tobacco info.ca

tobacco info.ca
Magazine for a Smoke-Free Canada
Issue 2
September 2010
Cigarillo distributors
sidestepping
the new Tobacco Act
“Next generation” of flavoured plus-sized
cigar products hit the market
JOE STRIZZI
In an effort to skirt new legislation banning the sale of flavoured
cigarillos and cigarettes, Casa Cubana, distributor
of Prime Time cigarillos, was the first to introduce a new size
cigarillo that circumvents the law. According to its website,
“Prime Time Plus cigars have been modified to be 100% compliant
with all regulations and requirements for the continued
sale of flavoured cigar products implemented by the passage
of Bill C-32.”
Other brands followed suit, with Casa Cubana’s resized
Bullseye Extra cigars, while competitor Distribution GVA introduced
Honey T non-filtered cigars, all of which circumvent
the new law’s guidelines for flavoured cigarillos.
Federal Health Minister Leona Aglukkaq has said that
some tobacco companies are going against the intent of the
law and that she’ll work to close the loophole. “Not only does
this action go against the intent of the legislation; it endangers
the health of Canada’s children. We will deal with this issue
and will continue working to ensure that Canada’s children
are protected from the dangers of tobacco.”
In a written statement, Prime Minister Stephen Harper
supported the amendments and promised the law would be
enforced. “Compliance with these rules will be monitored and
enforced in no uncertain terms,” his statement reads. “Adherence
to the spirit of the legislation will also be monitored, and,
if necessary, the legislation will be revisited.”
Cigarillos have simply become small cigars without filters, but with
the same attractive flavours such as cherry, strawberry and peach.
The law
Flavoured cigarillos and cigarettes were pulled from store
shelves across Canada on July 5, as the final stage of the federal
government’s updated tobacco legislation kicked in. The
extended restrictions on the advertising of tobacco products
came into effect on October 8, 2009, when the amendments
received Royal Assent. Effective April 6, 2010, the retail sale,
including duty-free sale, of little cigars and blunt wraps packaged
in less than 20 units was no longer permitted. Effective
July 5, 2010, the retail sale, including duty-free sale, of cigarettes,
little cigars and blunt wraps that contain a prohibited
additive (all flavouring agents excluding menthol, and certain
other additives) was no longer permitted.
Other tobacco products, like (big) cigars and smokeless
tobacco products are not covered by the law.
The amendment to the Tobacco Act defines the little
cigar as: 1- a roll or tubular construction that is intended for
smoking; 2- contains a filter composed of natural or reconstituted
tobacco; 3- has a wrapper, or a binder composed
The era of the
smoke-free
patio
has arrived
More and more Canadian
jurisdictions prohibit smoking
on the patios of bars and
restaurants, as well as in parks.
6
Plain
packaging:
Australia’s
take
Australia’s current government
hopes to make the land down
under the first country to introduce
plain packaging for cigarettes
by 2012.
12
SUMMARY
The legal market grows
JTI-Macdonald guilty of
smuggling in the 1990s
Dangers of SHS
Running against tobacco
Tobacco control heroes
NRT during pregnancy
OTRU abstracts
4
5
8
10
11
14
15

2 FLAVOURED CIGARS
tobacco info .ca No. 2, September 2010
During the 2008 election campaign, Prime Minister Stephen Harper
promised to prohibit flavoured cigarillos that appeal to youth.
of natural or reconstituted tobacco; 4- has a cigarette filter;
5- it weighs no more than 1.4 g, excluding the weight of any
mouthpiece or tip.
The legislation also allows for the definition to include any
tobacco product that is prescribed to be a little cigar.
Protecting our youth
The goal of the 2009 amendment is an encompassing
protection of Canada’s youth. The results of the 2008-09
Youth Smoking Survey, released in conjunction with World
No Tobacco Day on May 31, 2010, show that 9%, or 250,000
youths in grades 6-12 smoked cigarillos in the last month. Of
note, 85% of youths who smoked just cigarillos considered
themselves “non-smokers,” compared to 33% who smoked
just cigarettes.
As with cigarette consumption, the higher the grade level,
the higher the reported use, and in grades 10-12, 35% of
youths reported having ever tried cigarillos.
Rob Cunningham, senior policy analyst with the Canadian
Cancer Society, has applauded the efforts behind the revised
Tobacco Act.
“Without this law, many young people would have been
tempted by this type of flavoured product when they may never
have tried a traditional cigarette,” he said. “It’s outrageous
what Casa Cubana and others are doing, obviously determined
to continue marketing to youth.”
Cunningham argues that tobacco companies know full well
who they were targeting with chocolate or vanilla-flavoured
products, a new marketing tactic on their part, adding that
these flavoured products are just as dangerous as cigarettes
because they contain nicotine and thus could lead to addiction.
The first to skirt the new law
Casa Cubana was the first company to officially exploit
the loophole. Its newest Plus cigars were altered just enough
to satisfy the new regulations. Prime Time Plus cigars exceed
the minimum 1.4 g weight requirement, and according to the
company, they do not use a cigarette-style filter.
“Because Prime Time Plus weigh more and do not utilize
a cigarette-style filter, they are no longer classified as ‘little
cigars,’ and are therefore not subject to any limitations on
minimum transaction amounts, packaging formats or flavour,”
claims Casa Cubana on its website.
Prime Time Plus will be offered in flip-top hard packs of
10 cigars (10 packages of 10 per carton), 20 cigars (10 x 20
per carton) and singles (Western Canada only), and will be
available in a greatly reduced selection of flavours including
cherry, grape, vanilla, peach, rum and strawberry.
Anti-tobacco groups, like the Quebec Coalition for Tobacco
Control (QCTC), argue that a ban on the introduction
of new tobacco products is the only way to avoid problems
like this one.
“The tobacco industry has an uncanny way of finding
and exploiting loopholes or skirting regulations by modifying
their products and marketing. By allowing the industry
to put new products and brands on the market, governments
are essentially giving companies an opportunity to adapt
and sidestep measures,” explained Flory Doucas, codirector
of the QCTC.
Adding fuel to the fire
On the same day as the amendment to the Tobacco Act
came into full effect, the Canadian Convenience Stores Association
(CCSA) denounced the sale of flavoured cigarillos
and other tobacco products on Native reserves in Quebec
and Ontario.
The CCSA argues that some cigarette vendors on the
reserves believe they are above the law, selling large quantities
of tax-exempt cigarettes to ineligible buyers, selling to
minors and selling flavoured cigarillos in contravention of
the new law.
A private investigator hired by the CCSA visited and filmed
tobacco vendors on the reserves a week prior to the new
provisions coming into force. One of two videos released by
the organization on Monday, July 5, shows a 15-year-old girl
visiting 10 tobacco shacks on the Six Nations reserve in Ontario.
She purchased tobacco products at eight of them with
no difficulty and without being asked for identification.
The other video, shot on the Kahnawake and Kanesatake
reserves in Quebec, shows the sale of tobacco products,
including a range of flavoured cigarillos, at a fraction of the
price they sell for at convenience stores, and without tax.
“For the first time, we are showing Canadians that the
irresponsible large-scale selling of contraband tobacco on
Native reservations is nothing but a national disgrace caused
and tolerated by the federal government,” said CCSA senior
vice president Michel Gadbois.
However, despite the CCSA’s apparent enthusiasm about
eliminating contraband, health groups question its motives.
35% of youth reported having ever tried cigarillos.

tobacco info .ca No. 2, September 2010
BLACK MARKET
3
Drop in contraband in Canada
Many smokers have returned
to the taxed cigarette market
Flory Doucas, codirector of the Quebec
Coalition for Tobacco Control
“The industry and its front men
are cleverly trying to make the public
and politicians forget that kids first
learned of these flavoured cigarillos
because legal manufacturers put them
on the market and because retailers
displayed them prominently on
counter tops for many years,” added
Flory Doucas.
Contraband in some
convenience stores
In addition to these questions, 22
convenience stores in and around
Montreal are being pursued by Revenu
Quebec after a series of police raids
uncovered a contraband cigarillo ring
on June 16.
There were 17 suspects arrested in
the first ever bust involving contraband
distribution channels for these
types of legal tobacco products, police
said, adding that the contraband, imported
from Ontario, was being sold at
full retail prices in these convenience
stores for several years.
Each store likely faces a fine of
at least $3,000 along with orders to
repay tobacco specific taxes evaded,
plus undeclared Quebec sales tax plus
penalties, but none of the proprietors
were detained.
Of note, the Winnipeg Free Press
confirmed that cigarillos were still
being sold in convenience stores when
they had reportedly visited a handful
of shops in July, after the implementation
of the ban. Employees confirmed
that customers could purchase mini
flavoured cigars at their outlets. In
each case, the cigarillos were stored
out of sight with other non-flavoured
tobacco products, but were available
upon request.
PIERRE CROTEAU
Health Canada data confirms the
trend: in 2009, in Canada, there
was a 3.9% increase in the number of
cigarettes sold after having been taxed
in accordance with fiscal laws. This
was the first time that the volume of
cigarettes legally sold in Canada has
increased since 1996.
Murray Kaiserman, director of research,
surveillance and evaluation
for Health Canada’s Tobacco Control
Programme, believes the increase in
legal sales is due to a drop in contraband
sales in 2009. According to Health
Canada, there is no evidence to suggest
the sudden increase in legal sales
was driven by more Canadians taking
up smoking or by Canadian smokers
consuming more cigarettes per day, as
smoking behaviours have not changed
in a statistically significant way. In
fact, the Canadian Community Health
Survey, released in June by Statistics
Canada, shows the number of smokers
among Canadians aged 12 and over has
dropped from 6.01 million in 2008 to
5.73 million in 2009. The drop is said
to be statistically significant.
The raw data and the explanation
provided by Health Canada are the latest
available indications of the recent trend
in the tobacco market.
In December 2009, when their respective
governments updated their
budgets, both the finance ministers of
Nova Scotia and New Brunswick revised
expected revenue from the tax on tobacco
products upwards for the year
2009-2010.
In an update of Quebec’s financial
framework that was released in conjunction
with the 2010-2011 budget,
the Quebec Minister of Finance asserted
that “revenue from the specific tax on
tobacco products is revised upwards by
$65 million due to the increase in the
number of cigarettes sold legally. Better
control at the border and deployment
of a new Sûreté du Québec team in the
Valleyfield region impeded smugglers’
tobacco supply. The reduced supply of
illegal products led to an increase in legal
sales of tobacco products.”
Quebec and Ontario were identified
by the Canadian Convenience Stores Association
(CCSA) as the most affected by
the black market, and in Quebec, there
were more outlets for tobacco products
in the registry of the provincial Ministry
of Revenue in May 2010 than there were
when point of purchase displayed two
years earlier.
In its 2009 annual report, British
American Tobacco, the multinational
that owns Imperial Tobacco Canada, the
largest supplier in the Canadian market,
noted that, “profit in Canada increased,
benefiting from a strong currency and
some reduction in illicit trade.” In its
2010 half-year report, the company further
acknowledges that “volume growth
was achieved on the back of a significant
reduction in illicit product as a result of
the authorities' enforcement activities.”
In its Annual Report, cigarette manufacturer
Philip Morris International,
owner of Rothmans, Benson and Hedges,
states, “In Canada, the total tax-paid
cigarette market was up by 3.4% in 2009,
primarily reflecting stronger government
enforcement measures to reduce
contraband sales.”
One of many seizures by police originating
from one of the few Native reservations
that feed the black market.

4 BLACK MARKET
tobacco info .ca No. 2, September 2010
In its financial report for the first
two quarters of 2010, PMI again showed
increases in its sales volume and again
attributed this to “stronger government
enforcement measures to reduce contraband
sales.” For the second quarter,
PMI also reports an 18.7% increase in its
shipment volume and a slight market
share decline.
Obsolete data of the CCSA
In the past, the firm GfK Research Dynamics
tried to measure the scope of the
black market in the country as information
to be used by the Canadian Tobacco
Manufacturers’ Council (CTMC). Results
for 2006, 2007 and 2008 were published
and amply circulated by the CCSA.
Since September 2008, however,
neither the CTMC, nor the CCSA, nor
anyone else has published an update of
these estimates.
In spite of this, during a press conference
tour in various large Canadian
cities in mid-May, it was the GfK study,
made public in September 2008, which
served again as a reference for CCSA
spokespersons claiming that contraband
would furnish Ontario smokers
with close to 50% of their cigarettes,
and Quebec smokers with about 40% of
theirs. These figures have frequently
been echoed by the media.
The CCSA on tour (again)
For several years, the number two
man of the CCSA, Michel Gadbois, a
former public relations officer for the
cigarette industry, has made the most
of his active contribution to the 1994
tax reduction with small merchants, and
regularly denounces “excessive taxes”
on tobacco in his press releases. During
his press conferences, the vice president
of the CCSA is accompanied by small
local merchants who do not hide their
hope for a reduction in taxes.
On the other hand, before the Standing
Committee on the Public and National
Security of the House of Commons
on April 27 in Ottawa, the president of
the CCSA, Dave Bryans, another former
executive of the cigarette industry from
Ontario, asserted that, for the moment,
the CCSA was not demanding tax reductions
to reduce the level of the black
market.
In the latest list of demands that
the CCSA has presented to members of
parliament and legislatures as of May
10, there is no mention of a tax reduction.
The CCSA would rather, among
other “actions,” conduct meetings in the
schools to speak about contraband.
The Non-Smokers’ Rights Association
(NSRA) and the Quebec Coalition
for Tobacco Control (QCTC) publicly
question the sources of financing for the
endless tours and pro-tobacco activities
of the CCSA, particularly in the context
of the CCSA’s claim that thousands of
its members are disappearing due to the
illicit business in tobacco.
For years, the NSRA, the QCTC,
Physicians for a Smoke-Free Canada
and the Canadian Cancer Society have
demanded that public authorities take
action to settle the problem of contraband
cigarettes at its source.
President of the CCSA, Dave Bryans, did not
request lower taxes on tobacco, for now.
Taxation and dissuasion from smoking
In April, Saskatchewan, Manitoba and Newfoundland increased their taxes on
cigarettes. Ontario, British Columbia and Nova Scotia on July 1 implemented a
provincial portion of Harmonized Sales Tax (HST) on tobacco products meaning
that smokers are required to pay substantially more to purchase their cigarettes,
even though taxes specific to tobacco products did not increase.
On the other hand, the federal government has not increased the weight of its
taxes on the price of tobacco products since 2002, nor has Quebec done so since
December 2003.
With fewer contraband products offered in 2010, the taxes could have a renewed
dissuasive effect on smokers and more governments would be able to reconsider
an increase in the tax incentive to give up tobacco, an incentive the World Health
Organization firmly recommends governments use.
The online data from The Tobacco Atlas shows that there are more than 30 countries
where taxation as a proportion of cigarette price is greater than the Canadian
average, among which are Mexico, Uruguay, Portugal, Ireland, United Kingdom,
France, the Netherlands, Denmark, Germany, Italy, Poland, Pakistan and Thailand.
On May 28th, in Montreal, three federal ministers announced some minor measures to combat
tobacco smuggling, including the arrival of a canine squad for sniffing out illegal cigarettes!
This press conference, held on the Friday at 4pm, has had almost no spillover in the media.
Speaking: Veterans Affairs Minister Jean-Pierre Blackburn. At his right:
Public Safety Minister Vic Toews and National Revenue Minister Keith Ashfield.

tobacco info .ca No. 2, September 2010
BLACK MARKET
5
JTI-Macdonald and Reynolds admit to supplying
contraband cigarettes in the early 1990s
After more than 10 years of denials,
police investigations and even home
searches of the tobacco giants, a gloomy
chapter in Canadian history is now
closed without a judicial decision.
Through the process of an out-ofcourt
settlement with the Canadian
federal government, the cigarette
manufacturer JTI-Macdonald, formerly
RJR-Macdonald and still the supplier
of the brand Export ‘A’, as well as R.J.
Reynolds, the former parent corporation
of the Canadian company and the number
two tobacco company in the United
States, acknowledged having supplied
the Canadian cigarette black market
in the early 1990s. The two companies
agreed to pay public authorities $550
million in penalties in 2010 in exchange
for a suspension in judicial proceedings,
notably criminal accusations of
participation in tax evasion brought
against several of the former managers
of Macdonald; accusations that years of
police work made possible.
The settlement of the litigation announced
on April 13 occurred about
20 months after a similar settlement
between the Harper government and the
two other main cigarette manufacturers
in Canada, Imperial Tobacco Canada
(ITC) and Rothmans, Benson and Hedges
(RBH) was reached. On July 31, 2008, ITC
and RBH committed to paying a total of
$1.15 billion over 15 years to the federal
and provincial governments.
Representatives from the Canada
Revenue Agency boasted that in total,
the penalties assessed to ITC, RBH, JTI-
Macdonald and R.J. Reynolds are the
greatest ever assessed in this country
for tax evasion.
“It’s chicken feed compared to what
these people owe,” said Neil Collishaw,
research director at Physicians for
a Smoke-free Canada (PSC). In court
documents from 2005, the federal and
provincial governments filed claims for
nearly $10 billion against JTI-Macdonald
and related companies over contraband.
The lack of follow-up to the criminal
accusations against the executives of
JTI-Macdonald, which organized the
contraband, evoked this comment from
Garfield Mahood, executive director of
the Non-Smokers’ Rights Association
(NSRA): “Big Tobacco executives have
been given get-out-of-jail-free cards.
There was no attempt made to negotiate
health benefits to repair the health
damage caused by the criminal behaviour,
like those obtained in similar-kind
negotiations in the United States.”
1994 versus 2010: differences
In early 1994, Canadian smokers
had a choice between the big legal
brands, highly taxed, and the same
brands, made by the same companies,
but untaxed. ITC, RBH and Macdonald,
the three big cigarette suppliers to the
Canadian market, supplied the black
market through huge exports to the
United States, theoretically intended for
foreign markets, but quickly returning
to Canada as contraband.
In response to the outrage of Quebec
convenience store owners, the governments
of Jean Chrétien, in Ottawa, and
Contraband Export 'A' cigarettes were
very popular in the early 1990s.
Daniel Johnson Jr., in Quebec City,
decided to radically reduce taxation on
tobacco in February 1994. A few weeks
later, faced with the illegal traffic that
was developing between Quebec and
Ontario, the latter province resigned
itself to radically cutting its own tax,
followed by the Maritimes.
It was most notably through the
Mohawk Akwesasne reserve, overlapping
the borders of Ontario, Quebec and
New York State, that the big Canadian
cigarette manufacturers brought their
products into the country in 1994.
Today, about 50 illegal cigarette
factories are set up within the Akwesasne,
Kahnawake, Tyendinaga and Six
Nations reserves, according to the Royal
Canadian Mounted Police, and they are
the main source of tobacco products
sold by the contraband networks in the
eastern part of the country.
– by Pierre Croteau
Although headquartered in Toronto,
JTI-Macdonald has only one factory, in
Montreal, where it produces Export ‘A’.
Tobacco Info needs your
support through sponsorship
and advertising.
For information, please
contact Joanne Brown
at 514 525-7021 or
jbrown@tobaccoinfo.ca

6 PROTECTION OF NON-SMOKERS
tobacco info .ca No. 2, September 2010
Government urged by doctors group to
ban smoking on restaurant and bar patios
JOE STRIZZI
Hospitality workers and patrons continue
to be exposed to dangerously
high levels of second-hand cigarette
smoke, says Physicians for a Smoke-Free
Canada (PSC), a national health organization,
and it is calling on provincial
and municipal governments to make
restaurant and bar patios smoke-free,
and to be quick about it, according to a
May 25 press release.
“Canadian researchers have assembled
compelling evidence to demonstrate
that laws to keep restaurant patios
smoke-free are necessary to protect the
health of workers and the public,” said
Neil Collishaw, research director at
PSC. “Yet, eight in 10 Canadians live in
a community where such measures are
not in place.”
Four provinces (Newfoundland and
Labrador, Prince Edward Island, Nova
Scotia and Alberta), the Yukon Territory
and several cities in British Columbia,
Ontario and Alberta, as well as other
municipalities across Canada, have
legislation that provides protection
from second-hand smoke on restaurant
patios. Together, these communities
help safeguard 6.8 million Canadians.
Outdoor cigarette smoke is not only
unpleasant, it is harmful to your health.
On the other hand, 24.7 million
Canadians live in areas where no such
protection exists, and PSC, a group of
Canadian physicians whose aim is to
decrease tobacco-caused illness through
the reduction of smoking and exposure
to second-hand smoke, argues that this
needs to change because second-hand
smoke is dangerous.
The compelling evidence
Second-hand smoke is the smoke
smokers exhale and the smoke emitted
from a smouldering cigarette containing
some 4,000 chemicals, over 60 of which
are known to cause cancer. Medical
authorities, such as the World Health
Organization, contend that there is no
safe level of exposure to second-hand
smoke. In 1992, the US Environmental
Protection Agency classified secondhand
smoke as a Class A carcinogen,
the most dangerous category of cancercausing
agents.
Many people mistakenly believe that
there is no health risk from secondhand
smoke outdoors, as the smoke will
simply dissipate into the atmosphere
or blow away. The truth, according to
PSC’s examination of numerous studies,
is that when there is no wind, cigarette
smoke will rise and then fall, saturating
the immediate area with second-hand
smoke. When there is a breeze, cigarette
smoke can travel in multiple directions,
exposing people down-wind. Depending
on various factors such as the number
of smokers and cigarettes smoked, nonsmokers
can be exposed to as much
second-hand smoke in outdoor areas,
like restaurant patios, as they were in
indoor restaurants that allowed smoking
in the past.
Researchers in Victoria, BC monitored
tobacco smoke levels in outdoor
public places where smokers were
present, including restaurant and bar
patios, and sidewalk cafes. Descriptive
statistics including the outdoor smoking
area (OSA) size, percent of OSA
with a roof above, percent of enclosed
wall space, average number of patrons,
average number of burning cigarettes,
Too many Canadian children are still exposed
to their parents tobacco smoke.
and average cigarette proximity were
reported for each venue and averaged
for all venues. The results of the study
entitled Environmental Tobacco Smoke
in Indoor and Outdoor Public Places and
conducted by the BC Provincial Health
Services Authority in 2006 showed
that being close to smokers outdoors
resulted in similar levels of exposure to
smoke as spending the same amount of
time in a smoky tavern, which surpasses
accepted health standards. A comparable
review in 2007 by the Roswell
Park Cancer Institute showed similar
results.
“With as few as three cigarettes being
smoked, the air quality was very similar
on those patios [where smoking was permitted]
to that which used to be found in
indoor premises with no restrictions on
smoking,” said Richard Stanwick, chief
medical health officer with the Vancouver
Island Health Authority.
Outdoor smoking areas at restaurants
and other venues also cause problems
for the people inside. According to
a study conducted by Kennedy, Travers,
Hyland and Fong, smoke drifts indoors
from outdoor places that permit smoking.
The researchers from Waterloo,

tobacco info .ca No. 2, September 2010
PROTECTION OF NON-SMOKERS
7
Ontario conducted experiments on the
effect of as few as eight cigarettes on a
typical restaurant patio that had no roof,
walls, awning or umbrellas. Researchers
repeated the experiments 46 times
under different wind conditions and in
each case found that when cigarettes are
smoked, the air quality in the patio area
falls considerably. The study, entitled
Tobacco Smoke Pollution on Outdoor
Patios, found that measurements of air
particulates, which contain chemicals
that cause cancer and heart disease,
were also four times higher than a nonsmoking
patio.
“We now know that it is not enough
to ban smoking inside restaurants, and
that outdoor spaces must also be kept
smoke-free,” said Neil Collishaw.
These studies are not unique to Canada.
Stanford University researchers,
writing in the May issue of the Journal
of the Air and Waste Management Association,
concluded that a non-smoker
sitting a few feet down-wind from a
smouldering cigarette is likely to be
exposed to substantial levels of contaminated
air for brief periods of time.
A study in Ireland conducted by
Mulcahy, Evans, Hammond, Repace and
Byrne in 2005, and published in the
peer-reviewed journal Tobacco Control
by the British Medical Journal Group,
found that those who worked in bars
with outdoor smoking areas, and were
not otherwise exposed to second-hand
smoke, had much higher blood nicotine
levels than those who worked in bars
without outdoor smoking areas.
Diagnosed with lung cancer caused by
second-hand smoke, hospitality worker
Heather Crowe died in May 2006.
She campaigned vigorously
for non-smokers’ rights.
Progress is never ending
The Canadian Community Health
Survey (CCHS) conducted by Statistics
Canada shows that the number of Canadians
who reported being exposed to
second-hand smoke in public places fell
by half between 2003 and 2009, from
3.99 million (20% of people 12 years
of age or older) reporting past month
exposure in 2003, to 2.26 million (10%)
in 2009.
“Enormous progress has been made
since Victoria, BC became Canada’s first
jurisdiction to ban smoking in bars, restaurants,
bingo halls and other public
areas in 1999,” said Collishaw. “But the
job of protecting workers and the public
is not yet done.”
A study published in Circulation,
Journal of the American Heart Association
in September 2009 by Lightwood
and Glantz pooled the results of approximately
20 different studies in multiple
cities or regions across Europe and
North America. The researchers found
that when legislation was implemented
that banned smoking in workplaces and
other areas, hospital admissions for
heart attacks dropped rapidly, by about
20%, and improved over time.
A team from the Research Institute
for a Tobacco Free Society in Dublin,
Ireland studied environmental tobacco
smoke exposure in the city’s 42 pubs,
and tested 73 bar workers who volunteered
to take part. According to the
study published in the American Journal
of Respiratory and Critical Care Medicine
in 2007, the workplace smoking
ban has improved air quality in pubs,
as well as bar workers’ health, with an
83% reduction in air pollution, an 80%
reduction in cancer-causing agents and
an improvement in the lung function of
bar workers. “These results confirm that
the approach of a total ban on smoking
in the workplace is successful in reducing
the exposure of workers,” said Luke
Clancy, research leader.
PSC’s call for improved protection
of restaurant workers from cigarette
smoke was made last May, on the fourth
anniversary of the death of Heather
Crowe, a non-smoking Ottawa waitress
whose lung cancer was attributed to
exposure to cigarette smoke at work
and who successfully campaigned for
changes to the law to protect hospitality
and other workers from exposure
to smoke.
Almost 7 million Canadians are now protected
from SHS on the patios of bars and restaurants.
“Hospitality workers will continue to
be victimized by laws that allow them
to be exposed to higher levels of cancercausing
chemicals than are permitted by
law for any other sector, until outdoor
workplaces are also smoke-free,” said
Collishaw.
PSC aims to protect youth
Protecting young people from cigarette
smoke in public places is another
motivator for PSC. In a report entitled
Exposure to second-hand smoke in Canada
in 2008, PSC recounts findings from
the CCHS that 16.8% of young Canadians
aged 12-19 report being exposed to
second-hand smoke at home or in public
places, the highest exposure of any
age group.
“Children are almost twice as likely
to report being exposed to second-hand
smoke as the general population,” said
Collishaw. “Because young people’s
bodies are still developing, exposure
to cigarette smoke may be particularly
harmful in those years.”
Collishaw added that researchers
have found many problems with secondhand
smoke and children, including
an increased rate of heart disease and
respiratory failure. In addition, girls
who are exposed to second-hand smoke
during puberty, when their breast tissue
is growing, are at increased risk of early
breast cancer.

8 ENVIRONMENT AND PUBLIC HEALTH
tobacco info .ca No. 2, September 2010
City of Ottawa kicks off campaign exposing
health risks of second-hand smoke
Smoking outdoors pollutes your lungs and the environment
Ottawa Public Health has launched
a campaign to highlight the adverse effects
of second-hand smoke in public
spaces.
The city started the campaign on July
23 in response to concerns raised by
residents, and is the latest municipality
to delve into the outdoor second-hand
smoke (SHS) discussion.
“Exposure to SHS outdoors can be as
dangerous as it is indoors,” says a posting
on the public health website.
The trend of restricting smoking
in select outdoor areas is growing in
Canada, where 31 municipalities have
implemented some form of outdoor
smoking regulation, including large cities
like Toronto, Halifax and Vancouver,
where the Vancouver Park Board has
voted unanimously to ban smoking in
more than 200 city parks and on all city
beaches effective September 1. Other
municipalities have also taken action,
including Collingwood and New Tecumseh,
Ontario, banning smoking in or near
playgrounds; St. Albert, Alberta, on the
If you or your organization is
interested in becoming involved
in the Ottawa campaign,
please call the Ottawa Council on
Smoking and Health
at 613 580-2889 or write
to info@smokefreeottawa.com.
Several Canadian cities
have banned smoking in parks.
grounds of an outdoor public event;
Moncton, New Brunswick, and Stratford,
PEI, at municipal sports fields.
Ottawa Public Health is encouraging
people to get up and leave the area
when possibly exposed to second-hand
smoke.
“They shouldn’t sit there and breathe
in the second-hand smoke because
they are potentially doing damage to
themselves,” said Krista Oswald, the
supervisor of the city’s tobacco control
program. “We have the research that
says, yes, it is affecting people, it can
cause adverse health effects.”
That research is based on air quality
tests done on patios in Vancouver and
in the United States, Oswald said. (See
Outdoor tobacco smoke exposure studies
next page.)
The Canadian Cancer Society (CCS)
has long championed smoke-free outdoor
spaces, such as parks and playgrounds.
“Outdoor smoking results in
outdoor tobacco smoke, which poses the
same health risks as second-hand tobacco
smoke indoors,” wrote the CCS on
its website. “In particular, the Society is
concerned about children being exposed
to adult smoking behaviour in youthfriendly
areas like playgrounds. Not
only does adult smoking teach children
that smoking is acceptable, it exposes
them unnecessarily to the health risks
of second-hand smoke.”
The Ontario Tobacco Research Unit
estimates that second-hand smoke causes
the deaths of at least 1,000 Canadians
every year, and could be responsible for
as many as 7,800 deaths.
Smoking
and forest fires
Careless cigarette use is often
the cause of forest fires. Between
1996 and 2005, fires ignited
by smoking-related materials
accounted for 6% of all fires in
Alberta alone.
A cigarette-caused fire is
responsible for one of the largest
forest fires in Canadian history,
which was started by a discarded
cigarette in BC in 2003. Some 70
plus homes and tens of thousands
of hectares of forest were
destroyed in the Kamloops area.
In 2002 in Lake Tahoe, California,
a cigarette tossed from the
cabin of a gondola carrying riders to the top of the mountain started a fire that
burned 672 acres of forest. In 2007, a fire in the Kula Forest Reserve, in Hawaii,
burned for seven days and destroyed close to 2,300 acres of land. The fire was
traced to a cigarette butt, which had been improperly disposed of. In 2009, a discarded
cigarette ignited a wildfire in Texas, burning over 400 acres.
The estimated economic cost of fighting wildfires includes losses incurred from
extinguishing a fire, (human resources, ground and air support) and losses to the
forestry industry as well as to an already shrinking wildlife habitat. According to
a report released by the Canadian Council for Tobacco Control in lieu of 2009’s
National Non-Smoking Week, the cost of forest fires due to smoking in Canada was
$26 million in 2002.

tobacco info .ca No. 2, September 2010
ENVIRONMENT AND PUBLIC HEALTH
9
Outdoor smoking not green
“Outdoor smoking also has a negative
impact on the environment with
respect to smoking-related litter and it is
a source of fire in our provincial parks,”
wrote the CCS.
According to statistics compiled
by the CCS, over 4.5 trillion cigarettes
are littered worldwide each year and
are the most littered item in the world.
The Great Canadian Shore Cleanup
reports that in 2009, 37.8% of all litter
collected was tobacco-related. In total,
over 407,000 tobacco-related items were
picked up across Canada, up from 2008.
Cigarette filters (butts), cigar tips and
tobacco packaging all made the top 12
list of most littered items, with filters
topping the list at number one.
Composed of cellulose acetate, cigarette
butts are not biodegradable; they
only break down into smaller components,
making them an increasing and
ongoing threat to the health and natural
beauty of Canadian parks and beaches
and resident wildlife.
Restricting outdoor smoking would
reduce litter and pollution from discarded
cigarette butts. According to a
2004 report compiled by Nova Scotia
Capital Health, 58% of Minnesota park
directors in cities with smoke-free
policies reported cleaner park areas.
Discarded cigarettes pollute land and
water, while toxic butts can be eaten by
pets, birds, fish or even toddlers.
In 2009, the US Center for Disease
Control studied 146 children aged six
months to two years who had ingested
cigarette butts, and found that a third
of children who ingested cigarettes or
cigarette butts developed symptoms
including spontaneous vomiting (in 87%
of cases), as well as nausea, lethargy,
gagging and a pale or flushed appearance.
– by Joe Strizzi
Cigarette butts are the most
littered item in the world.
Outdoor tobacco smoke
exposure studies
James Repace’s Benefits of smoke-free regulations in outdoor
settings in 2006 reported that tobacco smoke contains at least
172 toxic substances, including three regulated outdoor air
pollutants, 33 hazardous air pollutants, 47 chemicals restricted
as hazardous waste and 67 known human or animal carcinogens.
The smoke from a single cigarette can be detected between
7-10 metres (23-33 feet approximately) away, depending on
environmental conditions like wind direction and speed. As a
result, second-hand smoke can easily travel and affect people
on a beach, park or playground, where that distance would be
easily encompassed.
Repace’s study also found
that the proximity to an
outdoor tobacco source
does affect your exposure to
second-hand smoke, where
air pollution levels were near
those of indoor exposure.
The California Air Resources
Board (CARB), in 2006, measured
the nicotine concentrations
in outdoor tobacco
smoke outside an airport,
college, government centre,
office complex and amusement
park. CARB found that
at these typical outdoor locations,
people may be exposed
to levels of outdoor tobacco
smoke as high as those of
indoor second-hand smoke.
Studies show that children are particularly susceptible
to the effects of second-hand smoke.
Klepeis, Ott and Switzer measured outdoor tobacco smoke
respirable particle concentrations in outdoor patios, on
airport and city sidewalks and in parks. They also conducted
controlled experiments of indoor and outdoor second-hand
smoke. Their report, entitled Real-time measurement of outdoor
tobacco smoke particles published in the Journal of the Air
and Waste Management Association in 2007, found that mean
second-hand smoke particle concentrations outdoors can be
comparable to second-hand smoke indoors.
A California health hazards study entitled Health effects of
exposure to environmental tobacco smoke: Final Report found
that children are particularly susceptible to the effects of
second-hand smoke due to their higher breathing rates per
body weight, their greater lung surface area relative to adults
and the comparative immaturity
of their lungs. Infants and
children are also generally
unable to control their environment,
and therefore cannot
take steps to avoid exposure to
second-hand smoke. As a result,
children inhale a greater percentage
of toxins than adults.
For these reasons, Nova Scotia
Capital Health believes it is particularly
important to prohibit
smoking in outdoor locations
where children congregate. In
addition, adult smoking in view
of children may send them the
message that smoking is associated
with enjoyable outdoor
activities since bans are now in
place at many indoor facilities.

10 ACTIVISM
tobacco info .ca No. 2, September 2010
Journey for a Tobacco-Free
World hit a few potholes
But cross-country runner is back on track
A journey of any kind comes with
bumps along the road, so it’s no surprise
that Errol Povah, the 57-year-old BC antitobacco
activist who is running across
Canada in order to raise awareness, hit
his first snag that actually landed him in
hospital.
“I was forced to take a break and went
to Mineral Springs Hospital in Banff [on
June 25],” said Povah. “The problem was
an infection in my lower right leg. The
doctor, who was quite aware of what I’m
doing, advised me to take a few extra days
Pictures from www.tobaccofreeworld.ca
off, but I was back on the road, getting
back into it gently. On July 1, I did 10km,
July 2, 20km, July 3, 30km, and July 4, I did
the full 42km, and have continued to do
that ever since, with no problems whatsoever.”
The Journey for a Tobacco-Free World,
a ‘first of its kind’ 6,300km run, walk or
crawl from Victoria to Montreal, began
on May 31, 2010, as part of the World
Health Organization’s (WHO) 23rd annual
World No Tobacco Day festivities. At
the estimated rate of 42km per day, six
days a week, the cross country, shore-toshore
trek is expected to take about six
months.
Time, energy and resources permitting,
the Journey will then head south
from Montreal to New York City. These
two destination cities were chosen specifically
because they are home to the
head offices of Canadian and American
tobacco companies, where large antitobacco
protests will be held to coincide
with the Journey for a Tobacco- Free
World’s arrival.
“Approximately 123 Canadians die
prematurely, and by an average of 10–15
years, each and every day as a direct result
of tobacco use. For the tobacco industry
to stay in business, at least 123 Canadian
kids have to start smoking, each and every
day,” said the 30-year anti-tobacco activist.
Povah, the current president of
Airspace Action on Smoking and Health
(AASH), Canada’s all-volunteer anti-tobacco
organization, has traveled all over
the world at his own expense to attend
international anti-tobacco conferences
and to protest tobacco industry conventions.
He said that he hopes to raise awareness
about tobacco, which is “largely
forgotten, and replaced by other social
concerns such as obesity,” the tobacco
industry, the anti-tobacco movement, as
well as help raise funds to “ramp up the
war on tobacco.”
“Globally, society is losing the war on
tobacco, big time. Forty-six years after the
first US Surgeon-General’s Report on the
hazards of smoking, one would expect
the death toll to be dropping fast and
nearing zero. But tobacco continues to be
the leading and most easily and cheaply
preventable cause of disease, disability
and premature death in Western society,”
Povah said.
Aside from opening eyes across Canada,
Povah is hoping to raise $540,000
during his campaign. A total of 30% of
the funds raised will be divided equally
among BC Children’s Hospital Foundation,
Variety Children’s Charity and
Toronto’s SickKids Hospital Foundation.
The remaining 70% of the funds raised
by the Journey will be used by AASH
to continue and accelerate its advocacy
work. To date, AASH has survived
exclusively on membership fees and
donations. As of mid-June, Povah has
collected over $4,000.
“Thanks primarily to Big Tobacco’s aggressive
and virtually unfettered marketing
and advertising campaigns – most
notably in developing nations and as
always, despite the industry’s vehement
denials, targeting teens and even pre-teens
– the WHO is predicting that unless drastic
action is taken, the death toll from tobacco
will actually double over the next 10 years.”
Povah and his team hope their efforts
will sufficiently inspire and motivate
everyone, but especially politicians at
all levels of government and all other
policy-makers, police and bylaw enforcement
officers, and others to “take off the
kid gloves when dealing with the tobacco
industry and its wide range of addictive
and deadly products, do the right thing
and tackle this issue with the very long,
overdue, aggressive and effective action it
deserves.”
Povah encourages others to join him
and his support crew along the way. In
fact, he hopes to have busloads of tobacco
industry targets – high school and
even elementary school-aged kids – join
the Journey, as he plans to personally
deliver a message to Ian Muir, the newly
appointed president and CEO of Imperial
Tobacco, Canada’s largest cigarette
manufacturer (Player’s and du Maurier).
So, despite a setback only a month
into his journey, Povah vowed to keep
on trucking because he says everyone
has been touched in some way by
tobacco-related disease.
“Everybody has a tobacco story and
none of them have a happy ending,” he
said.
– by Joe Strizzi

tobacco info .ca No. 2, September 2010
AWARDS
11
Tobacco control health heroes honoured
The Canadian Public Health Association
(CPHA) honoured three members of
the tobacco control community for their
long-standing and relentless contributions
to public health.
In Toronto, on June 15, during the
Dinner Gala of the CPHA’s Centennial
Conference, Rob Cunningham, senior
policy analyst with the Canadian Cancer
Society, Louis Gauvin, former head
of the Quebec Coalition for Tobacco
Control, and Garfield Mahood, executive
director of the Non-Smokers’ Rights
Association, were honoured with a National
Public Health Hero Award.
Rob Cunningham
Cunningham, a lawyer by profession,
was born and raised in Ottawa and has
degrees in political science (BA, University
of Western Ontario), law (LLB, University
of Toronto) and business (MBA,
University of Western Ontario).
He first became active in tobacco
issues in 1988-90, while in university,
when he became the founding president
of the Student Movement Aimed at Restricting
Tobacco.
Rob Cunningham has worked as a
consultant for provincial, national and
international health organizations including
the World Health Organization.
His regular email bulletins to those
working in tobacco control have become
legendary, and he has become a
recognized expert in the field of tobacco
control.
As one of the core group of Canadian
activists fighting for tobacco control,
Rob Cunningham
Cunningham has testified before parliamentary
committees, given hundreds of
media interviews in Canada and abroad,
published numerous tobacco-related
articles and initiated private prosecutions
for violations of tobacco-control
laws.
He is the author of Smoke & Mirrors:
The Canadian Tobacco War, which has
been a top seller among the International
Development Research Centre’s publications
and is a regular and popular
presenter at national and international
health conferences.
Louis Gauvin
Louis Gauvin
For over 20 years, Louis Gauvin
has been working to help society cut
down on tobacco use. As part of his
job with the Public Health Department
of Montérégie, outside Montreal, he
helped smokers quit, set up prevention
programs in schools and acted as a
consultant for businesses implementing
policies on tobacco use.
In 1996, the Association pour la santé
publique du Québec (ASPQ) created the
Quebec Coalition for Tobacco Control,
an initiative spearheaded by Gauvin and
Heidi Rathjen following a drastic cut in
cigarette taxes. Launched officially in
June 1996 and sponsored by the ASPQ,
the Coalition now includes thousands
of health care organizations and professionals
from all areas of Quebec.
For 14 years, until he retired in September
2009, Gauvin acted as spokesperson
for the Coalition, representing
the Quebec anti-tobacco movement in a
dignified, calm and reasoned – at times
even humorous – manner.
Gauvin’s vision and determination
have contributed to prolonging lives
and improving the quality of life of
thousands of Quebecers.
Garfield Mahood
Garfield (Gar) Mahood began his
professional career in sales, winning
numerous national sales awards. During
this time, he started taking a serious
interest in public issues. In the late
1960s, Mahood decided to work professionally
on public issues and returned
to university to study political science,
sociology and social change.
Upon graduation from York University,
he assumed the position of
executive director of the Canadian
Environmental Law Association. Three
years later, in 1975, he joined the Non-
Smokers’ Rights Association (NSRA).
Since then, he has built the NSRA into
one of the leading tobacco control organizations
in the world. He has given
countless presentations in Canada and
internationally, including addressing
eight world conferences on tobacco control,
and has participated in numerous
international strategy sessions.
Mahood was a member of the editorial
advisory board of Tobacco Control,
published by the British Medical Journal,
for many years. He is also the author of
an expert report on labelling and packaging
prepared for the World Health
Organization in 2003.
– by Joe Strizzi
written with files from the CPHA
Garfield Mahood

12 INDUSTRY
tobacco info .ca No. 2, September 2010
Marketing of tobacco products
The Australian government wants
plain cigarette packages starting 2012
PIERRE CROTEAU
By July 1, 2012, the packaging of tobacco products sold
in Australia will be required without logotypes, brand
images, distinctive colours or advertising copy, other than
the name of the product and the brand written in the same
place on the packaging, in letters of standard size, style and
colour, this according to an announcement by Australia’s
Labor Party government on April 29.
If this project is realized, Australia will become the first
country in the world to bring into effect a guideline of the
World Health Organization Framework Convention for Tobacco
Control (FCTC) that prescribes plain packaging for tobacco
products. The FCTC is an international treaty ratified by 167
countries, including Canada and Australia, as well as the
European Community. The Australian Minister for Health and
Aging, Nicola Roxon, says plain packaging will remove one
of the last frontiers for cigarette advertising.
The Labor government, led by Julia Gillard who succeeded
former Prime Minister Kevin Rudd on June 24, also proposes
to enlarge the pictorial health warnings that the law requires
affixed to the packaging of tobacco products. Since March
2006, the warnings cover 30-90% of the two main surfaces
of a cigarette package, and the seven illustrations that shock
are to be renewed every 12 months.
The Australian Parliament also voted on April 29 for a
25% increase in the excise tax on tobacco, the first increase
greater than inflation in 10 years, and the government
wants to allocate the entire tax revenue from tobacco to the
improvement of public health and hospital services. Among
the expenditures for the four coming years will be the increase
in advertising to encourage the population, particularly pregnant
women and the poor, to give up smoking.
Tobacco companies can advertise in magazines targeting
convenience store managers. These recent Canadian ads describe
the significance of the packaging for smokers and for the industry.
The prevalence of smoking in the Australian population
has been in steady decline since 1998. In 2007, 16.6% of
Australians 14 years and older smoked compared to 22% of
Canadians 12 years and older in the same year, according to
the Canadian Community Health Survey.
Reactions and justifications
Australian sociologist Simon Chapman
was editor of Tobacco Control in 2008,
when a feature was published entitled
“Plain packaging: which country will
lead the world?”
Australian cigarette manufacturers wasted no time in
threatening to fight the law in court. “Introducing plain
packaging just takes away the ability of a consumer to identify
our brand from another one – and that’s of value to us,”
stated a spokeswoman at Imperial Tobacco Australia on
Australian state radio (ABC). About 98% of cigarettes legally
sold in Australia are sold through the subsidiaries of Philip
Morris International, British American Tobacco and Imperial
Tobacco, three of the four multinationals that dominate the
world market outside of China.
Meanwhile, sociologist Simon Chapman, professor at the
University of Sydney’s School of Public Health, stated to the
daily newspaper The Age, “There’s ample evidence that if
you blindfold smokers, they can’t even tell their own brand.”
Professor Chapman was an advisor to the National Preventive
Health Taskforce that recommended to the Australian government
to move forward with the requirement of plain packaging.
Additionally, he is the former editor of Tobacco Control,
a top scientific journal that has published several research
papers showing the influence of brand colours and images
on smokers’ perception of product risk and “quality.”
Researchers from various countries examined 40 million
pages of internal documents that the cigarette manufacturers
had to make public after legal proceedings in Minnesota in
1998. They found evidence of an experiment conducted for
industry use, which revealed findings that smokers who were
offered cigarettes from different cigarette packages thought
they could distinguish the tastes, while all along, unbeknownst
to them, they were smoking the same cigarettes.

tobacco info .ca No. 2, September 2010 13
INDUSTRY
In an article that appeared in the Journal
of Adolescent Health in April, three
researchers, under the direction of psychologist
Melanie Wakefield of the University
of Melbourne, concluded that the removal
of the distinctive elements of a brand, such
as the colour and the graphics, changed the
perceptions of the tobacco “experimenters”
and of non-smokers, and not just of
regular smokers. Wakefield, Durkin and
Germain noted that adolescents perceived
a plain cigarette package as less attractive,
that a plain cigarette package lent fewer
positive attributes to the typical smoker.
Furthermore, they were more apprehensive
about the taste of the product than when
the cigarette was presented in the way the
manufacturers currently present it.
In a country like Australia, where folks
are pleased to say that half of all housing
is less than 12 kilometres from an ocean
beach, the third most popular brand, Longbeach,
has graphics evoking the beach; a
clear form of lifestyle advertising.
Director of Cancer Council Australia, Dr. Ian Olver,
believes that the illustrated health warnings on cigarette
packaging will attract greater attention in the absence of
diversionary elements.
The big bluff
The Australian subsidiaries of the cigarette multinationals
asserted that a ban on the use of logotypes and other brand
images on the packaging of tobacco products would be a
violation of their intellectual property rights, protected by
the Paris Convention for the Protection of Industrial Property.
Almost every time a government has considered compelling
the tobacco companies to sell their products in plain cigarette
packages, as occurred in Canada in 1994, the argument that
the state would be forced to buy back the trademarks was one
of the main influences used in the campaign of intimidation
and misinformation by the tobacco cartel.
The Paris Convention, however, contains nothing to
prevent the state as a contracting party, such as Canada or
Australia, from banning or limiting the use of a registered
trademark.
The Canadian industry is constantly introducing
new designs and formats of tobacco products.
This sample of plain packaging was
proposed by Cancer Council Australia.
In substance, this is how the World
Intellectual Property Organization
(WIPO) of Geneva responded on July
5, 1994, to a British American Tobacco
lawyer who, in the name of a committee
of which executives of several large cigarette
manufacturers were seated, asked
if a law compelling plain packaging
would violate the international law on
trademarks. On August 5, Ralph Oman,
a former U.S. Register of Copyrights,
submitted to the WIPO the legal opinion
of Carla Hills, the American negotiator
of the North America Free Trade Agreement,
and provided to a committee of
the Canadian House of Commons that
plain packaging would violate the industrial
property rights of the tobacco
companies. On August 31, the WIPO
reiterated its July 4 position: the Paris
Convention offered no grounds to contest
before a court of law the right of a
state as a contracting party to impose
plain packaging.
The long-standing collusion of the large tobacco companies
in this matter, their weak position coolly concealed following
the response of the WIPO in 1994, and their systematic
attempt to misinform the legislatures of several countries are
now known, thanks to the work initiated in 1998 by virtue
of the out-of-court settlement arrived at in Minnesota that
year.
The enormous bluff by the cigarette manufacturers is
brilliantly reported and all their traditional arguments are
countered by Physicians for a Smoke-Free Canada (PSC) and
the Non-Smokers’ Rights Association (NSRA) in submissions
filed with the Australian Senate, where a private bill has been
under examination since August 2009. The Labor government
has decided to make the bill its own this year.
In the land up over
The Canadian Medical Association in 1987, followed in
1988 by the National Council on Tobacco or Health (now called
the Canadian Council for Tobacco Control) and the NSRA,
asked Ottawa for a law imposing plain packaging for tobacco
products. The announcement of the Australian government’s
plan provided the NSRA and PSC with another opportunity
to bring the concept to light by issuing a joint communiqué
in April of this year.
Since the beginning of the 21st century, in the Canadian
market among others, cigarette manufacturers have attempted
to change the traditional appearance of their product
packaging. Not only the graphics, but also the size and format
of the cigarette packages, and even the way they open and
the texture of the cardboard, have been transformed.
To fully neutralize the marketing of cigarettes in Canada,
the degree of standardization of cigarette packaging should
go a little further than that discussed in the Australian Parliament.
The NSRA and PSC are calling on the federal government
to move quickly and require that all tobacco products
in Canada be sold in standardized packages.

14 CONFERENCE ON CESSATION
tobacco info .ca No. 2, September 2010
Doctor recommends NRT
use during pregnancy
“I’m comfortable telling my patients
to put a [nicotine] patch on or get some
[nicotine] gum,” said Dr. Greg Davies,
professor and chair of the Division
of Maternal-Fetal Medicine at Queen’s
University in Kingston, Ontario. “However,
it is totally off label right now. It’s
just a matter of time before there is a
consensus as to the benefits of medicinal
nicotine (NRT) versus the risks.”
As part of his presentation at the
Second Annual Ottawa Conference on
State of the Art Clinical Approaches to
Smoking Cessation in January, Davies
suggested that medicinal nicotine is
much less harmful than smoking cigarettes,
and thus should be made readily
available to women during pregnancy.
Concerns about using Nicotine
Replacement Therapy (NRT) during
pregnancy stem from the observed teratogenicity
of nicotine itself, and whether
there is a correlation between NRT and
congenital anomalies, such as oral facial
clefts or limb reductions. However,
Davies suggests that there is no concrete
evidence of a causal relationship, and if
there is one, its risks would be minimal
when compared to the risks associated
with smoking.
Although this idea may be off the
grid, Davies is not alone in his advocacy
of NRT.
The Ontario Medical Association
(OMA) published a position paper in
1999 suggesting that stop smoking
Overcautious package directions discourage
the use of NRT by pregnant women.
therapies should be used by pregnant
women if they are unable to quit on
their own, and affirmed that the nicotine
patch and gum are safer than smoking
for the pregnant woman and her fetus.
However, in a 2008 report, they reaffirmed
that there is no real safe dose
of nicotine for a fetus.
Meanwhile, in 2008, Health Canada,
which had historically advised against
the use of medicinal nicotine for pregnant
women, softened its stance after
examining reports conducted by Neil
Benowitz et al. in 2000, and by Benowitz
with Dalia Dempsey in 2001, whose
findings encouraged the use of nicotine
replacement therapies for women who
“are unable to quit smoking during pregnancy
after 12 weeks gestation to reduce
damage caused by inhaled smoke to both
the mother and the fetus.”
According to the Canadian Tobacco
Use Monitoring Survey (CTUMS) released
by Statistics Canada in 2008, approximately
8.8% of Canadian women had
smoked while pregnant within the previous
five years. It is as high as 22% in
the 20-24 age range.
Increased risks
associated with smoking
Studies examined and collected by
Davies, and showcased as part of his
presentation entitled Smoking Cessation
Strategies in Pregnancy at the Ottawa
conference, demonstrated a two-fold
risk of miscarriage, childhood obesity,
stillbirths and ectopic pregnancies for
women who smoke and a three-fold
risk of developing placenta previa or
having a child with attention deficit
hyperactivity disorder (ADHD). There
can be, according to Davies, a risk of up
to eight times higher for sudden infant
death syndrome (SIDS) in babies whose
mother smoked during pregnancy.
Preterm births for babies born to
mothers who smoke or are exposed to
second-hand smoke are more common,
and these babies weigh in at 250 g less
than babies born to non-smokers; and
can be up to 350 g smaller if the mother
smokes more than 20 cigarettes a day.
Increased risks of placental complications,
neurobehavioral effects and
transplacental carcinogenesis are also
more common with smoking-related
pregnancies.
Benefits of NRT
“NRT avoids high nicotine levels, as
well as the 4,000 other detrimental compounds
found in cigarettes, so to me, the
benefits are very clear,” said Davies.
According to Davies’ research, these
increased risks diminish considerably
if the woman quits smoking within the
first trimester.
Using national data, Dr. Katrine
Strandberg-Larsen and colleagues from
the University of Southern Denmark in
Copenhagen gathered information on
NRT use and smoking for 87,032 singleton
pregnancies. Two percent of women
reported using nicotine replacement
during pregnancy. Of these women, 14%
had not smoked during pregnancy, 30%
had quit smoking during pregnancy and
56% continued to smoke.
The study found that of the 87,032
pregnancies, there were 495 stillbirths,
only eight of which were among the
group of NRT users. Those women who
did use NRT had a 43% lower risk of
stillbirth after accounting for other risk
factors. Even for women who continued
to smoke while using NRT to quit or
cut down, the risk was reduced by 17%
compared to non-users.
By comparison, smokers who did not
use NRT during pregnancy had a 46%
higher risk of having a stillbirth.
“Ultimately, the best advice for pregnant
women is to quit altogether, but if
they are unable to [beat their nicotine
addiction], then I’d recommend using
NRT,” said Davies.
– by Joe Strizzi
Nationally, one in 11
women smokes during pregnancy.

tobacco info .ca No. 2, September 2010
BRIEFS
15
Research update by OTRU
The Ontario Tobacco Research Unit
(OTRU) is an Ontario-based research
network that is recognized as a Canadian
leader in tobacco control research,
monitoring and evaluation, teaching
and training and as a respected source
of science-based information on tobacco
control. In each issue of Tobacco Info,
OTRU will write a review of the latest
groundbreaking tobacco studies around
the world. More information can be
found on www.otru.org.
Framework Convention
on Tobacco Control
The American Journal of Public
Health published a feature issue on
tobacco including a focus on systems
theory and tobacco. Marcus and colleagues
found that NGO participation
in the Framework Convention Alliance
and membership in GLOBALink, a tobacco
control online community, were
predictors of early ratification of the
Framework Convention. In the Journal
of Public Health Policy, Blouin and Dubé
of Carleton University also applied the
lessons of the Framework Convention on
Tobacco Control to diet-related chronic
disease, and suggest that a global policy
response is necessary to deal with the
multinational actors and interests in
obesity prevention.
Smokeless tobacco
In Tobacco Control, Mejia, Ling
and Glantz use a simulation model to
explain the potential health impact of
smokeless tobacco promotion as part of
harm reduction strategy in the US. They
conclude that it is very unlikely that
smokeless tobacco promotion would
have any significant health impact, but
that it would not result in overall health
benefits at the population level.
Hardcore smokers
Michelle Costa and colleagues report,
in Nicotine and Tobacco Research, that
the prevalence of “hardcore” smokers
represents between 0 and 13% of the
population of Ontario, depending on
how hardcore is defined. Few smokers
are both highly nicotine dependent and
have no intention to quit. In Addiction,
Gundle, Dingel and Koenig examine
tobacco industry documents to suggest
that the industry supported genetic research
into nicotine addiction, with the
hope to relieve industry responsibility
for tobacco-related disease. They suggest
that the tobacco industry will look
into using genetic research to define
“safe smokers.”
Smoking in psychiatric
institutes
Canadian researchers make the case
for excluding tobacco use from psychiatric
institutions in the Journal of Addiction
Psychiatry, suggesting that, for too
long, tobacco has been accommodated,
despite its toll as the leading cause of
death among people with psychiatric
and substance use disorders. They call
for more hospitals to join Toronto’s
Centre for Addiction and Mental Health
in going smoke-free. In Australia, Wye,
in the Journal of Psychiatric Mental
Health Nursing, found that many nurse
managers are still reluctant to provide
nicotine dependence treatment to smokers
in psychiatric settings. Hajek, Taylor
and McRobbie suggest, in Addiction, that
not treating smoking can be detrimental
and that smoking may overall generate
or aggravate negative emotional states.
They examined the longitudinal changes
in stress levels of participants in a stop
smoking trial after quitting smoking,
and found that quitters recorded a significantly
larger decrease in stress than
those who continued smoking.
Second-hand smoke
Pam Kaufman and co-authors from
the Ontario Tobacco Research Unit, in
the journal Health and Place, identify
factors that influence where people
smoke outdoors, and the impact of
smoking on people who use outdoor
public places. Through direct observation
and semi-structured interviews,
they found that 37% of smoking at the
various sites observed was within nine
metres of an entrance, and that nonsmokers
found the smoking to be problematic.
Other factors related to outdoor
smoking locations include shelter, convenience,
the social culture of smoking,
visibility and the presence of non-smokers.
Good news on second-hand smoke
came from a report in Pediatrics which
showed that fewer kids are being exposed
to smoke in the home. Singh and
colleagues reported that, overall, about
5.5 million American children, or 7.6%,
were exposed to second-hand smoke in
the home in 2007, down from 35% in
1994. Winickoff, Gottlieb and Mello, in
the New England Journal of Medicine,
also called for regulation of smoking in
public housing in order to protect more
children from second-hand smoke.
– by Michael Chaiton

16 BRIEFS
Smoke-free cars
in Manitoba
Provincial legislation prohibiting
smoking in vehicles carrying children
under the age of 16 was proclaimed to
come into force on July 15, 2010, under
the Highway Traffic Amendment Act, and
carries a fine of $200 in Manitoba. Eight
provinces and territories have adopted
legislation to prohibit smoking in vehicles
carrying children: BC, Saskatchewan,
Manitoba, Ontario, New Brunswick, Nova
Scotia, PEI and the Yukon. (Saskatchewan’s
legislation is not yet in effect.)
Saskatchewan
amends tobacco tax
In Saskatchewan, the Tobacco Tax
Amendment Regulations 2010, were approved
June 24, and came into force on
June 25. The new regulations include
a limit on the quantity of tax-exempt
tobacco that a status native (tax exempt
purchaser) may purchase per week of 200
units (a unit is one cigarette, one tobacco
stick, one cigar/cigarillo, one gram of loose
tobacco). There is a limit on a status native
possessing more than 800 units of taxexempt
tobacco at any one time. All onreserve
retailers selling tobacco products
are required to register with the provincial
government. Duty-free stores are also
required to register with the province.
Smoking
in federal jails
On June 21, three judges of the Federal
Court of Appeal (FCA) unanimously set
aside a judgment by the Federal Court on
the authority of the Correctional Service of
tobacco info .ca No. 2, September BRÈVES 2010
Canada (CSC) to ban smoking indoors and
outdoors within the perimeter of federal
correctional facilities. On October 23, the
Federal Court judge had declared the Directive
no. 259 issued by the Commissioner
of the CSC null and void, a directive aimed
at protecting the health of non-smokers
among inmates, CSC staff, volunteers and
visitors. Now, the FCA states the judge
of the Federal Court ought not to have
intervened.
The federal prisons in Canada are
totally smoke-free since June 2008, more
than two years after a rule was enforced
allowing the possession of tobacco by
inmates and smoking in outdoor spaces.
The Commissioner of the CSC had then
concluded such a rule was hard to apply
seeing “intensive monitoring is required
to ensure that inmates do not smuggle or
steal cigarettes when they access their lock
boxes and that effective monitoring is almost
impossible when dealing with a large,
open population.” While recording a lot of
smoking-related disciplinary charges with
the former rule, the CSC had also noticed
“exposure to second-hand smoke within
institutions would not be eliminated.”
Alberta government
wins award
A coalition of prominent health organizations
presented the Alberta government
with a Tobacco Reduction Achievement
Award for its role in contributing
to three consecutive years of reduced
tobacco consumption in July. New data
released by Alberta Finance has revealed
that Albertans have smoked one billion
fewer cigarettes since 2007. The consistent
three-year reduction points to a strong
cause-and-effect relationship between
effective tobacco control policies and
consumption.
Smoking will remain prohibited in the
perimeter of federal correctional facilities.
Tobacco Info is published
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514 525-7021, jbrown (a) tobaccoinfo.ca
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