Public and Workplace Smoking Policies

1. Public and Workplace Smoking Policies Created by the Registered Nurses’ Association of Ontario

2. World Health International 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

3. MPOWER • 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

4. National 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

5. 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

6. National Tobacco Control (cont.) • Latest initiative  oblige tobacco companies to list more of cigarettes’ toxic ingredients on the package (Health Canada, 2009b)

7. Provincial/Territorial Tobacco Control • 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

8. 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

9. SFO • 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

10. SFO 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

11. Tobacco 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)

12. Tobacco Industry Tactics • Despite 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.

14. Marketing • In other countries: • Sponsorship by cigarette companies for arts and sporting events • Targeted packaging

15. Ottawa 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

16. Ottawa Model: On Admission • Ask • Ask about client/patient tobacco use in the past 6 months • Document smoking status & quitting history • Advise • Advise client/patient to quit • Assess • Assess the smoker’s interest in quitting (during hospital stay, within 30 days, within 6 months?” • Assist • Brief counselling (includes pharmacotherapy options)

17. Ottawa Model: During Hospitalizationfor people who want 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

18. Ottawa Model: During Hospitalizationfor people who DO NOT want to 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

19. Ottawa Model: On Discharge • 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

20. Ottawa Model: Best Practices • Document smoking status • Designate staff to provide treatment • Include tobacco dependence treatment in clinical pathways, care maps, or Kardex systems used for quality management • Ensure pharmacotherapy for smoking • Track tobacco users for more than 30 days after discharge, provide counselling • Ensure training for health-care professionals • Provide self-help material • Establish referral links • Evaluate the provisions of tobacco dependence treatment • Provide feedback to health-care professionals

21. Importance of Hospital Smoking Policies • Policies that restrict smoking: • Help people quit • smoking is made less convenient • encourages the use of NRT • Regulate second-hand smoke • staff • patients • visitors

22. Standard of care • All smokers have the right to the best care • No tradition of providing training in nursing curriculum (we’re changing that now!)

23. Smoking 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

24. What 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