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Study shows wide disparities in effectiveness of anti-smoking laws across Canada


The Institute for Clinical Evaluative Sciences (ICES) has developed a measure to gauge how well anti-smoking laws across Canada protect local residents against the harmful health effects of environmental tobacco smoke. When applied, the measure shows that there are wide disparities in the effectiveness of anti-smoking laws across the country, highlighting the need for both improved anti-smoking legislation and more performance measures of public health efforts.

“Reporting on the availability and performance of health services is now routine for many parts of the healthcare system. Public health is a glaring exception, despite many warnings about the state of public health services in Canada,” said report co-author and ICES scientist Dr. Doug Manuel. “There is still almost no publicly available information that describes what public health services are provided across Canada, the quality and level of these services, and how they differ between provinces or local public health departments.”

To this end, ICES scientists developed what they term the “Smoking Regulatory Index (SRI)” – a measure which can be applied across different jurisdictions to produce a score reflecting the degree of either an individual’s or community’s protection against tobacco smoke in public places. Investigators estimated SRIs for local municipalities across Canada using by-law information and estimated environmental tobacco exposure for different settings, such as workplaces and restaurants.

The results highlight wide disparities in public health protection against environmental tobacco smoke across Canadian municipalities. For instance, a municipality such as Abbotsford, B.C. would receive an SRI score of 3 (where 0 means no protection and 100 means complete protection against tobacco smoke) because smoking was only prohibited in elevators, places of public assembly, reception areas, retail stores, and service counters. This compares to a score of 98 in Surrey, B.C., where smoking is prohibited in workplaces, restaurants and licensed establishments, as well as municipal facilities, hospitals, places of public assembly, and public transportation.

“Previous research has shown that laws restricting smoking are an effective public health intervention. They can reduce both the consumption of cigarettes and exposure to tobacco smoke among smokers and non-smokers,” said Dr. Manuel.

“The SRI is an important tool that could be applied nationally and internationally to rank anti-smoking laws, monitor progress in curbing the negative community effects of smoking, as well as support broader efforts to evaluate public health interventions.”

The study, “The Smoking Regulatory Index: a new way to measure public health performance”, is in the May 9, 2006 issue of the Canadian Medical Association Journal (CMAJ).

Author affiliations: ICES (all authors); Department of Public Health Sciences, University of Toronto (Dr. Manuel); Division of Cardiology, Schulich Heart Center, Sunnybrook Health Sciences Centre (Dr. Alter).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Julie Dowdie
  • Media Relations Officer, ICES
  • (416) 480-4780 or cell (416) 432-8143


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