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Growing number of female smokers is a worrying trend

The anti-smoking battle in Hong Kong isn’t over yet.

John Tsang Chun-wah, the city’s financial secretary, will unveil the government’s Budget for the year ending March 31, 2017, today (Wednesday). He is strongly advised to raise tobacco tax again to discourage people, particularly women, from smoking.

The number of female smokers is small, but the growing trend is worrying. The number of female smokers rose to 3.2 percent in 2015 from 3.1 percent a year earlier. Just imagine the damage done to young people if they smoke at home with children playing in the same room.

The percentage of people who smoke in Hong Kong has fallen, according to government figures. It dropped to 10.5 percent in 2015 from 11.8 percent in 2009. The decline, however, did not look impressive. Joining hands, the government and the community can do a better job in reducing the population of smokers in the city.

The government’s Hospital Authority statistics show that 75,870 young people under the age of 18 were admitted to hospital between 2004 and 2012 (the latest numbers available) due to diseases caused by lower respiratory tract infections. They included serious complaints such as empyema, pleural effusions and abscesses in the lung. Of those admitted to hospital, 80 percent were pre-schoolers of five years old or younger. Many of the diseases were smoking-related.

The government should enact new laws to prohibit smoking in any common areas of any residential premises or buildings (e.g. common corridors, staircases); any covered or underground pedestrian walkways; any pedestrian overhead bridges; any bus interchanges (not just bus stops), including any area within a certain radius of bus shelters; and hospital outdoor compounds.

More importantly, the government should also ban smoking in public areas with a queue of three or more people. Hong Kong people love to queue. We queue for cinema tickets, we queue in front of a sushi shop or cha chaan teng (Cantonese-style restaurants) and we queue for application forms for our children to enter favored kindergartens. The second-hand smoke that people inhale, in case there is a smoker in the queue, can cause cancer or other serious — even fatal — diseases.

The government and NGOs in the city can expand publicity campaigns (NGOs can raise funds from wealthy tycoons in the city) to call on people to quit smoking and discourage others, particularly young people, from contracting this unhealthy habit. We should spread the message that smoking isn’t “cool.”

More than 60 percent of school-age children could avoid chest infections if there were more no-smoking areas in Hong Kong, University of Hong Kong (HKU) medical and public health academics advocated recently. They said youngsters under the age of 18 are susceptible to pollutants produced by smokers, so the risk of infection could be reduced if the government extended prohibition on smoking.

In a study, the HKU academics deduced that the effect of second-hand smoke on children aged 6 to 18 will be more apparent as they tend to spend more time outside the home and are therefore more exposed to pollutants. And of course, parents with minor children are strongly advised not to smoke at home.

Smoking in local universities is banned. Some university authorities have placed rubbish bins on the roads linking the campuses with neighboring residential districts. Scores of young students can always be seen smoking around these bins and extinguishing the cigarette butts on the dustbins. People often describe such scenes as dabinlo (eating around a hotpot). It is a good practice to keep the streets clean but, more importantly, university authorities are well-advised to dispatch volunteering teams (composed of teachers and students) to these gathering sites to talk to the smokers, trying to convince them to quit smoking and keep the campuses smoke-free. Students are society’s future leaders and they must set a good example.

This is a small step but it is a major step in the battle to rid campuses, and Hong Kong at large, of smokers.

The author is a veteran journalist and an adjunct professor at Shue Yan University.

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Kicking the habit: percentage of smokers in Hong Kong at new low, survey reveals

10.5pc of population indulged in habit last year as prevalence fell, but more women still smoke, Centre for Health Protection study finds

The percentage of smokers in the city last year dropped to its lowest level since records began 33 years ago, a study has found.

According to the survey of 10,000 households by the Centre for Health Protection, 10.5 per cent of the population above the age of 15 are daily smokers.

In 2008, the figure was 11.8 per cent and 10.7 per cent in 2012.

Undersecretary for Food and Health Sophia Chan Siu-Chee attributed the decline to effective tobacco control measures.

“The smoking prevalence in Hong Kong is amongst the lowest in the region. The government will continue to work towards bringing the figure down to a single digit,” she said.

The survey also showed that the smoking prevalence among young people between 15 and 19 dropped significantly – from 2 per cent in 2012 to 1.1 per cent last year.

However, Chan noted that the figure for female smokers saw a slight increase from 3.1 per cent in 2012 to 3.2 per cent.

“Research has shown the reasons that compel women to smoke are different from men. Therefore traditional methods for helping them to quit smoking may not work as well,” said Chan.

“We will review our current set-up and see whether we need to come up with specific services and measures targeting women.”

The survey also looked at the prevalence of electronic cigarette users in the city.

While e-cigarette usage in Hong Kong remained very low, the centre noted that 9 per cent of secondary school students have tried the devices, a trend Chan described as “worrying”.

“We are seriously considering prohibiting the import, manufacture, sale, distribution and advertising of e-cigarettes through legislation,” she said.

The undersecretary added the government is currently working on the details of the legislation but did not set out a timetable for when they will table the proposal at the Legislative Council.

Aside from regulating electronic cigarettes, Chan said the government is also aiming to start a legislative process on enlarging health-warning signs on tobacco products to cover 85 per cent of the packaging this year.

Another area Chan said authorities would continue to work on is the expansion of statutory no-smoking areas.

On March 31, the areas will be further extended to eight bus interchanges.

“Some suggested all bus stops in Hong Kong. Others suggested near schools and hospitals. So we have to consider all these factors and then we will work out a plan accordingly,” she said.

Chan declined to give an answer on whether tobacco tax would be increased in this year’s budget, only saying the current rate in Hong Kong is comparable to the World Health Organisation’s recommendation.
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Progression to Traditional Cigarette Smoking After Electronic Cigarette Use Among US Adolescents and Young Adults


Electronic cigarettes (e-cigarettes) may help smokers reduce the use of traditional combustible cigarettes. However, adolescents and young adults who have never smoked traditional cigarettes are now using e-cigarettes, and these individuals may be at risk for subsequent progression to traditional cigarette smoking.


To determine whether baseline use of e-cigarettes among nonsmoking and nonsusceptible adolescents and young adults is associated with subsequent progression along an established trajectory to traditional cigarette smoking.

Design, Setting, and Participants

In this longitudinal cohort study, a national US sample of 694 participants aged 16 to 26 years who were never cigarette smokers and were attitudinally nonsusceptible to smoking cigarettes completed baseline surveys from October 1, 2012, to May 1, 2014, regarding smoking in 2012-2013. They were reassessed 1 year later. Analysis was conducted from July 1, 2014, to March 1, 2015. Multinomial logistic regression was used to assess the independent association between baseline e-cigarette use and cigarette smoking, controlling for sex, age, race/ethnicity, maternal educational level, sensation-seeking tendency, parental cigarette smoking, and cigarette smoking among friends. Sensitivity analyses were performed, with varying approaches to missing data and recanting.


Use of e-cigarettes at baseline.

Main Outcomes and Measures

Progression to cigarette smoking, defined using 3 specific states along a trajectory: nonsusceptible nonsmokers, susceptible nonsmokers, and smokers. Individuals who could not rule out smoking in the future were defined as susceptible.


Among the 694 respondents, 374 (53.9%) were female and 531 (76.5%) were non-Hispanic white. At baseline, 16 participants (2.3%) used e-cigarettes. Over the 1-year follow-up, 11 of 16 e-cigarette users and 128 of 678 of those who had not used e-cigarettes (18.9%) progressed toward cigarette smoking. In the primary fully adjusted models, baseline e-cigarette use was independently associated with progression to smoking (adjusted odds ratio [AOR], 8.3; 95% CI, 1.2-58.6) and to susceptibility among nonsmokers (AOR, 8.5; 95% CI, 1.3-57.2). Sensitivity analyses showed consistent results in the level of significance and slightly larger magnitude of AORs.

Conclusions and Relevance

In this national sample of US adolescents and young adults, use of e-cigarettes at baseline was associated with progression to traditional cigarette smoking. These findings support regulations to limit sales and decrease the appeal of e-cigarettes to adolescents and young adults.

Young people and e-cigarettes – what do the latest data tell us?

Linda Bauld

In an article co-commissioned with The Conversation, Professor Linda Bauld – Director of the Institute for Social Marketing at the University of Stirling, and Cancer Research UK’s cancer prevention champion – looks at the latest evidence on e-cigarette use in young people.

Thanks to decades of action against tobacco, smoking rates among children and young people are in decline: far fewer teenagers are now taking up smoking than in the past.

In England, for example, just 3 percent of 11-15 year olds are regular smokers, with similar figures in Scotland and elsewhere in the UK. This is welcome news, and will play a significant role in protecting the adults of the future from the fourteen types of cancer linked to smoking, as well as other diseases such as heart disease and stroke.

Over the same period, we’ve also witnessed the advent of nicotine replacement as a means to help adult smokers quit. Reviewing these products back in 1991, Professor Michael Russell remarked that smokers ‘smoke for the nicotine, but they die from the tar’. In other words, it’s the many other toxic chemicals in combustible tobacco that cause disease and death – not nicotine.

Yet considerable public confusion exists about nicotine, with up to 90 percent of non-smokers, and 75 percent of smokers, believing it is harmful.

More recently, we’ve witnessed a rapid rise in the use of e-cigarettes, which has caused considerable debate and controversy – particularly surrounding their use and uptake among young people. This concern is probably partly caused by the confusion over the relative harmfulness of nicotine.

E-cigarettes commonly contain nicotine, as well as other substances including propylene glycol and flavourings. But unlike tobacco, they don’t expose people to many of the harmful chemicals found in tobacco. They’re widely available: the World Health Organisation recently estimated that half of the world’s population live in countries where e-cigarettes can be bought. And there’s a growing body of evidence that they can help adult smokers to stop using tobacco.

However, health professionals, policy makers and others are worried that e-cigarettes’ widespread availability might create a new generation of young nicotine addicts. If they were to take up tobacco smoking, this could undermine the great strides made against teenage smoking.

Is this a valid concern? What do the latest data tell us?

Emerging evidence

When my team at the University of Stirling first reviewed the studies on e-cigarette use in young people, early in 2014, we could only find nine published peer reviewed studies reporting prevalence of use in any country. Since then, more than 30 new studies have been published, from countries as diverse as Korea, France, Poland, Canada and Iceland. Most of these studies, particularly from larger countries like the USA, focus on a single region or school district.

The UK is an exception, and nationally representative cross-sectional data are available. What do they show?

Four representative surveys of UK teenagers were conducted in 2014, and while they focused on slightly different age groups, their findings were very consistent – a significant proportion of young people had tried electronic cigarettes at least once (8 percent in one survey in Great Britain, and 12 percent in a representative UK-wide survey, and in national surveys in Scotland and Wales).

The same survey for Great Britain had also been conducted previously in 2013, and in an analysis published just yesterday in Public Health, the proportion of young people who had tried e-cigarettes rose between the two surveys. But the proportion who regularly used e-cigarettes (i.e. more than once a month), was still very low in 2014 (from 0.4 per cent in Scotland to 2 percent in the UK survey), and concentrated in youth who also smoked.

Three of these surveys failed to find any young non-smokers who regularly used e-cigarettes
But what about among non-smokers?

Three of these surveys failed to find any young non-smokers who regularly used e-cigarettes, with the fourth – a survey of about 9,000 11-16 year olds in Wales – identifying just 54 participants who had never tried tobacco but who regularly used an e-cigarette.

What this all tells us is that, while young people are experimenting with e-cigarettes, and that the proportion who say they’ve tried them is rising, only very small numbers of young non-smokers are attracted to these products on any regular basis.

This, it’s worth remembering, is during a period when smoking rates among young people are continuing to fall, suggesting that – in the UK at least – there is no evidence yet that more young people are starting to smoke because of e-cigarettes.

But there’s an important caveat. The UK studies – like those in other countries – are cross-sectional surveys that merely provide a snapshot. They say nothing about longer-term trends, nor about changes in behaviour. For that, we need longitudinal studies, which follow the same group of people over time.

The US picture

New research – published today in the Journal of the American Medical Association – conducted in 10 high schools in Los Angeles, USA, provides the first example of a longitudinal study looking at e-cigarette and tobacco use.

It involved approximately 3,300 participants, who were 14 years old on average when they joined the study. They were followed up twice, after 6 and 12 months.

Among all participants, 7 percent had used an e-cigarette at least once in the past 30 days.

But once the researchers looked at the 2,530 who had never used tobacco at the start of the study, just 222 of them – 8.7 percent – said they’d ever tried an e-cigarette.

But were these young people more likely to then try smoking (either cigarettes, cigars or hookah pipes)?

The researchers found that those who said they’d tried an e-cigarette at the start of the study were also more likely to have tried smoking six months later (30.7 percent vs 8.1 per cent) and 12 months later (25.2 percent vs 9.3 percent).

The authors collected information on other factors that might put young people at risk of smoking (such as their socio-economic background) and adjusted for these – but still found the link.

So what to make of this finding? There are several caveats, as the authors make clear. This association doesn’t prove that e-cigarettes cause young people to take up smoking – it merely demonstrates a statistical link between the two. On top of this, the way e-cigarette and tobacco use were measured was very basic, only determining whether people had ‘ever’ or ‘recently’ used them – not whether this was regular or sustained use.

And importantly, the age group in the study had just moved to secondary school – a time of transition and trying new things.

The numbers that were the main focus of the analysis were also very small – just 222 non-smoking e-cigarette users.

So to find out more, future longitudinal studies are needed, that follow people up for longer, provide more information on how regularly they use e-cigarettes and tobacco, and also the types of products are used. And we need studies that provide evidence on the safety of e-cigarettes, and their role in smoking cessation.

And research is also needed to assess the impact of policy changes being introduced in a number of countries to regulate e-cigarettes, including measures to limit youth uptake.

For this reason research organisations such as Cancer Research UK are looking closely at the issue of e-cigarettes and funding a number of studies. Ongoing monitoring and research, including studies that involve the public and e-cigarette users, are important if we are to inform policy and practice.

Previous research has played a hugely valuable role in helping to protect young people from the disease and death that smoking causes. The place of e-cigarettes within this remains to be seen – but it may be important, and we need to study it.

India second largest consumer of tobacco

India is the second largest consumer of tobacco after China and 8-9 lakh deaths can be attributed to it each year, the government today. “India is the second largest consumer of tobacco after China.

As per the report of Tobacco Control 2004 published by Health Ministry, each year 8-9 lakh deaths in India can be attributed to tobacco use,” Minister of State for Health Shripad Naik told Rajya Sabha today.

He said that as per the Global Adult Tobacco Survey (GATS 2010) conducted by Health Ministry, 35 per cent of adults in the age group of 15 years and above consume tobacco in some form or the other.

“Among them, 33 per cent of the adult males and 18 per cent of the adult females use smokeless forms of tobacco,” Naik said. The Minister said that the government has taken a series of measures to educate citizens on the ill-effects of tobacco use and persuade them to quit it.

He said that public awareness campaigns on ill effects of tobacco use through media at national and state level as part of the National Tobacco Control Programme and National Health Mission has been undertaken while notification to regulate depiction of tobacco products or their use in films and TV programmes has been done.

Naik also said that notification for display of pictorial warning on tobacco product packages has been done while the government has set up tobacco cessation centre to provide counselling to those who desire to quit it as part of the district level activities under National Tobacco Control Programme in the 12th Five year plan has been done. PTI

Corporate results: Tobacco giant makes Rs1 million per hour in profit

Pakist­an Tobacc­o Compan­y record­s net profit of Rs4.7b for the first half of 2015
By Farooq Baloch

KARACHI: In what has become its highest ever earnings, Pakistan Tobacco Company (PTC) made more than Rs1 million per hour in net profit during six months ended June 30, 2015, the company’s financial results showed on Wednesday.

The Pakistani subsidiary of British American Tobacco Company reported an after-tax profit of Rs4.7 billion or Rs18.5 per share for the first half of 2015, increasing its bottom line by two-thirds compared to Rs2.8 billion or Rs11 per share in the corresponding period of 2014.

This is the highest income PTC has ever reported since it launched operations in the country.

The multinational tobacco giant, which pays more in taxes to the government than what is paid by the entire salaried class combined, contributed Rs49 billion – also its highest ever – to the national exchequer in the form of duties and taxes for the period under review. This is a 17% increase over the same period of previous year.

Pakistan’s largest tobacco manufacturer, which accounts for more than half the market, saw its net sales increase by 23% to Rs24.6 billion during the period under review compared to Rs20 billion in the first six months of 2014.

“This result was well above market consensus estimates,” Topline Securities said in its report, adding the company’s net profit was driven by record high gross margins of 41%, a year-on-year (YoY) increase of 543 basis points.

Decline in international oil prices helped improve macroeconomic conditions, which led to higher consumer spending during the six-month period, the report said. As a result, PTC’s sales increased by 23% YoY.

On a quarter-on-quarter basis, net sales grew by 17% to Rs13.2 billion while after-tax profit registered a growth of 27%. On a YoY basis, sales and net earnings for the quarter ended June 30, 2015 were up 23% and 65% respectively, it said.

The company has posted five-year (2010-14) sales and profit compound annual growth rate of 13% and 10% respectively.

Pakistan is one of the biggest markets in Asia in terms of cigarette consumption with an estimated annual consumption of 81 billion sticks – that is 422 cigarettes per person per year.

“With a 2% rise in Pakistan’s population in 2015, the company’s volumes are expected to reach an estimated 45 billion sticks,” according to Topline’s report.

The government has increased federal excise duty (FED) on tobacco to 63% in the new budget. However, Topline said cigarette manufacturers have already increased prices by 5% to 10% on average to pass its impact on to the consumer.

Published in The Express Tribune, July 23rd, 2015.

A horse, a horse … Turkmenistan president honours himself with statue

Chan said the country had ratified the framework convention on tobacco control in 2011, by which time it had already banned smoking in public places.

Also speaking at the forum, was Vera Luiza da Costa e Silva, the head of the convention’s secretariat, who challenged the central Asian state to drive smoking down to 5% in the coming years.

In 1990, 27% of Turkmen men over 15 and 1% of women smoked.

A decade later Turkmenistan banned smoking in public places, state buildings and the army, and all forms of tobacco advertising.

By comparison, 31.1% of the global male population over the age of 15 smoked in 2012, and 6.2% of women were smokers.

Berdymukhamedov, who trained as a dentist and is a keen horseman, has been in power since the death of his eccentric predecessor, Saparmurat Niyazov, in 2006. Niyazov campaigned against smoking and built a 36km “path of health” into the mountains surrounding Ashgabat which government officials were forced to walk.

In April, the gas-rich country of more than five million held a month of public exercises and sporting events under the slogan “health and happiness”.

Turkmenistan: the health-obsessed country where nobody smokes

The former Soviet republic tops the world’s non-smoking league with fewer than one in 12 people still using tobacco

Agence France-Presse

The health-obsessed former Soviet republic Turkmenistan is the country with the world’s lowest proportion of smokers, the World Health Organisation’s director general, Margaret Chan, said during a visit to the isolated nation on Tuesday.

“Recently a WHO overview showed that in Turkmenistan only 8% of the population smokes,” Chan told the country’s authoritarian president, Gurbanguly Berdymukhamedov, at a health forum in the capital, Ashgabat.

“This is the lowest national indicator in the world. I congratulate you on this achievement.”

The world’s most non-smoking country

Just 8% of the population smoke in this nation


Health-obsessed former Soviet Turkmenistan is the country with the world’s lowest proportion of smokers, World Health Organisation chief Margaret Chan said during a visit to the isolated nation on Tuesday.

Chan said that just 8 per cent of the population smoked, according to WHO figures.

“Recently a WHO overview showed that in Turkmenistan only 8 per cent of the population smokes,” Chan told the country’s authoritarian President Gurbanguly Berdymukhamedov, who is a dentist by training.

“This is the lowest national indicator in the world. I congratulate you on this achievement,” she said at a health forum in the capital Ashgabat.

Cited by state media, Chan noted that the country ratified the Framework Convention on Tobacco Control in 2011 by which time it had already banned smoking in public places.

Also speaking at the forum, Vera Luiza da Costa e Silva, Head of the Convention Secretariat, challenged the Central Asian state to drive smoking down to five per cent of the population in the coming years.

In 1990, 27 per cent of Turkmen males over 15 and 1 per cent of females smoked.

A decade later Turkmenistan banned smoking in public places, state buildings and the army, as well as all forms of tobacco advertising.

By comparison, 31.1 per cent of the global male population over the age of 15 smoked in 2012, while 6.2 per cent of females were smokers.

President Berdymukhamedov, in power since the death of eccentric predecessor Saparmurat Niyazov in 2006, is a keen equestrian, while Niyazov campaigned against smoking and built a 36-kilometre “path of health” into the mountains surrounding Ashgabat which government officials were forced to walk.

This April the gas-rich country of more than five million held a month of public exercises and sporting events under the slogan “health and happiness”.