Creating a system to address the chronic relapsing nature of tobacco smokers in Ontario

While tobacco prevalence rates in Ontario (Canada's most populous province) have dropped substantially over the last four decades, approximately 16% of Ontarians (15 and older) still smoke. The net tobacco related burden includes 44 deaths per day, about a third of all cancers (excluding non-melanoma skin cancer), and excess health care costs of 1.7 billion annually. In an effort to reduce the health, social and economic burden associated with tobacco use, a Cessation Task Group (CTG) was formed within Ontario's Ministry of Health Promotion's (MHP) Community Action Working Group to propose an approach for assisting remaining smokers to quit, within the context of an overall Smoke-Free Ontario Strategy. After identifying and assessing evidence-based best practices, intervention and implementation priorities and component costs, CTG devised a strategy blending Wagner Chronic disease and Center for Disease Control's models to address tobacco use, composed of integrated components including: system policies to reduce tobacco markets; media-campaigns to motivate tobacco users to quit, use appropriate services and remain abstinent; programs and a screening system to improve tobacco users' access to appropriate behavioural, social, and pharmacological support; interventions to build capacity in the system; and research, evaluation, monitoring and surveillance to improve decision making and accountability. The system must be integrated, proactive and responsive, actively seeking-out and inviting smokers to use and benefit from a comprehensive range of interventions in order to reduce the burden associated with tobacco use.