In January 2014, the Board of the Windsor-Essex County Health Unit resolved to endorse the following actions and policies to reduce the exposure of second-hand smoke in multi-unit housing:
- Encourage all landlords and property owners of multi-unit housing to voluntarily adopt no-smoking policies in their rental units or properties;
- All future private sector rental properties and buildings developed in Ontario should be smoke-free from the onset;
- Encourage public/social housing providers to voluntarily adopt no-smoking policies in their units and/or properties;
- All future public/social housing developments in Ontario should be smoke-free from the onset.
- Encourage the Ontario Ministry of Housing to develop government policy and programs to facilitate the provision of smoke-free housing.
In January 2014, the Board of the Windsor-Essex County Health Unit resolved to endorse several actions and policies to reduce the exposure of second-hand tobacco smoke in multi-unit housing. This included action from existing and future private landlords, existing and future public/social housing providers to adopt smoke-free policies in their rental units or properties, as well as encouraging the Ontario Ministry of Housing to develop government policy and programs to facilitate the provision of smoke-free housing. Since that time, emerging tobacco and non-tobacco products have evolved and/or become available legally such as e-cigarettes and cannabis. It is important that smoke-free policies adapt to include such products for the health and safety of all residents of multi-unit housing, and also to protect the investment of landlords and property owners.
In December 2015, the Government of Canada announced its commitment to legalize, regulate, and restrict access to non-medical cannabis in Canada, with the intent to keep cannabis out of the hands of children and the profits out of the hands of criminals. In response, the Windsor-Essex County Health Unit Board of Health passed a resolution on January 14, 2016 supporting a public health approach to cannabis legalization, including strong health-centered and age-restricted regulations to reduce the health and social harms associated with cannabis use. In addition, the resolution mandated the Windsor-Essex County Health Unit support the development of healthy public policies and enforcement of future regulations to ensure minimal negative effects on public health and safety. The federal government introduced Bill C-45, the Cannabis Act, in April of 2017. This legislation would legalize access to non-medical (i.e., recreational) cannabis in Canada and provide a foundation of regulations on which provincial/territorial governments could develop more specific controls for how cannabis is grown, distributed, and sold in their provinces and territories. This Act came into effect on October 17, 2018.
Prior to its legalization, cannabis was the most commonly used illegal substance in Canada (CCSA, 2017). Approximately 15% of Ontario residents report cannabis use within 12 months (CCSA, 2016). In Windsor-Essex County, approximately 28, 900 residents used cannabis in the last year and among those who consume cannabis, rates are highest among youth and young adults (WECHU, 2016). Cannabis smoke contains similar toxins to those found in tobacco smoke associated with cancer, heart and respiratory disease (SHAF, 2016). Due to the added psychoactive properties of cannabinoids such as THC (tetrahydrocannabinol), cannabis also increases the risk of injury or harms associated with impaired driving, falls, and other preventable incidents. Cannabis can also cause short or long term damage to cognitive functioning (i.e., memory, focus, ability to think and learn), depression, anxiety, psychosis, and addiction. These harms increase when cannabis use begins prior to the age of 25, and with frequent or heavy use (CCSA, 2016; Parachute Vision Zero Network, 2018). Lastly, maternal cannabis use is linked to low birth weight, pregnancy complications, and may affect children’s cognitive functioning, behaviour, mental health and future substance use (Best Start, 2017).
Exposure to cannabis smoke should be limited, especially for children and those with respiratory or cardiovascular illness. Smoking or vaping of cannabis should be restricted to outdoors (Health Canada, 2018). Research on the effects of second-hand cannabis smoke exposure is limited; however, studies have shown that exposure to second-hand cannabis smoke leads to cannabinoid metabolites in bodily fluids, and can cause exposed individuals to experience psychoactive effects (Holitzki, Dowsett, Spackman, Noseworthy & Clement, 2017).
Electronic cigarettes may or may not resemble traditional tobacco cigarettes. They consist of a battery, a heating element, and a cartridge that holds “e-liquid” or “e-juice,” a solution usually made of propylene glycol, glycerin, flavouring agents, and in many cases, nicotine. When a user “puffs” on the device, the solution is heated and the resulting vapour is inhaled into the lungs and exhaled in the same manner as a tobacco cigarette. E-cigarette devices can also be used to ingest cannabis-infused oils (PHO, 2018).
Bill S-5, which received Royal Assent in May 2018, established a new legislative framework for regulating vaping products in Canada. Under this framework, e-cigarettes and other vaping products are classified into two main categories: recreational or therapeutic. ‘Recreational’ e-cigarettes (with and without nicotine) do not make any health claims and are regulated under the federal Tobacco and Vaping Products Act for the manufacture, sale, labelling and promotion of vaping products. ‘Therapeutic’ e-cigarettes may be used to treat nicotine dependence, are allowed to make health claims, and are regulated under the more stringent Food and Drugs Act. On September 27th, 2018 the Government of Ontario introduced Bill 36 that makes amendments to the e-cigarette provisions under the Smoke-Free Ontario Act, 2017 and came in to force on October 17th, 2018, replacing the Smoke-Free Ontario Act, 2006 and the Electronic Cigarettes Act, 201 (PHO, 2018).
The safety of e-cigarette use and second-hand vapour in the short and long term is still unknown as the health effects have not been thoroughly studied. While Health Canada has approved propylene glycol and glycerin as food additives, it is possible that they may be dangerous when vaporized and inhaled. The particles in e-cigarette vapour, including flavouring compounds, are particularly hazardous because they reach deep into lung tissue when used as intended. Some studies have shown e-cigarette vapour can also include heavy metals and other cancer-causing compounds such as formaldehyde (Czoli, Reid, Rynard & Hammond, 2015). Exposure to e-liquids, including accidental ingestion, eye contact, or skin exposure can also lead to adverse health effects. As of May 2018, nicotine can be legally present in vaping products in Canada. The addictive properties of nicotine could result in dependence on e-cigarettes. Children and youth are especially susceptible to the negative effects of nicotine including addiction, and negative effects on brain development, memory and concentration (PHO, 2018).
In 2015, 3.2% of Canadians aged 15 or older used e-cigarettes in the past month. In all age groups, the prevalence of past month e-cigarette use increased from 2013 to 2015. Prevalence in Canada is highest among youth (15-19 years) and young adults (20-24 years), where 6.3% reported the use of e-cigarettes in the past month. In Ontario, youth and young adults report the highest past year use of e-cigarettes of all age groups. The CAMH Monitor estimates that in 2016, 20% of Ontario young adults (18-24 years) used e-cigarettes in the past year. The Ontario Student Drug Use and Health Survey (OSDUHS) estimates that in 2017, 18% of Ontario youth (grades 7-12) used e-cigarettes in the past year (PHO, 2018).
Under the Smoke-Free Ontario Act, 2017, smoking or vaping is prohibited in indoor common areas of condominiums, apartment buildings and college and university residences. Examples of common areas include elevators, stairwells, hallways, parking garages, laundry facilities, lobbies, exercise areas and party or entertainment rooms. This means that unless you have signed an agreement or lease or are in a condominium with bylaws that say otherwise, you are allowed to smoke or vape in your private home. In the Act “Smoking” means smoking (inhaling and exhaling) or holding lighted tobacco or cannabis (medical or recreational), and “vaping” means inhaling or exhaling vapour from an electronic cigarette (e-cigarette) or holding an activated e-cigarette, whether or not the vapour contains nicotine (Government of Ontario, 2018).
The legalization of cannabis and vape products in Canada may increase access, normalization, rates of smoking and/or vaping, exposure to second-hand smoke, and exposure to smoking behaviour. While more research is needed to understand the health effects of long-term exposure to second and third-hand smoke, it is recommended to align tobacco and marijuana smoking policies to be most effective (Holitzki, Dowsett, Spackman, Noseworthy & Clement, 2017). Given the potential harms of cannabis and e-cigarette use behaviour and smoke or vape exposure, it is vital that the Board of Health expand on its resolution for smoke-free multi-unit dwellings to encourage housing providers to adopt smoke-free housing policies which explicitly include these products.
Whereas, the federal government has passed the Cannabis Act, 2017 to legalize non-medical cannabis, coming into effect on October 17th, 2018, and
Whereas, cannabis smoke contains many of the same carcinogens, toxins, and irritants found in tobacco smoke with the added psychoactive properties of cannabinoids like THC, and
Whereas, Ontarians spend most of their time at home, and it is in this environment where exposure continues to be reported, and
Whereas, indoor air studies show that, depending on the age and construction of a building, up to 65% of the air in a private residence can come from elsewhere in the building and no one should be unwillingly exposed or forced to move due to unwanted second-hand smoke exposure,
Now therefore be it resolved that the Windsor-Essex County Board of Health endorse the following actions and policies to reduce the exposure of second-hand smoke in multi-unit housing:
- Encourage all landlords and property owners of multi-unit housing to voluntarily adopt no-smoking policies in their rental units or properties and explicitly include cannabis smoke and vaping of any substance in the definition of smoking;
- All future private sector rental properties and buildings developed in Ontario should be vape and smoke-free from the onset;
- Encourage public/social housing providers to voluntarily adopt no-smoking and/or vaping policies in their units and/or properties;
- All future public/social housing developments in Ontario should be smoke and vape-free from the onset.
- Encourage the Ontario Ministry of Housing to develop government policy and programs to facilitate the provision of smoke-free housing.
AND FURTHER that this resolution be shared with the Honorable Prime Minister of Canada, local Members of Parliament, the Premier of Ontario, local Members of Provincial Parliament, Minister of Health and Long-term Care, Federal Minister of Health, the Attorney General, Chief Medical Officer of Health, Association of Local Public Health Agencies, Ontario Boards of Health, Ontario Public Health Association, the Centre for Addiction and Mental Health, and local community partners.
- Best Start. (2017). Risks of cannabis on fertility, pregnancy, breastfeeding and parenting. Retrieved from https://www.beststart.org/resources/alc_reduction/RisksOfCannabis_A30-E.pdf
- Canadian Centre on Substance Use and Addiction [CCSA]. (2017). Cannabis: Canadian drug summary. Retrieved from https://www.cpha.ca/sites/default/files/uploads/resources/cannabis/ccsa-...
- Canadian Centre on Substance Abuse [CCSA]. (2016). Clearing the smoke on cannabis: Highlights. Retrieved from https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Cannabis-Use-Respir...
- Czoli, C. D., Reid, J. L., Rynard, V. L. & Hammond, D. (2015). Tobacco use in Canada: Patterns and trends, 2015 Edition, Special
- supplement: E-cigarettes in Canada. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo.
- Government of Ontario. (2018). Where you can’t smoke or vape in Ontario. Retrieved from https://www.ontario.ca/page/where-you-cant-smoke-or-vape-ontario
- Health Canada. (2018). Thinking about using cannabis before or during pregnancy? Retrieved from https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/health-effects/before-during-pregnancy.html
- Holitzki, H., Dowsett, L., Spackman, E., Noseworthy, T. & Clement, F. (2017). Health effects of exposure to second- and third-hand marijuana smoke: A systematic review. Canadian Medical Association Journal Open, 5(4): E814-E822. doi: 10.9778/cmajo.20170112
- Parachute Vision Zero Network. (2018). Cannabis and drug impaired driving: What’s happening in Canada right now? Retrieved from https://parachute.ca/wp-content/uploads/2019/06/Vision-Zero-Case-Study-4.pdf
- Public Health Ontario. (2018). Current evidence on e-cigarettes: A summary of potential impacts. Retrieved from https://parachute.ca/wp-content/uploads/2019/06/Vision-Zero-Case-Study-4.pdf
- Smoking and Health Action Foundation [SHAF]. (2016). Secondhand marijuana smoke: Health effects of exposure. Retrieved from https://nsra-adnf.ca/wp-content/uploads/2016/11/health_effects_of_exposure_to_secondhand_mj_smoke_2016-final2.pdf
- Windsor-Essex County Health Unit. (2016). Community needs assessment report. Windsor, Ontario.