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February 4th, 2016:

Shisha even riskier than cigarettes – Letters to the Editor

I agree with the views of Seki Chan (“Don’t overlook harm of shisha smoking”, January 29).

Besides the statistics provided by Ms Chan, shisha [or hookah] smoking has other harmful health effects.

According to the Centres for Disease Control and Prevention in the US, smoking shisha is actually more harmful than smoking a cigarette. According to the CDC, the amount of smoke inhaled during a typical shisha session is about 90,000 millilitres, compared with 500ml to 600ml inhaled when smoking a cigarette.

Furthermore, according to the American Lung Association, a study of shisha smoking found that nicotine and cotinine increased up to 250 per cent and 120 per cent respectively after a typical 40- to 45-minute smoking session.

Another potential problem is that commonly used heat sources for burning the tobacco, such as wood or charcoal, are likely to increase the health risks from shisha use.
This is because when they are burned on their own these heat sources release high levels of potentially dangerous chemicals, such as carbon monoxide and metals.

Furthermore, the social aspect of shisha smoking with shared mouthpieces may put many users at risk of contracting infectious diseases and viruses, such as tuberculosis, hepatitis and herpes. Even if the shisha smoke is second-hand, it is potentially dangerous because it contains smoke from the tobacco and from the heat source used to burn the tobacco. There are also harmful effects for pregnant women.

Research has also shown that teenagers who have smoked shisha before are more likely to become cigarette smokers.

I agree with Ms Chan that more people should be made aware of the harmful effects of shisha smoking.

Secondary schools in Hong Kong need to make students aware of the risks so they are not tempted to try out something that is becoming more popular in bars in the city. This should be part of general health education in these schools.

Eunice Li Dan-yue, Singapore

Source URL: http://www.scmp.com/comment/letters/article/1909311/letters-editor-february-4-2016?comment-sort=all

Kicking the habit: percentage of smokers in Hong Kong at new low, survey reveals

10.5pc of population indulged in habit last year as prevalence fell, but more women still smoke, Centre for Health Protection study finds

The percentage of smokers in the city last year dropped to its lowest level since records began 33 years ago, a study has found.

According to the survey of 10,000 households by the Centre for Health Protection, 10.5 per cent of the population above the age of 15 are daily smokers.

In 2008, the figure was 11.8 per cent and 10.7 per cent in 2012.

Undersecretary for Food and Health Sophia Chan Siu-Chee attributed the decline to effective tobacco control measures.

“The smoking prevalence in Hong Kong is amongst the lowest in the region. The government will continue to work towards bringing the figure down to a single digit,” she said.

The survey also showed that the smoking prevalence among young people between 15 and 19 dropped significantly – from 2 per cent in 2012 to 1.1 per cent last year.

However, Chan noted that the figure for female smokers saw a slight increase from 3.1 per cent in 2012 to 3.2 per cent.

“Research has shown the reasons that compel women to smoke are different from men. Therefore traditional methods for helping them to quit smoking may not work as well,” said Chan.

“We will review our current set-up and see whether we need to come up with specific services and measures targeting women.”

The survey also looked at the prevalence of electronic cigarette users in the city.

While e-cigarette usage in Hong Kong remained very low, the centre noted that 9 per cent of secondary school students have tried the devices, a trend Chan described as “worrying”.

“We are seriously considering prohibiting the import, manufacture, sale, distribution and advertising of e-cigarettes through legislation,” she said.

The undersecretary added the government is currently working on the details of the legislation but did not set out a timetable for when they will table the proposal at the Legislative Council.

Aside from regulating electronic cigarettes, Chan said the government is also aiming to start a legislative process on enlarging health-warning signs on tobacco products to cover 85 per cent of the packaging this year.

Another area Chan said authorities would continue to work on is the expansion of statutory no-smoking areas.

On March 31, the areas will be further extended to eight bus interchanges.

“Some suggested all bus stops in Hong Kong. Others suggested near schools and hospitals. So we have to consider all these factors and then we will work out a plan accordingly,” she said.

Chan declined to give an answer on whether tobacco tax would be increased in this year’s budget, only saying the current rate in Hong Kong is comparable to the World Health Organisation’s recommendation.
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Source URL: http://www.scmp.com/news/hong-kong/health-environment/article/1909667/kicking-habit-percentage-smokers-hong-kong-new-low

Latest cigarette smoking prevalence rate announced

http://www.info.gov.hk/gia/general/201602/04/P201602040963.htm

The latest government survey results reveal that the overall prevalence of smokers in Hong Kong has been on a continuous decreasing trend. The percentage of daily cigarette smokers aged 15 and above in the local population last year was 10.5%. Relevant figure in 2012 was 10.7%. The daily cigarette smokers among teenagers aged between 15 and 19 also decreased from 2% in 2012 to 1.1% in 2015.

According to the latest Thematic Household Survey Report of the Census and Statistics Department, there were 641 300 daily cigarette smokers in 2015, with 538 300 or 83.9% being male and 103 000 or 16.1% being female.

In another school-based survey conducted from October 2014 to April 2015 on smoking among students, the smoking prevalence among Primary 4 to 6 students and Secondary 1 to 6 students was 0.2% and 2.7% respectively, representing a decrease of 0.1 and 0.6 percentage points over that of the same period in 2012/13. The survey was done by the School of Public Health of the University of Hong Kong (HKU) and commissioned by the Food and Health Bureau.

Speaking at a press conference, the Under Secretary for Food and Health, Professor Sophia Chan, said today (February 4) that the Government is pleased to see that the overall prevalence of smokers is on a decreasing trend from 23.3% in early 1980s to 10.5% in 2015.

This shows that the Government’s multi-pronged approach in tobacco control, including legislation, taxation, law enforcement, health promotion and smoking cessation services, is proved to be effective with the support of the community.

“Although our daily cigarette smoking prevalence continues to be one of the lowest around the world, we cannot afford complacency, especially in the face of the fact that the smoking prevalence of certain groups did not see any significant decrease. For example, the smoking prevalence of female remains at the level of 3 to 4% in the past 10 years. At the same time, we also face challenges posed by e-cigarettes which have become more popular,” she said.

According to the survey done by the School of Public Health of HKU, a respective 2.6% and 9 % of Primary 4 to 6 students and Secondary 1 to 6 students were ever e-cigarette users, while 1.3% of the secondary students were current e-cigarette users.

“The Government has much concern about the use of e-cigarettes among students. The Government is therefore considering prohibiting import, manufacture, sale, distribution and advertising of e-cigarettes through legislation with an aim to protect public health. We hope that the relevant amendment bill can be introduced into the Legislative Council soon. In the meantime, the Government will continue to educate the public on the potential harms of e-cigarettes,” Professor Chan said.

She added that the Government will continue to push forward its tobacco control work. It will work closely with its community partners, step up health education and promotion to raise public awareness of the hazards of smoking, second-hand and third-hand smoke. The Government will also enhance the smoking cessation services to attract more smokers to quit smoking effectively, aiming at bringing down the smoking prevalence further down to single digit.

Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption

http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005992.pub3/abstract

Abstract

Background

Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and the smoking behaviour of those populations they affect. Since the first version of this review in 2010, more countries have introduced national smoking legislation banning indoor smoking.

Objectives

To assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption.

Search methods

We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL and reference lists of included studies. We also checked websites of various organisations. Date of most recent search; February 2015.

Selection criteria

We considered studies that reported legislative smoking bans affecting populations. The minimum standard was having an indoor smoking ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. Our search included a broad range of research designs including: randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before-and-after studies, interrupted time series as defined by the Cochrane Effective Practice and Organisation of Care Group, and uncontrolled pre- and post-ban data.

Data collection and analysis

One author extracted characteristics and content of the interventions, participants, outcomes and methods of the included studies and a second author checked the details. We extracted health and smoking behaviour outcomes. We did not attempt a meta-analysis due to the heterogeneity in design and content of the studies included. We evaluated the studies using qualitative narrative synthesis.

Main results

There are 77 studies included in this updated review. We retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes randomized controlled trials. Thirty-six studies used an interrupted time series study design, 23 studies use a controlled before-and-after design and 18 studies are before-and-after studies with no control group; six of these studies use a cohort design. Seventy-two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking-related diseases. A number of the studies report multiple health outcomes. There is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking-related illnesses. Effects on respiratory and perinatal health were less consistent. We found 24 studies evaluating the impact of national smoke-free legislation on smoking behaviour. Evidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long-term change in existing trends in prevalence.

Authors’ conclusions

Since the first version of this review was published, the current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in SHS for countries and their populations. The clearest evidence is observed in reduced admissions for acute coronary syndrome. There is evidence of reduced mortality from smoking-related illnesses at a national level. There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption.

Plain language summary

Does legislation to ban smoking reduce exposure to secondhand smoke and smoking behaviour?

Since the first national legislation banning indoor smoking in all public places was introduced in 2004, there has been an increase in the number of countries, states and regions adopting similar smoke-free legislation banning smoking in public places and work places since this review was first published. The main reason is to protect nonsmokers from the harmful health effects of exposure to secondhand smoke. Another reason is to provide a supportive environment for people who want to quit smoking.

Study characteristics

We searched for studies that investigated the effect of introducing a ban on any measures of health, or on smoking behaviour (up to February 2015). Since the previous version of this review had shown clear evidence that introducing legislation to ban smoking in public places does reduce exposure to secondhand smoke (SHS) in those places, we did not include studies that only reported exposure to SHS. We included 77 studies from 21 countries in this updated review. Studies of health outcomes typically used data from hospitals to look for changes in rates of admissions, discharges or deaths. Most studies looked at illnesses related to the cardiovascular system (heart or blood vessels), such as heart attacks and strokes. Studies also looked at effects on respiratory health, including chronic obstructive pulmonary disease (e.g. bronchitis), asthma and lung function. Seven studies looked at the health of newborn children. Eleven studies reported death rates. The best-quality studies collected data at multiple time points before and after the introduction of a ban in order to adjust for existing time trends. Some studies could compare events rates in areas with and without bans, or where bans were introduced at different times.

Key results

There is evidence that countries and their populations benefit from improved health after introducing smoking bans, importantly to do with the heart and blood vessels. We found evidence of reduced deaths. The impact of bans on respiratory health, on the health of newborn children, and on reducing the number of smokers and their cigarette use is not as clear, with some studies not detecting any reduction.

Quality of the evidence

Legislative bans have not been evaluated by randomized trials, and the quality of the evidence from the types of studies contributing to this review is lower. Changes in health outcomes could be due to other things, such as change in healthcare practices. However, many of the studies used methods of analysis that could control for underlying trends, and increase our confidence that any changes are caused by the introduction of bans.

International Cigarette Prices

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National (enforced) smoking bans improve health outcomes, Cochrane review shows

National smoking bans do reduce the harms of passive smoking, specifically cardiovascular disease, an updated systematic review from the Cochrane Library has found.1

Since the first version of this review in 2010, more countries have introduced national legislation to ban indoor smoking. The authors said that the updated review provided the most robust evidence yet that smoking bans have led to improved health outcomes.

A team of researchers based in Ireland included 77 studies, representing 21 countries, that investigated the effect of introducing a smoking ban on any measures of health or on smoking behaviour. They retained 12 studies from the original review and identified 65 new studies. Health outcomes were reported in 72 studies, of which 44 specifically assessed cardiovascular disease, 21 assessed respiratory disease, and seven assessed perinatal outcomes.

The review found consistent evidence of a positive effect from national smoking bans on improving cardiovascular health outcomes and reducing mortality from associated smoking related illnesses.

The clearest evidence it found was in reduced admissions for acute coronary syndrome. For example, one study in Ireland found a 12% reduction in admissions for acute coronary syndrome in the first year after the smoking ban, and another Irish study found an 18% reduction.

The greatest reductions in admissions for heart disease after smoking bans were identified in populations of non-smokers, the researchers found. Overall, they said that the evidence was of moderate quality in relation to cardiovascular disease.

But the effects of smoking bans on respiratory and perinatal health were found to be less consistent. Six of the 11 studies reported considerable reductions in admissions for chronic obstructive pulmonary disease, and seven of 12 reported considerable reductions in hospitalisations for asthma. In the seven studies looking at perinatal health the data produced conflicting results, and the study authors said that more research was needed in this area.

The review found 24 studies evaluating the effect of national smoke-free legislation on smoking behaviour. Evidence of an effect from legislative bans on smoking prevalence and tobacco consumption was found to be inconsistent, as some studies did not detect any additional change in existing prevalence trends.

Cecily Kelleher, a review author based at University College Dublin, said, “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in secondhand smoke exposure for countries and their populations.

“We now need research on the continued longer term impact of smoking bans on the health outcomes of specific sub-groups of the population, such as young children [and] disadvantaged and minority groups.”

BMJ 2016; 352 doi: http://dx.doi.org/10.1136/bmj.i701 (Published 04 February 2016) Cite this as: BMJ 2016;352:i701

Kicking the habit: percentage of smokers in Hong Kong at new low, survey reveals

10.5pc of population indulged in habit last year as prevalence fell, but more women still smoke, Centre for Health Protection study finds

The percentage of smokers in the city last year dropped to its lowest level since records began 33 years ago, a study has found.

According to the survey of 10,000 households by the Centre for Health Protection, 10.5 per cent of the population above the age of 15 are daily smokers.

In 2008, the figure was 11.8 per cent and 10.7 per cent in 2012.

Undersecretary for Food and Health Sophia Chan Siu-Chee attributed the decline to effective tobacco control measures.

“The smoking prevalence in Hong Kong is amongst the lowest in the region. The government will continue to work towards bringing the figure down to a single digit,” she said.

The survey also showed that the smoking prevalence among young people between 15 and 19 dropped significantly – from 2 per cent in 2012 to 1.1 per cent last year.

However, Chan noted that the figure for female smokers saw a slight increase from 3.1 per cent in 2012 to 3.2 per cent.

“Research has shown the reasons that compel women to smoke are different from men. Therefore traditional methods for helping them to quit smoking may not work as well,” said Chan.

“We will review our current set-up and see whether we need to come up with specific services and measures targeting women.”

The survey also looked at the prevalence of electronic cigarette users in the city.

While e-cigarette usage in Hong Kong remained very low, the centre noted that 9 per cent of secondary school students have tried the devices, a trend Chan described as “worrying”.

“We are seriously considering prohibiting the import, manufacture, sale, distribution and advertising of e-cigarettes through legislation,” she said.

The undersecretary added the government is currently working on the details of the legislation but did not set out a timetable for when they will table the proposal at the Legislative Council.

Aside from regulating electronic cigarettes, Chan said the government is also aiming to start a legislative process on enlarging health-warning signs on tobacco products to cover 85 per cent of the packaging this year.

Another area Chan said authorities would continue to work on is the expansion of statutory no-smoking areas.

On March 31, the areas will be further extended to eight bus interchanges.

“Some suggested all bus stops in Hong Kong. Others suggested near schools and hospitals. So we have to consider all these factors and then we will work out a plan accordingly,” she said.

Chan declined to give an answer on whether tobacco tax would be increased in this year’s budget, only saying the current rate in Hong Kong is comparable to the World Health Organisation’s recommendation.
________________________________________
Source URL: http://www.scmp.com/news/hong-kong/health-environment/article/1909667/kicking-habit-percentage-smokers-hong-kong-new-low?comment-sort=all