public and workplace smoking policies created by the registered nurses’ association of ontario
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Public and Workplace Public and Workplace Smoking PoliciesSmoking Policies
Created by the Registered Nurses’ Association of Ontario
World Health International World Health International Framework on Tobacco Framework on Tobacco
World Health Organization (WHO) developed the International Framework Convention on Tobacco Control
Encourages countries to set legislation that:• Controls tobacco companies’ operations within
their borders• Educates smokers about health risks• Protects people from second-hand smoke
MPOWERMPOWER• MPOWER Policy Package
• WHO Report on the Global Tobacco Epidemic, 2008• Policies to provide guidelines for worldwide reduction
of tobacco use
• Monitor tobacco use and prevention policies• Protect people from tobacco smoke• Offer help to quit tobacco use• Warn about the dangers of tobacco• Enforce bans on tobacco advertising,
promotion and sponsorship• Raise taxes on tobacco
National Tobacco ControlNational Tobacco Control• Health Canada’s Federal Tobacco Control
Strategy: A Framework for Action• Current goal to reduce overall smoking
from 19% to 12% (by 2011)
• Objectives include: • Reduce prevalence of youth smokers • Increase number of adults who quit smoking• Reduce prevalence of second-hand smoke
exposure• Contribute to implementation of WHO’s
Framework Convention on Tobacco Control• Monitor and assess contraband tobacco
National Tobacco Control (cont.)National Tobacco Control (cont.)
Federal government regulates aspects of the sale of tobacco:
Requirements for health messages Importation of tobacco products Control of advertising and sponsorship by tobacco
companies
National Tobacco Control (cont.)National Tobacco Control (cont.)
Ingredient Emission levels for a cigarette sold in CanadaPrevious Current *
Tar 8 mg 8 – 29 mgNicotine 1 mg 1 – 2.6 mgCarbon Monoxide 9 mg 9 – 27 mgFormaldehyde n/a 0.035 – 0.13 mgHydrogen cyanide n/a 0.073 – 0.25 mgBenzene n/a 0.034 – 0.08 mg
• Latest initiative oblige tobacco companies to list more of cigarettes’ toxic ingredients on the package
(Health Canada, 2009b)
Provincial/Territorial Tobacco Provincial/Territorial Tobacco ControlControl
Each province/territory has jurisdiction over tobacco products and their regulation
Youth smoking Ventilated smoking rooms Designated smoking area, etc.
Information about federal and provincial/territorial tobacco control legislation is available from the Canadian Council for Tobacco Controlwww.cctc.ca
Smoke-Free Ontario (SFO)Smoke-Free Ontario (SFO)• Administered through the Ministry of Health Promotion and
Sport under the Chronic Disease Prevention division• SFO’s Tobacco Control Act
• Regulates smoking in public spaces and workplaces• Regulates the conditions of sale of tobacco products• Prohibits the sale of tobacco to people under 19 years• Protects children from second-hand smoke when in daycare
programs• Restricts smoking in an around health-care facilities• Bans the use of point-of-sale advertising such as retail power
walls• Bans smoking in vehicles when children under 16 years are
present
SFOSFO• Supports awareness and prevention programs
through:–Public health programs (e.g. high school programs)–Monitoring access of minors to tobacco products–Cessation programs :• Smoker’s Helpline• Leave the Pack Behind - campus program• Driven to Quit Challenge - provincial contest• Stop Smoking Treatment for Ontario Patients (STOP) –
research study examining the effectiveness of NRT• Training Enhancement in Applied Cessation Counselling
and Health (TEACH) – certified training course for health-care professionals
SFO StrategySFO Strategy
Prevention Child/youth programs Restricted access to tobacco
Protection Legislation Smoke-free public spaces, workplaces etc.
Cessation Cessation programs Education for health-care professionals
Tobacco Industry TacticsTobacco Industry Tactics
Marketing◦In Canada marketing/advertising of tobacco has been highly restricted (federally & provincially) especially in regards to marketing towards youth
◦See www.cctc.ca for specific marketing legislation (federal and provincial/territorial)
Tobacco Industry TacticsTobacco Industry TacticsDespite the restrictions on tobacco
advertising, many Canadians report seeing tobacco ads.
In March 2006, Health Canada commissioned a survey of Canadians' recall of tobacco advertising. ◦"One in five (19%) Canadians recall seeing tobacco
advertising in the past few months." ◦"More than a third (36%) of those younger than 24
recall seeing ads”◦Among those who have seen ads, they are most
likely to recall seeing ads in magazines.
MarketingMarketing
In other countries: ◦Sponsorship by
cigarette companies for artsand sporting events
◦Targeted packaging
Ottawa ModelOttawa Model• A systematic approach to tobacco dependence
treatment for hospitalized smokers• Designed an implemented at the University of
Ottawa Heart Institute• Adopted by a number of hospitals in Ontario & other
provinces/territories
• Uses 5As Protocol (Ask, Advise, Assess, Assist & Arrange)
• Smokers are more likely to be hospitalized than non-smokers• Opportunity to help smokers quit smoking
Ottawa Model:Ottawa Model: On Admission On Admission1. Ask
• Ask about client/patient tobacco use in the past 6 months
• Document smoking status & quitting history
2. Advise• Advise client/patient to quit
3. Assess• Assess the smoker’s interest in quitting (during
hospital stay, within 30 days, within 6 months?”
4. Assist• Brief counselling (includes pharmacotherapy
options)
Ottawa Model: Ottawa Model: During During HospitalizationHospitalizationfor people who for people who wantwant to quit smoking to quit smoking• Counselling focuses on: –Managing withdrawal symptoms–Planning how to remain smoke-free following
discharge
• Pharmacotherapy –Offered during the hospital stay–Prescribed for 10 – 12 weeks after discharge
• Self-help materials for smokers wanting to quit are provided
Ottawa Model: Ottawa Model: During HospitalizationDuring Hospitalizationfor people who for people who DO NOT want DO NOT want to quit smokingto quit smoking
• Counselling focuses on: –Pros and cons of smoking• ie. ‘what do you see as some of the advantages
and disadvantages of smoking?’• Pharmacotherapy is offered during the
hospital stay to help patients remain comfortable in the smoke-free environment
• Self-help materials tailored to smokers who do not want to quit are provided
• Information about community cessation services is provided
Ottawa Model: Ottawa Model: On DischargeOn Discharge
5. Arrange Offer follow up to all smokers
Interactive, voice response (IVR) – mediated telephony system & database
Automated calls inquiring about smoking Results can be scanned by a nurse Clients/patients receive a telephone call form
a nurse if they appear to need more support
Ottawa Model: Best PracticesOttawa Model: Best Practices1. Document smoking status2. Designate staff to provide treatment 3. Include tobacco dependence treatment in
clinical pathways, care maps, or Kardex systems used for quality management
4. Ensure pharmacotherapy for smoking5. Track tobacco users for more than 30 days
after discharge, provide counselling6. Ensure training for health-care professionals7. Provide self-help material8. Establish referral links9. Evaluate the provisions of tobacco dependence
treatment10. Provide feedback to health-care professionals
Importance of Hospital Smoking Importance of Hospital Smoking PoliciesPolicies
Policies that restrict smoking:
◦ Help people quit smoking is made less convenient encourages the use of NRT
◦Regulate second-hand smoke staff patients visitors
Standard of careStandard of care
All smokers have the right to the best care
No tradition of providing training in nursing curriculum (we’re changing that now!)
Smoking PoliciesSmoking Policies
Many smokers mention that ‘no smoking’ policies help them to quit or limit smoking
These policies:◦Stimulate motivation to quit◦Facilitate quitting by avoiding triggers
What nurses can doWhat nurses can do
What nurses can do to contribute to an environment that is conducive to a smoke-free lifestyle & successful quitting:
◦Get involved with the development of smoking policies in your work place Action on Tobacco Control: Action Kit for RNs
◦Tool for nurses who want to advocate for healthy public policies regarding tobacco issues
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