The health evidence which encouraged those addicted to tobacco to quit in large numbers began to emerge in the 1960s.
Tobacco industry products have no safe level of use and are highly addictive. They are also the only consumer products that kill when used as intended by those who make them, and kill half of their long-term users prematurely.
No other industry’s products have caused anywhere close to the number of deaths and cases of disease resulting from tobacco addiction—more than 13,000 annually in Ontario alone.
Ontario Medical Review • April 2010 1 severity of addiction of individuals in the 1960s to the 1980s, it is clear that large numbers quit with or without the benefit of legislation, high taxes, or cessation programs.
Beginning in the early 1990s, Ontario governments implemented increasingly comprehensive legislative, programmatic, and financial responses to tobacco addiction. Sales to youth under 19 were prohibited. Workplaces and public places were made smoke-free (a policy extended to vehicles transporting children under 16 in 2009). Retail tobacco advertising and displays were prohibited. In order to reduce addiction initiation,media and programinitiatives intensified targetedmessages to young people. Following the 1994 federal and provincial tobacco tax reductions in response to the smuggling crisis, provincial tobacco tax levels began to climb again. (Ontario’s stalled in 2006 as a result of the proliferation of contraband tobacco, discussion of which follows below.) These advances have led some in themedia and the government to ask whether tobacco control is in fact “done.” Others ask whether tobacco addiction should be categorized as simply one among many other chronic diseases and associated risk factors, such as hypertension, diabetes, physical inactivity, and alcohol and drug abuse.
The absolute number of Ontario smokers today—about 2.1 million — is a much smaller proportion of the population compared to past decades, but still remains relatively high. Some have asked if this can be due to recent immigration to the province from jurisdictions where smoking prevalence is high. In fact, recent survey research data show that:
• The large majority of Ontario smokers speak English at home (1.8million);
• Are white (1.6million);
• Are born in Canada (1.6million);
• Learned and understood English as their first language (1.5 million).
Despite high incidence of addiction in their countries of origin, the same survey found that 9% of South Asian Canadians, and 10% of Chinese Canadians, reported smoking behaviour levels of prevalence that are considerably below the general population average. The picture is different for Ontario’s aboriginals, whomake up 5%(or 106,500) of all Ontario smokers, with a 40% smoking prevalence rate. There are also signs that the impact of efforts tominimize tobacco’s effect on Ontario society may have begun to weaken.
Unlicensed cigarettemanufacturers in Ontario,Quebec, and New York State are distributing illegal cigarettes across Ontario, and have taken up an increasing share of the tobacco market. By 2009, between one in five and one in two cigarettes smoked in Ontario were classified as contraband.
Contraband also fosters an atmosphere of lawlessness and disrespect for authority in many communities where the trade flourishes. Finally, it undermines existing tobacco control programs and legislation. Contraband tobacco is much cheaper than licensed tobacco, is free of government taxes, warnings, and many retail restrictions. The cheapest and most prevalent form of contraband is clear plastic bags of 200 cigarettes. These are manufactured and packaged in a half dozen locations in Ontario, Quebec, and northern New York State
Ontario’s response to the tobacco problemtoday can thus be characterized both by success and the significant challenges that still must be addressed. Physicians face a similar duality: progress in the evolution of treatments and patient outcomes, but challenges with respect to treatment complexity and resources, as will be described in the next section. The simple fact is that there are still far toomany Ontarians suffering from entirely preventable tobaccoinduced illnesses.