do to contribute to an environment that is conducive to a smoke-free lifestyle & successful quitting:

◦Get involved with the development of smoking policies in your work place Action on Tobacco Control: Action Kit for RNs

◦Tool for nurses who want to advocate for healthy public policies regarding tobacco issues