Health warnings on individual cigarettes, as presented by Dr. Moodie,1 are a novel intervention that could decrease smoking rates. However, public health evidence is clear that education alone has a limited impact on discouraging smoking without broader community-based changes.
Fortunately, there are many evidence-based actions that, combined, could immediately begin to decrease smoking prevalence and initiation rates in Canada. The following are some examples:
Increasing the minimum tobacco sales age to 21 years. Youth smoking decreases when the legal age of tobacco sales is raised, even when a neighbouring region maintains a younger legal age.2
Increasing tobacco taxes. Higher tobacco prices have been consistently associated with decreased rates of smoking, particularly among the more vulnerable people in our communities. 3 It is worth noting that, despite this evidence, the Government of Ontario recently cancelled a planned tobacco tax increase and continues to have the second-lowest retail tobacco price in Canada.4
Ensuring that the comprehensive ban on tobacco advertising set out in the World Health Organization Framework Convention on Tobacco Control is enforced. Studies consistently have shown an association between exposure to tobacco advertising and increased smoking in youth; even industry advertising of antismoking campaigns are linked to increased smoking rates.5 Industry is attempting to subvert this, most recently by advertising closely associated “initiatives” on race cars.6
Expanding smoking bans and restrictions. There is strong evidence that prohibiting smoking in public places decreases exposure to second-hand smoke and decreases smoking rates. Smoking in indoor public places and workplaces is banned across Canada; expanding this ban to outdoor places, including workplace grounds, is the next evidence-based step.7
Given the novel threat that e-cigarettes pose as a gateway to tobacco consumption, 8 we must move beyond awareness and education alone and concurrently continue to advance the whole suite of evidence-supported interventions to reduce death and disability from tobacco.
Footnotes
Competing interests: None declared.
References
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