Health Santé Canada Canada

r u n z o p h o n a W r / i u ^ u ' s

' f o b i i z z o J J s s JiJ C î J J i î id î J

HV 5 7 4 6 E R 2 6 1 9 9 6

Health Canada

The opinions expressed in this report are those of the authors and do not necessarily reflect the official views of Health Canada.

This report was prepared as part of the Women and Tobacco Initiative, a component of the Tobacco Demand Reduction Strategy.

Copies of this report can be obtained by contacting the:

Publications Unit Health Canada Telephone: (613) 954-5995 Fax: (613) 941-5366

Également disponible en français sous le titre : Consommation de tabac chez les femmes francophones du Canada

© Minister of Supply and Services, 1 9 9 6 Cat. H 3 9 - 3 5 0 / 1 9 9 6 E ISBN 0-662-24225-4

I N S T I T U T N A T I O N A L D E S A N T É P U B L I Q U E D U Q U É B E C CENTRE DE DOCUMENTATION

M O N T R É A L

Francophone Women's Tobacco Use in Canada

I N S T I T U T N A T I O N A L D E S A N T É P U B L I Q U E D U Q U É B E C c m î : D E d o c u m e n t a t i o n

MONTRÉAL

Table of Contents

Summary i

1. Introduction l

2. Methodology 3

2.1 Target Population 3 2.2 Information Sources 3

2.2.1 Review of documentation 3 2.2.2 Focus Groups 5 2.2.3 Inventory of Program and Resources 7

3. Summary of the Documentary Review 8

3.1 Demographic Profile of Francophones in Canada 8 3.2 Socio-economic Profile of Francophone Women in Canada 10 3.3 Women and Tobacco Use in Canada 12 3.4 Francophone Women and Tobacco Use 15 3.5 Critical Analysis and Summary 17

4. Summary of Qualitative Data From the Discussion Groups 20

4.1 Profile of the Participants 20 4.1.1 Profile of the Francophone Women 20 4.1.2 Profile of the Program Coordinators 24

4.2 Francophone Women 26 4.3 Program Coordinators 28 4.4 Observations and Summary 30

5. Inventory of Programs and Resources 33

5.1 Programs and Resources Statement 34 5.2 Summary 36

6. Observations and Recommendations 37

Appendices

Appendix 1 List of people contacted 41 Appendix 2 Bibliography 63 Appendix 3 F o c u s group moderator's guide 73 Appendix 4 Report on focus groups 8 1 Appendix 5 Recruiting forms 1 0 5

Appendix 6 Advance questionnaire - women 111 Appendix 7 Descriptive grid - programs and resources 117 Appendix 8 Inventory of programs and resources 123

List of Exhibits

Exhibit 1 : Data base searched and key words used

Exhibit 2: Focus group schedule

Exhibit 3 : Distribution and proportion of Francophones in Canada

Exhibit 4 : Women with French as mother tongue and population 15 and over with French as mother tongue, by province

Exhibit 5 : Percentage of current smokers in Canada, 15 years and older, broken down by age and gender

Exhibit 6 : Smoking rate and average number of cigarettes smoked per day in Canada, by gender, among persons aged 15-19 and 20 - 24

Exhibit 7: Smoking rates among Francophones in Canada, 1985 -1995

Exhibit 8 : Participant profile - Francophone women

Exhibit 9 : Results of advance questionnaire -Francophone women

Exhibit 10: Profile - program coordinators

Exhibit 11 : Overview of inventoried programs and resources

Summary

Mandate

The objective of this study was to form an information base that would allow the development and implementation of more effective policies, programs and resources to reach the target population i.e., Francophone females age 15 to 19 years and those 20 years and over who live in various regions in Canada, including women in the priority groups who have low incomes, little education, no employment, difficulty reading and writing, are single mothers, immigrants, or who work in the medical field.

Three major sources of information were used to reach the study objective. They were:

• a review of documentation on tobacco use among Francophone women;

• an inventory of available programs and resources for preventing and reducing tobacco use among Francophone women; and

• focus groups with Francophone women and adolescent women from various regions across Canada and with coordinators of programs targeting this clientele.

Socio-economic Data

According to Greaves, to effectively combat the use of tobacco by women in Canada, it must be understood that not only is their situation different from that of men, but that the sub-populations of women also present varying characteristics. The facts presented in the literature reveal that less advantaged people are more susceptible to tobacco use and that, more often than not, women find themselves in this category of the population. Furthermore, the difference in health between women and men who are poor is greater than between the poor and the rich in the overall population.

If the cigarette fad initially affected upper class men with university educations, its next victims were women and marginal groups. Currently, people who are the least educated and who inhabit less advantaged regions of the country form the majority of smokers. According to Roberta Ferrence, less advantaged groups, and women in particular, are the last to stop smoking. In general, women tend to smoke fewer cigarettes per day than men, but they are also less likely to give up tobacco than are men. On the other hand, women with higher levels of education are more likely to quit; the improvement in their financial situation increases the likelihood of quitting to a greater extent than is the case for men.

Tobacco Use Among Francophone Women Data in the literature indicate that more Francophones in Canada smoke and that the proportion of women who smoke has caught up to the proportion of men who smok* It is known tha the incidence of tobacco use in Quebec is among the highest in Canada and that more people who are

socio-economically less advantaged smoke.

Qualitative data gathered from the focus groups held with women reveal that the people around them family and friends influence smokers' behaviour, particularly in the case of adolescent S e s Among the factors leading to smoking, women cited stress, the fear of gaining weight, S reflex, and addiction. Smoking represents both a means of escape and a means of control. Some reasons adolescent females give for beginning to smoke are to be cool , because of curiosi ty to be like the others. The majority of the smokers say they are aware of the negative impacts of^moking on health, hope to stop smoking one day and have already attempted to do so X ^ o n c e Nevertheless, the effects linked to withdrawal and the difficulty of breaking the habit

are the two main barriers to quitting.

For Francophone women, the incentives for smoking, or for stopping to do so, and the perceptions and the bake r s to be overcome are not very different from one region of Canada to

another More differences are observed from one smoker to another than from one region to T o her Although the women have many points in common, this is not to the exclusion of their regional particularities. Moreover, several mentioned that they would like to have access to Francophone resources and programs, but stressed the importance of having someone from the region with whom they would be able to identify.

The participants were in agreement that, among the means to be used for quitting smoking it was necessary to substitute something else for the cigarette, to change routine, to associate with someone else who also wished to quit and to have support. The will to quit is considered to be the first step toward success. The importance given to quitting varies according to the participants. Some would like to quit but said they are incapable of doing so, at least without help. Others said they are capable of quitting without help but that they do not really want to.

The women want to have support resources that suit them and that appeal to them in their daily reality They want to meet and discuss with each other, but they also insist that quitting must be maintained and followed up. Telephone lines, discussion groups, "buddy systems", and programs tailored to the individual are some of the preferred means. Even though a group approach helps to break down women's isolation, there is a need for multiple, varied approaches because some of them are not prepared or able to live a group experience. The women need tricks, tools, support and encouragement; they do not want to be judged, but encouraged. Moreover, they point out the parallel with other drug addictions and believe they need support similar to that offered to people who have alcohol or drug addictions. They feel it is important that this support come from a person who has been a smoker and has lived the difficulties associated with quitting.

Perceptions of Program Coordinators

The program coordinators who participated in the focus groups came f rom various regions in Canada and represented a variety of organizations offering programs or services to Francophone women or adolescent women. In general, they do approach the subject of tobacco use with their clients, but very indirectly, and even more so when intervening with women in difficult situations. All the participants agreed in recognizing the importance of the doctor's role in the matter of tobacco use. Furthermore, the program coordinators, just like the women themselves, wish to see tobacco use integrated into a wider health perspective (physical and psychological) and see it dealt with within the context of women's reality. A global approach seems less threatening and opens the way to discussion and proposal of various alternatives to the smoking behaviour. It progressively leads the women to take positive actions with regard to their health.

The program coordinators emphasized the importance of tying the materials and the tools to the participants' needs and expectations. According to them, it is essential that the context in which the women live be taken into consideration in order to intervene effectively, to develop tools that address the population sub-groups and to tailor the content of the programs to the needs identified by the participants. They think the lack of resources and quality programs offered in French is deplorable. Translated material is often judged inadequate, but at the same time, there is an admission of little awareness of what is available. The participants pointed out the lack of distribution of information and material.

The program coordinators reported that they are interested in integrating to their services programs or tools for helping smokers. On the other hand, they feel they do not have the means required to do this. They hope to be supported in this undertaking and to be able to use the existing material that is deemed to be of quality and effective. They require concrete means to raise the level of awareness, to inform and to promote action in order to help women stop smoking. The primary needs expressed are recourse to a resource person, education in tobacco use, and the sharing of information and experiences.

Recommendations

Useful data and information characterizing Francophone women in the various regions in Canada are limited. Different other constraints are added to the paucity of available information and make it not only difficult to form a bank of comparable data, but also to interpret that information. The main constraints are: a lack of uniformity in definitions; problems related to sampling techniques; and the use of different terminologies for tobacco use. In order to better define the issue of tobacco use among Francophone women and to be better able to offer them adapted programs, it is necessary to expand the present data bank and information.

1. It is therefore recommended: • 1 l That the "language" variable be systematically integrated into national studies and

surveys on tobacco use.

The integration of the three (age, sex and language) variables into surveys requires nrovisions for representative sampling of each of the population sub-segments. This data will allow the development of profiles, the comparison of similar sub-groups, the identification of discriminant factors, a better targeting of priority groups and the development of interventions that are more effective because they are better targeted.

• 1 2 That at the outset, Health Canada, in cooperation with its partners, propose a standardized definition of French-speaking communities so that comparison of data from various studies be possible from one year to the next, and a base of useful information be obtained.

• 1 3 That Health Canada, in cooperation with relevant stakeholders, propose a set of common terminologies and definitions related to the use of tobacco (habitually, regularly, occasionally, currently, etc.) so that incidence-related data can be

compared.

• 1 4 That Health Canada adopt a conceptual framework for the analysis of the global information collated in terms of the selected theoretic model so that it is easier to define the issue and to prioritize, plan and orchestrate the interventions.

If it is true that the battle against tobacco use requires a knowledge of the smoking population and its various segments, it must be accepted that this knowledge assumes its entire significance from the fact that it enables to intervene in a more effective and efficient manner. The ultimate objective is to employ useful means to reach Francophone women in various sub-groups, to develop adapted interventions and to better priorize and orchestrate actions for them.

2. It is therefore recommended:

• 2 1 That particular emphasis be placed on the implementation of measures to assist quitting more specifically aimed at Francophone women in the priority groups, adolescent women and young women.

• 2.2 That greater efforts be made to adapt, promote and distribute existing materials and tools.

In fact, some materials and programs for prevention and cessation specifically designed for Francophones, or translated in French, are available. There are also resources and program for cessation or prevention that are more specifically addressed to sub-groups of Francophone women, such as women in less advantaged environments, adolescent females in school, pregnant women, Aboriginal women, etc. Although a variety of materials, tools and resources exist, they are not well

iv

known. Furthermore, some provinces offer very few programs or resources in French. Consequently, it is believed that the emphasis should now be on the adaptation, the promotion, the distribution and the evaluation of this material.

8 2.3 That resources developed in French and specifically suited to the Francophone culture, and the women's regional and economic context be available in the different provinces of Canada.

Information in French must be better than straightforward translation of Anglophone content that does not always correspond to the needs of Francophones. For example, it is said that the materials used should be as visual as possible. It seems, furthermore, that for Francophones, an oral approach works better than a written one and that an informal, interactive approach is more effective than a formal one.

• 2.4 That the messages given out be more positive and encourage women in their efforts by emphasizing the advantages associated with not using tobacco.

The approach used to recruit Francophone participants into tobacco reduction or cessation programs would be better served if it adopted a positive and free approach. The programs must also propose means of replacing the cigarette with something else, other pleasures or other ways of seeing things so that the women feel in control.

• 2.5 That the support resources meet and appeal to the women and their lifestyle. The women want to get out and talk with each other, but they also stress the maintenance of and follow-up to cessation. Telephone lines, discussion groups, "buddy systems" and individually tailored programs, are just some of the preferred means. Multiple and varied approaches are needed because, even though the group approach helps break the women's isolation, a certain number of them are not ready or able to live this kind of experience.

• 2.6 That initiatives centred on staying tobacco-free be developed to help the women through their decision to become non-smokers.

There appears to be few preventive interventions for adolescents and priority groups, and no specific interventions at all for maintenance and support after quitting. Some follow-up measures for participants are provided within the framework of certain programs. These vary from several weeks to a few months after quitting, when in fact, evaluations of different cessation programs tend to show that the cessation rate decreases as the length of time after the end of the program increases.

• 2.7 That preventive information be emphasized with adolescents. Young females wish to receive more precise information about the damaging effects of cigarettes and available resources. In-school discussions about tobacco use, recourse to peers or credible ex-smokers, updated and adapted videos are suggested means. What is important is that the information appeal to their values and concerns.

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. 2.8 That particular stress be placed on cooperative efforts to reduce tobacco use.

« 9 9 That tangible means (training, awareness-raising, distribution of material deemed to be of quality and effective, exchange of expertise, accessibility of resource people, etc ) be made available to those who wish to become involved in the battle against

the use of tobacco.

Existing programs are not well known in, and absent from, several regions. It is important to enhance the value of the role of the various intervenors and show them the significance of their collaboration in the battle against the use of tobacco. Their involvement, moreover, calls for diverse forms of support.

• 2 1 0 That doctors be made more aware of the importance of their role in the prevention, instruction and assistance of women in relation to tobacco use.

• 2 11 That the existing resources and services such as the CLSCs in Quebec the federations, associations, clinics, workers' health services, hospitals and schools increase their contribution and involvement.

In short promotion and distribution must extend well beyond the publication of the available progmns It must involve greater awareness and better training of the various p ayers, the coordination^f actions and an increase in the number of support areas for cessation and follow-up. From vilTon to action" is a slogan that both expresses and summarizes the steps and processes that

need to be emphasized in the battle against tobacco use.

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1. Introduction

The use of tobacco is the primary cause of premature death among Canadian women. More than 15,000 women die annually in Canada as a result of diseases caused by tobacco. In 1994, for the first time, mortality among women from lung cancer was higher than that caused by breast cancer. It is known that nearly 90% of lung cancers are related to cigarette use, and that the diagnosis and treatment of this cancer are not very effective; the five-year survival rate is about 13%.

Since 1991, the use of tobacco has increased in the 15 to 19 year age group and the 20 to 24 year age group, reversing the downward trend observed between 1981 and 1990. The proportion of smokers varies between the different groups of women. A higher number of smokers can be found among unemployed women and among those with less education. Similarly, Francophone women are among the groups most likely to smoke.

The reduction of tobacco use among Francophone women, including women in the priority groups, demands a better understanding of the reasons why they smoke and quit smoking. It also requires the development of effective interventions and approaches to reduce and prevent the use of tobacco by this population.

It is in this context that Health Canada asked Price Waterhouse to conduct a study on the use of tobacco among Francophone women and on the tobacco reduction programs and resources designed for this group.

The aim of this study is to form a knowledge base from which more effective policies, programs and resources can be developed to reach the target population, that is, Francophone women between 15 and 19 years of age and those 20 years of age or over, living in different regions of Canada. Priority women are defined as those "women whose rate of tobacco use is higher than Canadian women as a whole, that is, women with low incomes, with little education, who are unemployed, have difficulty reading and writing, are single mothers, immigrants and also those women working in the medical field" (Terms of Reference 'A', p.4, lanuary 1995).

The study includes the following objectives:

• to carry out a review of Canadian documentation and recent national survey data on tobacco use in order to obtain relevant information on Francophone women, the factors related to the individual and the environment that motivate starting and continuing to smoke, and the factors that would help them to quit smoking;

• to identify the programs and resources currently used to prevent and reduce the use of tobacco by Francophone women; and

• to identify the weaknesses of the programs and services for the prevention and reduction of tobacco use among Francophone women and recommend strategies aimed at correcting these weaknesses.

1

In addition to the Introduction, this Final Report contains the following chapters

• the methodology employed;

• the summary of the documentation reviewed;

• the summary of the qualitative data from the focus groups;

• the inventory of programs and resources for Francophone women; and

• observations and recommendations.

2. Methodology

2.1 Target Population

The study's target population was Francophone women in different regions of Canada, aged between 15 and 19 years and 20 years and over, and the women in the priority groups defined in the Terms of Reference, that is, women with low incomes, with little education, who are unemployed, have difficulty reading and writing, are single mothers, immigrants and also those women working in the medical field.

The review of the literature was, therefore, directed towards Canadian documentation and the data from recent national and provincial surveys on tobacco use among Francophone women, including women in the priority groups. With the agreement of Health Canada, the focus groups were divided between Francophone women and adolescent women from the priority groups, and women from the general population.

For the purposes of the study, a second priority group was identified, that is, representatives from organizations offering programs or services such as tobacco use prevention and cessation programs, programs centred on women's health, social services for women, adult education and training, workers' health, and services for immigrants.

2.2 Information Sources

The present study is based essentially on the following three sources of information:

• a review of the existing documentation related to tobacco use among Francophone women;

• qualitative data related to the use of tobacco by Francophone women collected during the focus groups with different groups of women and coordinators of programs for women; and

• an inventory of the programs and resources currently used to prevent and reduce the use of tobacco among Francophone women.

2.2.1 Review of Documentation

The review of the existing documentation, including national surveys, was based on the following processes:

• resource persons were contacted in various national and provincial organizations such as Health Canada, Statistics Canada, the provincial ministries of health, the National Clearinghouse on Tobacco and Health, the Quebec Council on Tobacco and Health, the Canadian Cancer Society, the Canadian Lung Association, etc. The list of the people contacted is provided in Appendix 1;

arrïpH nut bv the Price Waterhouse national libraries in Toronto and 9 S t r S S 1 on the following page, presents the list of the databases that

were s c r u t i n i z e d and the key words used;

« r e s e a r c h was also c o n d u c t e d at the Laval University library, using the key words

described above on the Ariane system;

. external experts a s soc i a t ed with Price Waterhouse were called upon to identify

relevant works, whether published or not; and

• the bibliographies of the whole body of work in the inventory were also reviewed.

The bibliography of the works that were consulted is provided in Appendix 2. The annotated bibliography is available from Health Canada.

Exhibit 1 - Databases Searched and Key Words Used

Database

• • •

• • • •

•

Psyclnfo

Sociological Abstracts Microlog Canadian Business & Corporate Affairs Dialog/Medicine

Embase Health Periodicals AMA Journals Online Medline Health Planning & Administration Addiction Research Foundation Library

Key Words

Hie following terms were searched using various combinations:

francophone(s), adolescences), jeune(s) femmc(s), femme(s), chômage, chômer, chômeuse, fumer, fumeur, frimeuse, groupes a risque, revenu faible, économiquement faible, sans emploi, sans travail, mère monoparentale, tabagisme, cigarette(s), Québec, Montréal, Canada and every province.

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2.2.2 Focus Groups

In all, thirteen focus groups were held in different regions across Canada from mid-May to mid-June 1995. Eight of the groups were with Francophone women and included smokers and ex-smokers. Five of the groups included program or service coordinators. Exhibit 2, below, presents the schedule for the focus groups held in the various cities as well as the number of participants.

Exhibit 2 - Focus Group Schedule

City/Region i i i s i B i i i i i i Group Number of Participants

Ottawa May 18 Program coordinators 10

Outaouais May 18 Program coordinators 5

Jonquière June 1 Priority adolescent women 9

Jonquière June 1 Priority women 10

St-Boniface June 5 Program coordinators 6

St-Boniface June 5 Priority women 10

Gravelbourg June 6 Program coordinators 7

Gravelbourg June 6 Women in general 9

Campbelton June 6 Women in general 11

Moncton June 7 Program coordinators 9

Baie Ste-Marie June 8 Women in general 12

Sudbury June 13 Adolescent women in general 12

Sudbury June 13 Priority women 6

Note: Priority women and adolescent women are defined as being "low income women, who have low education levels, who are not employed, with low literacy levels, single mothers, immigrants, and those who work in the medical profession" (Terms of Reference, "A", p. 4, January 1995).

A moderator's guide was developed prior to holding the groups. Different guides were used for moderating the women's groups and the program coordinators' groups. These documents are provided in Appendix 3. After having been reviewed by Health Canada representatives, the guides were sent to the participants prior to the discussions. Finally, each of the focus groups was recorded to facilitate the writing of the summary. Focus group summaries containing the highlights of the focus groups are presented as a table in Appendix 4.

5

Recruiting Criteria

Certain criteria related to the groups of women, smokers and ex-smokers, were established before proceeding with the recruitment of participants. The criteria selected for recruitment of the participants are described below.

9 The first criteria that had to be taken into account for all of the groups of women was mother tongue. This being said, persons whose mother tongue was French had to speak French at home, that is, with their family and friends, or speak both French and English. Persons whose mother tongue was French but who did not speak French at home were not selected.

» The level of education and family income were also considered for the recruitment of women in the priority groups. Completion of a level of education equivalent to community college was considered to be a discriminant factor. In terms of family income, the scale that was used took into account the number of dependent children and whether or not the person had a spouse. For example, the levels of family income were set at $20,000 or less for a family with a spouse and no children, and at $30,000 or less for a family with three or more children and a spouse. The level of education and family income criteria were used in combination. Thus, persons whose level of education was equivalent to community college completion could have been selected for the priority women's groups if the level of family income corresponded to the established scale.

There was no specific criterion for recruiting people in charge of programs or services other than that they worked with Francophone adolescent or adult women of all ages, including those in the priority groups.

Recruiting Procedures

Several venues were taken to form the focus groups in different regions across Canada so that they corresponded to the study's target population. These procedures included the following:

• Telephone calls were made to various organizations working with Francophone adult or adolescent women that were among the most likely to refer potential participants for the discussion groups, as well as to people in charge of programs or services. The list of the people contacted is provided in Appendix 1.

• Posters announcing the discussion groups were also circulated to certain organizations and in some public places to catch the interest of potential participants.

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9 Telephone contact was subsequently made with the people referred by the contact organizations. Participant selection according to the preestablished criteria was carried out with the help of a short questionnaire given during the telephone contacts with potential participants. Thus, a recruitment form including the selection criteria was used to recruit the groups of women. A recruiting form was also used to recruit program or service coordinators. These documents are provided in Appendix 5.

• In order to better understand the smoking behaviour of participants, a short questionnaire was administered by telephone of the focus groups to the women who agreed to participate in them prior to the scheduled date. This questionnaire is provided in Appendix 6.

2.2.3 Inventory of Program and Resources

The inventory of the programs and resources for the prevention and cessation of tobacco use offered to Francophone women in Canada was carried out using the following means:

• a review of the inventories already available or under development;

• telephone communication with various responsible organizations to obtain all relevant information or documentation in regard to programs or resources addressing Francophone women. The list of people contacted is provided in Appendix 1; and

• a descriptive grid developed for recording information related to programs and resources offered to Francophone women, and for forming a descriptive and analytical inventory. The descriptive grid used to collate the data is provided in Appendix 7, while the actual inventory can be found in Appendix 8.

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3. Summary of the Document Review

the results of the review of the documentation, and of the national survey data This section presents t ^ ^ ^ d i f f e r e n t r e g i o n s i n Canada. The chapter is divided into on F r a n c o P h o n e w o m e n a ^ ^ h i c ^ ^ F r a n c o p h o n e s i n C a n a d a f o l l o w e d b y a

five sections. nrsx, a ^ ° r a n c o p h o n e W Omen; then, a picture of tobacco use by women m socio-economic pro ^ c u r r e n t l y known about Francophone women of the various regions in general, fo^we^y ^ ^ o f tobacco; and lastly, a critical analysis that reviews the situation and

ÏÏrfc o f A e chapter.

3.1 Demographic Profile of Francophones in C a n a d a

1 ^ f m e the issue of tobacco use among Francophone women and the types of To t h e m best, it is important to perform an analysis that takes their life interventions 1

U o w i s e c t l 0 n s p r e s e n t t h e demographic distribution of

iïZ^^*^ Profi le o f t h e s e w o m e n b e f o r e dea l ing w l t h women's use

of tobacco. • • • .M.nomim. woken at home and the first language spoken, the proportion of

u m g the P n ^ ^ ^ S S 1 , , , . , i t t l e m 0 t e than 22% of the total population of Canada. h T ? near" X e ^ l l of whon, almost all (90.2%) live M the provtnoe of Quebec.

that is neariy u.^ , t t h e r p r o v i n c e s with a substantial number of

— breakd°™ °f the distributo and proportion of Francophones in Canada.

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Exhibit 3 -Distribution and Proportion of Francophones in Canada

Population l i l l l i l l l l l

l l i i l p i p l i i ! Francophones

l i l i H i l l i

Francophones/ population in the

provinces

% Francophones/ French Canadian

population

Newfoundland 568,474 1,235 0.2 0.02 Prince Edward Island 129,765 2,935 2.3 0,05 Nova Scotia 899,942 21,590 2.4 0.35 New Brunswick 723,900 220,590 30.5 3.55 Atlantic 2,322,081 246,350 10.6 3.97

Quebec 6,895,963 5,604,020 81.3 90.22 Quebec 6,895,963 5,604,020 81.3 90.22

Ontario 10,084,885 300,085 3.0 4.83 Ontario 10,084,885 300,085 3.0 4.83

Manitoba 1,091,942 23,545 2.2 0.38 Saskatchewan 988,928 6,345 0.6 0.10

Alberta 2,545,553 17,805 0.7 0.29 British Columbia 3,282,061 12,120 0.4 0.20

West 7,908,484 59,815 0.8 0.96

Yukon 27,979 360 1,3 0,01

Northwest Territories 57,649 610 1.1 0.01

Territories 85,446 970 1.1 0.02

Total Canada 27,296,859 6,211,240 22.8 100.00

(1) Statistics Canada, Catalogue 93-301. A National Overview. Census 1991.

(2) Statistics Canada, Catalogue 93-317. Home Language and Mother Tongue.

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A art from Quebec in 1986 there were a little over 400,000 Francophone women aged 15 years or over in the provinces of Canada1. Exhibit 4, on the following page, illustrates the details of their distribution in each of the provinces. In 1991, there were a little more than 2.8 million Francophone

women in Quebec.

3 . 2 S o c i o - e c o n o m i c Profile of Francophone Women in Canada

Disadvantaged people are more susceptible to tobacco use and, more often than not, women find themselves in this category of the population. In fact, an analysis of the status of women in Canadian society reveals that they are much more likely than other groups of the population to belong to the lower socio-economic layers, to be sole family providers, unemployed or on social assistance In this matter, Canada's Health Promotion Survey (1990) shows that men are more likely to be in the labour force and to have completed university studies, while women are more likely to be elderly or poor, to work in the service sector, to work in an office, keep house with no salary and to be separated, divorced or widowed.

In 1986 a quarter of Francophone women outside Quebec had a Grade 8 education or less and the highest education achieved by half of them was high school completion. More than half held positions of an administrative nature in sales and services. They were office employees, s a l e s p e r s o n s , waitresses, hairdressers, steam-pressers, cooks, etc. (RNAEF 1991). That same year in Quebec, there were 252,680 single parent families, that is nearly 21% of all families with children. Of this number, 82% were the responsibility of a woman . Elsewhere in Canada, one Francophone woman in eight was the head of a single parent family.

In Quebec, the poverty rate for women is 20°/o higher than for men. This over-representation of women is true for all age groups and is accentuated among the elderly. The state of women's health shows a more significant disparity between poor women and poor men than it does globally between the rich and the poor in the general population. Disadvantaged women battle daily to survive exclusion, insecurity, powerlessness and low self-esteem (Dunnigan, Gravel 1992). More than half of elderly single women live in poverty. In Montreal, for example, there are more than 5,000 homeless women of whom one third have a dependent child.

1 Réseau national d'action éducation des femmes. Pour les femmes: éducation et autonomie. La place des femmes francophones hors Québec dans le domaine de l'éducation au Canada, by Linda Cardinal and Cécile Coderre, Report No. 2, Report No. 3,1991.

2 Health, and Welfare Canada, Canada 's Health Promotion Survey, 1990: Technical Report, 1993.

3 Dunnigan, Lise and Gravel, Nicole, La santé des femmes démunies: mieux comprendre pour mieux intervenir, Service à la condition féminine, ministère de La Santé et des Services sociaux du Québec, November 1992.

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Exhibit 4 - Women with French as Mother Tongue and Population 15 and Over with French as Mother Tongue, by Province

Provinces I S l f H i l S s i Total Newfoundland and Labrador 1,240 2,610 Prince Edward Island 2,925 5,450 Nova Scotia 17,340 34,175 New Brunswick 95,810 189,780 Ontario 231,125 439,130 Manitoba 23,340 46,285 Saskatchewan 12,145 23,850 Alberta 26,830 54,440 British Columbia 23,785 48,320 Northwest Territories and Yukon 835 1,940 Total I l l l l l f l l l l l l P I I I I I 845,980

Source:

(1)

(2)

Source:

Statistics Canada, 1986 Census, special tabulations.

Mother tongue as first language learned or spoken during childhood and still understood by the person.

Hie data presented in this exhibit have been calculated from provincial profiles presented in report no. 3 of Pour les femmes: éducation et. autonomie - La place des femmes francophones

Research and Education (AWARE), 1991, by Linda Cardinal and Cécile Coderre.

Francophone Women and Total Francophone Population in Quebec

Female Total Quebec 2,853,660 5,604,020

Statistics Canada, Catalogue 93-317

11

According to Greaves, if the battle against the use of tobacco among Canadian women is to be Successful fc must be understood that their situation differs from that of men and that the sub-popuktions of women also present different characteristics .

If the cigarette fad initially affected upper class men with university educations, its next victims were women and marginal groups. Currently, the majority of smokers is composed of persons with

and who live in less advantaged regions of the country. Roberta Ferrence says hat less advantaged groups, and women in particular are the last to quit smoking . The double

burden of poverty and fear of violence, both inside and outside the home, is just another source of stress that can be linked to poor nutrition, drug abuse, lack of physical exercise and use of tobacco

in women.

3.3 Women and Tobacco Use in Canada In 1990 the rates of tobacco use among persons aged 15 years and over in Canada was 31% for men and 28% for women. In comparison to the 1965 rates, this represents a decrease of 10 nercentage points for women and 30 points for men. Apart from a much lower rate of decrease m tobacco use among women over the last two decades, we are now observing a higher smoking rate among young women compared to young men, and an increase in tobacco use among elderly

women.

Exhibit 5 on the following page, illustrates the proportion of smokers in Canada from 1985 to 19906 Between 1985 and 1990, the use of tobacco decreased in all age and sex categories, primarily in young women aged 15 to 19 years and in women 20 to 24 years of age Women between the ages of 20 and 44 years, as well as women with low incomes, female blue collar workers and unemployed women were among the most likely to smoke in Canada .

4 Hea l th and Welfare Canada, Background Paper on Women and Tobacco (1987) and Update (1990), prepared for the Health Promotion Directorate of Health and Welfare Canada and the National Work Group on Women and Tobacco, by Lon-aine Greaves, 1992.

5 Health and Welfare Canada, National Symposium on Women and Tobacco, Proceedings, Ottawa, Ontario, March 1-9,1988.

6 National Clearinghouse on Tobacco and Health, Focus On: Canadians and Tobacco, September 1993.

7 Health Canada, Report on Women and Tobacco, prepared by Price Waterhouse for the Tobacco Programs Unit, Health Promotion Directorate, Health Pro grams and Services Branch, 1993

100

Exhibit 5 - Percentage of Current Smokers in Canada, 15 and older, Broken Down by Age and Gender

Gender 1985 1986 1988 1989 1990

15 + Men 36% 35% 32% 33% 31%

15 + Women 32% 31% 25% 29% 28%

15-19 Men 28% 24% 20% 22% 21%

15-19 Women 29% 28% 23% 24% 21%

20-24 Men 40% 38% 33% 36% 35%

20-24 Women 41% 39% 40% 38% 34%

25-44 Men 41% 39% 41% 37% 36%

25-44 Women 39% 36% 31% 34% 34%

45-64 Men 36% 36% 32% 34% 30%

45-64 Women 30% 29% 24% 30% 26%

65 + Men 20% 20% 29% 21% 18%

65 + Women 18% 14% 14% 16% 14%

Source: National Clearinghouse on Tobacco and Health, Focus on: Canadians and Tobacco. September 1993.

In general, women tend to smoke fewer cigarettes per day than men while heavy smokers are more numerous among older women. They are, however, less likely to give up tobacco than men, particularly in the 35 years and over age group. More educated women quit more readily and, as a general rule, the improvement of their financial situation increases women's likelihood of quitting, but has much less effect on men. In 1989-1990, the smokers (men and women) who reduced their consumption or quit smoking did so due to greater awareness of the health risks (65%); support from family and friends (49%); the example set by others (42%); a change in social values (33%); and the advice and support of a health field professional (27%).

Q In 1994-1995 , the overall incidence of tobacco use among women (25%) decreased by 5 percentage points as compared to 1991 and the average number of cigarettes smoked per day is 15.6. Exhibit 6, on the following page, shows the data gathered on the incidence and the number of cigarettes smoked daily in Canada. Women between the ages of 20 and 24 remain the group in which the rate of tobacco use is the highest, even though a 7-point decrease is observed over the year 1994-1995, as well as a decrease in the number of cigarettes smoked. One out of three women with low incomes smokes, and nearly half of these are between the ages of 20 and 24 (47%).

8 Health Canada, Survey on Smoking in Canada, Cycle 1, August 1994, Cycle 2, November 1994, Cycle 3, February 1995, Cycle 4, June 1995.

13

Exhibit 6 - Smoking Rate and Average Number of Cigarettes Smoked per Day in Canada, by Gender, Among Persons Aged 15-19 and 20-24

Smoking Rate (Proportion of Smokers in Population) Canada Youth 15 to 19 i i i n i i i i i i i i B

Total Men Women Total Men S B i l l i l l l i Men Women % % % % % % % % %

1991 31 32 30 * * * * * *

June 1994 31 32 29 27 29 26 40 41 38

Sept. 1994 30 31 29 29 27 30 38 40 37 Dec. 1994 30 31 28 28 26 29 36 39 33 March 1995 27 29 25 26 25 26 34 37 31

Average Number of Cigarettes Smoked Per Day* * June 1994 18.8 20.6 16.9 13.2 14.7 11.8 16.5 17.2 15.7 Sept. 1994 18.7 20.5 16.8 12.7 14.3 11.1 16.2 17.7 14.7 Dec. 1994 18.4 20.0 16.6 12.2 13.5 10.9 15.4 16.5 14.1 March 1995 17.7 19.6 15.6 11.4 12.9 9.9 14.9 16.3 13.3

Source: General Social Survey Data, 1991 and Health Canada, Survey on Smoking in Canada, Cycles 1, 2, 3 and 4.

* The 1991 General Social Survey includes results forthe 15-24 age category.

** In 1991, tobacco consumption was measured according to the following amounts: 1-10,11-25 and 26 or more cigarettes, based on the proportion of smokers in each category.

According to the 1994-1995 data, nearly three-quarters of women who smoke smoked their first cigarette before the age of 18. Women smoke because they enjoy it (3 8%), because of habit (36%), to relax (19%) or because of addiction (14%).

Three-quarters of women smokers have tried to quit at least once because they fear health problems. Those who started smoking again did so to relax or because family and friends smoke. Of the methods used to quit smoking, the majority (89%) of ex-smokers (men and women) preferred going "cold turkey".

Women are better informed than men about the health risks of tobacco and the younger more so than the older women. This being said, nearly one third of the smokers indicated that it would take a disease associated to tobacco or a serious illness (31%) to make them stop smoking.

102

3.4 Francophone Women and! Tobacco Use

Two studies dealing specifically with Francophones and tobacco use were carried out by Georges Létourneau for Health Canada. The first, on Francophones in Canada, was completed in 1988 and the second, on Quebec Francophones, was completed in 199010. The 1988 study focuses on the population of the four Canadian provinces with the highest number of Francophones, that is, Quebec, Ontario, New Brunswick and Manitoba. Based on the estimates extrapolated from the data from the Health Promotion Survey (HPS, 1985) and the General Social Survey (GSS, 1985), the study summarizes the prevalence of tobacco use among Francophones as compared to the other Canadian linguistic groups. The 1990 study focuses on Francophones within Quebec and is based on the social and health data compiled in the 1987 Quebec Health Survey.

The national surveys that make a language distinction present the results in a very global manner. The same can be said about provincial comparisons drawn from national survey data where there is a lack of detailed data on population sub-groups, such as Francophone women, and few variables. Moreover, provincial survey data from across Canada that focuses on the use of tobacco according to linguistic variables is practically non-existent. When it does exist, the data is difficult to present, since it lacks significance because of the collection methods or too small sample sizes.

In terms of tobacco use, data and information focused on Francophone women in the different regions of Canada are limited. The following is a presentation of the primary information that has been gathered.

Exhibit 7, on the following page, displays the data on Francophones in Canada for 1985, 1990 and 1995. In 1995, there is an equal number of Francophone men and women smokers in Canada, that is 35% of women, 36% of men, while the Canadian incidence is 27%. Francophone women smoke an average of 16.4 cigarettes per day (Survey on the Use of Tobacco in Canada, Cycle 4). In relation to 1985, a decrease in the proportion of Francophone smokers is observed. The rate of tobacco use among Francophone women decreased by 3 percentage points between 1985 and 1995, while the rate for men matched the 7-point decrease observed in the overall Canadian rate.

Exhibit 7 - Smoking Rates Among Francophones in Canada

Year Francophones Anglophones (M/W)

Population of Canada Year

Women Men Total Anglophones

(M/W) Population of

Canada

1985 38% 43% 40% 33% 34% 1990 34% 31% 29% 1995 35% 36% 35% 26% 27%

Source: HPS 1985, HPS 1990 and Survey on Smoking in Canada, Cycle 4.

9 Health and Welfare Canada, Francophones and Smoking, background paper prepared by Georges Létourneau, presented to the Francophone Committee of the National Program to Reduce Tobacco Use, July 1988.

10 Health and Welfare Canada, Smoking in Groups at Risk : The Francophones of Quebec, background paper written by Georges Létourneau and Marie Bujold, presented to the National Strategy to Reduce Tobacco Use, June 1990.

15

Furthermore, the highest rates are seen among Francophones within Quebec (41%). The rate ' , n n Ontarians is 38% while in New Brunswick the percentage of Francophone smokers

Z S ^ X t Ô r s t u d L : 28.7% in the HPS 19S5 and 36.7% in the GSS .985 (tn Létourneau.

1988).

la 1994 more women in Quebec smoked (3 8%) than in any other region, and more smoked every day the national average being 31%. More young people aged 15 to 19 years smoked m Quebec 7lk) than elsewhere in Canada (27%). More young adults aged 20 to 24 years smoked in Quebec 4 % anTin Ontario (42%). In 1990, Quebec women scored a higher rate (33%) than the whole of

the Canadian population (29%) (HPS 1990), and in 1991, in all age groups 65 years and under (GSS 1991), they were more likely to smoke every day than men.

In Ouebec in 1987 young Francophone women aged 15 to 19 years smoked more than young men. Francophone women in the 20 to 24 year age group showed a rate of 50%, while in the 45 years andover group there were more smokers among the English-speaking women, the rate among Francophones b eing about 39%. More than half (56.1%) of Francophone women smokers were unemployed. Among them, 36% kept house, 9.7% were going to school, 7.5% were not looking for w o r k and 2 9% were retired. Adolescents, women, blue collar workers and the unemployed were among the identified Quebec Francophone at-risk groups (in Létourneau 1990).

Women from very less advantaged environments, particularly those aged 18 to 29 and 30 to 44 years were the most vulnerable to tobacco use (Santé Québec 1987).

Furthermore the 1987 data compiled according to social health regions reveals a significant disparity in the rates of tobacco use in different regions in Quebec. The highest rates are seen m the regions farthest from urban centres. There would be more smokers in the regions of the Cote-Nord,

Abitibi and the Outaouais (Létourneau 1990).

It is interesting to point out that, in 1994-1995, there are more women than men people 65 years of age and over less educated people and residents of Quebec and Ontario among the people who are not even considering quitting smoking. The people who are contemplating quitting, or are preparing to do so, are more likely to be men, to be between the ages of 15 and 19 years, to have a university degree and to be residents of British Columbia or Manitoba.

There is little information that makes it possible to establish comparisons related to the use of tobacco between Francophone women in different regions of Canada and single out factors that influence their behaviour. Furthermore a qualitative study carried out in 1993 on Franco-Ontanan women in the Ottawa-Carleton RegionU46e women felt they were dependent upon, and slaves to, smoking The majority of women would like to break this habit. According to them, however, their addiction is just as much a disease as other addictions and social intolerance of their behaviour provokes them more to smoke than to quit. This being said, the criterion for quitting that seems the most important to them is motivation, no matter what method is used to do it.

11 Gratton, Ginette and Lalotule, Gisèle, Parameters for the Development of a Strategy with Respect to Tobacco Use Among Francophones in the Regional Municipality of Ottawa-Carleton, a study earned out by Le Groupe GMG for the Regional Municipality of Ottawa-Carleton Health Department, January 1993.

16

A similar observation is made for pregnant Francophone women from less advantaged backgrounds living in Montreal12. At this point in time, women know that smoking is bad for their health. But for them, smoking is one of a series of coping mechanisms that compensate for their daily problems (inadequate material conditions, unsatisfactory marital relationships, family conflicts, distressed neighbourhood, depression, violence, etc.). Smoking is thus a pleasure they offer themselves. Social pressures only serve to increase their sense of guilt. Most have tried to quit smoking at some point in their life but say they are incapable of doing so. To try to quit smoking and fail is just one more defeat in the daily context of a life strewn with such obstacles.

3.5 Critical Analysis and Summary

The review of the literature showed that there are few national, provincial or regional studies focused on Francophone women that allow the extraction of information about tobacco use in this segment of the population. Moreover, there has not been a national study focusing specifically on Francophones since the Létourneau studies in 1988 and 1990. It must also be pointed out that these two studies were not actually national surveys and that their data is somewhat outdated (about ten years old).

If many studies and surveys on tobacco use, on the dangers of tobacco, on the health of the population or on tobacco consumption habits have been carried out in Canada, several difficulties must be overcome in order to apply the available information to a particular group such as Francophone women. Included in these difficulties are the lack of uniformity in the definitions, the absence of data related to population sub-groups, the problems linked to sampling techniques and the use of different terminology to define tobacco use .

The lack of uniformity even in the definition of the Francophone population causes a problem. Depending on the way French-speaking people are defined, significant differences are observed in the number of Francophones in Canada (between 6.2 and 6.7 million). Mother tongue, first language spoken and language spoken most often in the home are only a few of the different bases upon which the studies rely to define the Francophone population. This leads to the question of the position of French-speaking immigrants in the samples. If one of the criteria used to define French-speaking people is based on mother tongue, then a significant portion of immigrants is lost. At least in Quebec, the latter represent a significant part of the French-speaking population. In addition, immigrant women have been identified as being part of the priority groups, but depending on the way the population being studied is defined, they risk being excluded from the surveys.

Another problem that leads to careful analysis and interpretation of survey data is the variation in statistics. For example, the distribution of smokers according to language and province in the 1985 HPS indicates that the proportion of smokers among New Brunswick Francophones is 28.7%, while the GSS of the same year reports 36.7% Francophone smokers.

12 Conference given during the National Symposium for Francophones Working to Reduce Tobacco Use, "How do people in socio-economically less advantaged environments react to our programs?", Quebec, February 1991.

100

Given the sampling variability, it is also difficult to obtain significant results relating to certain population sub-groups. For example, the 1990 Létourneau study on Quebec Francophones reports that the limited representation of Anglophones in the Quebec Health Survey sample makes the comparison between men and women smokers in the two language groups impossible. The same can be said on the national level. Contrary to Cycles 1, 2 and 3, Cycle 4 of the Survey on Smoking in Canada (1994-1995) presents the results according to the language spoken most often in the home. Yet Cycle 4 does not permit the extraction of statistics that are significant enough to compare Francophones in the different provinces because of non-representative sampling.

The use of different terminologies to define tobacco use, such as habitual smokers, regular smokers, occasional smokers, and current smokers compound the difficulties in comparing survey data.

In addition to the methodological constraints, there is another difficulty in analysing tobacco use among Francophone women. Not only must all the aspects related to their situation as women be considered, the analysis must also take into account the cultural and linguistic factors. Francophone women in the different regions of Canada have unique characteristics related to their social and geographical environments. These women have some points in common, but they also have regional particularities, even within the same province. The women in Abitibi, Quebec, for example, live in a different social and economic context than do the women who live in the Montreal region. Moreover, Francophone women outside Quebec deal with being a double minority, an expression used by the Federation of French-Canadian Women.

This would appear to be a fondamental question when analysing the behaviour of Francophone women as it relates to tobacco use, but above all, when attempting to find solutions that will make prevention and cessation more effective for them. The real challenge is to reach them effectively.

Certain observations can be made from the review of the documentation in the context of this study.

• It is known that a higher number of Francophones in Canada smoke and that proportionately, rates among women smokers have reached men's. It is known that Quebec is the leader in the incidence of tobacco use in Canada and that more less advantaged people smoke.

Few surveys or studies, however, allow one to obtain significant results broken down into multiple variables (by sex, age group, socio-economic category, language, etc.) for population sub-groups such as Francophone women in different regions of Canada.

• The influence of family, friends and surroundings on the behaviour of smokers is recognized. There are, however, as many reasons for smoking as there are smokers. One smokes to relax, to control emotions or weight, by habit, by addiction, for the pleasure, etc. It is also known that the majority of smokers has tried to quit at least once, and many of those who have succeeded did it alone.

102

Survey questions have been asked about the factors facilitating quitting, the reasons for starting, for continuing, for quitting and starting to smoke again, on the will to quit, as well as on the population's attitudes, beliefs and knowledge related to the use of tobacco. The most recent results come from the Survey on Smoking in Canada. But, once again, its compilations only allow the sketching of an overall picture and do not permit the definition of what characterizes Francophone women of the different regions of Canada in this matter.

• Several principles did emerge about interventions for Francophones: giving greater importance to positive approaches; adopting strategies coming from the environment they belong to; considering the clientele's values; and taking the cultural context into consideration13.

What is known of the values, living environment or culture of the Francophone women of the different regions of Canada and the different regions of Quebec? How do we reach Francophone women who are not in the labour force, the young women who do not attend school anymore? By what means, what channels can we reach them? And what message do we send to them?

• Many components enter into account in the issue of the reduction of tobacco use. Legislation, policies prohibiting the use of tobacco in public places, the resources available, the programs offered (prevention, quitting, support), as well as the allotted budgets are among the elements that may explain some of the variations seen in the rates of tobacco use between certain groups and regions.

In this matter, we have no overall view that would allow situating the Francophone groups across Canada in terms of tobacco use or knowing the relative weighting of each of these factors.

• The participants at the National Symposium on Tobacco Use addressing Francophone stakeholders asked themselves if there were that many differences between Francophone and Anglophone groups. They tended to believe that if there are behaviour differences between linguistic groups, there are no reactions that are exclusive to Francophone groups. In other words, not all Francophones live in the same conditions or have the same means for confronting the use of tobacco.

13 Health, and Welfare Canada, Let's Stop for Starters!, National Symposium for Francophones Working to Reduce Tobacco Use, held in Quebec, February 17, 18 and 19,1991.

19

4. Summary of Qualitative Data From the Discussion Groups

The information collected during the eight focus groups with women and the five groups held with program coordinators was summarized using a grid encompassing the themes that were covered. The tables summarizing the information gathered during these discussions can be found in Appendix 4 and the discussion guide that was used is provided in Appendix 3.

This section presents first a profile of the participants, followed by the report on the main points that emerged from the discussion groups.

4.1 Profile of the Participants

A recruitment form that included the selection criteria was used to form the groups of women, and another form was developed for the recruitment of program or service coordinators. These forms are provided in Appendix 5. The profile of the participants was drawn up from these recruitment forms. In addition, to better define the participants' smoking habits, the women who accepted to participate were asked to answer a short questionnaire prior to the focus groups. This questionnaire is provided in Appendix 6.

Before presenting the main points of information that emerged from the focus groups, the following section gives a succinct profile of the women participants and of the program coordinators.

4.1.1 Profile of the Francophone Women

Exhibit 8, on the following page, provides an overview of the socio-economic profile of the women who participated in the focus groups. There are some gaps in the data because some women came to the meetings without having answered the questionnaire.

It must be remembered that the criteria for the selection of group participants were based on a combination of several factors. Hence, the level of education or income of participants was not necessarily a determining factor if taken in isolation. Women in the priority groups had to present one or more of the following characteristics: low income; limited education; lack of employment; difficulty reading and writing; single parenthood; or employment in the medical domain.

102

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The women in the groups described as general were drawn from the general population and were selected at random.

• Overall, the women from the priority groups (3 groups) had a high school or college level education. In relation to this, the distribution of the participants in the said general groups (3 groups) was wider, ranging from high school to university with a slight over-representation of women at the university level. The adolescents (priority and general groups) were at the high school level for the most part.

• Women in the priority groups were equally distributed between those who were employed and those who were not. Furthermore, women who were unemployed were rare in the general groups. Almost all of the adolescents were in school.

• In both the priority and general groups, the majority of the women were married or living with a partner. The adolescents (priority and general groups) were single for the most part and lived with their parents. Most of the women had at least one child.

• Most of the women in the priority groups had a family income of less than $20,000, while those from the general population had a family income in excess of $30,000.

" Exhibit 9, nn thp following page, shows that the vast majority (women and adolescent females) is aware of the health risks associated with tobacco use, hopes to quit smoking some day, claims the ability to do so and has already tried the experience. On the other hand, the fear of withdrawal, the stress, the habit, the addiction and the presence of other smokers in their surroundings all constitute roadblocks to quitting. Succinctly, they know, they want to, they think they can, but they do not dare do it.

Whether they belong to a priority group or not, there are a few more participants (women and adolescent females) who live in surroundings where there are smokers than vice versa.

The objective of this section was only to provide an overview of the characteristics of the participants in the discussion groups. Section 4.2 provides the details of the discussions and allows better understanding of what motivates smoking and/or quitting, as well as better identification of the desired resources.

102

Exhibit 9 - Results of Advance Questionnaire - Francophone Women

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23

4.1.2 Profile of the Program Coordinators

Five discussion groups in all were held with program or service coordinators. The participants worked with Francophone women or adolescent women, including those in priority groups. They represented organizations offering a variety of programs or services,

such as the following:

• programs for the prevention or cessation of tobacco use;

• programs targeting women's health;

• social services for women (women's shelters, low income family services, etc.);

• educational or training services (literacy, popular education); 8 drug addiction services;

• community services;

• counselling and therapy services for women; 8 prenatal programs, etc.

Exhibit 10, on the following page, provides an overview of the types of organizations, programs or services represented at each of the discussion groups.

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Exhibit 10 - Profile - Program Coordinators

Group Organization/Program Represented Ottawa 10 participants

• Health promotion program, University of Ottawa • «Grandir Ensemble» Program, St-Mary's Home • "Heart Beat" Program, Regional Municipality of Ottawa-Carleton

Health Department • Nurse having delivered the "Stop Smoking" Program • «La magie des lettres» (literacy prograin) • «Partir d'un bon pas pour un avenir meilleur» Program

(program coordinator and home visitor attended) • Place aux femmes (community organization) • Eastern Ontario Health Unit • Vanier Community Services Center

Outaouais 5 participants

• Groupe Entre-femmes de l'Outaouais (support group) • «Les poumons roses» Program (tobacco cessation) • Hull CLSC • Maison Vallée de la Gatineau (shelter for women) • Solidarité Gatineau-ouest (services for low-income families)

St-Boniface 6 participants

• Family and Child Services (services include support groups for young parents and single mothers)

• Pluri-elles (women resource center; a counsellor and the director attended) • L'Entre-temps (counselling and therapy for battered women and children) • Réseau de femmes • Manitoba Health nurse

Gravelbourg 7 participants

• Association provinciale des Fransaskois (general director and liaison agent attended)

• «Vieillir en santé» Program • Adult and popular (éducation populaire) education services • Collège Mathieu (the school director, student life director and a counsellor

attended) • Association franco-canadienne de la Saskatchewan

Moncton 9 participants

• Victoria Order of Nurses nurse • Smoking cessation program, Moncton Hospital • Nurse working with pregnant women, Dr. Georges L. Dumont Hospital • Dieppe Boys and Girls Club • Public Health • Drug-dependence Program, Social Services • Pre-natal Program, Social Services • Self-esteem Program, Social Services • Addiction Program, Community Services

25

4.2 Francophone Women The focus groups allowed the gathering of the points of view of Francophone women smokers and ex-smokers on various aspects related to the use of tobacco. Among the themes raised with the participants were: their smoking habits and the reasons why they smoke or quit smoking; their awareness of the effects of tobacco on their health; their perceptions about quitting and the barriers to be overcome; the programs and resources they need; and the kinds of assistance they would like

to receive.

• Among the reasons for smoking, the women mentioned stress, fear of weight gain, habit, reflex, and addiction. Smoking represents both a means of escape and a means of control. For many of the women, smoking a cigarette allows them to escape life's everyday occurrences for five minutes. They also do it in defiance and contradiction; smoking is a decision that belongs only to them, their one area of control. The fact that the more they are pushed to not smoke, the more they feel the need to do so, is one element that emerged in the groups as a whole. The adolescent women identified the influence of peer pressure and their parents as motivating reasons. They smoke to be "cool", because of curiosity, to be like the others.

The circumstances in which women say they smoke are related to certain habits (after meals, during breaks, while drinking a coffee, while watching television), particular states of mind (stress, problems, etc.), or simply for pleasure and taste.

• The cost of cigarettes does not seem to have a determining influence on the participants' behaviour toward tobacco. When one wants to smoke, one can always find a way. The purchase of cigarettes is part of their budget, no matter what the price. Some participants deny themselves other things so they can buy cigarettes. With the odd exception, it seems that the lowering of the price of cigarettes is not a motive for smoking more, while a rise in price can lead to a reduction in consumption or quitting. Although initially it appears that the price of cigarettes does not have a direct influence on smoking behaviour, it can be presumed that no one is indifferent to the price and that it does have an indirect influence. The higher the price, the more barriers there are to overcome in search of the pleasure. Women get around the high price obstacle (e.g., contraband, rolling, borrowing cigarettes, denying themselves other things), but this bothers them and makes them think about their need to smoke.

• Participants say they are well informed about the effects of smoking. It seems, however, that the information they receive is too general. They would like to have more precise, more specific information. Furthermore, they feel that the information that is circulated is too negative and shocking, particularly that in televised messages. These messages are initially frightening, but tend to be forgotten quickly when one wants to smoke. In most cases, "These messages are sickening and that's all." In contrast, they say they do not pay any attention to the messages printed on cigarette packages: "We do not look at them". This being said, they admit "hating to see them" (pregnant woman) and "ignoring them".

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8 The advance questionnaire administered to the participants prior to holding the group sessions brought out the fact that several women had already tried to stop smoking but had encountered difficulties. The participants shared the main barriers to be overcome during their attempts to quit. Among the points that came out were stress, fear of gaining weight and the difficulty of socializing with smokers. In the opinion of participants, the two major barriers to overcome were the effects linked with withdrawal (the need to smoke) and the difficulty of breaking the habit.

• Among the means to be used to stop smoking, the participants agreed on the need to replace the cigarette with something else, changing one's routine, associating with someone else who also wants to quit and having support. The will to quit seems to be the first step toward success. One must be motivated, make the decision for oneself and not do it for the others.

8 The importance given to quitting varies among the participants. They would like to quit but say they are incapable of doing so, at least without help. Others say they can quit by themselves but that they do not really want to. Furthermore, for some women, their own health and that of their children seems to be an adequate motive to stop smoking, while it is not a major preoccupation for others. According to the participants, social pressures and the fact that smoking is less accepted will eventually force smokers to quit, whether they want to or not.

8 The participants were able to express an opinion about the kind of help they would need to stop smoking and on the characteristics that should be part of any program or resource aimed at helping them through the process. Varied and different needs emerged from the focus groups. The participants need tricks, tools, support and encouragement. For example, several participants suggested the installation of a telephone line they could use when needed. Support groups that would take them out of the house, allow them to meet people and offer support were initiatives the women desired. This being said, they rate as important the fact that this support be offered by someone who has been a smoker and has already gone through the difficulties linked to quitting. A parallel was also drawn with other forms of drug abuse. Participants feel that they need support similar to that offered to people with alcohol or drug addictions. They do not want to be judged but encouraged. In relation to this, some of the participants feel that society judges women who smoke more negatively than it does men.

Lastly, some participants wish that more were invested in the means to help them than in the anti-smoking advertising that often only manages to make them feel guilty.

4.3 Program Coordinators

People working with Francophone women and program or service coordinators were invited to discuss various aspects of tobacco use. Among the subjects discussed with the participants were their way of intervening with their clientele; the importance they give to the issue; their knowledge of the habits and perceptions of their clients in relation to the use of tobacco; the policies existing within their organizations; their knowledge of currently available programs and resources; their assessment of the needs to be met; and their suggestions for the characteristics that should be taken into account during interventions with Francophone women.

• A large number of the participants reported that they talk about smoking with their clients, but for the most part, indirectly. According to them, it is a delicate subject that must be integrated into other health-related matters. The use of tobacco is not the first subject broached with their clients. "They must be respected, not shocked, given advice at the right time and place when they can extricate themselves from their daily routine". People working with women in crisis situations tend not to talk about it. It is not a subject that is proactively approached; it is preferred to wait until the client raises it. In some cases, the participants restrict themselves to their mandate and do not raise this issue with their clients.

• Participants were asked what importance they give to the question of tobacco use as compared to other subjects they talk about with their clients. The level of importance varies according to the area in which the participants intervene. For those working with women who are in crisis situations, have an alcohol or drug dependency or are victims of violence, tobacco use is not a matter of priority. They want to avoid frightening the women, making them distrustful, "nagging them about it". It is not a priority when women's life is turned upside down. For many of the participants, it is better to bypass the subject and first develop their clients' self-esteem and confidence. The approach is not to ask them to come and learn how to stop smoking, but rather to come and learn how to take care of themselves.

Moreover, the participants agree that doctors have a greater role to play in this matter and that it is they who could intervene in a more proactive manner. They readily admit that women place much trust in doctors.

• The participants know their clients' habits. According to them, smoking is a part of their clients' lifestyle and seems to be essential for some of them. Participants said this is often the only means their clients have to manage stress, the only area that they can control, the only pleasure they can offer themselves. They also smoke for other reasons, such as habit, dependency, fear of gaining weight, pleasure. According to them, young people often do it to be rebellious and because of peer influence.

• The participants perceive a great deal of reticence on the part of their clients to the question of tobacco use. There are many who react negatively when the subject is brought up. They are not interested, and negative remarks or attempts to pressure them make them even less receptive to discussion. Pregnant women and young mothers seem to be more open, whereas a lack of interest is observed in adolescent females. They do not feel an

102 28

immediate concern about the effects of smoking on their health. According to the participants, "Pushing too hard can push them away". As their other problems are solved, as they get more support, women are more and more willing to approach the subject of tobacco use.

• Most of the participants worked in areas where there are restrictions on tobacco use, varying from the establishment of reserved smoking areas to total prohibition. According to the participants, a policy controlling smoking in their workplace constitutes a message in itself. Quite a number of participants believe that such restrictions could pose a barrier to the use of their services by the women. Others do not share this opinion. Participants who work with women in crisis situations believe it is important for their clients to have access to an area where they can smoke.

® Participants were asked about the resources for helping smokers that are currently available to their Francophone clientele. Many participants deplore the lack of French resources and programs in their region. Furthermore, the material translated from English is often deemed inadequate for meeting the needs of Francophones. It seems hard for them to obtain quality material in French. This being said, the participants point out the lack of distribution of information. They feel they are not adequately informed on what is available. Moreover, the recruitment of participants seems to be a problem for those who organize assistance programs or within the framework of programs that already exist.

• Several suggestions were made as to the characteristics that should be taken into account during interventions related to tobacco use with participants' clients. In their opinion, integrating the subject of tobacco use into a larger body of concerns seems to be a less threatening way to bring the women, little by little, to take some positive action to improve their health. The participants believe that the importance of not using a head-on approach to this problem with their clients has been proven.

The necessity of offering interesting alternatives to smokers also emerged from the focus groups. Ways must be found to replace the cigarette with something else, other pleasures, other ways of seeing things so that the clients feel they are in control.

The context in which the women live must also be taken into consideration if intervention is to be effective, tools developed that address each sub-group and the contents of the programs adapted to the needs identified by the participants themselves.

Ways must also be found to approach the women individually and break through their isolation. The group approach stimulates the development of relationships and contributes to breaking the isolation, yet many women are not prepared to be part of a group. In regards to group approaches, the program or service coordinators agree on a certain number of prerequisites. Interventions made by peers are highly desirable since women are more receptive when they can identify with the group. Long-term support programs that are sustained and continuous and have good follow-up are also among the elements that emerged from the focus groups. This being said, there is a need for multiple interventions. There could be a buddy system, a permanently accessible telephone line, etc.

For the people working with Francophone women, the material used must be as visual as possible. It seems that for Francophones, and oral approach succeeds better than a written one, as does a more informal approach. Information in French must be of quality and closely tied to the Francophone culture. It must, therefore, go beyond the simple translation of English content.

Furthermore, the messages given out must be positive and encourage the women's efforts by stressing the advantages associated with not using tobacco. Televised messages that are likely to reach a lot of people are perceived as being too negative. A more positive approach that reduces guilt is highly desirable.

Other elements emerged from the focus groups. The participants pointed out the need for tangible means to raise awareness, to inform and to act to help women stop smoking. They also feel that the adequate distribution of information is primordial to the front line workers' awareness of the programs and resources available and their sensitization to the issue of tobacco use. In addition, many participants stress the importance of making doctors aware of the role they should play in this matter and of unifying the efforts of the various stakeholders.

Lastly, the participants highlighted the importance of emphasizing prevention among very young children. It was suggested that an anti-smoking program be integrated into academic programs and to call upon young leaders who are able to pass along the message.

The participants indicated their interest in integrating to their services resources or programs for helping women smokers. They feel, however, that they do not have the financial, material or human resources to develop this type of intervention. The majority hope to be supported in this process and to be able to use existing materials that are considered effective. Recourse to a resource person, training in the issue of tobacco use and wider sharing of information are needs that were expressed by the participants.

4.4 Observations and Summary

It is interesting to note that the motives for smoking or quitting smoking, and the perceptions related to quitting and the barriers to be overcome, are not really different among Francophone women from one region of Canada to another. The differences are more remarkable between individual smokers than between regions. One smokes out of habit, because of addiction, because of stress, to relax, because the people around are smokers, through fear of gaining weight, etc. Even though the women have many points in common, this does not preclude regional particularities. For example, Francophone women in Saskatchewan or Manitoba live in a different social and economic context than those in the province of Quebec. Several mentioned that they wanted French-speaking resources and programs, but stressed the importance of having someone from the region with whom they could identify. Within the same province there are regional particularities to be respected. The women in Abitibi, Quebec, for example, live in a different context than those in Montreal. Programs should be shaped to suit the regions and attached to resources that already exist in the different regions and provinces of Canada.

102 30

There is a general lack of awareness of support resources (very few participants have used them and few could name any) even though a part of the Francophone smokers in the different regions wanted them. The women expressed the need to get out, to meet and discuss, especially those in the priority groups. Moreover, several participants said they were delighted with their participation in the meeting and hoped to relive the experience. Many of the groups even prolonged the discussion well after the meeting ended, evidence of the interest and the need these women have to exchange ideas and meet.

The recommended support resources follow this direction. The question of accessibility (cost, place, child care facilities, etc.) is also important to consider. For some of the participants the question of language is important and the programs or resources made available should reflect this cultural difference. For others, the language is not as important an issue as having the support of an ex-smoker, "to have someone who knows what we are talking about". They wanted the use of tobacco to be approached in a wide perspective and to have the opportunity of exchanging ideas on various aspects of their life. Women need support to quit, but they primarily need help to sustain this behaviour. The telephone line represents one of the means suggested to help them stay off tobacco. The participants want more invested in ways to help them than in information campaigns. Information campaigns are important in that they can act as a catalyst in the decision to quit, or to prevent the behaviour, but, in the participants' opinion, they are not enough.

Aversion advertising does not really inform people. All it does is reinforce the idea that cigarettes are repugnant and bad for one's health. The participants would like more precise and positive information. Messages in the media could be directed more towards the means and resources for quitting smoking (e.g., to ease the stress, relax and calm myself, I instead of smoking; to avoid gaining weight, I instead of smoking; etc.) and carry more encouraging, positive messages (e.g., the more often you try to quit, the better your chances are to succeed. If you have trouble sticking with it, or you're thinking of quitting, you can call 1-800- and it's toll free; etc.). It is important to provide information that reaches the people, that is up to date, popularized and that corresponds to the values and concerns of the clientele served.

The program coordinators talk about the issue of tobacco use with their clients, but in a very indirect manner and even more so when they are intervening with women in difficult situations. All the intervenors agreed in recognizing the importance of the doctor's role in the issue of tobacco use. Women trust doctors, expect them to deal with the tobacco issue and influence them to stop or at least warn them of the dangers. Just like the women, the program coordinators would like tobacco use to be integrated into a wide health perspective (physical and psychological) and deal with the women's everyday experience. This global approach appears less threatening and allows discussion and suggestion of various alternatives to the smoking behaviour, as well as leading the women progressively toward positive actions related to their health. The workers stress the importance of shaping the materials and the tools to the needs and expectations of the participants. They find the lack of quality resources and programs offered in French deplorable. Often, the translated material is judged inadequate, but in the same breath, they acknowledge being poorly informed about what does exist.

There is a real need for varied resources. If the group approach stimulates the development of bonds and contributes to breaking the women's isolation, some of them are not ready or free to live the experience. A buddy system, a telephone line that is accessible at all times, a group approach, individual materials and tools, etc. are just some of the desired means.

The program coordinators are interested in integrating into their services the programs or tools for helping women smokers. They feel, however, that they do not have the means required to do this. The workers hope to be supported in this process and to be able to use existing materials that are considered to be of quality and effective. To raise awareness, inform and take action to help women stop smoking, they need concrete means. Recourse to a resource person, training in the issue of tobacco use, and sharing of information and experiences were the principal needs expressed. To them, it seems primordial that information be widely distributed so that the front-lme workers are aware of the issue and up-to-date on the programs and resources available in their region. Joint efforts by the workers and stakeholders is at the heart of the issue and would promote the proliferation of in-the-field actions on tobacco use.

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5. Inventory of Programs and Resources

The review of the inventories already available, or in development, revealed some initiatives that had been developed primarily for a Francophone clientele or for women.

Similarly, the Quebec Comité provincial des Départements de santé communautaire sur le tabagisme recently itemized the tools, programs and services related to the battle against the use of tobacco available in that province14. This index includes material aimed at prevention, cessation and protection, as well as an inventory of existing audiovisual documents and promotional material. It represents an important source of information on the resources available in French for all of the regions of Quebec.

The Ontario Prevention Clearinghouse is currently developing an inventory of programs addressing Francophones15. This index should be available in the next few months.

In addition to these two inventories are those developed by Health Canada, in particular the inventory related to smoking and pregnancy16, and the one for the providers of prenatal and postpartum care17.

The Smoking and Pregnancy index catalogues nine programs selected for their innovation and their application to a diverse clientele. Some of the programs are specifically centred on pregnancy while others address women in general, including pregnant women. The Tobacco Resource Material for Prenatal and Postpartum Providers: A Selected Inventory lists programs, brochures, resources, videos and various tools for prevention, information and cessation. It is divided into five sections: tobacco and pregnancy; women's programs for smoking cessation; second-hand smoke and its effects on family and children; resources for Aboriginal groups; and resources on women and tobacco. This index is available in either electronic or paper form.

Lastly, Price Waterhouse completed an inventory of the anti-smoking programs and resources designed for Francophones or offered in French in Canada. This was done for Health Canada, in the context of a study focusing on the needs of Francophones in different regions of Canada and led to the collection of useful information on the French language resources available in Canada for a varied clientele.

14 Gilbert, Martine, Roy, Jean-Maurice and Tremblay, Michèle, Inventaire des services et programs en matière de tabagisme au Québec. (For information contact the Direction des communications du ministère de la Santé et des Services sociaux du Québec, facsimile: (418) 644-4574.

15 Ontario Prevention Clearinghouse, 415 Yonge Street, 12thfloor, Toronto, Ontario, M5B 2E7, facsimile: (416) 408-2122.

16 Health Canada, Smoking and Pregnancy: Selected Program Profiles, Febmary 1995. (To obtain information or a copy of the inventory, contact Health Canada, Health Promotion Directorate, Women and Tobacco Reduction Programs, Jeanne Mance Building, 4 th Floor, Ottawa, Ontario, K1A 1B4, facsimile: (613) 952-5188).

17 Health Canada, Tobacco Resource Material for Prenatal and Postpartum Providers: A Selected Inventory, February 1995 (For information or a copy of this inventory, contact the above address).

33

In the framework of this study, we will only present the programs or resources addressing Francophone women specifically. Exhibit 11, on the following page, provides an overview of the itemized programs. The descriptive inventory can be found in Appendix 8, while the grid used to collect the information is provided in Appendix 7.

5.1 Programs and Resources Statement

The following section lists the main elements that emerged from the inventory.

• The inventoried programs and resources target different groups of women. One video developed by Health Canada and two programs currently being developed target adolescent women. Three cessation programs focus on women in the priority groups, that is, those with low incomes and little education. Several initiatives are directed primarily at pregnant women and their partners, as well as the people who work with them. Lastly, two methods address women in general.

• Several initiatives were developed specifically for Francophone women. A certain number of programs offered have been, or are in the process of being, translated from English. In some cases, part of the material is used in English only.

• Although some of the programs combine prevention and cessation elements, most of them are primarily curative interventions. If many of the programs provide for participant follow-up at various intervals (several weeks or several months) after they quit, no intervention is actually based on support for maintenance.

• The majority of the identified programs are group approaches based on information, counselling, various documentation, video materials, etc. that tackle the issues of tobacco use, health and other related questions (stress, physical conditioning, nutrition, etc.). Two programs targeting adolescent females allow for the use of peers or ex-smokers who can act as role models for the participants.

• Nearly half the programs in the inventory are currently being developed and most have only been offered in the last few years. Some of the programs that have been running for awhile have been evaluated, others not at all. Still others make no formal evaluation of the results they obtain.

• To meet the needs of the target clientele and take their financial situation into account, the listed programs for Francophone women and women in the priority groups are inexpensive or free.

• Almost all of the programs are offered by publicly financed community health organizations, funded health associations or non-profit organizations committed to tobacco use reduction. Only two of the methods originate from private enterprises.

" The promotion and recruitment for the selected programs is primarily done through medical and community services (doctors, nurses, hospitals, CLSCs, health associations, etc.). Only a few organizations do promotion through local papers or televised advertising.

100

Exhibit 11 - Overview of Inventoried Programs and Resources

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35

The programs in the inventory are primarily offered in Quebec and Ontario. Similarly, there are more programs and services offered in the large cities or urban centres. The Ottawa-Carleton Region in Ontario seems particularly well supplied with resource materials for Francophones.

Particular mention must be made of the lack of resources related to tobacco prevention and cessation available in French in the other Canadian provinces for Francophone women. According to people contacted in Saskatchewan, for example, little is done in this matter to serve the Francophone clientele. Moreover, some of the programs offered in French are no longer available because of a low demand and recruiting problems.

5.2 Summary Some programs focused primarily on cessation, designed for Francophone women, or translated into French, and targeting Francophone sub-groups such as women from less advantaged settings, adolescent females, pregnant women, etc. are currently available or being developed.

In contrast, few preventive interventions for adolescent females and priority groups are to be found and almost no interventions based specifically on support and maintenance after quitting. Follow-up measures for participants are provided within the framework of some cessation programs. These measures vary from several weeks to several months after quitting, when in fact, evaluations of various cessation programs tend to show that the rate of sustained cessation decreases as the time following the end of the program increases. It would appear that initiatives based on maintenance should be developed to help the women with their decision to stop smoking.

Although there are few French programs in the different regions in Canada, there are some interesting initiatives available in certain regions of Quebec and Ontario that could easily be adapted and distributed to other provinces.

Lastly, inventories of programs and resources directed toward tobacco prevention and reduction in Canada have been developed. In relation to Francophones, the report produced by the Quebec Comité provincial des Départements de santé communautaire sur le tabagisme on resources available there provides an important source of information on the tools, materials and programs that can serve this clientele, including women. The same applies to the Ontario Prevention Clearinghouse report that should be available soon. The inventory of anti-smoking programs and resources designed for Francophones in Canada that Price Waterhouse carried out for Health Canada is yet another source of information, as are the two Health Canada reports on tobacco and pregnancy.

The catalogued material as a whole is more than sufficient to allow the organization and development of interventions based on existing materials and specifically targeting Francophone women. Work should now be directed toward the adaptation, promotion, distribution and evaluation of this material and these tools.

102 36

6. Observations and Recommendations

The aim of this report was to provide a statement that would situate current knowledge about tobacco use among Francophone women and identify its principal deficiencies. The least that can be said is that useful data and information for characterizing Francophone women, whether in different regions in Canada or in Quebec, are limited. National surveys that make a language distinction present the results in a very global fashion. The same applies to provincial comparisons that are drawn from national survey data where little detailed data is available on Francophone women. Data by language and sex from provincial studies of tobacco use across Canada is practically non-existent. When it is available, the collection methods or insufficient sampling render the data insignificant.

To compound the paucity of existing information, various other constraints are added to the difficulty of establishing bases of comparable data and interpreting the information. Among these constraints, we must point out the lack of uniformity in definitions, the problems linked to sampling techniques and the use of different terminology for tobacco use. To better define the issue of tobacco use among Francophone women and to be better able to offer them adapted programs, the current knowledge and information base must be expanded.

1. it is therefore recommended:

• 1 . 1 That the "language" variable be systematically integrated into national studies and surveys on the use of tobacco.

The integration of the three variables (age, sex and language) into surveys implies that provisions be made for samples that are not only larger but, most importantly, representative of each sub-segment of the population. This way, it becomes possible to compare various segments of the population on the same question. This data will allow profiles to be developed, similar sub-groups to be compared, discriminant factors to be identified and priority groups to be better targeted. Similarly, the planning of more effective interventions will be possible since they will be better targeted.

• 1.2 That, in collaboration with its partners, Health Canada propose a standard definition of French-speaking people so that data from different studies can be compared from one year to another to obtain a useful base of information.

• 1 . 3 That, in collaboration with other relevant stakeholders, Health Canada propose common terminologies and definitions related to the use of tobacco (habitual, regular, occasional, current, etc.) so that data related to incidence can be compared.

• 1.4 That Health Canada adopt a conceptual framework for the analysis of the whole of the information collated in terms of the selected theoretical model and be thus more able to define the issues and to prioritize, plan and orchestrate interventions.

If it is true that the battle against the use of tobacco depends on knowing the population of smokers and its diverse segments, it must be recognized that the most important factor about this knowledge is that it leads to the ability of intervening in a more effective and efficient manner. At the end of the line, the final objective is to use the right means to reach the Francophone women of the various'sub-groups, to plan adapted interventions and to better prioritize and orchestrate the activities for them.

2. If is therefore recommended:

• 2 . 1 That particular emphasis be placed on the implementation of cessation assistance measures centred particularly on Francophone women in the priority groups, adolescent females and young women.

• 2.2 That greater efforts be made to adapt, promote and distribute existing materials and tools.

Materials and programs for prevention and cessation designed specifically for or translated for Francophones are, in fact, available. There are also cessation and prevention programs and resources that primarily target sub-groups of Francophone women, such as those in less advantaged environments, adolescents in school, pregnant women, Aboriginal women, etc. Even though a variety of materials, tools and resources do exist, they are not as well known among those who could use them as one would hope. Furthermore, some provinces offer very few programs or resources in French. Consequently, we believe that the emphasis should now be on the adaptation, promotion, distribution and evaluation of this material.

• 2.3 That resources developed in French and specifically adapted to the Francophone culture and the regional and economic context of women be available in the various provinces of Canada.

The information in French must go beyond simple translation of the English content since that does not always correspond to the needs of Francophone environment. As an example, it was mentioned that the material should be as visual as possible. For Francophones, an oral approach seems to work better than a written one and an informal, interactive approach better than a formal one.

• 2.4 That the messages given out be more positive and encourage the women in their undertaking by emphasizing the advantages of not using tobacco.

The approach for recruiting Francophone participants into reduction or cessation programs would be better if it were positive and if it reduced guilt. The programs must also propose ways of replacing the cigarette by something else, other pleasures, other ways of seeing things, so that the women feel that they have control.

102 38

• 2 . 5 That the support resources reach out and appeal to the women and their lifestyle. Women want to get out and discuss with each other, but they also stress the importance of maintenance and follow-up after quitting. Telephone lines, discussion groups, buddy systems, and personalized programs are some of the preferred means that were identified. Multiple and varied approaches are needed because, even though the group approach helps break through the women's isolation, some among them are not ready or able to live this kind of experience.

• 2.6 That initiatives focused on sustained maintenance be developed to help the women carry through with their decision to stop smoking.

To our knowledge, there are few preventive interventions for adolescent females and priority groups and none specifically designed to provide support after quitting. There are provisions for follow-up measures for participants within the framework of certain programs. These measures last from several weeks to several months after quitting, whereas evaluations of various reduction programs show that the cessation rate decreases as the time period after the end of the program increases.

• 2.7 That preventive information be emphasized with young people. Adolescent females wish to receive more precise information about the dangers of smoking and on the resources available. Discussions in school about tobacco use, recourse to peers or credible ex-smokers, up-to-date and adapted videos are suggested means. What is important is that the information reaches out to them and relate to their own values and concerns.

• 2 . 8 That particular emphasis be placed on the concentration of efforts to reduce the use of tobacco.

• 2 . 9 That concrete means (training, raising awareness, distribution of quality, effective material, exchanges of expertise, accessible resource persons, etc.) be made available to the stakeholders who would like to become involved in the battle against the use of tobacco.

Existing programs are either unknown to, or absent from, several regions. A community approach based on interdisciplinary exchange, the breaking down of barriers between fields of intervention and sharing would seem to be an interesting way, among others, of rallying the players to approach the tobacco issue together. It is important to enhance the role of the various players and to show them the significance of their collaboration in the battle against the use of tobacco. Furthermore, their involvement depends on various forms of support.

® 2 10 That doctors be made more aware of the importance of their role in prevention, information and help for women where tobacco is concerned.

Women tend to listen to and believe their doctor. From this point of view, the doctor is considered to be perfectly well-placed to intervene effectively and it would be advantageous to adopt a more proactive approach.

• 2 11 That the involvement and contribution made by existing resources and services such as the CLSCs in Quebec, the federations, associations, clinics, workers' health services, hospitals, schools, etc. be intensified.

To strengthen the forces against tobacco use, it is important to act in collaboration and to raise awareness, inform and train front-line workers such as doctors, nurses, inhalation therapists, social workers, etc.

102

Appendix 1 List of people contacted

41

National

Gary Catlin National Population Health Survey Statistics Canada Ottawa, Ontario 613-951-3830

Bob Ellis Survey on Smoking in Canada Health Canada Ottawa, Ontario 613-957-0697

Anne-Marie Comtois National Clearinghouse on Tobacco and Health Ottawa, Ontario 613-567-2730

Christina Forrester The Canadian Public Health Association Ottawa, Ontario 613-725-3769

Maurice Gingues Canadian Cancer Society Ottawa, Ontario 613-723-1744

Lyne Gagnon Canadian Lung Association Ottawa, Ontario 613-747-6776

Rachel Gaudreau Réseau national d'action-éducation femmes Ottawa, Ontario 613-741-9978

Cécile Coderre Réseau national d'action-éducation femmes Ottawa, Ontario 613-564-7172

Canadian Advisory Council on the Status of Women Ottawa, Ontario 613-992-4975

Dr. Pauline Greenhill Canadian Women's Studies Association Winnipeg, Manitoba 204-786-9752

Thérèse Roy Status of Women Ottawa, Ontario 613-995-7835

Fédération nationale des femmes canadiennnes-françaises Ottawa, Ontario 613-241-3500

Louanne Beaucage Fédération nationale des femmes canadiennnes-françaises St-Boniface, Manitoba 204-944-4266

Fédération culturelle canadienne-française Ottawa, Ontario 613-241-8770

Fédération des communautés francophones et acadiennes du Canada Ottawa, Ontario 613-241-7600

Canadian Women's Foundation 214 Merton Street Suite 208 Toronto, Ontario M4S 1A6 416-484-8268

42

British Columbia

Linda Brigden Health Department Victoria, B.C. 604-952-1711

Guy Custanzo British Columbia Public Health Association Vancouver, B.C. 604-736-2033

Barb Henry Canadian Cancer Society Vancouver, B.C. 604-872-4400

Shirley Thompson British Columbia Council on Smoking and Health/Lung Association Vancouver, B.C. 604-731-5864

David March Heart and Stroke Foundation Vancouver, B.C. 604-736-4404

Health Sciences Association of B.C. Vancouver, B.C. 604-439-0994

Jody Graham B.C. Doctors Stop Smoking Project Vancouver, B.C. 604-736-1226

Grant Yancey Victoria General Hospital Victoria, B.C. 604-727-4212

Respiratory Health Unit St-Paul's Hospital Vancouver, B.C. 604-689-9329

Mount St-Mary's Hospital Victoria, B.C. 604-384-7158

Lions' Gate Hospital Vancouver, B.C. 604-988-3131

Delta Hospital Vancouver, B.C. 604-946-1121

Greater Victoria Hospital Society Foundation Victoria, B.C. 604-389-6539

Langley Memorial Hospital Education Department Vancouver, B.C. 604-534-4121

Burnaby Hospital Burnaby, B.C. 604-431-4797

Grace Hospital Vancouver, B.C. 604-875-2424

Heather Brewster Mount St-Joseph Hospital Vancouver, B.C. 604-874-1141

Alcohol - Drug Education Services Vancouver, B.C. 604-874-3466

B.C. Prevention Resource Center Vancouver, B.C. 604-874-8452

43

Deborah Weatherspoon AIRSPACE Non-smokers' Rights Society Vancouver, B.C. 604-540-9112

Fairfield Health Unit Victoria, B.C. 604-389-6300

Deborah Prieur Women's Research Centre Vancouver, B.C. 604-734-0485

Marie Christine Centre culturel francophone de Vancouver Vancouver, B.C. 604-736-9806

Sandri Nejeune "Le Soleil" Newspaper Vancouver, B.C. 604-730-9575

British Columbia Women's Institute Langley, B.C. 604-533-6564

Leslie Anderson Vancouver YWCA Vancouver, B.C. 604-895-5756

Alberta

Alberta Alcohol and Drug Abuse Commission Calgary, Alberta (403)297-3028

Association canadienne française de l'Alberta Suite 200 8923 - 82e avenue T6C 0Z2 Edmonton, Alberta 403-466-1680

Saskatchewan

Paul Epel Office de coordination des affaires francophones Regina, Saskatchewan 306-787-1776

Gary Mousseau/Anne Lamont St-Joseph Hospital Gravelbourg, Saskatchewan 306-648-3185

Saskatchewan Lung Association Saskatoon, Saskatchewan 306-343-9511

Nicole Dubois "Stop Smoking" Program Military Community Resource Center Moose Jaw, Saskatchewan 306-694-2746

Florence Leduc Hypnotherapy Clinic Regina, Saskatchewan 306-789-2619

100

Shirley Mandis Zenon Park Community Health Unit Zenon Park, Saskatchewan 306-767-2221

Community Health Unit Saskatoon, Saskatchewan 306-655-4620

Annette Lab elle Commission culturelle fransaskoise Regina, Saskatchewan 306-565-8916

Association culturelle franco-canadienne de la Saskatchewan Claude Grenier Saskatoon, Saskatchewan 306-653-7442

Regina, Saskatchewan 306-569-1912

Camille Bell/Caroline Gareau-Jacques Association culturelle franco-canadienne de la Saskatchewan Gravelbourg, Saskatchewan 306-648-3288

Margot Fauchon-Michaud Association provinciale des fransaskoises Gravelbourg, Saskatchewan 306-648-2791

Association canadienne-française de Regina Regina, Saskatchewan 306-522-2772

Bellegarde ACFC Bellegarde, Saskatchewan 306-452-6324

Association culturelle de Bellevue Bellevue, Saskatchewan 306-423-5303

Dave Turcotte Association franscaskoise de Zenon Park 306-767-2203

Société canadienne-française de Prince-Albert Prince-Albert, Saskatchewan 306-953-6450

Josée Lévesque Association canadienne-française de Regina Regina, Saskatchewan 306-522-2772

Fédération des francophones de Saskatoon Saskatoon, Saskatchewan 306-653-7440

Cécile Demers Comité culturel fransaskois de Debden 306-724-2020

Les Auvergnois Ponteix, Saskatchewan 306-625-3340

Françoise Sigur-Cloutier Réseau national d'action-éducation femmes Regina, Saskatchewan

Catherine Darveault Réseau national d'action-éducation femmes Gravelbourg, Saskatchewan 306-648-3129

Édith Gendron Association jeunesse fransaskoise Saskatoon, Saskatchewan 306-653-7447

Scouts Canada Saskatchewan District Saskatoon, Saskatchewan 306-763-7738

45

Estelle Carson Regroupement des femmes fransaskoises Saskatoon, Saskatchewan 306-653-7459

Michel Hamil Association jeunesse fransaskoise Saskatoon, Saskatchewan 306-653-7447

Association des loisirs et centre culturel Battleford, Saskatchewan 306-445-6436

Cécile Leblanc-Turner Association coopérative du préscolaire fransaskois Prince-Albert, Saskatchewan 306-953-6451

M. Roy, 306-648-3105/Lucie Gauvin 306-648-2710 Collège Mathieu Gravelbourg, Saskatchewan

Northwest Territories

Rick Tremblay Health and Social Services Ministry Yellowknife, NWT 403-873-7276

Angèle Leblanc "Vieillir en santé" Program Gravelbourg, Saskatchewan 306-648-3349

Renée Bouvier Le Lien Gravelbourg, Saskatchewan 306-648-2240

Annette Leblanc Homecare Gravelbourg, Saskatchewan 306-648-2234

Heart and Stroke Foundation Regina, Saskatchewan 306-569-8433

Manitoba

Lise Lacombe Manitoba Health Winnipeg, Manitoba 204-945-6731

Jan Schmalenverg Department of Public Health St-Boniface, Manitoba 204-945-0924

Cathy Ruddick Environmental Health Promotion Winnipeg, Manitoba 204-774-5501

Lorette Beaudry-Ferland Santé en français St-Boniface, Manitoba 204-235-3293

100

Marge Adams Canadian Cancer Society Manitoba 204-774-7483

Linda Saruchuck Canadian Lung Association Manitoba 204-774-5501

Gerdy Stewart Council for a Tobacco-free Manitoba Winnipeg, Manitoba 204-774-7483

Adèle Wortzman "Smoke Free" Sessions Winnipeg, Manitoba 204-287-8621

Ste-Anne's Hospital Ste-Anne, Manitoba 204-422-8837

St-Boniface General Hospital St-Boniface, Manitoba 204-233-8563

Pat Ruthledge Carolyn Sifton-Hélène Fuld Library St-Boniface General Hospital St-Boniface, Manitoba 204-237-2067

Notre-Dame-de-Lourdes Hospital Notre-Dame-de-Lourdes, Manitoba 204-248-2112

Claire Comte Public health nurse for the Notre-Dame-de-Lourdes district Notre-Dame-de-Lourdes, Manitoba 204-744-2073

Hope Inc. Health Center Winnipeg, Manitoba 204-589-8354

Mount Carmel Clinic Winnipeg, Manitoba 204-582-2311

Women's Health Clinic Winnipeg, Manitoba 204-947-1517

Kathleen Messner Ste-Anne Health and Community Services Ste-Anne, Manitoba 204-422-8817

Seine Medical Center Ste-Anne, Manitoba 204-422-8811

Youville Clinic St-Boniface, Manitoba 204-233-0262

Raymond Théberge Centre de recherche du collège universitaire St-Boniface, Manitoba 204-233-0210

Doris Lemoyne Direction des ressources éducatives françaises St-Boniface, Manitoba 204-945-8594

Angèle Hébert Société franco-manitobaine St-Boniface, Manitoba 204-233-4915

Simone Neveu Service provincial d'information en français St-Boniface, Manitoba 204-233-2556

47

André Brin Conseil jeunesse provincial St-Boniface, Manitoba 204-237-8947

Aline Gosselin-Lemieux Conseil de la coopération du Manitoba St-Boniface, Manitoba 204-233-1560

Shane Barnabé Association culturelle franco-manitobaine St-Boniface, Manitoba 204-233-8972

Rollande Kirouac Pluri-elles Winnipeg, Manitoba 204-233-1735

Monique Hébert, 204-233-6863 (résidence) Carole Jung, 204-772-3693 (résidence) Réseau national action-éducation femmes St-Boniface, Manitoba

Sylvie Ross Réseau des femmes St-Boniface, Manitoba 204-235-0640

Anita Gobeil/Gisèle Erunet L'entre-temps St-Boniface, Manitoba 204-925-2550

Catherine Dupont Centre Alpha St-Boniface, Manitoba 204-231-0350

Gilles Beaudry Service de conseillers Winnipeg, Manitoba 204-256-6750

Gilberte Carrière Centre Miriam St-Boniface, Manitoba 204-237-5542

Gisèle Roch Services à la famille St-Boniface, Manitoba 204-231-2360

North End Women's Centre Inc. Winnipeg, Manitoba 204-589-7347

Ontario

Karen McLean Public Health Ministry Toronto, Ontario 416-314-5472

Hélène Gagné Ontario Prevention Clearinghouse Toronto, Ontario 416-408-2121

Paula Greco Addiction Research Foundation Toronto, Ontario 416-595-6888

Beth Marchand Addiction Research Foundation Toronto, Ontario 416-595-6037

102

Self-help Clearinghouse of Metropolitan Toronto Toronto, Ontario 416-487-4355

Céline Poliquin-Heintzman Lung Association Ottawa, Ontario 613-230-4200

Mary Robb Sault-Ste-Marie Lung Association Sault-Ste-Marie, Ontario 705-256-2335

Sue Tracey Heart Institute "Smoking Cessation" Program Ottawa, Ontario 613-761-4753

Carmen Paquette Convergence Consultants Ottawa, Ontario 613-241-7962

Debbie McCulloch/Sylvie Lapointe Regional Municipality of Ottawa-Carleton Health Department Ottawa, Ontario 613-722-2242

Sally Hunter Heart Beat Campaign Regional Municipality of Ottawa-Carleton Health Department Ottawa, Ontario 613-722-2328

Tobacco Information Line Regional Municipality of Ottawa-Carleton Health Department Ottawa, Ontario 613--724-4256

Coleen Curns "Les rencontres pour fumeurs et leurs partenaires" Program Regional Municipality of Ottawa-Carleton Health Department Ottawa, Ontario 613-722-2281

Joanne Lamoureux Eastern Ontario Health Unit Cornwall, Ontario 613-933-1375

Diane Patenaude Interagency Council on Smoking and Health Cornwall, Ontario 613-933-1375

East York Health Unit Toronto, Ontario 416-461-8136

Veronica ParyVElaine Rodhenizer Queensway-Carleton Hospital Ottawa, Ontario 613-721-2000

Chantai Roussel Sacré-Coeur Hospital Ottawa, Ontario 613-595-6046

Annie Boucher Public Affairs Ottawa General Hospital Foundation Ottawa, Ontario 613-737-8445

Yvette Paquet Ste-Anne Medical Center Ottawa, Ontario 613-789-1552

49

Christine Villeneuve Ste-Anne Health Center Ottawa, Ontario 613-562-0057

Jacqueline Plante Algoma Health Unit Sault-Ste-Marie, Ontario 705-759-5287

Francine Brunet Health Services Cité collégiale Ottawa, Ontario 613-786-2067

Suzanne Philips Humber College, "Healthline" Etobicoke, Ontario 416-675-3111

Élise Beauregard La Cité collégiale - Adult Education Programs Ottawa, Ontario 613-786-2180

Denise Hyde/Gisèle Henderson/ Shelley Westhaven Sudbury Public Health Services Sudbury, Ontario 705-522-9200

France Gélinas Sudbury Community Health Center Sudbury, Ontario 705-670-2274

Dave Cavanagh/Elaine Rodhenizer YMCA-YWCA Ottawa, Ontario 613-237-1320

YWCA Sudbury, Ontario 705-673-4754

Coeur en santé Sudbury, Ontario 705-671-9544

Robins Hill Aftercare Services Sudbury, Ontario 705-673-2413

Sylvie Lapierre Le carrefour francophone Sudbury, Ontario 705-675-6493

Karen Lwoma Windmere Youth Center Val Caron, Ontario 705-897-2850

Léonard Frapp ier Centre d'action pour jeunes de Sudbury Sudbury, Ontario 705-673-4396

Rosanne Lépine University of Ottawa Women's Resource Center Ottawa, Ontario 613-562-5755

Viviane Ruest University of Ottawa Alcohol Awareness Program Ottawa, Ontario 613-562-5800

Colette Auger Centre médico-social communautaire Toronto, Ontario 416-492-2672

Joan Robertson/Linda Pilon Regional Home Support Services Ottawa, Ontario 613-230-2978

100

Catherine Dubois Community Resource Center Gloucester, Ontario 613-741-6025

Myriam Levac Vanier Community Services Center Vanier, Ontario 613-744-2892

Ruth Smoley Cumberland Resource Center Orleans, Ontario 613-830-4357

Cheryl Smith, 613-238-8210 Claudine Guay, 613-238-1220 Somerset West Community and Health Center Ottawa, Ontario

Diana Fossa Pinecrest- Queensway Community Services Ottawa, Ontario 613-820-4922

Louise Tremblay Carlington Community and Health Services Ottawa, Ontario 613-761-1805

Linda Martin Southeast Ottawa Community Services Ottawa, Ontario 613-523-2223

Overbrook-Forbes Community Services Association Ottawa, Ontario 613-745-0073

Overbrook Community Center Ottawa, Ontario 613-742-5147

Tricia Kelly Kanata Resource Center Kanata, Ontario 613-591-3686

Margot Arseneau Downtown Resource Center Ottawa, Ontario 613-789-3930

Barbara Neuwelp Downtown Community Health Center Ottawa, Ontario 613-563-4336

Francine Ménard Community Health Center Cornwall, Ontario 613-937-2683

Edith Cloutier Sandy Hill Community Health Center Ottawa, Ontario 613-789-8458

France Gélinas Sudbury Community Health Center Sudbury, Ontario 705-670-2274

Sudbury United Way Sudbury, Ontario 705-560-3330

Mary Boileau Pre-school Resource Center for Parents Ottawa, Ontario 613-565-2467

Denise Chapdelaine Coopérative Carrousel pour parents et enfants francophones Ottawa, Ontario 613-789-4004

51

Miriam Avalos Place aux femmes - Information and Reference Center Ottawa, Ontario 613-789-2155

Centre d'action des femmes contre la violence d'Ottawa-Carleton Ottawa, Ontario 613-241-5414

Joanne Cardinal Gloucester Services for Battered Women Ottawa, Ontario 613-745-3665

Harmony House Ottawa, Ontario 613-233-3386

Pat MacKenzie St-Mary's Home Ottawa, Ontario 613-749-0340

Salvation Army Bethany House Ottawa, Ontario 613-725-1733

Maison d'amitié Ottawa, Ontario 613-747-0020

Maison Fraternité-femmes Ottawa, Ontario 613-744-7469

La Précense Ottawa, Ontario 613-241-8297

ABC - Apprendre pour bien comprendre Ottawa, Ontario 613-233-3232

Claire Allard La magie des lettres Vanier, Ontario 613-7480-3879

Céline Baillargeon-Tardif Le trésor des mots Ottawa, Ontario 613-824-9999

Carole Lanoux Mouvement d'implication francophone d'Orléans Orléans, Ontario 613-830-6436

Union culturelle des franco-ontariennes Ottawa, Ontario 613-741-1334

Rachel Maillet Service familial catholique Ottawa, Ontario 613-233-8478

Action logement Ottawa, Ontario 613-747-8957

Antoinette Breault Partir d'un bon pas pour un avenir meilleur Sudbury, Ontario 705-671-1941

102

Quebec

Claudette Lavallée Santé Québec 514-873-4749

Yves Archambeault, 418-646-2065/ Lise Tremblay, 418-646-2070 Ministère de la Santé et des Services sociaux Québec, Québec

Denis Côté Conseil québécois sur le tabac et la santé Montréal, Québec 514-525-7025

France Paradis Centre de santé publique de la région de Québec Québec, Québec 418-666-7000 extension 241

Louise Archambeault Centre hospitalier régional de Lanaudière Joliette, Québec 514-759-9900

Louise Desjardins Régie régionale de la santé et des services sociaux, région de Lanaudière Joliette, Québec 514-759-9900

Denise Couture Direction de la santé publique de l'Outaouais Hull, Québec 819-777-3871

Hélène Rollin Régie régionale de la santé et des services sociaux de l'Outaouais Hull, Québec 819-777-3871

André Marchand Régie régionale de la santé et des services sociaux Saguenay/Lac St-Jean Roberval, Québec 418-275-4922

Louis Gauvin D.S.C. Honoré-Mercier Inc. St-Hyacinthe, Québec 514-773-5501

Hélène Pigeon Heart and Stroke Foundation Montréal, Québec 514-871-1551

Ghyslaine Desjardins Canadian Cancer Society Montréal, Québec 514-255-5151

Quebec Lung Association Montréal, Québec 514-596-0805

Ruth Lafrenière Réseau national d'action-éducation femmes Maniwaki, Québec 819-449-6645

Sylvie Chevalier "Coeur en santé" Program Public Health Montreal General Hospital Montréal, Québec 514-528-2518

Centre hospitalier de Gatineau Gatineau, Québec 819-561-8100

53

Centre hospitalier régional de l'Outaouais Hull, Québec 819-595-6000

Tracey Barnett "Oui, j'arrête" Program Montréal, Québec 514-528-2400

Marie Marcaurelle "Les poumons roses" Program Offered at the Hull CHRO and Centre hospitalier de l'Outaouais 819-663-1776

Dr. Pronovost Public Health Centre hospitalier universitaire de Sherbrooke Sherbrooke, Québec 819-829-3404

Rénald Chabot Institut Chabot Programme "CigArrêt" (does not exist anymore) Montréal, Québec 514-521-3171

Claude Vandelac "Victoire" Program Hull, Québec 819-771-4401

Centre vivre mieux sans fumer Montréal, Québec 514-596-0805

Simone Bluteau Centre de santé de l'Hématite Fermont, Québec 418-287-5461

Andrée Dupuis Seventh Day Adventist Church "Respirez à pleins poumons" Program Longueil, Québec 514-632-5505

West Island Medical Center Montréal, Québec 514-736-4444

Marie-Martine Fortier Public Health Centre hospitalier de Verdun Verdun, Québec 514-528-2400

Centre de d'intervention et de prévention en toxicomanie Hull, Québec 819-770-7249

Jacinthe Dionne Réadaptation alcoolisme et toxicomanie Centre hospitalier de Jonquière Jonquière, Québec 418-547-3651

Université du Québec à Hull Hull, Québec 819-595-3900

Francine Renaud Hull CLSC Hull, Québec 819-770-6900

Monique Gascon CLSC Le Moulin Gatineau, Québec 819-663-9214

Jeanette Desjardins CLSC des Draveurs Gatineau, Québec 819-561-2550

102

Francine Bilodeau CLSC Petite-Nation Gatineau, Québec 819-983-7341

Sylvie Martel Saguenay-Nord CLSC Chicoutimi, Québec 418-545-1575

Lyne Larouche Aima CLSC Aima, Québec 418-668-4563

Dr. Jean Blouin CLSC des Maskoutains Clinique anti-tabac St-Hyacinthe, Québec 418-778-2572

Constance Alain Centre d'animation des femmes Hull, Québec 819-778-0997

Rolande Piché-Salko Groupe entre-femmes de l'Outaouais Hull, Québec 819-776-3694

Centre d'animation familiale Gatineau, Québec 819-561-5196

Marie-France Gosselin Outaouais United Way Hull, Québec 817-771-7751

Conseil interculturel de l'Outaouais Hull, Québec 819-777-1245

Denise Desaulniers Maison unies-vers femmes Gatineau, Québec 819-568-4710

Louise Gillet/Cécile Loranger Maison Vallée de la Gatineau Gatineau, Québec 819-827-4510

Michelle Lacroix Maison l'autre chez-soi 819-685-0006

Béatrice Gothfcheck Centre Mechtilde Hull, Québec 819-777-2952

Option femmes emploi Hull, Québec 819-246-1725

Françoise Rainville Carrefour de la miséricorde Gatineau, Québec 819-643-5797

Claire Ranger Espoir Rosalie Gatineau, Québec 819-243-7663

Naissance-renaissance Outaouais Hull, Québec 819-827-3843

Maison des naissances de l'Outaouias Gatineau, Québec 819-669-2323

Noëlla Tremblay Bien naître ensemble Hull, Québec 819-778-2124

55

Accueil grossesse Hull, Québec 819-776-1776

Claudette Boivin Solidarité Gatineau-ouest Gatineau, Québec 819-246-2029

Francine Bélanger Équipe soutien-famille Hull, Québec 819-771-2037

Carole Marchand Centre Actuel Buckingham, Québec 819-986-9713

Huguette Joli Entraide parents-enfants de l'Outaouais Hull, Québec 819-595-1905

Ann Parent Aide-maman plus Jonquière, Québec 418-547-4792

Rita Dallaire Maison de quartier Jonquière, Québec 418-542-8904

Claudine Gagnon Maison ISA Chicoutimi, Québec 418-545-6444

Joanne Canuelle Maison d'hébergement la Chambrée Jonquière, Québec 418-547-7283

Isabelle Harvey La Passerelle Aima, Québec 418-668-4671

Jovette Proulx Centre Mieux-être Jonquière, Québec 418-547-3763

Yvonette Tremblay Intro-vie Chicoutimi, Québec 418-545-6125

Centre féminin du Saguenay Chicoutimi, Québec 418-549-4343

Soeur Jeanne-d'Arc Girard Soeurs du Bon Pasteur Chicoutimi, Québec 418-545-1661

Monique Brassard Centre des femmes à quatre temps Aima, Québec 418-668-7698

Lyse Dallaire Habitations communautaires du Lac St-Jean Inc. Aima, Québec 418-662-6592

Madame Simard Femmes action séparation divorce Chicoutimi, Québec 418-693-1161

Henry Lavoie Unité Domrémy de Chicoutimi Maison Henry Lavoie, centre d'hébergement communautaire Chicoutimi, Québec 418-543-7162

56

Nathalie Lamy C.A.Y.A.C. (Centre d'aide aux victimes d'actes sexuels) Chicoutimi, Québec 418-543-9695

Manon Simard Centre amical de la Baie Ville de la Baie, Québec 418-544-4626

Jocelyne Pageau Le Patro Jonquière, Québec 418-542-7536

Marlyne Bolduc CEC de Jonquière Jonquière, Québec 418-542-8184

Suzette Coulomb e Association des citoyennes averties d'Alma Aima, Québec 418-662-2102

New Brunswick

Sue Leblanc Health Canada Moncton, N.B. 506-851-7007

Dr. Anette Séguin New Bruswick Department of Health and Community Services Bathurst, N.B. 506-547-2062

Achille Maillet/Aline Comeau Addiction Services New Bruswick Department of Health and Community Services Moncton, N.B. 506-856-2333

Bill Howard Department of Health and Community Services Fredericton, N.B. 506-457-4983

Jocelyne Maurice Department of Health and Community Services Richibuctou, N.B. 506-523-7607

Marie-Reine Renaud Public Health Moncton, N.B. 506-856-2401

Susan Linton New Brunswick Occupational Health and Safety Commission Fredericton, N.B. 506-453-2467

Johann Marshall-Forgie Atlantic Health Promotion Network Shediac, N.B. 506-532-6334

Vivian Leblanc Moncton Flospital Chest Clinic Moncton, N.B. 506-857-5265

Shelley Weismen Campbelton Regional Hospital Campbelton, N.B. 506-789-5000

57

Pierrette Duguay Bathurst Hospital Bathurst, N.B. 506-548-8961

Gaétanne St-Ange Edmunston Regional Hospital Edmunston, N.B. 506-739-2200

Lorraine Leblanc Dr. Georges L. Dumont Hospital Moncton, N.B. 506-862-4000

Health Services Moncton University Moncton, N.B. 506-858-4000

Régis Gaudet Moncton University Library Moncton, N.B. 506-858-4000

Janet Cooper School District 14 (Tobacco Reduction Strategy) Dalhousie, N.B. 506-684-7555

Vivianne Groslot Drug and Alcohol Addiction Campbelton, N.B. 506-789-2355

Reproductive Health Clinic Moncton, N.B. 506-856-3310

Rosala Molenson Advisory Council on the Status of Women Moncton, N.B. 506-857-9115

Sue Kelso Lung Association Fredericton, N.B. 506-455-8961

Dr. Barbara Robinson N.B. Medical Society Fredericton, N.B. 506-455-6111

Debbie Dowling N.B. Occupational Nurses Oromocto, N.B. 506-357-8465

David Ford N.B. Pharmacists' Association Moncton, N.B. 506-853-0820

Kathryn Barnes N.B. Council on Smoking and Health Moncton, N.B. 506-389-1129

Heather Erb-Campbell Heart and Stroke Foundation Moncton, N.B. 506-387-4357

Pauline Leblanc YWCA Moncton, N.B. 506-855-4349

Sharon Ferguson Fredericton Community Services Fredericton, N.B. 506-459-7461

Bella Smith Victorian Order of Nurses Moncton, N.B. 506-857-9115

100

Mae Boudreau-Pedersen Moncton, N.B. 506-855-2125

Linda Lequin Réseau national d'action-éducation femmes Moncton, N.B. 506-858-4018

N.B. Community College Dieppe, N.B. 506-856-2073

Luc St-Jules Dieppe Boys and Girls Club Dieppe, N.B. 506-857-3807

East Boys and Girls Club Moncton, N.B. 506-857-0358

Active Women Alliance Moncton, N.B. 506-858-4350

Family Services - Moncton Inc. Moncton, N.B. 506-857-3258

Lisa Maillet Family Support Services Moncton, N.B. 506-857-8009

Pauline Doiron Support to Single Mothers Moncton, N.B. 506-858-1303

Memramcook Valley Community Center St-Joseph, N.B. 506-758-2539

Paulette Thériault Centre culturel Aberdeen Moncton, N.B. 506-857-9597

Martin Pietre Société des Acadiens du N.B. Petit-Rocher, N.B. 506-783-4205

Linda Lavoie Récréaplex Dalhousie, N.B. 506-784-7610

Jessica Ryan City of Bathurst Bathurst, N.B. 506-547-2086

Gaston Richard Income Support Campbelton, N.B. 506-789-2311

59

Nova Scotia

Ray Gaudet Department of Health Yarmouth, N.S. 902-742-7141

Shirley Campbell Planification and Research Division Department of Health Halifax, N.S. 902-424-6267

Hubert Devine South Shore Drug Addiction Program Yarmouth, N.S. 902-742-2406

Church Point, N.S. 902-769-3419

Patty Sewell Nicotine Anonymous Program Halifax, N.S. 902-455-3008

Yarmouth Regional Hospital Drug Addiction Yarmouth, N.S. 902-742-3541

Smoke-free Nova Scotia Halifax, N.S. 902-424-2349

Dr. Tahira Ahmed Physicians for a Smoke-free Canada Halifax, N.S. 902-425-7074

Kay Porter/Harley Marchand/Nancy Hoddinott Canadian Cancer Society Halifax, N.S. 902-423-6183

Phylis Woods Lung Association Halifax, N.S. 902-443-8141

Jane Farquharson Coeur en santé Halifax, N.S. 902-494-1919

Helen Greenough Heart and Stroke Foundation Halifax, N.S. 902-423-7530

Ste-Anne University Church Point, N.S. 902-769-2114

Greg Wiseman Community Services Department Digby, 902-245-5811

Church Point, 902-769-0808

Paul d'Entremont Conseil scolaire Clare Argyle/ Société Madeleine Leblanc Meteghan-Pointe de l'Église, N.S 902-645-3117

Mildred Comeau Fédération acadienne Comeauville, N.S 902-769-0955

Corinne Poitier Société Madeleine Leblanc Anse de Béliveau, N.S.

Cobequid Multi-services Center Lower Sackville, N.S. 902-865-5750

102

Prince Edward Island

Health Canada Charlottetown, P.E.I. 902-566-7857

Cathy Sinclair P.E.I. Council on Smoking and Health Charlottetown, P.E.I. 902-368-7281

Dr. Sweet Health and Social Services Charlottetown, P.E.I. 902-368-4996

Mr. Gallant, French Section Head Department of Education Charlottetwon, P.E.I. 902-368-4600

Charlottetown Hospital Charlottetown, P.E.I. 902-566-6111

Lucie Arseneault Public Health Summerside, P.E.I. 902-888-8166

Colette Aucoin La société éducative Wellington, P.E.I. 902-854-3010

Jacinthe Laforêt La voix acadienne Summerside, P.E.I. 902-436-6005

Colette Arseneault Réseau national d'action-éducation femmes Wellington, P.E.I.

Réal Pelletier Addiction Services Charlottetown, P.E.I. 902-368-4120

Vicki Buyanten P.E.I. Lung Association Charlottetown, P.E.I. 902-892-5957

Jane Campton P.E.I. Cancer Association Charlottetown, P.E.I. 902-566-4007

Newfoundland and Labrador

France Bélanger Association francophone du Labrador Labrador City, Newfoundland and Labrador 709-944-660

Cyrilda Poirier Fédération francophone de T.N. et Labrador St-Jean, Terre-Neuve 709-722-0627

61

102

Appendix 2

Bibliography

63

National Literature

Health Canada, Tobacco Demand Reduction Strategy: Year One Review and Update, January 1995

Health Canada, Survey on Smoking in Canada -Cycle 4, June 1995

Health Canada, Survey on Smoking in Canada -Cycle 3, February 1995

Health Canada, Survey on Smoking in Canada -Cycle 2, November 1994

Health Canada, Survey on Smoking in Canada -Cycle 1, August 1994

Health Canada, Tendances dans l'incidence du tabagisme, 1991-1994, Workshop Report, 1994

Canadian Centre on Substance Abuse and Ontario Addictions Research Foundation, Profil Canadien - L'alcool, le tabac et les autres drogues, 1994

Health Canada, Les Canadiens et le tabagisme, Une mise à jour, 1991

Health and Welfare Canada, Health Promotion Survey, Canada 1990, Technical Report, under the direction of Thomas Stephens and Dawn Fowler Graham, 1993

Health Canada, Summary Report of the Workshops for Data on Monitoring Tobacco Use, Chronic Diseases in Canada, Vol. 15, No. 3, Summer 1994, p. 120-125

National Clearinghouse on Tobacco and Health, Focus On: Canadians and Tobacco, September 1993 '

National Clearinghouse on Tobacco and Health, Focus On: Ethnic Origins and Tobacco, September 1993

National Clearinghouse on Tobacco and Health, Focus On: Francophones and Tobacco, Septembre 1993

National Clearinghouse on Tobacco and Health, Focus On: Women and Tobacco, Septembre 1993

National Clearinghouse on Tobacco and Health, Focus On: Young People and Tobacco, Septembre 1993

Statistics Canada, Overview of the National Population Health Survey 1994-95, September 1995, Catalogue 82-567

102

Literature on Francophones

KINNON, Dianne, HART, Liz, Synthesis of the Literature on Priority Groups for Smoking Protection, Prevention and Cessation Programs, Health Canada Report, October 1994

Health and Welfare Canada, Cessons d'abord!. Proceedings of the National Symposium for Francophones Working to Reduce Tobacco Use, Quebec, 17, 18, 19 February 1991

Health and Welfare Canada, Smoking in Groups at Risk: the Francophones of Québec, Working document prepared by Georges LÉTOURNEAU and Marie BUJOLD, submitted for the National Strategy To Reduce Tobacco Use, June 1990

Francophones and smoking, Research Update, Health Promotion, Spring 1990, p.27-28

Health and Welfare Canada, Francophones and Tobacco Use, Working document prepared by Georges LÉTOURNEAU, presented to the Comité francophone of the National Program to Reduce Tobacco Use, July 1998

Literature on Women

Health Canada, National Roundtables - Women and Tobacco (September 30 to October 7, 1993)

Health Canada, Report on Women and Smoking, prepared by Price Waterhouse for the Tobacco Programs Unit, Health Promotion Directorate, Health Programs and Services Branch, Health Canada, 1993

Health Canada, Background Paper on Women and Tobacco (1987) and Update (1990), prepared for the Health Promotion Directorate, Health and Welfare Canada and the National Working Group on Women and Tobacco, by Lorraine Greaves, 1992

Canadian Council on Smoking and Health, Se prendre en charge - Guide d'action sur les femmes et le tabac, October 1989

Health Canada, National Workshop on Women and Tobacco -Proceedings, Ottawa, Ontario, March 7-9, 1988

Price Waterhouse, Research in the Areas of Social Science and Health Dealing with High Priority Adolescent Women and Smoking - Final Report, presented to Health Canada, January 27, 1995

FRY, Elizabeth A , FERRENCE, Roberta, GIOVINAZZO, Angela, HERSHFIELD, Larry, A Situational Analysis of Adolescent Women's Substance Use, Centre for Health Promotion, University of Toronto, March 31, 1994

65

WANKEL, Leonard M., HILLS, Carol A , HUDEC, John C., MUMMERY, W. Kerry, SEFTON, Judy M , STEVENSON, John, WHITMARSH, Blair, Self-System and body image: structure, formation and relationship to health-related behaviour. A report submitted to the Candaina Fitness and Lifestyle Research Institute on a literature review conducted for the Vitalty project, Department of Physical Education and Sport Studies, The University of Alberta, Edmonton, Alberta, February 1, 1994

Réseau national d'action éducation des femmes, Pour les femmes: éducation et autonomie, La place des femmes francophones hors Québec dans le domaine de l'éducation au Canada, par Linda Cardinal et Cécile Coderre, Rapport no. 1, 1990, Rapports nos 2, 3 et 4, 1991, Rapport n° 5, 1992

DUNNIGAN, Lise, Gravel, Nicole, La santé des femmes démunies: mieux comprendre pour mieux intervenir, Service à la condition féminine, ministère de la Santé et des Services sociaux du Québec, November 1992

Health Canada, Women and Tobacco: Act Now! Stop Smoking!

Eastern Ontario Health Unit, De roses ou de cendres? International Conference on Tobacco Use Among Women and Children, June 17-19, 1990

Canadian Cancer Society, Quand elle fume, 1993, no. 221562

Canadian Council on Smoking and Health, Votre guide à un avenir sans tabac, 02-92-016F

Commission des communautés européennes, Fume-t-elle encore?, September 1991

Canadian Cancer Society, Données féminines sur le cancer, Updated: 1993, pamphlet no. 221387

Canadian Lung Association, Le tabac et la grossesse - Voyez les faits dans cet info-poumons, 1990, pamphlet no. 233FX

Heart and Stroke Foundation, La femme et le tabac - Pourquoi fumes-tu?, pamphlet no. CAT34039223

LACHANCE, Paul, PARADIS, France, Le tabagisme dans une clinique de grossesses à risque -Problématique et proposition d'un plan d'action, Direction régionale de la Santé publique de Québec, October 1994

PARADIS, France, Projet «Le tabagisme dans une clinique de grossesses à risque» - Lettre d'intention présentée à la Direction de la santé publique, November 30, 1993

TREMBLAY, Annie, La prise de décision: l'usage du tabac chez la femme enceinte. Document de travail présenté à France Paradis, m.d., Hôpital du Saint-Sacrement, Québec, April 1994

Health Canada, Approaching Smoking in Pregnancy -Reference Guide. A project of the College of Family Physicians of Canada, Funded by Health Canada, project no. 6549-2-8873

100

College of Family Physicians of Canada, Approching Lifestyle issues in Primary Maternity Care (Focusing on Nutrition, Smoking, Alcohol Use. Drug Use and Active Living), September, 1993

BATTY, Helen P., KING, Hollister F., The Family Physician and Smoking in Pregnancy, The Journal of Family Practice, Vol. 30, no. 3: 344-346, Toronto,1990.

HALL, Philip F., Repenser la notion de risque, Le Médecin de famille canadien, Vol. 40, July 1994, pp. 1246-1251.

CHOLLAT-TRAQUET, Claire, for the World Health Organization, Women and Tobacco, presented at the 8th World Conference on Tobacco and Health, in Buenos Aires, WHO Information, no. 166, April 1992.

Les femmes et le tabac: un sujet brûlant, Promotion de la santé, Winter 1988, p. 11

Canadian Council on Smoking and Health, Les jeunes filles et le tabagisme: pas joli du tout!, Tobacco and Health Bulletin, summer/fall 1992

Provincial Documents

Quebec

Ministère de la Santé et des Services sociaux du Québec, Direction générale de la santé publique, Communiqués à l'occasion de la Semaine québécoise sans fumer 1995, 13 janvier 1995

Santé Québec, Health and Social Survey 1992-1993 -Highlights, produced by Bellerose, Carmen, Lavallée, Claudette, Camirand, Jocelyne, Government of Quebec, 1994

Bureau québécois de l'Année internationale de la famille, Association des centres jeunesse du Québec, Centre de recherche sur les services communautaires de l'Université Laval, Enquête, «Ados, familles et milieux de vie», Rapport synthèse, première édition, 1994

LÉVESQUE, Benoît, LAVOIE, Robert, LAVOIE, Michel, GAUVTN, Denis, Journée anti-tabac à l'hôpital: facteurs associés à la cessation du tabagisme, Revue canadienne de santé publique, vol. 84, no. 5, September-October 1993, pp. 350-351

Conseil québécois sur le tabac et la santé, Actes du colloque - Jeunes à l'air libre!,Colloque sur les jeunes et le tabagisme du 25-26 novembre 1992

LALINEC-MICHAUD, M , SUBAK, M.E., GHADIRIAN, A.M., KOVESS, V., Substance Misuse among Native and Rural High School Students in Quebec, The International Journal of the Addictions, 26(9), 1003-1012, 1991

O'CONNOR, Kieron, LANGLOIS, Robert, Modification de l'habitude du tabagisme, Science et Comportement (1991), Vol. 21, no. 1, pp. 1-25

67

Ministère de la Santé et des Services sociaux, Les personnes défavorisées - Et la santé, ça va?. Les publications du Québec, 1989

Ontario

Réseau Interaction Network, Les besoins de formation de la communauté franco-ontarienne en promotion de la santé, Final report presented to the Project Consultative Committee, by Daniel L. Larocque, 11 February 1994

Gratton, Ginette, Lalonde, Gisèle, Parameters for the development of a strategy with respect to tobacco use among Francophones in the Regional Municipality of Ottawa-Carleton, a study conducted by Le Groupe GMG for the Health Department of the Regional Municipality of Ottawa-Carleton, January 1993

Ministry of Health Ontario, Ontario Health Survey 1990 Highlights, September 1992

New Brunswick

NB Health & Community Services, NB Heart Health Survey Results, prepared for Health Promotion & Disease Prevention, prepared by Omnifacts Research Limited, June 1994

NB Health & Community Services,Enquête provinciale de 1992 sur la consommation de drogues par les étudiants, Unabridged Report, December 1992

Health & Community Services, Association des soins de santé du Nouveau-Brunswick, Sondage sur la politique relative à l'usage du tabac, 1991

NB Health & Community Services and Health and Welfare Canada, Rapport de l'étude sur la santé cardiaque au Nouveau-Brunswick, Fredericton, December 1989

Manitoba

Loi sur la protection de la santé des non-fumeurs, L.M. 1989-90, c.41- Chap. S125, came into effect on April 22, 1991, Manitoba Laws

Manitoba Health, Messages adressés aux propriétaires et gérants d'endroits publics, propriétaires et gérants de restaurants, aux détaillants manitobains qui vendent des produits du tabac, dans le cadre de la Loi modifiant la Loi sur la protection de la santé des non-fumeurs, came into effect on October 31,1994

102

Program Documentation

PHYLLIS, Jensen M., COAMBS, Robert B., Health and Behavioral Predictors of Success in an Intensive smoking cessation program for Women, Women and Health, vol. 21(1) in press 1994, pp. 1-13

LANGFORD, E. Robert, THOMPSON, Edward G., TRIPP, Sharon C., Smoking and Health Education during Pregnancy; Evaluation of a Program for Women in Prenatal Classes, Canadian Journal of Public Health, Vol. 74, July/August 1983, pp. 285-289

Health Canada, School Smoking Prevention Programs: A National Survey, prepared by the University of Waterloo, for the Tobacco Programs Unit, Health Promotion Directorate, Health Programs and Services Branch and the Canadian Cancer Society, 1994

National Clearinghouse on Tobacco and Health, Les programmes de renoncement au tabac: un inventaire des programmes individuels et de groupe, prepared for the Tobacco Programs Unit, Health Promotion Directorate, Health Canada, March 1994

Équipe régionale de santé publique, Centre hospitalier universitaire de Sherbrooke, Cyr, R., Bélanger, J., Lemelin C., Expérimentation et évaluation d 'une méthode pour cesser de fumer adaptée à la population socio-économiquement défavorisée, projet subventionné conjointement par le MSSS et la RSSS de l'Estrie dans le cadre du Programme de subventions en santé publique, September 1994

PARADIS, France en collaboration avec FORTIN, C., O'NEILL, M., Un nouvel air au travail -Guide d'interventions sur le tabagisme en milieu de travail, Département de santé communautaire, Hôpital du Saint-Sacrement, 1992

PARADIS, F., VÉZINA, M., Le counselling médical dans l'arrêt tabagique - Des minutes plus que rentables, Direction régionale de la santé publique de Québec, 1994

DÉPELTEAU, Louise, La prévention de la toxicomanie et de la délinquance des jeunes: vers une intégration des modèles, Revue canadienne de psycho-éducation, vol. 22, no. 2, 1993, p.p. 105-113

Canadian Council on Smoking and Health, Evaluation of "Oui, j'arrête" a smoking cessation course for the socioeconomically disadvantaged, Coeur en santé St-Henri/Petite Bourgogne, Heart Health Program, Public Health Unit, Montreal General Hospital, January 1994

O'LOUGHIN, Jennifer, LAMPRON, Ginette P., SACKS-SILVER, Gloria, Evaluation of a smoking cessation guide for low income, functionnally illiterate women: a pilot study, Canadian Journal of Public Health, Vol. 81, November/December 1990, pp. 471-472

69

Press Articles

PIPE, Andrew, Le contrôle du tabagisme: faire de la politique pour mieux prévenir, Revue canadienne de santé publique, volume 83, no. 6, November-Decemberl992, pp. 398-399

ÉMOND, Aline. Santé Québec - Mesurer la santé pour l'améliorer, Santé Société, Vol. 11, no. 2, Spring 1989, p. 49-62

LORTEE, Micheline, Tabagisme: toi et moi, c'est bien fini!, Femmes plus, February 1993, pp. 40-43

LAÇASSE, Germain, Les femmes et le tabac: première étude mondiale, L'Actualité médicale, June 10, 1992, p. 54

DUPONT, Luc, Miss Nicotine ne désarme pas facilement, Québec Science, February 1993, p. 5

La vraie nature de la cigarette, Filles d'aujourd'hui, July 1994, 14(9), pp. 22-23.

DE GRAMONT, Monique, Femme et cigarette - Le couple du siècle?, Châtelaine, June 1986

LORD, Catherine, LAUZON, Lyne, Passage à tabac, La Gazette des femmes, May-June 1990

GAGNON, Francine, La cigarette, Vidéo Presse VII, pp. 6-9

VALLERAND, Nathalie, Le tabac t'abats, Jeunes Consommateurs, Protégez-vous, September 1989

NOËL, André, Le tabac tue 10 000 Québécois par an, rappellent les médecins, La Presse, Wednesday February 2, 1994

LANDRY, Daniel, La promotion de la santé en entreprise est rentable pour les employeurs. Les Affaires, Saturday April 23, 1994

LAPLANTE, Andrée, Santé publique par trop politique, Le Devoir, 30 July 1994

BEAUDOIN, Sophie, À Montréal, les travailleurs manuels risqueraient plus de problèmes cardiaques, La Presse, Tuesday August 2, 1994

BERNATCHEZ, Raymon, Des milliers de pharmaciens s'engagent dans la lutte contre le tabagisme, La Presse, Sunday April 4, 1993

CHARTER, Jean, Le tabac tue plus de 38 000 Canadiens par année - Des médecins outrés par le MATRAC, Le Devoir, Wednesday February 2,1994

AFP, Paris, Anti-tabagisme: l'OMS compte sur les médias, La Presse, Tuesday May 31, 1994

DANSEREAU, Suzanne, 130 000 $ pour décourager l'usage du tabac chez les femmes. Le Devoir, Saturday September 10, 1994

102 70

GAGNON, Lysiane, Les jeunes et le tabac, La Presse, Thursday March 3,1994

PELCHAT, Pierre, Politique antitabac dans les cegeps: Seul F.-X.-Garneau traîne la patte. Le Soleil, Sunday septembre 1,1994

PC, Ottawa, La santé par les... Matinée?, La Presse, Wednesday May 4,1994

LESSARD, Richard, Tabac: la santé est tenue à l'écart du débat, La Presse, Friday February 4,1994

NOËL, André, Un plan visant à diminuer la consommation de tabac et à réprimer les marchands, La Presse, Sunday July 16,1994

COLPRON, Suzanne, LACROIX, Lilianne, Les jeunes fument plus, mais pas que du tabac!, et Drogue et tabac: pas facile, même à 16 ans, de se débarrasser d'une mauvaise habitude, La Presse, October 16, 1994

PC, Toronto, Ottawa enquêtera sur le tabagisme des jeunes, La Presse, Wednesday November 11, 1992

GAGNON, Martha, Les filles du secondaire II fument fort - Le Gardeur, La Presse, Thursday December 23, 1993

BLOCK, Irwin, Raise smoking age, health experts say; Survey finds increase in number of teenagers purchasing cigarettes, Montreal Gazette, January 16, 1995

AUTHIER, Philip, Province aims to stub out teen's tobacco use; $3-million ad campaign planned; ban on sales in drugstores under study, Montreal Gazette, January 12,1995

AUBIN, Henry, Trial in Montreal: Are cigarette ads aimed at youth?, Montreal Gazette, November 7,1989

Where there's smoke there's $180m: Ottawa delivers a massive but questionably useful sop to the anti-tobacco lobby, Western Report, v.9(21), June 20,1994, p.6-7

DRAPEAU, Jacques, Une tare génétique affecte 40% des moins de 25 ans - Jeunes au coeur fragile, Le Soleil, December 5, 1994

PAQUIN, Gilles, La réduction des taxes porte un dur coup à la contrebande, La Presse, February 28,1994

GAGNON, Lysiane, La réserve s'est agrandie!, La Presse, February 12,1994

PC, Québec, Les femmes de la Côte-Nord ont un taux de mortalité supérieur à celui des Québécoises des autres régions, La Presse, March 2,1993

Appendix 3 Focus Group Moderator's Guide

73

Focus Group with Program Coordinators

1. Introduction [study obj ectives, guidelines, introductions (role, brief description of the programs or services, brief description of the client group)]

10 min.

2. Do you usually talk about smoking with your clients? 5 min.

® If yes, what are their reactions?

• If no, why don't you talk about this issue? Are there barriers that limit your involvement in this regard (e.g., women's or staffs attitudes, lack of resources or training)?

3. How important is the issue of smoking to you, compared to the other topics that you discuss with your clients (less important, as important, more important)? Please explain.

5 min.

4. 10 min.

a) "What is your own estimate of the proportion of your clients who smoke?

b) Are your clients generally interested in quitting smoking? c) What are the barriers faced by your clients (particularly those from the priority groups)

when they try to stop smoking? Does your organization address these barriers, one way or another?

5. 10 min.

a) Is there a policy concerning smoking in your organization (e.g., no smoking everywhere, smoking allowed in certain areas)?

b) If there is such a policy, what impact does it have on the staff and on your clients? For example, have you noticed that people tend to smoke less, or to move in between places where smoking is allowed and those where it is not allowed?

c) If there is such a policy, do you think some of your current or potential clients avoid using your services because of it?

102 74

6. 15 min.

a) What are the support resources for women smokers to which service providers working with francophone clients have access?

b) To what resources do francophone women have access?

• To what extent are these resources effective?

• What makes them effective?

• What limits their effectiveness?

• To what extent do these resources meet the needs of francophone women smokers?

• Do you currently use the resources available? Are there programs or resources which you have used in the past but don't use anymore? If yes, why have you stopped using them?

7. In your opinion, is there a need for additional smoking prevention or cessation programs or resources specifically targeted to francophone women smokers?

20 min.

• If yes, what should these programs or resources look like? For example, should they address smoking only or should they be combined with other programs, resources or approaches? Why do you prefer this approach? If a combined approach is preferred: To what kind of programs or resources should a new program be combined?

• What type of approach should be emphasized? For example, should we emphasize group or individual approaches? Should these programs be offered by your organization? Should these programs be delivered by volunteers (such as peers) or health professionals?

• Are there programs which you think are effective and which could be taken as a model for a new program, or to which a new program could be combined?

8. If you think about your clients, and if you think about the fact that they are Francophones, what would you say should be the characteristics and features of these programs and resources in order to maximize their effectiveness?

15 min.

• How should the programs and resources be promoted? How could the target groups be reached?

9. 15 min.

a) Would your organization be willing to deliver (or develop) smoking cessation services for women in general? For women from the priority group?

b) What would be your needs, in terms of resources and training, if you had to integrate a smoking prevention or cessation program for francophone women into your organization?

c) What would b e your needs for information?

10. Would you have any other suggestions which could be taken into consideration in the development of smoking prevention or cessation programs or resources for francophone women?

5 min.

THANK YOU FOR YOUR PARTICIPATION

102

Moderator's Guide

Focus Groups with Women and Adolescent Women

Good afternoon/evening. My name is and I am from Price Waterhouse. Health Canada asked us to conduct a study on smoking among Francophones in Canada. In the context of this study, we are conducting focus groups with francophone women who smoke or have smoked. This is the reason we have asked you to participate in this focus group.

The information provided in this group will remain anonymous. We are recording the discussion on audio-tape to facilitate the writing of our report.

The objective of today's discussion is to talk about the needs of francophone women who smoke and about ways in which services should be offered in order to better meet your needs. We will refer, in general terms and without identifying anyone in particular, to the information that you have provided to us over the phone when we recruited you for the focus group.

Would you have any questions before we begin?

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1. Introduction, study objectives (background), overview of survey results, introductions. 10 min.

2. To what extent is smoking important to you, and why? 10 min.

• Develop the advantages stated during the telephone survey.

• Why do you keep smoking?

3. Does the price of cigarettes have an influence on your smoking behaviour? For example, do you tend to smoke more if the price of cigarettes decreases?

5 min.

4. Do you smoke in specific situations? 10 min.

• If yes, in what situations? What encourages you to smoke in these situations?

5. Do you feel well informed on the impacts of smoking? 10 min.

• If no, what kind of information do you need? What would be the most effective way of distributing this information (e.g., media, medical personnel)?

• If yes, where do you get the information from (e.g., media, medical personnel)? Does this information have an influence on you? For example, does this information motivate you to smoke less or stop smoking?

6. Some of you told us that you had tried to stop smoking but that you had faced barriers, such as . Furthermore, some of you told us that you did not feel capable of quitting.

If you tried to stop smoking again, do you think you would be able to overcome these barriers? 15 min.

• If yes, how would you go about it?

• Do you think you would be able to overcome these barriers alone? With help or support? What kind of help would you need?

8 If no, why do you feel that you would be unable to overcome the barriers? What could help you?

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7. For those of you who have stopped smoking or tried to stop smoking, what did you use to help you?

10 min.

• Did you face difficulties? If yes, which ones?

• Did one or more persons help you? If yes, who did? Was this resource or service available in French?

• Is it important for you that the service be available in French?

8. I will now ask you to think about the things you would like to accomplish in the near future. Compared to these things, how important is it to stop smoking for you?

5 min.

9. Do you think there is a need for support resources or help for francophone women who want to stop smoking in your region (think about yourself, friends, relatives)?

10 min.

• If yes, what kind of help do francophone women need?

• If no, why isn't it necessary?

10. What would be the characteristics of a smoking cessation program adapted to your needs? 20 min.

• What would motivate you to participate?

• What feature of the program, besides the language, would make it adapted to you as Francophones?

® Do you think the program should only include smoking-related issues or should it be incorporated into other services? For example, would you like the program to address smoking only or would you prefer that these issues be discussed during the use of other services or programs (such as health care services)? What would be the advantages of this approach?

• If you think the program or resources should be integrated into something else, to what program or services should they be integrated? What are the services that you use regularly? Do you participate in any program that could also help you to stop smoking?

• What should be the approach taken by the program? Should it include group sessions with other smokers or should there be individual sessions? Would you prefer to meet with professionals? Why do you prefer this approach?

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11. Are there any barriers that could limit your participation in a smoking cessation program? 10 min.

8 If yes, what are these barriers? How could these barriers be overcome?

THANK YOU VERY MUCH FOR YOUR PARTICIPATION

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Appendix 4

Report on focus groups

81

Focus Groups - P rogram and Se rv i ce Coordinators

Subject Ottawa Outaouais Moncton

The information they give their francophone clients about tobacco (Q2)

Most of the participants did not directly broach the subject of tobacco with their clients. ' I t ' s a delicate subject." "It is integrated to the different subjects such as health." Participants who work with parents suggest ways of changing their routines (e.g., open the windows when smoking), and emphasize the importance of reducing their children's exposure to second- hand smoke. One participant who works with students said that "the information they receive does not seem to modify their behaviour. They don't need information, they are already very well informed."

Participants reported that they have to be careful about the type of information they give to certain clients. For example, telling a teenage girl that smoking while taking the pill could cause some health problems could push the teenager to stop taking the pill which, according to some workers, would be more harmful than if she kept smoking.

One participant said she simply tells her clients that smoking is bad for their health. "It's not my place to tell them what to do, we do not ban smoking in our offices." The issue of tobacco is part of the evaluation done by the nurses. "It is not a problem for us because our meetings last two hours and they can keep from smoking for that length of time." "We don't bring up the subject of smoking when the women come in. Often, when they come in, they are in a crisis situation."

"The person I mentioned who gives prenatal classes, talked about matching young parents to pregnant teenagers. They meet once a week, give them fruits and vegetables and try to replace cigarettes with healthy foods. You have to go about it in a round about way."

Nicotine addiction is part of the evaluation done by the nurses.

One of the participants targeted mostly prevention among young people. The youths can't smoke during any of the activities and the organization offers programs and presents videos.

One of the participants reported that he gives an information session every week.

Relative importance given to the issue of tobacco (Q3)

Tobacco is a relatively important issue except for those who work with women in crisis situations. "It is not a priority when you meet them and their life is upside down." To get a positive response from their clients, they can't approach the subject directly, except if the second-hand smoke is affecting the children. They bypass the subject by bringing up other issues related to health or issues such as self-esteem. For instance, the theme of an intervention would not be "Come leam how to stop smoking", but rather "Come learn how to take care of yourself'. Some participants first have to improve their clients' self-esteem before they can consider bringing up tobacco. "The more they regain confidence in themselves, the more they can talk about it. "

Tobacco is not a priority for participants who work with women in crisis situations. "It is very difficult to find answers with these types of clients. Smoking is only a bad habit for some people, but for these clients, whose life is full of hardships, smoking is like a little ray of sunshine."

Some participants believed doctors could act in a more proactive way with their clients. "Women have great confidence in doctors and doctors don't emphasize this very much. They don't educate. They don't talk about tobacco very much with their clients."

The issue of tobacco is not a priority for people who work with women who can get scared off by the subject. "Clients don't want to be bothered with that." Others, however, don't have a choice. One of the workers mentioned that she never used to talk about addiction to smoking with her clients because they had bigger problems (drugs, alcohol). "We didn't want to scare them from the start." She now has to talk to her clients about smoking because they can no longer smoke in their offices.

Some participants said doctors don't put enough importance on tobacco. "Doctors say, 'At least you cut down, don't get too stressed out about this'."

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St*Bonit'ace Gravelbourg Summary

Tobacco is one of the issues they discuss with their clients. It is not, however, the first issue that is brought up. "We have to respect them, we can't make them angry, we have to give them advioe when the time is right, when it is possible for them to escape their lives. But it is not only tobacco. Some young people take drugs that are much more dangerous." Participants don't often bring up the issue of tobacco in a proaotive way: they wait for the clients to talk about it first. "I answer to her needs. She asks me for advice, information, I answer to those needs, but I don't ask her if she feels like smoking."

A fairly large number of participants said they discuss the subject of tobacco. They talk mostly of the health impacts of smoking. However, tobacco is not necessarily broached directly. They often wait for clients to bring it up first before talking about it.

Participants who work with women in crisis situations or on issues that are not directly related to tobacco tend not to talk about it.

The issue of tobacco is more or less important for these coordinators because it is not the reason why their olients use their services. "It is not that women don't need these services, but it is not our mandate." Tobacco could come up in a health program, but it was not necessarily a main issue.

The priority given to the issue of tobacco varied according to the field of work of the participants. The issue is more or less a priority for those working with women in crisis situations or women who would become weary if they brought up the subject (e.g., women who are victims of violence, drug addicts or alcoholics). Workers can sometimes hesitate to bring up the subject because they believe their clients don't want to be "bothered with that".

Some of the participants feel doctors could play a greater role in regards to tobacco. They don't believe doctors put enough emphasis on the issue.

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Subject Ottawa Outaouais Moncton

Coordinators' knowledge of the characteristics of their clients who smoke (Q4)

Smoking is apart of the lifestyle of the women in the target groups. Between a third and most of the clients smoked. ' I t is a pleasure for some, it is a way to live with stress. It is also the only area where they feel they have some control." For many oftheir clients, cigarettes are like a "crutch". "A cigarette is comforting, it is a friend, it's always there. Their boyfriends can leave, the roofs of their houses can fly away, but the cigarette is there." The idea of it eventually being taken away scares them. "You can't take something away without replacing it.» Talking about cessation directly would mean that possible participants to a program had started thinking about quitting smoking, which is rarely the case. "When we say we are going to have a group called Stop smoking, we limit participation because of the subject." As the other problems are solved and as the client receives more support, she can become more and more ready to talk about nicotine addiction. "We can't push too much or we will push them away." "The women will eventually avoid us because they are tired of hearing us talk about smoking cessation."

One can have some influence on the behaviour of pregnant women that one would not otherwise have.

According to some participants, smoking is part of their clients' lives. "You can see it quite quickly. We never see them without their pack of cigarettes, as if they could not live without it."

"Economically speaking, it is an added stress factor because, at the end of the month, when they receive their welfare cheques, it is certain that they have to buy cigarettes. They have to deal with two problems. Firstly, people look at them when they buy cigarettes because they can't afford to buy them. And secondly, it is not good for your health, for the health of your children. It gets to a point where they only hear negative things and it eventually crushes them so much that they smoke more and more."

"Young mothers, those who breast-feed, have a tendency to quit, to find it a priority to do so."

"Young people are concerned with drugs and alcohol. When you get to cigarettes, you get a smile. Cigarettes don't scare them, they have other things to think about before cigarettes."

According to the participants' observations, there had been a decrease in the number of smokers, but they now see more people smoking. They believed this was due to the fact that people don't want to be controlled.

Some clients want to stop and these women ask for help. The others don't want "to be hassled",

Coordinators have noticed that more people ask for help since the last awareness campaign and since the introduction of new regulations.

Some of their clients just have to smoke. "You don't make someone on social assistance stop smoking." '^Unconsciously, they will set some money aside, even if they are very poor, in order to feed their need for smoking." Cigarettes are their only possessions.

Yoimg people don't see tobacco addiction as a problem. What is important to them is to reduce their consumption. "For them, that is acceptable." "One of the problems with young people is that they believe it will not happen to them but to other people, the effects of smoking are not felt immediately. They won't say that they are not okay, they say to themselves that they are in control."

The organization's policies on smoking (Q5)

The offices where most of the participants worked have policies on smoking that range from having a smoking room to smoking being forbidden on the premises. The fact that they have a policy is "a message in itself'. Some feel that these policies may prevent some women from using their services. "Some women would not attend the literacy programs simply because they couldn't smoke during the break." Other participants feel that banning smoking would not keep people from usingtheir services. "In my experience, people go smoke outside, there's nothing stopping them from doing that."

Most of the participants worked in offices where it is forbidden to smoke or where there are restrictions regarding where clients can smoke. One participant who worked in an office where it is not forbidden to smoke put up a poster because she was bothered by cigarette smoke. "It's an incentive."

According to a few participants, some women would keep from using their services because there are restrictions on smoking. "People who have a vital need to smoke would keep from doing certain things or activities if they can't smoke."

Most of the participants restrict the possibility of smoking. They didn't believe these rules kept their clientele from using their services. "They smoke before or after, it is part of the changes that have taken place."

One of the participants talked about the limits of the rules on smoking in schools. "I have a new challenge in the schools. In high school, it is permitted to smoke on the school grounds. I used to bring in documentation for them to try to discourage the people who smoked on the school grounds, but I am not sure I convinced them."

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St-Boniface Gravelbourg Summary

For some of their clients who need security, smoking is "like a refuge". Their clients don't see their smoker's behaviour as a problem and they don't necessarily believe the information they receive. Smoking relaxes them, it is their only pleasure. They also smoke in order not to gain weight. "They don't even want to quit and that is a fact of life. It is as important as bread or milk. It is the only pleasure they have, they don't go out." "She is very tense, very stressed and it is one of the ways she uses to compensate for the stress. She won't go drinking, she won't exercise because she can't do these activities at night, therefore she smokes her cigarette while she's having a cup of coffee after supper and that relaxes her." "It is mostly due to stress, to the fact that they have 2 jobs instead of one (they work outside the home and they have to do housework)." Young people smoke to assert themselves.

Participants felt that society's acceptance of smoking is one of the obstacles to cessation. "We accept it even if we complain about it in the background." Participants also believed that information on smoking is generally too negative. "I see negative messages and comments, that's why women don't want to stop smoking."

According to participants, some women smoke in order to handle stress. "For some people, smoking is a way for them to handle stress. It is not physical activity, a healthy diet or leisure activities." Others smoke because they are addicted or because they want to control their weight.

Young people who smoke the most are the ones who are less busy with college life or with after school activities. Some smoke to rebel. "I am against smoking and I tell that to the kids. But it seems that the more I tell them, the more they smoke."

According to the majority of coordinators, smoking is a part of their clients' lifestyles. For a certain part of their clientele, smoking is vital. It is the only way they could deal with stress, the only area where they have control. That is why many of them react negatively to discussions on smoking or are not interested in participating in groups that deal with smoking. However, pregnant women and new mothers are more sensitive and open to the issue. Smoking can also be the only pleasxire some female clients offer themselves. Some smoke because they want to control their weight or because they are addicted.

Women often receive negative comments regarding their smoker's behaviour, which makes them even less receptive to discussions on the subject,

Young people don't put too much importance on the issue of addiction to smoking. They feel invincible, as if smoking could not affect them.

Not all the participants worked in offices where it is forbidden to smoke. "In our offices, I encourage people not to smoke, but if a client came in and wanted to smoke, if it relaxes her... It is mostly women who are having a personal crisis." Participants who work at the clients' homes said they could not keep their clients from smoking in their own homes.

Most of the coordinators worked in offices where there are rules concerning smoking on the premises. Some believedthese rules would keep some women from using their services. Coordinators working with women in crisis situations believed it was important that thes e women hav e access to an area where they can smoke.

Subject

Knowledge and characteristics of the resources and programs currently available (Q6)

Ottawa

There are either very few resources available in French, very few interesting audio-visual materials or else people just don't know about them. Participants felt they were not very well informed. "Some of the French documents are excellent because they were developed in French. Others are not quite so good because they were translated, which means that all the cultural connotation, the way of speaking and the familiarity are not there." It is difficult to recruit Francophones and to keep them in a group. "The reality of it is that there are 10 times more English programs than there are French ones. There are waiting lists for the French programs. Many Francophones in Ontario tell themselves 'I 'm bilingual, I'm going to take the best service, the one with the most years of experience, the one with the best staff or the most stuff and the nicest manuals because I can manage in that language.' If the choices were equal, they would take the French programs because it is much easier to talk about your emotions in your mother tongue."

One participant said there are few materials she could use with people between 19 and 24 years old who were in school. "They are mostly aimed at people who are not very educated or at parents. There are few things that I can use where people can say 'Yes this sounds like me, this sounds like the stress that I have to deal with'. This group is forgotten."

Outaouais

Participants expressed varying levels of knowledge of the existing programs and resources. One of the deficiencies is the fact that information is not being spread veiy well. "There isn't any information, unless there is some and we just don't know about it." "People don't know about the programs or resources that exist." "A better way has to be found to circulate information."

According to one participant, there was a pilot project two years ago entitled "Tabagisme Anonyme", "but it fell through because there were no participants."

Recruitment for existing programs is difficult. "One program does exist, but how do we encourage people to participate?" "The resources are there but people don't want to hear about them. Women are even scared to sit down and listen."

Moncton

Participants have access to pamphlets but they didn't know which resources existed. "Each person does his or her own thing. Most of the time, we can't bring all the workers together to work towards the same goal."

It is often difficult to obtain the material in French. "I often have to ask for it many times, it sometimes takes a long time." "You have to put in a request a long time in advance if you want something in French." The ads generally don't reach young people. According to the participants, the Health Canada ad ("the commercial with the glass") had a certain impact.

"The information that we believe should be included is not there. The responsibility often falls on teachers, but if some of the information is missing, they won't teach it." There is a health program in schools but the subjects that are dealt with are limited because of time restraints. A program dealing with resisting surrounding pressures (family, peers) is expected to be implemented soon.

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St-Boniface Gravelbourg Summary Participants said there were many French programs and a great deal of information available in that language. However, even if the information is available, participants had doubts as to its scope. "The people who read the information are the people who already know about it. The others ignore it."

According to participants, there are few resources or programs available in French in their area, One participant said a program used to be available and that a new program will be developed based on the old one.

Even if a certain number of participants indicated there was a lack of French resources and programs in their regions, others believed the problem was mostly one of circulation of information. They didn't feel they were very well aware of what was available. It is sometimes difficult to get quality material in French,

The coordinators said that one of the problems they experienced was recruiting women to participate.

One of the participants reported that few resources are aimed at people between 19 to 24 years old who are in school.

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Subject Ottawa Outaouais Moncton

Desired characteristics of programs or resources (Q7-Q8)

The subject of tobacco has to be integrated to other issues discussed with the clients so as not to scare them. "It would be good to offer information within the different groups. It is part of everyday life and we have to make the information available in different centres and in different programs." "We shouldn't necessarily target smokers. We should target a program that deals with many problems." "It is an excellent way to reach people who don't come to the registration sessions. We might have less recruitment problems." "If we get them to take positive steps to improve their health, it might be easier," Participants said they had to find ways to approach women individually and to put an end to their isolation. "Many women are not ready to be part of a group."

The context in which the women live has to be considered. "In my group, the 5 participants were taking anti-depressants. It is a major factor that we have to take into consideration because they already have emotional problems. They arc interested in quitting smoking, but not really." "The clients who are addicted to alcohol and drugs also say, 'I have quit everything else, I can't give that up as well'."

The participants said there is a great need for a multitude of interventions. One of the advantages of the group programs is that they break the possible isolation of the participants, "hi order to break free of an addiction, we have to replace it with something. When you are in a group, you can create bonds." However, "it is very difficult to get people to participate." hi a group intervention, the group has to manage itself, it can't be headed only by professionals (like Alcoholics Anonymous, for example). (This approach had been tried before and had not worked according to one participant).

"We have to increase awareness among doctors because underprivileged people often go to health clinics. In CLSCs, we do a lot of work in prevention, we really work on daily routines. We don't get our message across as well as doctors."

"The on-going programs that are maintained work much better than the sporadic programs. But that is expensive."

There must be prevention with very young children, at the primary school level. "Tobacco companies know it too."

Smokers have to be taught other ways to control stress, they have to be given positive options. Visual material (videos) have to be used with the illiterate clientele. "I think television ads could be much more positive and could reach many more people because these people watch TV."

Participants need information and concrete ways to show their clients the effects of tobacco and to help these women stop smoking.

Prevention has to be done with very young students but complete programs, programs that have a beginning and an end, are needed to sustain prevention. Positive messages have to be emphasized. There is a need for additional training for teachers.

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St-Boniface

It is important to encourage women in a positive way, with meetings, without making them feel guilty. It would be preferable to integrate the tobacco issue to existing programs or resources and to adjust the content according to the needs identified by the participants. Smokers have to be given alternatives, they need help in replacing cigarettes with something else. "If this is my only pleasure, if smoking to reduce stress is my only flaw, what am I going to do to compensate? I don't want to quit because I will eat more, I will gain weight, my boyfriend will not love me anymore, it will be awful. Maybe a program based on what can replace cigarettes or what are the alternatives to smoking instead of showing only the negative side."

Women also need help in understanding why they smoke, to help them "see what is underneath."

Gravelbourg

It is important that smokers receive long-term support, eventually in a group environment. "There would have to be follow-ups, maybe for a couple of months."

They have to deal with issues that are broader than simply nicotine addiction. They have to help women understand why they smoke and emphasize those issues. "Otherwise, no program will be successful if you simply mask the problem." They also have to work on self-esteem because many women smoke to control their weight.

The message has to be positive, it has to identify the advantages of not smoking and help participants replace cigarettes with something else. The message also has to be visual.

A program aimed at young people has to be integrated to an academic program in order to reach as many youths as possible. "Many kids smoke to imitate their friends. They won't admit in front of the other kids that they don't like to smoke and then enroll in a program when all of their friends smoke." They also have to reach the young "leaders" in order to get the message across. It is important to do prevention with young children.

Summary

It would be important to integrate nicotine addiction to existing programs or resources. The issue of smoking would then be only one part of such a program. The women who would participate in such a program would not be scared off and they could be brought, little by little, to consider quitting smoking. Women who smoke have to be given alternatives to smoking and they need to understand why they smoke. It was important to discuss the issues underlying addiction to smoking. The material used has to be as visual as possible, especially with illiterate clients. It is important to encourage smokers and to send them a positive message.

It is important to do prevention with very young students.

Participants believed that in order to be effective, interventions should be done by peers. Support also has to be available.

It is important to circulate information so that the front line workers know what resources are available.

Information in French must be of good quality and be adapted to the French culture.

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Subject Ottawa Outaouais Moncton

Desired characteristics of programs or resources (Q7-Q8)

Hiey have to use very visual material and very little written documents with women in the target groups. Women have to be shown ways to replace cigarettes. "When the kids are screaming and the phone is ringing and it will be disconnected because she hasn't paid the bill, and she sits down at the kitchen table to smoke her cigarette, those 5 minutes belong to her. If you tell her, 'You won't have that 5 minutes 6 times a day', she has to want to quit and has to find other pleasures or other ways to feel she's in control."

Forpeople who are well informed, "we have to find tools to help them go from being informed to doing something about it. How can we encourage people to try a slightly different behaviour that is not too scary? Give them another way of looking at things."

The intervention should be done by peers. "With a professional, you're only getting theory." "We don't have problems and we don't have credibility."

The issue of tobacco has to be part of a series of other issues. "I think if we integrate it to a broader program, it becomes less threatening." "To bring women to talk about themselves. They confide in each other and say, 'We have a problem, what can we do to solve it?' It is a very indirect way of going at it. It is very important not to attack the problem head on."

"For Francophones, it is very important that it not be translated into French. It does not work in Quebec."

The intervention would be more effective if it was given by peers. "They are more receptive in a group where they can identify with others." "For us, the buddy system works very well. The other person tells you not to give up, that he or she is doing well. They are living through the same thing as you. Support is crucial."

With Francophones, "verbal works betterthan written, smaller groups (sitting around a table, drinking coffee and eating something) is more effective than classrooms, informal works better than formal." "Francophones are more open and more ready to share their life experiences than Anglophones. Revealing a little bit about yourself helps to create bonds and from there we can start working together."

"All the front line workers have to know where to find the programs. To redevelop a program... Everything is already there. It might make a difference if we redistribute the resources and raise awareness among front line workers.

"Women who are trying to quit smoking need constant support. "For people who have decided to quit and who need help at a given time, they could call someone on the phone and they could talk about it in order to avoid relapse."

Tobacco addiction has to be treated as a disease, the same as alcoholism.

Tools that reach each sub-group have to be found. One can't take a global approach.

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Subject Ottawa Outaouais Moncton

Possibility of using existing infra-structures and identified needs (Q9)

"We have to find a base in their community (e.g., shopping centre, doctor's office) where they won't have a choice but to see us because it is part of their routine to go there.

"Participants felt they needed training. The money issue is also important.

Other "We send conflicting messages to young people. On the one hand, we setup awareness campaigns, but on the other hand, we don't reinforce the rules. It is easy to get cigarettes."

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St-Boniface Gravelbourg Summary

The lack of financial and human resources seemed to be an obvious obstacle to setting up a program or resources that deal with tobacco within the organizations represented by the participants.

A great deal of information already exists. Organizations don't need extra brochures, but a resource person who would be available to offer services attire provincial or regional level. The existing information has to be shared or disclosed better. Professionals who work with women have to gain greater awareness of the issue of addiction to smoking and they have to be better informed of the available resources.

Participants didn't believe they had the skills, the time or the money needed to develop a program from start to finish. They would be interested, however, in integrating existing programs or resources to their organizations. "The funds we currently receive for our programs are very tight. That is why we say we would need a budget that would be devoted to that program. But we can easily administer and coordinate the program."

Participants wanted to have instructions that could tell them what means to use and what means to avoid when adapting a program to their clientele.

It would be interesting to have a resource person who could help francophone organizations all over the province.

Coordinators would be interested in integrating resources pertaining to tobacco to their programs. They don't, however, have the financial or other capabilities to develop their own program. They need to be shown how to do things and they have to use materials that have been proven effective. Many of them would need training,

Some of the participants believed it would be a good thing to have access to a resource person who could tell what materials are available.

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Focus Group - Francophone Women

Subject Jonquière Women

(priority)

Jonquière Adolescent

Women (priority)

Sudbury Women

(priority)

Sudbury Adolescent

Women (general)

Motivation and opportunity (Q2-Q4)

Participants smoke out of habit (while having a cup of coffee, while watching television), it is a reflex, they smoke even if they don't feel like it. "You haven't smoked from 7:30 to 8:30 a.m. and you don't think about it, but the minute your break comes, something magical happens and you feel like smoking." Smoking helps them to relax. "It isn't easy, when your kids got on your nerves all day, when your husband is getting on your nerves... At least cigarettes don't get on your nerves." "It's a way to escape, a way to keep from, eating, a way to keep from cooking when you're tired. I prefer to smoke and to have five minutes to sit down."

Participants smoke out of habit (after meals, while having a beer, during their break) to relax and because their girlfriends smoke. Also some women say they are addicted to cigarettes.

Participants smoke out of habit (when getting up in the morning, while driving, at work) "I just can't take a bath if I don't have a cigarette in my hand. If I forget my cigarettes, I will get up, get out of the tub, dry myself off and go get my cigarettes".

"I have been at work before and I 'm sitting there working away and all of a sudden, without even realizing it, I have a cigarette in my mouth!"

Some women smoke to control their stress, to relax.

Some participants smoke any time, just because they love to smoke.

Adolescent girls start to smoke because they see their parents smoking, to be like their friends, out of curiosity, to be "cool". "You see ads where beautiful women are smoking and you feel like smoking and you tell yourself, you'll be as beautiful as the woman in the commercial." "I started smoking because I liked the hand movement. It's stupid!"

They keep smoking out of habit and sometimes to rebel. "The more they hassle us, the more I feel like smoking."

Cost of cigarettes (Q3) The price of cigarettes has no influence on the smoking behaviour of most of the participants. For example, they will roll their own cigarettes or buy contraband when the prices increase. However, a few participants said that a decrease in price helps them decide to continue smoking or to start up again.

Participants could do without certain things in order to buy cigarettes. "If I have to take $4.00 from my grocery money to buy cigarettes, that's nothing."

The cost of cigarettes doesn't really have an effect on the smoking habits of participants. "No matter what the price of cigarettes, if you want to smoke, you'll manage."

Participants did not believe the price of cigarettes had any influence on their smoker's behaviour. "They could cost $20.00 a pack and I would still buy them. People tell me, 'Look at the money you could save.' But I would spend it on something else."

"We are used to it and if we want cigarettes, we will buy them 'no matter what'."

"Smoking is such a habit that sometimes, you want to buy something but you tell yourself that you need to buy your pack of cigarettes first."

102

Bàie Ste-Maric Women/Adolescent

Women (general)

Campbellton Women (general)

St-Boniface Women (priority)

Gravelbourg Women (general)

Summary

Participants smoke to control their stress, to relax. "The minute I have a problem, I grab a cigarette. "Smoking is a habit (with coffee, after meals, during the break)." It is an "illness", an addiction ("It's like taking drugs except it is not illegal.")

Smoking can be linked to control. "The more we tell ourselves not to smoke, the more we smoke."

Smoking is "fun", it passes the time, it's a habit (during the break, in the morning with coffee). Smoking is also an addiction. It keeps one from gaining weight.

Some participants said they smoke to defy those who push them to quit.

Participants smoke because they are bored. "Smoking is the only pleasure I have." They also smoke because they feel addicted to cigarettes and to control stress.

Participants smoke in order to control stress. "I mostly smoke when I feel stressed, distressed, hyper, busy..." Smoking is part of the routine, it's a habit, a reflex (in the morning, during lunch, during the break). Participants smoke because they like it.

Cigarettes are like friends, they are a way to escape. "I smoke my emotions. All my emotions, I need a cigarette, the company." "My cigarette understands me."

Smoking is linked to control. "You lose some things when you get married. It is like the only form of control that I don't want him to have on me. I can smoke if I want to, and if I don't want to smoke, it will be my decision.

"Participants smoke for different reasons. Many smoke because of stress and to relax. Others smoke to keep from gaining weight. Most of them said they smoke out of habit: smoking is part of then-daily routine. However, participants felt that smoking is also more than a habit, they are addicted. A few participants mentioned that cigarettes are like friends to them and that smoking is their only pleasure.

For some of them, smoking is linked to a sense of control. Participants in almost every group mentioned that the more they feel people are pushing them to stop smoking, the more they want to smoke.

Participants said they don't smoke more if the price of cigarettes goes down but they thought that a price increase could persuade them to quit

The price doesn't really have an influence on the smoker's behaviour, except for some.

Issue not discussed. Issue not discussed. In general, participants don't believe the price of cigarettes had a great bearing on their smoker's behaviour. If the price of cigarettes goes down, for example, they would buy cigarettes instead of rolling them. The attitude of most of the participants is that "if I want to smoke, I will find a way to smoke no matter what the price of cigarettes."

Some participants s aid they did without certain things in order to be able to buy cigarettes. Buying cigarettes is part of their budget's.

95

Subject Jonquière Women

(priority)

Jonquicre Adolescent

Women (priority)

Sudbury Women

(priority)

Sudbury Adolescent

(general)

Information on the effects of tobacco (Q5)

Some of the participants who had stopped smoking said the Health Canada ads did have an influence on their decision. The ads bothered those who still smoke but not to the point of making them quit. "I don't see any connection to my health, I just change the channel." "The commercials scare me, but when you're in a stressful period, you don't think about that."

Hie Health Canada messages on the packs of cigarette make some of them stop and think, others just ignore them.

Participants said they are aware of the effects of tobacco, even too aware. "We are sick of hearing it." However, some of them thought the information is too general. They want more precise information.

The messages on the packs of cigarettes don't reach them, "non-smokers and ex-smokers look at them."

Participants felt they are fairly well aware of the effects of smoking. "If you want to push something, put it on television."

Participants said they pay little attention to the printed messages on cigarette packs. "The messages on the packs of cigarettes don't do anything. We know it already! They should make the packaging less attractive."

Participants rcceive information, mostly at school and on television. They felt, however, that they receive conflicting messages. The information is not precise." "Why and how is smoking so bad for your health?" "I know a man who is 82 years old and he is still healthy. There is nothing wrong with him and he smokes 2 packs a day."

102

Baie Ste-Marie Women/Adolescent

Women (general)

Campbellton Women (general)

St-Boniface I I I I I l lM

(priority)

Gravelbourg Women (general)

Summary

All the participants felt they are well aware of the effects of smoking. They thought the messages on cigarette packs are "stupid" and "ridiculous". "It won't change anything." However, they sometimes thought of the possible consequences and it scares them.

Participants said they knew what are the effects of nicotine addiction. They don't read the messages on the packs of cigarettes. One of the participants said she hated seeing the messages when she was pregnant.

Television commercials have an impact on them, but only for the few seconds they are on. There are too many shocking messages and not enough specific information (Why do I smoke? Why do lungs become black?). Participants don't believe all they hear ab out the effects of smoking. Some of them smoked when they were pregnant and had healthy babies, others knew people who have smoked all their lives and are not sick.

Issue not discussed. All the participants felt they are well aware of the effects of cigarettes. "We know all the junk there is in there. The commercial where you see the man drinking tar, it makes me sick but that's all it does. All this impact is negative, what good does it do?"

Participants felt they are well aware of the effects of smoking. However, some of them said they found the information they receive too general. They would like to have more specific information on the effects of smoking (e.g. why does smoking have this orthat effect?)

Participants receive information from television, among other places. They pay little attention to the messages printed on packs of cigarettes. Participants believed that advertising is often too negative and too shocking.

97

Subject Jonquière Women (priority)

Jonquière Adolescent

Women (priority)

Sudbury Women

(priority)

Sudbury Adolescent

Women (general)

Barriers to overcome and means used (Q6-Q7)

One of the major barriers to overcome is stress. "I smoke because I am stressed. I will smoke as long as I am stressed."

"I realized that I smoke much less when I learned to relax."

Some of the participants are afraid of gaining weight.

They have to do something else with their hands, replace cigarettes with something else.

The following barriers were noted: the fear of gaining weight, the stress in their lives, being around other people who smoke, the "cravings".

One participant saw her lack of willingness as her main obstacle. "I feel so guilty that it's depressing me. I feel guilty for smoking in front of my son, but I 'm not good enough to stop for him."

Another person has to quit smoking at the same time as them. One has to change one's habits.

One of the barriers identified is being around friends or other people who smoke.

They have to find other ways to occupy their time.

102

Baie Ste-Marie Wom cn/A do lestent

Women (general)

One of the barriers identified is the lack of resources. "Alcoholics have AA, drug addicts have the drug rehab, but smokers have nowhere to go." (One person mentioned a smoking cessation program offered in Yarmouth). "It is more difficult to stop smoking than it is to stop drinking."

Hie other obstacles are the fear of gaining weight, not knowing what to do with one's hands, mood swings and being depressed.

You have to be motivated ("If you haven't decided to quit, you won't quit."), you can't be pushed into it by other people. Another person has to stop smoking at the same time. One has to replace cigarettes with something else (a sucker, gum, toothpicks). One has to keep busy.

Lampbellton Women (general)

Some participants are afraid of gaining weight. For others, the "cravings" are the obstacles. They have nothing with which to replace cigarettes. The questions people ask ("Did you smoke today?") make it difficult to keep from smoking. Participants had mood swings when they stopped. They are too stressed to stop. Other people around them who smoke are a barrier to cessation. The addiction and the habit are difficult to break ("Worse than drinking"). There is a lack of resources (help, activities). Smokers are pushed to quit, but are then left to themselves.

One has to motivate oneself, repeat it often ("I will quit.") One has to decide for oneself, quit for oneself, not for others. One has to change one's routine (e.g. drink tea instead of coffee), replace cigarettes with something else (knit, chew toothpicks). Another person has to quit smoking at the same time.

St-Boniface Women

(priority)

Participants said they needed support. Some are afraid of change. "I don't really like change. So if I stop smoking, I would have to find something else and I don't feel like doing that." Others are afraid of gaining weight. They aw too stressed to quit.

"I realized that I used cigarettes as a shock absorber so that I don't have to express my feelings. With my support group, I learned to express my feelings without cigarettes. Someone had to help me find that solution."

Gravelbourg Women (general)

Stress is a barrier to cessation. 'T didn't smoke for a period of ten years. Hien, a stressful situation made me start up again." Being surrounded by people who smoke can act as a barrier to quitting. Some are afraid of gaining weight. "I stopped for 6 years and gained 50 pounds. I wasn't happy about that so I started to smoke again. I said that I would rather be skinny than fat in my coffin." It is difficult to break the ritual, not to have something in one's mouth. Participants like to smoke too much to stop.

One has to change her routine. "You have to change because it is an integral part of your routine, iike setting the table before eating. You take out your plate, your cigarette, your lighter, your ashtray. It's long." One has to compensate with something else, sports for example. Participants said they need encouragement, to hear positive things.

Summary

There are many barriers to cessation according to participants. Many smoke to relax and s aid they are too stressed to quit. Others are afraid of gaining weight if they stop smoking. It is also difficult for participants to keep from smoking when they are around other people who smoke. Two of the greatest barriers to quitting are the cravings that come with quitting and the difficulty in breaking the smoking habit. Some of them also identified the lack of resources in their region as a barrier to cessation.

Participants said that in order to stop smoking, one should change one's routine, replace cigarettes with something else and stop smoking at the same time as another person. It is essential to want to stop smoking in order to succeed.

99

Subject Jonquière Women

(priority)

Jonquière Adolescent

Women (priority)

Sudbury Women (priority)

Sudbury Adolescent

Women (general)

Relative importance given to quitting smoking (Q8)

Some thought they could quit smoking without help, with will-power, others didn't think they could. "If I really liked myself, I would stop smoking."

Seven participants wanted to quit within six months. For three participants, their health would be a sufficient motivating factor to encourage them to quit. Two said it wasn't a strong enough motivating factor.

Half the participants said they felt capable of quitting, the other half didn't. "It's easy to stop. I stop when I want and I don't have any problems." "I would need a good reason and my health isn't a good enough reason."

Two didn't want to quit. It wasn't very important for them to stop smoking at the moment, except for one pregnant participant.

One participant said she would stop smoking if she were pregnant. Otherwise she is afraid of gaining weight ("I like to smoke, I am not ready to quit.") Another didn't really feel capable of quitting. One believed she could quit if she had help. Another believed that all she needed is a little push, to get rid of stress. She would stop for the sake of her children.

Issue not discussed.

100

Baie Ste-Marie Women/Adolescent

Women (general)

Campbellton Women (general)

St-Boniface Women

(priority)

Gravelbourg Women (general)

Summary

Participants more or less wanted to stop smoking. "I would like to stop smoking, but I don't want to." "I would honestly like to stop smoking but I like smoking, I like the taste, I like the smell." "We heard that some people coughed, they vomited at night (whenthey quit)... What good does it do?"

Smoking is less and less accepted, smokers are less and less respected, which can create a feeling of guilt. Smokers will have to quit whether they want to or not ("It's as if you wear clothing in a large size and you wake up one day and there is only clothing in a small size in the stores.") "I will start smoking when I'm 65 years old. That encourages me to keep going (not to smoke)."

"I think that I have to stop smoking, but I don't think I will have the strength to do it." Participants said they needed support. "I am really scared to stop by myself because I know it will be really hard." "You need people to help you."

Participants said they would like to quit (for their health, the health of their children) but many don't really want to (they don't want to gain weight, smoking is the only way they had to fight boredom, they are too stressed or they liked smoking too much). "I don't think I could live without smoking at the moment."

One participant intended to stop smoking at the same time as her husband, for her health.

Many wanted to stop smoking but felt incapable of doing it. "I know it isn't good for me, but it's so hard." Some are afraid of gaining weight. "I stopped for six years and for six years I was unhappy with myself. It really took away my self-esteem. I am terrified by the thought of quitting, of gaining weight." "I am also afraid of gaining weight."

Others weren't ready to quit because they liked smoking too much.

Many participants are ambivalent concerning the possibility of quitting. Many said they would like to stop smoking but felt they are incapable of doing it or that they don't really want to. Even if some participants felt they could stop smoking by themselves, many others said they would need support and encouragement. Some participants would have liked to have been able to stop smoking in order not to harm their own health or the health of their children.

Some participants weren't interested in quitting because they enjoyed smoking too much.

Some participants believed the current climate would force them to quit smoking, whether they wanted to or not.

101

Subject Jonquière

Women (priority)

Jonquière Adolescent

(priority)

Sudbury Women

(priority)

Sudbury Adolescent

Women (general)

Desired characteristics of a program or resources (Q9-Q10-Q11)

Participants said they wanted a support group made up of women. They want to be able to '"talk, chat, get out of the house," They suggested setting up a helpline called "S.O.S cigarette" (someone to listen to you until the craving goes away).

Half the participants didn't believe they needed help to stop. For them, it is a question of will-power. A few of them thought that support and additional information could be useful (e.g., in the CLSC, on television programs, well known speakers who had cancer). They are not really interested in programs.

Participants said they needed a program like the ones that exist for drug or alcohol abuse. "There are programs for drug addicts, for alcoholics and there should be programs for smokers."

They wanted support groups with weekly meetings. The program coordinators has to understand what a person who is quitting smoking is going through. They needed someone they can talk to (an ex-smoker), someone who would encourage them. They suggested setting up a telephone help line (bilingual). "I'm often alone at home and instead of sitting outside and smoking a cigarette, I would pick up the cordless phone and call this person who would take the time to listen to me."

Language is not important, what is important is to have someone who knows what the women are talking about.

Participants wanted to participate in activities that would make them think of something other than cigarettes, something that would keep them busy. "Interesting things so that you're not just sitting there and listening to them saying 'Stop smoking'."

They thought they could meet people who used to smoke and who are now sick (e.g., go visit someone with lung cancer in the hospital). (Most of them thought it is a good idea, but some doubted it would have an influence on them.)

Participants liked the idea of helping each other. They would be interested in participating in a program that would help them practice their French and quit smoking at the same time, but only if they wanted to quit.

Other Some participants tried to hide (from their children) the fact that they are smoking.

Most of them spoke French at home and English with their friends.

102

Baie Ste-Marie Women/Adolescent

l l l l l l l ! ^ ^ (general)

Campbellton Women (general)

St-Boniface Women (priority)

Gravelbourg Women (general)

Summary

The majority of participants did not believe they could stop smoking by themselves, they felt they would need help. They wanted to have access to a telephone help line that they could call anytime. They wanted a support group, a sort of rehab centre that would help them get through the first 2 weeks of withdrawal (to get answers to questions such as: "What will happen to me when I quit?"), to participate in individual, group and family meetings, to receive counseling. They all agreed they would go to a camp in an isolated area for 2 weeks. They would discuss diet (how to avoid gaining weight), health, lifestyle, activities (dancing, makeovers), self-esteem. The group would be made up of about 10 people of the same gender.

The program would have to be given by a women, an ex-smoker from the region (who could understand that there are few "smoke free" places) who had a hard time quitting.

Participants wanted a support group (like AA or Weight Watchers) where they could share experiences, encourage each other (lukewarm interest for the group approach), but more than "gossiping" (to have guests, for example, a doctor, a beautician). It shouldn't last too long. Treatment at a detoxification centre could be incorporated.

Some wanted pamphlets with ideas and tricks to quit ("a thousand and one ways to quit, things to avoid to keep from starting up again") and receiving information on what to expect when one stops smoking. Emphasis should be put on the immediate well-being and not on the possible future illnesses.

Participants suggested setting up a telephone help line. The counseling should be done by an ex-smoker. It is important for some that it be offered in both languages, but for others, "language is not important".

Participants said they needed resources such as those offered to people who want to stop drinking or taking drugs. "Alcoholics spend a month in a detoxication centre. Why wouldn't there be someplace like that for smokers." Participants said they needed support. "A support system, someone who helps you find the tools to stop smoking. You have to change things in your life." "Groups are veiy nice, but when you get home and you have no one to talk to..."

The group would have to be in French in order for participants to understand each other (culture and different mentality). The group could help create bonds." "We women have less opportunities to go out because we have obligations waiting for us at home. It seems to me that we could make friends in a group like that."

Participants wanted a support group (two believed they could quit by themselves). They wanted to meet ex-smokers (to help each other). They don't want to be judged or made to feel guilty (accepting, compassion, empathy). "I don't want to be labeled as a smoker." "Now people give you such stares, you feel so rejected... You already have enough emotional problems and ontop of that you are rejected. The minute you feel accepted, you want to do your part."

They needed encouragement, support from their surroundings. "If you have a husband or children, it won't help you if they make underhanded remarks. They could help you. They would also need to attend an information session." "Ifthe people around you don't help you, if you are all alone, you can't do it."

It is important to participants that it be in French because of cultural differences.

Participants identified different needs when it came to programs or resources. Some only wanted certain tools, such as a brochure describing tricks. However, many would like to be able to get some support, through a group. Many participants also suggested setting up a telephone line that they could call to get some support. Many participants said they needed to talk to someone and to "get out of the house". The support groups and the telephone line would serve these purposes. It is important for many participants that they receive help in French from someone who had smoked in the past and who had a hard time quitting.

Participants said they needed the same kind of support as that given to people who are addicted to drugs and alcohol. They don' t want to be judged and they need encouragement.

Resources should be spent on helping instead of on publicity.

Some smokers hid (from parents, from their husbands) the fact that they smoke.

Participants believed that society saw women who smoke more negatively than men who smoke.

103

104

Appendix 5 Recruiting Forms

102 104

Recruiting Form - francophone Women

Good morning/afternoon/evening. My name is and I am calling from Price Waterhouse. Health Canada asked us to conduct a study on smoking and francophones across Canada. In the context of this study, we will be conducting focus groups with francophone women (adults and adolescents) who smoke or who have smoked in order to talk about smoking in their lives. For persons to whom we were referred: Mister/Ms. (name of person and organization) told me you might be interested in participating in this focus group.

Do you smoke or have you ever smoked?

• no

Do you know someone who smokes or who has smoked whom we could call and who might be interested in participating in a focus group?

[H no - - -> Thank you for your time.

• yes

Name and telephone number

• yes

There will be a focus group in (city) on (date) at (time) . Participants will receive $40 in cash at the end of the focus group to help pay for any expenses incurred as a result of coming to the focus group. Would you be interested in participating in this focus group?

• refuse - - -> Thank you for your time. • accept

We have to recruit participants with various profiles for the group. I would like to ask you some questions before confirming your participation to make sure that your profile corresponds to the one we're looking for.

What is your mother tongue?

• French • English • • -> I thank you for your time but we are looking for people whose

mother tongue is French.

102

What language do you speak at home? When I say "at home", I also mean with your friends and relatives.

• French • French and English • English only - - -> I thank you for your time but we are looking for people who

speak French at home.

Are you employed?

• working (specify occupation) • not working

Do you have any children?

• 0 • 1 • 2 • 3 • 4 or more

How old (is your child/are your children)?

What is the highest school level that you completed?

• did not complete grade 12 • completed grade 12 (obtained a diploma) • did not complete CEGEP • completed CEGEP - - -> refuse if recruiting for priority groups • did not complete university - - -> refuse if recruiting for priority groups • completed university • • -> refuse if recruiting for priority groups

If refused: I would like to thank you for your time but we are looking for participants with a profile slightly different from yours.

Are you...

• single and living alone • single and living with a spouse • single living with someone other than a spouse • married or living in common law

Is your spouse employed?

• yes

• no

107

Is you annual household income...

• less than $10 000 • between $10 and 15 000 • between $15 et 20 000 • between $20 and 25 000 • between $25 000 and 30 000 • over $30 000

Income Criteria Table (for the recruitment of priority groups)

Without a Spouse With a Spouse 0 children $17 000 or less $20 000 or less 1-2 children $20 000 or less $25 000 or less 3 children or more $25 000 or less $30 000 or less

Thank the person if she does not correspond to the required profile. If she does, confirm her interest in participating and finish the interview.

We would like to obtain some information concerning the smoking behaviour of women. We could complete a short telephone questionnaire now or at a time that is more convenient for you. The interview will not last longer than 10 minutes. What would you prefer?

• complete telephone questionnaire now • complete telephone questionnaire on (date) at (time)

I would like to send you a letter confirming the date, location and time of the focus group. Could you give me the complete address where I should send the letter?

Name of participant

Address:

Telephone number: ( )

City:

Date: _ _ _ _

Time

100

Recruiting Form - Program Coordinators

Introduction to use with people to whom we have been referred:

Good morning/afternoon. My name is and I am calling from Price Waterhouse. Health Canada asked Price Waterhouse to conduct a study on smoking and francophones across Canada. In the context of this study, we are going to conduct focus groups with program coordinators who work with francophone women or adolescent women, including women from the "priority" groups, that is low-income women, those with low levels of education or those who have difficulty reading or writing, unemployed, single mothers, immigrants and women who work in the medical field.

told me you might be interested in participating in a focus group as program representative.

There will be a discussion group in (city) on (date) at (time) . The focus group will last approximately 2 hours and will be used to discuss, among other things, the characteristics of a program or resource that would be useful for your clients who smoke, the possibility of integrating this kind of program to other types of program for the targeted group as well as effective strategies for reaching this client group.

Would you be interested in participating in this focus group?

• refuse - - -> Thank you for your time. • accepts

109

Information on the participant:

What kind of program do you represent?

• smoking prevention/cessation • women's health • social services • pre-/post-natal programs • occupational health and safety • immigrant services • mass education/adult education • other (specify)

What is your title?

We would like to send you a letter confirming the location, date and time of the focus group. Where can I send the letter?

Name and complete address :

Telephone number:

City:

Date:

Time:

100

Appendix 6 Advance Questionnaire - Women

1 1 1

Questionnaire Profile of Focus Group Participants

The information that you and other participants will provide will help to better understand the background for the discussion and analyze the findings.

1. How long have you been smoking?

years - - -> go directly to question 2 months - - -> go directly to question 2 weeks - - -> go directly to question 2

• you don't smoke anymore

Questions la to lc should only be asked of women who don't smoke anymore

1 a. How long has it been since you have stopped smoking?

years months weeks

lb. What made you decide to stop smoking?

lc. Did you find it difficult to stop smoking?

• Yes, why?

• No, please explain

The remaining questions should only be asked of current smokers.

102

2. Have you ever tried to stop smoking?

• no - - -> go directly to question 3 • yes

2a. If yes, how often have you tried to stop smoking for more than 2 days?

2b. What was the reason or reasons you started smoking again?

3. Do you smoke every day?

• yeS - - -> go directly to question 4

• no - - -> go directly to question 5

4. How many cigarettes do you smoke in a day? READ

• less than 10 cigarettes per day • between 11 and 20 cigarettes per day • 1 pack per day • 1 pack and a half per day • 2 packs per day • 3 packs per day • more than 3 packs per day

5. What do you like about smoking?

113

6. What is it that you don't like about smoking?

7. Does someone else smoke at home?

• yes • no

If yes, does this have an influence on you?

8. Do you think smoking is dangerous to your health?

• yes • no • don't know

Would you like to stop smoking one day?

• yes - - -> go directly to question 9a • no « - «> go directly to question 10 • don't know . . „> go directly to question 10

9a. If yes, by when?

• 1 month • 6 months • 1 year • 5 years • more than 5 years

102 114

10. Do you feel capable of quitting?

• yes • no

If no, why not?

Thank you for your time. We are looking forward to meeting you at the focus group. If you can't make it on that day or if you have questions concerning the focus group, feel free to call (613) 238- 8200 collect and ask to speak with

T

116

Appendix 7 Descriptive grid - programs and resources

117

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102

Appendix 8 Inventory of programs and resources

123

Province; Ail (possible)

Name and address of organization:

Health Canada

Type of organization:

Name and description of the program:

Target clientele:

Type of approach:

Recruitment and promotion:

Cost per participant:

Evaluation and results:

National Health Department

The video "Diary of a Teenage Smoker" was developed and adapted for Francophones by Health Canada in 1989. It depicts the experiences of a teenage girl addicted to cigarettes. The approach focuses on prevention and cessation. The video and the accompanying guide are available at Health Canada, the Heart & Stroke Foundation and the Lung Association.

The program is aimed at teenage girls.

The intervention is done individually. The video is accompanied by a guide that can help the teenager in her efforts to quit smoking.

The program is promoted to doctors and CLSCs by the organizations who distribute it, such as the Heart & Stroke Foundation, the Lung Association and Health Canada.

The material can be rented for $2 a day.

Information not available.

124

Province: Ontario

Name and address of organization:

Type of organization:

Name and description of the program:

Targeted clientele:

Type of approach:

Recruitment and promotion:

Cost per participant:

Evaluation and results:

The Ontario Physical and Health Education Association (OPHEA) 1185 Eglinton Avenue East North York, Ontario M3C3C6 (416) 426-7120

Health Association

OPHEA received a grant from the Ontario government to develop a smoking cessation program aimed at teenage girls between 13 and 19 years old. The program doesn't have a name yet. It will be translated into French.

The program will be aimed at teenage girls aged between 13 and 19 and more specifically at girls with little education, who have left school early, girls who don't have a job, who are handicapped and other members of the at-risk groups.

A coordinator's guide will be developed according to the results of a study done by a research team. The guide is intended for leaders in the community who work in the health, education, recreation and leisure fields. They will try to recruit ex-smokers who could act as role-models for participants. The strategies will be based on the theory of social change. The guide will be developed with the help of different organizations and will incorporate elements of successful existing programs.

N/A

N/A

N/A

102 124

Province: Ontar io

Name and address of organization:

Type of organization:

Name and description of the program :

Targeted clientele:

Type of approach:

Recruitment and promotion:

Heart & Stroke Foundation of Ontario 477 Mount Pleasant Road Toronto, Ontario M4S2L9 (416)489-7111

Not for profit organization

The "Fly Higher! Young Women Taking Charge and Taking Care of Their Health" Program is currently be ing developed. It will be available in 1996 and will be translated into French. The program will deal with women's health issues.

Young women between 12 to 19 years old.

The intervention will be done by peers who have received special training and will deal with health issues, including nicotine addiction.

Promotion is expected to be done through youth organizations, schools, educators and other networks linked to the Foundation, and with the help of special events and brochures sent through the mail.

Cost per participant:

Evaluation and results:

N/A

N/A

102

Province: Quebec, Ontario

Name and address of organization:

Type of organization:

Name and description of the program:

Targeted clientele:

Type of approach:

Montreal General Hospital Healthy Heart Public Health Department 980 Guy St., Suite 300A Montreal, Quebec H3H 2K3 (514)528-2400

The Department is a publicly funded community health organization.

The program "Oui, j'arrête!" was developed by the Public Health Department of the Montreal General Hospital. It was developed specifically for Francophones. It has been available since 1989 and deals with nicotine addiction, health and other related issues (increasing one's motivation, stress management, assertion, self-control). The approach is curative.

Even if it would be possible to offer the program in French in Ontario, especially in the Ottawa and Toronto regions, there is apparently no demand for the program according to the person consulted. The program is therefore given in French only in the province of Quebec.

The program is aimed at women, especially at women with a low economical status and with little education.

The intervention consists of weekly group meetings for 5 weeks, each meeting lasting two hours. A sixth meeting is held 2 weeks after the last session (1 month after quitting). Participants also receive something in the mail during the 3rd and 6th month after quitting to encourage them to continue. The program is given by a woman from the community who volunteers her time. She receives training on nicotine addiction. The program, based on information and counselling, concentrates mostly on verbal communication since it targets women with little education. Questionnaires, participation sheets, participants' guides and leaflets are used. A video is used to explain to participants what is addiction to cigarettes and give them ways to stop smoking and to remain smoke free. The program also includes the use of Nicorette gum, of the nicotine patch and of relaxation and aversion techniques.

127

According to the person consulted, the program attracts an "older" clientele, a clientele who believes that it is important to stop smoking more than a "younger" clientele does. This explains why community organizations that tend to young girls and adolescents no longer offer the program.

Recruitment and promotion: The program is promoted by nurses working in CLSCs, by doctors, through brochures and publicity posters in community centres, pharmacies, hospitals, medical clinics, corner stores, local papers and door-to-door.

The cost is $8 per participant, tax included. The price includes the delivery of the participant guide that is in the shape of a calendar with stickers, a cigarette counter, a schedule and a wheel with practical tips.

According to an evaluation of the program, 30% of participants had attended at least 5 meetings and 40% had attended 1 or 2 meetings. One month after the last meeting, 26.8% of the 123 people registered in the workshops had stopped smoking. After 6 months, this rate had dropped to 15.4%. It seems that the motivation to stop smoking and the intention to do it progressively decrease after the end of the workshops.

Cost per participant:

Evaluation and results:

116

Province: Ontario

Name and address of organization:

Type of organization:

Name and description of the program:

Target clientele:

Type of approach:

The Canadian Public Health Association 1565 Carling Avenue, 4th floor Ottawa, Ontario K1Z 8R1 (613) 725-3769

The Association is a national health organization.

The "Smoking Cessation Program for Women" was developed in collaboration with 7 community centres in Ontario and has been available since 1993. It aims to help women in the target groups by supporting them in their efforts to stop smoking and decrease their tobacco consumption. The program was not specifically developed for Francophones but was translated into French and tested in that language. It is now offered in French to interested organizations across Canada. The approach is curative and deals with issues related to nicotine addiction, health and other subjects such as motivation, nutrition, stress management and self-confidence.

Low-income women with little education

The intervention has 4 phases. The first is a visit to the participant's home, or a telephone conversation, in order to develop trust. The second, "motivation", consists of 4 two-hour group sessions, spread out over 1 or 2 weeks, according to what the group decides. These sessions are for women who are still undecided and are thinking of quitting smoking. The third phase is "cessation" and it consists of 6 to 8 sessions spread out over 3 to 4 weeks. These sessions last 2 hours each and are designed to help participants deal with withdrawal. The forth phase is "support". It consists of 5 follow-up sessions, at one month intervals each. Each session lasts between 1 to 1 1/4 hours. The intervention is done by volunteers and employees of the centre where the program is offered. It is based on information and counselling. Brochures and pamphlets that discuss addiction are used. Participants also receive a diary and a calendar.

129

Recruitment and promotion:

Cost per participant:

Evaluation and results:

In order to promote the program, flyers are sent through the mail, and pamphlets and brochures are sent to community organizations and hospitals.

$24.95 per participant.

The French program is currently being evaluated. However, the cessation rate is not the only way to measure the success of the program because emphasis is put on helping women to better control their lives (stress management) without necessarily smoking a cigarette.

102 130

Province : Quebec

Name and address YWCA of Montreal of organization: 1355 René-Lévesque Blvd. West

Montreal, Quebec H3G 1T3 (514) 866-9941

Type of organization: Not-for-profit community organization

Name and description of The "Vitality" Program is a national project whose objective is the program: to help women with addictions, including nicotine addiction, to

make positive changes in their lifestyles. The program incorporates issues such as developing self-esteem, good nutritional choices, physical activity and tobacco reduction.

Target clientele: Underprivileged women with an addiction.

Type of approach: A draft of the coordinator's guide has been developed. YWCAs in Vancouver, Yellowknife, Winnipeg, Brockville, Oshawa and Montreal will develop and organize pilot groups, or have already developed and organized them (summer 1995). Feedback by the participants will be used to further develop the program and to bring changes to the guide. The pilot project being done at the YWCA in Montreal aims to evaluate the behavioural changes in 45 women who participated in the program and to compare the results to those of 2 control groups who did not participate in the program (one group was made up of women who were not underprivileged and the other of underprivileged women). The program's sessions give support to the participants, and helps them find ways to achieve their goals and maintain their participation. The frequency of meetings varies from one YWCA to the other. The program at the YWCA of Montreal consists of weekly meetings.

Recruitment and promotion: N/A

Cost per participant: Free

Evaluation and results: The pilot projects will be evaluated in September 1995. A program guide will be available in the spring of 1996. Manuals and training will be available for the YWCAs across Canada during the spring and summer of 1996. Evaluations will be incorporated into the program.

Province: Quebec

Name and address of organization:

Type of organization:

Name and description of the program:

Target clientele:

Type of approach:

YWCA of Montreal 1355 René-Lévesque Blvd. West Montreal, Quebec H3G 1T3 (514) 866-9941

The YWCA is a not-for-profit organization.

The "Programme d'action communautaire" is currently being developed. The intervention has 2 sections: prevention and cessation workshops. The Program is being developed specifically for Francophones with the help of the Public Health Department at the Montreal General Hospital. The program will be offered both in French and English. Coordinators are waiting to see if they receive funding before continuing to develop the program. The prevention section will cover nicotine addiction and health, and the cessation section will deal with issues related to smoking (stress management, physical exercise). They plan to offer the program to interested organizations.

The Program will be aimed at YWCA employees and the population in general, but mostly at young families, pregnant women and low-income women with little education.

The prevention part of the intervention will consist in information sessions aimed at raising awareness among the general population of the impacts of addiction to smoking. It will have a positive approach. There will be 3 information sessions every 2 weeks for YWCA employees and every week for the general population. Each meeting will last 1 1/2 hours. People who want to quit smoking will be referred to the cessation program. The programmers plan to use material from the Canadian Cancer Society and the Lung Association. The prevention program will be available in September 1995.

The cessation program will be made up of 8 weekly two-hour meetings. The intervention will be done in groups and will be given, like the prevention program, by a resource-person who has knowledge of nicotine addiction (i.e. lung disease specialists). The frequency of meetings has not yet been determined but there will be an individual follow-up session (if needed) and a collective session (support-group) incorporated in

116

Recruitment and promotion:

Cost per participant:

Evaluation and results:

the program. The program will be available to Y W C A employees in January 1996 and in March of the same year for the general public.

Information not available.

The prevention program is free and the cost to participate in the cessation program will be low because it is aimed mostly at an underprivileged population.

Not applicable.

133

Province: Ontario

Name and address of organization:

Type of organization:

Name and description of the program:

Target clientele:

Type of approach:

Recruitment and promotion:

Cost per participant:

Evaluation and results:

Health Department of the Regional Municipality of Ottawa-Carleton 495 Richmond Road Ottawa, Ontario K2A 4A4 (613) 722-2281

Regional Health Department

The "Prenatal Program for Women and Their Partners Who Smoke" was developed in French by the project coordinator in collaboration with the Program Training and Consultation Centre. It has been available since 1994. The intervention is both of preventative and curative type. Addiction to smoking and health during pregnancy are discussed.

The program is aimed at pregnant women and their partners.

The intervention is done both individually and collectively. The program lasts 6 weeks and consists of weekly two-hour meetings during which nicotine addiction is discussed. Furthermore, if participants feel they need them, sporadic and informal meetings (for example in a restaurant) are held in order to talk strictly about addiction to smoking. A follow-up (on the phone or in person) is done 2 or 3 times during the 6 months following delivery. The intervention is done by a hygienist-nurse. Pamphlets, brochures and a manual entitled "Stopping When You're Ready" are used.

Promotion is done through brochures, pamphlets and tear-off information sheets for pregnant women. These are distributed to hospitals, CLSCs, community health centres and shopping centres.

The cost is $35 per couple. The program is free for participants who can't afford to pay.

An evaluation was done of the pilot-project and the results indicated that none of the women who participated had quit smoking after the program.

116

Province: Ontario

Name and address Health Department of the Regional Municipality of of organization: Ottawa-Carleton

495 Richmond Road Ottawa, Ontario K2A4A4 (613) 722-2281

Type of organization: Regional Health Department

Name and description of "Stopping When You're Ready" is an individual help kit that the program: was developed for Francophones by the Health Department of

the Regional Municipality of Ottawa-Carleton in collaboration with the University of Ottawa. The draft of the guide has been available since February 1995. The final product will be available around the fall of 1995. The guide deals with nicotine addiction, health and other related issues (stress, exercise, etc.), and targets smoking cessation.

Target clientele:

Type of approach:

Recruitment and promotion:

Cost per participant:

Evaluation and results:

Pregnant women who smoke.

The intervention is done individually. However, counsellors are available for participants who wish to get help or to get additional information. The kit includes three brochures, one pamphlet and posters that encourage women to think about why they started smoking, gives them documentation on the effects of tobacco on women and their babies, identifies the advantages of quitting smoking and offers suggestions concerning ways to stop smoking.

The final product will be promoted to doctors.

The kit is free.

The kit was developed very recently and has therefore not been evaluated.

135

Province: Ontario

Name and address of the organization:

Type of organization:

Name and description of the program:

Target clientele:

Type of approach:

Health Department of the Regional Municipality of Ottawa-Carleton 495 Richmond Road Ottawa, Ontario K2A4A4 (613)722-2281

Regional Health Department

The "Tobacco Use Prevention for Pre-natal Women" and "Tobacco Use Prevention for Post-natal Women" are part of a global approach to tobacco reduction. This approach includes training for health professionals and people who care for children on ways to talk about nicotine addiction to their clientele. The programs use social marketing techniques in order to help smokers quit smoking and to make people aware of the effects of second-hand smoke. The tools that are used were translated into French. However, the help kit "Stopping When You're Ready", used with the "Pre-natal Program" was developed specifically for Francophones.

The "Prenatal Program" is aimed at pregnant women. The "Post-natal Program" is aimed at health professionals and people who look after children (day care and pre-school personnel, parents).

Two series of prenatal courses are offered: a regular course and a special course for quitting smoking. The "Stopping When You're Ready" kit is used in the special prenatal courses. Pregnant women who smoke and don't want to take the special courses take the regular course, but they have access to a nurse with whom they can discuss issues related to tobacco and who can direct them towards community support groups. The guide "Stopping When You're Ready" is available to women who choose not to take the special courses but who still want to deal with the subject. The "Post-natal Program" offers health professionals and people who look after children help to integrate tobacco prevention and reduction strategies in their workplaces or in their homes.

102

Recruitment and promotion:

Cost per participant:

Evaluation and results:

Posters, articles in community newspapers, television commercials.

The kit used in the "Prenatal Program" is free for Ontario residents and $20 for non-residents.

These programs have not been evaluated.

137

Province: Ontario

Name and address of organization:

Type of organization:

Name and description of the program:

Target clientele:

Type of approach:

Recruitment and promotion:

Cost per participant:

Evaluation and results:

Council for a Tobacco-Free Ontario 412 Mount Pleasant 3rd floor Toronto, Ontario M 4 S 2 L 7 (416)322-6660

The Council is a provincial organization specialized in the fight against tobacco. It is made up of resource centres across Ontario.

The guide "How to talk about smoking with high risk pregnant smokers" was developed by the Council in collaboration with provincial chapters of the Heart & Stroke Foundation, the Lung Association and the Canadian Cancer Society. The guide was developed in English and was translated into French. It has been available since June 1995. The program deals with addiction to smoking, health and other related issues (nutrition, stress reduction, self-confidence, breast-feeding).

The French guide is available in the Council's regional offices and workers in the different provinces can obtain it.

The program is aimed at people who work with high risk pregnant women (women who have a low income, are illiterate, those who smoke as well as their partners).

The intervention is curative. The guide is used by workers who counsel pregnant women. The guide will be integrated into a group workshop in September 1995. There will be a follow-up phone call after the program.

The guide is promoted through ads in the Tobacco Free Times.

The guide is free.

The pilot project was evaluated from December 1994 to March 1995 and improvements were brought to the guide as a result.

116

Province: Quebec

Name and address of organization:

Type of organization:

Name and description of the program:

Target clientele:

Type of approach:

Recruitment and promotion:

Cost per participant:

Evaluation and results:

Institut Chabot 2475 Sherbrooke St. E Montreal, Quebec H2K 1E8 (514)521-3171

Private organization

The "Méthode Chabot" (formerly "Cig-arrêt") was developed in French by the founder of the Institut, in collaboration with doctors from the Notre-Dame Hospital. The program has been available since 1978-1979. It is a curative intervention involving a global perspective to smoking cessation and promotes quality of life.

The program is aimed at women aged 35 to 49 who have been smoking for at least 10 years.

The intervention is done individually and autonomously in two phases: motivating and sustaining. A short questionnaire is first sent to people interested in trying the method in order to determine how motivated they are. Those who are motivated enough receive the method which includes 2 guides (1 to be used during the motivating period and the other for the sustaining period) as well as 4 audio cassettes (3 for the motivating period and the other for the sustaining period). Users have access to a telephone help line during normal business hours. A questionnaire is sent by mail to participants 3 months after the "Méthode" has been sent.

The program is promoted through advertising in the newspapers and in collaboration with CLSCs and doctors (pamphlets).

The cost is $44 per method.

Among the users who returned the questionnaire that is sent to them after the treatment, half of them reported that they no longer smoked.

139

Province: Saskatchewan

Name and address of organization:

Type of organization:

Name and description of the program:

Target clientele:

Type of approach:

Recruitment and promotion:

Cost per participant:

Evaluation and results:

Self-help Clinic 42 Houston Road Regina, Saskatchewan S4V 0G4 (306) 789-2619

Private company

The clinic offers individual hypnotherapy sessions to help clients stop smoking. The issues of nicotine and drug addiction as well as health are discussed (e.g., stress, weight problems, depression). The program has been available for 3 years. It was not developed specifically for Francophones, but it can be given in French.

The clinic tends to the general population but it is used mostly by women.

The intervention is done by a hypnotherapist and involves information, counselling and therapy. It generally consists of 3 one-hour sessions. There is a follow-up with participants 1 to 2 weeks after the last session. Magazines on hypnotherapy are given to participants. Cassettes are also available, but only in English.

Promotion for the clinic is done through advertising in the newspapers.

The cost is $40 per session. Therefore, the cost of the entire program is generally $120.

There is no formal evaluation of the program. According to the person consulted, approximately 85% of participants stop smoking.

140

C 13,549 V.A.

i