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Every year in Canada, smoking causes 18% of all deaths and costs the taxpayers $16 billion7.
Over one million Canadians suffer with smoking-related diseases7,8.

Smoking morbidity and mortality is 100% preventable9.

Diagnose the problem

Cigarette smoke addiction

Cigarettes became mainstream in the early 20th century due to automation which made them economically viable to produce10. Over decades, tobacco company scientists experimented with chemicals to produce the most addictive product in the world10.

Currently, up to 600 ingredients are added to tobacco cigarettes to cause physiological outcomes and enhance the delivery and effects of nicotine11. Ammonium salts increase nicotine bioavailability; menthol acts as a local anaesthetic and cough suppressant12. Eucalyptol and theobromine are bronchial dilators to increase the volume of  smoke inhaled12. Then, lactones reduce the body’s ability to metabolize nicotine; and acetaldehyde mimics monoamine oxidase inhibitors (anti-depressant effect)12.

Cigarettes are more addictive than just nicotine on its own and the most harmful source of nicotine13. When smokers switched to tobacco harm reduction (THR), they reported improvements in chronic diseases14 and general health 15.

At-risk populations

Higher prevalence in vulnerable populations

Those with metal health disorders have double the smoking prevalence of the general population16. For instance, people with schizophrenia have up to 80% prevalence17. Cigarettes are the most harmful source of nicotine18.

While smoking prevalence has significantly declined in the last 50 years, people of lower socio-economic status prevalence has hardly changed19. Considering that a pack of cigarettes in Canada costs up to $20, this expense adversely effects their ability to afford healthy food for themselves and their children.

Smoking rates

15% of Canadians smoke

About 4.6 million Canadians 15 years and older are addicted to cigarette smoke20. It is the most common addiction in Canada21. Toxins in smoke include: carbon monoxide which displaces oxygen on RBC; hydrogen cyanide which paralyses lung cilia; free radicals which cause atherosclerosis22.

7000+ chemicals in smoke

Combustion is a problem

Burning chemical laden cigarettes cause new toxins to form22. Cigarette smoke contains hundreds of known disease causing agents and 69 carcinogens11, 22. Smoking is responsible for 36% of respiratory diseases, 29% of cancers, 14% of cardiovascular diseases, 85% of lung cancer and 87% of COPD23.

100% preventable costs

Death and taxes

Premature deaths caused from smoking leads to 599,390 potential years of life lost24. Tax expenditures include $6.4 billion in direct health care costs and indirect costs includes $6.8 billion for long-term disability24.

The needless suffering

The human element

The accumulative effects of the toxins deteriorates the smoker’s health22. This adversely effects their families such as when the main earner can no longer work and their children cannot afford a higher education24.

Long term effects

The next generation

If we help grandparents stop smoking, they can enjoy active relationships with their grandchildren. After one year of quitting smoking, patients’ risk of heart attack reduces by 50%; after 10 years, risk of lung cancer is reduced to 50% and risk of coronary heart disease is the same as a never smoker25.

Harm reduction for smokers

Medical autonomy

When patients are unable to cease risky behaviours, the next best intervention is harm reduction such as practising safe sex to avoid HIV26. Health professionals are responsible to promote harm reduction27.

Stay current in the evidence

What you don’t know can harm your patients

Let the scientific findings guide your practice.


7. The Conference Board of Canada. (2017). The costs of tobacco use in Canada, 2012.

8. Centres for Disease Control and Prevention. (2014). Fast facts: Diseases and death.

9. Health Canada. (2014). Health concerns: Notice of proposed order to amend the schedule to the Tobacco Act.

10. Institute of Economic Affairs. (2013). Free market solutions in health: The case of nicotine.

11. Rabinoff, M., Caskey, N., Rissling, A., & Park, C. (2007). Pharmacological and Chemical Effects of Cigarette Additives.

12. Europa. (2010). Public Health: Tobacco additives.

13. Laugesen, M. (2013). Nicotine and health.

14. Farsalinos, K. E., Romagna, G., Tsiapras, D., Kyrzopoulos, S., & Voudris, V. (2014). Characteristics, perceived side effects and benefits of electronic cigarette use: A worldwide survey of more than 19,000 consumers.

15. Polosa, R., Rodu, B., Caponnetto, P., Maglia, M., & Raciti, C. (2013). A fresh look at tobacco harm
 reduction: the case for the electronic cigarette.

16. Mental Health and Smoking Partnership. (2017). Statement on Electronic Cigarettes

17. Royal College of Physicians. (2013). Smoking and mental health: A joint report by the Royal College of Physicians and the Royal College of Psychiatrists.

18. Nutt, D. J., Phillips, L. D., Balfour, D., Curran, H. V., Dockrell, M., Foulds, J., Fagerstrom, K., Letlape, K., Milton, A., Polosa, R., Ramsey, J., & Sweanor, D. (2014). Estimating the harms of nicotine-containing products using the MCDA approach.

19. Public Health England. (2015). E-cigarettes: an evidence update A report commissioned by Public Health England.

20. Reid, J., Hammond, D., Tariq, U., Burkhalter, R., Rynard, V.L., & Douglas, O. (2019). Tobacco Use in Canada: Patterns and Trends, 2019 Edition.

21. Public Health Agency Canada. (2014). Tobacco.

22. A Report of the Surgeon General. (2010). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General.

23. Dawkins, L. (2013). Why is it so hard to quit smoking?

24. Conference Board of Canada. (2017). The Costs of Tobacco Use in Canada, 2012.

25. Canadian Cancer Society. (2020). Amazing ways your body bounces back.

26. Canadian Nurses Association. (2017). Harm reduction & illicit substance use: Implications for nursing.

27. Canadian Nurses Association. (2018). Harm reduction and substance use: Joint position statement.