We’re not smoke-free yet

Liz Fraser, Addictions Prevention, South Shore Health

I recently facilitated a workshop about addiction and harmful use of alcohol, drugs, and gambling. During one presentation, the group were asked about the most common drugs used by Nova Scotian youth. Alcohol and marijuana were easily identified as the top two substances. But even with prompting about the third most commonly used drug, no one thought of cigarettes.

17.3% of Canadians still use tobacco, and in Nova Scotia tobacco rates are 18.1%. In 2000, our tobacco rates were about 30%, so we’ve done an excellent job in reduction. Tobacco legislation and policies are cited  as success stories, and this rightly deserves celebration. But we often seem to forget that we’re not smoke-free yet. In recent years, tobacco use rates have plateaued. Tobacco is still the leading preventable cause of chronic disease, disability, and death in Nova Scotia, and accounts for more than 20% of all deaths annually.

Nova Scotia’s 2011 Comprehensive Tobacco Control Strategy takes a population health approach by recognizing the need to “substantially reduce tobacco-related health disparities between populations in Nova Scotia”. Those most affected by tobacco use include low-income communities, especially female-led households with children, First Nations, and those affected by mental illness. Mortality rates related to tobacco use are two to three times higher among low-income populations than higher income populations. So how can we address these disparities?

One social determinant of health we can focus on is housing. Access to decent housing contributes to overall health through safety, sense of identity, connection with community, etc. Most Canadians spend the majority of their time at home, and home remains the primary location of exposure to second hand smoke. And it’s a well established fact that there is no safe level of exposure to second-hand smoke. Studies have shown that up to 65% of the air in multi-unit dwellings (such as apartments, condos, duplexes, townhouses, etc.) can come from elsewhere in the building. This means that second-hand smoke can get in through things like open windows or balcony doors, electrical outlets, heating and air conditioning ducts, ventilation systems, and cracks and gaps in construction. One-third of Canadians live in multi-unit dwellings, and much of this population is already marginalized by lower income, as well as higher rates of chronic disease and disability than average Canadians. There is currently no legislative body in Canada that has addressed the issue of adults smoking in their own homes when the smoke affects other people in neighbouring homes.

Addressing the social determinants of health involves removing barriers and enabling opportunities for all to enjoy optimal health. The opportunity to live in a smoke-free home should be available to all. Smoke Free Nova Scotia is working to address this issue by advocating for smoke-free multi-unit dwellings (seehttp://www.smokefreens.ca/current-initiatives/smoke-free-housing/ for more info). We know that the choices people make are shaped by the choices they have available to them. If people (particularly low income, vulnerable populations) had the option to live in a smoke-free home, they would not only be protected from the dangers of second-hand smoke, but would also be facilitated to make healthier decisions regarding their own smoking behaviours.

What other determinants of health do we need to address to further reduce our smoking rates and improve the health of all?

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