Use and misuse of tobacco among Aboriginal peoples

Question 1

What is the current prevalence of smoking in Canada?

Answer 1

20%

Question 2

What is the current percentage of smoking in First Nations people in Canada?

Answer 2

59%

Question 3

What percentage of Canadian youth 15-19yo smoke?

Answer 3

20%

Question 4

What percentage of Canadian First Nations youth 15-17yo smoke?

Answer 4

47% boys

61% girls

Question 5

What percentage of Manitoba First Nations youth 15-19yo smoke?

Answer 5

82%

Question 6

What percentage of Inuit 18-45yo smoke?

Answer 6

70%

Question 7

What are the risks of tobacco use?

Answer 7

1. Myocardial disease
2. Vascular disease
3. Chronic lung disease (e.g. emphysema)
4. Lung cancer
5. Other cancers
6. Type 2 DM
7. Fires

Question 8

What are the risks to the fetus with smoking during pregnancy?

Answer 8

1. Perinatal deaths
2. Placental problems
3. Preterm deliveries
4. Fetal growth retardation
5. Congenital abnormalities i.e. gastroschisis
6. SIDS
7. Miscarriage
8. Learning disabilities
9. Withdrawal symptoms
10. ADHD in childhood
11. Subsequent nicotine dependence

Question 9

What are the risks of postnatal exposure to second-hand smoke?

Answer 9

1. LRTI
2. Lung growth decrease
3. Otitis media
4. SIDS
5. Asthma

Question 10

What percentage of Canadian homes with children <12yo have regular smoking?

Answer 10

21%

Question 11

What are the specific concerns associated with nicotine addiction and its influence on nicotine use?

Answer 11

1. Highly addictive substance
2. Addiction is worse in adolescents
3. Genetic factors (nicotinic acetylcholine receptor, dopamine transporter gene, cytochroe P450 2A6)
4. No data suggesting racial differences related to nicotine metabolism

Question 12

What are the specific concerns associated with youth access to tobacco and its influence on nicotine use?

Answer 12

56% of underage smokers obtain tobacco from friends and family

33.3% retailers continue to sell cigarettes to underage Canadians

Question 13

When does smoking initiation begin in Canada?

Answer 13

As young as 11-13yo

As young as 7-8yo in Aboriginal youth

Question 14

What socioeconomic factors are associate with high rates of smoking?

Answer 14

1. Poverty
2. High unemployment
3. Low income

Question 15

What are the specific concerns associated with cost of tobacco and its influence on nicotine use?

Answer 15

1. 10% increase in price is associated with a 14% decrease in the prevalence of youth smoking
2. Availability of tax-free tobacco on reserves undermines the cost of smoking

Question 16

What cultural factors are associated with nicotine use?

Answer 16

1. Tobacco is used for medicinal purposes and is considered sacred in many First Nations people
2. First Nations Elder and the Assembly of First Nations state that recreational tobacco use is disrespectful of the spiritual, medicinal, and traditional use of tobacco
3. Traditional Inuit culture was smoke-free

Question 17

What programs have have been established by provincial and territorial governments to target the broad social environment (most do not apply to reserves)?

Answer 17

1. The establishment of smoke-free public and workplaces to protect nonsmokers from second-hand smoke.
2. Efforts to standardize legal age limits for tobacco use and penalties for selling to minors.
3. Keeping tobacco products out of sight – the so-called ‘shower curtain law’.
4. Banning tobacco advertising and displays.
5. Taxing tobacco at a high level to produce cigarette prices sufficiently high to deter regular smoking among adolescents.
6. The use of health warnings on cigarette packages.`

Question 18

What are some Helath Canada and national Aboriginal organizations national programs to increase awareness of the problems of tobacco misuse?

Answer 18

1. First Nations and Inuit Health Branch works in partnership with national Aboriginal organizations to raise awareness of tobacco misuse
2. Tobacco control programs strategies include:
   a) capacity building
   b) developing and delivering comprehensive, culturally sensitive, and effective tobacco control programs
   c) promoting the health of First Nations and Inuit people by decreasing the prevalence of tobacco smoking and smokeless tobacco use
   d) engaging leadership of First Nations and Inuit in learning to voice opinions and support tobacco control strategies

Question 19

What are the five steps to quitting?

Answer 19

1. Get ready.
2. Get support.
3. Learn new skills and behaviours.
4. Get medication and use it correctly.
5. Be prepared for relapse or difficult situations.

Question 20

What resources for smoking cessation are listed on the First Nations and Inuit Health Branch website?

Answer 20

1. Toll free smoking lines
2. List of nicotine replacement and medications to assist in smoking cessation
3. List of community based cessation programs and counselling services
4. Details self help suggestions e.g. “5 steps to quitting”

Question 21

What are some aims of anti-smoking messages?

Answer 21

1. promote smoke-free spaces (public, private and work places), and are aimed mainly at adults under the age of 35 years (current prevalence for those aged 20 to 34 years is 27%, which is higher than the smoking rate of the general population);
2. target pregnant and postpartum women;
3. target third-party suppliers of tobacco products to youth (eg, parents, siblings, older teens and other adults) with the goal of curtailing the supply of tobacco to youth; and
4. continue bans on smoking advertisements and tobacco company sponsorship.

Question 22

What are the recommendations regarding bans on smoking in the workplace?

Answer 22

Although it is true that some communities are passing bylaws that provide less protection than provincial smokefree legislation, other communities are passing bylaws that not only support provincial legislation but in some cases surpass it.

Question 23

What are other measures designed to address the individual misuse of tobacco?

Answer 23

1. Teaching and practicing ‘resistance’ skills.
2. The use of antismoking medication, either nicotine substitution (eg, the ‘patch’) or non-nicotine drugs such as bupropion (Zyban, Biovail Pharmaceuticals, Canada).
3. The enforcement of age limits on tobacco sales and measures to remove cigarettes from public view.
4. Emphasis on the role of the physician and health care professional in smoking control. This includes counselling patients to help prevent and stop smoking. This emphasis should be part of routine preventive care at each office or community health visit. The five ‘As’ should be used routinely:
   a) ASK about tobacco use
   b) ADVISE urge to quit
   c) ASSESS willingness to attempt quitting
   d) ASSIST – counselling and pharmacological therapy
   e) ARRANGE follow-up
5. Taking advantage of educational opportunities; for example, use the experience of a smoking-related illness of a family member to educate family and community members about the dangers of tobacco, emphasizing control measures, cessation strategies and the use of nicotine substitution therapy such as the ‘patch’.
6. Advocacy: Actively promote school-based prevention programs and be actively involved in policy interventions related to smoking.

Question 24

What are the CPS recommendations for tobacco misuse in First Nations and Inuit?

Answer 24

1. Aboriginal communities should adopt a minimum age for the sale of cigarettes.
2. Aboriginal communities should encourage dialogue in the community to help change attitudes toward the acceptability of recreational tobacco use.
3. Aboriginal communities should continue to discourage smoking in the workplace and institute bans of nontraditional use of tobacco in public places such as restaurants, recreational facilities, bingo halls and casinos.
4. First Nations reserves should focus on continuing to educate retailers on-reserve about the Tobacco Act and discourage the sale of tax-free tobacco products, especially to non-Aboriginals.
5. Because cost influences tobacco use, Aboriginal communities should be encouraged to place their own surcharge on tobacco products (when purchased for nontraditional use) to increase the price to match off-reserve prices; the increased revenue should then be directed to smoking prevention programs in the community.
6. A well-defined system should be established within a community to enforce all tobacco laws. The consequences of breaking these laws should be well defined.
7. Cigarettes and other tobacco products should remain behind counters and out of sight in all stores.
8. Aboriginal communities should encourage community members to establish smoke-free homes to diminish exposure of children to second-hand smoke.
9. Nicotine replacements such as the ‘patch’ and nicotine-free tablets such as bupropion should be encouraged as part of a smoke cessation program. While at present there is limited availability of these drugs under the Non-Insured Health Benefits Program, it is recommended that these drugs be readily available when clinically appropriate.
10. Physicians and health care workers should use the opportunity afforded by clinic visits to explore smoking and tobacco use habits, to educate about the dangers to individuals directly or through second-hand smoke, and to introduce smoking-cessation strategies.
11. All Aboriginal communities should discourage nontraditional use of tobacco products.