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Minutes Board of Health HL29.1 8/4/2014 2014-03-24 Minutes - Board of Health Minutes To be Confirmed Board of Health Meeting No. 29 Contact Nancy Martins, Committee Administrator Meeting Date Monday, March 24, 2014 Phone 416-397-4579 Start Time 1:00 PM E-mail [email protected] Location Committee Room 1, City Hall Chair Councillor Joe Mihevc HL29.1 ACTION Amended Ward:All Health Risks of Indoor Waterpipe Smoking Board Decision The Board of Health: 1. Requested the Medical Officer of Health, in consultation with the City Solicitor and community stakeholders including Toronto Universities and Colleges, to report to the Board of Health by end of 2014 on measures, including prohibition, to address the health risks of indoor waterpipe smoking in Toronto commercial establishments and connected patios thereof; 2. Requested the Medical Officer of Health to include in the requested report international best practices on waterpipe legislation and an economic impact analysis on businesses; 3. Urged the Federal Minister of Health to amend the Tobacco Act and regulations to explicitly include waterpipe tobacco products; and 4. Forwarded the report (March 10, 2014) from the Medical Officer of Health, for information, to the Ontario Minister of Health and Long-Term Care, Public Health Ontario, the Association of Local Public Health Agencies, the four Toronto School Boards, and Ontario Universities and Colleges. Decision Advice and Other Information The Medical Officer of Health gave a presentation to the Board of Health. Origin (March 10, 2014) Report from the Medical Officer of Health Summary Since 2006, the Smoke-Free Ontario Act (SFOA) has prohibited the smoking of lighted tobacco in http://app.toronto.ca/tmmis/viewPublishedReport.do?function=getMinutesReport&meetingId=7930 1/7 8/4/2014 2014-03-24 Minutes - Board of Health enclosed public places and workplaces, including the use of waterpipes (also known as hookahs) for this purpose. However, the SFOA does not apply to indoor use of waterpipes to smoke herbal, non- tobacco products. This has led to a proliferation of waterpipe bars, restaurants and cafes across the province where indoor smoking of ostensibly ‘tobacco-free’ products is permitted. Waterpipe smoking gives rise to at least four concerns for public health: 1. smoking of waterpipe tobacco products poses well-established health risks for users and those exposed to second-hand smoke; 2. waterpipe smoking of even non-tobacco products indoors undermines the success of the SFOA, because it contributes to the social acceptability of smoking in public places; 3. it is difficult for smokers or enforcement staff to ensure that the product smoked is non-tobacco based; and 4. emerging research indicates that waterpipe smoking of non-tobacco/herbal substances has an adverse impact on indoor air quality that can lead to unhealthy exposures. This report reviews evidence on the use and health effects of waterpipe smoking in indoor public places, including recent evidence on indoor air quality at waterpipe cafes in Toronto. It recommends that the Medical Officer of Health report, in consultation with the City Solicitor and community stakeholders, on measures to address health risks from indoor waterpipe use at commercial establishments, including possible prohibition. Background Information (March 10, 2014) Report from the Medical Officer of Health on the Health Risks of Indoor Waterpipe Smoking (http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-67436.pdf) (March 10, 2014) Appendix A - Toronto Commercial Waterpipe Smoking Locations, 2014 (http://www.toronto.ca/legdocs/mmis/2014/hl/bgrd/backgroundfile-67437.pdf) Communications (March 17, 2014) E-mail from Roberta Ferrence, PhD, Senior Scientific Advisor, Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto (HL.New.HL29.1.1) (http://www.toronto.ca/legdocs/mmis/2014/hl/comm/communicationfile-45979.pdf) (March 21, 2014) E-mail from Pippa Beck, Policy Analyst, Non-Smokers’ Rights Association (HL.New.HL29.1.2) (March 21, 2014) Letter from Michael Perley, Director, Ontario Campaign for Action on Tobacco (HL.New.HL29.1.3) (http://www.toronto.ca/legdocs/mmis/2014/hl/comm/communicationfile-46002.pdf) (March 24, 2014) Submission from Nathaniel Demisse, The Youth Health Action Network (HL.New.HL29.1.4) (http://www.toronto.ca/legdocs/mmis/2014/hl/comm/communicationfile-45996.pdf) (March 24, 2014) Submission from Yasmin Abu, Toronto West Youth Coalition (HL.New.HL29.1.5) (http://www.toronto.ca/legdocs/mmis/2014/hl/comm/communicationfile-45997.pdf) (March 24, 2014) Submission from Ibrahim Malik, Canadian Cancer Society (HL.New.HL29.1.6) (http://www.toronto.ca/legdocs/mmis/2014/hl/comm/communicationfile-46051.pdf) Speakers http://app.toronto.ca/tmmis/viewPublishedReport.do?function=getMinutesReport&meetingId=7930 2/7 8/4/2014 2014-03-24 Minutes - Board of Health Dr. Roberta Ferrence, Ontario Tobacco Research Unit Michael Perley, Director, Ontario Campaign for Action on Tobacco Nathaniel Demisse and Akeela Tulloch, Youth Health Action Network, Toronto Public Health Ibrahim Malik, Canadian Cancer Society Christine Pu, Catherine Lee, and Aziza Farrah, Youth Health Action Network, Toronto Public Health Samira Mohyeddin Motions Motion to Amend Item moved by Councillor Sarah Doucette (Carried) That: 1. Recommendation 1 be amended to include consultation with Toronto Universities and Colleges. 2. Recommendation 3 be amended by adding the four Toronto School Boards, and Ontario Universities and Colleges to the list of bodies the report is forwarded to. Motion to Amend Item moved by Monte Harris (Carried) That Recommendation 1 be amended: a. by replacing "at" after "waterpipe smoking" with "in"; and, b. adding "and connected patios thereof" following "commercial establishments" Motion to Amend Item (Additional) moved by Councillor Joe Mihevc (Carried) That the Board of Health request the Medical Officer of Health to include in the report international best practices on waterpipe legislation and an economic impact analysis on businesses. Motion to Adopt Item as Amended moved by Councillor Joe Mihevc (Carried) HL29.2 ACTION Adopted Ward:All Tobacco Use Cessation Support for Marginalized Communities in Toronto Board Decision The Board of Health: 1. Requested the Ontario Minister of Health and Long-Term Care to expand the availability of free/low cost smoking cessation medication; and 2. Requested the Ontario Minister of Health and Long-Term Care to integrate cessation interventions into primary health care services for those with mental illness/addictions, Aboriginal people and Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) http://app.toronto.ca/tmmis/viewPublishedReport.do?function=getMinutesReport&meetingId=7930 3/7 8/4/2014 2014-03-24 Minutes - Board of Health populations. Origin (March 10, 2014) Report from the Medical Officer of Health Summary This report provides an overview of cessation supports available to tobacco users in Toronto, especially for marginalized communities in Toronto, including the LGBTQ community, homeless and underhoused people, low income residents and students. In 2012, 18% of Ontarians aged 12 years and over had smoked cigarettes in the past 30 days and had smoked at least 100 cigarettes in their lifetime, representing 2.13 million people. There has been no significant change in this rate in the past five years. Females aged 12 and older had a significantly lower rate of tobacco use than males, a finding consistent with previous years. The prevalence of current smoking was highest among males aged 50-54 years (34%). The greatest number of current smokers among males was in the 50-54 and 20-24 year old age groups, while the greatest number of current smokers among females was in the 50-54 and 30-34 year old age groups. Across the province, 2011/12 rates vary from a low of 14.1% in Ottawa to a high of 27.1% in Porcupine. Toronto's rate was 15.3% (Ontario Tobacco Research Unit, 2014). There are certain populations however, with much higher rates. People with mental illness and/or addictions, homeless/underhoused people, LGBTQ populations, and indigenous populations experience high rates of tobacco use. The prevalence of smoking among those with mental health and addictive disorders is two to four times greater than the general population. Research shows that 43% of the First Nations communities smoke daily compared with 19% of the general Canadian population. Smoking rates within LGBTQ communities remain between 24% and 55%. Available data shows that 46-63% of individuals with HIV in Ontario smoke cigarettes (Els, Kunyk and Selby, 2012). There are many reasons why rates remain high among these groups. In spite of investments made in the provision of cessation services in Ontario since the introduction of the Smoke-Free Ontario Strategy in 2005, problems continue to exist in both the reach and effectiveness of those services. The province's cessation efforts have focused largely on providing cessation supports to smokers to make quit attempts. As such, the Strategy funds Smokers' Helpline, the Driven to Quit Challenge, the STOP Study and the Ottawa Model of Smoking Cessation. These interventions are only reaching about 5% of smokers annually, and only a small proportion of participants succeed in quitting. In recent years, there have been no statistically significant changes in the number of adult smokers (18 years of age and older) who intend to quit in the next 30 days or 6 months, made at least one quit attempt per year, and quit for at least one month in the past 30 days. With the exception of Leave the Pack Behind, a program that operates at all 20 universities and 24 applied arts colleges in Ontario, current cessation programs and services tend to reach more female than male smokers and in general, tend to serve an older smoking population. In addition, tobacco treatment is not routinely integrated into health services that may be more http://app.toronto.ca/tmmis/viewPublishedReport.do?function=getMinutesReport&meetingId=7930 4/7 8/4/2014 2014-03-24 Minutes - Board of Health acceptable to and/or accessible by members of these groups than mainstream services.
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