Vaping and e-cigarettes in Hong Kong: a dangerous gateway or a safe tool for quitting smoking?

As the Hong Kong government considers banning e-cigarettes and legislating against vaping, we talk to experts, detractors and fans of the 13-year-old phenomenon

PUBLISHED : Wednesday, 26 July, 2017, 6:45am
UPDATED : Tuesday, 28 November, 2017, 10:40am

RTHK Radio 3 DJ Peter King puffs thoughtfully away as he recalls the exact date he kicked his half-century tobacco habit. “It was the 3rd of March, 2014. You never forget the day. It’s a week, then two weeks, then a month. Now, it’s been more than three years.”

Three months after he gave up smoking, King ate a ploughman’s lunch and noticed how creamy the cheese tasted. He hadn’t tasted anything that good since he was a child, he says.

“Another thing I’ve noticed is that my chest has expanded because my lungs are working more efficiently. My sense of smell has definitely improved, and my energy levels have gone up.”

King, 62, started smoking at the age of 11 and was burning his way through two packets a day when he stubbed out his last stick and picked up an e-cigarette for the first time at the recommendation of a friend.

As well as noticing his health improve, King reckons he saves between HK$3,500 and HK$3,800 a month.

E-cigarettes have boomed in popularity since they went on sale in 2004. From a single manufacturer in China, the use of e-cigarettes – known as vaping – has become a multibillion-dollar industry with more than 450 brands, according to the World Health Organisation. They work by creating a vapour from a mixture of propylene glycol, glycerine and flavourings – often including nicotine – that replicates the smoking experience but without most of the toxic chemicals found in traditional cigarettes.

Proponents say they are comparatively harmless and highly effective in weaning smokers off cigarettes – but opponents say e-cigarettes, often sold with candy and fruit flavours, are a gateway to smoking and want them banned.

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Among those in the latter camp is the Hong Kong government. By next year, e-cigarettes are likely to be illegal in Hong Kong as the Food and Health Bureau draws up legislation expected to outlaw their sale and possession.

Already, possessing or selling e-cigarette liquid containing nicotine, which is categorised as a poison, carries a potential penalty of up to two years in prison and a HK$100,000 fine.

More than a dozen countries and territories have imposed a blanket ban on e-cigarettes, including Norway, Uruguay and the Seychelles, while in the US, Britain and most other European countries, they can be legally sold to anyone over the age of 18.

The debate over e-cigarettes has been triggered by a mix of conflicting medical reports into their effects, tobacco company interests, and the controversy over whether vaping should be seen as a smoking cessation aid or a back door to nicotine addiction.

A 2015 study by Public Health England, an agency of Britain’s Department of Health, found e-cigarettes are 95 per cent less harmful than tobacco and that most of the chemicals causing smoking-related diseases were absent in e-cigarettes.

Last year, the Royal College of the Physicians in London endorsed the use of e-cigarettes as a substitute for smoking. And this month, the country’s Department of Health advised that vaping is acceptable in the workplace.

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By contrast, a survey conducted last year at Baptist University and commissioned by the Hong Kong Council on Smoking and Health (COSH) came to the conclusion that e-cigarettes contained one million times more cancer-causing substances than outdoor air after tests on 13 brands.

Separately, public health specialist Professor Lam Tai-hing of University of Hong Kong said he was concerned about the prevalence of young people using e-cigarettes and called for a total ban to prevent an “epidemic” of use among youngsters.

A spokesperson for COSH said in a statement: “At least 16 countries have imposed a total ban on e-cigarettes, including Singapore, Thailand and Brazil. COSH urges the government to enact a total ban on the sales, advertising, promotion and sponsorship, distribution, import and manufacturing of e-cigarettes in Hong Kong promptly.”

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The WHO has voiced concerns about the marketing of e-cigarettes to young people, saying it wants e-cigarette juice with fruit, candy-like and alcohol-like flavours banned until it has been proved they are not attractive to children and adolescents.

“E-cigarettes have been marketed in almost 8,000 different flavours and there is concern they will serve as a gateway to nicotine addiction and, ultimately, smoking, particularly for young people,” the WHO said in a report. “Experimentation with e-cigarettes is increasing rapidly among adolescents, with e-cigarette use in this group doubling from 2008 to 2012.”

However, Ray Story, president of the Tobacco Vapor Electronic Cigarette Association, who has lobbied in Hong Kong for rules on e-cigarettes to be relaxed, dismisses the argument that teenagers who vape will go on to become smokers.

“If it was a gateway product, my question would be, how many people have you killed since you were a little kid and played cowboys and Indians? You had a toy gun. You must have wanted to buy an AK-47 and try it out in real life,” he says.

“How many times have you drunk Coca-Cola and thought, ‘You know what? I’ve drunk this since I was a kid. I need to put some Bacardi in it’. If you follow that logic, every product is a gateway product.

“There is absolutely no history of harm with vaporisation devices. Studies have found this product is at least 95 per cent less harmful than conventional tobacco. If you are trying to lower healthcare costs and look after the population, why wouldn’t you want people to have the choice between e-cigarettes and tobacco?”

Story believes the global campaign against e-cigarettes is being pushed by big tobacco companies, particularly on the mainland where they are state-owned – and where, ironically, most of the world’s e-cigarettes are made.

“Hong Kong gets its marching orders from China and if you are caught with an e-cigarette in China you can get two years in jail and a 100,000 yuan (HK$115,518) fine,” he says.

“In the US and Europe, cool heads have prevailed. Big tobacco companies understand they have to come back with a less harmful product. Elsewhere, they have absolutely rallied against e-cigarettes to make sure they stay banned for as long as possible so they can continue to sell the product that makes them monstrous profits.”

A spokesperson for the Food and Health Bureau says: “Contrary to the claims made by electronic cigarette advocates and manufacturers, there is evidence that e-cigarette aerosol is not merely water vapour.

“In view of the potential health effects and hazards arising from the use of e-cigarettes, the wider long-term impact on students and youngsters as well as the recommendations of the World Health Organisation … the government will actively study the proposal to regulate e-cigarettes through legislation.”

King says he fully supports a ban on e-cigarettes and liquids being sold to people under the age of 18 or with what he calls “fairground flavours”, and argues they should be used solely as an aid to give up smoking.

“The government should be looking at these surveys done overseas, not just the ones paid for by the tobacco companies or people with a hidden agenda,” he says. “If the government really wants to wean people off cigarettes, they should look at what is on the market and not just close it down.”

The prospect for e-cigarettes being accepted in Hong Kong looks like little more than a pipe dream for now, however, as COSH pushes for a total ban backed by fines and possible jail terms in what it says are the interests of public health, while cigarettes remain openly on sale.

The looming ban is likely to drive the market for e-cigarettes underground, and King is ready for what comes next. Drawing on his e-cigarette, he says: “Do they think they can force me back onto cigarettes so I risk lung cancer after three years of vaping? No chance. They’d better come looking for me, because I’m not doing it.”

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“While they are likely to be less toxic than conventional cigarettes, e-cigarette use poses threats to adolescents and fetuses of pregnant mothers using these devices.”

World Health Organisation (2014)

“Compared to tobacco products, electronic cigarettes are significantly safer. In the UK, the devices are used primarily as an aid to cutting down or quitting smoking … There is no evidence that use of electronic cigarettes leads to a take-up of smoking.”

Action on Smoking and Health UK (2016)

“The level of PAHs (polycyclic aromatic hydrocarbons) in e-cigarettes is at least one million times more than roadside air in Hong Kong.”

Dr Chung Shan-shan, biology department, Baptist University (2016)

“The evidence is increasingly clear that e-cigarettes are significantly less harmful to health than smoking tobacco … Public Health England recommends that e-cigarette use is not covered by smoke-free legislation and should not routinely be included in the requirements of an organisation’s smoke-free policy.”

UK Department of Health (July 2017)