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Providing Leadership in Tobacco Reduction

MAY, 2015

Comment on the Manitoba Budget

The Province of Manitoba Budget released on April 30 was a good news budget for tobacco control.  The Province raised the tobacco tax a small amount, $1 dollar a carton and said it would take the extra $2 million raised and dedicate it to smoking cessation programs.

This move goes to partially fulfill the 2011 NDP election promise to increase tobacco control funding over the course of their latest term in office to eventually dedicate 2% of tobacco tax revenues to reducing smoking rates.  Projected revenues this year are about $250 million, so to fulfill this promise total funding should reach the $5 million mark.

Investment in smoking cessation is one of the most cost effective health interventions there is when looking at the cost of the intervention per life year gained and more investment is necessary considering the financial toll of tobacco use in Manitoba is about $250 million in health care costs alone.

More funding is welcome because Manitoba has lagged behind other provinces in tobacco control investment. The $2 million is a needed boost to help reduce smoking rates in Manitoba which at 17% smoking prevalence is higher than the Canadian average of 15%.

MANTRA has always supported increases to tobacco taxes because studies have shown that when the price of cigarettes go up, young people choose to quit or not take up the habit at all.

 According to the Campaign for Tobacco Free Kids the “general consensus is that every 10 percent increase in the real price of cigarettes reduces overall cigarette consumption by 3-5 percent, reduces the number of young adult smokers by 3.5 percent and reduces the number of kids who smoke by 6 or 7 percent.”

In Manitoba, we have seen youth rates of smoking go down significantly and high prices of cigarettes have undoubtedly played a part in this.

So we are fortunate that Manitoba has had the most expensive cigarettes in Canada for some time.  A tobacco tax map put together by Non Smokers’ Rights Association shows the average Manitoba carton costing over $127 which is more than $10 more per carton than Nova Scotia, the second highest province.

This means a pack a day smoker in Manitoba spends close to $6000 a year, a massive expense and considering the cost of smoking is listed as the second biggest reason for quitting (behind health) this gives the roughly 2/3 of Manitoba smokers who want to quit, a huge motivation to do so.

The second good news piece in the budget is that people seem to be really quitting or reducing their smoking.  Budget estimates for Tobacco Tax revenues projections have fallen greatly from last year.

Despite the $1 per carton increase, revenue projections are estimated to decline significantly.  Projections from last year’s budget estimated revenue of $286 million this year it is estimated to be $252 million, a decline of $34 million or 12% in total tobacco consumption.

Though a decrease in Tobacco Tax revenue could potentially signify an increase in contraband tobacco smuggling, we have little evidence that contraband is actually increasing in Manitoba as it has been steadily decreasing in other parts of the country.  With declining smoking rates in the province, it is more likely that people are choosing to quit or cut back which is great news for public health.

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New Studies Highlight Greater

Mortality Risk from Smoking

As part of MANTRA’s work delivering smoking cessation programming, we often quote Richard Doll’s British Doctor’s Study. This huge 35,000 person (all men), 50 year study began in the early 1950’s and was some of the first compelling evidence that long-term smoking significantly impacts a person’s life expectancy. Depending on both the length of time smoked and the amount smoked, the average amount of life lost for regular smokers was around 10 years and it was concluded that about 50% of long term smokers died of an illness caused by their smoking. The 50% stat is still often quoted today.

Two recent studies demonstrate that this previous estimate of smoking deaths may be quite a bit lower than the reality. A study from the American Cancer Society (ACS) released in February, 2015 pooled data from almost a million men and women ages 55 and older over a ten year period and noted significant number of deadly diseases among smokers that had not previously been causally linked to smoking. The study found excess risks of renal failure, various heart and respiratory diseases as well as prostate and breast cancer. If the research is correct, the New York Times reported that this represents an increase of about 60,000 American deaths per year in addition to the nearly half million that are currently attributed to smoking. In Canada, there would be significantly more than the currently accepted 37,000 Canadian deaths from smoking.

A study out of Australia released shortly after the ACS study found something similar.  The study looked at 200,000 men and women ages 45 years of age and older and concluded that up to 2/3 of deaths in current smokers can be attributed to smoking.  Harm around intensity of smoking was quantified in the study finding that smokers who smoked about 10 cigarettes a day had twice the mortality risk and smokers who smoked 25 cigarettes or more a day had quadruple the mortality risk.

So the news around the dire health effects of smoking just keeps getting worse. The good news is that quitting smoking is effective. After 1 year excess risk of coronary heart disease is about half that of a continuing smoker and after 5 years stroke risk is that of a never smoker. For more health benefits of quitting click HERE.

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FEBRUARY, 2014

Flavoured Tobacco Ban Needed

It is very important that Manitoba responds to tobacco marketing to youth and high youth usage rates by banning flavoured tobacco. Manitoba has made gains in reducing youth smoking and failure to act on flavoured tobacco could cause rates to stagnate or even regress. New data from the University of Waterloo’s Centre for Population Health Impact (Propel) shows widespread adoption of flavoured tobacco by kids in Manitoba, where nearly half (45%) of all students in grades 6-12 who used tobacco in the last 30 days, used some form of flavoured tobacco.

This evidence from Propel confirms that tobacco companies, which are now severely restricted in their marketing and advertising practices, are still very successfully recruiting new users by adding flavours. Flavoured tobacco comes in many forms.  Cigarillos, chew, water pipe tobacco, cigarettes, kreteks, and other forms of tobacco all have flavoured options. Grape, cherry, peach and vanilla flavours make tobacco more palatable to young taste buds. In many cases, flavoured tobacco comes in packaging that is indistinguishable from candy wrappers.

The Federal government attempted to address part of the problem by passing Bill C-32 in 2010. The bill covered individual sales of flavoured cigarillos but had little effect in reducing use because it was easily circumvented by the tobacco industry which only had to change the size of cigarillos to continue selling them. Although there was hope Ottawa may amend the bill to close loopholes or cover additional forms of flavoured tobacco, so far no such action has taken place leaving provinces to lead on the issue.

Recently, Alberta and Ontario have acted in response to high flavoured tobacco use among their youth by introducing legislation to ban it. These announcements have shown that governments are learning from imperfections in the federal regulations.  Ontario introduced legislation in November to amend the Smoke Free Ontario Act. Part of this amendment includes banning fruit and candy flavours from all tobacco products, including smokeless tobacco. Although the Ontario legislation is generally strong, menthol cigarettes are exempted and this is a glaring omission considering high rates of menthol use among youth.

Alberta was the first province to take action on flavoured tobacco and has recently passed very strong legislation that prohibits all flavoured tobacco, including menthol in cigarettes. This legislation is particularly effective because it will allow the government to add any new products introduced by the tobacco industry without having to change the law.

It is very important that Manitoba follows the lead of Alberta and Ontario in banning flavoured tobacco, and any ban that Manitoba attempts should include a ban on menthol cigarettes.  In Manitoba, approximately one third of students in grades 9-12 who smoked in the last 30 days, used menthol cigarettes, this is a staggeringly high number compared to the general smoking population in Canada which uses menthol at less than 5%.

Banning flavours will not just impact youth smoking rates in Manitoba but will also have an effect on young adults which is an age group of great concern here. At 27% smoking, Manitobans aged 20-24 have more than double the smoking rate of 15-19 year olds and have the dubious distinction of having the highest smoking rate of any age group in all of Canada. 20-24 year olds are frequent users of flavoured tobacco, with research showing that cigarillo and cigar usage rates are even higher than youth. Reducing smoking among in this demographic is vitally important to address to reduce smoking rates in Manitoba.

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PRESS RELEASE – JUNE 25, 2013: SMOKE-FREE MULTI-UNIT DWELLINGS

Manitoban’s Demand for Smoke-Free Housing

in Multi-Unit Dwellings Not Being Met

Winnipeg, Manitoba (June 25, 2013) – The Manitoba Tobacco Reduction Alliance Inc.’s

(MANTRA) new research on multi-unit dwelling tenants and owners conducted by PRA

(Prairie Research Associates) Inc. finds that:

• More than 7 in 10 Manitobans would prefer to live in a building that does not allow

smoking anywhere inside (i.e. “smoke-free”).

• Only about 4 in 10 actually do because of a lack of supply.

• 42% of those who smoke or have a family member that smokes, would choose

to live in a building that is smoke-free.

Exposure to second hand smoke that drifts into units from other parts of the building

is the driver for why many Manitoban tenants of multi-unit dwellings desire a smoke-

free environment. In fact, 1 in 3 tenants say such drifting has taken place at least once

in the last six months and about 8% have reported a negative health outcome from

this exposure.

Tenants seeking smoke-free housing are further challenged by the fact that there

appears to be no standard definition of the term “smoke-free” and that it is applied

to a wide variety of situations. For example, among tenants who stated they live in

smoke-free housing, 35% also said that smoking is actually allowed in the building.

Further, among property managers who say they have formal smoking policies, 44%

allow smoking in suites.

Managers and building owners see advantages to addressing smoking in and around

their buildings such as: reduced fire risk, lower maintenance costs, reduction in tenant

complaints, and benefits to tenant health. However, these advantages alone have not

translated into buildings transitioning to completely smoke-free, possibly because they

are not aware of the high demand (indeed, few actually kept track of the demand for

smoke-free units) nor do they realize that many smokers would choose to live in

a building that is smoke-free.

The result is that many Manitobans living in multi-unit dwellings may be living

in buildings that do not meet their expectations and property managers are receiving

complaints that could be avoided with clearly written disclosure of a buildings smoking

policy at the signing of a lease. Although the vast majority of tenants want to live

in housing that does not allow smoking inside, the lack of clarity around the definition

of smoke-free, combined with no requirements for smoking policies to be disclosed

means that tenants may not realize the true situation they are moving into and may

have little recourse against second hand smoke entering their homes.

So if there exists high demand for smoke-free multi-unit dwellings and suppliers

of such housing see the benefit of non-smoking buildings, why then is the demand not

being met? We believe in part it is because there is confusion in the market place.

MANTRA would recommend the following to help both tenants and owners clarify the

situation in multi-unit dwellings:

1) A standardized definition of the term “smoke-free”

2) Complete and formal disclosure of building’s smoking policies to tenants

3) A shift to smoke-free housing by individual building owners

4) Increased government encouragement to transition buildings to smoke-free

Methodology

For this research PRA employed a combination of three approaches: 1) a survey

of 50 property management companies responsible for managing a total of 1,655

apartments, condominiums, and multi-until housing buildings, conducted by phone

in late May; 2) fifty mystery shops, 40 with multi-family apartment leasers and

landlords, and 10 with multi-family condominium real estate agents by phone between

May 17 and May 29; and 3) a random sample survey of 401 Manitobans living

in residents with shared-walls, conducted by phone from May 9 to 31, 2013 (theoretical

error rate: ±5%, 19 times out of 20).

The full spectrum approach of this research enables MANTRA to understand the

source of smoking policy governance (rental management companies), the

communication and implementation of the policies (leasers, landlords, and real estate

agents), and the adherence to and outcomes of the policies (shared-walls residents).

About MANTRA

Founded as a non profit in 2002, MANTRA functions as a catalyst and coordinator

for tobacco reduction activities in Manitoba. Our vision is to eliminate tobacco use

for a healthier Manitoba.

For more information please contact:

Contact Murray Gibson, Executive Director MANTRA

204.784.7030

mgibson@mantrainc.ca

www.mantrainc.ca

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PRESS RELEASE – MAY 31, 2013 PHARMACY BAN

MANTRA Applauds Recent Pharmacy Ban, Calls for

Reduced Locations for Tobacco Sales

May 31 is World No Tobacco Day

Winnipeg, Manitoba (May 31-2013) – Today, legislation comes into effect banning

tobacco sales in pharmacies and vending machines. MANTRA (Manitoba Tobacco

Reduction Alliance) recognizes that reducing the number of locations where tobacco

is sold is a vital measure toward lowering Manitoba’s smoking rates.

“The legislation coming into effect today is certainly a welcome first step,” says

Murray Gibson, Executive Director at MANTRA “unfortunately we’re seeing that many

stores containing pharmacies are choosing to continue selling tobacco, a product that

is lethal when used as intended.”

The Manitoba legislation allows stores to continue selling tobacco if they create

a separate entrance to the pharmacy, making it inaccessible to the rest of the store.

MANTRA commends businesses like Rexall and Shoppers Drug Mart that have

chosen to stop selling tobacco while we find it regrettable that others such as Sobeys

have chosen to go to great lengths to continue selling. Before the May 31 ban, there

were 92 Manitoba pharmacies or stores containing pharmacies selling tobacco, that

number will reduce by more than half as a result of the legislation.

Even with the pharmacy and vending machine bans, tobacco products continue to be

much more widely available in Manitoba than alcohol. There is 1 tobacco retailer for

every 104 smokers in the province compared to 1 alcohol retailer for every 390

persons who consume alcohol.

Reducing the number of locations where tobacco is sold is an important element

of MANTRA’s newly released Comprehensive Tobacco Control Strategy. Taking

action in this area has the benefits of lowering cigarette consumption, de-normalizing

tobacco use and enhancing enforcement efforts at remaining outlets.

MANTRA recommends further reducing the number of outlet locations using the

following methods:

1. Introduce annual retail license fees – In Manitoba, a license to sell tobacco costs

nothing and never has to be renewed, this is in stark contrast to alcohol license

fees which are costly and have to be renewed annually. The number of tobacco

licenses issued should be capped.

2. Establish tobacco free zones around educational facilities and hospitals. Work

with colleges and universities to ban tobacco sale on campus.

Founded as a non profit in 2002, MANTRA functions as a catalyst and coordinator

for tobacco reduction activities in Manitoba. Our vision is to eliminate tobacco use

for a healthier Manitoba.

For more information please contact:

MANTRA – 204.784.7030

wcooke@mantrainc.ca

www.mantrainc.ca

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Investing in Cessation

Many provinces in Canada pay for prescription and non-prescription cessation

medications that help people quit smoking. Coverage varies from province to province.

Quebec and British Columbia provide extensive coverage, making available various

forms of nicotine replacement therapy as well as the prescription drugs Zyban and

Champix. Ontario has funded quit and win competitions where they have provided

NRT. In Manitoba, Champix was recently added to the provincial formulary.

Covering these drugs is an excellent way to help people quit smoking. Studies show

that using them doubles to triples the chance of a successful quit attempt. This adds

up to an excellent investment for governments as it is widely recognized that funding

smoking cessation is among the most cost effective treatments that exist and an

even better investment than treating things like commonly covered conditions like

hypertension or high blood cholesterol. At the cost of a couple hundred dollars

worth of treatment now, several thousands of dollars will be saved to the health

care system down the road.

The financial cost is small however compared with the human cost of smoking.

Considering that 37,000 Canadian die each year from smoking and that lifetime

smokers lose at least 10 years of life, it is not just financially prudent to invest

in cessation, but it is the compassionate thing to do as well.

Many argue that people who can afford to smoke can also afford to buy the

medications to quit, but many medications require a large initial investment and

they don’t get people off smoking right away, but instead require that people slowly

cut down at the same time, meaning people are buying cigarettes and medications

at the same time. This makes the initial expenditures prohibitively high.

It is very important for Manitoba to address smoking cessation. Nearly 16% of

Manitobans over 45 years of age are still smoking and this group makes up a huge

38% of our total smoking population. Due to the decreasing health benefits of

quitting smoking as people get older, this middle aged to older group of smokers

is most desperately in need of quitting and the economic benefits of helping these

people quit would be realized the soonest.

In addition to having recently added Champix to the formulary, Manitoba needs

to begin funding nicotine replacement therapies to help people quit. Champix is

a very effective medication but it is not recommended for everyone and because

it requires a prescription, people have to go to the doctor in order to get it. NRT

requires no prescription and therefore has fewer barriers to its use. Because

it works by delivering nicotine in a safe form rather than eliminating a smokers’

desire for nicotine, it is a completely different approach than Champix and is

therefore an option that people must be encouraged to try.

Making cessation medications more accessible to help smokers quit makes sense

when the numbers are crunched. Recently, the province of Manitoba committed

to spending more money to help people quit.  The Province has said it will increase

tobacco control spending to about 2% of tobacco tax revenue, or about $5 million

of the $250 million they expect to collect his year.  Considering that the total cost

of smoking in Manitoba is over $500 million annually, helping people to quit

is a prudent investment.

Youth Smoking Down in Manitoba

In Manitoba, there are three major mechanisms that track youth smoking. The

Canadian Tobacco Usage Monitoring Survey (CTUMS) is an annual survey that

tracks smoking use across several age categories and all provinces of Canada.

The survey samples approximately 2700 Manitobans.

The Youth Smoking Survey (YSS) measures smoking in grades 6-12 and has

an even greater sample size than the CTUMS at 7500 participants. It is carried

out every 2 years. The final measure is the Manitoba Youth Health Survey (MYHS)

which was only conducted in 2008 with another survey taking place in late 2012.

This survey is the largest polling nearly 34,000 grade 9-12 students.

The news from CTUMS and YSS both show a downward trend in youth smoking

in Canada. CTUMS has collected statistics about smoking rates in Canada since

1999 when a staggering 28% of Canadians aged 15-19 year were current smokers.

Now, only 12% of that same age group have taken up the habit.

Manitoba is following the national trend. 1999 CTUMS data shows a 29% smoking

rate among 15-19 year olds compared to 14% in 2011. This downturn in Manitoba

smoking rates is even greater according to the YSS data. In 2006/2007, almost

20% of Manitoba students in grades 10-12 smoked. In 08/09 that number came

down to 12% and in 2011, it measured fewer than 9%.

The recent progress announced in the YSS is particularly encouraging because

it suggests that Manitoba has lowered youth smoking rates at a much faster pace

than the Canadian average, but these results should be interpreted with caution.

The Manitoba Youth Health Survey has the largest sample size and we are hopeful

but do not yet know if it too will confirm this downward trend.

It is no coincidence that youth smoking rates in Manitoba have fallen at the same

time as federal, provincial and municipal governments invested money and passed

legislation to reduce smoking.

The Federal Tobacco Control Strategy announced in April 2001, worked in conjunction

with individual provincial strategies to reduce overall smoking rates in Canada

including preventing youth smoking. Manitoba released a strategy in 2003 that

lead to funding many prevention measures and enacting smoke free legislation.

Despite the obvious success of both the federal and Manitoba strategies, they are

in need of renewal. The 10 year FTCS ran through 2011 and has extended through

2012, but new vision is needed to build on the original success.

The FTCS also needs to return to an adequate level of funding. In 2012, the strategy

received only $28 million, down from $68 million in 2006. The current level of funding

amounts to less than 1% of the $3 billion the feds take in from tobacco taxes every year.

In Manitoba, our strategy has expired and we are in need of a new one. The

province has recently conducted consultations for a tobacco control strategy and

we look forward to seeing a publicly released strategy with measurable outcomes

and benchmarks, similar to strategies we have seen in other provinces.

This strategy must also be well funded. Historically, Manitoba has invested among

the least money in Canada to reduce smoking and while the Province has been

successful in reducing youth smoking, Manitoba has not made as much progress

in other age categories or in the overall smoking rate which remains higher than

the national average.

MANTRA and other stakeholder organizations look forward to the Province fulfilling

its recent commitment to increasing tobacco control fundingto 2% of tobacco tax

revenues or approximately $5 million, from the 2011 level of slightly over $1 million.

Tobacco Free Campus

Historically in Manitoba, there has been little done to actively promote smoking

cessation or peer to peer tobacco education on campuses, but there is currently

some action being taken to reduce smoking at the post secondary level.

Students completing Manitoba SWAT high school training programs have recently

started working at the University of Manitoba Fort Garry Campus. SWAT, which has

a mandate to counter tobacco industry messaging has partnered with MANTRA

and they are in the process of recruiting members and strategizing how they will

reduce tobacco on campus. Such grassroots action is a welcome start and it is one

piece of the puzzle to reduce young adult smoking rates.

Working to reduce smoking on campus is becoming more important. It is commonly

held that about 90% of adult, regular smokers start smoking before the age of 19,

but data we are seeing from the more recent Canadian Tobacco Usage Monitoring

Survey (CTUMS) is that more Manitobans are picking up the habit after their high

school years. In 2011, only 14% of Manitobans aged 15-19 smoked cigarettes,

compared to 27% of 20-24 year olds.

This trend is alarming. On one hand it points to the success that governments and

other concerned groups have had in keeping cigarettes out of the hands of minors

but it also shows that a huge number of young adults are still experimenting with

and becoming addicted to cigarettes.

It is difficult to understand why young adults are picking up the habit later in life,

but whatever the reason, it is important for legislators and policy-makers to do what

they can to combat high smoking rates.

One way to combat the problem is to look to our college and university campuses.

Almost 40% of Canadians aged 17-24 attend university or college, making these

places the single biggest opportunity to reduce young adult smoking.

Many campuses across Canada and North America have responded to the problem

by implementing smoke free bans that vary in strength. Some create designated

smoking zones while others ban smoking and all forms of tobacco on the entire

campus. Many campuses in Canada have some version of smoke free policies,

but most still have a long way to go.

The Non Smokers’ Rights Association has developed a Tobacco Free Campus

Guide that provides a lot of great tips on how to put policies in place. From this

guide, I have summarized four areas that Manitoba colleges and universities can

work in to create a healthier, smoke free environment on campus.

Protect the student body from second hand smoke. It is important to protect

students from the dangers of second hand smoke by developing a strong smoke

free policy. In most cases, it is best to have 100% smoke free grounds, but on large,

isolated campuses that is not always possible due to concerns for student safety.

In these cases there should be designated smoking areas that are far from

entranceways and common areas.

Ban tobacco sales on campus. There is ample precedent for banning tobacco

sales on campus. Many provinces and institutions now prohibit sales on campus.

Alberta, British Columbia, Quebec, Newfoundland and Labrador have all passed

provincial legislation to ban sales. In provinces where there is no legislation, many

institutions have taken the initiative and developed their own policies to ban sales

on campus.

Prohibit tobacco company ties with a college or university. Institutions of higher

learning should have a tobacco free policy that prohibits tobacco companies from

participating in on campus career fairs and funding research grants, or campus

events. Also, university investments should be divested of all stock related to the

tobacco industry.

Provide programs that help employees and students quit. The institution’s

health and benefits plan should provide coverage for prescription medications and

the nicotine replacement therapies that help people quit smoking. Also, institutions

should provide funding for the promotion of cessation. Ontario’s Leave the Pack

Behind program provides a model for Canadian institutions that utilizes social

media, cessation counselling and peer to peer programs.

Welcome to the New Website!

Hello all, the MANTRA team is very excited about the December launch of our

revamped website. As part of MANTRA’s efforts to be a leading voice for tobacco

reduction, we will be updating the blog with a Manitoba perspective on tobacco

control developments and activities in Manitoba, Canada and elsewhere.

Blog posts will address a range of topics, from changes in legislation to stop smoking

programming, to international news. We will also draw from our experience in

tobacco advocacy to provide a source of commentary related to reducing tobacco

use in Manitoba.

Also new to the site is a MANTRA Resources and Quit Resources section.

MANTRA’s Health Behaviour Change facilitation manuals as well as our Tobacco

Basics presentation and other MANTRA materials are now more accessible through

the website. The Quit Resources list features Manitoba sourced content for people

that are looking to quit, or help people quit smoking. Be sure to check out these

resources to promote cessation in your own community.

Having just completed compiling some data for the website, it is amazing to see

how many positive things have happened aiming to reduce tobacco use in Manitoba

since the inception of MANTRA ten years ago. Remember when smoking was

allowed in bars and restaurants? Even though smoking sections seem like they are

in the distant past, it’s difficult to believe that it has only been since 2004 that

smoking in indoor public places became illegal!

Despite the good work around smoke free public places and other measures, there

is a lot of work to be done to make sure Manitoba’s youth don’t start, and help our

current smokers quit.

Hope you will check in often to see the latest issues and info from Manitoba’s leader

in tobacco reduction!

Thanks!

MANTRA team

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