Canadian Medical Association Journal 1996; 154: 230-232
Smoking is totally prohibited in schools (including school grounds) and child-care centres, and is restricted to designated smoking areas in hospitals, nursing homes, homes for the aged, colleges, universities and shopping malls. It is also banned in the public areas of all retail stores, financial institutions, laundromats, hair salons, and video and amusement arcades.
The legislation has teeth. Selling to minors may result in fines of up to $2000 for a store owner and $5000 for a corporation for a first offence; subsequent offences can attract fines of up to $75 000, and retailers with two or more convictions risk being banned from selling cigarettes for a period. Smoking in a "no-smoking" area can result in a fine up to $1000 for a first offence, and $5000 thereafter.
Ontario has had antismoking legislation in place for a long time, but until recently enforcement by police and bylaw-enforcement officers had been lax, even nonexistent. Now, however, all municipalities have appointed provincially funded tobacco-enforcement officers -- public-health inspectors specifically dedicated to enforcing the act. Many municipalities also have trained public-health inspectors to monitor compliance.
So far, emphasis seems to be more on education than enforcement. Joanne Godin, tobacco-enforcement officer for the Niagara region, says education means visiting all tobacco retailers in the area to explain the regulations and penalties for violations. First the retailers have to be identified -- no mean task given all the new outlets, from gas stations to restaurants, taverns and bars, that filled the void left when pharmacies were forced out of the tobacco market. Many enforcement officers have started by visiting retail outlets that are near high schools.
A compliance study undertaken before the new legislation was passed found that 46% of retailers would sell tobacco to minors. Godin believes retailers will rapidly stop turning their back on the law once they become aware of the penalties. However, laying a charge is not simple: an inspector has to witness the infraction and obtain the name and age of the minor.
High schools have new problems now that school property has been declared a no-smoking zone. After the act was passed, says Barbara McDonald, principal of Holy Cross High School in St. Catharines, student littering, loitering, trespassing and obstruction of traffic in the neighbourhood reached such proportions that the school was forced to call a meeting for the 200 smokers in the student population of 1500. They were reminded about their responsibility to be good neighbours, and cleanup crews were sent out each week to collect cigarette butts and other litter. Another undesirable outcome is that student smokers now use the local mall and railway tracks as away-from-the-school smoking zones. The school has offered smoking-cessation courses, but there has been little response.
Ontario hospitals are allowed to designate a limited number of smoking areas, but some facilities have decided to become even more smoke free. At Welland County General Hospital in Welland, smoking lounges are being phased out, and by Jan. 1, 1996, only the extended-care and psychiatry units will have smoking areas. Tim Wright, the hospital's president and chief executive officer, says there has been "some low-key grumbling" but so far no strong opposition. Reaction from staff has been mixed; few doctors smoke, he says, but many nurses are still puffing. Smoking will still be permitted in the grounds, except within 9 m of an entrance.
Dr. Steve Corber, the former medical officer of health for Ottawa-Carleton who was recently named director of disease prevention and control for the Pan American Health Organization, believes the new act will be "very effective" in keeping young people from smoking. He thinks the retailers who profited by selling cigarettes to minors will quickly disappear. They will have to be educated, he argues, and that may require some successful charges and penalties.
[In the Ottawa area, the first successful charge was laid in May, when the owner of a Nepean gas station and his clerk were charged. In September they were fined $80 and $40, respectively, for selling cigarettes to a 16-year-old high school student. A second charge could result in a 6-month suspension of his licence to sell tobacco. The angry station owner referred to the health inspectors as "Gestapo" and "cigarette police." -- Ed.]
The next logical step, Corber suggests, would be to declare tobacco a hazardous substance and further control its sale. He also believes plain packaging would "reduce the glamour" and thus reduce tobacco consumption by minors.
In southern Ontario's tobacco-growing region, Dr. Sandor Demeter, medical officer of health for Haldimand-Norfolk, reports "no significant resistance" to the legislation, although his was the last region in the province to appoint a tobacco-control officer.
Even though the position is funded by the province, "it took a lot of persuasion" for the local board of health to authorize acceptance of the funding. There was no significant opposition to the posting of no-smoking signs in retail stores, however, and overall there was less resistance than expected. "The number of tobacco farmers is diminishing," Demeter says. "They see the writing on the wall."
Enforcement officer Brian Rayner says the restrictions on selling tobacco to minors are being emphasized and "it's hard for anyone to disagree with that." He notes that smoking rates in the tobacco-growing region are no different from the provincial average.
How have pharmacists reacted to the ban on the sale of cigarettes in drugstores? A court challenge by a small group did not succeed, and since then, says Leroy Fevang, executive director of the Canadian Pharmaceutical Association (CPA), "it's almost a nonissue." The CPA, which fought long to persuade its members to stop selling tobacco, welcomes Ontario's legislation.
Jim Dunsdon, registrar of the Ontario College of Pharmacists, personally believes the sale of tobacco "is incompatible with the role of the pharmacist." Generally Ontario pharmacists are complying with the act, he says, although a few are circumventing the law by subdividing their store or setting up separate kiosks. Apparently this is legal; the law says that cigarettes may not be sold in pharmacies, not that pharmacists may not sell cigarettes. Dunsdon is not happy with this situation, but says it's not his job to impose his principles on others.
Not all pharmacists support the views of their professional associations. Tom McAnulty, a pharmacist with an IDA pharmacy in St. Catharines, believes that if the act was intended to reduce the incidence of smoking, it hasn't worked. "It's ticked off a lot of customers," he says, "but they then walk down the mall to the nearest variety store."
He believes it would have been better to classify cigarettes as a drug and restrict purchases to behind-the-counter sales in pharmacies. Pharmacists could then counsel patients about the adverse effects of tobacco used in conjunction with prescription drugs and, where appropriate, provide advice about cessation. On whether selling cigarettes is incompatible with the role of a health care professional, McAnulty says: "We sell a lot things that are bad for people - chocolate bars, for example."
He does see one positive development because of the legislation: it reduces the likelihood a drugstore will be robbed, and insurance premiums may drop as a result.
Michael Perley, executive director of the Ontario Campaign for Action on Tobacco (OCAT), a coalition of antitobacco groups that campaigned for the Tobacco Control Act, thinks things look good. Charges are being laid against retailers for illegal sales to minors, he says, and convictions are being obtained. (In September the Ottawa Citizen reported that more than 50 charges had been laid across the province in the previous 10 months, resulting in 20 convictions. Most fines were in the $100 range, although the maximum first-conviction fine is $2000 for a clerk and $5000 for an owner.)
Perley accepts that minors will always be able to obtain cigarettes if they want to, but the act's aim is to reduce demand by "pruning the tree," thus reducing access. Although he favours either a licensing system for retailers or the restriction of sales to government-controlled outlets, he acknowledges that this would affect thousands of small retailers and "no government is ready to do that yet."
However, he feels that the federal government "took the single most regressive public-health move [possible]" by reducing tobacco taxes, and is now in "extreme denial" about the thousands of tobacco-related deaths that will result. OCAT is campaigning for additional smoke-free outlets -- restaurants, recreational facilities such as billiard and bingo halls, and bowling alleys -- and for a complete ban on smoking in the workplace.
However, the major emphasis is on keeping young people from smoking. To achieve this, he maintains, the reimposition of taxes is essential. Price, plain packaging and the abolition of sponsorship advertising by tobacco companies are critical weapons in the war against smoking, Perley says.
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