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Extension of Hong Kong no-smoking areas cut hospital admissions among children by almost half, HKU study finds

Doctor calls for areas close to schools, playgrounds and childcare centres to be made smoke-free

The extension of no-smoking areas has been found to reduce by almost half the number of children admitted to hospital with more severe forms of respiratory infection, a University of Hong Kong study found.

HKU researchers looked into 75,870 hospital admission cases between 2004 and 2012 involving patients aged 18 or younger suffering from lower respiratory tract infections. The number of cases dropped 47.4 per cent in the first year after no-smoking regulations were extended to indoor area of all restaurants, workplaces and public places in 2007.

A sustained reduction of 13.9 per cent was observed in the following five years – meaning an estimated 13,635 fewer admissions in the six years after the new regulations were implemented.

Lower respiratory infections usually refer to more serious forms of illness, including pneumonia, acute bronchitis and excess fluid in the lungs. Acute respiratory infection is a leading cause of death among children aged under five around the world, killing 1.6 million every year.

The effect was more marked among school-age children aged between six and 18, who are believed to spend more time away from home and stand a higher chance of breathing in second-hand smoke compared to preschool children.

Paediatrics professor Lau Yu-lung, who co-authored the study, said smoke can harm lung tissue.

“There are more than 5,000 types of harmful substances in tobacco. When one inhales, lung tissue becomes inflamed easily and immunity is weakened,” said Lau. Some 70 chemicals found in tobacco are carcinogenic.

The study took outdoor air pollution into account and found higher levels of respirable suspended particulates and ozone also led to more admission cases, particularly among preschool children

Dr Lee So-lun, who also worked on the study, said younger children tended to be more vulnerable to air pollution.

“They have weaker immunity and a smaller trachea. The impact of cold is greater than for school-age children,” said Lee.

The researchers acknowledged that other factors including flu epidemics and weather could have affected the results. However, they admitted their study had limitations as they did not assess how legislation was enforced and the time that children spent indoors and outdoors.

No-smoking areas will be further extended to eight bus interchanges on March 31. But Lau said this was not enough as areas close to schools, playgrounds and childcare centres should also be included.

Professor Lam Tai-hing, the university’s chair professor of community medicine who did not take part in the study, said quitting cigarettes was still the best way to reduce health problems.
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