Within three days of learning that their program’s government funding had been unexpectedly cut, staff at Leave the Pack Behind were packing up their office, at Brock University. “Today [May 31] is World No Tobacco Day,” manager Heather Travis says. “Exactly 20 years ago, the World Health Organization’s theme was ‘leave the pack behind.’ That’s where we got our name.”
Since its launch, 19 years ago, Leave the Pack Behind has helped nearly 41,000 adults aged 18 to 25 quit smoking and distributed support materials to almost 200,000 people. The $1 million program is the only one in Ontario that’s specifically designed to promote smoking cessation in young people, and it’s grounded in focus-group-tested approaches.
Young adults don’t always respond to the interventions that work for older smokers. They engage primarily in digital environments, Travis says, and most programs operate in person, in print, or over the phone. And, she notes, “We know that young-adult triggers are different — for instance, social situations, drinking, and the stress of finding a job.”
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Leave the Pack Behind also targets particular subgroups that are at higher risk of smoking, such as Indigenous and LGBTQ young adults and those in the trades and service sectors. LGBTQ individuals are two to three times more likely to smoke than the general population. Suzanne Thibault, Toronto Public Health’s manager of chronic-disease and injury prevention, says that common triggers include “discrimination, stigma, feeling isolated and alone.” According to Travis, LGBTQ young adults make up roughly 37 per cent of the program’s clientele.
With these considerations in mind, Leave the Pack Behind was brought in to host TPH’s One Day … Day 1, a social-media campaign specifically geared toward sexual- and gender-minority young adults, in winter 2018. The cessation campaign ran primarily on Instagram and Facebook and reached LGBTQ youth through interactive materials, such as videos, that featured real voices from the community. Travis says that the number of social-media engagements was three times the industry average for similar campaigns. But, as a result of the Tory cuts, the campaign faces an uncertain future.
Partnering with Leave the Pack Behind on the campaign was an obvious choice for TPH, according to Thibault. The program, she says, “totally fits with our mandate — we want to reach marginalized youth.”
When 19-year-old Dev Vyas saw ads on social media for Leave the Pack Behind’s annual quit-smoking contest, “wouldurather,” they knew this was a challenge that they and their partner should take on. (Vyas uses they/them pronouns.)
“I was never successful on my own,” says Vyas of their attempts to quit. Vyas was bullied in high school for their trans identity; an early graduation led to some travelling — and then to cigarettes as a kind of social currency and coping mechanism.
The contest, which closed on March 29, provided weekly support emails, as well as free smoking-cessation aids that participants didn’t need appointments to get. Vyas says that the emails provided opportunities for the couple to talk about challenges and successes.
“I started being able to go rock climbing, and singing, and all the kinds of things that I could enjoy,” Vyas says, adding that they are an organ donor, so staying healthy is crucial. They ended up quitting smoking, being randomly selected as one of two “Quit for Good” winners for having completed the whole six weeks, and splitting the $2,500 winnings with their partner. “There’s a lot of strength I’m feeling,” Vyas says, “and a lot of pride.”
Vyas’s success is far from an isolated incident, according to Travis: “There’s not a week that goes by that we don’t hear from young people thanking us for the work we do and saying that the reason they’re smoke-free is because of our programs.”
Robert Schwartz, executive director of the Ontario Tobacco Research Unit and a professor at the University of Toronto’s Dalla Lana School of Public Health, says that programs targeting young adults are “where we need to actually redouble our efforts.” Schwartz notes that the number of young-adult smokers is falling, saying, “If it weren’t for Leave the Pack Behind, I’m convinced that the rates of smoking for this age group would be even higher.”
The move by Doug Ford’s government has left many questioning its overall commitment to smoking-cessation and -prevention efforts. “Until this year, there was a $50 million investment in Ontario in tobacco control, and the government is chopping that,” Schwartz says. “The cutting of Leave the Pack Behind is only one thing that they’re doing to basically kill the existing comprehensive tobacco-control strategy.”
The government has a different take. “No one ‘pulled funding’ from the Leave the Pack Behind program,” Hayley Chazan, press secretary for Minister of Health and Long-Term Care Christine Elliott, told TVO.org in an email. “The wind down of this program started in 2017 under the previous government and the reduced, one-time funding ended this year.”
Leave the Pack Behind’s director, Kelli-an Lawrance, says that this is “patently false,” telling TVO.org via email that “funding agreements of the past three years include absolutely no indication that ‘wind-down’ was being contemplated or that funding was expiring. Annual — ‘one-time’ — funding had been renewed for 19 consecutive years. And, as recently as March 2019, the PC government invited Leave the Pack Behind to re-apply for 2019/2020 annual funding as usual.”
Chazan emphasizes that the Ford government wants to “reduce duplication” in the health-care system. But none of the programs that continue to receive government funding tailor their supports, materials, or campaigns specifically to young adults — or to LGBTQ communities.
“Younger adults are not the same as older adults,” Travis says. “What appeals to an older adult is different than for a young adult.” Schwartz notes, for example, that many of the remaining programs are housed within medical settings and physicians’ offices. Such programs, he says, may not appeal to younger adults, who are already less likely to visit their physicians. And, as LGBTQ individuals may have experienced discrimination or stigma in medical settings, such programs are even less likely to draw them in.
Travis is hopeful that the program can survive the funding cut one way or another. “We are certainly hoping to preserve Leave the Pack Behind’s expertise, infrastructure and assets in a way that continues to inspire young adults to resist, reduce or quit smoking/vaping,” she told TVO.org in an email. “All options are being explored, including seeking alternative sources of funding.”
“It’s incredibly short-sighted to cut funding for this program,” Vyas says, noting how safe and affirmed they felt in their trans identity with Leave the Pack Behind. “But I also feel like, once people see the impact of programs like these, we have the ability to build them back up. And our communities deserve that.”