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December 9th, 2008:

Should The Ban on Smoking in Bars be Delayed?

SCMP – Updated on Dec 09, 2008

Jeffrey Tam Chun-kit, chairman of the Hong Kong Bars and Karaoke Rights Advocacy (Talkback, November 29), argued that if the ban was imposed, the businesses of the bars and other entertainment venues would be hurt.

I disagree.

If a ban were imposed, would smokers stop going to bars and just stay at home? I do not think so.

I have been living for a while in Britain and I find that I enjoy myself more in bars and nightclubs now because smoking is banned in all indoor areas. I do not have to inhale second-hand smoke any longer.

Have those bar owners wanting the ban delayed ever considered the possibility that a ban would attract more non-smoking customers?

It is important for the government to make the Tobacco Control Office more effective.

If the office cannot perform its role properly, there will not be a level playing field for bars. Smokers will simply move to bars that are located upstairs, because they are seldom checked.

I do not see any advantage in delaying the ban.

Karina Ng, Durham

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

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.


  • 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.


Display Ban ‘Reduces Child Smokers’

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’

Smoking ban lessons from abroad

Cigarette display ban will cost us £252m, say shops

Q&A: Anti-smoking measures

Source: BBC News

16,000 At Risk From Smoking Clientele: Study

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

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.