Report of the Second Legislative Review of the Tobacco and Vaping Products Act

Table of Contents

• Executive summary
• Introduction
• Setting the frame: Tobacco use in Canada
• Assessment of the TVPA
• Objective 1: To protect young persons and others from inducements to use tobacco products and the consequent dependence on them
• Objective 2: To protect the health of young persons by restricting access to tobacco products
• Objective 3: To prevent the public from being deceived or misled with respect to the health hazards of using tobacco products
• Objective 4: To enhance public awareness of those hazards
• Compliance, enforcement and regulated parties
• Conclusions and observations
• Areas for potential action
• Appendix A – Who we heard from
• Appendix B – Summary of what we heard from First Nations, Inuit and Métis organizations
• Endnotes

Executive summary

Tobacco use remains a significant preventable cause of premature death in Canada, with approximately 46,000 people dying from tobacco-related illnesses every year.^{Footnote 1} Canada's Tobacco Strategy, launched in 2018, sets an ambitious target to reduce the prevalence of tobacco use in Canada to less than 5 percent by 2035.

In Canada, responsibility for health-related matters such as tobacco control is shared between the federal, provincial, and territorial governments. The Tobacco and Vaping Products Act (TVPA) is the federal legislation that regulates the manufacture, sale, labelling and promotion of tobacco and vaping products. Each province and territory also has laws and regulations in place for tobacco control. These pieces of legislation work together with other tobacco control tools such as policy and programs, to address tobacco-related disease and death.

As written in the legislation, the TVPA's overall purpose is to "provide a legislative response to a national public health problem of substantial and pressing concern and to protect the health of Canadians in light of conclusive evidence implicating tobacco use in the incidence of numerous debilitating and fatal diseases". It supports four specific objectives related to tobacco products: to protect young persons and others from inducements to use tobacco products and the consequent dependence on them; to protect the health of young persons by restricting access to tobacco products; to prevent the public from being deceived or misled with respect to the health hazards of using tobacco products; and to enhance public awareness of those hazards. The TVPA includes a requirement for a legislative review of its provisions and operation to take place every two years.

This review assessed whether progress was made towards achieving the tobacco-related objectives of the TVPA and whether the federal response, from a legislative perspective, is sufficient in addressing tobacco use in Canada. It serves to complement the first review on the TVPA's vaping-related provisions, tabled in parliament in December 2022, and together provide a baseline assessment of the TVPA.

The review was informed by relevant data and studies, and extensive consultations to gather the perspectives of Canadians. Overall, consultation respondents provided suggestions to further limit inducements to tobacco use, restrict youth access to tobacco products, enhance awareness, and prevent Canadians from being deceived or misled. Consultation respondents also provided suggestions with respect to monitoring the tobacco market, enhancing compliance and enforcement, and improving the overall operation of the Act. Many discussed the need to ensure a distinctions-based approach to First Nations, Inuit and Métis consultations and meaningful co-development of TVPA revisions, to prioritize and support cessation efforts, and to consider new restrictions for innovative nicotine products.

The analysis undertaken shows that Canada has made progress towards the TVPA's tobacco-related objectives and its overall purpose to address tobacco-related death and disease. Smoking rates for people aged 15 years and older have dropped from 26.8 percent (6.6 million people) in 2001 to 11.9 percent (3.8 million people) in 2022. Despite significant declines in smoking prevalence for the population as a whole, some have not benefited from the same rate of decline; some communities and regions have disproportionately high rates of tobacco use. In addition, although smoking rates have declined significantly, the rate at which people are quitting smoking have remained stable over the past two decades.

Although the legislation has contributed to declines in smoking prevalence rates, it is not possible to determine which portion of these successes can be directly attributed to the TVPA. Policies and programs, and the collaborative efforts of tobacco control partners, have also played a significant role in reducing tobacco use in Canada.

The analysis indicates that there are areas for potential action that require further exploration and that legislative or regulatory amendments could be considered based on this further analysis. Input received throughout this process was diverse. The areas for potential action listed below were selected based on current available evidence. Other input that goes beyond the areas for potential action will continue to be assessed and considered in future legislative reviews of the TVPA.

Prioritizing First Nations, Inuit and Métis engagement, cooperation and reconciliation

The process of developing and amending the legislation lacked extensive consultation and meaningful engagement with First Nations, Inuit and Métis Peoples. To build lasting reconciliation, healing, and cooperative relations, more needs to be done to assess the impact of the TVPA on these communities to better understand their unique needs, priorities and recommendations. This assessment should be distinctions-based and ensure that the distinct rights, interests and circumstances of the First Nations, Inuit and Métis are acknowledged, affirmed and implemented. Additionally, interventions led by First Nations, Inuit and Métis to address the high rates of commercial tobacco use in their respective communities should be supported. More work needs to be done to understand and address barriers to cessation among First Nations, Inuit and Métis Peoples. Recommendations regarding addressing barriers to cessation are reflected in the following area of potential action. The Government of Canada recognizes the sacred and ceremonial role that traditional tobacco has for many First Nations and Métis Peoples which differs from the use of commercial tobacco.

Addressing barriers to cessation

While youth smoking prevalence rates are at an all-time low, there are still 3.8 million Canadians who smoke; more can be done to help people quit tobacco. Work could be undertaken to develop a cessation plan, with a focus on certain populations that have disproportionate smoking rates. This would include examining barriers to quitting and engaging partners, including: people with lived and living experience, particularly from equity-deserving^{Footnote 2} groups; First Nations, Inuit and Métis Peoples; provinces and territories, and health care professionals. Information about existing cessation supports and programs delivered by health care professionals could be shared to promote best practices and expand reach, and national smoking cessation standards could be implemented to establish consistent practices across the health care system. Work with provinces and territories could enhance awareness of the availability of and access to cessation medications and services, particularly for equity-deserving groups. Finally, the recovery of costs from industry related to cessation programming and public education for equity-deserving groups, including funding provided to First Nations, Inuit, and the Métis Nation to develop and implement their own self-determined, culturally appropriate and distinct approaches to reducing commercial tobacco use based on their own needs and priorities, could be considered.

Strengthening enforcement, increasing transparency, and addressing industry interference

Consistent with the first review of the TVPA, more tools are needed to support compliance and enforcement activities relating to the TVPA. Legislative and regulatory options should be explored when considering additional tools to address compliance and enforcement related issues. Given the shared responsibility over compliance and enforcement, work with provinces and territories should continue to identify, monitor and address compliance-related issues. With respect to transparency, accountability and the use of data by other orders of government, academics and citizens, information about compliance and enforcement activities could be regularly published. As well, information received from industry on tobacco products that could be proactively disclosed should be made publicly available. More can also be done to articulate Canada's obligation to protect public health policies with respect to tobacco control from the commercial and other vested interests of the tobacco industry. To address this, guidance could be disseminated to Canada's policy and decision-makers to raise awareness of the World Health Organization Framework Convention on Tobacco Control Article 5.3 obligations. Lastly, remaining promotional activities by tobacco product manufacturers and importers, including intra-industry promotional activities and activities related to price promotion and segmentation, could be examined to better understand the impact of these measures on tobacco use in Canada.

Preserving gains and ensuring the legislative framework is responsive to modern realities

Canada has experienced significant declines in smoking prevalence rates overall, and particularly for youth. This does not mean that the Government of Canada's work is done; the gains made to date through legislative and other contributions must be preserved. Protecting the health of youth and people who do not use tobacco from nicotine addiction remains a priority under Canada's Tobacco Strategy. Understanding the changing market and ensuring the legislative framework remains responsive to modern realities is one part to preserving gains made, and collecting new information about technical innovations and new products can enhance understanding of the changing market. It is recommended that work continues with provinces and territories to examine the retail environment to assess the current provisions and practices, identify collaborative opportunities and consider all possible regulatory, policy, program and research activities to ensure that youth are adequately protected. Guidance or regulatory requirements could be developed to set out, in greater detail, age and identity verification actions for regulated parties involved in online and distance sales. As well, compliance and enforcement actions under existing authorities could be enhanced to prevent youth from accessing tobacco products online. It is also noted that Health Canada is currently taking action to address risks associated with the access and apparent appeal to youth and people who do not smoke of certain nicotine replacement therapies approved under the Food and Drugs Act.^{Footnote 3} While this work is outside the scope of the TVPA and this review, it will be important to ensure the appropriate oversight is in place to protect youth, while maintaining the smoking cessation objective of authorized nicotine replacement therapies to meet Canada's Tobacco Strategy objectives. Finally, work with international counterparts can identify measures beyond those required by the World Health Organization Framework Convention on Tobacco Control. Health Canada can assess the feasibility and effectiveness of implementing these measures within Canada.

Introduction

Tobacco use is one of the biggest global health threats with an estimated 1.2 billion people using tobacco products worldwide.^{Footnote 4} Tobacco kills up to half of its long-term users; over 8 million people globally die each year from tobacco-related use.^{Footnote 5} Eighty percent (1 billion) of people who use tobacco products live in low- and middle-income countries,^{Footnote 6} however tobacco use is the leading preventable cause of premature death in many high-income countries.^{Footnote 7} Tobacco use imposes a significant economic cost on society. It is responsible for 22.7 percent ($11.2 billion) of the measured costs of substance use in Canada, compared to 40.1 percent ($19.7 billion) for alcohol and 14.4 percent ($7.1 billion) for opioids.^{Footnote 8} International cooperation is important to respond to the globalization of the tobacco epidemic, both in Canada and abroad. To address the global health threat, the World Health Organization Member States adopted the World Health Organization Framework Convention on Tobacco Control in 2003, which aims to protect present and future generations from the devastating health, social, environmental, and economic consequences of tobacco consumption and exposure to tobacco smoke.^{Footnote 9} Canada became a Party to the World Health Organization Framework Convention on Tobacco Control in 2004. Canada continues to implement the Convention, in accordance with its national laws, and strives to implement all its obligations.

Tobacco use remains a significant preventable cause of disease and premature death in Canada, with approximately 46,000 people dying from tobacco-related illnesses every year.^{Footnote 10} Canada's Tobacco Strategy, launched in 2018, sets an ambitious target to reduce the prevalence of tobacco use to less than 5 percent by 2035. The main themes of Canada's Tobacco Strategy are helping Canadians quit tobacco, protecting youth and people who do not use tobacco from nicotine addiction, supporting First Nations, Inuit and Métis organizations to develop and implement self-led distinct approaches to reducing commercial tobacco use, and strengthening science, surveillance, and partnerships.

In 2021, the United Nations Declaration on the Rights of Indigenous Peoples Act received Royal Assent and immediately came into force.^{Footnote 11} This Act provides a roadmap for the Government of Canada and First Nations, Inuit and Métis to work together to implement the United Nations Declaration based on lasting reconciliation, healing and cooperative relations. The TVPA was developed before the coming into force of the United Nations Declaration on the Rights of Indigenous Peoples Act and was therefore not developed in alignment with these principles.

The Tobacco Act was amended on May 23, 2018, and was renamed the Tobacco and Vaping Products Act (TVPA). The TVPA is the federal legislation that regulates the manufacture, sale, labelling and promotion of tobacco and vaping products. The TVPA's overall purpose is to provide a legislative response to a national public health problem of substantial and pressing concern and to protect the health of Canadians in light of conclusive evidence implicating tobacco use in the incidence of numerous debilitating and fatal diseases.

The TVPA is one tool that is used to advance Canada's Tobacco Strategy. In Canada, responsibility over health-related matters such as tobacco control is shared between the federal, provincial, and territorial governments. Therefore, along with federal legislation, each province and territory also has laws and regulations in place for tobacco control. These pieces of legislation, along with other tobacco control tools such as policy and programs, work together to advance Canada's Tobacco Strategy and protect Canadians from tobacco-related disease and death.

The TVPA requires that a legislative review of its provisions and operation to be conducted three years after coming into force, and every two years thereafter. A sharp increase in youth vaping rates led to focussing the first review on the vaping-related provisions and operation of the TVPA. Complete findings of the first review can be found in the Report of the First Legislative Review of the Tobacco and Vaping Products Act.

Scope of the review

This second legislative review of the TVPA focusses on the tobacco-related provisions and operation of the TVPA. Tobacco-related measures that fall under other federal legislation, such as the Canadian Consumer Product Safety Act, the Excise Act, 2001, the Food and Drugs Act and the Non-smokers' Health Act, were not examined within the scope of this review.
The TVPA is the federal legislation that protects the health of Canadians from tobacco-related death and disease. With respect to tobacco products, the TVPA supports this overall objective as well as four specific objectives which are:

1. to protect young persons and others from inducements to use tobacco products and the consequent dependence on them;
2. to protect the health of young persons by restricting access to tobacco products;
3. to prevent the public from being deceived or misled with respect to the health hazards of using tobacco products;
4. to enhance public awareness of those hazards.

This review assesses whether progress is being made towards achieving the tobacco-related objectives of the TVPA and whether the federal response, from a legislative perspective, is sufficient in addressing tobacco-related disease and death in Canada. This review complements the first review on vaping products. Together, these reviews provide a baseline assessment of the TVPA.

Conduct of the review

A dedicated secretariat within Health Canada conducted this review. The analysis, contained in the following pages, includes an assessment of relevant data and studies (e.g., population-level surveys conducted by Health Canada and Statistics Canada, public opinion research carried out by Health Canada and peer-reviewed scientific literature).
Public consultations also played an important role in the data gathering effort. The public consultation took place during fall 2023. Canadians were encouraged to provide feedback on a discussion paper. The paper, titled The second legislative review of the Tobacco and Vaping Products Act Discussion Paper, was framed around seven themes: Canada's tobacco landscape; Addressing inducements to tobacco use; Monitoring the tobacco market; Restricting youth access to tobacco products; Enhancing awareness and preventing Canadians from being deceived or misled; Compliance, enforcement and regulated parties; and Engaging with Indigenous Peoples. Each theme of the discussion paper included a list of key questions to assist in providing input. However, respondents were not restricted to these questions and could provide any feedback on tobacco regulation in Canada.

Who we heard from

Individuals and organizations participated in the consultation through a variety of ways, ranging from discussion groups to written submissions. Health Canada received a total of 115 written submissions and held 19 meetings with partners and stakeholders (see Appendix A for more information). Given the shared responsibility for regulating tobacco products, meetings were held with provincial and territorial governments and Council of Chief Medical Officers of Health. Meetings with some First Nations, Inuit and Métis representatives and organizations were also held to engage in conversations regarding their tobacco-related priorities and concerns, though this engagement was by no means representative of all Indigenous Peoples. A meeting was held with people with lived and living experience to hear perspectives of Canadians who use or have used tobacco products. The secretariat met with a health-focused youth advisory council and a tobacco and vaping youth leadership team to gather the perspectives of youth, and discussions were also held with non-governmental organizations. The input received informed the final observations and areas for potential action. A summary of what we heard is outlined in this report. It is important to note that the views expressed throughout this report may not necessarily represent the views of Health Canada. Health Canada would like to thank those who provided their time and feedback on the regulation of tobacco. We will continue to take an evidence-based approach to explore all recommendations received.

Setting the frame: Tobacco use in Canada

Tobacco use and smoking prevalence

Canada has a long history of tobacco control, dating back to 1963. Canada has been working towards reducing tobacco rates since then, with a particular focus on cigarette smoking as it is the most widely consumed tobacco product. Few other countries have been as successful as Canada in lowering smoking rates and shifting public attitudes about tobacco. Over the years, surveys have shown large declines in the number of people who use tobacco products in Canada. In particular, prevalence rates of cigarette smoking^{Footnote 12} for people aged 15 years and older, were 26.8 percent (6.6 million people) in 2001 and 11.9 percent (3.8 million people) in 2022.^{Footnote 13}

While smoking rate declines have been observed among all ages, youth (aged 15-19) smoking rates have seen the steepest decline and are at an all-time low of 1.6 percent.^{Footnote 14} Other age groups have not shown this same rate of decline. Canadians aged 45 years and older have the lowest average decline per year (0.4 percentage points) over the past two decades, compared to those in the 15 to 19 years of age group with the highest average decline per year (0.9 percentage points).^{Footnote 15} Figure 1 shows Canada's progress in decreasing cigarette use prevalence, from 2001 to 2022, for different age groups.

Source: Canadian Community Health Survey Annual Share File, 2001 to 2022. (Note: Does not include rates for First Nations People living on reserve, full-time members of the Canadian Forces, the institutionalized population, among other sub-groups. Data in this figure from 2001 to 2014 included respondents living in the provinces and territories, while data from 2015 onwards included only respondents living in the provinces.)^{Footnote 16}

Figure 1: Text description

Table Figure 1: Current smoking by age group, Canadian Community Health Survey, 2001 to 2022

Year	Percent
	15-19	20-24	25-34	35-44	45+
2001	25.5	34.9	32.0	31.5	21.2
2003	21.9	32.9	28.3	28.0	19.0
2005	17.6	30.6	27.6	27.1	18.5
2007	17.0	30.8	28.6	26.1	19.3
2008	17.0	29.4	28.7	24.3	18.9
2009	16.5	26.8	26.2	21.8	18.3
2010	16.7	27.3	27.2	23.3	19.0
2011	12.9	25.7	26.8	23.3	17.4
2012	13.1	27.9	26.6	22.4	18.3
2013	12.2	26.1	26.0	21.9	17.4
2014	10.9	23.9	24.4	20.6	16.1
2015	11.2	20.9	23.4	19.3	16.8
2016	9.4	21.2	22.2	18.5	16.2
2017	8.7	19.7	20.3	19.4	15.4
2018	10.4	18.5	19.3	18.3	15.0
2019	7.8	15.0	19.0	17.4	14.3
2020	5.7	12.7	16.3	15.6	12.8
2021	2.9	10.4	12.8	14.2	12.8
2022	1.6	6.3	13.4	13.7	12.9

Who is smoking?

Health Canada created a profile of Canadians aged 15 years and older who smoke cigarettes (those who report daily and occasional cigarette smoking) by examining a number of characteristics using data from the Canadian Community Health Survey (CCHS) between 2001 and 2022. A Sex- and Gender-Based Analysis Plus (SGBA Plus) analytical approach was applied, which the Government of Canada uses to assess how different factors affect how Canadians experience federal initiatives.^{Footnote 17Footnote 18} Health Canada examined characteristics such as: age, sex, education, household income, visible minority status, and Indigenous identity.

As shown in Figure 2, Canada's smoking population has become relatively older over time. In 2001, people who smoked aged 45 years or older made-up 35.1 percent of the smoking population; however, this share of the smoking population increased to 57.9 percent in 2022. In addition, the share of the smoking population in 2022 that was very young (15 to 19 years) (0.9%) decreased since 2001 (8.1%). A similar pattern is seen for young adults aged 20 to 24 years (11.4% in 2001 to 3.5% in 2022) and for adults aged 35 to 44 years (25.4% in 2001 to 18.3% in 2022). In contrast, the share of the smoking population aged 25 to 34 years has not changed over time (20.1% in 2001 and 19.3% in 2022).

Source: Canadian Community Health Survey Annual Share File, 2001 to 2022. (Note: Does not include rates for First Nations People living on reserve, full-time members of the Canadian Forces, the institutionalized population, among other sub-groups. Data in this figure from 2001 to 2014 included respondents living in the provinces and territories, while data from 2015 onwards included only respondents living in the provinces.)

Figure 2: Text description

Table Figure 2: Distribution of age among Canadians who smoke cigarettes, CCHS 2001 and 2022

Age group	Percent
	2001	2022
15-19	8.1	0.9
20-24	11.4	3.5
25-34	20.1	19.3
35-44	25.4	18.3
45+	35.1	57.9

Subpopulations disproportionately affected

Despite significant declines in smoking prevalence for the population as a whole, some communities and regions in Canada are disproportionately affected by smoking. Disproportionate smoking prevalence among specific subgroups of the Canadian population, a form of health inequality, is a result of complex social, political, and economic factors. Measuring health inequalities helps to inform and strengthen interventions, including policy and program interventions tailored to subgroups with poorer health outcomes.^{Footnote 19} The Canadian Community Health Survey (2022)^{Footnote 20} shows that some groups of Canadians aged 15 years and older have higher smoking rates when compared to other groups:

• Canadians living in the North (63.6% (18,000) of those living in Nunavut, 25.7% (9,000) of those living in Northwest Territories, 20.1% (7,000) of those living in Yukon versus 8.8% (391,000) in British Columbia and 11.2% (1.4 million) in Ontario)
• Construction workers (22.8% (298,000) versus 6.2% (87,000^{Footnote 21}) in educational services)
• Canadians with a mood and/or anxiety disorder (17.2% (1.1 million) versus 10.7% (2.7 million) of those who do not have a mood nor anxiety disorder)
• Canadians in the lowest household income quintile (18.4% (1.2 million) versus 6.5% (407,000) of those in the highest household income quintile)
• Canadians with less than a secondary education (16.7% (613,000) versus 6.3% (596,000) of those with a university degree or more)

First Nations, Inuit, and Métis aged 18 years and older have among the highest smoking rates of any population group in Canada with 66.9 percent of Inuit living in Inuit Nunangat reporting smoking daily in 2017, followed by 27.1 percent of First Nations off-reserve and 22.7 percent of Métis.^{Footnote 22} Data from 2015 - 2016 show that 40.3 percent of First Nations on-reserve^{Footnote 23} reported smoking daily.

Quit rates in Canada

Unlike the significant declines seen for smoking prevalence, the prevalence rates for quitting^{Footnote 24} smoking have remained stable for Canadians over the past two decades. The percentage of people who smoke cigarettes and have quit has consistently been about 8 and 9 percent. Figure 3 shows the prevalence rates for Canadians quitting from 2001 to 2021.

Source: Canadian Community Health Survey Annual Share File, 2001 to 2022. (Note: Does not include rates for First Nations People living on reserve, full-time members of the Canadian Forces, the institutionalized population, among other sub-groups. Data in this figure from 2001 to 2014 included respondents living in the provinces and territories, while data from 2015 onwards included only respondents living in the provinces.)

Figure 3: Text description

Table Figure 3: Quitting prevalence over time among all current cigarette users, CCHS 2001 to 2021

Year	Percent
2001	8.4
2003	10.1
2005	8.2
2007	8.7
2008	9.0
2009	7.8
2010	7.5
2011	8.7
2012	8.2
2013	7.7
2014	9.1
2015	8.2
2016	8.3
2017	7.7
2018	7.6
2019	9.3
2020	7.7
2021	8.6

Many of the health effects linked to tobacco use can be reversed or reduced after a person quits smoking. The body starts to recover from the effects of smoking as early as the first day of quitting.^{Footnote 25} There are health benefits from quitting for all people who smoke (regardless of age or sex). Even those already living with a smoking-related chronic health condition like cancer can benefit from quitting and improve their health outcomes and the effectiveness of their treatment.^{Footnote 26} Quitting smoking is challenging and often requires multiple attempts; however, many want to quit. A public opinion research study conducted in 2022 indicated that among Canadians aged 15 years and older who smoked at the time, about half reported that quitting was important to them, and reported using various quit methods in their attempts to quit.^{Footnote 27} An analysis of the 2021 Canadian Community Health Survey showed that, among Canadians aged 15 years and older, of those who made a quit attempt in 2021, 14.8 percent (358,000 people) were successful.^{Footnote 28Footnote 29} The prevalence of quitting smoking also varied across different groups. Quit intentions^{Footnote 30} and attempts^{Footnote 31} were higher among people under the age of 65 and people with higher income. It also noted that quit attempts were higher among those with a university degree, those living in urban areas, immigrants, and visible minorities.^{Footnote 32} The only difference in quit success^{Footnote 33} was seen between genders, with men having higher quit success than women.^{Footnote 34}

People have options when trying to quit smoking. In 2022, the most commonly cited approach for quitting smoking was to try to quit on one's own, without special preparation or help (62.4% or 851,000 people), followed by reducing the number of cigarettes smoked (39.5% or 539,000 people). The use of nicotine replacement therapy as an approach for quitting smoking was also cited, but less often (26.3 percent or 375,000 people).^{Footnote 35} This data indicates that cessation aids, although effective, are underutilized.

Canada's tobacco market

According to Statistics Canada, retailers sold $11.8 billion worth of tobacco products and accessories in 2022, compared to $12.6 billion in 2020.^{Footnote 36} The TVPA requires industry to report various types of information to Health Canada, as set out in the Tobacco Reporting Regulations, such as sales data. In 2022, cigarettes represented 94 percent of the total tobacco market share in Canada; cigars, fine-cut tobacco (e.g. cigarette tobacco to roll your own cigarettes) and smokeless (e.g. chewing tobacco, oral snuff and nasal snuff) accounted for the remaining 6 percent.^{Footnote 37}

Based on data that Health Canada collects under the Tobacco Reporting Regulations, cigarette sales declined by almost 42 percent from 2013 to 2022. There has also been a dramatic decline in sales for cigars, fine-cut tobacco, and pipe tobacco over the last decade. Cigar sales have declined by more than 50 percent since a 2009 high of $650 million, while fine-cut tobacco has seen a 60 percent decline in sales in the last decade. Pipe tobacco sales declined by 47 percent over the last decade. Smokeless tobacco sales have declined at a steadier rate of 30 percent in the last decade, after having peaked at 333 000 kilograms in 2012. Based on 2022 industry reports, all tobacco products have shown a decline in sales with the wholesale tobacco value having decreased by 6.6 percent (-$504 million) from 2021.

Source: Health Canada, Tobacco Reporting Regulations (TRR) Section 13

Figure 4: Text description

Table Figure 4: Canadian Tobacco Market by Product Category, 2022

Product Category	Market Share
Cigarettes	94.2%
Cigars	2.9%
Fine cut	1.5%
Smokeless	1.3%
Pipe	0.1%

Cigarettes are the most commonly sold tobacco product in Canada. The number of cigarettes sold in 2022 was 18.4 billion, down 12.1 percent from 2021.^{Footnote 38} The decline in sales was spread out across all regions in Canada and all major cigarette manufacturers. Industry revenues have also declined. As of 2022, tobacco industry revenue for cigarettes was estimated at $4 billion, a decline of 6.1 percent ($261 million) from 2021.^{Footnote 39}

Canada does not standardize tobacco product prices. The purchase price of cigarettes is made up of a number of components, such as industry revenue, federal excise duty, provincial or territorial tobacco specific taxes and sales tax. The Excise Act, 2001 sets out the federal excise duty for tobacco products, which is adjusted each year according to the Consumer Product Index.^{Footnote 40} For 2022, Health Canada estimates that this duty made up 21.7 percent of the final retail price for cigarettes nationally. Provincial and territorial taxes vary throughout Canada, with Quebec^{Footnote 41} and Ontario^{Footnote 42} having the lowest tobacco specific taxes and Yukon^{Footnote 43} and the Northwest Territories the highest^{Footnote 44}. Provincial and territorial taxes are estimated to make up an average of 31 percent of cigarette prices nationally in 2022.^{Footnote 45} Industry revenue represents the largest percentage of the final retail price, estimated at 38.4 percent.^{Footnote 46}

Research shows that significantly increasing tax and price is the single most consistently effective tool for reducing tobacco use; it can lead some to quit or reduce their consumption, or can prevent people from starting to use tobacco altogether.^{Footnote 47} Despite this, tobacco companies have voluntarily raised the price of cigarettes every year since 2013. In 2022, industry revenue increased to 22.1 cents/stick from 20.6 cents/stick in 2021.^{Footnote 48} Figure 5 below shows increases in industry revenue despite decreases in the number of cigarettes sold.

Source: Health Canada, Tobacco Reporting Regulations (TRR) Section 13

Figure 5: Text description

Table Figure 5: Cigarette Sales in Canada versus Tobacco Industry Revenue^{Footnote 49}, 2013 – 2022

Year	Units	Industry Revenue
2010	31,599,864,319	$2,890,387,285.15
2011	31,179,734,516	$2,863,229,512.05
2012	31,335,056,903	$2,754,365,839.25
2013	31,469,061,436	$2,795,202,698.23
2014	29,434,174,983	$2,806,542,700.25
2015	29,002,235,605	$3,390,908,077.08
2016	28,630,583,963	$3,720,960,439.03
2017	27,110,716,886	$3,856,225,415.28
2018	25,838,401,275	$4,157,636,635.51
2019	23,895,350,226	$4,207,003,277.87
2020	23,126,861,524	$4,399,206,258.88
2021	20,906,599,707	$4,312,886,416.35
2022	18,376,765,809	$4,051,728,625.06

Industry uses a price segmentation strategy that offers a value-brand product at a lower price point than a premium branded product.^{Note de bas de page 50} The price difference between value brands and premium brands is close to $5 per package in most provinces.^{Note de bas de page 51}

Along with legal sources of tobacco products, illegal tobacco products (also referred to as contraband tobacco products) have also been available in Canada for decades. These products are available at prices that are below the price of legal products. In 2022, it was estimated that there was $400 million revenue loss in federal excise duties from illegal production/smuggling of cigarettes for the 2018 tax year.^{Note de bas de page 52} The illegal tobacco trade undermines tobacco control measures and is a complex issue for law enforcement in Canada. Public Safety Canada, the Royal Canadian Mounted Police, and the Canada Border Services Agency play a key role in understanding and preventing the import and sale of illegal tobacco in Canada through policing and enforcement efforts.

Assessment of the Tobacco and Vaping Products Act

The TVPA is the federal legislation that regulates the manufacture, sale, labelling and promotion of tobacco and vaping products. The TVPA's overall purpose is to provide a legislative response to a national public health problem of substantial and pressing concern and to protect the health of Canadians in light of conclusive evidence implicating tobacco use in the incidence of numerous debilitating and fatal diseases.

Health Canada assessed each tobacco-related objective of the TVPA, along with the operation of the TVPA, to determine if progress was made and whether the federal response, from a legislative perspective, is sufficient in addressing tobacco-related death and disease in Canada. The review was informed by data and studies, as well as extensive consultations to gather the perspectives of Canadians.

A high-level summary of consultation feedback is presented under each of the objective sections below. Some comments Health Canada received were outside the scope of this review. Additional measures that fall under other legislation were suggested, such as, increasing taxes, banning smoking in federally regulated places, prohibiting smoking in vehicles, prohibiting smoking any substance where smoking cigarettes is banned, and addressing the illegal tobacco market. Some suggested reviews of other pieces of legislation that have an impact on tobacco use including the Business Corporations Act, Competition Act, and Income Tax Act. Although these topics will not be examined within the scope of this review, relevant feedback was shared with the appropriate departments as necessary.

Objective 1: To protect young persons and others from inducements to use tobacco products and the consequent dependence on them

Context

Tobacco products are highly addictive for many people, who may experience cravings and withdrawal symptoms that make quitting smoking difficult.^{Note de bas de page 53} Most tobacco use begins during adolescence.^{Note de bas de page 54} Young persons are particularly sensitive to the dependence-causing effects of nicotine in tobacco and report symptoms of dependence even at low levels of cigarette consumption.^{Note de bas de page 55} In 2022, 71.1 percent (2.7 million people) of people who currently smoke reported smoking their first whole cigarette before the age of 18, 23.9 percent (900,000 people) between the ages of 18 and 24 and 5 percent (188,000) at 25 years of age or older.^{Note de bas de page 56} A much lower proportion of youth aged 15 to 19 years (1.6%)^{Note de bas de page 57} reported current smoking in 2022 compared to 2001 (25.5% or 532,000 people).^{Note de bas de page 58}

Because tobacco products are highly addictive, it is important to protect young persons and others from inducements to use them. Tobacco product promotions are intended to communicate aspects and information about the product, but also to create and maintain the perception that tobacco use is desirable, socially acceptable, healthy and more common in society than it really is. Promotional effects of tobacco packages and products may be particularly effective on impressionable adolescents and young adults, as this is when brand loyalty and smoking behaviour are beginning to be established.^{Note de bas de page 59} Prohibiting tobacco advertising, promotion and sponsorship is recognized as a means to reduce the consumption of tobacco products.^{Note de bas de page 60} The World Health Organization Framework Convention on Tobacco Control states that Parties recognize that a comprehensive ban on advertising, promotion and sponsorship would reduce the consumption of tobacco products.^{Note de bas de page 61}

What has been done

The TVPA aims to protect young persons and others from inducements to use tobacco products and the consequent dependence on them. The TVPA includes a broad and comprehensive approach to addressing promotional activities that could influence people to begin using tobacco products. A general prohibition on the promotion of tobacco products or tobacco-related brand elements is in place in order for legislation to keep pace with changing marketing practices in tobacco product promotion. The TVPA sets out specific prohibitions on the promotion of tobacco products or tobacco-related brand elements. For example, sponsorship promotion is prohibited. Providing any consideration, including a gift, any bonus, premium, cash rebate, right to participate in a game, draw, lottery, etc., to a purchaser of a tobacco product is prohibited. It is noted that the TVPA does not prohibit manufacturer-to-retailer promotions that encourage reduced prices and include incentives. Any testimonials and endorsements of tobacco products are prohibited. It is also prohibited to publish, broadcast or otherwise disseminate, on behalf of another person prohibited promotion (e.g., through media), except for imported publications or the retransmission of radio or television broadcasts that originate outside Canada. It is also prohibited to promote a tobacco product by means of advertising, with some exceptions. Some forms of advertising directed towards adults can still take place, such as signs in adult only entertainment venues indicating availability, brand and price.

Canada was among the world's first jurisdictions to ban the use of flavouring additives in tobacco products to make them less appealing to young persons and people who do not use tobacco. Today, there is a comprehensive ban on flavourings in certain tobacco products including cigarettes, little cigars and blunt wraps in Canada. Some provinces and territories have further restricted flavours in all tobacco products including large cigars and pipe tobacco.

The TVPA provides the powers to make regulations to help protect young persons and others from inducements to use tobacco products. Promotion through packaging was one of the last promotional outlets for reaching youth. In 2019, Canada introduced the Tobacco Products Regulations (Plain and Standardized Appearance)^{Note de bas de page 62} to standardize the appearance of tobacco packages and products to make them less appealing, particularly to youth and young adults. When introduced, these regulations were the most comprehensive plain packaging regulations in the world. These regulations included plain appearance requirements for all tobacco product packages – the same drab brown colour, bearing only the permitted text displayed in a standard location, font style, colour and size and products. In 2023, these regulations were amended and named the Tobacco Products Appearance, Packaging and Labelling Regulations. These regulations consolidate all tobacco product appearance, packaging and labelling requirements under a single set of regulations. New and amended measures introduced aim to enhance public awareness of the health hazards of tobacco use, and help prevent the public from being misled or deceived about those hazards. In addition, health warnings displayed on cigarettes and on little cigars that have tipping paper and on tubes, support the objective of protecting young persons and others from inducements to use these products. Having messages directly on the products themselves allows health warnings to reach and inform youth of the health hazards and health effects of tobacco use and can make the products less appealing. Canada is the first country in the world to take this approach.

The Tobacco Reporting Regulations require manufacturers (including importers) to submit information about their tobacco products, including promotional activities, such as advertising in publications, on signs or on permanent facilities; promotional material that accompanies the tobacco product package; promotions at retail; and accessories that display tobacco product-related brand elements or a manufacturer's name, among other information.^{Note de bas de page 63} Having this information helps the government to keep pace with changing marketing practices in tobacco product promotion, and informs future tobacco control policies and activities.

What we heard

Those who responded to the consultation were generally of the opinion that the current restrictions are not sufficient to protect youth and non-users of tobacco products from inducements to use tobacco products and the consequent dependence on them, however some suggested that the TVPA was sufficient and that no further changes were needed.

Several submissions recommended further restricting tobacco advertising and promotion. For example, a non-governmental organization recommended banning the use of descriptors like "smooth", as this could portray a more enjoyable experience. Some regional health authorities and a non-governmental organization recommended banning confectionary items resembling a tobacco product that may be appealing to youth. Additionally, a First Nations organization, a Métis organization, some youth, regional health authorities, non-governmental organizations and provincial/territorial governments recommended prohibiting or restricting the portrayal of smoking in media broadcasts, including social media, movies and television programs, to further protect youth and others from being influenced. Suggestions included banning such imagery or requiring a warning message when smoking or tobacco imagery is shown, similar to requirements India has implemented. A Métis organization, a non-governmental organization and a provincial/territorial government suggested prohibiting discounts on tobacco products, such as volume and multipack discounts offered by retailers, which they have argued is a form of promotion and undermines inducement protections.

A First Nations organization shared that First Nations students report stress and anxiety as a motivation for smoking, as well as having parents or other role-models who smoke, at different rates than non-Indigenous peers. Métis organizations shared that the use of commercial tobacco is complex and that various individual, social, environmental, and societal factors need to be addressed.

In addition, many respondents recommended introducing additional measures to make tobacco products less addictive and appealing. For example, health professionals, regional health authorities, non-governmental organizations, a provincial/territorial government and a Métis organization recommended setting a nicotine limit in tobacco products, in hopes to reduce nicotine addiction potential.

Introducing price-related regulations was also suggested. For example, a health professional and a provincial/territorial government recommended increasing tobacco product prices, indicating that price increases can have a strong impact on tobacco use deterring people, particularly youth, from taking up or continuing to smoke. Other examples included establishing a national pricing system for cigarettes to remove pricing as a marketing tool, and increasing taxes on tobacco products regularly to keep pace with inflation. Furthermore, we heard from regional health authorities, non-governmental organizations and a provincial/territorial government that manufacturer-to-retailer incentives to sell more products and offer volume discounts should also be prohibited. They also suggested that price segmentation (i.e., dividing brands into different price tiers to offer alternatives of the same product at different prices) should be addressed. An industry respondent indicated that any new fee introduced would have an impact on the lower-income population and would move people who use cigarettes who are more price-sensitive to look for cheaper alternatives in the illegal market.

Some respondents noted that the provisions within the TVPA are sufficient to protect young persons from inducements to use tobacco. Some members of the general public, industry and non-governmental organizations commented that Canada has made progress in reducing the smoking prevalence over the years, with some noting that its regulations are more stringent than other jurisdictions and that Canada appears to be doing well given the low youth smoking rate. A person with lived and living experience expressed that the current regulations in place are sufficient, but that more needs to be done to enforce these regulations.

Objective 2: To protect the health of young persons by restricting access to tobacco products

Context

Restricting access to tobacco products is a control measure that is shared by federal, provincial, territorial, or municipal legislation. Preventing youth from accessing tobacco products has been a shared priority since the early 1990s.^{Note de bas de page 64}

Prior to the year 2000, cigarettes were sold just about anywhere, including restaurants/food venues, bars, hotels, movie theatres, and department stores. Today, due to provincial and territorial laws, tobacco products have virtually disappeared from all hospitality venues and from all retail outlets other than convenience stores, grocery stores, gasoline stations^{Note de bas de page 65} and specialty shops.

There are approximately 30,000 to 35,000 points of sale for tobacco products across Canada where cigarettes are available for sale.^{Note de bas de page 66} Many studies have shown that lower levels of retail density and decreased proximity to tobacco retailers are associated with less tobacco use.^{Note de bas de page 67} The density of tobacco retailers has fallen over the years, with 383 outlets per 100,000 people in 1976, to 130 outlets per 100,000 people in 2000, to 75 outlets per 100,000 people in 2019.^{Note de bas de page 68} It is noted that the primary source from which youth access cigarettes is social sources, with 73.4 percent (50,000 people) of Canadian youth (students in grades 7 - 12) who smoked in the past 30 days obtaining their cigarettes from social sources such as friends and family, while 26.6 percent (18,000 people) reported obtaining from retail sources.^{Note de bas de page 69}

What has been done

The TVPA restricts young persons access to tobacco products. It sets the minimum age for people who are sold tobacco products and prohibits anyone from furnishing (e.g., selling, lending, assigning, giving or sending) tobacco products to young persons (under 18 years of age) in a public place or place to which the public has access (e.g., retail establishments, online stores, etc.). Provinces and territories can also adopt legislation to set a higher legal age for tobacco access. Six provinces and three territories have prohibited the sale and furnishing of tobacco products to persons under 19 years of age and one province to persons under 21 years of age.^{Note de bas de page 70}

Measures are also in place that prohibit someone from sending or delivering a tobacco product to a young person. This prohibition addresses online sales and other forms of distance sales that are now available for consumer goods. The TVPA extends the responsibility of taking appropriate measures to restrict youth access to tobacco products to everyone involved in the transaction. Anyone delivering a tobacco product has to verify that the person taking delivery of the product is at least 18 years of age. The TVPA also sets restrictions around self-service displays and dispensing devices of tobacco products.

The TVPA requires the minimum number of cigarettes, little cigars or blunt wraps that a package that can be sold must contain. The higher price associated with a larger package acts as a disincentive to purchase by young persons who have limited funds.^{Note de bas de page 71} The TVPA has flexibility for this measure; it also allows for other tobacco products to have a prescribed quantity limit.

The Tobacco (Access) Regulations set out the types of documentation that may be used to verify age and identity of a person for furnishing tobacco products.

What we heard

Most respondents generally felt that restrictions around accessing tobacco products could be further strengthened to protect the health of young persons. On the other hand, some respondents indicated that TVPA measures are sufficient for restricting youth access to tobacco products.

A range of suggestions aimed at further limiting youth access were proposed. For example, some regional health authorities, non-governmental organizations, industry and a provincial/territorial government recommended further restricting retail availability by prohibiting online sales or strengthening its regulation. A submission from an industry respondent recommended that online vendors be prohibited from accepting multiple large orders of tobacco products that exceed an amount reasonably required for personal use or the use of adult family members, to reduce the risk of youth accessing tobacco products from social sources. Some respondents also discussed further restrictions for brick-and-mortar establishments. For example, some regional health authorities and non-governmental organizations recommended requiring a minimum distance between tobacco retailers and schools and restricting the number of stores that are permitted in a given area, which could limit youth exposure. A Métis organization and a regional authority suggested that the number of cigarette retailers in low-socio-economic areas be reduced. A person with lived and living experience, regional health authorities, provincial/territorial governments and non-governmental organizations suggested further limiting the sale of tobacco products to tobacco designated stores, or age restricted stores, to reduce accessibility and facilitate quitting.

To further reduce access, some members of the general public, regional health authorities, youth, non-governmental organizations, a provincial/territorial government, and an industry respondent recommended implementing a smoke-free generation policy to eventually end tobacco use by phasing in restrictions on the acquisition of tobacco products to all those born before a certain year or after they reach a certain age. Additionally, members of the general public, regional health authorities, non-governmental organizations, provincial/territorial governments, an academic and an industry respondent recommended increasing the minimum age of sale, with most recommending 21 years of age. Conversely, industry and a member of the general public felt that adults should remain free to make their own choices regarding tobacco use and not be restricted. As well, a regional health authority commented that a complete prohibition of tobacco would not reduce smoking rates to zero but would result in more people obtaining tobacco products from illegal sources.

There were also suggestions around strengthening age verification and expanding where it is illegal to furnish tobacco products to youth. For example, industry recommended introducing audit requirements for age verification when tobacco products are purchased online or delivered and requiring mandatory age verification training for retailers. Some regional health authorities and a non-governmental organization also recommended effective age verification training for retail staff. As well a member of the general public, industry and some health professionals recommended strengthening age verification requirements to make them more uniform and robust. In addition, some regional health authorities and a non-governmental organization recommended removing the limitation that sales to minors are only illegal if done in a public place, and many called for further actions to address youth access to tobacco products through social sources. This concern was also raised by a Métis organization and youth groups, stating that it was relatively easy for underage individuals to access tobacco products, often through social connections.

As mentioned, some felt that the TVPA measures are sufficient for restricting youth access to tobacco products. Some industry respondents stated that the regulations are well-designed to prevent minors from accessing tobacco products if properly enforced, including that convenience stores are strictly adhering to all regulations and laws concerning the sale of tobacco products. A member of the general public and a non-governmental organization commented that the measures in place appear to be working well since the data presented by Health Canada demonstrates that the youth smoking rate has declined over the past few years.

Objective 3: To prevent the public from being deceived or misled with respect to the health hazards of using tobacco products

Context

The World Health Organization Framework Convention on Tobacco Control requires Parties to protect their public health policies, with regards to tobacco control, from commercial and other vested interests of the tobacco industry. The World Health Organization's guidelines for implementing Article 5.3 do not create obligations on the Parties but recommend measures intended to assist Parties in meeting their obligations. The guidelines highlight the fundamental conflict between the tobacco industry's interests and public health policy interests. Limiting engagement with tobacco industry to only where it is necessary is a way to avoid industry interference. Article 5.3 is an important instrument to protect Canadians against the tobacco industry's attempts to weaken tobacco control measures in place.

Canadians should have accurate information about the products they purchase or use. They should not be deceived or misled with respect to the health hazards of these products, to ensure they are making informed decisions. Prohibiting misleading terminology from tobacco products, packaging, and promotion helps protect people from false inferences about product harm.

What has been done

Canada has committed to protecting its public health policies related to tobacco control from commercial and other vested interests of the tobacco industry pursuant to Article 5.3 of the World Health Organization Framework Convention on Tobacco Control. The Government of Canada limits interactions with the tobacco industry to the extent necessary to regulate the industry, and furthers transparency by publishing information on the department's meetings with industry on Health Canada's public record of meetings. As well, Health Canada has developed a document to raise awareness of Article 5.3 obligations and to provide guidance to Canada's policy- and decision-makers on how to interact with the tobacco industry appropriately.

The TVPA prohibits promoting tobacco products in a manner that is false, misleading or deceptive with respect to health effects and health hazards, and prohibits comparative claims in promotion that suggest a tobacco product or its emissions, are less harmful than another product or their emissions. The TVPA prohibits the use of additives, such as vitamins, probiotics, and minerals, in the manufacture of certain tobacco products. This prohibition prevents, among other things, the misperception that products containing these are less harmful than products that do not.^{Note de bas de page 72}The list of prohibited additives can be found in Schedule 1 to the TVPA.

Canada actively monitors tobacco product contents and emissions. The Tobacco Reporting Regulations set out requirements for the reporting of information on sales, ingredients, emissions, manufacturing procedures, promotional activities and research and development activities. These regulations require that information be submitted for certain types of tobacco product, such as cigarettes, leaf and cigarette tobacco, little cigars, cigars, pipe tobacco and smokeless tobacco. The Government of Canada uses this information to inform policy decisions and to implement effective tobacco control strategies to protect the health of Canadians.

The Tobacco Reporting Regulations has limitations in that it does not currently require reports for all tobacco products, such as waterpipe tobacco, products made of tobacco intended for use with a device (e.g. heated tobacco products), blunt wraps or any novel type of tobacco product that could be introduced in the future. It also does not require any sales reports on cigarette papers, filters sold separately to make cigarettes, or any devices used to consume tobacco. Data on intra-industry promotion is also not collected. A Notice of Intent — Measures under consideration to modernize tobacco and vaping products information reporting requirements, was published on March 2, 2024, seeking feedback from interested parties on possible regulatory measures that are expected to better support the objectives of the TVPA and future tobacco control measures. The measures under consideration would consolidate the Tobacco Reporting Regulations and the Vaping Products Reporting Regulations, modernize and streamline existing reporting requirements for tobacco products, and add new information reporting obligations for tobacco and vaping product manufacturers and importers. Comments received during the consultation period will be considered in the development of future reporting regulations.

The Tobacco Products Appearance, Packaging and Labelling Regulations standardize the appearance of tobacco packages and products. Restrictions under these regulations protect Canadians from misleading information, or misperceptions of risk communicated through packaging design features^{Note de bas de page 73} (e.g., lighter coloured tobacco product packaging could be perceived as less harmful than products in darker coloured packaging^{Note de bas de page 74Note de bas de page 75Note de bas de page 76}). These regulations also prescribed standard cigarette lengths and diameter, as well as little cigar diameter. As a result, products such as super slim and ultra slim cigarettes that could be perceived as less harmful than regular cigarettes because they are noticeably slimmer became prohibited.^{Note de bas de page 77} The Promotion of Tobacco Products and Accessories Regulations (Prohibited Terms) prohibits cigarette descriptors such as "light" and "mild" which could be perceived as being less harmful; this perception is not supported by research.

What we heard

Most respondents thought that the TVPA could be strengthened to protect Canadians from being deceived or misled. On the other hand, some respondents felt that the TVPA was sufficient in protecting people from being deceived or misled.

Some regional health authorities recommended banning products designed to cover pictorial health warnings and health information messages on tobacco products. They also suggested shortening the transition period provided to manufacturers to comply with changes to Tobacco Products Appearance, Packaging and Labelling Regulations. Furthermore, they, along with members of the general public and non-governmental organizations suggested expanding labelling requirements to other tobacco products.

The concept of prohibiting filters on cigarettes was also mentioned. Some submissions, including those by members of the general public, regional health authorities and non-governmental organizations, recommended prohibiting filters on tobacco products as they could be incorrectly perceived as filtering out some of the harmful chemicals of the cigarette.

On the other hand, an academic stated that the TVPA prevents communication regarding relative risk information and therefore Canadians are being misled about the relative hazards of smoking compared to vaping products. Some respondents, including some members of the general public, health professionals and industry also noted this restriction and suggested that the TVPA should help facilitate discussions around relative risk of using various tobacco, vaping and other nicotine products.

Some health professionals, regional health authorities, non-governmental organizations and provincial/territorial governments expressed concerns about industry interference. They recommended further advancements with respect to Canada's World Health Organization Framework Convention on Tobacco Control Article 5.3 commitment, such as publishing advice to policy makers to raise awareness of these obligations. Some members of the general public, industry respondents and an academic called for engagement with the tobacco industry when implementing regulations or in charting an approach to reduce smoking rates.

In addition, some regional health authorities and non-governmental organizations called on the government to ensure that data and industry reports – such as information about tobacco industry marketing and advertising – are proactively disclosed in a timely and frequent manner.

Some felt the TVPA measures are sufficient in protecting people from being deceived or misled. Submissions, including those from non-governmental organizations and regional health authorities, said that current prohibitions – including the appearance, packaging and labelling requirements – are effective in preventing the public from being deceived or misled about the health hazards of tobacco products. They also mentioned that they support regulations prohibiting slim cigarettes. While specific examples were not given, industry commented that prohibitions on promotion are sufficient to prevent the public from being deceived or misled about the health hazards of tobacco products.

Objective 4: To enhance public awareness of those hazards

Context

Canadians need to be aware of the health consequences of tobacco use in order to make informed judgements about its use, as well as decisions that could affect their health. Health warnings and information about toxic substances on tobacco product packages enhance public awareness of the hazards of tobacco use. Evidence indicates that displaying health-related messages on tobacco packaging is one of the most effective approaches to inform people of the health hazards of tobacco use.^{Note de bas de page 78}

Canada was the first country to require pictorial health warnings on packages of cigarettes. A 2023 study showed that smoking tobacco regularly was viewed as having moderate or great risk by the vast majority (93 percent) of Canadians aged 16 years and older.^{Note de bas de page 79} A 2020 study showed that most Canadian adults who smoke were aware of the specific diseases and conditions caused by smoking, although the level of awareness did vary by specific health effect. For example, there was high awareness that smoking causes lung cancer and heart disease, but lower awareness that smoking causes blindness or bladder cancer.^{Note de bas de page 80}

What has been done

A manufacturer or retailer is prohibited from selling a tobacco product unless the product and its packaging display the required information about the product and its emissions, the health hazards, and the health effects arising from the use of the product and its emissions as prescribed by regulations. As well, a manufacturer is prohibited from packaging a tobacco product unless the product and the package display the required information about the product and its emissions, the health hazards and health effects arising from the use of the product and its emissions as prescribed by regulations.

The Tobacco Products Appearance, Packaging and Labelling Regulations, which came into force in 2023, made several changes to existing packaging and labelling requirements. These regulations brought Canada into full compliance with World Health Organization Framework Convention on Tobacco Control Article 11 obligations by extending health warnings and toxicity information requirements on all tobacco product packaging, including the package of any new tobacco product that enters the market. As in the previous labelling regulations, the Tobacco Products Appearance, Packaging and Labelling Regulations use a combination of health warnings, health information messages and toxicity information to inform users of the health hazards and health effects associated with tobacco use. They also require a pan-Canadian toll-free quitline number and cessation web address on all tobacco product packages. While health warnings focus on the health hazards of smoking, health information messages focus on positive cessation messages, including tips about quitting, motivational life experiences, and testimonials from people who formerly used tobacco. These health-related messages are updated regularly to maintain effectiveness and ensure they reflect the latest research and science available. The 2023 renewed health warnings feature thirteen new themes (including new health conditions) to help expand awareness. As well, the regulations include a rotation scheme that requires that the information be changed on a predetermined schedule (every 24 or 36 months depending on the product). This was included to enhance the novelty and relevance of the health-related messages and health warnings on individual cigarettes, little cigars with tipping paper and tubes.

Through the Tobacco Products Appearance, Packaging and Labelling Regulations Canada became the first country to require that health warnings be displayed directly on individual cigarettes, little cigars that have tipping paper and tubes. These requirements have a phased-in approach with the health warnings being implemented on king-sized cigarettes available at retail by July 31, 2024, and on the regular size cigarettes, little cigars that have tipping paper, and tubes available at retail by April 30, 2025. Like any new regulatory measure, the government will monitor this new requirement to see what impacts the regulations may be having.

In addition to regulatory measures, the Government of Canada participates in a variety of public awareness campaigns. Recent campaigns have included: "Break it Off" (2019-2020) tailored towards young adults aged 20-24 years old, "It's Never Too Late" (2020-2021) tailored towards older adults aged 50-65 years old, and "Tools for a Smoke-Free Life" (2022-2023) tailored towards adults who smoke between the ages of 35-64. In addition, the Government of Canada, through Canada's Tobacco Strategy, invests approximately $17 million annually in contribution funding to support smoking prevention and cessation initiatives. This funding is delivered through Health Canada, the Public Health Agency of Canada, and Indigenous Services Canada. Funding has helped reach groups who experience health inequities and face rates of tobacco use that are higher than the general population including First Nations, Inuit and Métis. In the fall of 2023, Health Canada's Substance Use and Addictions Program held an open call for proposals seeking projects that focus on developing innovative stop-smoking supports in populations with a high prevalence of tobacco use, including projects incorporating vaping as a cessation tool and harm reduction measure for adults who smoke, as well as projects that would transfer or apply evidence-based knowledge to build capacity to implement and embed smoking cessation services within the health care system. Health Canada continues to collaborate with provinces and territories to fund and operate the pan-Canadian quitline.

What we heard

Most respondents felt that federal regulations are sufficient to increase public awareness about the health hazards of tobacco products. However, recommendations to further tailor and expand the reach of public education materials and campaigns were also received. For example, a Métis organization suggested that funds be allocated for year-round, age-appropriate prevention and stop-smoking campaigns that promote awareness of the health impacts of smoking, using a harm reduction approach. An Inuit organization suggested increasing the development of online resources and information tools, such as awareness resources on health risks of tobacco products. As well, a member of the general public recommended providing support and further education to new immigrants and refugees. In addition, a non-governmental organization recommended that health care professionals lead educational sessions, regarding the implications of tobacco use, be given in schools, community centres and libraries to reach youth and others. Youth suggested that public awareness campaigns and resources shared by governments be modernized to better reach youth. They also identified that public awareness messaging has not reached rural regions equally, and that tailored approaches and communication tools can be considered to better reach sub-groups and sub-populations.

Some submissions recommended the creation of new messaging about tobacco products, to be used for public awareness and educational initiatives and on tobacco product packaging. Health professionals, regional health authorities, non-governmental organizations and a provincial/territorial government suggested including messaging pertaining to non-health related impacts of tobacco use; this messaging could include, for example environmental impacts (such as litter, pollution and climate change) and economic impacts. They also wished to see renewed and enhanced message content for additional health conditions, such as breast cancer and diabetes.

Some regional health authorities recommended simplifying messaging on packaging, or delivering messaging in other languages. Health professionals, regional health authorities, general public and industry suggested using comparative statements to share information with the general public and health care practitioners about the relative risks of using various tobacco products.

Some health professionals, regional health authorities, non-governmental organizations and a provincial/territorial government expressed support for the new requirement for health warnings on individual cigarettes, little cigars with tipping paper, and tubes. Some members of the general public, people with lived and living experience and an academic expressed concerns that the health warnings on individual cigarettes are ineffective and can be considered stigmatizing. In addition, some suggested that labels include positive messaging rather than information about the harms, such as providing information on the many ways to quit smoking.

Health Canada also heard the TVPA measures are sufficient to increase public awareness about the health hazards of tobacco products. Submissions from regional health authorities said that much progress has been made to change attitudes about cigarette smoking over the years and to protect the population from the harms of tobacco use through policy efforts. Regional health authorities, industry and a non-governmental organization commented that Canada is renowned for being a leader when it comes to policies and regulations that protect Canadians from the harms of tobacco products, including the recent requirement for health warnings on individual cigarettes. A non-governmental organization also said that regulations for cigarette packages are the strongest in the world and are a model for governments in other countries. A comment from a provincial/territorial government said that the current regulations are sufficient to increase awareness of the health hazards of tobacco products to the consumer. Some youth respondents and a member of the general public also said that there was a high level of awareness that tobacco products are harmful.

Compliance, enforcement and regulated parties

Context

Health Canada follows a progressive compliance and enforcement approach, outlined in the Compliance and Enforcement Policy for the Tobacco and Vaping Products Act, to reduce and respond to non-compliance. To help ensure regulated parties meet their legal obligations, Health Canada has a variety of compliance and enforcement activities, including compliance promotion, compliance monitoring and enforcement action.

Health Canada proactively engages in compliance promotion activities with regulated parties to inform and encourage compliance with requirements under the TVPA. Health Canada inspectors may provide documents such as copies of applicable regulations, information letters, and facts sheets. Health Canada monitors and verifies industry compliance through regular inspections of tobacco product manufacturers and retailers, which may include tobacco product sampling for laboratory analysis or compliance assessments, and reviews of industry reports provided under the Tobacco Reporting Regulations. If non-compliance is identified, a range of compliance and enforcement actions are available to Health Canada, as noted under the Compliance and Enforcement Policy for the Tobacco and Vaping Products Act. These may include issuing warning letters, publishing advisories on non-compliant products, seizing non-compliant products or promotions, and pursuing prosecution.^{Note de bas de page 81} There is also authority, under the Contraventions Act, to issue a ticket for particular offences that are designated as contraventions under Schedule XIV of the Contraventions Regulations, such as furnishing a tobacco product to a young person or obstructing an inspector.

In response to the Minister of Mental Health and Addictions and Associate Minister of Health's 2021 mandate letter commitment to "require tobacco manufacturers to pay for the cost of federal public health investments in tobacco control," Health Canada is working with federal government partners to examine next steps to implement a cost recovery program.

What has been done

To achieve its purpose of providing a legislative response to address tobacco-related death and disease, the TVPA includes compliance and enforcement mechanisms. The TVPA provides a range of powers to designated inspectors to undertake compliance and enforcement activities. Inspectors are designated and trained to conduct compliance and enforcement activities in a fair, consistent, and unbiased manner, following standard procedures.

Since 2018, Health Canada's tobacco compliance and enforcement activities have been directed primarily at provisions relating to reporting, packaging and labelling, promotion, and prohibited additives in tobacco products.

In 2019-2020, Health Canada conducted 691 tobacco retail inspections and two tobacco manufacturer inspections. These inspections resulted in enforcement action in the form of 22 warning letters, 13 instances of which the manufacturer was not aware of their obligations but came into compliance within the timeframe negotiated with Health Canada, and 60 seizure activities (including 2,078 tobacco packages (cigarette and other tobacco products) and 36,414 individual tobacco product units (cigarettes and cigars)). In 2019, Health Canada published a guidance document, Facts about Tobacco Products Regulations (Plain and Standardized Appearance), to facilitate compliance with the TVPA and the Tobacco Products Regulations (Plain and Standardized Appearance).

During the COVID-19 pandemic, Health Canada continued to do inspections and used remote or virtual tools to complement onsite inspection activities.^{Note de bas de page 82} In 2020-2021, 10 remote inspections were conducted to assess tobacco manufacturers' compliance with the tobacco product and packaging requirements pursuant to the then new Tobacco Products Regulations (Plain and Standardized Appearance). This resulted in one warning letter issued.

During the 2021-2022 fiscal year, Health Canada conducted inspections at three manufacturers. Three manufacturers received warning letters for observed non-compliance with the Tobacco Products Regulations (Plain and Standardized Appearance) based on detailed assessments of samples taken during the inspections. Over 1,300 retail establishments were inspected resulting in seizures at 66 retailers.

In 2022-2023, Health Canada conducted 14 manufacturing inspections resulting in 13 warning letters being issued. Over 2,000 retail inspections to assess compliance with the packaging and labelling requirements were completed. This resulted in 15 instances of which the manufacturer was not aware of their obligations but came into compliance within the timeframe negotiated with Health Canada. Health Canada also seized non-compliant tobacco products at 348 retailers. This was the first fiscal year that the complete Tobacco Products Regulations (Plain and Standardized Appearance) was in force, including the required slide and shell packaging for cigarettes that have prescribed dimensions and can only be opened by moving the slide vertically. It is not uncommon to see an increase in non-compliance in the retail market after the implementation of new regulations. In 2023, a background document on the Tobacco Products Appearance, Packaging and Labelling Regulations was published, detailing the requirements of the new regulations and the transition periods for manufacturers and retailers to comply with the new packaging and labelling requirements for tobacco products.

As set out in the Justice Canada Forward Regulatory Plan, the Government of Canada is considering designating additional offences in the TVPA as contraventions.^{Note de bas de page 83} This would provide Health Canada inspectors with an additional enforcement tool to enhance regulatory compliance and enforcement activities.

What we heard

Most respondents suggested that compliance and enforcement could be strengthened to address current and future issues in tobacco control. In contrast, industry suggested that there should be more of a focus on the illegal tobacco market.

Some regional health authorities and non-governmental organizations recommended expanding the TVPA to add new enforcement tools, such as a licensing system, new or increased penalties, recalls, and orders to comply (e.g., cease and desist orders). In addition, some regional health authorities, non-governmental organizations, and provincial/territorial governments recommended increasing enforcement capacity and inspections, improving enforcement related to online activities (e.g., online sales, marketing and promotion), improving the coordination of enforcement efforts with provinces and territories, and publishing more comprehensive and frequent compliance monitoring and enforcement reports.

Finally, some respondents said that a robust cost recovery framework should be implemented in a timely manner.

Conclusions and observations

The second review of the TVPA focussed on assessing whether progress was made towards achieving the tobacco-related objectives of the TVPA and whether the federal response, from a legislative perspective, is sufficient in addressing tobacco-related disease and death in Canada. The review was informed by relevant data and studies, and extensive consultations to gather the perspectives of Canadians. In Canada, responsibility over health-related matters such as tobacco control is shared between the federal, provincial, and territorial governments. While tobacco legislation has been an important tool to address tobacco use in Canada, it is important to recognize that the collaborative efforts by tobacco control partners have also played a significant role in Canada's success in reducing tobacco use.

Canada has a long history of tobacco control and has been working towards reducing smoking rates for decades. In the mid 1990s, approximately one third of the population aged 15 years and older (6.9 million) smoked cigarettes^{Note de bas de page 84Note de bas de page 85} and smoking initiation was increasing among young Canadians, particularly young women.^{Note de bas de page 86Note de bas de page 87Note de bas de page 88Note de bas de page 89} The Tobacco Act of 1997, amended to be the TVPA in 2018, introduced measures that focused on reducing the demand for tobacco products and on preventing youth and others from experimenting with and becoming addicted to tobacco. This included restrictions on advertising, promotion and sponsorship and restrictions on access.^{Note de bas de page 90} Other priorities of the Tobacco Act were packaging and labelling requirements to enhance public awareness of the health hazards of tobacco use and assist Canadians in making informed decisions, and requirements for manufacturers to report information about tobacco products, their emissions, and research and development to monitor the industry activities.

The Tobacco Products Regulations (Plain and Standardized Appearance) which came into effect in 2019, standardized the appearance of tobacco packages and products to make them less appealing, particularly to youth and young adults. In 2023, the Regulations Amending the Tobacco Products Regulations (Plain and Standardized Appearance) included all appearance, packaging and labelling requirements for tobacco products under a single set of regulations. With these amendments the regulations were renamed the Tobacco Products Appearance, Packaging and Labelling Regulations. The regulations set out a new generation of health warnings, health information messages and toxicity information for tobacco product labelling, expanded the health warnings and toxicity information requirements to all tobacco products, required a rotation scheme of health-related messages every 24 to 36 months, and required the inclusion of the Pan-Canadian toll-free quitline number and web address on all tobacco product packages to inform people about the availability of tobacco cessation services. They were also the first regulations in the world to require health warnings directly on selected tobacco products (cigarettes, little cigars with tipping paper, and tubes).

Canada is considered a world leader in tobacco control and has focused on leading-edge regulatory initiatives in the areas of product content regulation, testing and measuring the contents and other additives of tobacco products, packaging, and labelling requirements. The Government of Canada has implemented nearly all of the available measures recognized as best practices in tobacco control by the World Health Organization.^{Note de bas de page 91} Canada championed a draft decision on Article 2.1 during the Tenth Session of the Conference of the Parties to the World Health Organization Framework Convention on Tobacco Control, calling on parties to explore and implement innovative measures beyond those required by the Convention.^{Note de bas de page 92} The World Health Organization ranks Canada among the countries with the highest level of implementation for monitoring tobacco use; smoke-free environments; cessation programs; and pack warnings.^{Note de bas de page 93} Among the 38 Organisation for Economic Co-operation and Development (OECD) countries, Canada had the fifth lowest smoking rate in 2021.^{Note de bas de page 94}

Canada has been successful at denormalizing tobacco use over the decades. Canadians have a high level of awareness of the health hazards with tobacco product use. Canada was the first country in the world to require pictorial health warnings on cigarette packages and continues to advance and strengthen regulations to ensure these health warnings and other messages are effective and current. The vast majority (93 percent) of Canadians aged 16 years and older view smoking regularly as having moderate or great risk.^{Note de bas de page 95} Measures are in place that protect Canadians from being deceived or misled with respect to health hazards from using tobacco products and enhance public awareness of those hazards.

Data shows that smoking prevalence rates have been declining for all age groups, including most profoundly for Canadian youth. A number of legislative measures, such as prohibitions on advertising and sponsorship, authorities for the making of plain and standardized packaging requirements, flavouring additive bans in cigarettes, and access restrictions for youth have likely played a role in reducing inducements to tobacco use. In 2022, smoking rates were at an all-time low of 11.9 percent (3.8 million) for people aged 15 years and older, and 1.6 percent^{Note de bas de page 96} for youth.

Based on the assessment, from a legislative perspective, significant progress has been made towards achieving the intended purpose of the legislation to address tobacco-related death and disease in Canada. Amendments at the level of the Act are not proposed at this time. Although there has been significant progress, tobacco use is still a pressing issue in Canada. There are approximately 46,000 deaths in Canada per year related to tobacco use. The analysis indicates that there are areas that could be considered to further reduce tobacco use in Canada, preserve the gains made, and ensure the legislation remains modern and responsive to emerging issues and products. Additional analysis in the areas for potential action could result in future legislative or regulatory amendments. For example, legislative and regulatory options should be explored when considering additional tools to address issues related to compliance and enforcement issues.

It is noted that input received throughout this process was diverse and the areas for potential action listed below were selected based on current available evidence. Input received that is not directly reflected in the areas for potential action will continue to be assessed and considered in future legislative reviews of the TVPA.

Areas for potential action

Prioritizing First Nations, Inuit and Métis engagement, cooperation and reconciliation

In 2021, the United Nations Declaration on the Rights of Indigenous Peoples Act (UNDRIP Act), received Royal Assent and immediately came into force. This Act provides a roadmap for the Government of Canada and First Nations, Inuit and Métis to work together to implement the Declaration based on lasting reconciliation, healing, and cooperative relations. The UNDRIP Act requires the Government of Canada to take, in consultation and cooperation with First Nations, Inuit and Métis Peoples, all measures necessary to ensure that existing and new federal laws are consistent with the UNDRIP while also respecting the protection of Aboriginal and treaty rights as recognized and affirmed by Section 35 of the Constitution Act 1982. The TVPA was developed before the coming into force of the UNDRIP Act and the process of developing and amending the legislation lacked extensive consultation and engagement with First Nations, Inuit and Métis Peoples. Furthermore, the Government of Canada recognizes the sacred and ceremonial role that traditional tobacco has for many First Nations and Métis Peoples which differs from the use of commercial tobacco.

The analysis has shown that while Canada has been very successful at reducing smoking prevalence rates, not everyone in Canada is experiencing the same progress. The legacy of residential schools, racism, displacement and colonialism have contributed to First Nations, Inuit and Métis smoking rates which are among the highest of any subpopulations aged 18 years or older in Canada. Some First Nations, Inuit, and Métis representatives and organizations participated in engagements and/or provided written submissions that informed the second legislative review of the TVPA. The Government of Canada recognizes, however, that these engagements were very limited and not representative of all First Nations, Inuit and Métis Peoples; there may be differing perspectives from organizations and communities that we have not had the opportunity to engage. In an attempt to begin to better understand First Nations, Inuit and Métis tobacco-related priorities, the approach taken during the public consultation was intentionally broad. The feedback received is therefore not limited to legislative measures.

The public consultation for this second TVPA legislative review provided invaluable insights into some of the unique perspectives and tobacco-related priorities for certain First Nations, Inuit, and Métis organizations. A summary of what we heard from the First Nations, Inuit, and Métis organizations has been validated by the respective organizations: First Nations Health Authority, Inuit Tapiriit Kanatami and the Inuit Tobacco and Vaping Working Group, Métis Nation of Ontario, Health Department of the Otipemisiwak Métis Government of the Métis Nation within Alberta, and Métis Nation of Saskatchewan – Ministry of Health. These summaries are included as Appendix B to show our commitment to understanding the unique needs, priorities and recommendations presented, as Health Canada moves forward with the regulation of tobacco and vaping products. The activities for consideration that are listed below pertain specifically to First Nations, Inuit and Métis engagement, but there are additional activities for consideration in the following section that relate to addressing barriers to cessation among First Nations, Inuit and Métis Peoples.

Activities for consideration:

• Recognizing the Government of Canada's obligations to take, in consultation and cooperation with First Nations, Inuit and Métis Peoples, all measures necessary to ensure that existing and new federal laws are consistent with the UNDRIP, an assessment of the impact of the TVPA on First Nations, Inuit and Métis Peoples to better understand their unique needs, priorities and recommendations related to the regulation of tobacco and vaping products in their respective communities is necessary. This assessment should be distinctions-based and ensure that the distinct rights, interests and circumstances of the First Nations, Inuit and Métis are acknowledged, affirmed and implemented.
• Continue to support interventions led by First Nations, Inuit and Métis to address the high rates of commercial tobacco use in their respective communities.

Addressing Barriers to Cessation

While smoking prevalence rates have decreased, there are still 3.8 million Canadians who smoke. Quitting smoking is challenging. The prevalence of quitting smoking has been stable over the past 20 years. In 2021, only 8.6 percent (358,000 people) of people who smoked quit in the past year.^{Note de bas de page 97} Many who do quit will relapse. There are a number of effective cessation aids and services currently available to Canadians, however these are underutilized.^{Note de bas de page 98} The Government of Canada's public education and awareness campaigns set out to assist Canadians with cessation, and recently have been tailored towards adults aged 35 and older who smoke. However, tobacco use is complex and can be influenced by multiple individual, social, environmental, and societal factors and more can be done to help certain populations quit tobacco.

Health care falls under provincial and territorial jurisdiction. Through Canada's Tobacco Strategy, the federal government collaborates with provinces and territories to support the pan-Canadian quitline initiative, and funds cessation projects and campaigns, including equity-informed initiatives, to help Canadians quit smoking. Further, a national voluntary standard for smoking cessation is under development by Health Canada in collaboration with provinces and territories.

Some regulatory measures under the TVPA have contributed to increasing awareness around cessation supports. The Tobacco Products Appearance, Packaging and Labelling Regulations regulate packaging, appearance and labelling of tobacco products. These regulations require that all tobacco product packages display health warnings, as well as a toll-free telephone number and web link to the pan-Canadian quitline. They also require the display of health information messages on the inside of packages of cigarettes, little cigars and cigarette tobacco that inform people who use tobacco products about the benefits of quitting and provide tobacco cessation tips to help users of tobacco products live a smoke-free life. However, legislation may not be the most appropriate tool to address the ongoing challenges around cessation.

The majority of consultation respondents agreed that the Government of Canada should consider new measures or make adjustments to current measures to better support smoking cessation efforts. Health professionals, regional health authorities, a First Nations organization, an Inuit organization, Métis organizations, members of the general public, people with lived and living experience, non-governmental organizations, academics, provincial/territorial governments, and youth recommended improving access to, and affordability of, approved cessation aids, programs, and services, including tailored, culturally appropriate approaches for at-risk populations, and improving the promotion of these cessation supports and tools. Some consultation respondents, including health professionals, a Métis organization, members of the general public, industry, non-governmental organizations, and an academic called for improved integration of smoking cessation into the broader health care system, including cessation and cultural safety awareness training and compensation for health care professionals.

Activities for consideration:

• Develop an equity-informed cessation plan by examining barriers to quitting and engaging partners, including: people with lived and living experience, particularly from equity-deserving groups; First Nations, Inuit and Métis Peoples; provinces and territories, and health care professionals.
• Information about existing cessation supports and programs delivered by health care professionals could be shared to promote best practices and expand reach. National smoking cessation standards could be implemented to establish consistent practices across the health care system.
• Work with provinces and territories to enhance awareness of the availability of and access to cessation medications and services, particularly for equity-deserving groups.
• Recover costs from industry related to cessation programming and public education for equity-deserving groups, including funding provided to First Nations, Inuit, and the Métis Nation to develop and implement their own self-determined, culturally appropriate and distinct approaches to reducing commercial tobacco use based on their own needs and priorities.

Strengthening enforcement, increasing transparency and addressing industry interference

Strengthening enforcement

Health Canada develops and implements compliance and enforcement policies and undertakes compliance and enforcement activities to ensure that regulated parties are complying with the TVPA and its regulations.

Challenges with respect to enforcement activities exist in both physical and online retail environments. There are over 30,000 points of sale for tobacco products across Canada,^{Note de bas de page 99} all of which are required to comply with the TVPA and its regulations. Health Canada conducts in-person inspections at retail establishments to verify compliance, and takes enforcement actions when appropriate. Additionally, the online environment presents unique challenges for compliance and enforcement. While there are a number of enforcement actions to address non-compliance, there is data to suggest that the current range of enforcement tools in the TVPA may limit the ability to address non-compliance in situations for which a warning letter was not effective.

Responsibility for tobacco control is shared between the federal, provincial, and territorial governments. Municipal governments also have a role. Provincial, territorial, and local municipal governments may enact their own tobacco and vaping legislation, and corresponding compliance and enforcement programs. Their legislation may enhance, be similar or be more restrictive than the requirements of the TVPA, and they may have compliance and enforcement policies that apply to the activities they regulate.^{Note de bas de page 100}

Regional health authorities, non-governmental organizations and provincial/territorial governments noted the need to strengthen compliance and enforcement efforts, consistent with the findings of the First Legislative Review of the TVPA and the 2021 Evaluation of the Health Portfolio Tobacco and Vaping Activities, including the need for new enforcement tools to support the efficiency and effectiveness of activities in this area.

Activities for consideration:

• Develop additional tools to respond to non-compliance with a progressive enforcement approach and continue to work closely with provinces and territories to identify, monitor and address issues of non-compliance. Legislative and regulatory options should be explored when considering additional tools to address issues related to compliance and enforcement issues.

Increasing transparency

The Government of Canada is committed to open government, which promotes information management practices that enable the proactive and ongoing release of government information. Currently, data collected from industry under the Tobacco Reporting Regulations is not shared. Data transparency can help highlight industry practices and tactics, further strengthening science, surveillance, and partnerships in tobacco control. Regional health authorities and non-governmental organizations recommended that the government proactively publicly disclose information and data reported by industry, and publish reports on compliance and enforcement activities in a timely and frequent manner.

Activities for consideration:

• Expand efforts to make compliance and enforcement more transparent by regularly publishing information about actions resulting from compliance and enforcement activities.
• Proactively disclose information on tobacco products from industry, that can be made publicly available, to increase transparency, accountability and the use of data by other orders of government, academics, and citizens.

Addressing industry interference

Canada is committed to implementing Article 5.3 of the World Health Organization Framework Convention on Tobacco Control, which sets out an obligation in setting and implementing public health policies with respect to tobacco control. It seeks to protect these policies from commercial and other vested interests of the tobacco industry in accordance with national law. Health professionals, regional health authorities, non-governmental organizations and provincial/territorial governments noted that the implementation of Article 5.3 Guidelines could be improved by making government-wide policy guidance publicly available, so that other orders of government understand the obligation and adopt protective measures. Health Canada has developed such a guidance document.

Information on industry activities and practices allows the government to effectively regulate tobacco products.^{Footnote 101} Consultation respondents have expressed concerns that tobacco industry price segmentation and price promotions strategies have a greater impact on equity-deserving groups. The Government of Canada has published a Notice of Intent seeking feedback on measures under consideration to modernize tobacco (and vaping) products information reporting requirements. One objective of these measures is to collect additional information on tobacco (and vaping) industry practices, such as intra-industry promotional activities (e.g. directed to retailers by manufacturers).

Activities for consideration:

• Disseminate guidance to Canada's policy and decision-makers to raise awareness of the World Health Organization Framework Convention on Tobacco Control Article 5.3 obligations.
• Examine remaining promotional activities by tobacco product manufacturers and importers, including intra-industry promotional activities and activities related to price promotion, discrimination and segmentation, to better understand the impact of these activities on tobacco use in Canada.

Preserving gains and ensuring legislative framework is responsive to modern realities

Technical innovations and new products

Canada has experienced significant declines in smoking prevalence rates overall, and particularly for youth. Youth prevalence rates are at an all-time low of 1.6 percent.^{Footnote 102} This does not mean that the Government of Canada's work is done to protect youth and others from inducements to use tobacco products and the consequent dependence on them. The gains made to date, through legislative and other contributions, must be preserved. Protecting the health of youth and people who do not use tobacco from nicotine addiction remains a priority under Canada's Tobacco Strategy. One part of preserving the gains made is to be aware of and responsive to the current nicotine market.

The nicotine market continues to evolve. In recent years, technical innovations in vaping products, and most recently, new nicotine pouches have been introduced to the Canadian market. There have been concerns regarding the access to, and potential appeal of, certain new nicotine replacement therapies to youth, namely the new nicotine buccal pouches authorized by Health Canada in July 2023 under the Food and Drugs Act. Health Canada is currently taking action to address risks associated with the access and apparent appeal to youth and people who do not smoke of certain nicotine replacement therapies approved under the Food and Drugs Act.^{Footnote 103}

Health professionals and regional health authorities, members of the general public, industry, non-governmental organizations, academics, and provincial/territorial governments recommended the development of a strategy to address nicotine products comprehensively. Some respondents, including health professionals, members of the general public, people with lived and living experience, industry, and academics suggested regulating different categories of tobacco and nicotine products based on their level of health risk. Others, including health professionals and regional health authorities, non-governmental organizations, and provincial/territorial governments recommended subjecting all nicotine products to the same restrictions on sale and promotion as tobacco and vaping products under the TVPA, with the ultimate purpose being to eliminate both nicotine and tobacco use.

Activities for consideration:

• Enhance Health Canada's understanding of how the market is changing by collecting new information about technical innovations.
• As Health Canada takes action to address risks associated with the access and apparent appeal to youth and people who do not smoke of certain nicotine replacement therapies approved under the Food and Drugs Act, it will be important to ensure the appropriate oversight is in place to protect youth, while maintaining the smoking cessation objective of authorized nicotine replacement therapies to meet Canada's Tobacco Strategy.

Online sales

The TVPA does not permit sending or delivering a tobacco product to anyone under 18 years of age through online sales and other forms of distance sales available for other consumer goods. Anyone delivering a tobacco product has to verify that the person taking delivery of the product is at least 18 years of age. However, age verification requirements under the current regulatory regime may not be sufficiently responsive. This is consistent with the findings of the First Legislative Review of the TVPA.

Many consultation respondents, including health professionals and regional health authorities, industry, non-governmental organizations, and provincial/territorial governments indicated that current measures to prevent youth from accessing tobacco products could be strengthened to better address online sales, and some recommended online sales be banned.

Activities for consideration:

• Enhance compliance and enforcement actions under existing authorities to prevent youth from accessing tobacco products online.
• Continue examining retail environment with provinces and territories with a view to assessing the current provisions and practices, identifying collaborative opportunities and considering all possible regulatory, policy, program and research activities to ensure that youth are and remain adequately protected.
• Consider developing guidance or regulatory requirements to set out in greater detail the actions that regulated parties involved in online and distance sales may take to verify age and identity.

Innovative international best practices

Globally, tobacco prevalence rates continue to decline. In 2022 about 1 in 5 adults worldwide were consuming tobacco compared to 1 in 3 in 2000.^{Footnote 104}

Canada is considered a world leader in tobacco control and has implemented nearly all of the available measures recognized as best practices in tobacco control by the World Health Organization. To drive the global collective response, Canada championed a draft decision on Article 2.1 during the Tenth Session of the Conference of the Parties to the World Health Organization Framework Convention on Tobacco Control, calling on parties to explore and implement innovative measures beyond those required by the Convention.^{Footnote 105} Although measures are not yet defined, some countries are considering innovative measures such as, reducing the amount of tobacco that is allowed to be sold each year to achieve a specified level of commercial sales, implementing tobacco-free generation legislation, and continuously decreasing the number and density of outlets selling tobacco products. Greater information sharing and collaboration could be beneficial to address new challenges and are important to preserve gains and successes to date.

Activities for consideration:

• Work with international counterparts to identify measures beyond those required by the World Health Organization Framework Convention on Tobacco Control and assess the feasibility and effectiveness of implementing these measures within Canada.

Appendix A – Who we heard from

Health Canada held a public consultation, guided by a discussion paper, on the second legislative review of the Tobacco and Vaping Products Act that ran from September 7, 2023, to November 17, 2023. Over 5,000 registered and interested parties were notified of the consultation via Health Canada's consultation and stakeholder registry. Additionally, over 200 of Health Canada's established tobacco control stakeholders and partners were notified of the consultation by email, including national Indigenous organizations, people with lived and living experience, youth advocacy groups, academic institutions, research groups and academics, Canada's Tobacco Strategy federal partners, provinces and territories, non-governmental organizations, health professionals, and retail and vaping associations and advocacy groups.

Health Canada would like to thank those who provided their time and feedback on the regulation of tobacco.

Written Submissions

We received 115 written submissions from a variety of partners and stakeholders during the public consultation. The breakdown of submissions can be found below.

Meetings

In addition to receiving written submissions, we held 19 meetings with 120 individuals over the course of the review. The breakdown of the meetings can be found below.

Note: Some organizations provided a written submission and participated in a meeting. Some organizations participated in more than one meeting.

Appendix B – Summary of what we heard from First Nations, Inuit and Métis organizations

Health Canada held a public consultation, guided by a discussion paper, on the second legislative review of the Tobacco and Vaping Products Act that ran from September 7, 2023, to November 17, 2023, and invited all interested parties to comment. Over 220 parties registered to receive notifications related to "aboriginal" consultations were notified via Health Canada's consultation and stakeholder registry. In addition, letters were also sent to national Indigenous organizations, academics and clinicians who have expertise in the health of Indigenous peoples and communities and the Indigenous Community of Practice for Canada's Tobacco Strategy, coordinated by the National Indigenous Diabetes Association, to invite participation in the consultation. Consultation opportunities remained open for First Nations, Inuit and Métis organizations until spring 2024.

The Government of Canada would like to thank First Nations, Inuit, and Métis representatives and organizations for taking the time to participate in the consultation to support the second legislative review of the Tobacco and Vaping Products Act.

The Government of Canada recognizes that the process of developing and amending the legislation lacked extensive consultation and engagement with First Nations, Inuit and Métis Peoples. The objective of these engagements was to initiate discussions and begin to better understand First Nations, Inuit and Métis tobacco-related priorities, concerns related to the regulation of tobacco in Canada, and elements necessary for reducing commercial tobacco use among First Nations, Inuit and Métis Peoples.

The public consultation provided invaluable insights into some of the unique perspectives and tobacco-related priorities for certain First Nations, Inuit, and Métis organizations. Organizations were encouraged to share feedback and context that went beyond legislative measures. In an effort to begin prioritizing First Nations, Inuit and Métis engagement, cooperation and reconciliation, a summary of what we heard is presented in greater detail below. In order to respect their individual and distinct perspectives, statements are attributed to the individual organizations that participated in the public consultation and the statements were validated by the organizations that provided the input.

The Government of Canada recognizes that these engagements were very limited and were not representative of all First Nations, Inuit and Métis Peoples and that there may be differing perspectives from organizations and communities which we have not had the opportunity to engage.

First Nations Health Authority

Addressing Commercial Tobacco Use

• Self-determination and autonomy are key, funding should be provided to groups disproportionally impacted by commercial tobacco to determine their own strategies to reduce commercial tobacco use.
• Recognize that colonization contributes to the high rates of commercial tobacco use in Indigenous populations.
• Funding should be provided to create a First Nations-led process to regulate access, provide education on ceremonial and cultural tobacco use and to provide supports for those using unsafely.
• Indigenous people can create their own rules and policies around tobacco or consider Indigenous-led working groups for guiding future regulations.
• Enhance and co-develop the process for reviewing the TVPA as tobacco pertains to the rights of Nations to practice their cultures and any changes may impact these rights.
• Address discriminatory practices at the health authority level, such as Indigenous exclusion from employment opportunities like secret shopper roles.

Traditional Tobacco and Wholistic Wellness

• Promote a wholistic strategy addressing commercial tobacco use by enhancing mental health and wellness supports and broaden Canadian Tobacco Strategy funding to encompass culturally supportive wholistic wellness activities that support culture.
• Provide First Nations people the option to access traditional tobacco, that is distinct from the commercial supply, to support safe cultural practices.

Youth

• Commonly heard factors that lead to tobacco use in Indigenous youth include stress and anxiety, desire to fit in with peer group, addiction, experimentation, enjoying the physical effects of nicotine, and parents or other role models smoke.
• A distinctions-based approach is needed to address youth-use rates of tobacco. First Nations students report stress and anxiety as their motivation for smoking and having parents who smoke at different rates than non-Indigenous peers.
• Address the influence of social media platforms, such as TikTok, in promoting tobacco and vaping use among youth.

Inuit Tapiriit Kanatami and the Inuit Tobacco and Vaping Working Group

Supporting Inuit Self-Determination, Governance and Funding

• Recognize and endorse Inuit self-determination and decision-making as part of the funding, design and delivery of tobacco prevention and cessation strategies and initiatives.
• Incorporate a distinctions-based approach as part of the early development and design of policies and initiatives to ensure Inuit perspectives are included from policy concept to program implementation.
• Expand Inuit specific financial supports to further empower Inuit regions in autonomously shaping processes based on Inuit priorities and processes.
• Enhance Inuit specific tobacco use related data especially around Inuit youth to better support and inform Inuit tobacco use, prevention and cessation needs and programming.
• Consider an Inuit specific Community of Practice Model rather than a diabetes prevention driven approach (i.e., The National Indigenous Diabetes Association) to best support Inuit Regions in their efforts to knowledge share, network and improve access to Inuit tobacco tools and resources.

Incorporate Inuit Social Determinants of Health

• Incorporate and link Inuit social determinants of health and its impacts to inform the development of tobacco cessation initiatives and strategies.
• Incorporate goals and outcomes aimed at improving the status of Inuit health.

Improving National Policy Development, Implementation and Program Supports

• Streamline national policies and processes between federal government departments (i.e., Heath Canada to the First Nations and Inuit Health Branch of Indigenous Services Canada, Non-Insured Health Benefits program, etc.) to improve timely access to program resources.
• Support the development and funding of Inuit regional capacity building initiatives such as the creation of Inuit tobacco and vaping educators.
• Increase development of online resources and informational tools (i.e., awareness resources) on the health risks of tobacco and vaping products.
• Provide tools (i.e., awareness resources), particularly on vaping.

Métis Nation of Ontario

UNDRIP

• Acknowledge the impact of colonialism and trauma on smoking cessation and the effects this has had on the disproportional rates of smoking in Métis communities.
• Study and adopt practices used within Métis communities and include cultural distinctions in federal smoking cessation efforts.
• Provide more funding opportunities for Métis organizations to support community level programming and research to assist with commercial tobacco cessation.
• Acknowledge that the Métis People are a distinct population and apply a distinctions-based approach to policies and strategies.
• Recognize that the Métis relationship with traditional tobacco will vary by region.

Education

• Include information on the associated risks of nicotine products to ensure informed choices.
• Allocate funds for year-round, age-appropriate prevention/stop-smoking campaigns that promote awareness of the health impacts of smoking and vaping, using a harm reduction approach.

Protecting Youth and Vulnerable Populations

• Take steps to reduce the availability of flavoured tobacco products which are attractive to youth.
• Take action on restricting tobacco product exposure on television, social media, and streaming services to further prevent their normalization.
• Protect from second and third-hand smoke exposure by offering education of the effects of tobacco smoke on others and establishing more smoke-free spaces, such as apartment complexes, particularly in Métis communities where exposure is high.
• Implement greater consequences for distributing tobacco and vaping products to youth, as they often acquire these products through social sources.
• Recognize that various factors contribute to commercial tobacco use, such as personal and peer substance use, family dynamics, societal norms, mental health, stress, trauma, impacts of colonization, second-hand smoke exposure, community prevalence, accessibility, advertising, cultural influences, education, age of initiation, and socioeconomic status.

Research

• Collaborate with various agencies to ensure culturally distinct Métis representation and sufficient sample sizes to research and evaluate tobacco regulations within individual Métis communities.
• Highlight Métis underrepresentation in tobacco research and prevention initiatives.
• Ensure that research is conducted in a culturally relevant and respectful manner and ensure that Métis Communities have data sovereignty.
• Require research on effective youth commercial tobacco prevention strategies and intervention methods.

Cessation

• Enhance cessation product access and advocate for inclusion in benefits plans.
• Address smoking normalization in Métis communities.
• Recognize that health warnings have limited efficacy, with time graphic images become normalized and ignored.
• Reduce the amount of nicotine available in different products.
• Implement cessation efforts that aim to connect individuals back with culture and community, that recognize the harms of smoking on the individual, their family, and their community and that recognize the impacts of commercial tobacco products on the land.
• Consider cessation efforts that recognize the difference between the use of commercial and traditional tobacco.

Health Department of the Otipemisiwak Métis Government of the Métis Nation within Alberta

UNDRIP

• Recognize the need for autonomy over programs and services being offered to Métis people.
• Ensure sufficient time, resources, and funding to adequately engage with and represent Community voices.
• Sustainably fund Métis Nation of Alberta who are committed to developing and implementing programs and services that help reduce commercial tobacco use and improve the health outcomes of Métis Albertans.

Protecting Youth and Indigenous Peoples

• Fund and support Métis-led youth tobacco prevention programs.
• Increase cultural safety awareness training among health service providers to create safer spaces for Indigenous people to access support.

Cessation

• Increase free access to nicotine replacement therapies.
• Fund and support the implementation of initiatives led by Elders, Knowledge Keepers, people with lived experience and community champions that are rooted in wholistic wellness and traditional ways of knowing.
• Acknowledge that commercial tobacco use is complex and that multiple individual, social, environmental, and societal factors need to be addressed.
• Reduce commercial tobacco use by implementing wholistic land-based cessation programs, providing access to culturally relevant programs and addressing the cause of dependency.

Métis Nation of Saskatchewan – Ministry of Health

UNDRIP

• Acknowledge that Métis populations have the legacy of residential schools, racism and displacement impacting them directly as survivors, or through intergenerational trauma and that smoking may be used to cope with difficult emotions, stress and with their other substance use.
• Recognize the need for autonomy over programs and services being offered to Métis Peoples, to allow for control over design and for the delivery of culturally appropriate services and programs related to tobacco cessation.
• Recognize the sacred and ceremonial role that traditional tobacco has for many Métis Peoples.
• Provide federal funding that is adequate, stable, equitable, and ongoing and not limited in time or approaches to allows Métis communities to focus on generating community-driven, community-based, client-centered, culturally appropriate, and effective intervention for citizens.

Protecting Youth and Vulnerable Populations

• Reduce the number of cigarette retailers in areas with a low socio-economic status and prohibit discounts on tobacco products.
• Consider that any legislation aimed at Métis commercial tobacco reduction needs to be informed by a harm-reductionist and trauma-informed approach.
• Recognize Métis youth's vulnerability to peer pressure, exposure to tobacco via cannabis, and lack of connection to traditional and spiritual tobacco use.

Cessation

• Enhance access to cessation products and nicotine replacement therapies.
• Stop using smoking cessation advertising campaigns and initiatives that involve shame tactics, as this often reinforces smoking.
• Some marketing strategies include success stories that rely on resources that are inaccessible to some Métis people and can leave them feeling demoralized. Consider smoking cessation initiatives that involve Elders sharing knowledge on traditional tobacco.
• Recognize that tobacco dependence is perceived to be less concerning or harmful relative to managing an addiction to other substances like alcohol and as a way of coping with difficult emotions and stress.
• Recognize that tobacco is often used to connect with others, such as before and after substance addiction support groups.

Health Canada extends its sincere gratitude to the Indigenous Community of Practice for Canada's Tobacco Strategy (coordinated by the National Indigenous Diabetes Association), Manitoba Métis Federation, and to Women of Métis Nation, for engaging in discussions. We value your input and perspectives, and we look forward to continuing our dialogue and collaboration in the future.