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November 15th, 2013:

SCMP letters: Tobacco tax hike deters young people from starting to smoke

by Lisa Lau, chairman, COSH

A recent report funded by the tobacco industry claimed that the illicit cigarette problem in Hong Kong is serious.

A spokesperson for the study said the key drivers included tobacco tax rises in 2009 and 2011 and strength of enforcement against smuggling by the government. Hong Kong Council on Smoking and Health (COSH) has expressed reservations on its findings and believes there is no causal link between tobacco tax rise and the surge in illegal cigarettes.

The tobacco industry always opposes increases in tobacco levies arguing that they intensify cigarette smuggling activities, but there is no evidence to support this. In fact, smuggling is also found in countries with a lower tobacco tax, like Malaysia (tax accounts for 53.7 per cent of the retail price) and Vietnam (41.59 per cent). Canada and Sweden attempted to combat cigarette smuggling in the 1990s by reducing tobacco tax, resulting in a hike of consumption and contraband cigarettes seizure.

The World Health Organisation believes the most effective measure against smuggling is tight control and aggressive enforcement. Hong Kong Customs and Excise Department is determined to undertake stringent enforcement against illicit cigarette activities. A total of 65 million sticks of illicit cigarettes were seized in the first nine months of this year, an increase of over 30 per cent compared to the same period last year. The most effective way to tackle the root of the problem is to strengthen law enforcement and publicity and educate the public on the illegitimacy of illicit cigarettes.

A significant tobacco tax hike deters young people from starting smoking and encourages smokers to quit. The World Bank claims every 10 per cent increase in the price of a packet of cigarettes results in a 4 per cent decrease in tobacco consumption in high-income regions like Hong Kong.

Hong Kong’s tobacco levy accounts for only 65 to 68 per cent of the retail price, which is below the standard suggested by the WHO (at least 70 per cent). Compared to Asia-Pacific countries like Singapore, and EU countries, whose tax is over 70 per cent, Hong Kong’s rate is lenient*.

Each year, smoking causes nearly 7,000 deaths in Hong Kong, including 1,324 non-smokers, as well as HK$5.3 billion economic loss.

To save lives, we want the government to implement a progressive and long-term tobacco tax increment policy and strengthen smoking cessation services.

28 Oct 2013

*A standard pack of Marlboro retails including tax for HKD50 in Hong Kong; in Singapore it costs HKD 76, London HKD 84, in New York HKD 85, Dublin HKD 93, Brisbane HKD 129; Hong Kong still has the highest cost of living among these cities, making tobacco a relatively affordable commodity in the city.

Raise the Smoking Age to 21

New York City’s higher tobacco sales age should be copied across the country.

The Obama administration is facing a health care deadline. I’m not referring to the White House’s self-imposed target date to unsuck I mean that the administration has until summer 2014 to advise Congress of the health benefits of raising the age of tobacco sales from 18 years old to 21. In the meantime, there’s a mini-movement afoot in several municipalities to tighten restrictions. It’s clear that raising the smoking age would have massive health benefits. Congress should consolidate this momentum into a nationwide regulation that lifts the minimum sales age to 21.

New York City offers the highest-profile example of a city’s legislative efforts to stop young people from getting hooked on tobacco. Last month the City Council approved legislation that raised the minimum legal sales age from 18 to 21. It will take effect six months after garnering a mayoral signature. There’s a similar bill before the Washington, D.C.’s council, and Hawaii and New Jersey are expected to soon consider statewide legislation.

The authors of both the New York City and Washington, D.C., bills specifically cite the success of Needham, Mass., as a source of inspiration. The Boston suburb enacted a regulation in 2005 barring anyone under 21 from buying tobacco products. Since then, the adult smoking rate in Needham has been shown to be fully 56 percent lower than the overall rate in Massachusetts, according to recent findings by the Massachusetts Department of Public Health. In part, local officials attribute the lower smoking rate and its corollary health benefits—lower mortality rates and fewer hospitalizations due to lung cancer—to the decision to raise the age for tobacco purchases to 21.

Every day in America, about 4,000 people under 18 smoke their first cigarette, and 1,000 go on to become daily cigarette smokers. Most adolescents who have smoked more than 100 cigarettes have reported that they’d like to quit but can’t. So perhaps it’s not surprising that one of the most persuasive arguments for raising the minimum sales age came from a high schooler.

Prompted by an essay contest about how to change the world, then-17-year-old Jessica Adelson argued for increasing the age for tobacco sales from 18 to 21. In 2007, the teenage Adelson appeared before the state legislature in her home state of Connecticut. “By increasing the age, we can stop many young people from getting their hands on cigarettes,” she told lawmakers. According to the AP, Adelson further testified that “Younger teens typically know a lot more 18-year-olds than 21-year-olds who might buy them cigarettes.” Adelson’s argument is borne out by the authors of a recent article in the Annals of Internal Medicine, who write that people aged 18–20 are responsible for 90 percent of the cigarettes purchased on behalf of minors. Cut them off, and the benefits would extend down to much younger teens.

But the 18–20 set does more than just supply cigarettes to underage smokers. According to a mix of firm statistics, anecdata, and a damning confession by a Big Tobacco official, this age group also gets addicted to nicotine in big numbers. “A significant number do in fact start between 18 and 21,” John Banzhaf, the executive director of Action on Smoking and Health, told CNN in 2002. Among 18-to-25-year-olds, the average age of first use is 18.9 years old, according to cardiologist Mehmet Oz.

On the retail side, one New York City vendor told a local CBS affiliate that half of his cigarette sales go to people between the ages of 18 and 21. But perhaps the most damning line (and maybe the obvious causal explanation) comes from a 1982 internal memo penned by an employee of the tobacco manufacturer R.J. Reynolds: “If a man has never smoked by age 18, the odds are three-to-one he never will. By age 24, the odds are twenty-to-one.” To put it another way, in the words of Patrick Reynolds, the grandson of R.J. Reynolds who would spurn the family trade to become an anti-smoking advocate, “Once they reach 21, it’s no longer an interesting vehicle for rebellion.”

It’s tempting to point to the Needham, Mass., statistics and other data as ironclad proof that raising the age of tobacco sales across America would lead to a national health bonanza. While the findings represent a promising first step in substantiating such a proposition, the empirical data lack the depth and breadth necessary to overcome the backlash from Big Tobacco that a national push would provoke. This is where the White House could make itself useful by exploring the health benefits of a higher tobacco sales age—especially considering the Obama administration is required by law to do exactly this.

In 2009, when Congress passed the Family Smoking Prevention and Tobacco Control Act, which allowed the FDA to regulate certain aspects of tobacco sales, advertising and use, lawmakers also gave the administration a June 2014 deadline. “The Secretary of Health and Human Services shall … convene an expert panel to conduct a study on the public health implications of raising the minimum age to purchase tobacco products; and … not … later than 5 years after the date of enactment of this Act, submit a report to the Congress on the results of such study.” But according to Chris Bostic, the deputy director of policy at Action on Smoking and Health, the administration has yet to convene the expert panel mandated under the 2009 statute. Astonishingly, an 899-page report published by the Department of Health and Human Services three years after the law’s passage fails to even mention the Needham, Mass., statistics that have catalyzed New York City and the nation’s capital to act, and sheds no light on the correlation between a higher tobacco sales age and improved health, as Congress requested. “I wouldn’t be surprised if they wait until the last minute,” Bostic told me.

The Obama administration has no excuse for dragging its feet over the past four and a half years, particularly after the president trumpeted the Family Smoking Prevention and Tobacco Control Act as a vehicle to protect American youth. It’s hard to imagine the Obama administration could do anything besides adding momentum to this growing municipal movement if it simply followed its congressional mandate to explore the nexus between higher tobacco sales ages and health benefits. Given that Congress has already demonstrated its ability to persuade states to set the age of alcohol sales at 21, and that it’s capable of producing a similar scheme for tobacco sales, the main obstruction to a nationwide movement with political traction should not be federal government inertia.