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Proceedings of the Standing Senate Committee on
Energy, the Environment and Natural Resources

Issue 3 - Evidence, April 24, 2001 (afternoon)

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CALGARY, Tuesday, April 24, 2001

The Standing Senate Committee on Energy, the Environment and Natural Resources, to which was referred Bill S-15, to enable and assist the Canadian tobacco industry in attaining its objective of preventing the use of tobacco products by young persons in Canada, met this day at 1:33 p.m. to give consideration to the bill.

Senator Nicholas W. Taylor (Chairman) in the Chair.

The Chairman: Honourable senators, our meeting this afternoon in Calgary is a continuation of hearings held yesterday in Vancouver. Over the next few days we will be hearing from Canadians in Edmonton, Toronto, Montreal. Our goal is to allow us to get a sense of views that Canadians have on issues to the Bill. The hearing is built on previous work that Senate committees have done on the subject of youth and tobacco use.

Once the committee decides it has received all the necessary information, it will go through the bill clause by clause and then make a report to the Senate. After that, the Senate may choose to send the bill to the House of Commons for its consideration. Once both Houses agree on the bill, it should be presented to the Governor General for Royal assent and become law.

Before we begin, I would point out that earphones are available for those who wish to hear the simultaneous translation from French to English and English to French.

Our first panel this afternoon includes Joanne Pawelek of the Alberta Tobacco Reduction Alliance, Jennifer Duncan from the Alberta division of the Canadian Cancer Society, and Dr. Paul Hasselback, Medical Health Officer for the Chinook Health Region.

Thank you very much for joining us today. We are hoping that you can collectively keep your talks to 15 or 20 minutes as a group and then we will be able to ask questions.

Ms Joanne Pawelek, Executive Director, Alberta Tobacco Reduction Alliance: Mr. Chairman and honoured members of the Standing Senate Committee on Energy, the Environment and Natural Resources, on behalf of Albertans, I welcome you. We are confident that your two sessions here in Alberta will be enlightening, energizing and engaging. Here in Alberta we probably have one of the most enthusiastic and dedicated Bill S-15 fan clubs you will find anywhere across Canada. We are honoured to share our experiences and insights as well as express our support for Bill S-15, the Tobacco Youth Protection Act.

We are especially proud to have some of Alberta's most valuable natural resource, our youth, with us here today in Calgary and tomorrow in Edmonton. I know they are thrilled and excited at the opportunity to present at these hearings.

What is ATRA? The Alberta Tobacco Reduction Alliance is a unique model for tobacco reduction that was created by the Alberta government three years ago. In many ways, it is a living example of how program funding generated by Bill S-15 could be managed by an independent, arm's-length organization or, as in the case of Bill S-15, a foundation. ATRA is an alliance of 94 member organizations which include provincial organizations and associations, such as the Alberta Medical and Dental Associations, the Alberta Dental Hygienists Association, the Alberta Cancer Board, the Alberta Employer Committee on Health Care; non-government organizations like the Canadian Cancer Society, Alberta Lung Association and the Heart and Stroke Foundation; all 17 regional health authorities, government departments and agencies, as well as the private sector including the Alberta Blue Cross, Alberta Energy Company Limited, and Canada's research-based pharmaceuticals.

We are an independent, not-for-profit organization with a board of directors nominated and elected by our membership. We receive $1 million in annual funding from the Alberta government as well as about $200,000 from grants and our member organizations.

ATRA's role is to act as the collective voice of our membership. By virtue of these 94 member organizations, we demonstrate credibility in the public eye as an independent, extremely knowledgeable voice on tobacco reduction. We play a unique provincial facilitating and coordinating role to support tobacco reduction in this province. We try to accomplish what individual member organizations working independently cannot: provincial public awareness activities including mass media, program resources and training, public opinion surveys, issues management support for our members, evaluation, information sharing and dissemination. Each of our 94 member organizations has its own perspective on various tobacco issues. However, we all share a common desire for a tobacco-free Alberta and especially to keep our youth tobacco free.

Since 1998 ATRA has advocated a comprehensive tobacco reduction strategy. This strategy focuses on tobacco-free youth, clean indoor air to breathe, healthy and safe workplaces, and support for users who want to quit.

What level of resources is currently devoted to youth programming? Very few young people in Alberta are being exposed to the kind of substantial and ongoing tobacco reduction program that would be needed to significantly lower rates of tobacco use. However, many young people regularly get short-term exposure to anti-tobacco messages in elementary and junior high schools.

With respect to the major challenges, gaps and needs, there is a need for better networking opportunities, sharing information and resources, training and skill development, quality program materials, and additional human and financial resources. Overall, tobacco programming needs to shift from being underfunded, short term and sporadic in coverage, to long term, consistent and well evaluated.

Based on the successes of hard-hitting mass media campaigns that have proven effective in jurisdictions such as Florida, California, Massachusetts, and recently in Newfoundland, there is agreement that a social marketing approach is most effective with the youth population. Policies relating to youth access, clean air and an understanding of tobacco use as a health issue need to be addressed at a broader level. There is a lack of resources for early elementary age groups.

Where does ATRA stand vis-à-vis the recent federal government announcement and Bill S-15? ATRA has voiced its support for the recent federal government announcement of $480 million in new tobacco reduction funding spread over five years. This increase is significant and important and will be able to deliver positive benefits to public health.

At the same time, Bill S-15 offers several advantages that the federal government commitment does not. Bill S-15 would provide $360 million per year for tobacco control initiatives, programs, and projects.

The CDC, or Centers for Disease Control, in the United States estimates that an effective, comprehensive tobacco reduction effort requires - and I am putting it in Canadian dollars - between $7 and $20 Canadian per capita annually. Bill S-15 would raise approximately $12 per capita.

Resources allocated by Bill S-15 would be sustained and not be time-limited to five years. Program funding generated by Bill S-15 would be managed by an arm's-length foundation independent of government. A key feature of the bill is that it is completely transparent and that 10 per cent of each project would be set aside for evaluation.

An effective tobacco control program needs stable funding, and that can be provided with reasonable certainty by means of a levy that is found in Bill S-15. Subject to the availability of sustained funding, ATRA's members already working at the local level can deliver the school and community-based programs from prevention to cessation. However, increased funding is needed to do the things to a degree and a level of effectiveness that has not been feasible with current funding levels. Bill S-15 would assist the more than 94 organizations in this province to do more programming.

In summary, there is exciting momentum for tobacco reduction within Alberta and across Canada. ATRA is committed to building and maintaining a partnership with all levels of government and with initiatives such as Bill S-15. We previously met with the majority of Alberta MPs about Bill S-15's predecessor, Bill S-20, which contained identical provisions to the current bill but was not acted upon by the House of Commons before the last federal election. A majority of Alberta MPs expressed their support for the bill at that time.

Through our broad-based and influential alliance of 94 member organizations, ATRA has the credibility, independence, and experience needed to launch and develop creative partnerships amongst key tobacco reduction stakeholders, as well as to deliver unique and sustainable tobacco reduction initiatives. Our goal is to make it harder to start and easier to quit, and to contribute to the ultimate goal of a province where the people, the economy, and the environment are free from the harmful impacts of tobacco. Bill S-15 would provide ATRA and our members with the opportunity to continue with the work that has been initiated. ATRA looks forward to the dawn of tobacco reduction in this province and across Canada that Bill S-15 would provide.

Ms Jennifer Duncan, Community Education Coordinator, Canadian Cancer Society, Alberta Division: Honourable chairperson, committee members, and members of the audience, this year over 130,000 new cases of cancer will be diagnosed in Canada. Thirty per cent of those cancers could have been prevented through the elimination of tobacco use. The Canadian Cancer Society asks you to support Bill S-15 because this bill can significantly reduce Canadian cancer rates.

Tobacco use causes lung cancer, the leading cause of cancer death for Canadian men and women. Tobacco use is also a contributing cause of other cancers, including cancers of the mouth, throat, cervix and colorectal cancer.

The recent federal government announcement of $480 million over five years for tobacco control is welcome, but it is not enough. Tobacco use takes away the lives of 45,000 Canadians every year. Yes, every year Canadian tobacco companies lose 45,000 customers, and each year Canadian tobacco companies need to attract new replacement customers. The majority of the new customers are Canadian youth.

Many youth have their first cigarette before the age of 12, long before they have the information they need about the highly addictive nature of tobacco. As the mother of two elementary school-aged boys, I hope that when my children reach adolescence they live in a country in which the youth smoking rate is closer to California's rate of 6.9 per cent than to Canada's currently unacceptable rate of 29 per cent.

How can Canada reduce its youth smoking rate? Canada can reduce its youth smoking rate with the types of programs and the level of funding proposed by Bill S-15. Bill S-15 would provide a sustainable source of $360 million a year to adequately fund a comprehensive, best-practices tobacco control program.

The recently announced federal government program would provide only $110 million annually and only for five years. That is not enough time, nor is it enough funding, for a sustainable, comprehensive program, and there is no guarantee that that funding level would not be reduced, as were the funding levels of previous federal tobacco programs.

To attract new customers, tobacco companies promote sports, culture and fashion programs, and by doing so create a misleading association between those programs or events and tobacco use. The linkage of tobacco products with promotions such as the Player's Racing Team and the Matinee Fashion Foundation falsely creates the impression that tobacco use is normal and acceptable. Those promotions also create the illusion that more people smoke than actually do.

Bill S-15 would fund comprehensive tobacco programs that would denormalize smoking, through hard-hitting media campaigns developed at arm's-length from the government.

Our youth need to be educated or made aware that the glamorous association of tobacco products with appealing events and life-styles is false and that in reality there is no linkage. These days, as people become increasingly less willing to be exposed to the hazards of secondhand smoke, tobacco use often means huddling outside the back door of a building.

Canadian Cancer Society offices receive repeated requests from schools, from community groups, and from parents for resources, programs and other supports to reduce the youth tobacco use.

With youth smoking rates at 29 per cent, we know that what we are currently doing is not enough. Here in Alberta, in response to repeated requests from teachers, the Canadian Cancer Society is piloting a teacher resource for grade 7 students. The pilot educates youth to critically examine tobacco promotions and exposes tobacco industry marketing tactics. The pilot is progressing well, but it is only a start and it is only for one grade.

We know from evaluations conducted in the States that educational programs need to be reinforced by hard-hitting media campaigns that denormalize tobacco use. We also need grass-roots, peer-led programs at the community level and we have to continually evaluate our programs to make sure they are working and to improve them if they are not making a difference.

Bill S-15 would make a difference. Bill S-15 would provide the financial resources and the evidence-based programming that we need to reduce tobacco use and ultimately to reduce cancer rates in Canada.

In closing, on behalf of the Canadian Cancer Society and as a mother of two young children, I ask you to support Bill S-15.

Dr. Paul Hasselback, Medical Health Officer, Chinook Regional Health Authority: Mr. Chairman, honourable members of the committee and valued guests of the audience, as you wander the far reaches of our country I suspect that you will hear several consistent themes: that tobacco is our leading cause of premature death, preventable hospitalization, and greatest cause of health care expenditures; that tobacco tax revenues currently cover less than half of the actual health care costs associated with this addiction; that tobacco companies have targeted and continue to target youth as a major source of future addicts to sustain their profits; that Canada is now lagging behind our neighbour in aggressive approaches to tobacco reduction, and what we have learned from their experiences related to the required investment to achieve these gains.

I should like to spend my few minutes discussing with you some relative successes as a basis for your deliberations on Bill S-15. Southwestern Alberta is home to 150,000 persons. The Chinook Health Region was ranked no. 1 by Maclean's as a rural health care organization. The lifestyle backdrop could have been the model for the Marlboro man. Local attitudes favour individual rights and minimum government interference in daily lives.

Tobacco reduction has been a priority area for the Chinook Health Region and its predecessors. Through a comprehensive approach to preventing initiation, promoting cessation, supporting those that have chosen to quit, and reducing exposure to secondhand smoke, the region has attempted to grapple with the tobacco issue in relative isolation.

Strategies for policy modification have targeted smoke-free public places, smoke-free campuses, smoke-free workplaces, and smoke-free home spaces. However, policy modification is a resource intensive and time-consuming activity, and our own health care facilities needed to first reduce tobacco use inside their own buildings, though smoking is still permitted for selected clients. We do not have smoke-free health care campuses at this time.

While most schools have adopted smoke-free campuses, smoking is still permitted on some campuses. The two largest communities and two others have adopted bylaws that preclude the use of tobacco in locations when minors can be present. A fifth community will likely follow this path in the next few months. These were the first communities on the prairies to go smoke-free in public places, but these communities only house half the population of the region.

Health Canada has funded several projects aimed specifically at young women and tobacco in the region in terms of both prevention and cessation. In collaboration with our partners provincially, we have built upon opportunities for school youth to be leaders in addressing tobacco use in their school communities. Several of these projects have contributed to community decisions to restrict smoking where youth can be present.

For several years Health Canada was an active partner in educating vendors and in enforcing regulations on the sale of tobacco to minors. That collaboration resulted in one of the highest compliance rates by vendors in Western Canada in not selling tobacco to minors.

We have had a few opportunities to measure the use of tobacco in our region. Our adult rates started at less than the Canadian average and may well have slipped just below the 20 per cent level in the year 2000 that we were striving for.

Youth use of tobacco exceeds that of adults; it has been hovering at about the 25 per cent level throughout the past six years, but more information would be useful as well.

Our approaches to cessation are still being moulded with field trials in tobacco cessation for high-risk pregnant mothers and rural cessation programming where insufficient numbers for support groups are a major obstacle to supporting individuals who have chosen to quit.

We have developed and implemented courses for youth cessation both in school and in youth group settings. However, in the midst of the successes are the challenges. We do not have the resources to monitor tobacco use trends more often than every five years. We have not even started to address smoke-free workplaces, and our meagre attempts at smoke-free home spaces, including vehicles, have been inadequate to justify their continuation.

We have not been able to utilize the counter-advertising that has been such a highly effective adjunct to programming in the U.S. We are fortunate to have some exposure to American television stations, which are aggressively addressing tobacco reduction. We benefit minimally from television activity in Calgary and Edmonton, as local stations have not been the focus of counter-advertising initiatives.

While our initial compliance-check partnership was highly effective with Health Canada, we have not had an enforcement partnership for the one and a half years since Health Canada moved these operations to Edmonton. Thus we are unable to adequately resource the cessation activities within the region to entice the partnerships needed for youth cessation and rural cessation programs. We have not even attempted to touch the issue of tobacco use in our two large First Nations communities, where use is suspected to be around 70 per cent for adults. Nor have we attempted to target other special populations such as new immigrants or Hutterite colonies. Our policy support initiatives simply consist of whatever spare time I can muster, and I am already doing the equivalent of two full-time jobs.

The last few years have seen increasing evidence of tobacco company involvement in lobbying and supporting resistance efforts locally, requiring additional resources to counter that activity. While we have been addressing the problem of tobacco smoke, the use of smokeless tobacco has grown until it has become a major problem amongst rural youth and residents.

Our success has been limited to holding youth tobacco rates at a steady state, not in reducing them. Based on lower and stable initiation rates, when increases have been noted elsewhere in the province, we have estimated that during these past few years 500 to 1,000 youths in our region have avoided addiction. We recently celebrated a major event when the number of new smokers was just less than the number that ceased the habit or quit through death, something that few jurisdictions can actually state.

We have estimated that the health region invests, locally, just over $1 per person to prevent smoking, which comes to about $500 to $1,000 per smoker prevented. We estimate that, for each dollar spent in that way, $4 was spent in other activities by federal or provincial governments, through media coverage, through U.S. counter-advertising, through school boards, or through the wide range of partner agencies that form a local tobacco reduction coalition.

Regrettably, being faced with many priority areas for action in health, I have not been able to sustain the resourcing for our own anti-tobacco initiatives; as a result, they have eroded over the past couple of years. The government of Alberta has seen fit to support local initiatives through the Alberta Tobacco Reduction Alliance but has funded that organization at less than 50 cents per capita.

When I hear consideration is being given for a national strategy at $4 per person, I am pleased that some concerted attention is being given to the matter, but, based on other experiences, to see anything more than 10 per cent of this at a local level is being optimistic, and while 40 cents per capita would be welcome, it might only replace what we have eroded over the past few years. Nationally announced dollars rarely make it to the front line, something that Bill S-15 provides some promise for.

It is important to have resources directed at maintaining compliance enforcement, at national policy development, at provincial initiatives and through non-governmental organizations that are doing excellent work so that the money being spent at other than the local level is not being wasted. Based on our own experience, I know that in order to drive down the tobacco use rate we will require considerably more that $5 per person. Our program shortcomings in comparison with the successes of California and Massachusetts help to illustrate that such successful activities require appropriate and adequate resourcing.

Bill S-15 carries considerable strengths over the proposed updated version of the national tobacco reduction strategy. The proposed resources are in keeping with what is required to lead to a reduction in tobacco use amongst youth and Canadians in general. The focus is on youth and preventing the steps of experimentation, habituation and addiction. The funds are to be administered at arm's length from the government to ensure that the resources are put in the hands of local communities. Youth are acknowledged for their capacity to contribute and lead in addressing tobacco use issues.

I do have a few suggestions. The main focus of prevention of initiation activities should be on grades 7 through 10, or even younger. The structure of the youth advisory committee is such that youths of this age will be challenged to participate and attend out-of-area meetings on a quarterly basis. Our experience is that schools are somewhat reluctant to provide for student absences of such duration and frequency.

Alternative strategies for meetings such as on-line meetings and videoconferencing should be facilitated in the legislation. Currently the interpretation of the word "meeting" in the legislation might suggest face-to-face meetings, which may preclude participation of the very youth we would like to engage.

Reasonable home expenses for youth advisory committee members should be acknowledged and facilitated in legislation, such as computers, internet access, and telephone lines so they can talk to each other.

Bill S-15, the proposed Youth Tobacco Reduction Act, is one further step that is required in the overall approaches necessary to reduce the burdens caused by tobacco use. It is not all-encompassing or a complete solution to the issues of tobacco use, but it is a welcome addition to the vast array of resources needed to grapple with these issues.

I thank the committee for giving us this time and I would welcome any questions that members may have.

Senator Kenny: If I may, Mr. Chairman, I want to respond to Dr. Hasselback briefly and draw his attention to clause 6, subclause (h) of the bill, because his suggestions are right on.

Sir, you commented on the importance of young people taking a leading role. The CDC, or Centers for Disease Control, tells us that if young people are not involved in the planning, and not only in the planning but in the execution, of strategies, those strategies will not work. I certainly subscribe to what you are saying. The suggestions you make are, I believe, covered in clause 6(h), where it says, "to develop and distribute educational tools," and that could be the computers you were talking about and the phone lines, "to plan and execute communication strategies," and those strategies do not have to be face-to-face meetings, but could be the teleconferencing that you are talking about. The clause goes on to cover other aspects there.

Your suggestions are well taken, and I would contemplate that someone could actually do those things that you suggest under clause 6(h) of the bill. I do not know if you were thinking of something beyond that or if you felt this was not sufficient to accommodate your interests.

Dr. Hasselback: Senator Kenny, it might be worthwhile taking the scenarios and actually having them pass through, because specific clauses of the proposed legislation refer to the structuring of the youth advisory committee, how it is to meet and the ages of the participants. As it is currently written, there may be some leeway relative to options and there may actually be options that exist, but I believe the terminology of the clause on the youth advisory committee could literally be interpreted as being restrictive.

Senator Kenny: I follow what you are saying, but that is under a separate part of the act. Let me refer you to the objects clause in Part II; when you combine the objects clause with the youth advisory council, I see program funding there. If it is not clear enough, we will have a chat with the lawyers and make it clear, and I think that is really what you are asking us to do.

The Chairman: Does anyone on the panel have any suggestions on this? I have noticed when driving by high schools that, although the students are not allowed to smoke in the yard, there is always a clutch of kids smoking just across from the front door. You can hardly ship them out of town, because they have to be quick enough to get back to class, but do you have any ideas on how to handle that?

Dr. Hasselback: Mr. Chairman, it is one of the things we grappled with considerably when we put in smoke-free campuses. Initially there was a white line drawn that separated school property from the city property and, sure enough, there was a large contingent of individuals who crossed that line. It became difficult actually to drive one's car through the area, initially.

Just as an example, Lethbridge has six schools in two blocks, quite literally, and there is a large congregation of students; the number of students who are out there smoking and actually have to cross the line has dropped considerably. We know they are still smoking, but their habits are changing, and where they are smoking is changing and how they go about doing so is changing.

We have worked with several of the schools quite specifically, usually in conjunction with bringing neighbours together with the students in joint planning activities about how they can address the issues of local vandalism and concerns about students wandering off campus, and that has been highly successful in a couple of locations; in a couple of others it has not been as successful, but certainly a part of what we are seeing amongst the changes in the last four to five years is a difference in attitude amongst youth who do smoke and a greater respect for the environment in which they are trying to take up their habits. So it does happen, but it does not happen overnight. It is like the issue of the smokers outside the front door of the hospital and what do you do with them.

The Chairman: So you think it is better to have a law saying you cannot smoke on campus than to have special rooms that they can smoke in.

Dr. Hasselback: Absolutely. Part of our work has been to get students and youth to clarify for us why it is that they do not get the message, and the main point that the youth within our region made was: "Don't give us an ambiguous message. If you tell us not to smoke, don't smoke in front of us; don't allow us a place to smoke, and don't make it easier for us to smoke. If you make it ambiguous and say, `don't smoke,' and then provide a smoking room for us, we probably will take up smoking. So be clear and be concise."

Mr. Chairman: I have noticed that there are some cities in the U.S. that have declared themselves smoke-free, even outside, on the sidewalks or anywhere, very much as it was a hundred years ago. If you smoke, you have to go home and do it in the privacy of your own home. You are not allowed to smoke in public or in public buildings. Is that going too far?

Dr. Hasselback: We certainly have not addressed that issue, but it is part of the private entrepreneurial effort. I have noticed lately that on the main streets in Lethbridge there are signs that encourage smokers to smoke behind the buildings instead of out on the street. That has not been something as a policy direction or something that has been encouraged specifically. We have at this point in time suggested that there is sufficient fresh air outside and good enough winds that blow through Lethbridge that we need not worry about external air pollution. But we are actually more concerned about people smoking in their homes because they often smoke where there are children present in those homes.

Senator Adams: I would just like to congratulate you, on the work your panel has done. I am especially pleased to see that your delegation includes a number of students. It is not very often that we see students in the Senate, and I think that is important, especially today when we are talking about Bill S-15. Where I come from, people have traditionally started smoking at a very early age. I believe that is especially true in the Arctic, where kids as young as 10 to 12 years old start smoking. I have even caught my grandchildren smoking a couple of times. I tell them they should not start. I quit over 30 years ago, and at that time we were not even concerned that cigarettes were bad for your health.

Senator Kenny has been working on the tobacco bill for the last four years, and he knows the truth of what I am saying.

What you were saying about the reserves applies equally to the Arctic, and it is really bad, and certainly worse than in the city. We try to tell the people in the Arctic communities about the dangers that exist from smoking, but it is very difficult for them. We try to warn them, especially the young people, about what is in store for them in the future if they continue to smoke, pointing out how people are dying from lung cancer because of smoking, and so on, but even though the government is now pointing out some of the things that are happening to people who have sicknesses from smoking, it seems that people in some of the communities are not really concerned about it.

In the community where I live, many people have a problem with finances; they have no jobs; and yet those same people apparently have no problem getting cigarettes at $9 a package, or over $60 a carton. Somehow they are able to get their cigarettes and have a smoke. I certainly hope this bill is able to help the people across Canada, including my own community, maybe by showing us how to help ourselves.

I do not know how many patients you have, as a doctor, or whether they are concerned about lung cancer, but specialists, both doctors and dentists do come into our communities, and I wish that those doctors and dentists would tell everybody they are treating that cigarette smoking is bad for them and their family and especially for the future of their young kids.

Yesterday at our hearing in B.C. we heard from a doctor who had travelled to the communities in the North. As he pointed out, with satellites and modern technology we now have up to 100 TV channels available to the northern communities, and most kids today are watching TV and they are seeing the commercials. What are the commercials? They are often cigarette ads. Those ads go with the action in the movies, and they make the kids want to smoke. The people in the community have video rentals too, though, and we spend quite a lot of money there, the government does, just advertising the dangers of cigarettes for health, using videos, but it is not reducing smoking, not like we heard for the people in California, where the percentage of people smoking dropped way down, or the percentage of young people starting to smoke.

Nothing like that has happened yet in Canada. Maybe you can tell us how we could do that. At any rate, I hope this bill passes this time through the House of Commons.

Dr. Hasselback: Senator Adams, one thing that I would really like to stress is that no specific activity will work; we have learned that a comprehensive approach is essential. What we have tried to do in our jurisdiction, with limited resources, is to put in the best comprehensive program possible, and yet I am just celebrating the fact that maybe we are keeping our head above the water. We do not have the resources, based on our existing financial allocations, to actually be able to do the sorts of things that we want to be able to do, which we know when put together into a full package would make a big difference. I think we are on the verge of getting there.

Six years ago we decided we would do this, and I am glad that we did it, because I certainly do not think that the wheels of government move fast enough to help support those who are actually out on the front line. We need to pick up the speed of the government wheels, whether they are provincial or federal, combine the activities at the federal, provincial and local levels, and make sure that there are adequate resources out there that can be put in front of those who are making the choices, whether the choice is to start smoking or experiment with it or whether the choice is to quit and give it up. We have to have at that point in time the resource that is necessary just to put them over the edge to make the right choice. That is where I think Bill S-15 might actually take us.

Senator Banks: Ms Pawelek, Senator Adams has referred to the fact that there are cultural differences in this country that are very wide, and that the things that would work in Rankin Inlet might not work in St. John's, might not work in Victoria, and might not work in Calgary. There is no doubt that there has to be a certain amount of tailoring of this program to those regional and cultural differences. But when I heard you talk I got the impression, and I am wondering if I have the right impression, that you are hopeful, if not expectant, that, if this bill passes and the levy contemplated is put into place, they will start collecting that money and they will give the money to a foundation, to the various regional organizations that are already involved in this undertaking. In your view, is that what you think ought to happen?

I ask that because I think it is equally possible, depending on what happens, that because this foundation will be independent it will not be subject to pressures or influence from the tobacco companies or from government, and the establishment of such a foundation might result in that foundation's determining that there is a different way, maybe not a better way but a different way, than the one which I think I hear you contemplating in order to get the job done on the ground. Would you tell me about that, please.

Ms Pawelek: I appreciate the opportunity to clarify that. What ATRA has tried to do is provide a coordinating-facilitating role, but what we are not able to do is fund the kinds of activities and initiatives we would like - in much the same way as Dr. Hasselback was talking about today. We cannot use a cookie-cutter approach, and there are some very exciting activities, projects, initiatives which you will hear about from the next panel. What we are in support of is this funding source so that programs that are evidence-based that have been proven to be effective will have a good opportunity to receive these funds, not to come through a central body like ATRA or through government, but that programs that stand on their own merit, evidence-based, that have been proven to be effective will have the opportunity to have some success.

Senator Banks: Thank you. Ms Duncan, you said that you welcome the $480 million that was committed a couple of weeks ago by the Minister of Health. There are those of us on this committee and many in the Senate who believe that that is not enough money, that it is like prescribing half the pill or, as I think Senator Kenny said, a quarter of the pill. But when you say to Canadians the government has committed $480 million to combat youth smoking and that is not enough, most Canadians say, "$480 million is not enough? What is going on here?" So far we are running into resistance, it seems to me, publicly from people who are saying, "You already have $480 million; why are you continuing to pursue this?" What do we need to do? What would you say to those people?

Ms Duncan: I would go back to what the Centers for Disease Control recommend in terms of per capita funding. The per capita funding promised by the federal government is less than $4; it is actually closer to $3. It is clearly not enough, based on what has worked in the past and what is shown to have results in reducing tobacco youth rates. The fact is that Bill S-15 would provide a rate closer to $12 or so, which is still at the low end of that recommended level of funding.

Senator Banks: You know that and I know that. How do we convince people of that, the voters?

Ms Duncan: Again we can go back to what our current youth smoking rate is. It is 29 per cent. Adding a few million a year really won't make a difference. We know that we need to have adequate financial resources, and again we need to have that evaluation component. That is a really key element of it. We cannot keep spending money on programs that do not work.

Senator Banks: Doctor, you mentioned that tobacco companies are targeting youth now. We have had the presidents of the three biggest tobacco companies appear before this committee. They were not all that anxious to; in fact, we had to subpoena them. The Senate does not very often do that, but it can. These three men swore up and down to us, in effect, that, "Yeah, maybe we used to do that, and maybe our parent companies used to do that, and all that stuff in the archives in London proves that we used to do that, and maybe we even did it here and maybe some other people in the world are doing it now and maybe even companies with which we are associated are doing it elsewhere in the world, but we do not do that anymore," they said, looking us straight in the eye, "in Canada." Do you have specific evidence that Canadian tobacco companies are now targeting Canadian youth to try to convince them to smoke?

Dr. Hasselback: Do I have specific evidence that the Canadian tobacco companies are targeting Canadian youth? The answer is no. Do we have evidence that youth are being targeted to take up smoking? The answer is yes. What is difficult to track, however, is where those dollars that support cigarette distribution are coming from; let's say they come from the hospitality industry, through the bars and lounges, to support the distribution of cigarettes, which they are not allowed to do but they still do, for parties occurring within their facilities.

Now, they are not supposed to be doing that, and the tobacco industry will tell us that, no, they are not supporting that. However, during the considerable discussions that we had over bylaw implementation within our jurisdictions, there was evidence that did exist and does exist that the Canadian Tobacco Manufacturers Council provided the literature, resourcing and backups in resourcing to support the hospitality industry in the lobby efforts to resist the implementation of the local bylaws. We know they are there. We know roughly what their faces look like at a local level. We do not have the evidence that can link it backwards into the actual industry, nor do I believe that it is my job to actually find that.

Senator Spivak: Would you not agree, doctor, that there is no need for Canadian companies to do that, because the major sources of entertainment for young people are videos and movies, and in those videos and movies people are smoking cigarettes much, much more now than they did a few years ago when it was rather frowned on? You do not need much evidence. You just have to go to the movies or look at a music video and everybody is smoking in those videos, and those are models, those are people that kids look at all the time.

Dr. Hasselback: Senator Spivak, Senator Banks' question was quite specific: Canadian tobacco industry targeting Canadian youth. There is a whole spillover of counterculture that exists which is supported perhaps by the tobacco industries in the U.S. I do not follow that except out of my own amusement in terms of some of the rhetoric that comes out of the U.S., but that spillover is there.

Just as we are trying to develop a comprehensive approach to reducing tobacco use, they are using a comprehensive approach to increase its use. Those marketing tobacco in this day and age know that there is a group such as ourselves who are actually trying to reduce the use of tobacco; so they will use a comprehensive approach to support the use of tobacco, and that means addressing it in a variety of fashions, including whatever advertising can be used, whatever names they can get out there, whatever means can be used to normalize it, and suggesting that tobacco is actually used by the majority - and that is still something our youth believe, according to our surveys of them. They still believe that the majority of youth smoke. Even though only 25 per cent of them admit to smoking, if you ask them if they believe that the majority of youth smoke, the answer is yes.

So the perception still exists out there that smoking is the norm, and we are having trouble changing that perception for a variety of sociological influences that exist within the culture around us.

The Chairman: Yesterday, when there were comments about the tobacco companies backing the bill, even putting their own ads out supporting it, one of our witnesses had a rather jaundiced view of that. He said the tobacco companies might be practising a sort of reverse type of attraction. Instead of going directly after youth, what they are trying to imply is that smoking is a risky adult pleasure. I just mention that in passing.

I want to ask one question of Joanne Pawelek from the Alberta Tobacco Reduction Alliance. You referred to the many organizations that come under your umbrella. Is anybody attacking the matter of income tax write-offs for tobacco advertising? Tobacco companies are allowed to deduct from their income tax every penny that they spend on trying to convince people to smoke, so we as taxpayers subsidize our own fate, if you want to call it that. I was just wondering if any of your organizations have been doing any work on that?

Ms Pawelek: I have a very quick answer. No, not that I am aware of.

Senator Kenny: The question of smokeless tobacco has come up. Is that particularly prevalent here, and is it part of the rodeo culture, if you will, or is it part of a rural culture? Could you elaborate on that? Are there programs in effect, either through the Cancer Society or through you, doctor? Do you know of any programs that do address that?

Dr. Hasselback: The answer is yes. In my part of the country, it is rodeos, and the companies sponsor the rodeos, they support them. It is advertising for the tobacco companies, and their name is all over the rodeo, without being limited in any fashion.

We are grappling with the issue of smokeless tobacco. We have tried to put in place a couple of programs but have not had the opportunity to evaluate the effectiveness of those programs in southern Alberta. We do know that up to 10 per cent of our young males in the rural parts of our region have actually tried chewing tobacco, but the utilization does not seem to be quite the same. The addictive properties are not quite the same. Moreover, the research relative to comparing smokeless tobacco or chewing tobacco with cigarette tobacco is not quite on a par at this point in time. We do not understand it well enough to be able to target our programs appropriately. We have talked a great deal about evidence-based programming, and I will stand by evidence-based programming. I think we have a lot to learn there, but I think there is a lot of research that needs to be done before we understand it.

Senator Kenny: Do either of the other of you have comments about it?

Ms Duncan: I will just add that you will hear tomorrow in Edmonton from a panel speaker who will speak specifically to that issue, so you will get your question answered at that time, hopefully.

Senator Kenny: There was mention of Hutterite colonies. Can you tell the committee a little bit about the prevalence of smoking there?

Dr. Hasselback: There are several hundred Hutterite colonies right across Alberta, so it is a significant population in which, we understand, the communal living values are quite different from that of the general society. I have used it as an example where we need to be able to target appropriately, just as with the First Nations, and, yes, there is no preclusion to the use of tobacco amongst Hutterite colonies specifically.

The Chairman: With respect to our next group of witnesses, I think the best way to proceed is to have them introduce themselves.

Ms Becky Freeman, Project Coordinator, Alberta Lung Association: Honourable senators, my name is Becky Freeman. I am the tobacco reduction coordinator for the Alberta Lung Association.

Ms Sirisha Tunuguntla, Member, Women's Initiative in Tobacco: My name is Sirisha Tunuguntla, and I am part of WINIT, which is Women's Initiative in Tobacco.

Ms Gorana Radovic, Member, Women's Initiative in Tobacco: My name is Gorana Radovic, and I am also part of WINIT, Women's Initiative in Tobacco.

Ms Diane Cassidy, Youth Tobacco Project Coordinator, Calgary Regional Health Authority: My name is Diane Cassidy. I am the Youth Tobacco Project Coordinator for the Calgary Regional Health Authority.

Ms Shawna DeKort, Youth Action and Advocacy Project: I am Shawna de Kort. I go to Father Scollen School, and I am one of the leaders of the non-smoking committee.

Ms Robyn Leclair, Youth Action and Advocacy Project: My name is Robyn Leclair, and I am a representative of the non-smoking committee at Father Scollen School.

Mr. Phil O'Hara, Project Coordinator, Youth Action and Advocacy Project: My name is Phil O'Hara. I am project coordinator of the Youth Action and Advocacy Project. I am also project manager of a province-wide youth tobacco survey that is going on right now.

Ms Leclair: On behalf of Father Scollen School and as representatives of the non-smoking committee, my partner Shawna de Kort and I are here today to discuss the reasons why we are involved in helping to reduce teen tobacco use. I also wish to discuss my experiences with the BLAST program.

I strongly feel it is up to the children of today, who will become the adults of tomorrow, to take the responsibility of reducing teen tobacco use in our society. If young teens today are not voicing their opinions, then they will not be heard and they will not receive the freedom that they deserve. So with the help of the peers who are involved, there will be a definite sense of satisfaction towards the success of the decline in teen tobacco use.

In attending the BLAST session, I have encountered many useful resources throughout my BLAST binder. I have also received several statistics that have given me the knowledge to speak to my peers with the understanding and the awareness of what is taking place in today's society. The BLAST program has given me, as well as many others, the wonderful opportunity to make a difference. It has also provided me with the strength and encouragement that I need in order to have a voice that is strongly favoured by those who are against tobacco use and the fatal results that it tends to have.

In conclusion I would just like to say that I am incredibly thankful for the BLAST program and what it has enabled me to do as a teen who can make a difference.

Ms DeKort: I would just like to add to Robyn's comments. Robyn and I have put forth an extreme effort in the preparation of our final project that has been sponsored by the YAAP program.

Father Scollen School has currently received a confirmed amount of money from the YAAP program that will be put towards our main and final project of the year: our "haunted house," showing the effects of tobacco use. The decision made by our non-smoking committee was to name the haunted house "Death Valley."

The objective of the project is for our peers to recognize the risks that are associated with smoking. The haunted house will include some of the following features. There will be sound effects throughout the course of the haunted house that the participants will hear, occasional sounds of somebody coughing, people crying after the death of a family member due to lung cancer, and people screaming because they are in pain due to the fact that they have smoked for several years. There will be special lighting. The lighting will include black lights and strobe lights as well as lights that will be borrowed from Father Scollen's drama department.

There will be some hands-on effects. This will allow the participants to have the hands-on learning experience of what a diseased lung would feel and look like. They would also have the opportunity to touch a fake heart of one who had just had a cigarette.

This is only the beginning of what will become an awesome haunted house; thanks to the YAAP program all this will be made possible. If we had not had the YAAP program sponsoring our school, we would not have been able to have the haunted house, as the committee set out to do throughout the course of our grade 8 school year. We, as the committee, know that this will be an accomplishment because of what the YAAP program has provided us with.

On behalf of Father Scollen School and the non-smoking committee, we would like to thank all those who have taken the time to listen.

Ms Cassidy: My name is Diane Cassidy. I work for Calgary Regional Health Authority as a youth project coordinator for tobacco reduction.

An estimated 22,500 young people start smoking every year. That is 61 every day. Twenty-nine per cent of teens aged 15 to 18 smoke cigarettes, and smoking costs Alberta's health care system $215 million every year. Studies show that if somebody has not started smoking by the age of 19, it is unlikely that he or she will start. Eighty-nine per cent of smokers take up the habit before the age of 19.

Bill S-15 would raise $360 million a year. That is $12 per capita for a comprehensive tobacco control program aimed at young people, and it would have a huge impact on the numbers of young smokers.

On a limited budget, the CRHA has been able to pilot some peer-led tobacco prevention and cessation programs for young people, to try to slow down the rate of uptake by teens and also work with those who have already started smoking to encourage them to stop.

We are collating our tobacco education resources aimed at young people and will be offering a grab-and-go pack for teachers, school nurses and youth workers, along with training on how to deliver tobacco education to young people.

We have also supported the development of WINIT, Women's Initiative in Tobacco. I will let the members of WINIT here today tell you more about that, and you are welcome to look at our display outside afterwards.

Our initiatives have been led by youth and developed by youth. This method has proved to be successful, as young people are more likely to listen to their peers. We have only been touching the surface, though. If we had more resources, such as the money that will be generated by Bill S-15, then we could expand the work we do to reach a larger number of young people, thus reducing the number of teenage smokers. Our work could also be expanded to include at-risk groups, minority populations and new immigrants.

I would now ask Gorana and Sirisha, both long-standing and active members of WINIT, to offer you their ideas from a young person's perspective. Thank you.

Ms Tunuguntla: My name is Sirisha Tunuguntla, and I am a member of WINIT, which is Women's Initiative in Tobacco; our group is made up of young people from across Calgary and we do advocacy and awareness work on tobacco issues for our peers. We have been running successfully for over three years now, and this model has proved to be very effective in raising awareness on youth issues. I recommend that the WINIT model be adopted province wide or even country wide.

There are various methods that WINIT has developed that others groups could adopt if funding was available. These include SHOUT; the Calgary bylaw campaign; letter writing; a video; a web site; presentations; compliance checks; newsletters, and the media.

SHOUT is our annual smoke-free festival. This year it will be held in Olympic Plaza to offer young people fun activities as an alternative to smoking and also offer information in an informal way. Young people love events like this.

The Calgary bylaw campaign has been supported by WINIT to ensure that the voice of young people is heard, as youth are affected by secondhand smoke while they are in restaurants and often have no say over where their parents take them and are concerned about the effects of secondhand smoke. It is important for young people's views to be heard for decision making.

The WINIT members regularly write letters to politicians to make sure the voice of young people is heard on tobacco issues.

WINIT is making a video to show when it does presentations to youth groups and to help with recruitment of new members. If this bill is adopted, we hope there will be money to go towards more programs like this.

The WINIT web site, www.winityouth.com, is now up and running. It has loads of useful facts for young people on smoking. If more money were available, more youth tobacco sites could be developed, because young people spend a lot of time surfing the internet.

With regard to presentations, WINIT regularly visits schools and youth groups and involves young people in discussions and quizzes about smoking. We find young people listen to us as we are on their level.

Regarding compliance checks, WINIT sends out test shoppers to see which retailers comply with the law and refuse to sell tobacco to young people. If more money became available, more compliance checks could be done, and that would make it harder for young people to buy tobacco. Stricter fines could be given to retailers who break the law, and their licenses could be suspended.

We regularly produce our own newsletter to promote the group and inform people about what we are doing, but more money could certainly go towards newsletters and magazines relevant to young people.

WINIT also commissioned a study entitled "Media Marketing: a Non-Smoking Lifestyle." Focus groups were set up across Calgary. The report outlines what is needed to make a successful anti-smoking advertisement. These recommendations could be taken further, and young people could be involved in the designing and making of anti-smoking commercials.

All of these methods could be developed with other groups so that they too could keep youth tobacco in the news.

I would like to pass it over to Gorana.

Ms Radovic: My name is Gorana Radovic, and I am a grade 12 student at Western Canada High School. I also have been part of WINIT for more than three years now, and I can truly say that it has been a wonderful, informative and educational experience.

So why exactly am I here today, you might be asking yourselves. Well, the answer is quite simple really. I am here because I want to be here. I want to do more for my peers, friends, and the youth of today in general, and the only way this can be accomplished is with the help of Bill S-15.

There are so many different things that could be done with the extra money raised by this bill. For instance, new organizations for helping youth, new drop-in centres, new help lines, new peer support groups, new activities, magazines, youth web sites, play writing, fun runs, awareness raising events and the like could be developed. However, in my eyes, the primary and the most important thing that could be done with it is to set up a mandatory tobacco education class in schools, starting with kindergarten and probably ending with the first year of junior high school, since by then youth will probably have a pretty clear image of what they do and do not want to do, of what they like and what they do not like and of what they consider is cool and not cool.

It is true that educating them afterwards will help, but it is a fact that it will not help as much as it would have in their childhood. Do not get me wrong, however. I am not saying that it does not help, because it does. It helps a lot. All that I am saying is that early-age tobacco prevention and education is more effective. Therefore, since tobacco education after junior high school does help, the money that is left can be used for media literacy, where youth will be granted an opportunity to critically analyze advertisements, which will increase their awareness and empower them to make informed decisions.

Of course, however, all of this education would have to be done in a fun and non-preachy way, because, when looking at my own experience, this is the most effective way of learning. An example of this could be to take tobacco ads and convert them into anti-smoking ads by changing things around in the original picture. Also in addition to this the same thing could be done with slogans, cartoon strips, and movies.

The money from Bill S-15 could also make the numerous prevention activities or events much more effective by giving us the ability to get well-known celebrities to awareness raising events, which would, without doubt, catch people's attention and would make the turnout much greater and awareness and information much more effectively processed, as young people like to look up to role models.

Yet another thing that could be done is to put quitting information packets and anti-smoking posters into the smoking pits around Calgary public high schools, along with free nicotine patches, healthy snacks, like vegetables and fruits, and pictures of kids their own age who have been affected, either directly or indirectly, by tobacco.

Therefore, as seen here, by providing us with the extra money, many things could be accomplished, things that we only dreamt about in the past. So keeping this in mind, I encourage you to give Bill S-15 a chance because your decision and the decision of the MPs can make our future a better place.

Ms Freeman: My name is Becky Freeman. As I mentioned before, I am the tobacco reduction coordinator for the Alberta Lung Association. I am also the project leader for the BLAST program that Robyn spoke of earlier.

The Alberta Lung Association began in 1939 as the Alberta Tuberculosis Association. Its goal was to educate the public about TB, conduct mass chest x-rays, and provide a rehabilitation service for TB sanatorium patients. The fight against TB has been largely successful, so over the years the Alberta Lung Association has broadened its scope to encompass all aspects of lung health.

Our current mandate is to raise funds to support respiratory research, community health, education programs and professional education in Alberta and the Northwest Territories.

Tobacco use is the number one preventable cause of respiratory illness and, therefore, it is our key priority. We also know that more than 80 per cent of the smokers begin before they are 18, thus youth must be a focus for many of our tobacco reduction programs. That is why I find it so incredibly interesting that tobacco companies claim not to target youth when they are their biggest source of new customers. I find that a little hard to believe.

Reducing tobacco use among youth is possible. In fact, we know how to do it. We need to fund an evidence-based, comprehensive tobacco reduction strategy. Currently there is not sufficient funding to implement such a plan. Bill S-15 would provide these much needed dollars. While $3 per capita, which was announced recently by Health Minister Allan Rock, is certainly welcome and we will be able to do a lot with that, it is not within Centers for Disease Control's guidelines. The $12 per capita that Bill S-15 is proposing is.

Bill S-15 also guarantees that the funding will be provided for youth tobacco reduction. A reliable and sustainable funding source is essential for successful initiatives. The possibility and opportunities this level of funding would provide make change a real possibility.

The California experience shows that it is possible to achieve stunning results, to move youth smoking rates out of the 30 per cent range and down to the 10 per cent range, if funding is made available for community-based programs, mass media counter-marketing campaigns, policy implementation and outcome measurement and evaluation.

The Alberta Lung Association currently coordinates and funds several youth tobacco reduction initiatives, but we could be doing so much more. For example, we know there is a demand for a youth smoking cessation program, one that complements our adult program. We constantly receive requests from concerned parents, schools, and youth centres for this type of resource. In fact, we receive requests every single day for anti-tobacco resources of any type, be it posters, curriculum guides, pamphlets, anything. We are inundated with requests like that every day.

Our smoke-free class curriculum and program is rolled out in schools all across Alberta, but that program has the potential to reach many more students, and the materials themselves are in dire need of being updated.

The ALA also runs a program called BLAST, Building Leadership for Action in Schools Today. That program gives students the necessary tools and information to develop action plans within their own schools to reduce tobacco use. It is a peer-to-peer education and leadership program.

The levy that Senator Kenny has proposed would help to further develop these types of programs. By creating a dedicated fund to reduce tobacco use, communities will be able to implement new and creative initiatives regarding youth tobacco reduction and cessation.

The current funding of 50 cents per capita that the provincial government provides for tobacco reduction is not enough to achieve a reduction in youth smoking rates. In fact, there is evidence that smoking is on the rise in young females in Alberta and that for the first time it is higher than that of young males.

The Chairman: On the rise right across the board or for certain age groups?

Ms Freeman: It is on the rise in young women.

Like other members of the health community, the ALA has been rolling out these programs with a minimal budget and unsustained money. It is very difficult to conduct long-term project planning when applying for funding is a constant concern year after year. Sustainable funding enables project planners like myself more freedom to develop and implement quality programs rather than struggling to find funding on an annual basis.

The Alberta Lung Association fully supports Bill S-15 for what it will enable youth-based tobacco production programs to ensure. The bill is long overdue in being passed, and I encourage all Canadians to support it. Thank you very much for your time.

Mr. O'Hara: Honourable Chairman and members of the committee, as I said before, my name is Phil O'Hara. I coordinate YAAP, the Youth Action and Advocacy Project, in Alberta. I am also project manager of a province-wide two-year research study that we are doing to figure out the level of smoking among young people in Alberta.

Young people need to share in making decisions about issues that directly affect them. With this shared responsibility, there is a need for youth to take action on these issues and to advocate on their own behalf. With adult guidance and a minimum of resources, young people, with their energy, enthusiasm and creativity, can accomplish amazing things. In a nutshell, that is the message I want to convey to the committee today.

The passage I cited is taken literally from the funding proposal I developed on behalf of ATRA, the Alberta Tobacco Reduction Alliance. Through its Population Health Fund, Health Canada provided financial support to ATRA to launch the Youth Action and Advocacy Project in August 2000.

YAAP helps teens aged 13 to 19 to take leadership roles in helping to reduce youth tobacco use. It has three main components: regional capacity building workshops, seed grants to support local youth-led initiatives, and the creation of an Alberta teen advocate counsel. Think of the components as education, action, and advocacy.

YAAP is based on the best available evidence and builds on the strategies that have worked in other jurisdictions. It focuses on youth-led activities and not on health education by adults.

Research tells us that 90 per cent of grade 4 students know that smoking is unhealthy. The problem is not young people's lack of basic knowledge about tobacco; rather, it is the difficulty many young people have in acting on the knowledge. Only 13 per cent of teens told Health Canada that providing more information about smoking and health would help to cut youth smoking.

Studies show that to better enable youth to act on their knowledge about tobacco, particularly within their social network, young people need to enhance their assertiveness skills and their ability to recognize and resist negative influences. We know an effective strategy to enhance assertiveness is to provide people with opportunities and support to increase their own sense of empowerment. When young people feel they can make a difference, they will make a difference.

YAAP provides youth with access to resources to take on projects in their communities that affirm their own decisions not to use tobacco. Through the projects, youth communicate in creative ways with their peers about tobacco use and the associated high risk behaviours. As well, through the teen council, youth participate in developing provincial programs and strategies to reduce youth tobacco use.

Through their participation in their activities, youth are better able to resist the pressure from their own social network and from the broader social environment to engage in activities that they know are harmful. This is the theory behind YAAP. How does it translate into practice?

The main measurable outcomes of YAAP over the past year are the following. We hosted eight regional capacity building workshops attended by about 250 young people. Two of the workshops were piggybacked on the BLAST conferences that Becky talked about. Forty project proposals were submitted by youth, 33 projects were funded and $74,000 was distributed in seed grants to young people. That was about 50 per cent of the total YAAP budget. Eighteen young people from throughout Alberta were nominated as the inaugural members of the Alberta Teen Advocate Council. Robyn here is one of them.

Local collaboration is essential to projects funded by the YAAP seed grants. Local adult mentors help youth identify possible partners. Youth can apply for a seed grant of up to $3,000, but they must match those funds with local partners putting in funds or in-kind contributions. The involvement of partners such as the Regional Health Authorities, AADAC, the Alberta Lung Association, schools, youth councils, municipalities, and others, is vital to the success of these projects. Without their support there would be no local projects.

You have heard today about some of the projects that YAAP funds, and you will hear about a couple more tomorrow when you are in Edmonton.

The Youth Tobacco Reduction Act is a major step forward in developing and supporting the comprehensive approaches we know are necessary to reduce youth tobacco use. The act will help to build the essential national and regional infrastructure to support these approaches. For those of us working the front line of youth tobacco reduction, the act offers the welcome prospect of resources to sustain local youth-led activities and advocacy, which are key parts of an effective and comprehensive approach.

The Chairman: Thank you. Before we start asking questions, I wanted to tell members of the audience, who may have joined us or have been here for a while, that this is a review of the committee touring on Bill S-15, the Tobacco Youth Protection Act. We had hearings in Vancouver yesterday; we are in Calgary today; we will be going on to Edmonton, Toronto and Montreal. The goal of these hearings is to let the committee get a view of what Canadians' thoughts are on the bill, and if something new comes up, or amendments are suggested, we will change the bill before it goes back to the house for the third and final reading. If it is passed by the Senate, it will go to the House of Commons and then, if it passes there also, it will go to the Governor General for Royal assent.

I would just remind people that if anyone in the audience wants to hear the evidence in French or in English we have translation sets.

Senator Banks: I wish to thank the panel of witnesses very much, first, for all the work they have done and, second, for appearing today. It is very good of you.

I want to ask Robyn and Shawna, who are sort of on the ground and in the place we are talking about, just anecdotally, do any of your friends smoke?

Ms Leclair: Yes.

Senator Banks: And if some of your friends smoke, I am sure that since you have this demonstrable commitment to convincing young people not to smoke, you must from time to time have talked to them about it. We always hear that we have to have a comprehensive approach to convincing young people not to smoke, and we believe that is true, all the evidence suggests that, but I am just curious to know these days, because it is different than when I was your age, what the reaction is of young people when you explain, "Haven't you seen the pictures? Haven't you seen the videos? Haven't you seen the commercials? Don't you know about so-and-so, and besides you're my friend and I don't want you to hurt yourself?" What kind of reaction do you get from your friends who smoke, if you have any, when you ask them those questions?

Ms Leclair: I have friends that smoke, and when I do confront them about it, because they are my friends they listen to what I have to say. Honestly, they do not like what I have to say, but I still tell them; but showing them and telling them what it does to them does not really seem to have much of an effect on them.

Senator Banks: Do you understand that?

Ms Leclair: Yes.

Senator Banks: Can you understand why that is so?

Ms Leclair: No. They basically just say that they can quit when they are ready and they can quit any time they want, so they don't think it is affecting them now; but they don't see what will happen in the future.

Senator Banks: How about you, Shawna?

Ms DeKort: It happens to me pretty much the same. I have pretty much talked to the same people Robyn has from school, and they listen because we are friends, but they don't care. They think it will never hurt them and that nothing will ever happen to them, even though there is a better chance something will happen to them.

The Chairman: They probably say they will die anyhow.

Ms DeKort: Yes.

Senator Banks: May I ask Sirisha a question. You said, if I understood you correctly, that one of the things WINIT does is to volunteer to go out and check on compliance. Do I understand that correctly?

Ms Tunuguntla: Yes.

Senator Banks: Why do you need more money to do that?

Ms Tunuguntla: For compliance checks, we need volunteers to come, and we also need to inform people about it, so we need funding for that.

Senator Banks: For informing people about the compliance requirements?

Ms Tunuguntla: Actually, I am not sure about the money requirements for that. I think Diane can better answer that question. She is our coordinator.

Senator Banks: Okay. So the question, Diane, was, if you are volunteering to go out to check on compliance, why do you need any more money?

Ms Cassidy: I think the issue is not money specifically for compliance checks but that, to look after or support the WINIT group, we do need paid members of staff to support the group.

Senator Adams: My question is in regard to your families, those at the panel table right now; do your families smoke? Does your dad or mom smoke? Either one of you can answer.

Ms Leclair: My mom smokes, and so does my brother.

Ms DeKort: And my mom smokes.

Senator Adams: Both of your moms smoke. Now, you are concerned that you do not want to smoke. Is your mom kind of feeling guilty about smoking right now, and how do you feel? You are doing your job. Is she glad you are doing your job?

Ms Leclair: I know that my mom, after the BLAST conference, wants to quit. She just - I do not know.

Senator Adams: In the communities I am familiar with, there will always be some kids who take a pack of cigarettes to school. A lot of the time during the school breaks in the morning and afternoon they will be smoking and, typically, they will offer cigarettes to some of the kids who do not smoke. They will ask if they would like to have a cigarette. Do you see that kind of thing happening in your schools here? I know you are not allowed to smoke in the classroom, but how does the system work?

You say today that you are concerned about Bill S-15; will you feel stronger and tell the other kids, when you go back to school, that it is bad for their health in the future?

Ms DeKort: Well, most of the time people smoke either before they come to school or after school or during lunch hours, or if they skip the afternoon, but when we tell people the risks they are taking, they never think it will affect them. They never think they will have lung cancer. They always think it will happen to their friends, never to them, and that is why I think that Bill S-15 should put money towards this.

Senator Adams: Maybe I could ask Diane this question.

You are a director of a group advocating that young people not start to smoke. Like Senator Banks, I would like to see every classroom in all the schools across Canada teaching young people not to smoke. If you had more money today to do it, do you think you could convince a lot more of the kids not to start smoking?

Ms Cassidy: In the CRHA we have been concentrating on training peer educators. So we have been training up young people to run programs with their own classmates or maybe some young people a bit younger than themselves. We found that to be more effective than having the teacher delivering it. The young people have been better at delivering these programs. At the moment we are only just evaluating the programs. We have been doing some pilots. Initial findings are showing that they are having an effect and young people are taking notice of what they are saying.

The WINIT girls also go out into the classrooms and do presentations. We put money towards developing packs for teachers and school nurses and youth workers and also training them how to speak to young people and how to work with young people.

Senator Adams: Maybe Senator Kenny knows the answer to this, but do teachers have any policy on smoking, and on how to teach kids not to smoke? If this bill is passed and given Royal Assent, will teachers have more authority to tell students not to start smoking?

Senator Kenny: Well, the Atlanta Centers for Disease Control template has in it a recommendation for funding for school programs. That does not necessarily mean it will tell teachers not to smoke, but it does mean there would be a significant increase in funding that would go to schools that currently does not go to schools if the foundation adopted a similar sort of format.

Senator Adams: One more question, Mr. Chairman. I don't see very many boys here today. Maybe they are too busy in school, or is it because boys have more interests and are not really concerned about some smoking?

Ms Leclair: The guys in our school are concerned with their sports; for us, we have meetings every Thursday at lunchtime, but the guys don't want to come to the meetings, not because they do not want to do it, really. It is just because they do not want to come to meetings. They would rather go outside. Right now in our committee we only have one guy and even sometimes he does not come because he would prefer to go outside.

Senator Kenny: Mr. Chairman, this is an impressive panel. I have enjoyed this panel more than a lot of panels, and this is really what the bill is all about.

I have a question that I will work my way down the table with, and I will start with you, Sirisha. What got you interested in this? Why have you devoted your time to working on tobacco prevention or helping your friends not smoke?

Ms Tunuguntla: It seemed like a very good thing to do, a good volunteering opportunity, and also a very interesting issue, because I know that many people smoke these days, a lot of kids at school, so I wanted to learn more about it and get more informed, and it seemed very interesting.

Senator Kenny: Gorana?

Ms Radovic: Both of my parents smoke. My mom quit three years ago, and I saw her through her period of quitting and it was really not a pretty picture. So I just wanted to do something and to help my peers and my friends, and I joined this because it is just an opportunity to meet new people and it is really informative. It is fun, and we do a lot of activities. Basically, I just want to help my friends, inform them and help them quit smoking if I can.

Senator Kenny: Shawna.

Ms DeKort: I joined this because at our school lots of my friends smoke, and my mom smokes, and I do not like people who smoke. It is not their personality. It is just I am against smoking, and I think it is disgusting; how can people do that to themselves? I play a lot of sports, and people on my sports teams smoke. So I just wanted to get them to do other things instead of wasting their time sitting at home smoking; to go out and have fun with their friends and not ruin their life.

Senator Kenny: Robyn.

Ms Leclair: At first it did not seem like the best idea; I was not really into it; I thought I had more important things to do; but then, once I started finding out things, it kind of interested me. Then we just carried it on farther. I play soccer as well, and Shawna and I are on the same soccer team. We do know a lot of people who smoke but still play soccer. We thought that together we could try to help them quit smoking. We do know a lot of people through soccer, so we thought getting together and doing this, then we could definitely help a lot of people that we know.

Senator Kenny: I just want to tell you that hearing folks like you talk makes it all worthwhile. That is why we are here; it is because you folks are here, and I want to thank you very much. It makes a big difference to hear how you see things, and it helps the committee an awful lot to know how you think.

Senator Spivak: I also want to thank the panel. This has been very interesting. I want to question Robyn and Shawna particularly. I guess you are the youngest members. It seems to me that kids want to have fun, right?

Ms Leclair: Yes.

Senator Spivak: And out here in this part of the country there is snowboarding. I have kids that snowboard and so forth. Is part of that culture, part of the having fun, smoking? You mentioned soccer and that they also smoke; is that all part of it? Is smoking and going out to have a drink or have a cup of coffee part of having fun? Snowboarding or playing soccer, whatever - is that what they think? I just want to know whether it is just taken for granted that that is part of the fun.

Ms Leclair: It just kind of weaves into playing sports; before a game you have a smoke and then after the game you have a smoke, or you go to the lounge after you are done playing a soccer game. Right now we are trying to write a letter to the Calgary Soccer Centre to get smoking banned from the soccer centre.

Senator Spivak: Does it make a difference to you, for example, if people like Madonna smoke? I am not sure that Madonna smokes; I have not seen some of her videos lately, but you know Madonna never goes in the sun and so she has a gorgeous complexion. Does that make a difference? Do you think kids would not suntan as much if they knew that Madonna, who looks absolutely gorgeous, never goes in the sun and has nice skin? I am trying to get at the psychology here. No? It would not make a difference, or would it?

Ms DeKort: It depends on the person, because I know a lot of people who smoke just to smoke, and then I know a lot of people who smoke because they think it looks cool. It just depends why they smoke.

Senator Banks: Let's talk about that for a moment. Just based on your experience and talking to people, why would somebody begin? In the face of all of the evidence that we now have about what it can do to you, why does somebody begin to smoke? Is it because they see cool guys in the movies? Is it because their big brother smoked? Is it because their parents smoked? What do you think, just off the top of your head, might be the reason young people start smoking.

Senator Spivak: Before you go on with that, let me just tell you something. When I was growing up, having a cigarette was part of everything we did. We went to golf, we smoked; we had coffee, we smoked; we sat around and talked, we smoked. It was part of the fun, and I am wondering if that very old-fashioned idea is alive and well.

Ms DeKort: Sometimes.

Ms Leclair: I think that the ads today from tobacco companies are very convincing. That has a big role, and people who are publishing the ads and get people to do the ads for them, they are not just any person. They are somebody who is known. That also has a big effect. So they do not use just any person. They use somebody well known to people so they know who it is.

The Chairman: Could that same technique be used to help convince people not to smoke? If there was some leading athlete or rock star or somebody that made a big fuss about saying how bad cigarettes were, and all that, would that help you then?

Ms DeKort: I think it would, because if it helps people to smoke it should help people not to smoke.

Mr. O'Hara: If I may, I will just add something to what you are asking there. Young people, in picking up the addiction and the habit and experimenting with tobacco, are not making a rational decision or choice; so to suggest that there are certain phases and steps that they go through that are very predictable is not really typically the way it happens. It usually takes two years for young people to get addicted, and they go up and down through that process, sometimes experimenting a lot, sometimes not at all.

So it is not a very easily understood process. It is extremely complex, and it is definitely not a rational choice. Moreover, people's attitudes change. I have talked to a lot of young people, who at Robyn's age and Shawna's age were dead set against tobacco, but in a couple of years, because their social world had changed and smoking was an important part of that social network, found an incredible value in doing that behaviour. It is very difficult for them to quit because they would be quitting that social network too. So it is incredibly complex.

Senator Spivak: Everybody wants to fit in. It is a lifestyle thing. It is not easy because you have to have a whole different lifestyle. It is done. You go to Scandinavia; that is a whole different culture and lifestyle. I just find it so peculiar that this is so strongly rooted that it does not let go, and it was strongly rooted when I up.

Mr. O'Hara: The good news is that three-quarters of young people do not smoke. About 70 per cent of young people try smoking, but two-thirds of those do not become regular smokers. So while a large number of young people try smoking, they do not become regular smokers. So there is really good news here too. It is not strictly bad news.

The Chairman: I have one question. One result of this bill will be a much higher price for cigarettes. How much effect do you think the price has? In other words, if the price goes up by 50 cents a package, will that stop smoking? It has gone up a lot in the last couple years. Do you think it has anything to do with it?

Ms Cassidy: There is research that has actually just been published today from the University of Illinois in Chicago; their research has been done over six years of studying young people, and they say if you put the price of cigarettes up 10 per cent you will reduce the number of teenage smokers by 10 per cent.

The Chairman: Price does bring it down a little bit.

Ms Cassidy: Yes.

Senator Adams: What effect on employment do you think no-smoking regulations might have? If I am businessman, for instance, with a small business and I am not a smoker, maybe I do not want to hire somebody who smokes, or maybe I hate to hire him because he smokes; or maybe no-smoking regulations apply. Are you sensing something right now in school that, when you graduate from college or from high school, in order to get a job in the future if you do not smoke you have more chance than if you do? Is that your feeling now too, or is there nothing in the future right now that says that because you are not a smoker you are able to get a better job?

Ms Leclair: Yes, I believe that a lot of people think that if they do not smoke they will have a better chance of getting a job or even baby-sitting or anything, because people would prefer somebody who does not smoke to be with their children.

Senator Adams: Today there are boy scouts and girl guides and other kinds of memberships that have their own rules. Do you feel that non-smokers and young people should have some sort of membership which stresses that members will not start to smoke in the future?

Ms Leclair: I do not know.

The Chairman: I have one question to Phil O'Hara. Is there any tie-in between smoking students and the marks they get? Somebody here said that they may want to play hooky for the afternoon. Do they have a tendency maybe to stay away from school because they smoke? I know in business we used to say, dealing with somebody who smoked, all you had to do to get them to sign anything was just keep going on and on because eventually they would want to run out and get a smoke. So I was wondering if smoking affected students' grades, or is there any tie-in between grades that students get and smoking?

Mr. O'Hara: There is a tie-in with socioeconomic background, and that is also related to grades that people get, in particular around experimentation rather than people who become addicted to smoking. People who get lower grades in school, people who come from a lower socioeconomic background are more likely to experiment with tobacco and then they are more likely to become regular smokers.

As I said before, it is incredibly complex, and we do not begin to understand all these complexities about why some young people become experimenters and why some of those young people smoke for a little bit of time and then give it up and other young people who are experimenters become regular smokers. We do not understand that yet.

The Chairman: The youth groups here seem to be very well organized. Has anybody - and that of course applies to the previous group if they want to speak up - thought about boycotts? In other words, if there is a video that shows somebody smoking, you just have to tell everybody not to buy it; or if a movie has the heroine or hero smoking, you do not get it. Is there any attempt at boycotting, say, even a drugstore that sells tobacco? Has there been any thought of boycotts or has anybody worked on things like that?

Ms Freeman: From the Alberta Lung Association's point of view, we have been offered money from tobacco companies for sponsorship of programs, and we will not accept that money because we believe it is tainted.

The Chairman: I think we have a minute or two, and somebody said they saw Dr. Hasselback shaking his head in the audience. Did you have something that you disagreed with or agreed with?

Dr. Hasselback: I think there were several questions related to why youth start smoking, and I think Phil has actually provided you with a bit of information relative to the complexity of the decision process that goes into that.

I do have some documents here relative to some studies that have been done in our area, taking a look at specifically why those choices have been made. The largest correlation, of course, being whether the family smokes; the second largest being whether the major significant other in that person's life at the point in time chooses to smoke, whether boyfriend or girlfriend; and subsequent to that are their friends. So it is somewhat peer oriented. It is not the partying atmosphere associated with tobacco. As a matter of fact, some of that appears to be on its way out.

There are changing times, changing attitudes and part of what is trying to occur here is the counterculture in terms of changing what the belief structures are for youth; but when it comes to boycotting, I think it is up to the youth to tell us when to boycott, and we have had youth in our region who have decided that certain restaurants who opposed bans should not get their business.

Senator Banks: I agree with you, Phil O'Hara, that it is a complicated question, and I agree with you that it is not rationally explicable, because smoking is irrational, but I do not agree with you that it is all that complicated or hard to explain. I suspect if you sat down and asked, in a really serious cross-examination, people to imagine why they smoked, we have probably talked about most of the reasons here today. It may vary from person to person, but I think you could make a list of the commonest reasons people smoke. I look back and wonder why. It is partly because in those days in movies every time something important was to happen, unless it was in the Roman Colosseum, everybody stopped and had a cigarette. When the tension grew, it was cigarette time, and so on. I think that we could probably make a list of those things and say that those are the reasons that, in the main, cause young people, despite the evidence that they ought not to, to smoke. I agree that it is a long list.

The Chairman: Thank you very much for attending here today.

Our next panel, honourable senators, is made up of three groups: Building Leadership for Action in Schools Today, BLAST, Kim Ehrhardt and Renae Lazorko; North of McNight Youth Group, Justienne Galbraith and Juan Delgado, and the Calgary Regional Health Authority, Dr. Brent Friesen.

Please proceed.

Ms Renae Lazorko, Member, Building Leadership for Action in Schools Today (BLAST): Good afternoon, ladies and gentlemen. I am Renae Lazorko, and beside me is Kimberly Ehrhardt. In November 1999, Kim and I were invited to attend a BLAST conference

In the three days that we took part in the BLAST camp, we learned how to set up and run a non-smoking campaign. We gained an abundance of knowledge, and we used that knowledge not only to start our campaign but throughout it as well. During the BLAST camp, we viewed presentations that were fun and educating. We gained courage and were not afraid to speak our minds when we went back to our junior high school.

Before starting our campaign, we had to decide which age groups we would target. Kim and I decided to target grades 5 through 8 because our gym teacher told us that there were grade 5 kids at our school who were smoking.

It is easy for kids as young as that to obtain cigarettes. Many corner stores supply tobacco readily to minors. Once a person starts smoking, it takes an average of five attempts to quit smoking before actually stopping.

Ms Kimberly Ehrhardt, Member, Building Leadership for Action in Schools Today (BLAST): Our campaign consisted of a series of goals. We started a non-smoking club, and at the meetings we coloured posters and brainstormed about ideas to prevent smoking. Our membership included people from grades 5 to 8, and we met every Tuesday. Once the posters were complete, we put up them up around the school. We produced an exhibit of the ingredients contained in a cigarette, and displayed it in the library showcase. We videotaped students from grades 5 to 8 and recorded their comments about what they thought about smoking before and then after watching the "Truth or Dare" video, although we did not get to complete this as we wished.

For the family health night at our school, four grade 8 students put together a song and dance routine about their thoughts on smoking. As well, a group of grade 5 students acted out a play about what can happen to a person who smokes. We did a letter-writing campaign to the Northeast Sportsplex to encourage them to be smoke-free.

Ms Lazorko: We were not able to put some of our ideas to work because of a lack of financial support. With more financial support, we could have completed our video. With more financial support, we could have purchased for our school educational videos and other materials related to smoking, to teach the students on an ongoing basis. If there were more money available, more kids would be able to attend BLAST conferences and learn what we learned, to be able to go back and educate their peers.

Ms Ehrhardt: Our campaign, however, was a success. We know, so far, that we have made a difference. We know this because we have received letters in response to the video from students who smoke telling us that they will think twice before lighting up again. We achieved our goals, and all the teachers and students from grades 5 through 8 participated. We would not change anything about our plan except to do everything in the period of time our principal requested we do it. Even if we have stopped only one person from smoking, we know our campaign has been a success.

Ms Lazorko: If Bill S-15 were to pass, we believe there would be enough money to fund more peer-led programs like ours. Bill S-15 would really help the youth of this country.

Ms Justienne Galbraith, Member, North of McNight Youth Council: Good afternoon Mr. Chairman and honourable senators.

With me today is Juan Delgado.

I am a 16-year-old student from James Fowler High School. We are a group of youth in partnership with adults. Our group offers youth the opportunity to become more involved and influence community decisions.

Many Canadians, especially youth, are lured into tobacco use. Of the $2.2 billion the federal government collects in tobacco taxes annually, $80 million is from the illegal sales of tobacco to youth.

My friends began to use tobacco because of media advertisements and peer pressure. It was the cool thing to do. They also began to use tobacco without prior knowledge of how harmful it would be to them and to the people around them. As youth, we do not have enough education to know the damaging effects of tobacco on our lives. We have just been told in our growing-up years that tobacco is probably not the best thing for us and that we should discontinue using it. I have watched how hard it is for my friends to quit without the help, resources and support that they need.

If this bill passes, a levy on tobacco companies will raise $360 million per year to help these youth, as compared to the government program of $120 million per year.

It has been said that youth behaviours regarding tobacco are more difficult to change than those of adults. That is why this bill is so important. It will enable many groups and organizations, first, to find ways to help the young people of Canada who do smoke to stop and, second, to spread knowledge about the damaging effects of smoking in the hope that those who do not currently use tobacco will not start. Groups such as mine will be able to focus on helping young people quit smoking and preventing others from starting, because both issues need to be addressed in order to realize a true reduction in youth smoking.

This will not be a five-year, band-aid approach. It will be here long enough to make a real difference. There will be many tactics out there to help eliminate tobacco use. Some measures will work for certain people and not for others, and not every attempt will be successful.

A June/July 2000 national Environics survey found that Canadians endorsed Bill S-20, the predecessor to Bill S-15, by a margin of 74 per cent to 25 per cent. The government has expressed its interest in reducing smoking among Canada's youth. Bill S-15, the proposed Tobacco Youth Protection Act, received second reading in the Senate and is now at the committee stage.

Through my work with youth council and through personal experience, I have learned that youth feel better and do better when they realize that someone cares. Putting in place this proposed legislation would indicate not just that one or two people care about their well-being but a whole county, including the government. With this realization, youth would participate in helping groups and organizations find ways to end the destructive path of tobacco use.

It is not as though the money will just be given to the proposed Canadian Tobacco Youth Protection Foundation, to be given out to anybody who is looking for money, and that nobody will find out about the disbursements of the funds; the proposed foundation must report annually to Parliament.

One of the best things that will come out of this is the establishment of the proposed youth advisory committee. In this way, youth will believe that they indeed do have a role to play. Partnerships between youths, adults and government is what will continue to make our country the best to place to live and what will build a wonderful future for all of us. The partnership between youth and adults has worked for the youth council and aided in making our community a better place.

This bill is a small but influential part of many things to come; there will be much success, in more than one way, if it is given the go-ahead. My belief and that of many others is that this proposed legislation is a big step in the right direction. Anything that has the potential to improve awareness and health is worth a try.

This issue is your hands. I hope you take into consideration what has been said and discussed here today. I would like to thank you all for your interest in this issue, for realizing that there is a problem and a solution.

The Chairman: Our next witness is Dr. Friesen. Please proceed.

Dr. Brent Friesen, Medical Officer of Health, Calgary Regional Health Authority: Mr. Chairman and honourable senators, as Medical Officer of Health for the Calgary Regional Health Authority, I am responsible for the city of Calgary and surrounding communities. Just under 1 million people live in the area. The Regional Health Authority is responsible for providing a full range of health services, from prevention-promotion services to acute care services and long-term care services.

Within that population, just under 250,000 are 19 years of age or younger, and that is the group that is of primary interest to you in your hearing today.

I appreciate the opportunity to be able to speak to you today in support of Bill S-15. This bill is important because of its potential to help protect youth against one of the major threats to their health and well-being, and that is tobacco. This proposed legislation is timely, given the loss of momentum in tobacco control in Canada and the evidence that tobacco addiction is increasingly becoming a disease associated with poverty, further adding to the inequities that exist in health among the poor. Effective tobacco-reduction strategies that we have seen in other jurisdictions have the potential not only of protecting youth but also of reducing some of the inequities that exist in health within Canada.

There is a need for action at a national level; the ability to take action at a local level is constrained. We have not been able to achieve the successes that we had hoped to in the 1980s, and I would like to illustrate this through local experience.

It was over 13 years ago that the Calgary Winter Olympics were held. As a result of initiatives by Calgarians, the Calgary Winter Olympics were the first smoke-free Winter Olympics to be held. Smoking was not allowed in the venues where athletes were competing.

This was a time when Canada was recognized internationally for its efforts in tobacco control and the successes achieved in reducing smoking. At the local level, we were very enthusiastic about our progress. In fact, linked to the Winter Olympics and in conjunction with the local school boards, we announced an initiative called the Smoke-Free Class of 2000. The intent of that initiative was that students entering grade 1 in 1988 would graduate in 2000 as non-smokers.

That initiative failed. In fact, over that time period, from 1988 to 2000, the number of 15- to 19-year-old girls who smoke increased by 32 per cent, from 23.5 per cent in 1989 to 31 per cent. Among 15- to 19-year-old boys, smoking increased by 26 per cent, from 21.6 per cent to 27.2 per cent. The real tragedy in our region is that there are over 4,140 more girls than boys smoking in this age group than would have been had we been able to maintain the rates that existed in 1989.

Now, this is in spite of the Calgary Regional Health Authority identifying tobacco control as a priority area for health improvement. As a Regional Health Authority, we have used specifically targeted health-promotion funds from Alberta Health to support regional tobacco-control initiatives. You have heard some of them discussed today. The Women's Initiative in Tobacco, WINIT, as well as Igniting Cochrane Against Tobacco program, a local community program where the rate of smoking was higher than 30 per cent, in and of themselves were very successful. There were also other successes with individual schools, where pilot programs have been tested. However, together they were not enough to change the momentum across the region.

In spite of this being a priority for our region, in spite of a commitment in terms of resources, the amount of funding that we have put into it translates into about $1 per capita. It would be virtually impossible for the region, out of its existing funding, to allocate the type of money that is being talked about in terms of the best-practices document. To come up with $14 per capita for youth, to support effective, comprehensive programs, is just not in the cards in terms of for. We are not able to do it out of the funding we receive from the province - and that is in spite of us being in an extremely wealthy province.

There are pressures on the acute care system. There are issues such as access to diagnostic imagings, to MRIs. It is difficult in terms of making funding decisions whether to fund an MRI or to fund a youth tobacco prevention program. The person who is waiting at the door of the hospital ends up the priority.

So without a foundation like that being proposed in Bill S-15 where there are targeted, dedicated funds for prevention of tobacco among youth, it will be very difficult for health organizations across this country to reach the levels that are being proposed in the best-practices document.

The final point I wish to emphasize is the importance of prevention among youth as a strategy to reduce the inequities in health. Studies have shown us that persons with lower incomes and lower levels of education have poorer health. We monitor health practices within our region on a regular basis, and we know, through these surveys, that smoking is strongly correlated to the level of education that people report.

To illustrate that, 11 per cent of those people who have a university education report themselves as smokers. For those who have a technical/college education, 24 per cent report themselves as smokers. For people who have completed grade 12, 38 per cent report themselves as smokers. If those who have not completed grade 12, these are adults, it increases to 58 per cent.

It will be very difficult, if not impossible, to reduce the inequities that exist in terms of health status between these different income groups without tackling smoking. If we can put in place an effective strategy to prevent the youth from starting to smoke, we will at least have a strong base upon which to build the other initiatives to address other inequities related to health status.

I want to emphasize my support for the passage of Bill S-15. The objectives of Bill S-15 are consistent with and supportive of those of the Calgary Regional Health Authority. They are consistent with what we want to achieve, in terms of the prevention of smoking among youth. The type of resources and support that are being advocated through Bill S-15 are crucial if we are to make progress in this area.

In addition to thanking honourable senators for their interest in this matter, I also wish to thank the youth of Calgary who made the effort to come out and make their presentations to you.

Senator Kenny: I am impressed with how well researched the panel is. Clearly, the group has done a lot of homework and preparation, which is helpful to us.

I am curious about how you get access to cigarettes. How do your friends get them? Where do you buy them? Are they sold in packs, or are they sold in smaller units?

Juan, do you have any information you would like to share with the committee?

Mr. Juan Delgado, North of McNight Youth Council: We can go to any corner store and ask an older person to buy them for us. Often, store attendants will not even ask the age of a young person who is asking to purchase cigarettes. Often, store attendants will not even ask for proof of age. It isn't hard to get cigarettes.

The Chairman: Do most young people who start smoking swipe cigarettes from family members, or do they actually go out and buy them?

Mr. Delgado: There are many ways to get cigarettes, older brothers, friends, parents. There are cigarettes everywhere. You cannot hide the fact that there are cigarettes everywhere in society.

Senator Kenny: Kim or Renae, what do you have to say about how young people get access to cigarettes?

Ms Lazorko: My friends either just walk into the store and buy them, because store clerks do not ask for proof of age, which is pretty bad, or they get older friends to buy their cigarettes.

Senator Kenny: Something that has not come up is the issue of young women smoking because they think it will keep them thinner. Is that true?

Ms Galbraith: I do not think that is really it. Sure, there are some myths around that, but as a young teenage girl I did not heard anything about that. I did not really hear that until we started holding meetings. In the olden days, girls were expected to be lady-like. They wore the dresses, and there was this whole stereotypical way for a girl to look and behave. Now, there is more freedom to do your own thing. So I guess that is why we have seen an increase in smoking among young girls.

Senator Kenny: But you two nodded when I said that.

Ms Ehrhardt: Well, one of my friends thinks that smoking will make her look better, thinks it will make her all skinny and everything, but I do not think that is true.

Senator Kenny: Are skinny girls more popular?

Ms Ehrhardt: Not always, because usually they will have the big attitude.

Senator Kenny: Tell us more about setting up and running a campaign. How does a campaign work when you are trying to get your friends and classmates to think differently?

Ms Lazorko: It was hard when we first started. We did not think our friends would listen to us. We did not think that people would care. We thought we would turn into outcasts. What teenagers go against smoking and stuff? But our friends were pretty good actually. They listened to us. They were pretty good.

Ms Galbraith: To start a non-smoking campaign, I think you have to talk to the youth and get really involved with the smokers. That is basically where it would start. Just in terms of the communication aspect of it, it is a lot easier if they start to understand what you are trying to do. So you have to educate them a lot, and then it makes the whole campaign a lot easier to run I think.

Mr. Delgado: However, it is hard to get the smokers out to an anti-smoking event. It would be the non-smokers who would support an event like that. So, it is a struggle getting the education to the right people.

Senator Kenny: You are preaching to the converted, in other words.

Mr. Delgado: Yes.

Senator Kenny: So you go where the sinners are.

Mr. Delgado: Yes.

Senator Kenny: And where are they?

Mr. Delgado: Again, they are everywhere.

Senator Kenny: You do not have any trouble finding them, right?

Mr. Delgado: No, not at all; the problem is getting them to the right place. That is where the problem lies.

Dr. Friesen: The pilots we have done have included what we call the comprehensive school health approach. What that involved was putting resources into a particular school to help the students and teachers determine what are the health issues within that school. We found that sometimes it takes a while before smoking will surface as an issue the particular school or student body wants to address.

Often, it means just starting with the basics, in terms of the students becoming more involved in making decisions about how a particular school is operated. For example, it could be an issue of privacy and safety in terms of the students wanting doors in the washrooms. The point here is just one of involving students in discussions about issues they feel affect them when they are in the school.

We have found, as those comprehensive schools get established, that the students begin to say, "What are the things that are influencing our health and well-being?" It may be that violence will be identified as an issue; it may be that smoking will be identified as an issue; or it may be that physical activity or dietary issues came forward as concerns.

The point here is that this is an evidence-based approach, which would be, as I understand the bill, eligible for consideration; in other words, it is an approach that could be brought forward in terms of building the capacity at that school level to deal with tobacco.

Senator Kenny: How much of your funding is devoted to evaluation?

Dr. Friesen: I could not give you a percentage at this time. It is certainly much less than the 10 per cent proposed in the bill, and I think that is an important element of the bill. There is a tendency to underfund evaluation, to try to tack it on at the end. As a result, it tends not to be done as well as it probably should be.

Senator Banks: Statistics such as the ones you gave us, about the incidence of smoking among people relative to their various levels of education, are quite useful in terms of answering some of the resistance to this bill. Could you talk just for a moment about the methodology of this data, and where it came from, how reliable, how widespread, and how statistically accurate it is?

Dr. Friesen: The data I provided to you is from the Health Canada Web site. It comes from their report on smoking trends among Canadians from the early 1980s through to 1996-97.

There has been some variation in the types of studies that have been used to collect the data over the years, but that was the source of the information, and I can provide you, Senator Banks, with more details on the actual studies.

Senator Banks: It broke it down to schools in the Calgary region?

Dr. Friesen: No. Unfortunately, there is no good region-specific data, so I was using national level data.

Senator Banks: I think you may have misunderstood me. I am talking about the item in your presentation that referred to proportion of smokers by level of education in the Calgary region.

Dr. Friesen: That information is generated from an annual random-digit telephone survey we do ourselves as a Regional Health Authority. One year we survey adults, the next year we survey families with young children and seniors. We have asked the same questions over the duration of the survey.

Senator Banks: So this is a survey by the Regional Health Authority.

Dr. Friesen: That is right.

Senator Adams: Renae, before coming here, how did you feel? Do you think that because of your experience you will be able to help kids not to start smoking? Does it make you feel good to come here?

Ms Lazorko: It makes me feel good to come here. I also feel good trying to help kids not to smoke. I am strongly against smoking. I do not know why kids start in the first place. I feel good about doing all this.

Senator Adams: When you go back into your classroom tomorrow and tell your classmates that you met senators from Ottawa, how do you think the other kids will feel? Will they listen more to you? Will you have more influence in terms of what you decide to do for the other kids?

Ms Lazorko: I told a couple of kids today that I was appearing in front of this committee, and they thought it was pretty cool actually.

Senator Adams: You can tell them that you are now part of the record of this committee proceeding. Your testimony will go down in history. The proceedings of committees are kept in the Library of Parliament, in Ottawa. In 10 or 15 years time, you can look up your testimony. It will be on record forever. You can tell the other kids that. Do you feel good about that?

Ms Lazorko: I feel good about that, too.

Senator Adams: Dr. Friesen, you have known many people I am sure who have been diagnosed with lung cancer. How does that make you feel? How do you feel when somebody you have advised to quit smoking gets lung cancer?

Dr. Friesen: I worked in Northern Manitoba and in the District of Keewatin in the Northwest Territories at, I guess, a very unfortunate time. It was during my time there that the first Inuit person underwent coronary artery surgery as a result of eschemic heart disease. Up until that point, it was virtually unheard of among people of Inuit descent.

What we were starting to see at that time was the impact of lifestyle changes, related to tobacco use, diet and other factors, in that population.

Another issue of importance was the number of young women experiencing pregnancy complications, again linked back to smoking. At that time, we were seeing rates of smoking among the youth in the District of Keewatin of over 50 per cent, and that was a horrendous public health problem.

Other witnesses have commented on the importance of a comprehensive strategy. One of the things that I have learned is that there is no single magic bullet in terms stopping smoking. For those people who want to stop smoking, it is important that they have an environment that is supportive of them.

This is where issues such as smoke-free restaurants, smoke-free public places become important, in addition to providing protection against environmental tobacco smoke.

Smoking is an extremely addictive behaviour, one that is very difficult to stop. It is important to put in place effective anti-smoking campaigns. It is important, once someone has decided to stop smoking, to assist and be supportive of that individual. My father, who stopped smoking in 1963, still remembers the last cigarette he smoked. He is 85 years old, and he remembers the last cigarette as though he smoked it yesterday. It is an extremely powerful addiction.

Anything we can do to prevent smoking is well worth it. It is important for us to regain the momentum we had in the 180s. Had the trend of that time continued, the rate of smoking in the population would have dropped to around 10 per cent or less. Instead, smoking has increased. We must regain the momentum. In my opinion, one of the most important things Bill S-15 offers is a chance to regain the momentum that was lost. The announcement from Health Canada is not sufficient enough to do it. Although it is important, it will not provide sufficient momentum in and of itself. Bill S-15 has the potential to do that.

Senator Adams: Health Canada puts out a lot of advertising about how bad cigarettes are for your health. Does that help? In some of the communities I am familiar with, in post offices and stores there are posters, et cetera, about the damage cigarettes cause. One talks about mouth cancer. It makes people scared, they don't want to look at it, but they are not quitting smoking. The government is putting a lot of money into advertising, on television, on cigarette packages, and stuff like that. Does that help a little bit?

Dr. Friesen: Once again, I would draw your attention to the importance of a comprehensive approach. It does not help very much trying to frighten someone into quitting if they do not have access to information about how to quit smoking. That is what was different about the approach in California. They had a 1-800 number, offering a multilingual service. Not only that, the service would call people back at convenient times for them. They know how critical day 3 or day 4 is, day 10 or 12, when people are likely to really crave a cigarette, and they would phone. These are important factors in a successful campaign.

It is also important to do compliance checks on vendors. We must ensure that cigarettes are not being sold to minors, either intentionally or unintentionally. That is also part of the comprehensive approach.

I think what we have learned over the past decade is that there is no sort of magic regulatory bullet that will do all of it for us, that we need all of the elements outlined in best-practices.

Senator Adams: If we pass Bill S-15, will there be some more improvement?

Dr. Friesen: Absolutely. It will give us a chance to gain back some of that momentum that we lost.

Senator Adams: How do the youth feel about those signs in the corner stores, that you have to be 19 to buy cigarettes? How do the kids feel about being asked how old they are?

Mr. Delgado: In terms of buying cigarettes, it is funny how youth are so determined when they have a goal in mind. If they want to get cigarettes, if that is what they really want to do, they will get them, one way or another. It does not matter if there is a sign, it does not matter if there is a law, it does not matter if their parents do not want them to smoke, it does not matter if the school will not let them smoke on school property. These things don't matter. Youth are pretty stubborn. When we want something, we will get it no matter what. Unfortunately, smoking is one of those things, and it is causing big problems.

Senator Adams: Do you ask the kids why they smoke? Do you ask them if they are bored? Do they smoke because their family members smoke?

Mr. Delgado: In my opinion, the reason people smoke is because it is everywhere. It is part of society. You see it in the movies, on television, everywhere you go. It is normal to see someone smoking. It is not abnormal. Go anywhere and look down and you will probably see a cigarette butt. It is everywhere. And unfortunately, that is what we have to deal with.

That is why Bill S-15 is so important. It is the first real step in the fight to stop smoking among young people.

Senator Adams: Do you think that young people who smoke might be encouraged to stop if Bill S-15 is passed? We already have a law that prohibits young people from buying cigarettes, but that does not seem to discourage them from smoking. Even if their mothers catch them smoking, they continue. Do you think that young people would be more afraid to smoke because we have a regulation, a law? I am not referring to you, but to those kids who smoke.

Mr. Delgado: Maybe, but I cannot speak for other kids. However, we have to do something to stop young kids from smoking. If we don't, more kids will start smoking, and ultimately health care costs will increase. So we have to do something, and Bill S-15 is that something. It is not a complete solution, but it is part of the solution, and it will help.

Ms Galbraith: Can I just say something on that? I do not think teenagers think to themselves, "I am not 18, so I should not be smoking." I think they are more likely to think, "Well, it won't do anything to me, so why should it matter if I smoke?"

The reason this bill is so important is that it will provide more funds to help people realize that smoking is harmful. These funds will allow a consistent message to get out to smokers, telling them the dangers of smoking. The message will not just be one of, "Well, you are a youth, you should not be smoking." After all, kids see their parents smoking and see other adults smoking, so they think to themselves, "Well, if they can smoke, why can't we?"

I think this is important because, through the funds, smokers will learn what will happen to them in the long run, and maybe kids will decide not to smoke for those reasons and not because of some law.

Senator Adams: Young people know that more than 40,000 people die every year in Canada from lung cancer?

Ms Galbraith: Those are statistics, and those statistics often do not get talked about in schools. There are smoking videos that are shown in school, but only five classes a year see it. There are 1,600 kids in my school. It will not make a difference. The message has to be consistent, it has to contain hard statistics, and everyone has to hear it. It cannot be just a once-a-year message heard by 10 people. The message has to be there consistently, and it has to be strong. That is what might make a difference.

The Chairman: My questions are for Dr. Friesen.

There is bill in the House of Commons, not presented yet, but the government has suggested how much per person in education?

Senator Kenny: Three dollars per capita.

The Chairman: Bill S-15 has that figure at about $12.

So, there is a bill in the other place that will see $3 per capita spent on this issue, which is more than what was spent in the past.

Senator Kenny: Sixty-six cents.

The Chairman: Yesterday, however, we were told by a presenter that $3 was worse than useless; in other words, unless the amount per capita is $8, $10, $12 or $14 it is pointless.

Now, would you go so far as to say that the $3 is worse than 66 cents? In other words, do we have to go to $12 before we get there?

Dr. Friesen: It will not allow you to do the comprehensive program. You will be forced to make hard choices like what we made in our region.

You heard about WINIT, which is funded through the Calgary Regional Health Authority. We chose to fund that because of our concern about rates of smoking among women within the region. So we gave a higher priority to focusing on smoking among women than smoking among males. Since we could not do everything, we made the decision to focus on the problem among women rather than men. As I said earlier, one of the reasons for that decision was to make some headway into the issue of pregnancy and smoking.

Similarly, because the rate of smoking in the community of Cochrane was 33 per cent, we decided to support a community development approach there. However, there are other communities out there that have high rates of smoking, 28 per cent, 29 per cent, and we were not able to fund an approach in those communities.

So, if the per capita rate is insufficient, you will have to make tough choices. You will have to target only certain groups. There will not be room for a comprehensive strategy, which is what is needed to bring down the overall rates.

The Chairman: It is apparent that with $3 per capita only we will not be able to do anything about prevention among youth. We will only be doing band-aid work.

Dr. Friesen: You will have to focus in on very specific populations and write off other ones. If you try to do a little bit for everybody, it will be worse than nothing at all, because it will give the belief that you are doing something when in fact you are not.

The Chairman: I think I read something in a Calgary newspaper about a penalty with respect to respiratory diseases or diseases that result from tobacco use. Would it make sense in our health care system to impose higher premiums on smokers or force smokers to the back of the line, in terms of treatment, or something like that?

Dr. Friesen: You are asking a pretty tough ethical question. My understanding is that people who start smoking, regardless of the information about the health risks of doing so, believe they are invincible, in terms of those risks.

The Chairman: So penalties are not likely to work; is that what you are saying?

Dr. Friesen: It is along the lines of victim blaming. These people have an addiction, and to penalize them for that addiction is not appropriate. From a personal point of view, I would have a lot of difficulty charging a penalty or putting smokers further down a treatment list.

The Chairman: There has been reference in the past number of days to a reversal in momentum vis-à-vis smoking cessation. In other words, 10 years ago it looked like we were reducing the incidence of smoking, then it turned. Why did it turn? Why did we lose momentum? Did the tobacco companies put on a full-court press, or did we just lose interest? Someone suggested that cheap cigarette prices added to the lack of momentum, the reversal.

Senator Kenny: I do not want to pre-empt the Dr. Friesen's answer, but in 1994 there was a significant cut in the price of cigarettes in the five eastern provinces.

The Chairman: So making them cheaper is part of the answer. But what else happened?

Dr. Friesen: There was a heavy focus on the taxation approach, that if we were able to significantly increase the cost of cigarettes - and there was evidence to this effect in other jurisdictions - we would see a dramatic drop in rates of youth smoking. We put a lot of eggs in that basket. So when the government dropped taxes on cigarettes, we lost that momentum; there was a reversal, in fact.

In addition, we did not deal with the comprehensive approach or take into consideration the spillover in terms of the media effects that people have talked about from the U.S. into Canada. I think that is the learning that we have from the best-practices document, that it needs to be comprehensive. That is consistent with our experience locally, where we know that if we want to be effect we have to combine different strategies. We need to look at the creation of smoke-free schools.

The other thing that contributed, I think, on the public health side is that a lot of time in the 1990s was devoted to health restructuring. I believe that that significantly affected our ability to develop new programs and to expand existing ones.

Senator Banks: Dr. Friesen, you raised the question of ethics when you said that we ought not to punish somebody for being an addict. I am wondering how far that goes. I am just asking you for a personal view now, but you are the medical officer of health so you run into ethical questions all the time. Maybe we should not punish somebody for after the fact of their having become an addict, but at some point are they not responsible for something? Should we not punish them for being stupid, say? Or should they not be made responsible for their extraordinarily high cost of personal health care? Is there no responsibility here for the consequences of bad behaviour?

One of the problems in society today - and this is talked about by people who are educational curriculum specialists and educational administrators - is the issue of an absence of discipline in the schools; in other words, there are no consequences for bad behaviour.

Should there not be some consequence - after all, no one can honestly say that they started smoking or shooting up or gambling, or whatever, without knowing that there were bad consequences to this behaviour. Should not persons who bring those things on themselves, and I will ask the questions about smokers, have some responsibility for that?

Dr. Friesen: I guess I probably find it easiest to answer your question by using an example in another area, HIV. On occasion, we are forced to deal with people who are infected with HIV.

Senator Banks: But you can become accidentally infected by HIV. You cannot accidentally start smoking.

Dr. Friesen: If I can just finish my analogy in terms of HIV. If someone is infected with HIV, either accidentally or as a result of lifestyle practices, we go through a process. We make sure they are educated about the disease and talk to them about what precautions they need to take to protect themselves and others. If we encounter a situation where somebody, in spite of being given all that information, being able to understand that information, continues to place other people at risk, then there is an expectation and an obligation for us to take action to protect others.

In the case of someone who is addicted to tobacco, again there is an obligation for us to provide information about the addiction and to provide an opportunity for effective treatment for the addiction. Again, that is part of a comprehensive strategy. We make sure that health professionals are aware of approaches in terms of counselling and providing support to people who are addicted to tobacco.

If the person chooses to continue to smoke, in spite of being offered that, then I can see where some physicians, if they were to be providing a treatment, may say to a patient, "It does not make sense to offer you this treatment because it will not be effective if you continue to smoke." So, yes, there are physicians who will make that decision and use the rationale that the treatment they will offer will not be effective if the person continues to smoke.

So I think those decisions can be made, but we have got to remember that tobacco is still an addictive substance and that we have to be really assured that the individual has been provided with the appropriate information and opportunity to stop smoking, stop using tobacco, before we blame them in terms of that addiction and take sanctions against them.

I guess I see it very low down in terms of as a tool to control tobacco. It may be there at some point, but I think it is way down in terms of the list of things that we should be doing.

Senator Spivak: Just a comment if I may, Mr. Chairman. The thing about this is that society's ills can be best approached through preventive measures rather than after-the-fact acute measures, never mind even punishment. Among those most responsible here are the tobacco companies. Sometime ago there was a movement to include tobacco in the Hazardous Products Act, but somehow it never got through. Why, I do not know. Obviously it has to do with money. If tobacco were included in the Hazardous Products Act, I think it would give it more of a stigma. It could be treated like other dangerous drugs - not that that would stop its use. However, if we are talking about blame, that is where I would start, in my opinion.

The Chairman: Thank you Ms Lazorko, Ms Ehrhardt, Ms Galbraith, Mr. Delgado and Dr. Friesen.

The committee adjourned.

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