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December, 2008:

HKU Study Shows High Health Risks for Catering Workers (and Bar Patrons) in Venues Exempted from the Smoking Ban

Dec 9th, 2008
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Department of Community Medicine, School of Public Health, The University of Hong Kong – December 9, 2008

Secondhand smoke
Secondhand smoke (SHS) is a dangerous poison. Major studies in Hong Kong have shown how breathing SHS causes a serious injury to the heart, other blood vessels and lungs. SHS kills over 1,300 people a year in Hong Kong. However, in 2006, the Government and legislators supported exemptions from the Smoking (Public Health) (Amendment) Ordinance for “qualified premises” selling alcohol and food, until June 2009.

The Study
A new survey conducted by a team from the Department of Community Medicine, School of Public Health, The University of Hong Kong; a biophysicist from Repace Associates, a secondhand smoke consultancy in Maryland USA, and Professor Neil Benowitz’s laboratory in the University of California, has examined the exposure to tobacco smoke and the health of catering workers in both smoke-free and exempted premises.

157 non-smoking workers in smoke-free Chinese restaurants and Char Charn Ting (Hong Kong style café) and 47 non-smokers who worked in exempted bar/restaurants were examined by interviews, lung function tests and analysis of urine samples for tobacco chemicals.

Results of the study

1. Air pollution level

  • The level of fine particulate pollution (PM2.5) in exempted venues was four times as high as (300% higher than) the level in the smoke-free premises.
  • The indoor pollution was
    o slightly lower than outdoor pollution for smoke-free venues
    o over 100% higher than outdoor pollution for exempted venues

2. Toxic substances in urine of workers

  • Cotinine is a breakdown product of nicotine which can be measured in urine. It is a marker in the human body for other toxic substances from tobacco smoke which cause heart disease, stroke, cancers and other health problems.
  • The research team found that cotinine in the urine of workers was
    o highest in those working in exempted hospitality venues
    o also raised in workers serving smokers on patios and terraces
    o raised in many non-smoking workers who we found were exposed to tobacco smoke at work from their co-workers during break periods
  • Catering workers who served smokers had higher levels of tobacco chemicals in their urine than those in other jobs.

3. Lung function in catering workers

The level of indoor air pollution, as measured by fine particulates, was strongly associated with reduced lung function in catering workers:

  • In the group of workers in exempted venues who successfully completed a lung function test, the average level of PM2.5 was 261 microgrammes per cubic metre (μg/m3), and in smoke-free venues was 61 μg/m3. All workers show declining lung function with increasing PM2.5 levels. The research team estimates that the average difference in lung function between workers in exempted and smoke-free venues on the day of the survey is 6.3% for ages 18-65 years; for older workers (aged 30-65) the estimated average difference is much higher at 10.9%. At the average level of PM2.5 in exempted venues the estimated overall reduction in lung function is 14% for ages 18-65 and up to 22% for ages 30-65.
  • We regard these reductions in lung function as very important indicators of harm to current and future health. Other scientific studies have shown that damage to the lungs carries a serious risk of both acute and chronic disease including bronchitis, pneumonia and chronic obstructive pulmonary disease (COPD). Reduced lung function is a strong predictor of reduced life expectancy.

4. Health risks:

  • More workers in exempted venues than in smoke-free venues perceived that the poor indoor air quality increased their health risks:

Workers who said they were always bothered by smokers near them had lower urine cotinine levels than those who were seldom bothered. This apparent reduction in exposure, from action to protect themselves from smoke, was much greater in workers in non-smoking venues compared with those in exempted venues.

  • In 2001, we estimated the average increased risk of fatal heart disease and lung cancer in Hong Kong catering workers was 1 in 33 (3%) and up to 1 in 10 (10%) for the highest (top 10%) exposures. For those workers in catering venues which were exempted under the 2006 Amended Ordinance, this increased risk will remain unchanged for 2.5 years (from 1.1.2007 to 30.6.2009). The result of this unchanged risk will cause serious life-long harm to the health of many of them.
  • This study clearly shows that indoor air quality in Hong Kong is generally extremely poor and very much worse when smoking is permitted.

o In non-smoking venues the average levels of fine particulates (PM2.5) in our spot tests (61 μg/m3) were 240% above the World Health Organization (WHO) 24 hour guideline of 25 μg/m3 and 610% above the annual WHO guideline of 10 μg/m3.
o In exempted catering premises, the extremely high levels of particulates and other tobacco chemicals we measured will cause serious harm to the health of workers, both smokers and non-smokers.

Recommendations:

  • All exemptions of premises from the smoke-free workplace policy creates a serious health risk for workers and should be rescinded as a matter of urgency. While the HKSAR government used the research evidence on the serious harm caused by SHS to promote public acceptance of smoke-free policies it should not have introduced legislation which perpetuates and increases catering workers exposure to SHS.
  • The introduction of “smoking-rooms” currently being argued for by the catering and tobacco industries should not be permitted for the following reasons:

o Smokers suffer additional health problems when subjected to intensive exposures to SHS.
o We have previously shown in Hong Kong that smokers who inhale SHS from other smokers experience higher risks of lung disease.
o Smoking rooms in catering and licensed facilities will create an intense source of pollution which will contaminate surrounding air. Existing smoking rooms in Hong Kong, such as those in the Airport Authority, are poorly managed and create health risks for those who use them or have to clean them.

  • These facts on the harm caused by SHS should not be ignored by the Hong Kong health authorities (the Food and Health Bureau and the Department of Health) in formulating future policy.
  • The government should focus on improving its compliance with the WHO Framework Convention on Tobacco Control rather than spending public money on smoking rooms.

Professor Sarah McGhee, a leading member of the research team said, “The study shows that the occupational health impacts of smoking in catering facilities must outweigh any other argument for the continuation of exemptions or the introduction of smoking rooms. There was no evidence anywhere in the world that the food and licenced trade had suffered any economic downturn on top of existing background trends from smoke-free policies.”

Dr Chit Ming Wong, a researcher leading several environmental health projects of the Department of Community Medicine, The University of Hong Kong emphasized, “The evidence of impaired lung function in catering workers had serious implications for their current and future health. All exemptions should end, including smoking patios and terraces, which are a health risk for waiters and others in such places.”

Professor Tai Hing Lam, director of the Public Health Research Centre, School of Public Health, The University of Hong Kong said, “All sectors of the community must now be involved in tobacco control and particularly the elimination of involuntary exposures to tobacco smoke. Tobacco tax should be increased to support smoking cessation in Hong Kong to reduce illness and premature deaths from smoking and secondhand smoke.”

Professor Anthony Hedley said “We thank the government for supporting the study. We hope that government leaders would take careful note of the study results and adopt a more pro-active and consistent approach to the incorporation into policy and legislation of the overwhelming scientific evidence on health risks of SHS. The new study is an important demonstration of the need for accountability in all public health and environmental regulations.”

For media enquiries, please contact Ms Winnie Lam (Tel: 2809 5102 / 9107 1676) or Mr Terence Poon (Tel: 2819 9305 / 9316 6267) of The University of Hong Kong Li Ka Shing Faculty of Medicine.

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Display Ban ‘Reduces Child Smokers’

Dec 9th, 2008
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The open display of tobacco in shops is to be banned in England and Wales, the government has announced.

But plans for an outright ban on tobacco vending machines and branding on cigarette packets have been scrapped – at least for now.

Ministers hope the display ban, which is also under consideration in Scotland, will reduce smoking. Northern Ireland is yet to decide a policy.

Critics say the moves do not go far enough to stop young people smoking.

A government consultation on how to deter young people from smoking launched six months ago found the “overwhelming majority” of 100,000 responses backed the display ban.

Health Secretary for England Alan Johnson said he had been impressed with evidence from other countries, suggesting the move would have an impact on smoking rates.

Ministers say where other countries – such as Iceland and Canada – have removed displays, smoking prevalence among young people has fallen by up to 10%.

Alan Johnson said: “They see the point of sale display and as a result of seeing it, it encourages them to take up smoking. This is the key evidence as to why we have 200,000 11 to 15-year-olds smoking.”

He said people who start smoking in their youth – aged 11 to 15 – are three times more likely to die a premature death than someone who takes up smoking at the age of 20. They are also more likely to be hooked for life.

Deborah Arnott, director of the anti-smoking group ASH, backed the ban and said the prohibition of the display of tobacco products at point of sale would be “a proportionate response to the death and disease caused by tobacco”.

England’s Chief Medical Officer, Professor Sir Liam Donaldson, called the move “another step on the road to victory on tobacco-related illness.”

Liberal Democrat Shadow Health Secretary Norman Lamb said it was “the nanny state going too far.”

Simon Clark, director of the smokers’ lobby group Forest, said a display ban would inconvenience millions of consumers.

“It’s gesture politics, designed to denormalise adults who wish to purchase and consume a perfectly legal product.”

The Tobacco Manufacturers’ Association also opposes the cigarette display ban and says it could have serious unintended consequences, such as driving the sale of illicit tobacco.

It could also damage the income of smaller shops that rely heavily on tobacco sales, said the TMA’s chief executive Mr Chris Ogden. Mr Johnson said the big supermarkets would be asked first to remove their displays – in 2011 – followed by corner shops – in 2013.

Restricting access

He said other plans had been scrapped as a result of the consultation – such as getting rid of 10-pack cigarettes. Only selling cigarettes in packs of 20 might drive people who are trying to quit to smoke more, he said.

But Mr Johnson said they would clamp down on underage sales from cigarette sales vending machines – people wanting to buy these cigarettes will have to show proof of age to obtain a token to work the machine.

If this doesn’t work, Mr Johnson said they had the power to ban vending machines altogether.

The British Heart Foundation says a total ban on vending machines is the only way to prevent children accessing cigarettes.

Vending machines are the source of cigarettes for nearly one in five young smokers aged 11 to 15 – some 46,000 children.

A British Heart Foundation spokeswoman said: “When the government announces further steps on tobacco control we expect nothing less than a robust tobacco control plan which includes a total ban on cigarette vending machines.

“We are concerned about the large number of children being able to access cigarettes without a face to face transaction.”

The British Lung Foundation agreed, saying: “Nearly three quarters of people with lung disease tell us that they believe there should be a total ban on cigarette vending machines as they are the main source of cigarettes to young smokers.”

Dr Vivienne Nathanson of the British Medical Association said: “We hope the proposals to make vending machines ‘child-proof’ will be rigidly enforced and that if they do not work then this issue will be revisited by ministers.”

The government had also considered banning all promotional material from tobacco packaging.

But ministers say until there is enough evidence such a move would actually stop young people taking up smoking it will not introduce a ban.

See related news items:

Cigarette sales forced ‘under the counter’
http://www.independent.co.uk/…

Smoking ban lessons from abroad
http://news.bbc.co.uk/…

Cigarette display ban will cost us £252m, say shops
http://www.thisislondon.co.uk/…

Q&A: Anti-smoking measures
http://www.guardian.co.uk/…

Source: BBC News

16,000 At Risk From Smoking Clientele: Study

Dec 9th, 2008
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Hong Kong Standard – 9 December 2008

As many as 16,000 service sector employees in Hong Kong face serious health hazards as they work in bars that have been exempted from adhering to a territory-wide smoking ban, according to the latest study by University of Hong Kong researchers.

The study also warned that staff who are exposed to cigarette smoke over several years are in danger of losing between 10 percent to 30 percent of their lung function.

Anthony Hedley, chair professor of community medicine at the university, said the city should impose a complete smoking ban.

Allowing smoking in specific rooms and terraces of restaurants and bars were not practical as they harmed workers health, Hedley said.

Tobacco Hike What Doc Orders

Dec 9th, 2008
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Adele Wong, The Standard – Tuesday, December 09, 2008

An anti-smoking activist has called on the government to drastically increase tax on cigarettes since they cost less in real terms today than seven years ago when the tax was last raised.

Professor Judith Mackay, director of the Asian Consultancy on Tobacco Control and senior policy adviser to World Health Organization, said a higher tobacco tax will help cut the number of smokers.

“Taxation is the single most effective measure to reduce smoking,” Mackay said, citing overseas experience showing a relationship between higher tax and a decrease in sales.

“The Hong Kong government thinks education is the key,” Mackay said, adding that she disagreed.

“If taxes are raised to at least 75 percent of the retail value as opposed to the current 50-plus percent, it will have a big impact,” Mackay said.

“The last tax increase in Hong Kong was in 2001, when it was raised by only 5 percent. Thus cigarettes are becoming cheaper in real terms, year by year. It is no surprise that consumption is rising in Hong Kong, in spite of all our other actions.”

Mackay credited Hong Kong for being one of only about 20 places to insist on pictorial warnings on cigarette packets. But it is now time to go further and push for plain packaging carrying nothing but the name of the product and a warning, stripping it of any advertising appeal.

“Several countries are actively considering this,” Mackay said. “[We should push for] Hong Kong to be the first.”

Mackay said Hong Kong should also be meticulous and careful when deciding on smoking regulations.
In the past some lawmakers pushed for extensions and exemptions to the smoking ban implemented in restaurants in 2007, resulting in an uneven playing field and chaos.

Mackay was recently given approval by the Clinton Global Initiative for a Hong Kong- based project aimed at providing corporate incentive programs to migrant workers in China who demonstrate good health habits.

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Should The Ban On Smoking In Bars Be Delayed?

Dec 8th, 2008
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Dec 08, 2008 – SCMP

It is of the utmost importance that Hong Kong sticks to its guns and enforces the ban on smoking next year for the well-being of workers in the food and beverage industry. As it is in Macau, people can smoke in all locations without any restraint, and people are free to light up in bars, restaurants and nightclubs. Let us see, with the full implementation of the ban next year in Hong Kong, what action Macau will take.

Stephen Anderson, Macau

Should The Ban On Smoking In Bars Be Delayed?

Dec 6th, 2008
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Dec 06, 2008 – SCMP

James Middleton, chairman of the anti-tobacco committee of Clear the Air (Talkback, December 2), takes issue with the Entertainment Business Rights Concern Group (Talkback, November 28) and accuses it of wanting to profiteer by failing to protect catering workers from harmful cigarette smoke in bars and entertainment facilities which still permit smoking.

I, too, am a member of Clear the Air but have long argued that its remit should be cleaning up Hong Kong’s polluted atmosphere and the air pollution on our streets.

Smoking indoors is mainly a personal health issue, not a major pollution issue.

Clear the Air uses emotive language to try to convince the world that only it is right about indoor smoking in bars, to wit, “This flagrant attempt to abuse workers’ rights is typical and akin to the Liberal Party’s disregard for the health of workers in the catering industry”.

What Clear the Air ignores is that these workers and customers should also have the right to smoke if they so wish, provided they are in “smoking” premises.

I have a very small residual interest in an English pub and I can state truthfully that over 23 years, 95 per cent of the staff were smokers and wanted to smoke while on duty.

During this time not one of our customers was ever forced to come into our premises and inhale second-hand cigarette smoke. They had a choice – not to come in.

This never, incidentally, stopped the eminent Clear the Air tobacco group chairman, Mr Middleton, from visiting our premises.

The answer to this problem is not “separated smoking areas”, as now being considered by the government (this would not work), but “smoking” bars and entertainment facilities and “non-smoking” premises, depending on a business owner’s choice.

P. A. Crush, Sha Tin

What Do You Think of The Smoking Ban?

Dec 5th, 2008
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SCMP – Updated on Dec 05, 2008

It is unbelievable and embarrassing to read legislator Tommy Cheung Yu-yan’s claim that it is a human “need” to keep smoking, and that no law should ignore that need. (Talkback, May 14). His letter shows that he is still out of touch with reality, and is simply trying to hold on as long as possible to the support of the threatened tobacco lobby. His main constituency is the catering industry, and part of the reason for his claim that the recent smoking ban is painful to some of his members is because the government has yet again failed to live up to its moral obligations.

Smoke is a pollutant, and it also happens to be cancer-causing, not only to those who smoke but also to bystanders who inhale the exhaust from those who disregard themselves and others in their surroundings. In every city in the world that has – out of moral civic duty – installed a smoking ban, the catering industry has actually benefited.

The majority of the world is non-smoking, yet smokers end up ruining it for the rest of us, and we therefore do not patronise the venues which allow smoking. The catering industry should therefore benefit by catering to the majority. This is not rocket science.

The government’s weak stance to allow exemptions to the smoking ban has caused Mr Cheung’s constituents to lose out because there is not a level playing field.

If the government had done what was right for its citizens, and protected them from pollution and significant health risks, as the smoking ban was meant to do, then every catering establishment would have been equal. In an equal world, they can compete based on the quality of their food and service, which is what their main business is meant to be in the first place.

Customers will not stop eating just because the venues which allow them to carry out their “need” to smoke have been changed. Instead, the majority of the population, which the government seems to keep forgetting, can come out to eat because they can breathe. An economic analysis of these benefits is something Mr Cheung needs to carry out.

K. Lim, Wan Chai

Smoking Clampdown Ignores Tobacco Sales To Minors: NGO

Dec 2nd, 2008
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Tiffany Lam – Dec 02, 2008 – SCMP

Rampant selling of cigarettes to minors had gone largely unnoticed by the government, an anti-smoking group said yesterday.

The Committee on Youth Smoking Prevention found that more than 60 per cent of cigarette retailers in a study in Tseung Kwan O had sold cigarettes to under-age customers this year. The stores did not check for identity cards and displayed signs warning against sales to minors in places where they could not easily be seen, the non-governmental organisation said.

There had been six convictions of retailers across the city for breaching the law in the first 10 months of the year, according to the government, with penalties of between HK$500 and $1,500 imposed following 1,200 inspections of cigarette retailers.

But the NGO said the maximum penalty for selling to minors is HK$25,000, and court fines were as low as HK$400 last year. Committee chairman Tik Chi-yuen said: “With such light fines and no one catching offenders, it is little wonder that more young people are slipping up.”

Mr Tik, who is a vice-chairman of the Democratic Party, said that since statutory no-smoking areas were expanded to cover indoor restaurants and workplaces last year, the office had overlooked tobacco sales to minors. The government should spend more on educating retailers and the public on the perils of under-age smoking, he said.

The three-month pilot prevention project conducted in Tseung Kwan O this year had been a success and should be extended to all 18 districts with government funding, the committee said. Tobacco sales to minors dropped by 30 per cent after volunteers distributed leaflets and handed out Smoking Ordinance-approved warning signs to 85 tobacco outlets from May to August. More shopkeepers asked for the age of under-age customers two months into the campaign, said committee research officer Kan Ming-yue.

The group also called for the government to issue licences for tobacco retailers. “Retailers won’t jeopardise their licences by selling to minors, as licences are crucial for business,” said Mr Tik. However, University of Hong Kong professor of public health Lam Tai-hing questioned the effectiveness of prohibiting cigarette sales to young people.

“It is most ineffectual when pitted against other measures such as prohibiting advertisements and increasing the tobacco tax,” he said.

The environmental group Clear the Air’s anti-tobacco head, James Middleton, said the most effective way of preventing smoking by youngsters was to double tobacco tax to HK$33 a pack.

He said it had been shown worldwide that a 10 per cent increase in tobacco tax would lead to a decline of between 4 and 7 per cent in smoking among young people.

He also warned young people against tobacco advertising, saying that the 10-19 years age group was increasingly targeted by tobacco companies “to replace their core product users who are dying off at [the rate of] 7,000 a year in Hong Kong”.

Ms Chan, a street vendor in Quarry Bay, said she seldom checked for identity cards when selling cigarettes, but tried not to sell to customers who looked under age. “People won’t show you their ID cards anyway, it’s not like I’m the police,” she said.

Convenience chain 7-Eleven declined to comment.

Selling Tobacco to Minors

Should The Ban On Smoking In Bars Be Delayed?

Dec 2nd, 2008
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Dec 02 2008 – SCMP

On November 24 the government stated sensibly on the RTHK website that it would not consider extending the qualified establishment smoking exemption status of licensed premises from July 1, next year.

The letter from Lillian Chan of the Entertainment Business Rights Concern Group, however (Talkback, November 28), asks the government to delay the exemptions further, until 2012.

Anti-smoking legislation is intended to protect the lives of the staff working in those premises, which this so-called rights group chooses to ignore in the quest for profits.

The government data shows restaurant takings after the smoking ban increased by 31 per cent in the third quarter of this year versus the third quarter of pre-ban 2006. The concern group should realise the ban is good for its business and that it already has a legal obligation under the occupational safety laws to keep its workplaces safe and free from dangers to the health of its workers.

This flagrant attempt to abuse workers’ rights is typical and akin to the Liberal Party’s disregard for the health of workers in the catering industry when it demanded the smoking exemption in the first place in return for allowing the diluted law to pass (after delaying it for six years).

World experts state that no known ventilation system can remove the toxins of cigarette smoke from the air in a room, and internal documents show that the tobacco companies know this fact.

The government has already stated that it will not allow smoking rooms in hospitality premises.

It commissioned a study on smoking rooms last year supposedly to find places other than the street for people to smoke; in so doing and at taxpayers’ expense, it is in effect working on behalf of the tobacco industry to find ventilation solutions that do not exist.

James Middleton, chairman, anti-tobacco committee, Clear the Air

Should The Ban On Smoking In Bars Be Delayed?

Dec 1st, 2008
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Dec 01 2008 – SCMP

Some bar owners have asked that the ban on smoking in their premises should not be implemented on July 1, but should be delayed. They think the time is not right given the problems Hong Kong is going through.

However, I disagree. I do not think the ban should be postponed.

Bar owners fear they could lose customers who smoke, but what about the non-smoking patrons? They want to be able to enjoy drinking in a bar that has a better, smoke-free environment.

Hopefully it will also make smokers think about their habit. If they are in bars and cannot smoke, it may encourage them to think about giving up cigarettes.

I have read some newspaper reports where people have actually said that after the restrictions were introduced, it would hopefully make them more determined to give up cigarettes.

I think a total ban in bars will be another step forward for the anti-smoking movement.

We also have to look at the issue of human rights. Non-smokers should not have to breathe in second-hand smoke. A smoker has to realise that he is affecting those people who are around him.

Only a total ban can protect non-smokers in bars.

The government should not delay the total ban. We must try to move closer to the goal of a smoke-free city.

Bonnie Lam Hiu-wai, Tseung Kwan O

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