Clear The Air News Tobacco Blog Rotating Header Image

October, 2015:

E-Cigarette Awareness, Perceptions and Use among Community-Recruited Smokers in Hong Kong

Download (PDF, 563KB)

Philip Morris Asia Limited Submission To The Legislative Proposals

Download (PDF, 588KB)

Clear The Air Letter to Legco Panel on Health Services

Download (PDF, 588KB)

FCTC Treaty Guidelines

Download (PDF, 255KB)

Framework Convention on Tobacco Control Treaty

Download (PDF, 4.08MB)

The advertised price of cigarette packs in retail outlets across Australia before and after the implementation of plain packaging

Download (PDF, 959KB)

On anti-smoking policies, mainland China can learn from Hong Kong

So chronic is the addiction to smoking on the mainland, so dilatory is the official response to science-based appeals for action to combat it, that it could seem a waste of time to keep on about it. But occasionally researchers come up with a new angle that cannot be ignored. In this case it is that smoking could eventually kill one in three young men in China in what will be a crisis for a labour force depleted by ageing and for the public health system.

What sets this scenario apart is not just that it is so grim. It is also because it is based on collaborative studies by researchers from Oxford University, the Chinese Academy of Medical Sciences and the Chinese Centre for Disease Control. These showed that two-thirds of China’s young men smoke and, unless they quit, half will die from smoking-related diseases.

China has more than 350 million smokers who consume more than a third of the world’s cigarettes and account for a sixth of the global smoking death toll. The principal beneficiary is not Big Tobacco – the multinationals fighting over a shrinking market in the West – but the state-owned tobacco monopoly and its administration. The government needs to break its addiction to the huge profits and tax revenue they amass.

China does have smoking bans in public areas but there is room to extend them and enforce them with greater urgency and rigour. As Wu Yiqun, from the think tank Research Centre for Health Development, says, persuading people to cut down and quit smoking will not hurt the economy as it is a gradual process rather than abrupt dislocation of an industry that provides or helps provide a living for millions.

According to Chinese Academy of Medical Sciences professor Yang Gonghuan, failure to heed scientific studies could lead to catastrophic losses in health expenditure and the workforce. To avoid them, the government must resort to incremental tax rises on cigarettes, backed by relentless focus on public education, and inexorable tightening of restrictions on where people can smoke. In these respects, Hong Kong and its smoking rate of just 10 per cent is a model of kinds.

Man left with hole in lung after e-cigarette spits out burning nicotine

Richard Courtney took up vaping to kick his 16-year habit

Richard Courtney, from Horley, in Surrey, bought the £100 device – which is meant to turn the fluid into vapour – with the aim to give up smoking.

The 33-year-old said: “I started vaping to try to give up after 16 years of smoking. I can’t believe it put me in hospital.”

The Sun newspaper reported that Richard was walking home from a friend’s house when he tasted fluid and started coughing.

He said “Then it felt like I’d got a trapped nerve in my shoulder. In the morning I had a really tight chest and couldn’t breathe properly.

“I went to hospital. One of the nurses there put my vape on an oxygen tube and showed that it was spitting liquid out.”

AAP releases multiple policies to protect youths from tobacco, nicotine

For the first time, the Academy has released three linked, evidence-based statements to help protect children from tobacco addiction and exposure. The policies call for raising the minimum age to purchase tobacco to 21 years; urge pediatricians to screen patients for use of tobacco and nicotine delivery devices; and address tobacco dependence in parents as part of pediatric health care.

The policies and a technical report grading the evidence supporting the policies are available online and appear in the November issue of Pediatrics. (See resources.)

A related policy statement Electronic Nicotine Delivery Systems also is available online and appears in the November Pediatrics. All of the documents are from the AAP Section on Tobacco Control.

Harms of tobacco use, exposure

Tobacco addiction and tobacco smoke exposure are among the most important, preventable causes of sickness, disability and premature death in both the developed and developing worlds. There is no safe level of tobacco smoke exposure.

The landmark 2014 U.S. surgeon general report’s conclusions on the health consequences of smoking ( include:

Cigarette smoking has been causally linked to diseases of nearly all organs of the body, to diminished health status and to harm to a fetus.

Exposure to tobacco smoke has been causally linked to adverse effects on the health of infants and children.

The tobacco epidemic was initiated and has been sustained by the aggressive strategies of the tobacco industry. Advertising and promotional activities by tobacco companies cause the onset and continuation of smoking among adolescents and young adults.

Effective, evidence-based tobacco control interventions continue to be underutilized and implemented at funding levels far below those recommended by the Centers for Disease Control and Prevention.

The impacts on cardiovascular disease, cancer, emphysema and premature death are well-known. Tobacco smoke exposure of children increases severity of bronchiolitis and asthma, increases middle ear disease, leads to findings of preclinical atherosclerosis, and increases risk for childhood cancers. Tobacco and nicotine exposure harms brain and lung development.

In addition to the well-documented impact on adverse fetal outcomes such as stillbirth and sudden infant death syndrome, recent research demonstrates that in utero tobacco and nicotine exposure increases risks for wheezing, asthma, obesity, learning disabilities and neurobehavioral problems.

Treatments underused

The adolescent’s developing brain is particularly susceptible to tobacco dependence. Nicotine — a neurotoxin — changes brain structure and chemistry.

The Food and Drug Administration has approved prescription and over-the-counter medications for tobacco dependence; however, these treatments are underutilized. Tobacco dependence treatment medications include shorter-acting relievers such as nicotine gum and nasal sprays and long-acting controllers such as nicotine patches, bupropion and varenicline.

Combination therapy is more effective than monotherapy. State-of-the-art approaches initiate treatment intensity based on severity of the tobacco dependence and on treatments the patient is ready to accept. Treatment intensity and duration are adjusted based on control of nicotine withdrawal symptoms (

Electronic nicotine delivery systems (such as e-cigarettes) should not be recommended because clinical trials have failed to demonstrate their effectiveness, and there is evidence of harm from these devices.

Recommendations for pediatricians

Tobacco use prevention is an important — and effective — part of anticipatory guidance.

Pediatricians should inquire about tobacco use and tobacco smoke exposure as part of health supervision visits and visits for conditions that may be caused or exacerbated by such exposure. Be aware of the different tobacco products — not just cigarettes -— available to youths. With fruit and candy flavors, hookah (water pipe) and electronic nicotine delivery system use is rising rapidly among middle and high school students. Adolescents often will use two or more different tobacco or nicotine products.

Parental tobacco dependence should be addressed as part of the child’s health care. Approaching tobacco dependence as a severe, chronic disease, pediatricians can acknowledge the severity of the parent’s addiction and recommend treatment and/or treatment resources to protect the health of the child. Recommendations can involve over-the-counter nicotine replacement therapy, national or state help lines (such as 1-800-QUIT NOW) and/or the parents seeing their own doctor or clinic for treatment. The motivated pediatrician can, with appropriate documentation, prescribe for the parent to protect the health of the child. If the parent is not ready to stop smoking, a smoke-free home and car should be advised.

Tobacco dependence treatment or referral should be offered to adolescents who want to stop smoking. There is very good evidence for effectiveness of behaviorally based approaches — especially for those with mild levels of addiction. For those with moderate to severe addiction, medications that are effective in adults are an option for use in adolescents, although evidence is limited. Close follow-up is needed as non-adherence to regular medication use and relapse of tobacco use after stopping therapy are common. Electronic nicotine delivery systems (e-cigarettes, others) should not be recommended as their use is associated with reduced rates of stopping smoking in adolescents.

Public policy guidance

Tobacco control programs need to be funded adequately. Programs should change the image of tobacco by telling the truth about tobacco.

Increasing age of purchase decreases youth smoking rates. The age of purchase of tobacco products should be increased to 21 years, and such regulations need to be enforced. Tobacco taxes should be increased as this decreases tobacco use among youths.

In addition to comprehensive smoking bans in workplaces, recreation facilities, public areas, and campuses of educational and health care institutions, smoking in multi-unit housing should be prohibited. Smoking in or near one unit exposes and harms children living in nearby units.

Advertising and promotion is a cause of tobacco use initiation in adolescents. Therefore, tobacco advertising and promotion that is accessible to children should be prohibited, including point-of-sale advertising, product placements in movies and other entertainment media, and promotion in print or Internet-based media accessible to youths.

Flavoring agents, including fruit, candy and menthol flavors, should be prohibited in all tobacco and nicotine products as flavored products encourage tobacco use initiation among youths.

Dr. Farber, a lead author of the tobacco reports, is policy chair of the AAP Section on Tobacco Control Executive Committee.

Up in smoke: illicit cigarette trade cost Hong Kong government HK$2.5b in lost tax revenues last year, study reveals

Gloria Chan

One in every four cigarettes smoked in Hong Kong last year was illicit, costing the government HK$2.5 billion lost in tax revenues, according to study released on Wednesday.

The “Asia-16” study, conducted by UK-based Oxford Economics and funded by tobacco giant Philip Morris, shows 1.3 billion, or 28 per cent, of cigarettes consumed were illicit. Despite a 5.6 per cent point drop compared to 2013, Hong Kong ranks fourth in illicit cigarette trading out of 16 Asia-Pacific markets studied, behind Brunei, Macau, and Malaysia.

Adrian Cooper, chief executive officer of Oxford Economics, said the city had a “significant problem” with illicit cigarettes. “[It’s] driven in part by the substantial retail price gaps with neighbouring countries that were exacerbated by tax rises in 2009 and 2011,” he said, adding that the price difference created a huge incentive for cross-border trade of cigarettes.

According to the report, the price of the most-sold brand in Hong Kong last year was US$7.1 per pack of 20, significantly higher than US$1.1 in China, US$3.8 in Macau, and US$3.0 in Taiwan.

In 2014, excise taxes were raised by 11.7 per cent, which brought up the retail price of the most-sold brand by 10 per cent.

Concern groups called for stronger action against organised smuggling gangs and syndicates.

“Hong Kong’s serious illicit tobacco problem is dominated by cross-border organised crime groups that use the proceeds to finance other criminal activities,” said Jeff Herbert, adviser to the advocacy organisation Hong Kong United Against Illicit Trade (HKUAIT) and a former senior superintendent with the Hong Kong police force. “[The government] needs to get a lot tougher with such organised crime syndicates.”

Herbert suggested three main solutions: use the Organised and Serious Crimes Ordinance as an effective means to seek heavier penalties, freeze assets of organised criminals, and confiscate their crime proceeds; run more public education campaigns; and introduce a balanced excise policy with regular but moderate tax increases in pace with inflation.

Herbert also warned against excessive tax increases as he believed that would only push more smokers to consume illicit cigarettes.

The HKUAIT admitted being sponsored by tobacco companies but added that their group’s focus is not only on the cigarette trade.

Source URL: