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November 29, 2001
Standing Committees
Community Services
Meeting topics: 
Community Services -- Thur., Nov. 29, 2001

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HALIFAX, THURSDAY, NOVEMBER 29, 2001

STANDING COMMITTEE ON COMMUNITY SERVICES

9:00 A.M.

CHAIRMAN

Ms. Mary Ann McGrath

MADAM CHAIRMAN: Good morning. I expect us to be joined by Mark Parent in a little while. I will give Mr. MacEwan a bit to get to his seat, I guess, and then we will begin. Shall we go around the table and introduce ourselves to our guests? Fluff, do you want to start?

[The committee members introduced themselves.]

MADAM CHAIRMAN: Please feel free to introduce yourselves.

[The witnesses introduced themselves.]

MADAM CHAIRMAN: You can begin any time you're ready.

MS. JANET BRAUNSTEIN MOODY: Thank you, Madam Chairman, for this opportunity. The events of September 11th and since then have certainly highlighted for me how fortunate we are to live in a democratic society. Being here today is an important part of our democratic process and I'm really pleased to be able to speak with you on a very important public health issue.

Nancy Hoddinott and I will share the presentation today on discussion of a Comprehensive Tobacco Strategy for Nova Scotia. We understand the focus is on youth and we will certainly address the youth issues. One of the background pieces is that a comprehensive smoking strategy for Nova Scotia is for adults and for youth. When you address adult smoking, you also address youth smoking and vice-versa. I'm not a big techie, so I hope all works well here.

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Nova Scotia has the highest smoking rate in the country - it's 30 per cent - and 25 per cent of the youth between the ages of 15 and 19 are smokers. Every year over 1,600 Nova Scotians die from smoking-related illness and what people often don't realize is that we have a significant number of deaths as a result of exposure to second-hand smoke. The costs to our health care system are significant. Smoking and the diseases of smoking are preventable.

The development of the comprehensive, integrated strategy for Nova Scotia has been very much developed on participation of a wide range of stakeholders. Their participation has been from the very beginning, through the development and post approval of the strategy. We anticipate that our stakeholder groups will work with us in implementing the important strategy. It is a cohesive group, one that believes in a prevention smoking strategy for Nova Scotia and they are fundamental to the success.

The provincial strategy that we are going to talk to you about today is comprehensive in that it addresses a wide range or a broad range of issues; it needs to be sustainable, which has a long-term view of the issue; it needs to be adequately funded; we need to address targets and measurements along the way; and it is developed on partnership - that has been primarily with our stakeholder groups - that's broad. One of the important pieces - and you will probably hear Nancy and myself say this multiple times - is it's the integration of the strategy and the comprehensiveness that will make it successful. It's not something that we can pick apart in terms of pieces but that it has to work together.

The tobacco strategy was released on October 11, 2001. It was after approximately 18 months of consultation and work with the stakeholder groups. The stakeholder groups were not only involved but fundamentally involved with the development of the strategy. It was released at the Provincial Tobacco Conference, Nova Scotia Communities Taking Action on Tobacco, which was a very successful conference.

There are seven key elements of the strategy: taxation, legislation and policy, treatment and cessation, community-based programming, youth smoking prevention, media and public awareness, and monitoring and evaluation. What's important, again, is that the success of this will be moving forward on all seven of these fronts in terms of having a successful strategy. So the strategy will not be one element only or two elements only, but moving ahead on all seven.

What we will do is Nancy and I will very briefly go through the seven elements and then we will be open to go through the question period.

One of the first and very important pieces is the element of taxation. The development of the strategy was very much based on evidence and best practices. What's important there is that every element for this strategy is based on those two. So the evidence in other jurisdictions, primarily in the United States, have indicated that the use of taxation significantly impacts the uptake and use of both youth and adults. We announced a tax

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increase in March of this year and again in November of this year that significantly increased the cost of cigarettes. The evidence suggests that with the increase of tax of approximately 10 per cent, it decreases the consumption by 4 per cent.

The second piece, a very important piece of the strategy, is legislation and policy. The strategy commits to having this as an important element and on October 11th of this year, our minister announced a commitment to workplace legislation to be passed in the spring. This is an important element. It's very evidence-based. In jurisdictions such as California and Massachusetts, there have been significant decreases in smoking rates of both adults and youth after the passage. That is not immediate. It usually takes five to seven to 10 years.

There are increasing numbers of municipalities that are passing bylaws within the province and a significant number of jurisdictions across Canada and the United States that have legislation for smoking in public places or in workplaces. We circulated the GPI Atlantic report on The Economic Impact of Smoke-Free Workplaces, and that concludes that smoke-free policy is indeed good for business.

I'm going to now turn it over to Nancy and she will go through the other elements.

MS. NANCY HODDINOTT: The third element of the strategy, and it is one that has been getting some particular attention lately, is around the whole issue of how we help smokers to quit. It is a very important element. What the strategy proposes is funding for dedicated nicotine addiction treatment programs through our currently existing Addiction Services programs. Through those programs, for individuals who are interested in quitting and who enrol in those programs, there should be some partial coverage of pharmaceutical aids. We are looking at things like the patch, the gum and medications like Zyban. What the evidence suggests is, the most effective combination of treatment programs are counselling and then when you combine that with a drug, you increase the success rate significantly.

We are also looking at a telephone counselling line that would be available across the province, a 1-800 line, where smokers could call if they are interested in quitting and get counselling over the phone. They could make arrangements for follow-up telephone calls so people could work with them down the road to help them quit. If they weren't interested in going to a group program, that would be another option for someone to get counselling.

The next element is community-based programs. This was really the focus of the provincial conference that was held in October. Actually, we had 180 people from across the province come out to that conference and at the end of it they were very vocal in terms of supporting this strategy and indicated that they were quite ready to take action. As soon as the conference was over, they were going to go back to their organizations and their workplaces and get started on doing some community programs around tobacco reduction.

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The other key element here is we know that if programs in the community are going to be implemented and sustained, people need to be out there who are working on this full-time. So this strategy also supports providing funding through district health authorities to support coordinators who would coordinate some of those activities at the community level.

That would involve working with schools around issues like school policy, for example, or curriculum pieces and in-servicing teachers, as well as getting some of these other programs through community organizations like the Cancer Society and the Heart and Stroke Foundation and bringing those people together to ensure that there is a coordinated approach, not only at the provincial level with this strategy, but at the community level as well.

[9:15 a.m.]

It is interesting - when we went through the stakeholder consultation, a number of organizations were quite eager to get started on a number of initiatives. The Canadian Cancer Society and Cancer Care Nova Scotia actually committed to sort of moving this community-based component forward and have developed what they call a community action tool kit on tobacco, which sort of pulls together all of the research around what works in communities to reduce tobacco, and they have listed programs that community volunteers and community members can implement at the community level to reduce smoking rates.

We also realize that we have to do some work in supporting ethnically-diverse communities in Nova Scotia, and we are currently working with the Atlantic Health Promotion Research Centre to pull together what data we have available on smoking among different groups, looking at where there are gaps in services and how we need to move some of that forward.

We do have a component in the strategy called Youth Smoking Prevention, but I want to reiterate what Janet said at the opening. This entire strategy is a youth smoking prevention initiative, but we do know that particularly at the school level there are some very unique things that we can do to impact youth smoking rates. We currently have in place a Provincial Youth Tobacco Advisory Committee, and that is 10 teenagers from around the province who meet - they have met three times now - to sort of look at what is happening in the province and bring forward some recommendations for the minister, as well as the Premier, in terms of what they think would be effective youth smoking prevention initiatives. They have, to date, come up with some very good ideas.

The other issue we are looking at is comprehensive school smoking prevention programs. If we are going to have an impact at the school level, it again needs to be a comprehensive approach. We need to look at the school policies around tobacco. We need to look at what is happening in the curriculum, the in-servicing and the support to teachers, as well as programs that are available to youth to help them quit smoking.

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The other program that is currently available in Nova Scotia and has been ongoing now for at least five years is the Sales to Minors Enforcement Program. It is currently illegal in Nova Scotia to sell tobacco to anyone under 19 years of age, and we have inspectors who work full-time going around the province and ensuring that retailers are complying with that law.

The next component is media, public awareness. We currently have a tobacco control unit Web site online where we provide statistical information, information on health effects, as well as some links to sites that can help people quit smoking. We would like to jazz that up a little bit, so we are looking at using some of the monies for the strategy to enhance that Web site a little bit and particularly to incorporate a youth Web site because we know that youth are online and they are accessing things on the Internet all the time. So we need to provide the appropriate information that is going to be visible and accessible by youth.

The other thing that we would like to do is develop a mass media campaign: television, radio and print advertising. We know that has worked in other jurisdictions, like California and Massachusetts. We would really like to start looking at developing some ads here locally in Nova Scotia that we could put out through TV and radio.

The final element, which is a critical piece, is monitoring and evaluation. This strategy was just launched in October, so we need to, over the next few years, monitor on an annual basis how we are doing, what is working and what isn't, and modify the strategy as we go along in terms of lessons learned. Currently, we have a working group that is together now developing a framework for that ongoing evaluation - what kinds of things are we going to measure, how are we going to get that data, those kinds of things.

Just some final thoughts on youth smoking prevention because I know that is why you invited us here today. Again, just to reiterate what Janet said, there is a focus on youth smoking prevention in this province, and that is very important, but we do know that we can't focus on youth smoking alone. We need to combine it with efforts to reduce adult smoking as well. We circulated some information from a presentation that Dr. Paul MacDonald made at the October 11th conference, and Dr. MacDonald has done a lot of research around youth smoking prevention.

The kinds of things that he brought up, that he emphasized at the conference in terms of what works with youth are the points that we raised here on the slide. In terms of education, we need to move beyond just telling kids that smoking is bad for them, because we've been doing that for a number of years and, in the end, it really doesn't work. The kinds of approaches and models that do work are emphasizing with youth the whole decision-making process and informing them about what influences there are in their home or in their communities in terms of influencing them to smoke, things like advertising, whether parents smoke, peer pressure, those kinds of things. So it's using a social influences model and it's using those approaches through the mass media as well, not just getting messages out on TV

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that smoking is bad for you, but looking at what impacts the tobacco industry and what impacts advertising has on you smoking.

In terms of policy, these are critical as well if we're going to reduce youth smoking. The first one that's very critical, and it has certainly been monitored in the States, particularly in California and Massachusetts, again, are restrictions on smoking in public places. Generally when we talk about restricting smoking in workplaces and public places, it's proposed as policy to protect people from second-hand smoke, and that's very important because we need to be doing it for those reasons, but restrictions on smoking in public places also has an impact on youth smoking. We know in communities where if you go to the mall, or you go to a restaurant, or you go to any public place where people can't smoke, they're generally communities that are very supportive of other initiatives as well, and when you combine those community-based initiatives with those policies that exist, that's when youth smoking rates start to drop.

School tobacco policies are very important as well. Currently in Nova Scotia there are some differences across the province in terms of how schools are dealing with this issue and what the policies are, and we need to look at standardizing those approaches and looking at how teachers can be supported and how schools can be supported in restricting tobacco use on school grounds. The final one is what Janet has already talked about and that's price increases. We do know that increasing the price of tobacco has the most impact on youth in terms of smoking rates.

So just some final thoughts on the tobacco strategy. Why is it important to Nova Scotia? Well, it demonstrates a commitment to a major public health issue. The strategy that we have proposed is evidence based; it's based on best practices in other jurisdictions as well as consultation with key stakeholders across the province. It's integrated and it's comprehensive and we know that if we're going to make an impact on smoking in this province we need to do all seven components in the strategy. It's based on partnerships, and the partners that were listed up there in terms of the consultation are very supportive and they're out there behind the scenes doing a lot of this work already and would like to be supported to continue that work. It's a long-term plan. We're not going to see reductions in smoking rates overnight, it's going to take years and we need to be in this down the road. We need to be in it for the long term. So this strategy outlines a long-term comprehensive approach which we think, in the end, will be very successful.

MADAM CHAIRMAN: Thank you very much. That was a lot of information. I will open the floor to questions.

MR. MARK PARENT: I am interested in the issue of banning smoking on school grounds, because one of the senior administrators in my area wrote me a letter in which he admitted that he had been against this for most of his life because he felt it just drove tobacco use off the school property causing a problem to people who lived nearby. He said he's

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changed his mind because that strategy of trying to deal with it without banning it hadn't worked and smoking was on the rise in the schools he was at. You seem to be in support of banning it on school grounds. Would that have to go in hand with some way of controlling it if the students went off property, or could that just be done and the other would have to accept whatever followed there was from the other? Am I clear on my question?

MS. HODDINOTT: Yes, you are. There hasn't been a lot of research around school tobacco policy. There has been some, and the research out there indicates that when there are strong policies banning smoking in schools and on school property, combined with curriculum in the schools as well as supports to help students quit, that smoking rates in those communities dropped.

MR. PARENT: The problem now for the new school that we have, for example, it becomes a club. The smoking becomes a club where the cool kids smoke and all the younger ones, particularly now, our school runs from six to 12 where the six year old sees this club where they go and they get to smoke and they want to come. The ironic thing about it is if a teacher wants to smoke, they have to get in their car, go off property and the kids have this smoking room, it becomes a smoking club. You have seen that, that with strong counselling and curriculum really is effective?

MS. HODDINOTT: Yes, and the policy has to be enforced. There has to be a commitment that the school is actually going to enforce the policy. I think the other key issue is we can't look to schools to solve this problem either. This approach would work much better in a community that was supportive of that kind of approach as well. So in a community where they have policies that you can't smoke in indoor public places, for example, so the policies are consistent, we recognize that smoking is hazardous, we have these policies in place and the parents and the teachers and the community supports the policy on school grounds as well.

MR. PARENT: One last quick question then I will shut up. Do you find any correlation between students who are involved in sports programs, is there a decrease in smoking amongst those students? Is that one way of helping to deal with the smoking problem, to get kids more active in recreational and sporting programs?

MS. HODDINOTT: Yes. There have been those correlations made and sports is one example. I think it's really involvement in something. It's having something to do besides just sort of hanging around and doing nothing and smoking. Again, it's those community approaches where you have places for kids to go that are smoke free and there are activities for kids to get involved in, whether it's sports or arts or any other kinds of things. It's just involvement in general.

MR. PARENT: Thank you.

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MS. MAUREEN MACDONALD: Thank you for your presentation. Not so long ago all members of the Legislature were given a copy - actually November 20th we received a letter from the Canadian Cancer Society here in Nova Scotia from Maureen Summers, their Executive Director. She included, in that, youth tobacco possession laws, a policy analysis paper, which I found to be excellent in helping us understand what the research tells us and various things. One of the things that I found quite interesting was a point that's made in this paper that sometimes if you ban youth smoking it sends a message that smoking is a pleasure that's reserved for adults only. The other thing about this paper that was quite interesting to me was just how long we've actually had legislation in this country prohibiting the sale of tobacco to youth. In 1908, the federal government enacted the Tobacco Restraint Act, which remained on the books until 1994 and it prohibited the sale of tobacco to minors under the age of 16.

It seems to me that this is an issue that's been around for a long time, it's been an issue that government certainly has paid some attention to. I guess my concern would be that all this century later we still haven't been able to deal adequately with it. In fact, the data indicates, as Mark says, smoking among young people is on the increase in Canada in the 1990's; this is something that has occurred. One of the things that I am always very puzzled about when I see the comprehensive strategies that are being proposed - which I think are excellent, I don't want to suggest that I don't think that what's being laid out is not excellent - is there's never in those strategies any attention to suing the pants off tobacco companies. Let's just call it what needs to happen here. In fact, there's lots of evidence that certain components of tobacco control strategies are components that the tobacco companies themselves advocate very strongly for.

[9:30 a.m.]

I would like you to speak to that if you can. I know that in American jurisdictions tobacco companies have been sued in an attempt to hold them accountable for the health problems that occur. In B.C., the former government initiated an action against tobacco companies there. I find it curious that the political will in government to, first of all, deal with smoking in public places and to take on the source of this problem rather than the victims of tobacco use, is never really openly addressed.

MS. MOODY: Thank you very much for that. I think you're right, you can't just approach the users and the consequences of the tobacco and also the producers of it. Some of the very scary things are that a lot of, on the surface, seemingly anti-smoking messaging is really supported by tobacco companies and then when the literature is looked at and the use of it in fact increases smoking rather than decreases it, so it's a very insidious, dangerous, inappropriate practice. Much of the research that is often touted for not supporting banning smoking in public places, the use of ventilation, et cetera, is supported through tobacco companies and often finding that out is very, very difficult.

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In the recent American Journal of Public Health, the entire journal was devoted to the misuse and use of tobacco industry's funding for these issues. So I think that it is becoming talkable and addressable in our society, and at a recent Federal/Provincial/Territorial Advisory Committee on Population Health, of which I sit on, there is some movement to get jurisdictions together to address the issue of how do we collectively have some strength to address some of the issues that are through the litigation issues and through the tobacco industries. So I am hopeful and optimistic that that will occur.

MS. MAUREEN MACDONALD: Just a final comment. Speaking as the Health Critic in the NDP, if our government went in that direction we would be very supportive because, ultimately, I think this is what - the power of governments is extensive, governments are more powerful than individuals and to send that signal by governments to the tobacco industry, I think is critical, it's very important. Thank you.

MR. JERRY PYE: I guess we all know the consequences of smoking, all we have to do is visit a palliative care unit of any particular hospital and see the consequences of smoking. The concern I want to centre around is the inspectors and the selling of tobacco to minors, the selling of tobacco to minors by the proprietors of stores usually ends up in a penalty or a fine, yet the minor who has it in their possession receives no charge. I know that the President of IFSA, the Independent Food Stores Association, has made some very serious comments with respect to this, why the proprietors are charged, when in fact minors are in possession of the tobacco, yet they are not charged themselves. When we look at the restriction of tobacco we know that minors are charged if they are in possession of alcohol. I am wondering why we could not impose such a penalty or fining system similar or akin to those in possession of alcohol. That's one of the questions I have for now.

MS. MOODY: I think one important issue to address in that issue from the stores versus the youth who is in possession, it really speaks to adult and youth responsibilities and how we, as a society, view our youth and our organizations. I think that's something I would argue with a store owner to say you shouldn't be charging me, you should be charging the youth, because we have a responsibility as adults and folks to set some examples.

I am going to have Nancy speak to some of what the literature says on youth possession because that's a very important and hot topic at this point.

MR. PYE: I would just want to say to you that the store owner is not saying that they ought not to be charged, but there is a two-way street here. The one in possession as well as the store owner ought to receive some sort of . . .

MS. HODDINOTT: You've probably noticed in the strategy there was no mention of youth possession legislation.

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MR. PYE: Absolutely.

MS. HODDINOTT: The reason for that is when we look at the evidence from other jurisdictions that have been very successful at reducing adult and youth smoking rates, youth possession legislation hasn't been part of their comprehensive approach. I think the paper that you mentioned, by the Cancer Society, really gives a good summary of that issue. While we currently don't have it in this round of the strategy, a key piece here is this is a long-term strategy, and the component around evaluation and monitoring will shape that strategy as we roll it out over the coming years. Currently, we don't have a proposal for youth possession legislation because we don't have evidence or research that it works. If that evidence comes to light down the road then we need to look at this again, given that new information.

Just to comment around the alcohol legislation as well. There is a survey that's done in Nova Scotia every two to four years, it's called the Nova Scotia Student Drug Use survey. The last one was done in 1998, the survey prior to that was done in 1996. What the survey found in 1998 was that between 1996 and 1998 there wasn't a significant increase in youth smoking in Nova Scotia, there was an increase in alcohol use. While we do have alcohol possession legislation in this province, the rates of alcohol consumption among youth are still going up. We have to look, again, at this comprehensive approach and all of the pieces that need to be in place to reduce youth smoking, as well as student alcohol use.

MR. PYE: I would say to you, though, that's no reason not to introduce legislation to prevent youth from being partly responsible for their own actions and causing them to pay a penalty for possession. The other concerns that I have, and I will be somewhat brief, is that I would like to know just exactly how much money the Department of Health is putting into an education program on cessation of tobacco smoking, and I would like to better understand your monitoring and evaluation of the process. Obviously this is new to you, and it's going to be monitored and it's going to be evaluated over the end of the year. I am wondering if you are going to put out a report card, and if the report card is going to be available to all members of the Legislature. I am sure it will be. I would like to hear some clarity around that.

MS. HODDINOTT: The first piece around education programs for youth - are you talking about curriculum in the school to educate youth?

MR. PYE: Well, no. I'm talking about it in general. It can be a component, the curriculum in school can be a component of that, but the whole education process, vis-à-vis the media, the public.

MS. HODDINOTT: We do currently have a program called Smoke-Free for Life, which is a curriculum for Grades Primary to 9, and we do know that over the next year or so we need to reprint that and get out to schools to do some more in-servicing. So, there will be funds dedicated to that, as well as programs in the school to help youth stop smoking. The media campaign, we're looking at focusing on a number of different elements over the

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coming years, one of which will be youth smoking. So it will be working with your advertising people and youth, doing some focus tests with youth around what messages affect them and what campaigns would be effective in that light. We will be dedicating some funds towards that piece as well.

The monitoring and evaluation component, again we do have a committee that's working on - and it's not just within the Department of Health, we are working with the stakeholder groups as well to define that evaluation piece, that they're comfortable and happy with it and we're comfortable with it as well, to look at what kinds of things we need to monitor so we can evaluate where we've been successful and where we haven't been successful. The strategy does call for an annual report that will be available to the public as well as the stakeholder groups and others.

MR. PYE: How much money?

MS. HODDINOTT: For the evaluation piece?

MR. PYE: No, what I asked is how much money is the Department of Health putting into the cessation of tobacco smoking program? That's the whole . . .

MS. MOODY: For this year . . .

MR. PYE: For this year.

MS. MOODY: . . . 2001-02 is $1 million. We don't have it necessarily broken up by components all the time because of the interrelationship of them all.

I would like to make two comments. In terms of education it's really important to recognize the work that has been going on for years within the public health units, within the Addiction Services units that address smoking. One of the things that the best practices and the literature support is that oftentimes the education is around good decision making and choice making, and it's not necessarily only a don't smoke campaign or a don't use drugs, but it's all around, as an adolescent, what are the things I need to consider when I make a decision, is it a good decision, what are the consequences.

One of the things we think is very important in the implementation of this strategy is, obviously, the partnership with our stakeholders, but also the partnerships that we identify with staff who are already on the ground. The public health folks and the addiction folks would tell you that they are looking forward to the additional resources and work and partnerships that are going to happen in the community.

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The second issue I wanted to talk about in terms of evaluation is, at this recent meeting I was at for the Advisory Committee on Population Health, the national strategy for tobacco committed to a yearly report card. One of the issues that comes up, as Nancy said, we don't see the change on a yearly basis perhaps as quickly as you see a trend over five to 10 years, so a report card will be important in terms of what is done, what are the activities, but we won't necessarily see drops in utilization of smoking immediately. I usually tell folks that public health folks are very patient, we see changes in decades. I think it's important to see that in this important issue we will see change, but we have to be patient and not keep turning and steering the course in that direction.

MR. PYE: Just one final question. Is it against the law to grow your own tobacco in Canada?

MR. PAUL MACEWAN: Lots of farmers in Prince Edward Island do it for an occupation. (Interruptions)

MR. PYE: No, grow your own, not farming. I don't mean the process of farming. I'm simply asking that question because it becomes so prohibitive to buy tobacco. If you have your own backyard and you grow your own tobacco, maybe - is it against the law? That's all I want to know. (Interruptions)

MR. DAVID HENDSBEE: Not at the present time.

MR. PYE: That's all I wanted to know.

MADAM CHAIRMAN: I have a couple of questions of my own. The statistic you used was that 30 per cent of the population in Nova Scotia smoke. Is that the whole population from birth to death?

MS. HODDINOTT: Fifteen and over.

MADAM CHAIRMAN: Thirty per cent of the population 15 and over. Okay. My other question was around - I suppose it's widely accepted that one of the main reasons that youth begin to smoke in the first place is peer pressure, that's certainly the reason my kids started. They were fine up until high school, they thought it was a terrible thing that their father smoked then, poof, in high school they all started smoking, every one of them. After all this time, and Maureen spoke to the amount of time we've been trying to deal with teen smoking, we don't seem to have an effective strategy around peer pressure except to tell them it's bad and it will turn their lungs black and all that stuff. Then you talked about something called the social influences model, and I am wondering if that's the piece that's meant to counter peer pressure, and if you could talk a little bit more about that.

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MS. HODDINOTT: This is something that Dr. Paul MacDonald focuses on quite a bit. I think it's because when we think of peer pressure we generally think of one student offering another student a cigarette, saying, come on try it, when it's really much broader than that. The social influences approach looks at all of those things around a teenager who could be influencing them to use tobacco, and that includes advertising, it includes whether their parents smoke, it includes how many friends they have who smoke, and whether tobacco is accessible, if the store in the community is selling regularly, or if every time they go and try to buy tobacco the store owner says no, you're not old enough, you can't have it. It's all of those things working together that are ultimately going to influence whether someone starts smoking or not. It's moving just beyond that topic of peer pressure, to look at all those things.

So we have to look at advertising and there currently are advertisements in stores where they sell tobacco. I mean, you see them up there behind the counter, they have the big advertising displays. Every time you go to a movie, there is somebody smoking. In Hollywood the rate of smoking onscreen is actually higher now than it ever was, which is interesting.

[9:45 a.m.]

They did an analysis a couple years ago, the smoking rates in California now are less than 20 per cent. I think it was through the American Journal of Public Health, they did an analysis of 10 of the leading movies in the last couple of years, 60 per cent of the leading characters were smoking. So it's this shift, you have most people who don't smoke and yet in movies it appears that most people do smoke. So there's a lot of international kind of work that needs to be done around how we portray things in movies and the media and those kinds of things. It's all those things combined that influence youth.

MADAM CHAIRMAN: That's what the influences are, but then what do you do, take those influences, lay them all out for kids and say, okay, this is how you're being reeled in?

MS. HODDINOTT: I think if you look at Florida, which has done an amazing job around media campaigns for youth, what they've done is involved the youth in looking at how the tobacco industry has manipulated them over the last five to 10 years and the kinds of approaches that the industry has taken to get kids hooked on tobacco. So their advertising campaigns actually have kids calling up - in Canada it would be an Imperial Tobacco rep - saying, we just saw this, something came in the mail around your tobacco product, did you know that that's probably influencing kids to smoke, and the person saying, oh, no, no, you know we don't try to encourage kids to smoke, those kinds of messages. They actually put those on the air, kids talking to tobacco industry reps when the reps are sort of feeding them a line. So it's encouraging kids to look at how they've been manipulated over the last decade, and encouraging them to combat that by not starting to smoke.

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MADAM CHAIRMAN: Reverse psychology.

MS. MOODY: I think that also some of the kids don't stop or don't start because it's bad for you. So that whole, you know, black lungs, wrinkled faces and all that, it works for older folks but it doesn't work for kids.

MR. MACEWAN: When you're young, you feel that way. (Interruption) It's only when you get older you realize that there is an end to it somewhere.

MS. MOODY: What kids respond to is more disposable income and costs of things and how they can alternate use and that's, again, related to good decision making and how do I make decisions, what are the consequences of my decisions. If I spent this amount of money on cigarettes, I could buy the CD machine that I want at the end of the month as opposed to - so it's that kind of good decision making, or critical thought process. The issues as it relates to teenage pregnancy to drinking, to drugs, to tobacco, they're all interrelated and so they really can't be separated, they need to be together. One of the things that is always a scary statistic for people is when both parents smoke, the chances of your kid smoking is 80 per cent. When one parent smokes, it's 40 per cent. That's a really scary statistic to realize that we do influence, there are other influences, but those are significant.

MADAM CHAIRMAN: In my own case, then I guess my statistics are skewed because only one parent smokes and all three kids do.

MR. MACEWAN: And who's that?

MADAM CHAIRMAN: The husband, he's the bad one. (Interruption)

MS. MOODY: Yes, and that's why having a tobacco strategy that addresses adults is really important because that influences kids so much and also smoking in pregnancy, the negative sequelae of that are very significant. There is good evidence that says people who are pregnant really do try to smoke because it doesn't help them as much as they see it helping their baby, so it sort of addresses the psychology around why do you quit.

MR. HENDSBEE: I have three questions. Alluding to what Maureen MacDonald had stated earlier about class action suits that some states have taken, I understand some provinces have taken. What's the status of those class action suits in our own country?

MS. MOODY: I don't have a handle on that other than, the beginning of next year it's my understanding that B.C. is leading and convening a group of all jurisdictions to have some of those discussions around that, but I don't know specifically.

MR. HENDSBEE: So do you know which provinces are participating in collectively having a joint action taken?

[Page 15]

MS. MOODY: I don't know with a surety that I would say it here, sir.

MR. HENDSBEE: I was surprised to also receive from the Cancer Society of Nova Scotia - they say it's premature for having youth possession laws, and my two colleagues on the other side have asked the questions already related to that. I am surprised that alcohol is prohibited for possession, but why not tobacco? Why isn't it treated the same as a controlled substance? You're not allowed to buy it, you're not allowed to smoke it on school property, but you can possess it. It makes no sense. Why not just ban it altogether? I see other jurisdictions have fine structures or suspension of driver's privileges, whatever the case may be, why do you think it's premature to have possession laws?

MR. MACEWAN: It would be awfully hard to enforce. What do you do if a kid steals a cigarette out of his mother's purse, put him in reform school?

MS. HODDINOTT: Again, we can only come back to, when we put together this strategy, we looked at those jurisdictions that had been very successful at reducing youth smoking. The jurisdictions that have been most successful were places like California, Massachusetts, British Columbia, and youth possession legislation wasn't part of the strategy that they were using. Again, that's not to say that once this strategy gets rolling and new evidence comes to light that we can't look at that down the road.

I think at this particular point in time, because this strategy is just sort of moving forward, we need to have some of those other key pieces in place before we look at youth possession legislation. I will just give you an example. The piece of legislation that's sort of being pursued right now is smoking in public places and workplaces. Currently, in Nova Scotia, you can go into any public place for the most part and have a cigarette. If the message that we're trying to get across to youth is you shouldn't smoke because smoking is dangerous, and we bring in a piece of legislation saying we're going to make it illegal for you to possess tobacco because it's harmful, why is it when the youth goes into a shopping mall or into a restaurant, they're going to be exposed to second-hand smoke? It's an inconsistent message. If it's harmful, why am I exposed to it?

So we need to have consistent messages and I think we need to look at the strategy on a step-by-step basis, that once we get some of these comprehensive pieces in place and we get smoke-free-places legislation in place and as more evidence comes to light, perhaps that says that youth possession legislation is effective, then we can move in that direction. I think right now we need to focus on those elements that we have evidence and research behind us to back them up.

MR. HENDSBEE: My last question in regard to the smoking policy in public areas, the hospitality industry is going to be out there saying let the proprietor, let the property owner decide what type of clientele they wish to serve, don't let the governments force the smoke-free policy on us. Let us decide if we wish to have a smoke-free environment or a

[Page 16]

smoke-freely environment and let the consumer know when they're walking in their establishment; it's the consumer's choice if they wish to patronize a particular facility.

My last question related to that would be, not just the proprietors of the hospitality industry, but what about those community facilities and those community charities that run bingos and stuff? If you ban smoking in that, there's going to be a considerable amount of their clientele who are not going to be sitting for three hours playing bingo and not have a cigarette. You're going to drive the businesses of those things away.

MS. HODDINOTT: Just a couple of points, the reason for looking at smoke-free-places legislation is because we have overwhelming evidence that exposure to second-hand smoke is a health risk. The data through some of the work that has been done here is that 200 Nova Scotians die every year from exposure to somebody else's tobacco smoke. So the reason we look at banning that in indoor public places is really a matter of public health. If we know that we're exposing people to something that's hazardous, then we sort of have an obligation to protect people from that substance.

The second piece is, and we did circulate the GPI Atlantic report that looked at the economic impacts of smoke-free places and workplace legislation and, overwhelmingly, where this issue has been studied and where the studies have looked at sales tax data before a ban comes into place and then sales tax data after the ban is implemented, the overwhelming evidence is over the long term it does not have a negative impact on businesses.

In terms of your community organizations, I was involved in some work in the Valley around some municipal legislation and we actually had some letters come in from Newfoundland, from bingos and other community facilities, that say they've been smoke-free for a number of years now and are making as much revenue as they ever did. There is evidence that these places can operate and still make money, and businesses will stay open and the tourism industry in Nova Scotia, I think, could flourish even with smoking bans in public places.

MADAM CHAIRMAN: John Chataway.

MR. JOHN CHATAWAY: Good morning . . .

MR. MACEWAN: Madam Chairman, just on a point of order. We have another member of the committee who has arrived, Mr. Russell MacKinnon, the member for Cape Breton West. I would like his name entered into the minutes.

MADAM CHAIRMAN: Thank you, Mr. MacEwan. John.

MR. CHATAWAY: Good morning, friends and Mr. MacKinnon.

[Page 17]

MR. MACEWAN: He was at another committee meeting, that's why he wasn't here.

MADAM CHAIRMAN: Yes, Mr. MacEwan. John, go ahead.

MR. CHATAWAY: I certainly very much appreciate the information that you've gone over, and it has certainly updated everybody when you have the facility to do this. It's great to know what's going on. I do realize that the Premier has suggested that there will be new legislation in the spring session. How does Nova Scotia compare to other jurisdictions in this country and elsewhere, in terms of public smoking bans and basically on the things we're talking about?

MS. HODDINOTT: Atlantic Canada in general is a little bit behind the western provinces in terms of the amount of protection that's provided from second-hand smoke. Generally, if you look at Quebec, Ontario and then westward, there are far more municipal regulations that ban smoking in public places than we have here in Nova Scotia. Newfoundland is currently looking - not looking at, they've actually passed a piece of legislation that will ban smoking in all public places to which youth will have access. That's in place and will be enforced as of January 1, 2002.

MR. CHATAWAY: I know you mentioned California, for example, that only 20 per cent of the people there basically, and here at least some of us, 30 per cent, are smoking in Nova Scotia. In Canada, do westerners smoke less cigarettes than the easterners?

MS. HODDINOTT: Yes, generally.

MR. CHATAWAY: Interesting. I'm aware that we have the Nova Scotia Tobacco Access Act, which basically penalizes retailers. We have had a discussion about that already. Another thing, if you raise taxes on tobacco sales and things like that, people won't pay, they'll smuggle. Certainly, it's been aware of in the past. Why is there less concern for this problem nowadays?

MS. HODDINOTT: In terms of smuggling, the prices right now in the Maritimes are pretty much equivalent, so there is no reason to go across the border to buy tobacco products. In the last couple of years, the prices in the U.S. are now higher than in Canada, so there is certainly no Canada-U.S. smuggling. That's the basis for it.

MR. CHATAWAY: Maybe you could re-emphasize how effective the tax hikes are in lowering tobacco consumption.

MS. HODDINOTT: How effective they are?

MR. CHATAWAY: Yes.

[Page 18]

MS. HODDINOTT: Again, just to reiterate some of the data that Janet talked about earlier, the evidence that we have indicates that a 10 per cent increase in price reduces consumption by 4 per cent, that's overall. The consumption drops a little bit more among youth, generally it's a 7 per cent consumption drop. It's interesting too when you talk about the western provinces and having lower smoking rates, when the prices of tobacco dropped in 1994, some of the provinces out west and Newfoundland in the east maintained their higher prices. In that interim, I think what you've seen out there is a drop in smoking, whereas here in Nova Scotia we are still number one in the country. Newfoundland certainly has seen some drops at a higher rate than we have as well.

MR. CHATAWAY: I very much appreciate the chance to ask these questions. I certainly agree that we should have newsletters and things like that brought out on a regular basis so that we all think about it. Whether we smoke or do not smoke, we have to think about what's happening, certainly the economic effects, the health effects, all sorts of things are things that should be considered by everybody. Thank you.

[10:00 a.m.]

MADAM CHAIRMAN: Mrs. Baillie.

MRS. MURIEL BAILLIE: My questions are concerning the youth. Is there any evidence that young people who smoke tobacco cigarettes, are they more at risk for smoking marijuana?

MS. HODDINOTT: Again, I'm going to come back to the Student Drug Use survey which is done periodically in Nova Scotia - every four years - and one of the findings of the survey that was done in 1998 is, kids who are using tobacco, there is a higher risk that those kids are also going to be using alcohol and a higher risk they are going to be using some of the other drugs. So there is some evidence that - tobacco actually has been called the 'gateway drug'. That's sometimes where kids start using and then they move on to other drugs as well.

There is the possibility that if you impact smoking rates, you can impact use of other drugs as well.

MRS. BAILLIE: Just two quick questions. Your Provincial Youth Tobacco Advisory Committee, do you know if any of those are smokers or were they smokers?

MS. HODDINOTT: We have non-smokers and ex-smokers on the committee.

MRS. BAILLIE: The other question is, looking back on my years in education, we had the kit with the black line - we went through the process - of course, not being a smoker myself, what bothers me is that all that education out there - TV, schools - and yet, youth

[Page 19]

smoke; a lot more education than I had, but I didn't smoke. So why, with the knowledge and education, do youth still smoke? I asked my daughter this and she said, Mom, it's because they don't see the harm right now. Is that it? What's your take on it?

MS. MOODY: I often say to people, if education worked alone, no one would smoke, no one would be fat and we'd all eat the right stuff. None of that's true, so education alone doesn't work. The epidemiology and the science of public health says it's a combined approach in terms of education, policy and interventions that allow us to make the right choices and behaviours. I think that's something that has evolved over - remember I said we in public health are very patient folks - 30 years. That knowledge, it has to be integrated, it has to be comprehensive, it has to hit policy and when I say the interventions, it has to involve things like making harder to access or making better choices, so having better foods available makes choices easier. Not having lead in paint decreases our risk to lead exposure, so it's the combination of education, policy and interventions that will have an impact, and it takes time.

We also know that kids live for today, they don't worry about tomorrow; they don't save money, they don't do other things that we would like them to do because it's for the long term. We have to find different ways, in addition to policy, to help understand what we can do to have them not start and to stop. As I said, one of the key ones is the financial impact. That makes a difference to kids. It really requires a creative and evolving approach to how we address it, which is what makes it exciting.

MR. RUSSELL MACKINNON: A couple of general questions. Has your organization done any analysis as to the impact of areas of high unemployment versus low unemployment? Do youth smoke more in areas of high unemployment as opposed to low unemployment?

MS. MOODY: There is an enormous amount of data that looks at the determinants of health and what makes people healthy. Poor people are less healthy than people who have money. The smoking rates in people in lower incomes are higher than those with higher income. Income is a key determinant to health.

MR. MACKINNON: What do you attribute that to? Is it stress? Or what other factor would you consider?

MS. MOODY: Again, it's multifactored in terms of what makes people healthy. The determinants of health are broad ranging. Some of it, probably the least important is health service that we receive, but income is important, education is important, social supports are important, your employment status is important. All of these issues influence whether or not people are healthy. What the work in the broader health field, what the people are calling the population health environment, says is we all have a part to play in making people healthy

[Page 20]

and so addressing issues of employment, income, education are all important to help make people healthy.

MR. MACKINNON: I flagged that because obviously the government is dealing with a cash crunch and certainly within the Department of Community Services. I often wonder if perhaps the government may not be doing enough to address some of the issues that surround families that have to depend on community services. The allotment of the resources is absolutely critical, so I flag that with you. If I could, one other issue with regard to the legalization of marijuana. I think I know your position on it, but do you have . . .

MS. HODDINOTT: On marijuana?

MR. MACKINNON: Well, it's a federal issue, the legalization. You've heard a lot of talk recently, Minister Allan Rock - it's somewhat paradoxical, a Health Minister legalizing a drug. I'm still trying to come to terms with that. Do you have any data that would give you some insight as to how many young people in Nova Scotia actually use marijuana?

MS. HODDINOTT: I don't have it with me, but again, the Student Drug Use survey that was done in 1996 would have that data. If you're interested in that, we can get the information through our Addiction Services people and get that out to you.

MR. MACKINNON: And has your organization made any representation to the federal minister in opposition to this particular policy?

MS. MOODY: I'm not aware.

MR. MACKINNON: Would you be prepared to do so?

MS. MOODY: I would have to get back to you, sir.

MR. MACKINNON: Okay, thank you.

MR. MACEWAN: That's what a voter tells you on the doorstep at election time. (Laughter)

MADAM CHAIRMAN: Did you have a question, Mr. MacEwan?

MR. MACEWAN: Well, the others got three questions, surely I can get at least one or two.

MADAM CHAIRMAN: I think that's reasonable.

[Page 21]

MR. MACEWAN: I brought over to this meeting this morning this nice binder called Teen Smoking, Nova Scotia Tobacco Strategy, prepared by our Clerk, the director of the Committees Office. Nice big book, it weighs about two pounds, but I see I'm the only one who brought my book here. (Interruptions) Oh, David did too, all right, two of us did. A lot of work went into preparing for this meeting and I would like to refer to a little bit of what's in this book.

I see here the Government of Canada Tobacco Act, T-11.5, 1997, Chapter 13, that's a composition of the honourable David C. Dingwall who is a pretty close friend of mine to this day. I was with David before he left for a trip to France where he got enlightened on this matter because up until then he had not seen this as a priority, but when he came back from that trip to France, it was like St. Paul having gone en route to Damascus, he saw the light and back he came and he got this Act passed by the Parliament of Canada after a great deal of work, getting it through caucus and, through the House of Commons, passed as law.

For all that work, Dave Dingwall got defeated shortly thereafter. He had the biggest majority in Canada the election before and he had one of the smallest votes in Canada after he got that passed through. So that was the reward he got for his effort. It doesn't always pay.

What I'm trying to say is that you seem to be fishing around here trying to identify a solution to a problem, but you also identify that there hasn't really been a consensus within the government collectively - federal, provincial, whatever - on how to address the issue. If you go across the street to the Legislature, you will see the smoker's gallery just outside the building on the steps that lead up to it across the street and you will see representatives of all three Parties in the House out there puffing away. Look and see. With that kind of a situation, it is clear evidence that there is not a consensus as to how to deal with these matters.

Now I know that when the prohibition legislation was put in after World War I, there was at least a majority consensus there that yes, we had to ban all alcohol, notwithstanding that it was our Lord's first miracle to change water into wine. But there isn't on this and I think that's why you haven't seen the progress that you would like to see. I know how Dave Dingwall worked on getting that law passed through. I remember Dr. Ron Stewart, who was a zealot on these matters, wanted to abolish licorice pipes and candy cigarettes and others told him that was going too far so he pulled back. But there are some politicians who have tried to do those things. There are others who feel we should perhaps steer a middle path rather than veering too far one way or the other. I'm probably among them.

I'm not giving you a confession here. I don't smoke. I did at one time. I remember buying Trump cigars for 5 cents each when I was about 19. So there's a confession for you, Mark, but it was a long time ago. I think I have had time to be granted absolution.

MADAM CHAIRMAN: I think Mark is the wrong faith for confession.

[Page 22]

MR. MACEWAN: You want to hear about Islam, is it?

MADAM CHAIRMAN: No, I want you to ask your question, Paul.

MR. MACEWAN: My question is, do you agree with any of the preceding comments? (Laughter) If they want to say what they said to Russell and pass judgement next time around, that's fine.

MS. MOODY: I would only make one comment that if you look at the smoking rates since the mid-1960's, there has been a significant decline in smoking rates across Canada. I think it was in the mid-40's per cent at that point. So I think we really have seen a decrease, in fact a fairly sharp decrease, over two decades. Over the 1990's, we have really seen it stabilize and that has been the difficulty in saying we know we can get it under 30 per cent, how can we do it? Some of those sharp decreases were for the people who did respond to the education - don't smoke it's bad for you, or whatever. So I think that, again, we see things in decades and we have seen those changes and we want to see it go down well below 20 per cent.

MR. MACEWAN: I have only one other question to raise and that is about movies, because I think I heard advocacies of censorship of movies. Now if one was making a movie about World War II, the big three were Franklin D. Roosevelt, Winston Churchill and Iosif Vissarionovich Dzhugashvili, better known as Stalin. One of them was well-known for smoking a cigar, that was Winston Churchill; one was very well-known for smoking a cigarette at the end of a long cigarette holder, that was F.D.R.; and Stalin was known for smoking a pipe, but actually the tobacco he put in it was cigarette tobacco. Now if you were making a movie about those men and their conduct of World War II, how would you take the tobacco out of that movie? Would you go for historical inaccuracy?

MS. HODDINOTT: I don't think anybody would advocate for historical inaccuracy. I think what we are talking about are movies that are set in the year 2000-01. We need to portray realistic smoking rates and currently we are not doing that.

MR. MACEWAN: Well said.

MADAM CHAIRMAN: Maureen.

MS. MAUREEN MACDONALD: Just a final couple of questions for you. It comes from, really, Mr. MacKinnon was talking about issues around poverty and income and smoking, I think.

[Page 23]

[10:15 a.m.]

The government has allocated an additional $1 million for the strategy. I know I've had many calls in my office from people who are interested in getting into smoking cessation programs or getting assistance with the pharmaceuticals that are necessary, but they haven't been able to afford the cost of those programs. I think, for example, the Lung Association's program costs more than $100 to go to the sessions over at the IWK and, of course, the patch and those things are extremely expensive. What is the status of assisting people with those things? Do we have to wait until the spring budget before there's any actual implementation of this financial assistance, this piece that's going to assist people and particularly people in low income groups, seniors and others?

MS. HODDINOTT: What's proposed in the strategy is in line with treatment programs for other addictions. Treatment for nicotine addiction would be available free of charge through Addiction Services, trained counsellors who can deal with those issues; the pharmaceutical aids, partial coverage would be available to anybody who is enrolled in those programs; and the 1-800 one would be free of charge as well. So we're not looking at setting up financial barriers at accessing those kinds of things.

The 1-800 line we hope to have in place in the new year and in terms of providing the funding to the districts to get some of those programs up and running, we're looking at getting that out as quickly as possible as well so we can get some of those people hired in some of those programs offered. Again, it's an issue of, you know, you distribute funding. There's recruitment that has to go on. There are people who have to be put in place before those programs will be available consistently across the province.

MS. MAUREEN MACDONALD: Just for clarity though, 1-800 number in the new year; counselling services to come, not in place yet; and assistance with pharmaceuticals to come?

MS. HODDINOTT: The pharmaceutical assistance will be combined with those Addiction Services' programs. So that assistance will be combined; when you go to a counsellor through Addiction Services, you get access to those. So that will come when the . . .

MS. MAUREEN MACDONALD: So we've had the announcement of the program, we've had the announcement of the money but, in fact, nothing is in place right now. So it's important, I think, for the public to know that that hasn't happened yet because I can say from my own constituency there was an expectation, as soon as they heard the announcement, that they could then get access and that has certainly created some problems.

[Page 24]

The other thing that I want to ask about is the gender component of smoking. I recall reading something about the increases in smoking among youth as being very disproportionate in terms of young women being the fastest growing group of smokers and increasingly becoming the largest number of smoking people around youth. I'm wondering, you know, whether or not that's accurate in terms of the evidence, and what is the plan then to particularly get at this problem among young women?

MS. HODDINOTT: Again, I will refer you back to some of the information that Dr. MacDonald provided at the conference. The smoking rates among youth have actually, at this point we think they sort of plateaued. They're not decreasing, but they're not increasing significantly as well and among certain age groups, the younger age groups, males still outnumber females in terms of percentages of smokers. When you get into the early 20's, into the late teens and early 20's, there may be a little bit of shift and there may be some more females smoking than males, but overall, if you look at overall smoking rates, male smoking rates are still higher than female smoking rates.

I think it is important to look at gender in terms of the kinds of assistance and the programs that are available out there to help people quit and also in terms of the messages that we have put out around reasons not to start and reasons to quit. I think some of that will happen through those community-based initiatives. That's where you really get at those fundamental - let's work with those community groups that already are working with young women and let's see what we can do to build into their processes some programs to help young women not to start, or some young women to quit. So it's at that level, when we provide funds through the DHAs for those community-based programs, that I think we can get at some of those issues.

MADAM CHAIRMAN: Mark.

MR. PARENT: Two very quick questions. The cost to the health system of people who smoke, do we have those statistics?

MS. HODDINOTT: It's $170 million a year.

MR. PARENT: Another question which was sparked by my honourable colleague, the member for Cape Breton Nova . . .

MR. MACEWAN: You didn't read my latest attack on you on Tuesday . . .

MADAM CHAIRMAN: Chill, Paul.

MR. PARENT: Is there any evidence that the tobacco industry funds political campaigns or do you have that sort of evidence?

[Page 25]

MS. HODDINOTT: I think that has been done on a national level and I would have to go back and look through that. I wouldn't have that kind of information provincially, but I think some of those studies have been looked at nationally.

MR. PARENT: But they are available?

MS. HODDINOTT: I would have to go back to check but, yes, I think they would be available.

MADAM CHAIRMAN: Russell.

MR. MACKINNON: Just a supplemental to what my colleague, the member for Halifax Needham, raised. I'm a little perplexed here that the Department of Health hasn't a program, particularly for individuals and families on social assistance, but yet they do for prisoners. Why is there a non-smoking plan in place for prisoners, but not for people who are struggling to get out of poverty?

MS. MOODY: Through the Addiction Services, tobacco or nicotine is considered one of the addictions and there are services that are available. They aren't at the level that we would like to see them and that's why we have the additional funding for additional counsellors across the province through the district health authorities. I think one of the key issues and the complexity of the impact of poverty on people's health is that it is a combination of what makes people healthy and what doesn't make people healthy that impacts the poor. So oftentimes there are unique and different strategies that work.

There are other issues that are of higher priority or of bigger importance, or more significant to them in their lives, and so oftentimes self-identified by folks who are of lower incomes or on social assistance, often that isn't their priority and so it's also like, I don't think we can use a group as having a single priority and issue in an approach to things, but it is one that I believe is a target group that we need to look at, just like we need to look at different gender and youth, et cetera, to address those issues because low income has a higher incidence of smoking.

MR. MACKINNON: Just one final supplemental on it, because if you work out the meal budget for any individual, particularly for a child on social assistance, it works out to less than $1.00 per meal per day and every penny is of paramount importance. What I've heard you just say was mea culpa, I'm sorry, but we haven't done anything yet and we're talking about doing it. I mean like . . .

MS. MOODY: I don't think I said that, but . . .

[Page 26]

MR. MACKINNON: Well, that's the way I read it because I mean we've got tens of thousands out there who need help and I would say being proactive instead of saying, well, we're going to wait as a government for them to come through the door and say we have a smoking problem, I don't think cuts it. I think there's a bigger obligation here, but I'll flag that with you. I respect your opinion; I don't agree with it, but I respect what you say.

MADAM CHAIRMAN: Mr. Pye.

MR. PYE: One brief comment and I guess you might be able to answer; I'm sure you can. Earlier when I asked you how much the provincial government was putting into this program for cessation of smoking in Nova Scotia, you indicated to me approximately $1 million this year. The Canadian Cancer Society in its letter indicated that the provincial government should be putting somewhere between $3 million to $5 million into the program annually. When I was listening to you speak about the expenditures of those dollars, you had indicated that the program would be up and running after the coordinators throughout the province got into place. I'm just wondering how much of this money is going to be eaten up into administrative costs rather than into programs, and what kind of an effect is that going to have if in fact the Canadian Cancer Society indicates that this ought to be a $3 million to $5 million annual project?

MS. HODDINOTT: We had actually gone back to our stakeholder consultation group once the $1 million was announced and they gave us some very clear recommendations on how they think those monies should be spent. So that's what we're looking at now in terms of budget: how much money do we allocate per component and what does that money get put towards. So they're quite happy with how we're looking at allocating those funds and most of the monies actually will be going into programs and initiatives, media campaigns, the 1-800 line, staffing for Addiction Services, so it's those kinds of things that are going to eat up the majority of the money.

I think they are very wisely allocated and, again, that will be part of the ongoing evaluation: to look at how we have spent the money, what components get the majority of funds and to get back to the stakeholder group on a regular basis to check in with them to make sure we are doing what they think is appropriate. The Cancer Society is actually one member of that stakeholder group.

MADAM CHAIRMAN: Are those all the questions?

MR. MACEWAN: Do you want more?

MADAM CHAIRMAN: That's okay. It has been quite a lively discussion. I hate to say I enjoyed it because it's not a topic that I wish we had to discuss at all, but it has been extremely informative. We had hoped to have somebody here from the Provincial Youth Tobacco Advisory Committee, but their schedule, of course, doesn't mesh very much with

[Page 27]

ours, so I was going to make a suggestion to the committee. If you're interested in hearing from one or two members of that group, if we were to schedule a follow-up meeting, say for 4:00 p.m., subject to the schedule of the kids, and get a couple of them in here just to give them our perspective, is that something you would be interested in doing?

MR. MACEWAN: This would be at a future time, not today?

MADAM CHAIRMAN: No, not today.

MR. MACEWAN: This committee room will be in use this afternoon by another committee.

MADAM CHAIRMAN: Does that sound okay?

SOME HON. MEMBERS: Yes.

MADAM CHAIRMAN: Fine then. We will follow that up and let you know what kind of a schedule we can find. I would like to suggest now that we break for 10 minutes or so and then we have a couple of things on the agenda to clean up, a bit of correspondence.

[10:28 a.m. The committee recessed.]

[10:43 a.m. The committee reconvened.]

MADAM CHAIRMAN: Let's call the meeting back to order. First thing, the next meeting date, under "Tentative" it says Disabled Persons Commission, it should say Senior Citizens' Secretariat, since that was the topic we had discussed for our next meeting. Just a bit of a typo and a mix-up in old lists and new lists and middle lists and everything else.

The second thing is we have a letter from Gordon Balser.

MR. MACEWAN: Is item number one passed before . . .

MADAM CHAIRMAN: That meeting with the Senior Citizens' Secretariat, that was an approved subject. We had already approved that.

MR. MACEWAN: I know, but is the date approved? Can I put that in my appointment book now or should I wait? Are they available that day?

MR. PYE: We automatically assume that's the case, Madam Chairman.

[Page 28]

MS. MORA STEVENS (Legislative Committee Coordinator): It's tentative at the moment, but I will be shoring that up and sending out a notice. That's the tentative date they had.

MADAM CHAIRMAN: Further to my suggestion that we speak to the Premier's Youth Tobacco Advisory Committee, Nancy mentioned to me, in conversation just before she left, that for the kids, if all of the press and everybody showed up, that whole circus atmosphere might be just a little bit intimidating. What she suggested - she meets with them regularly, with the group - is that those of us who are interested be invited to join in on one of their meetings. How would you feel about that? Okay, she'll get back to me, the next time she meets with them and let me know and get a time frame so we can go to their meeting for our own information. (Interruptions) Yes, I kind of like the tone of that better. We're just saying, Maureen, that the next meeting, the "Tentative" the subject matter is a mistake, it's the Senior Citizens' Secretariat.

[10:45 a.m.]

Now, we have correspondence from Gordon Balser suggesting that MADD would like to meet with us.

MR. MACEWAN: MADD meaning Mothers Against Drunk Driving.

MADAM CHAIRMAN: Yes. How would you feel . . .

MR. MACEWAN: Any drunk drivers around this table?

MR. PARENT: Is this just with the Digby chapter? It would make more sense to meet with the provincial . . .

MADAM CHAIRMAN: Well, he was approached by the Digby chapter, but . . .

MR. PARENT: I was just reading the request. It would make sense, I think, to meet with the provincial . . .

MADAM CHAIRMAN: And it may be, and we can have Mora look into that. As a subject matter is that something the committee would be interested in looking at? (Interruptions)

MR. MACEWAN: There's no harm in members of the House sending you their requests so that we can discuss them?

MADAM CHAIRMAN: Absolutely not. Do we need a motion . . .

[Page 29]

MR. MACEWAN: That's what's going to keep us going.

MADAM CHAIRMAN: Do we need a motion to put this on the floor as a subject matter and approve it?

MR. MACEWAN: We could just agree.

MADAM CHAIRMAN: Okay.

MR. PYE: I think we want to be clear that the member for Kings North indicated that this ought to be the provincial chapter - or association, I should say, not chapter, because there are individual chapters - of MADD, and that if, in fact, a representative from Digby wanted to come with the provincial association then that might be a way to accommodate.

MADAM CHAIRMAN: Well, when I read the letter it says that they have developed an educational format that they would like to share. It's unclear to me whether he means that the Digby chapter alone has this format or if it's something that MADD as a whole uses. That's what we'll find out and bring the appropriate people in.

MR. MACEWAN: Gordon Balser represents Digby.

MADAM CHAIRMAN: Yes.

MR. MACEWAN: His job is to try to get re-elected in Digby. If I was him, I would write exactly what he wrote to you, the Digby chapter wants to meet, I'm trying to get them an audience with you.

MADAM CHAIRMAN: Ever the politician. What I'm trying to get a sense of is do we specifically want to invite the Digby chapter, or would you be happy with anybody (Interruptions) It was convenient.

MR. MACEWAN: Mark wants Kings North in there.

MR. PARENT: I want Kings North because I want to get re-elected. (Laughter) I would think that if the Digby chapter is saying they have a novel thing, then they should be taking that to the provincial MADD.

MADAM CHAIRMAN: Yes, and that's what I'm trying to drive home.

MR. PARENT: So I would think we would invite the provincial MADD, and Digby could come along with them.

[Page 30]

MADAM CHAIRMAN: If they have something different to offer, yes. Okay, I follow you.

MR. PYE: That's one of my concerns too, Madam Chairman . . .

MR. PARENT: That's what the member for Dartmouth North . . .

MR. PYE: . . . that you could get requests from every single chapter across the province if you set the precedent of allowing one to come in. It could be an exercise . . .

MR. PARENT: You also don't want, if say the provincial association says no, this approach of this particular chapter is counterproductive, you don't want them bypassing their provincial association to get an audience with us, then fracturing the association.

MADAM CHAIRMAN: Okay. We'll do a little investigating and we will find the appropriate members of MADD to invite in.

SOME HON. MEMBERS: Agreed.

MADAM CHAIRMAN: The other piece of correspondence is from Dale Robbins about a travelling budget. When I look over the list of topics that we have approved for discussion, there is nothing in that that necessitates travel. In terms of fiscal responsibility, I don't think we need to ask him for any travel budget for this committee for the upcoming year.

MR. MACEWAN: We are entitled to claim for the costs of mileage from home to Halifax to attend the committee meeting and back, without any intrusion on our 52 trips a year. So that part is covered anyway, plus the $60 a day, plus any overnight hotel rooms.

MADAM CHAIRMAN: Some of us get $60 a day.

MR. MACEWAN: Well, press for all to get it.

MADAM CHAIRMAN: No, that's all right.

MR. MACEWAN: I certainly support that, now that I no longer have a say in it. (Laughter)

MADAM CHAIRMAN: That being the business concluded, I would move for a motion to adjourn. (Interruptions)

[Page 31]

We are adjourned.

[The committee adjourned at 10:49 a.m.]