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
See: Nursing Faculty Education Guide (NFEG): Tobacco Use and Associated Health Risks: Section 2;

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
See: NFEG: Section 2;

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
See: NFEG: Section 2;
FTCS Objectives:
Reduce prevalence of youth (ages 15 – 17) smokers from 15% to 9%
Increase number of adults who quit smoking to 1.5 million
Reduce prevalence of people exposed to second-hand smoke from 28% to 20%
Examine the next generation of tobacco control policy in Canada
Contribute to the global implementation of WHO’s Framework Convention on Tobacco Control
Monitor and assess contraband tobacco activities and enhance compliance

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
See: NFEG: Section 2;

6. National Tobacco Control (cont.)
Latest initiative  oblige tobacco companies to list more of cigarettes’ toxic ingredients on the package
Ingredient
Emission levels for a cigarette sold in Canada
Previous
Current *
Tar
8 mg
8 – 29 mg
Nicotine
1 mg
1 – 2.6 mg
Carbon Monoxide
9 mg
9 – 27 mg
Formaldehyde
n/a
0.035 – 0.13 mg
Hydrogen cyanide
0.073 – 0.25 mg
Benzene
0.034 – 0.08 mg
See: NFEG: Section 2
(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 Control
See: NFEG: Section 2;

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
See: NFEG: Section 2;
For more information see the Ministry of Health Promotion and Sport website:

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
See: NFEG: Section 2;
For more information see the Ministry of Health Promotion and Sport website:

10. SFO Strategy Prevention Protection Cessation Child/youth programs
Restricted access to tobacco
Protection
Legislation
Smoke-free public spaces, workplaces etc.
Cessation
Cessation programs
Education for health-care professionals
See: NFEG: Section 2;
For more information see the Ministry of Health Promotion and Sport website:

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 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.
More information:
Physicians for a Smoke-free Canada:
Health Canada survey information is available from the Library of Canada:

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
NFEG: Section 2;

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)
NFEG: Section 2;

17. Ottawa Model: During Hospitalization for 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
NFEG: Section 2;

18. Ottawa Model: During Hospitalization for 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
NFEG: Section 2;

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
NFEG: Section 2;

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
NFEG: Section 2

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
See: NFEG: Section 2

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!)
Discuss empathy, how a client/patient’s smoking habits could affect your attitude towards them etc.
How can this be avoided.
See RNAO’s eLearning Course: Helping People Quit Smoking.
Module: Intensive Intervention
Section: Helping Smokers

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
Action on Tobacco Control: Action Kit for RNs:

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
See: NFEG: Section 2