Does Level of Tobacco Control Relate to Smoking Prevalence in Canada: A National Survey of Public Health Organizations

Abstract

he prevalence of cigarette smoking among Canadians aged 15 years and older has declined dramatically in recent decades, from 50% in 1965 to 17.5% in 2009. 1,2 Public health interventions-including, promotion of indoor and outdoor smoke-free policies; enforcement of policies limiting tobacco availability; improvement and expansion of free, comprehensive and evidence-based cessation services; and increased prevention programming 3-5-have been central to this decline. However, the prevalence of smoking remains much too high and tobacco control continues to be a critical role for public health practice and policy. Most jurisdictions in Canada have well-established tobacco control strategies involving numerous organizations 6 that are diverse in mission, structure and funding. In addition to regional-level health authorities and public health units, these organizations include, among others, all levels of government departments, non-governmental and non-profit organizations, coalitions and alliances, paragovernmental agencies and resource centres. Together they provide tobacco control leadership, resources, and advocacy, and deliver programs that contribute to national and provincial goals to make Canada smoke-free. With the dramatic declines in smoking prevalence and the attendant view in some jurisdictions that the problem of smoking has been "solved", there is increasing concern 7-9 about declining political will, waning levels of institutional support and reduced public interest priority for tobacco control activities in Canada. Over the past few years, the decline in the prevalence of smoking has, in fact, stalled, 1 possibly related in part to a declining commitment to tobacco control. It is therefore becoming increasingly important to monitor the breadth and depth of tobacco control activities in chronic disease prevention (CDP) organizations across Canada, and to better understand the impact of these activities on the prevalence of smoking. However, few reports describe tobacco control activities within the provincially-mandated public health systems in Canada, 7,8,10 and there are no reports that describe the effort expended in tobacco control by the many different types of organizations that comprise these systems. This paper describes levels of tobacco control "effort" in public health organizations across provinces in Canada, and tests whether "effort" is associated with

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