LCQ12: Tackling smoking problems
Following is a question by the Hon Lillian Kwok and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (February 12):
Question:
It is learnt that recent years have seen a trend of vapers getting younger, and there are even primary pupils among them, which is worrying. In this connection, will the Government inform this Council:
(1) of the number of cases reported by schools to the Government in each month of the past three years regarding students vaping or smoking at school;
(2) of the numbers of enforcement actions and prosecutions initiated by the Government in each month of the past three years against the illegal sale of tobacco products by shop operators to persons under 18 years of age;
(3) whether the Government will ramp up efforts in education and publicity about smoking bans, including educational efforts targeting such e-cigarette oils as “space oil” which contain illegal harmful substances; if so, of the details; if not, the reasons for that; and
(4) whether the Government will allocate additional resources for smoking cessation counselling services to assist smokers in smoking cessation; if so, of the details; if not, the reasons for that?
Reply:
President,
Having consulted the Security Bureau (SB) and the Education Bureau (EDB), the consolidated reply to the various parts of the Hon Lillian Kwok’s question is as follows:
The Government has been adopting a multi-pronged and progressive approach, including legislation, taxation, publicity, education, enforcement and promotion of smoking cessation services, in a bid to reduce the hazards caused by smoking products to the public and the society. Currently, the EDB does not require schools to report figures relating to the number of students who smoke e-cigarettes or cigarettes. The Census and Statistics Department conducts Thematic Household Surveys (THS) regularly to keep track of the local smoking situation. The THS results in 2023 showed that the percentage of daily conventional cigarette smokers among all persons aged 15 and above has dropped steadily from 11.1 per cent in 2010 to 9.1 per cent in 2023. The percentage of daily conventional cigarette smokers among teenagers aged 15 to 19 decreased continuously from 2.5 per cent in 2010 to 1.0 per cent in 2017. In the survey conducted in 2019, 2021 and 2023, the sample count for smokers aged 15 to 19 was too small to produce a representative prevalence estimate. Regarding e-cigarette use, in 2023, about 11 600 persons aged 15 and above reported daily use of e-cigarettes, accounting for 0.2 per cent of the population. The relevant sample count was also too small to produce a representative estimate of the proportion of such persons aged 15 to 19. The proportion of daily smokers from 2010 to 2023 is at Annex I. Separately, the Health Bureau (HHB) has commissioned the School of Public Health of the University of Hong Kong to conduct school-based surveys on smoking among students (school-based survey) since 2010, and the results of the last school-based survey conducted in 2023 showed that the smoking prevalence among primary and secondary school students (see Annex II) maintained at a low level.
However, over the years, tobacco companies have been using a myriad of tactics to lure young people to smoke so as to sustain their long-term profitability. Considering the harm brought about by tobacco products to the society, especially young people, there is a need for the Government to implement more effective and targeted tobacco control measures to combat smoking hazard and to prevent smoking prevalence from rebounding. Therefore, the Government announced in June last year the introduction of 10 tobacco control measures to safeguard the health of the community.
First, the findings of the THS showed that the younger the age group, the higher the rate of smoking flavoured cigarettes. For instance, among the conventional cigarette smokers aged from 20 to 29, over 70 per cent of them currently smoke flavoured cigarettes, while nearly 70 per cent smoked flavoured cigarettes when they first smoked. Besides, over 70 per cent of female smokers of conventional cigarettes currently smoke flavoured cigarettes; and over 60 per cent of current female smokers of conventional cigarettes smoked flavoured cigarettes when they first smoked (see Annex III). Scientific evidence shows that flavoured cigarettes, such as menthol or fruit-flavoured cigarettes, reduce the awareness of the hazard of tobacco and in turn increase the chances of non-smokers (especially teenagers) to start smoking. They also make consumers more vulnerable to getting into and continuing with the smoking habit. Flavoured cigarettes are indeed “sugar-coated poison”. Tobacco companies add flavours to conventional cigarettes to cover up the harshness of tobacco smoke, so as to lure members of the public, especially young people, to smoke and become addicted to smoking. The situation is worrying. The Government therefore proposes to prohibit adding flavours in conventional smoking products to counteract the intention of tobacco companies to use flavouring agents to disguise the toxicity of tobacco products and attract young people to smoke.
Secondly, alternative smoking products (ASPs) have rapidly gained popularity around the world in recent years. The Government resolutely banned the import, promotion, manufacture, sale or possession for commercial purposes of ASP on April 30, 2022, so as to reduce the chance for tobacco companies to use ASPs as another means to lure the public, especially the younger generation, to become addicted to smoking.
Recently, e-cigarette devices have even been used for drug abuse. E-liquid, mixed with drugs such as etomidate (commonly known as “space oil drugs”), a psychoactive substance, can be inserted into e-cigarette devices and heated to generate aerosol for smoking. By their appearance, “poisonous capsules” (or “zombie capsules”) containing “space oil drugs” or other regulated drugs or narcotics are no different from regular e-cigarettes capsules, and it is difficult to distinguish the ingredients by bare eye, thus largely increasing the possibilities of smokers to abuse drugs through ASPs anytime, anywhere and in a more covert manner. Young people may become addicted to drugs by smoking e-cigarettes containing “poisonous capsules” without realising it.
The Government will strengthen the control of etomidate, which is the main active ingredient of “space oil drugs”, and planned to gazette to list etomidate as a dangerous drug (i.e. narcotic) on February 14, 2025, so as to increase deterrence and enable law enforcement agencies to effectively respond to the relevant situation.
On publicity and education on the harmful effects of smoking and ASPs, the Department of Health (DH) and the Hong Kong Council on Smoking and Health (COSH) will strengthen their collaboration with the EDB to publicise the harmful effects of smoking and ASPs to students through seminars, dramas and mentorship programmes. The EDB has also been organising seminars and professional development programmes continuously for teachers to enhance their understanding and awareness of tobacco products, especially ASPs. On school curriculum, health education (including resistance to harmful substances) is a key component of values education. The Values Education Curriculum Framework (Pilot Version) issued in 2021 has further strengthened values education in related areas (including resistance to harmful substances including drugs, traditional tobacco products and ASPs) and outlined the expected learning outcomes for students across various key learning stages. The Whole School Health Programme launched by the DH will also step up publicity and education on tobacco hazards.
On the other hand, the Narcotics Division (ND) of the SB has been collaborating with various government departments, the COSH and non-governmental organisations to explain the harmful effects of “space oil drug” to the public through different channels, raise self-awareness on drug prevention among the public, and seek more ways to reach out to hidden drug abusers. To target drug traffickers selling “space oil drugs”, the Government is stepping up efforts to educate students on their harmful effects. The ND and the EDB will jointly launch an “anti-space oil drug” week in schools, during which a series of activities will be held, including talks, anti-drug video broadcast, anti-drug drama shows, with a view to preventing the spread of “space oil drugs” among the younger cohort and to tie in with the legislative work.
The relevant ban on ASPs has been in force for nearly three years. At present, there are no legal channels to import or purchase ASPs, and ASPs purchased for personal use before the ban came into effect should have been largely consumed after a certain period of time. Yet the findings of the aforementioned school-based survey indicated that the ratio of primary and secondary school students who smoke e-cigarettes to those who smoke conventional cigarettes is nearly one to one, suggesting that e-cigarettes, among other tobacco products, are particularly popular amongst the younger generation. It is worrying that young people are still exposed to ASPs despite the implementation of the ban on their import and sale. Prevailing legislation does not prohibit the possession of ASPs for non-commercial use. To suppress the continued circulation of ASPs, which are hazardous novel tobacco products, in Hong Kong and to tackle the problem of “poisonous capsules” at its root, the HHB will further strengthen the regulation of ASPs, including banning the possession of relevant products, so as to curb the emergence of ASPs as an alternative drug abuse product. Details will be announced later.
Thirdly, to prevent young people from smoking and suppress the harm posed by tobacco on them, the Smoking (Public Health) Ordinance (Cap. 371) stipulates that no person shall sell any conventional smoking product to any person under the age of 18. The number of complaints/referrals received, the number of inspections conducted and the number of summonses issued by the DH in relation to the restrictions on the sale or giving of conventional smoking products under the Smoking (Public Health) Ordinance (Cap. 371) from 2022 to 2024 are set out in Annex IV. For the comprehensive protection of the underaged, the Government proposes to further prohibit giving tobacco products to persons under the age of 18 such that the provider is to be held liable.
Fourthly, the Government has been actively conducting public education programmes on multiple fronts to promote a smoke-free environment. The DH collaborates with the COSH, non-governmental organisations and healthcare professionals to promote the harms of smoking and smoking cessation, including joining with district service organisations to disseminate smoke-free messages through promotional activities, smoking cessation competitions, smoking cessation counselling, targeting at young people, women, elderly groups, etc. Promoting smoking cessation is also an important pillar under the tobacco control strategy. Since 2021, the DH has launched the Quit in June campaign to promote smoking cessation services and one-week nicotine replacement therapy (NRT) trial packs have been distributed for free at more than 250 designated community pharmacies, smoking cessation clinics and District Health Centres (DHC)/DHC Expresses with a view to encouraging smokers to attempt quitting. Last year, the DH introduced a trial programme on the use of Chinese medicine ear-point patches for smoking cessation. So far, more than 3 500 NRT trial packs and more than 300 Chinese Medicine Ear-point Patch trial packs have been distributed, and most of the smokers who have tried the ear-point patches have found them helpful in alleviating the symptoms of addiction and the response has been very positive.
Besides, the DH has subvented two more service providers (increased from two to four) since last year to operate smoking cessation clinics focusing on counselling and pharmacotherapy, and is planning on subventing three more Chinese medicine smoking cessation service providers (increased from one to four) in the second half of this year to operate smoking cessation clinics focusing on counselling and acupuncture. It is expected that the number of service users can be increased by about 40 per cent and doubled respectively.
The Government will continue to step up the work on smoking cessation and explore various tobacco control measures in the medium and long term in order to eliminate the hazards posed by tobacco products on the society in all aspects and protect the health of the community under a progressive and multi-pronged approach. read more