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Municipality of Chatham-Kent Public Health Unit PO Box 1136, 435 Grand Avenue West, Chatham, ON N7M 5L8 Tel: 519.352.7270 Fax: 519.352.2166 Email ckhealth@chatham-kent.ca

July 23, 2018

The Honourable Doug Ford Premier of Ontario Legislative Building, Queen’s Park Toronto, ON, M7A 1A1 Delivered via email

Dear Premier Ford, RE: Pause in Implementation of the Smoke-Free Ontario Act, 2017

At a special meeting of the Chatham-Kent Board of Health on July 16, 2018, the Board received a staff presentation (attached) regarding the pause of the implementation of the Smoke-Free Ontario Act, 2017 (SFOA, 2017). The Board felt there was significant evidence presented to raise concerns over the provincial government’s pause of this important legislation. While gains have been made in tobacco control, and the rate of smoking is declining, tobacco remains the leading cause of preventable disease and death in Ontario. According to the Canadian Substance Use Costs and Harms Study released in June 2018, substance use costs the Canadian economy $38.4 billion, or almost $1,100 for every person in Canada, with tobacco use alone contributing to 31.2% ($12.0 billion) of these costs, second only to alcohol ($14.6 billion or 38.1%). The healthcare burden associated with tobacco remains high; in 2014, substance use-related healthcare costs amounted to $11.1 billion in Canada, with tobacco use contributing to 53.1% ($5.9 billion) of these costs. It is understood that the delayed implementation of the SFOA, 2017 is because the government wishes to review the new regulations related to vaping and how e-cigarettes could be used as a cessation tool. Although more research needs to be done to understand the long-term effects of e-cigarette use, a recently published (2018) comprehensive evidence review by the National Academies of Science, Engineering and Medicine concluded the following:

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Premier Doug Ford 2 July 23, 2018

• The effectiveness of e-cigarettes as a cessation aid for smokers is unclear. • E-cigarette use is associated with subsequent cigarette smoking among youth. • While chemical levels of second-hand exposure from e-cigarettes are lower than

that of combustible tobacco cigarettes, this exposure could have the potential to lead to adverse health effects.

From these findings, it cannot be assumed that e-cigarettes are harmless. The modernized legislation would protect Ontarians from second hand smoke and vapour, and regulate not only the sale, supply, use, display, and promotion of tobacco and vapour products, but also the smoking of medicinal cannabis. These are important policy measures to reduce tobacco use to 5% by 2035 and protect the health of Ontarians, especially vulnerable populations, including youth. It is critical that any policy framework that allows vaping as a cessation tool include safeguards to prevent youth uptake.

The Chatham-Kent Public Health Unit and the Chatham-Kent Board of Health look forward to continuing to work collaboratively with the Ontario government to protect Ontarians from the effects of tobacco, vapour, and cannabis. We urge the government to reconsider implementing the Smoke-Free Ontario Act, 2017 as intended and without delay so that all Ontarians are able to live, learn, work, and play in the healthiest environment possible.

The public health community looks forward to the opportunity to share their expertise and experience, working together under the leadership of the Ministry of Health and Long-Term Care, to create a healthier, more productive population with enhanced quality of life and reduced health care costs. Sincerely, Joe Faas Chair, Chatham-Kent Board of Health

Attachment

c: Hon. Christine Elliott, Minister of Health and Long-Term Care Hon. Monte McNaughton, MPP, Lambton-Kent-Middlesex

Rick Nicholls, MPP, Chatham-Kent – Leamington Ontario Boards of Health

Comprehensive Tobacco Control2018

Board of Health Presentation July 16, 2018

1) Update on emerging evidence2) What’s happening in cessation, protection/enforcement, and prevention3) What’s covered in which Acts/Bylaw?4) Current Opportunities5) Current Challenges

Evidence updates • Regional situational assessments will be completed for fall 2018 to help guide and direct

work throughout 2019-2020

• Public Health Ontario just completed an E-cigarette literature review in response to a Ministry request. The review concluded that:

1)The effectiveness of e-cigarettes as a cessation aid for smokers is unclear 2) E-cigarette use is associated with subsequent cigarette smoking among youth 3) While chemical levels of second-hand exposure from e-cigarettes are lower than

that of combustible tobacco cigarettes, this exposure could have the potential to lead toadverse health effects

• Youth (young adults) are often using a variety of products (dual usage), from a regional LHIN perspective we know the following about local high school students:

1) 14% have smoked cigarettes in the past year2) 16% have used e-cigarettes in the past year3) 7% have used smokeless tobacco in the past year4) 30% have used marijuana in the past year

Evidence update: Retail Density

of CK schools are within500m of a

tobacco retailer

Wallaceburg: 100%Dresden: 100%Thamesville: 100%Ridgetown: 0%

-Coordinate community cessation services (education,Community of practice, MCIImplementation, sharing of resources, “You Can Make it Happen”)

-Support provincial cessation initiatives(Wouldurather, Smoker’s Helpline First Week Challenge, LTPB)

-Build local capacity for cessation supports

-’Smoke Free Chatham-Kent’Bylaw enforcement/education(special events, arenas, sportfields, Municipal facilities)

-Enforcement, mandatoryInspections (schools, hospitals retailers), vendor compliance

-supporting facilities and workplaces to implement their own local policies to protect workers/residents

-Addressing SHS in multi-unitdwellings

-Support regional preventionpriorities for at risk youth and young adults via youth engagement and community collaboration

-School supports for youth caught smoking on school property with education and diversion

Cessation 2018

Protection 2018

-Supporting Housing Services new tobacco policy

-Supporting landlords in addressing SHS for tenants

-Supporting adherence to Smoke-Free CKby assisting event organizers

-Supporting CKHA and their transition to a smoke-free campus

Enforcement 2018• The Smoke-Free Ontario Act 2017 (SFOA 2017) was expected to have

been passed on July 1, 2018. • This law was to replace the current SFOA and Electronic Cigarettes Act

(ECA) and combine them into a single, harmonized provincial statute.• The new government has put the changes to the SFOA 2017 and the

repeal of the former SFOA and ECA on hold for further study, specifically in regards to changes in legislation around electronic cigarettes, such as prohibition on their use in certain areas, and how they should be displayed prior to sale.

• Enforcement of the Smoke-Free Chatham-Kent by-law #137-2014 has gone well, with very few complaints. Areas of focus this year was the Park Avenue Business Centre.

• The Tobacco Enforcement Officer also met with Municipal staff to help update the Corp. of Chatham-Kent’s internal policy to bring it up to date and in line with provincial legislation.

E-Cigarette Act, 2015 Smoke-Free Ontario ActSmoke-Free Ontario Act,

2017Smoke-Free Chatham-Kent

By-Law, 2014

Prohibits E-cigarettes Tobacco

Tobacco, e-cigarettes/any vapour product, medicinal

cannabis

Tobacco, or tobacco-like product, including e-cigarettes, cannabis

An enclosed public place or workplace x x x x

Municipal property, (including but not limited to, parks, playgrounds, beaches, boardwalks, and walkways)

x

Outdoors within a publicly owned sports field and spectator area

x(including public areas 20m

from these places)

x(including public areas 20m

from these places)x

Any land containing playground equipment

x(including public areas 20m

from playground)

x (including public areas 20m

from playground)x

Within 9m of entrance to Municipal facility x

Within 4m of any Municipal bus stop x

Reserved seating area of a sports arena or entertainment venue

x x x x

Restaurant and bar patiosx

x(including public areas 9m

from patio)

x(could opt in)

Elementary and secondary schools and their grounds x x

x (including public areas 20m

from grounds)Grounds of a community recreation facility

x (including public areas 20m

from grounds)x

Outdoor grounds of hospital, psychiatric facilities

x x

• In the remainder of 2018, all vendors of electronic cigarettes will undergo an enforcement check (a.k.a. a test shop). All vendors of tobacco products will undergo a second round of enforcement checks and a Display/Promotion/Handling inspection.

• Vendors of electronic cigarettes will likely find the next 6 months to a year to be a very uncertain time in regards to regulation on sales and promotion. We hope to get a clearer picture of the legislative changes moving forward and provide accurate and long-term guidance to vendors.

• Preparation for the impact of cannabis-related enforcement issues in the Fall.

“A Year of Uncertainty”

Prevention 2018

-Education and advocacy to address smoking in youth rated media (outdoor movie night in partnership with CMBA, partnership with Racing Against Drugs Committee)

“Uprise” Alternative

youth project

Young adult Male campaign research and development

Big Prevention News!!!!

PLAIN AND STANDARDIZED

PACKAGINGCOMING SOON!

Current Opportunities• Continued partnership with Chatham-Kent Housing Services in supporting

residents as they transition to their smoke-free policy

• Recreational cannabis legalization has motivated local landlords to explore local smoke-free housing policies for their buildings and has elicited our supports

• Continued collaboration with CKHA in addressing cessation gaps for those patients who are being discharged from hospital

• Completed regional situational assessment will provide several evidence informed recommendations to reduce tobacco initiation in priority population youth

• Explore increasing local tobacco/e-cigarette vendor licensing fees as CK has some of the lowest fees province wide

Current Challenges• Pausing of the long awaited introduction of the SFOA 2017

(combining the SFOA with ECA) introduction on July 1, 2018

• Confusion with regard to recreational cannabis and the associated smoking laws related to where it can be used, purchased and resulting enforcement issues

• Tobacco resource centres (PTCC, YATI, OTRU) have had their funding cut. Cuts will reduce training/education and evaluation supports and shift staff time to these areas

• Reduced NRT funding locally will impact the amount of quit supports available to our local priority populations