Proceedings of the Standing Senate Committee on
Energy, the Environment and Natural Resources
Issue 4 - Evidence, April 25, 2001 (afternoon)
EDMONTON, Wednesday, April 25, 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 1:14 p.m. to give consideration to the bill. Senator Nicholas W. Taylor (Chairman) in the Chair. [English] The Chairman: Before we get underway, I want to introduce an old friend of mine, and a very distinguished Albertan, in the audience, Stan Schumacher. Stan was a long-time member of the legislature and a Speaker of the House. The first panel is composed of Steve Patterson, Gerry Predy, Les Hagen and Roger Hodgkinson. Are you all from different groups? Perhaps you might just say a word or two about your group before you get into your presentation. Dr. Roger Hodgkinson, Honorary Chairman, Action on Smoking and Health: I am a pathologist by training. Mr. Les Hagen, the executive director of ASH, has asked me to present on his behalf. As you have already indicated, we are indeed honoured to have Mr. Stan Schumacher in the audience today, not only because of his previous contribution to political life in Alberta, but because he is also on the honorary board of Action on Smoking and Health. On behalf of today's presenters, I would like to welcome you to Alberta's capital, and we commend you for consulting with stakeholders across Canada on this very important bill. We hope that you will find your brief visit to be a productive and rewarding experience. We are very pleased to observe that no one has had to be subpoenaed to attend today's hearing. In fact it was difficult to pare down the presentations to just two panels. Action on Smoking and Health has been Western Canada's leading tobacco control organization for the past 22 years. ASH has provided local, regional and national leadership on the tobacco issue from its base in Edmonton. We would like to begin by congratulating Senator Kenny for bringing this issue to the fore and for his unwavering determination to protect the health of young Canadians. Senator Kenny has been a source of tremendous inspiration to those of us who are fighting in the trenches for tobacco control. We also thank the senators present for their continued support of this very important bill. Although it is not necessary to repeat to this committee in detail the grim statistics associated with tobacco use, we would like to set the appropriate tone for today's hearing. Three million Canadians presently alive will die from tobacco use if current smoking rates go unchecked. One in every five deaths in Canada results directly from tobacco use. It is by far the single most preventable cause of disease and premature death in this country, resulting in more deaths than alcohol, injury, illicit drug use, murder, suicide and AIDS combined. To put this death toll into perspective, tobacco use results in the equivalent of 17 Walkerton outbreaks every day in Canada. By any measure, we are dealing with an unparalleled epidemic that is screaming out for our full and undivided attention. Smoking rates are at an all-time high, with 28 per cent of young people aged 15 to 19 smoking regularly. In fact, smoking rates among this age group exceed those in the general population. Over 100,000 kids are taking up smoking each year in Canada, with no immediate end in sight. Canada's appalling track record on youth smoking is shameful. Forceful action is required immediately if we are to reverse these alarming trends. As you all know, tobacco addiction is fundamentally a pediatric disease, because the vast majority of smokers start before age 18, long before they have the capacity to make a life-affecting decision about such a uniquely deadly and addictive product. Vigorous denials notwithstanding, the tobacco industry relies on these youngsters to replace customers who have quit or who have died from using their products. To date, no Canadian jurisdiction, federal or provincial, has adopted and adequately financed an evidence-based strategy predicated on current best practices. The available resources simply do not reflect the enormity of the problem. As you will find in your travels, there is a tattered patchwork of programs and resources across Canada that vary greatly in scope, application and impact, and there is a disturbing lack of direction, coordination and leadership at all levels. The package of tobacco use reduction measures recently announced by the federal government is woefully inadequate. Despite past assurances by the Prime Minister, tobacco taxes have not been restored to 1994 levels, although smuggling between Canada and the U.S. has been virtually eliminated. The federal tax increase announced earlier this month had no impact on Western Canada whatsoever, due to the tax disparities between the provinces. The increased federal funding is a pitiful one-quarter of what is needed and of what Bill S-15 would provide. Based on the substantial experiences of California, Massachusetts, Oregon and Florida, this funding will not create the critical mass required to achieve results. The funding is also not stable or guaranteed and could easily be cut back due to other fiscal pressures. The inadequacy of the current federal strategy is best reflected in its abysmal performance targets. These targets fall far short of the outcomes being achieved in jurisdictions with well-financed, evidence-based reduction programs. In fact there are no targets related to youth smoking. Bill S-15 has the potential to transform Canada's tobacco reduction strategy. The bill is based on a solid foundation of science and practical experience from jurisdictions that have significantly reduced tobacco use. The bill would fulfil all the best-practice criteria established for effective tobacco control programs by the U.S. Centers for Disease Control. These criteria include: funding in the range of $7 to $21 per capita; comprehensive, evidence-based programming; strict program funding criteria with mandatory evaluations; transparency in governance and operations; rigorous and regular reporting; and most importantly, an arm's-length relationship from government. The funding resulting from Bill S-15 would provide the critical mass that is essential to achieving results. This funding would be stable and sustainable and would be tied to the levels of tobacco consumption. Best of all, the program would be entirely financed by tobacco companies. Bill S-15's commitment to comprehensive, evidence-based programming will ensure that the funding is spent on programs that clearly work. Continual adjustments can be made to maximize the impacts of the overall strategy, based on best current practices. We support the establishment of a transparent, arm's-length foundation to coordinate this effort. This foundation will ensure that scientific rigour is applied to each grant and that all the projects are independently evaluated. An arm's-length foundation will also prevent political interference that could hinder the program. For example, the federal Tobacco Demand Reduction Strategy was announced in 1994 to counteract the health impacts of the tax rollbacks. This strategy was funded by a 3 per cent surtax on tobacco industry products. However, within three years, the entire program was scrapped, even though the government continues to collect the surtax. Bill S-15 will prevent this experience from being repeated. Bill S-15 would finance a national mass-media campaign similar to those that have been so successfully deployed in California, Massachusetts, Oregon and Florida. Tobacco industry denormalization has been a cornerstone of these campaigns by emphasizing that the tobacco industry operates outside the norms of legitimate business. As stated by an official with the California campaign: Debunking the industry is the bedrock on which the campaign rests. If you do not have the bedrock, your campaign will ultimately fail. The Florida media campaign has been particularly successful at promoting an anti-industry-manipulation strategy among young people. So successful, in fact, that youth smoking rates have declined by an astonishing 40 per cent in just two years. The Florida campaign urges young people to rail against the tobacco industry and to refuse to buy into their sophisticated advertising messages. A landmark review of tobacco control programs published in 1999 found a comprehensive approach is effective in reducing teenage smoking, and that this approach has the biggest bang for the buck among all interventions. I am tabling a copy of this report with the committee. We are very suspicious of the tobacco companies' motives in supporting Bill S-15. We believe that their apparent support is just a smokescreen intended to obscure their grotesque track records. The tobacco companies' claim that they have no interest in the youth market is just not believable. Their actions, and their internal documents, reveal exactly the opposite. However, Bill S-15 has succeeded in trapping the companies in their own rhetoric about their so-called "desire" to prevent youth smoking. If the companies were sincere about reducing youth smoking, they would not have had to be subpoenaed to testify before your committee, and they would be calling also for complementary measures to support Bill S-15 such as a tobacco tax increase, smoking bans, and further marketing restrictions. They are deafeningly silent about these measures of support. They would also be launching a major, national lobbying effort that would match their past self-interested campaigns to roll back tobacco taxes and fight marketing restrictions, smoking bans and health warnings, et cetera. We believe that their efforts to support Bill S-15 to date have been purely cosmetic attempts to hide their motives. Their real motives are simply to replace smokers who have quit or who have died using their products. The vast majority of their new customers are in fact adolescents. In summary, we offer our full, unqualified support for Bill S-15, and we are anxiously awaiting its speedy passage in the Senate and the House of Commons. This bill holds tremendous promise for Canada's youth and for the creation of a smoke-free generation. We hope that the government will not interfere with the passage of this important bill, and we urge Health Minister Allan Rock to endorse it in its entirety. The answer to the youth smoking problem is staring the minister in the face, as it has been for years, and we hope that he will respond accordingly. If Allan Rock really wants to prevent young people from smoking, he should not be allowed to reject this bill. Dr. Gerry Predy, Medical Officer of Health, Capital Health Authority: Mr. Chairman, the Capital Health Region is one of Canada's largest integrated health-care systems. We provide a full range of services, from prevention to heart transplants. I am not going to go repeat the statistics that Dr. Hodgkinson went over, but I will just reiterate that there is a tremendous human cost behind those statistics. If you visit any one of our facilities, you will see the unfortunate effects of tobacco on our population. Our hospitals are full of people with diseases that could have been prevented. Since this is such an important issue, it is obviously a priority for us at Capital Health, and our board has endorsed this as the number one issue with which we must deal. As such, we strongly support Bill S-15. I will keep my comments brief and just speak to three components: first, funding, then the foundation, and finally, the need for comprehensive programming. Obviously, we will not succeed in reducing tobacco consumption without adequate funds, and Bill S-15 does propose a mechanism whereby the necessary resources for implementing a program at the local, regional, and national level can be provided. The bill would provide substantial support along the lines, as Dr. Hodgkinson mentioned, that have been suggested by the Centers for Disease Control in the United States. Based on their review of best practice, they suggest that funding between $9 and $24 per capita is required. Bill S-15 does propose about $12 per capita, which is just above the minimum amount. The recent announcement by the federal government offers less than $3 per capita, which is only one-quarter of that recommended by CDC. I just want to again emphasize the need for a funding critical mass. If you are not going to put in enough dollars, you may as well not put in any. You will be doing more harm than good, in the sense that you will be lulled into a false belief that something is being done. However, if the funding is inadequate, you will not succeed in reducing tobacco use and will just be wasting your money. I want to emphasize again that there is research, from California particularly, that shows that for every dollar they spent on tobacco control, they saved $3.62 in tobacco-related health care costs. However, this can only happen if you achieve a critical mass in spending. You have to spend the dollar. If you spend 10 cents, you will get nothing. You will just throw your 10 cents away. I might just quote Hugh Winsor in The Globe and Mail: In the poorly understood interface between kids and smoking, it seems the Canadian penchant for low-budget, middle-of-the-road compromises does not work. Second, I want to talk about the establishment of the foundation, which would exist at arm's-length from government and report annually to Parliament. Again, this would allow for the necessary long-term planning in programming, transparency in decision-making, and as Dr. Hodgkinson mentioned, the particularly important evaluation component. We have learned through health care reform that we do a lot of things that are not based on evidence, both in prevention and in treatment. The emphasis in reforming the health care system has been to move to an evidence-based model. We would strongly support making evaluation a strong component of the foundation. We would also endorse the provision that the foundation would put a ceiling of 5 per cent on administrative costs. I have one cautionary note about a national-level foundation. Some national efforts with respect to tobacco and other issues have not been successful because of insufficient funding at the local level of the health authority or public health department. This is where staff interface with kids in schools on a daily basis. Therefore there needs to be adequate funding at that level as well as at the national and provincial levels. That brings me to my final point, which is the need for comprehensive programs. The federal government has concentrated to date on restrictions on tobacco advertising, packaging, and promotion, and they have now introduced tax increases that should have an impact, especially on youth. However, the approach has not been comprehensive. Just to reiterate Dr. Hodgkinson's comments, the rate of youth smoking has declined by 43 per cent in California since 1995. In fact, I spent last summer in California, in the San Jose area, and when you walk down the street there, you do not see kids smoking. It is actually quite striking. If you walk down the street in Edmonton, or in any of Canada's major cities, you will see 13- and 14-year-olds smoking. They have been successful because they mounted comprehensive programs. These programs include policy initiatives, social marketing, cessation, education and youth conferences. As I said, these need to be delivered at the local, provincial and national levels. I would applaud Bill S-15 for providing a thorough outline of the steps that the proposed foundation would take to address youth tobacco use, including developing a multi-year strategy, examining models of best practice, and creating a Canadian model. I will close by saying tobacco use is not just a problem for people in the health care business. It is a society-wide problem and should be everyone's concern. The solutions must involve a broad sector of society. Bill S-15 recognizes this, and if approved, would go a long way toward implementing the solutions that we know will work and have worked elsewhere. Dr. Steven K. Patterson, Regional Dental Officer, Crossroads Regional Health Authority: Mr. Chairman, and honoured members of the committee, I appreciate the opportunity to be part of this panel. I certainly recognize the tremendous effort being expended to ascertain views across the nation. I am a dental officer for the Crossroads Regional Health Authority, which is a rural community just southeast of Edmonton. I come first and foremost to express the viewpoint of a health care provider who has seen the impact of tobacco addiction on the lives of Canadians. I see it as primarily a health issue, and not necessarily a rights issue or a public policy issue or a freedom issue. I have noted that even though approximately 29 per cent of our adults over age 15 smoke, which is about one in three people, the percentage of tobacco users that we see in the clinical practice of dentistry or medicine is actually much higher than that. People who use tobacco not only experience shortened life spans, they are also sick more often during their lives and require medical and dental treatment more frequently than those who do not smoke. We have heard much about the health costs and the impact of tobacco use on general health, but there is an added cost from oral diseases that are dealt with outside the medicare system. Tobacco use is a major risk factor for many oral diseases and conditions, and millions of dollars are spent each year to deal with those effects. Although these are not necessarily government dollars, they are spent by individual Canadians, and employers through dental plans. Reducing risk factors for disease such as tobacco use will go a long way toward bringing about changes in morbidity and mortality that will help lower health care costs. As a health care provider, I have had the opportunity to work in the tobacco cessation field and I have seen the psychological impact of nicotine addiction. Data indicate that the vast majority of people who use tobacco become addicted to it. In watching their struggles to leave this addiction behind, I have seen the power it has to ruin their health and many aspects of their lives. As many have already indicated to you, the major problem is the initiation of this behaviour in youth. Virtually all tobacco users begin to use these products well before the legal age at which they can be purchased, and in spite of our efforts thus far, youth continue to engage in tobacco use at alarming rates. Certainly any major initiatives to reduce tobacco use need to address youth access to tobacco products. I would like to speak to a subject that often does not receive the same attention in our discussions as smoking, and that is smokeless tobacco or chewing tobacco. National studies show that although there seems to be a low percentage of use of these products, these were random sample surveys that often miss out on pockets of high use. We have experimentation with and usage rates of chewing tobacco in many health regions in this province that far exceed national averages. Surveys in some parts of Alberta, including the Crossroads region, show usage rates 8 to 25 times national rates. Many use these products well before age 12 or 13. A variety of these smokeless tobacco products are actually less-potent starter brands. They are sweeter, appealingly packaged to make them easier to use, and encourage graduation to stronger brands. These stronger brands have extremely high levels of nicotine. Just like cigarettes, smokeless tobacco products contain many harmful and cancer-causing agents and are strongly linked to many oral diseases, including oral cancer. With the push to create more smoke-free locations, many youth are opting to use smokeless tobacco. These products are readily available, and sales of moist snuff are also increasing in Canada. Alberta has 40 per cent of moist snuff sales, whereas we only have 9 per cent of the population. Many in the health care field, particularly dentistry, and those involved in youth athletics can attest to the frequent use of these products. Any tobacco reduction initiatives need to also address regional issues surrounding smokeless tobacco use. My recommendations to this committee are as follows: As has already been said, we need wholehearted support for tobacco legislation, including Bill S-15. The de-marketing of tobacco products requires a comprehensive, community-based approach that encompasses social policy and environmental strategies. These include raising prices and limiting youth access, monitoring sales, controlling advertising and communicating health risks. These are all part of a comprehensive strategy. As proposed in Bill S-15, funding for these initiatives needs to be stable and ongoing. A levy on tobacco retailers will generate both sufficient funding to make a difference and sustain funding for future initiatives. These should be administered by an organization at arm's-length from government. This comprehensive program should include: community interventions involving schools, governments and health agencies; counter-marketing to change social norms on tobacco use; policy and regulation on minors' access to tobacco; pricing; indoor air quality; and tobacco cessation. Tobacco companies invest huge sums in promoting their products. From 1986 to 1997, tobacco companies increased their advertising and promotion budgets by 95 per cent. If we are serious about tobacco reduction, funding needs to be at levels that will create meaningful, sustained impacts. This bill will certainly help to bring that about. Lastly, I strongly encourage increased involvement of health professionals in tobacco reduction. Primary caregivers, particularly those working in medical and dental offices, need to be strong advocates of tobacco reduction. This will require focusing on issues surrounding tobacco use and cessation, the formal education of our professionals, encouragement through their associations, and continuing education efforts. We welcome any questions that you might have. Senator Kenny: Gentlemen, we really appreciate hearing from you. Your testimony was clear, to the point, and in my opinion, very helpful to the proposed legislation. We appreciate your taking time out of your busy schedules to appear before us. I first have a brief comment, if I may, to do with Dr. Predy's concern about local funding. I draw his attention to subclause 6(j) of the bill, where we refer to local funding before we refer to regional or national funding. I am sure you noticed that, but that is clearly the premise that we started from throughout the bill. It is the foundation of the best-practices document produced last August by the Atlanta Center for Disease Control, and while we did not reference that document directly in the bill, we did require the proposed foundation to first seek out templates in North America, and then elsewhere, in the hope that their attention would be drawn to the Atlanta proposal in particular, since it appears to be particularly thorough and rigourous, and to enjoy a broad level of acceptance. I will start by asking Dr. Hodgkinson to comment on the importance of a comprehensive tobacco control program, and how that differs from what is going on in Canada today. You made some reference to it, but perhaps you could give us examples of the differences between current practices and a comprehensive program. Dr. Hodgkinson: Having been an astute observer of this scene for the last 20 years, I can tell you categorically that attempts to counter this problem over the past two decades have been mere window dressing and coloured by political opportunism. It has been a band-aid approach to a substantial and horrific national health-care problem. I think it is scandalous. I find it impossible to understand why there has been a lack of appropriate resources directed to this until the potential offered by your bill. Nothing appropriate to the scale of the problem has been done until now in this country, and that is why smoking rates are at the levels they are. On the other hand, a truly comprehensive policy, such as you are proposing and we are supporting, has the potential to radically change that in ways that have been clearly demonstrated south of the border. It is not a question of whether it will work. We know it will, but it has to be adequately funded. I would echo Dr. Predy's comments that unless there is a willingness to spend the appropriate amount of money, you might as well not spend anything. Let us do this properly and achieve the results that we know we can, and not meddle and turn this into yet another Canadian compromise. Senator Kenny: You are almost stealing my lines, because I was going to ask Dr. Predy if he would elaborate on that point. You were pretty clear. You said, better nothing than quarter measures or half measures. Would you care to comment on the government's recent announcement? It is in the area of $98 million a year for the next five years. That sounds like a lot of money to many people. I believe you said it would be better not to spend that at all than to go with something less than what is in the bill. Give us your reasoning behind that. Dr. Predy: It is based upon the work that the CDC, which is probably the premier public-health agency in the world, has done in looking at what works and what does not. They found that there needs to be a minimum level of funding in order to make a difference. Now $98 million is certainly a lot of money, but in a country as large and diverse as Canada, it is not really sufficient to deal with a major public-health problem. Given the magnitude of the problem, the number of people who become sick and who die prematurely, and the costs that we incur in our health care system, we need a concerted, coordinated effort by the national and provincial governments, as well as the local authorities and agencies. I think we have seen to date some well-intentioned efforts and some that are actually successful on a small scale, but nothing that will really address this on a broad, comprehensive, national basis. Again, that can only occur with the base level of funding that CDC has identified, which is considerably above what the federal government is now proposing. Senator Kenny: Dr. Patterson, you talked about the importance of stable funding. Can you give us examples of the consequences of a lack of stable funding? Dr. Patterson: A number of initiatives occurred in our local health region when monies were made available for projects. These were funded on a one-time basis through the Community Health Promotion Fund. A program is started, but the next year, the organization has to find the funding within its existing budget to maintain it. Often, some initial work is done, but then the ability within the fiscally challenged health region to maintain that is not there. Senator Kenny: Mr. Chair, if I may, I have a last question for Mr. Hagen. I do not think I have been to a meeting before where he has been so quiet, and I think it is important that we hear from him. That was intended as a compliment, Les. The organization of which you are executive director, ASH, has a well-deserved reputation for being a very effective health advocate. Can you tell us what you think needs to be done to move this bill forward politically? Mr. Les Hagen, Executive Director, Action on Smoking and Health: We issued a news release today asking for what Roger outlined in his presentation. We are asking the minister to endorse this bill because we think this kind of initiative will be successful. We believe that the current package falls short of what could be done to reduce tobacco use in Canada. We know that other private members' bills, and other bills from the Senate, have enjoyed the support of the House of Commons in the past, including, I believe, one or two of yours, senator. We believe that an endorsement from the minister at this time would go a long way toward seeing this bill pass. Senator Spivak: Dr. Hodgkinson, we did not deal much with the actual operations of the board, as specified in the proposed legislation, during our journeys here in the West. You mentioned a multi-year strategy. I know this is perhaps a little premature, but how you would view the granting situation versus the need to develop a multi-year strategy? I worked for a social policy agency in Winnipeg that was affiliated with the United Way, so I am familiar with the pitfalls that a granting agency can encounter due to the competition and the needs. Should part of the funds perhaps be designated for grants and the rest for a multi-year, national strategy, because there is a risk here too of creating a patchwork of programs? I am wondering what your thinking is on that issue. Dr. Hodgkinson: It is a very good question, and I would like to defer, with your permission, to Mr. Hagen, who I think is probably much more able to respond. Mr. Hagen: I think one way to deal with that type of problem is to develop some very strict funding guidelines with which all grant applicants have to comply, and which are consistent across Canada. Bill S-15 could ensure sustainable funding for programs that are successful, and those that are not will hopefully be abandoned and replaced with ones that are. Senator Spivak: I understand that, but that may not create a national strategy. I understand that you want local programs tailored to the local situation, but how about the question of an overarching national strategy, which is missing? You do not have any doubts that that will happen? Mr. Hagen: That is right. We would certainly like to see it happen. I think the best scenario would be for Bill S-15 to create a national umbrella strategy complemented by provincial and regional strategies. Senator Spivak: That is how you would see it? Mr. Hagen: Absolutely. Senator Spivak: You would see the board developing a national strategy and proceeding from there? Mr. Hagen: I think that would be the best place to start and to encourage provinces to take up this issue themselves and increase funding to address any specific local issues. We have problems in Alberta with smokeless tobacco that other provinces do not, and that would allow you to address those regional differences. However, we definitely need a national base level of funding and a nationally coordinated campaign. Senator Spivak: I am just looking ahead, but you would not place these things in legislation. I also encountered, certainly in my experience in the education field, the issue of communicating best practices, and I wonder if you can throw any light on strategies to do that. I was the Chair of the largest school board in Winnipeg, and I found that information about the very best programs was often not communicated. It is rather complicated, and I am just wondering if you have any thoughts on it. Mr. Hagen: We are very fortunate that within the past two or three years, a number of best-practice documents have emerged, including that from the Center for Disease Control. We have a lot of evidence about tobacco reduction to build on, and some 50,000 studies on a variety of different interventions have been conducted worldwide. I think it is important to continue to put those best practices to work, but they do change with time. What we consider best practices today may change in another three or four years, so it is also important - and I think Bill S-15 has this type of flexibility - to adapt to the best evidence currently available. Senator Spivak: I want to thank you for a very clear and a very good presentation. Senator Banks: Mr. Hagen, we all very much admire the work that you do, and I believe that the phrase "comparable organizations," as it applies to other provinces, is perhaps an oxymoron. However, you have called on the minister today to endorse this bill. Do you have any idea whether any comparable organizations, if there are any, are going to call for the same thing on approximately the same day, and with the same loud voice? Mr. Hagen: I certainly hope so. Your next hearing will be in Toronto, and we hope that you do get that kind of response from the national health organizations. We have certainly communicated our position very clearly, and we think it is an appropriate one to take if we truly want to see this bill passed. Senator Banks: I am sure you know better than I that if you approached some average people on the street and told them that the government is committed to spending $98 million a year over the next five years to combat smoking among young people, they are going to say, "Well, that sounds like an awful lot of money to me." I used to be in the ad game, and I can tell you that the mouths of most advertisers in Canada would water at the thought of spending $90 million a year on an advertising or awareness campaign of some kind. California and Florida are often given as examples of very successful campaigns. What would be wrong with simply lifting that campaign, including the television component - television is the best medium for raising public awareness these days - and spending $90 million a year on it in Canada? That is going to be a hell of an advertising campaign. Mr. Hagen: We need a comprehensive approach. A mass-media campaign is only one part of the puzzle, and Bill S-15 would also finance community programs, school programs, stop-smoking and enforcement initiatives. These would all complement a national media campaign. We think the media campaign will be a cornerstone of an effective strategy, but it is only one piece. Yes, $98 million does sound like a lot of money, but spending it purely on an advertising campaign would be really just throwing it away, given what we know from available evidence and the experience of other jurisdictions. Dr. Hodgkinson: I would add to that comment, Senator Banks, that we are certainly not averse to adapting the best ads from the States to the Canadian scene, if they are appropriate. There is no point in reinventing the wheel. They have produced a lot of very good material down there. Also of course, the reduction in the production costs that that would produce could be applied to the other elements of the program to which Les was referring. Senator Adams: Dr. Patterson and Dr. Predy, where I live in the Arctic, a lot more people smoke than in the south. I do not know how patients must feel who come to you and are told they have lung cancer or something like that. Right now, Bill S-15 is worth more to the education system and begins to encourage young people not to start to smoke. In the meantime, where I live, even though the government is spending $90 million a year to advertise that people should not start to smoke, my feeling is that if the bill were passed, you would have more approaches to the people, your patients, even elders, to enable them to quit. How do they feel about that? Dr. Patterson: Yes, I am very much in agreement that the kind of funding proposed by the bill, although I am sure that the majority of it could go to prevention or trying to get people to not initiate the behaviour, could create a comprehensive campaign that would include cessation activities, so that people desiring to quit could access appropriate and evidence-based programs. That affects all ages of the life span, certainly not just the youth. I agree that that is part of it. I work particularly with individuals in trying to help them in that cessation process, and it is often not an easy one. However, again, there is certainly good evidence to support the idea that something can be done. I think a comprehensive program would include cessation as well as prevention activities. Senator Mira Spivak (Deputy Chairman) in the Chair. The Deputy Chairman: Thank you very much for appearing. We are most grateful to you all for taking the time, and good luck to all of us. The next panel members, if you would come forward, are from the David Thompson Regional Health Authority, the "Butt Ugly" Theatre Group and the Caslan School Trust. Ms Gail Foreman, Tobacco Reduction Team Leader, David Thompson Regional Health Authority: I am here to speak about a particular youth-oriented program within the David Thompson Health Region boundaries. Again, it is one piece of a comprehensive tobacco control program, and certainly not the entire answer, but it can be a very important piece. "Butt Ugly" is a social issue drama written and performed by youth to address concerns about youth tobacco use. A pilot project was launched in 1995 with funding from the Alberta Lung Association, and since the opening season, we have received further funding from a variety of partners, including several local service clubs, school districts, Health Canada, the Alberta Tobacco Reduction Alliance, and recently now from David Thompson Health Region and the Youth Action and Advocacy Project through ATRA. The notion of using drama as a tool for tobacco use education and prevention came from the students' own desire for a different way to deliver the message. Youth are consummately bored by someone like myself, a health professional, standing up in front of the class and lecturing about the evils and health consequences of tobacco use. The concept of engaging youth to teach their peers and role model the consequences themselves, in addition to offering some concrete resistance strategies, was unique at the time this project was piloted, although these kinds of strategies are now considered to follow best-practices guidelines. Our troupe is comprised of teens from all three of Red Deer's high schools who receive special school credit for their involvement in the project. Our target audience is students entering junior high or middle school, which in some school districts is grade 6, and in others it is grade 7. We tour in the fall so that we do reach these students early in the school year, when they are most at risk for experimentation as they enter a new environment. To date we have been in production for about six years, and have reached about 15,000 students in the David Thompson Health Region area. Interest remains very high among the youth in the audience. They are very much engaged by the actors who deliver the drama, and the competition to participate as an actor is fierce. The first year that we put this program together, we did not tell the students what they were auditioning for, because we knew no one would come. It was not cool to be involved in the tobacco issue. However, we now have well over a hundred students auditioning every season, and there is fierce competition for the privilege of participating in this project. Since most people start smoking when they are younger than 18, programs that help to prevent the onset of smoking during the school-aged years are a crucial component of a tobacco reduction strategy. Several studies have shown that school-based prevention programs that identify the social influences that promote tobacco use among youth can reduce or delay the onset of smoking. Studies have also indicated that tobacco education needs to be offered at the elementary, junior high, and high school level. Presently, the "Butt Ugly" project is the only one within the David Thompson Health Region boundaries that involves high school students in tobacco reduction activities. We have done a very rough estimate of how much it costs per capita audience member to produce "Butt Ugly," and it is about $4. It costs $10,000 to $15,000 per year to run the drama. This project could certainly expand with more money. We do not visit every junior high school within David Thompson Health Region boundaries. We just do not have the funding to tour on that kind of a level. It is very difficult to find ongoing funding for a project like this. You would think that anything youth-oriented would garner a lot of support in the community. We discovered that that is not the case. It is often very difficult to get service clubs or other groups to buy in, depending on how many people in that club actually use tobacco themselves. It is also often very difficult to fit within certain service clubs' philosophical bases. They think that everything should be done through volunteerism. However, we do need to transport the set, costumes and actors, and buy insurance for the same, and there are some significant costs attached to that. Certainly the health region is an obvious partner for a project like this, but because of tight fiscal situations, not every health region has dedicated funding for tobacco control. I am currently the Tobacco Reduction Team Leader for David Thompson Health Region, but that is a brand-new position. I have only been there for 18 months. Currently, we are still waiting to hear if there will be any more money budgeted for programming, other than my position, within the health region. Obtaining scarce money for a project like this is very difficult, and we were very fortunate this year to find some through David Thompson Health Region through the action for health fund. Health Canada has identified some lessons learned from the Tobacco Demand Reduction Strategy that have been incorporated into the "Butt Ugly" project since the beginning, including peer pressure, the perception that everyone is doing it, and looking at teens between the ages of 15 and 19 as probably more open than most to cessation efforts. Of the cast members involved in this project, some smoke, some have never smoked, and some did smoke and quit. We have about a 30 per cent quit rate among students who smoke who are involved in the project, which is better than most cessation programs, and has been a positive spinoff that we really did not anticipate when we began. Certainly successful programs are dynamic, fun and multi-issue. The classroom lecture style of delivering tobacco prevention programs is definitely over, and I think the two young members of our cast here will certainly speak to that aspect of the program. Programs with active youth involvement have the greatest success. Our project has had another very positive spinoff, in that the students who have been involved with the project over the last six years have become very strong tobacco control activists within their community. They have served as role models, not only in the classroom, but also in the community to children who have seen their performance, and they have been a very positive force for change. Tobacco use is peer-influenced, and so tobacco reduction should also be peer-influenced, and that is the basis of the program. Our support for Bill S-15 is based on the fact that it could provide a more stable source of funding for a project such as ours, which has received money from Health Canada in the past through the Tobacco Demand Reduction Strategy, but which only lasted for a year. It was a kind of one-off. Drop the program in and then take it away, and it takes an awful lot of time away from the project itself when you have to spend so much time fundraising. That time could be better spent working with the students and expanding the program, so that we can get out to all the smaller communities in our health region. That is why we are really hoping that Bill S-15 is successful and that it will come before the House of Commons and be passed. Ms Tara Sampson, "Butt Ugly" Theatre Group: I went into "Butt Ugly" thinking it was just another drama production, another script to hang on my wall, and it started out that way with rehearsals and other things. Since we were to be given school credits, we were required to do some fairly rigourous research on tobacco and statistics, et cetera. However, I do not think any of the actors really realized how valuable that would be. We just thought, "Well, we are getting credits; we may as well do the assignments." We started touring and performing our show, and afterwards there is a facilitation session, where we speak to the kids. We have a question-and-answer period. Then we break into smaller groups and speak to them on a more one-on-one basis. When we fired these statistics at them, we could see the looks of shock on their faces, and they were so intrigued. These kids were honestly looking up to us and really listening to what we were saying. I had kids opening up to me. One girl in tears told me, "My father has lung cancer because he smoked, and I will never do it." Then they are all hugging you, and it is quite amazing. It works. It reaches them. It completely blew me away. I had no idea. In my job - I work at a fun centre of sorts - I constantly have kids approaching me saying, "Oh, I saw you. You were at my school, and yes, smoking is gross, and I never knew there was toilet bowl cleaner in a cigarette, and I will never smoke; it is not cool." The reaction is amazing. Senator Banks, you talked previously about television campaigning, and how perhaps that is all that is necessary, but this is so different. There is a difference between flipping the channel, and having someone there interacting with you, telling you that the minute your dad quits smoking is the minute he is going to get better; that smoking is not cool and you are setting a great example. It is just so different; it really hits you, and not just the actors who were involved with the kids. The Deputy Chairman: Especially if you have inspirational people like you. I am ready to do it myself, and I do not even smoke. Ms Sampson: Honestly, I know it sounds so cheesy and so hokey, but this was just the greatest thing I have ever done. I think we need more outreach programs like this, getting the players out to different communities and different schools, and using different troupes. The more kids we can reach, the better. Mr. Brandon Walsh, "Butt Ugly" Theatre Group: As Gail has already mentioned, there has been tremendous support from the teens who perform this drama. For example, the director just put up the audition sheet at my school on the Thursday before our Easter break. She put it up at lunch hour. By the end of this Monday, the day we came back, the sheet was already completely filled out. There is great support for it among the teens. The funding is a big issue. There was some question by the end of the run in November or December whether there would be a "Butt Ugly" in Red Deer next year, because no funding had been secured. That only happened in the last month to month and a half and we were able to say, "Okay, yes, it is going to go ahead next year." This bill would definitely help us to obtain sustained funding, and then there would not be so much question of whether it was going to go on or not. The Deputy Chairman: Have you asked the oil companies? Ms Foreman: The oil companies are mostly in Calgary. It is mostly oil servicing companies in Red Deer. Also, drama is a very difficult sell because it is not a capital project. It is intangible. It is not something onto which you can tack a name plaque, and it has proven to be a very big challenge to get that kind of funding. The Deputy Chairman: Invite them to the performances. Ms Lisa Cardinal, Caslan School Trust: I am 15 years old. I live in the Buffalo Lake Métis settlement, but I am attending Grade 9 at the Caslan School. Buffalo Lake is a Métis settlement of approximately 1,000 people about two hours north of Edmonton, so it is not really that far away. I like to play baseball. I am enrolled in the Lac La Biche Army Cadet Corps, and like most people here, I like to get involved in things like this that help people. I feel that the Bill S-15 is a great piece of proposed legislation. It really shows that youth themselves are taking a huge responsibility for youth issues and that we are not just passive victims. The project that my school is working on is called, "Up in Smoke," and it consists of two activities. One is a movie, in which we will be showing how tobacco use is affecting my community, as well as my peers and me. This video will be filmed by a group of students in my class, and we hope it will be finished by June. The other project that we are organizing is an information night, where we will be putting on a presentation that will explain how bad tobacco use is for you, mentally and physically. We will also have a "buddy system" where each person will help another quit. Afterwards, we will have a traditional supper. The early intervention program within our settlement is helping with the supper, so we really have a lot of support for our projects. The health unit will also have a big part in our presentation. They will have information about tobacco use, and they will be handing out goodie bags to everyone, so it will be cool. Our get-together will be on June 11 at the Buffalo Lake Recreation Centre, which is a really big facility with a gym. Everyone is welcome, if you want to come. It will be great fun. The main reason I want to be a part of this project is to help my peers and fellow community members to stop smoking. It is really hard to watch friends and family members smoke, because they know exactly what it is doing to them, but they still will not listen and try to stop. That is why I am hoping that our project will work and open everyone's eyes, because they need to know that we teens do want to help and that we are trying to make a difference. When I refer to my family members, I am excluding my parents, because no one at my home smokes. The YAAP seed grant is a fantastic idea. It will allow us as teens to express our feelings about tobacco use among teens as well as adults, and the money that we are receiving will pay for everything in our project. Some people say that it is not enough, but with a lot of support and encouragement, this project will go on. I think that what you are trying to do for us with the Bill S-15 and other things is wonderful. Sometimes people do not actually see what you are trying to do for them, and they take that for granted. That is why I really appreciate knowing that there are people like you trying to help people around the world, and not just in Canada. I thank you for taking the time to listen to my presentation, because I know you must have very busy schedules. I wish success to Bill S-15 and everyone who supports it. Senator Banks: Thank you all very much for coming, and thank you for what you are doing. I am not surprised to hear that the sign-up sheets fill up quickly, because actors would sign up if you were talking about a program to clean up the bottom of some sludgy lake somewhere. Actors do not care what they are acting in; they want to act. However, when you are doing some good, it is all the better. Lisa, we have heard from people across the country over many years that the incidence of smoking among young people, and, in fact, among the general population, is higher in Aboriginal communities than it is anywhere else. Senator Adams, for example, tells us about the people in his community who smoke to a greater degree than anybody else. You talked about this excellent program of which you are a part, and you said that you are going to try to deal with the question of what smoking is doing to the people in your community. Just off the top of your head, would you tell us what it is that smoking is doing to people in your community? Ms Cardinal: There are a lot of people in our community who do smoke, and also a lot of people who do not, but the reason we want to try to persuade everyone not to smoke is so that we can have a healthier population. We just want our people to have good health. Senator Banks: Who did you say was funding your film project? Ms Cardinal: The YAAP seed grant. Senator Taylor: Thank you for coming here; you have been a big help with information. I have been told a couple times that, although it is illegal, you can buy cigarettes one at a time at some stores. Are you familiar with that? Does that indeed happen? Mr. Walsh: I do not know about buying them one at a time from a store, but I often see students buying them from each other one at a time. Senator Taylor: It is not from a store? Mr. Walsh: No. Senator Taylor: One of the problems with the tobacco industry was that they used to sell mini packs to gain converts. As a matter of fact, in Asia they still give them away free in schoolyards two or three at a time to try to get people hooked, so I just wondered whether any stores were doing that. Mr. Walsh: I have not seen it myself. Senator Taylor: I heard that they were doing it in Calgary. Senator Kenny: You are a terrific panel, and I appreciate your being here. I have the same question for all three of you. What got you going? What got you interested in and motivated to address tobacco issues? Mr. Walsh: I do not know. I have never tried smoking myself. I have never been interested in trying it, but I have had people around me, friends and family members, who smoke. It is just something I have never really agreed with. I do not do it. I do not like it, and I do not want to see youth smoking because they are basically wasting their lives. Ms Sampson: I have never smoked. I have never tried it. I have never liked it, but I was always pretty apathetic about it. I thought, if people want to do it, it is their life; that is their choice. It was the research, actually, when I started seeing the statistics. Every 13 seconds someone dies from a tobacco-related disease; one in two smokers will die from it. When I started hearing these kids' stories about their parents or how their dog died, it just really angered and disgusted me. It angered me to see how accessible tobacco is for youth and how glamourized and glorified it has become. It drove me crazy - and no offence - that the government was so loose about it, there were not stricter restrictions, and there was not enough promotion of anti-tobacco projects. Ms Cardinal: Like Brandon, I did have lots of friends and family members who smoked - and I still do. I have tried it, but I do not like it, and I will never do it again. It is just something that comes from peer pressure, and your family does it, so you think it is okay. I was motivated by not wanting to see my friends die from all these different diseases. I did not want people in my community to suffer those kind of effects, and I just hope that I can succeed in what I am trying to do. Senator Kenny: You have all mentioned that you can get cigarettes from your friends, but where do your friends get their cigarettes from? Mr. Walsh: I know some people whose parents will buy cigarettes for them. I have other friends who will stay outside a store, for example, and get someone who is walking by to go in and buy them. Some will steal them from their parents or from other people. They will find a way to do it. Senator Kenny: Any other thoughts? Ms Sampson: Brandon and I, and a lot of our friends, have reached the legal age to buy cigarettes, so they can do that themselves. We heard much the same as Brandon was saying when we interacted with the younger kids. Part of our research involved interviewing teen smokers, and one of the questions was, "Where did you get your cigarettes from if you started smoking when you were 12, 13, or 14 years old? A really disturbing number of them said they simply walked into a convenience store, gas station or grocery store, put down the money, and someone passed them the cigarettes. Ms Cardinal: I think many get them from older sisters or brothers who smoke, and who do not think it is a problem. Senator Adams: Ms Foreman, you mentioned the Lions Club. Does the Lions Club help your organization a lot? I remember the Lions Club from when I used to live in the far north in Manitoba, but we used to go there and have a drink and a cigarette. I quit smoking over 30 years ago. How do such associations help? A lot of other organizations help people who have a family of young kids or something like that. Does it help prevent young kids from starting to smoke? Ms Foreman: We have had some assistance in the past from several service clubs in the Red Deer area, but it is still an issue of long-term funding and not being able to tack a plaque on us. We have had sporadic funding from the Optimist clubs in our area, and we certainly had some nice partnerships in kind with the Red Deer Legion. Their people sometimes drive our actors around in the Legion van. They will take them to different performances when they are touring. Unfortunately, a lot of our support has been in kind, and a lot of our costs are capital. Our director spends probably fully half her time preparing the students to tour, get ready for facilitation, and do the research and so forth, as well as conducting auditions. She is paid an honorarium for what she does. If we had to pay her the same salary that she earns as a drama instructor at the Red Deer College, the cost of mounting a production would skyrocket. It would more than triple. She puts in a phenomenal number of hours. Certainly the work that I have done with the project since its inception six years ago has been mostly volunteer. I have done it in addition to my work as a public health nurse and as Tobacco Reduction Team Leader for David Thompson Health Region. It has been a challenge to find some sustainable source of funding for a project like this, which seems odd. You would think that because it involves youth, it is so visible, and there is such a positive response to it in the community, that finding funding would be simple. All that they would have to do is see a performance, and they would be lining up to give us money, but that is not the case. There is a lot of competition among communities for funding for a variety of projects, and we have struggled with finding sources of ongoing funding. Senator Adams: I will maybe ask Brandon if some of the students who see you trying to persuade kids to stop smoking like you doing that, or do some hate it and ask you why you are doing it, why you do not like smoking? Do some of them like to follow you? How do you feel in the classrooms? Mr. Walsh: I have never really been bothered by peer pressure. Senator Taylor: You put the pressure on. Mr. Walsh: Yes. Senator Adams: If they tell you that you should start smoking, you tell them that in the future, maybe in 30, 40 years' time, they will be dying from lung cancer. Mr. Walsh: Oh, yes. Senator Adams: How do you feel about it? Mr. Walsh: I tell them about it, and some of them will just ignore me. Others will say they did not know about that. Individual responses vary. Some of them will be totally shocked that they never knew this. They will say, "I never knew there were all these risks with it. Then others will say, "So what? It is not going to be me. It is not going to be this." You can try and tell those people, but it is up to them to decide if they are going to continue to smoke or to stop. Ms Sampson: Part of the reason that we target the young kids is that the show is not about quitting smoking. We emphasize not starting. When you get to our age - that dates me - you see people who are really still kids, but have been smoking for awhile. Mind you, we had one actor in our show when we were doing our research and came across information that that there is rat poison in cigarettes. Her eyes widened, her mouth dropped, and she took her package of cigarettes - because she was a smoker at the time - out of her pocket and just threw them in the garbage in front of all of us and said, "No more." We were talking over lunch about the peer pressure, and how when the kids see non-smokers having so how much fun, especially us when we get to relay this message to other kids, and they see the little drawings that people make for us, it is not even an issue. Senator Adams: In the meantime, you see some of the kids asking if somebody else has a carton or a package of cigarettes or something, because you do not have any. Senator Kenny, if Bill S-15 passes, maybe it should be possible to punish a kid who gives another a cigarette. Senator Kenny: No, there is no punishment in this bill. It is persuasion. Senator Adams: Anyway, I know where I live, even adults sometimes ask their friends for a cigarette. The Deputy Chairman: Always bumming cigarettes. Senator Adams: I think that many of the kids start in the schoolyard or somewhere like that, because other kids have the cigarettes. How are 12- and 14-year-olds able to get the money to buy tobacco? They do not have part-time jobs at that age. Where do you get the money to buy cigarettes? Typically, young kids start smoking because a family member gives them money to buy a package of cigarettes. Senator Banks: I have a quick question for the three youngest of you. We hear statistics which tell us that across the country, 28.9 per cent of young people smoke. We also hear from those who know that most young people think that the rate is higher than that, that more than a third of their peers smoke. What do you believe? Do you believe that about 30 per cent, about one in three, of your young friends smoke, or is it higher or lower than that? Ms Cardinal: I cannot give you an exact number, but I would say yes, about 30 per cent. Most of my friends do not smoke, but some of them do. Senator Banks: Tara, what do you think? Ms Sampson: I am actually quite surprised by that number. I would have thought it would be a lot lower. It is a common myth that all or many youth smoke. My high school has an outside smoking area, and I am thinking of the 30 kids who stand out there at lunch hour compared with the 1,270 who are filling the school, eating in the gathering area or the cafeteria. I am surprised. I would think it would be much lower than that. Although I do not think that many kids smoke, I also think there are too many who do. Mr. Walsh: I actually found that statistic when doing research for "Butt Ugly," that approximately 30 per cent of youth smoke. Yes, I think that is about right Senator Banks: One final question. Tara, in your presentation, you were disdainful of classroom anti-smoking education, and you said you were going to tell us about that later, but you did not. Ms Sampson: Do you remember what it was pertaining to exactly? Senator Banks: You said that classroom efforts were not really effective. Then you said, "I will tell you about that later." Tell us about that. Ms Sampson: What I meant, and Gail touched on this a little, is that the education system is so repetitive. It is typical to just be seated and have facts shot out at you that you are supposed to be absorbing. It becomes so much more interesting if you use a different medium. Drama is one way, but there are so many others. I think what these guys are doing is excellent. I know that YAAP has given seed grants to a whole host of projects, to conferences, posters, all kinds of different things. They put a new spin on things, and they still catch the kids' attention, but at the same time, they are educating them and really spreading awareness. I think that is really what needs to be done. Senator Banks: Have you graduated yet? Ms Sampson: I graduate in June. Senator Banks: Are you going to be an actor? Ms Sampson: Do I want to be an actor? Senator Banks: No, are you going to be an actor? Ms Sampson: No, I am going to the University of Lethbridge in September. I am planning on becoming an English teacher. Senator Banks: Good for English. The Deputy Chairman: Thank you for coming. You are all extremely articulate and effective, I must say. The only other thing I would like to say to you is that some of you should think about running for public office. The committee adjourned.