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City Weekend

Are e-cigarettes all smoke and mirrors? One man’s quest for clean Hong Kong air

Antonio Kwong, chairman of the Hong Kong Council on Smoking and Health, is worried about a new trend targeted at young people or those who want to quit smoking

PUBLISHED : Saturday, 21 April, 2018, 4:02pm
UPDATED : Saturday, 21 April, 2018, 4:02pm

With the daily smoking rate of Hong Kong’s population at a record low, one might think public health advocate Antonio Kwong Cho-sing could not be any happier as head of the Hong Kong Council on Smoking and Health, an anti-smoking activist group.

But he now faces a new challenge that has reared its ugly head: e-cigarettes.

“If I have the power to make it work, I wish Hong Kong can be a smoke-free society, Kwong says. “Is this a far-fetched idea? I personally don’t really think so.”

Fewer smokers in Hong Kong but among those who light up, more are turning to e-cigarettes, survey reveals

A census report released in March showed that although the proportion of regular smokers in Hong Kong had dropped to 10 per cent of the total population – the lowest figure ever – the use of electronic smoking devices among this group is on an alarming upwards trend.

Those above the age of 15 using e-cigarettes and heat-not-burn tobacco products rose almost sixfold in two years, from less than 1,000 in 2015 to 5,700 last year, according to the report, which polled 10,000 households in the second half of last year.

Such products 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. However, recent local studies and experts worldwide have shed light on the fact that the substances in such products are still extremely unhealthy.

Call for Hong Kong tobacco tax hike next year, and cigarette ban in 10 years

Kwong says the increase in local usage is because there is no legislation on the sales and promotion of e-cigarettes, and manufacturers are targeting young people with new flavours and designs.

Kwong also points to an administration that he says, is less proactive compared with governments overseas such as in Singapore.

According to the World Health Organisation, tobacco kills up to half of consumers, or more than seven million people each year.

“I’ve never seen any other consumer product that can kill half of its customers,” Kwong says.

“Tobacco producers might have paid lots of tax, but the real price is the toll on public health and the overburdened medical system.”

Hong Kong anti-smoking body hit by manpower shortage and dismal night enforcement

Have you ever smoked a cigarette?

I’ve never smoked, mainly because I have been suffering from asthma since I was a child. But like many teenagers, I was curious about smoking at a young age, especially when in boarding school in Britain. I was surrounded by peers who smoked.

I think for many young people back then, smoking made them feel grown up and cool. In the old days, it was legal to advertise tobacco products. There were no heath warnings printed on cigarette packs.

In my opinion though, the young today don’t widely perceive smoking as cool anymore, as our studies have shown the smoking rate of Form One to Six pupils in Hong Kong to be at 2.5 per cent.

This is a totally different picture, especially compared with the 1980s, when a quarter of Hong Kong’s population were smokers.

Why have e-cigarettes become increasingly popular in Hong Kong, especially among young people?

Hong Kong currently has only two relevant ordinances to regulate the use of e-cigarettes – the Pharmacy and Poisons Ordinance, which requires nicotine-containing products to be registered for selling, and the Smoking Ordinance, which stipulates that e-cigarettes, like normal cigarettes, cannot be used in designated non-smoking areas.

I’ve never seen any other consumer product that can kill half of its customers

Apart from these, the city has no other legislation on e-cigarettes. Lots of other ordinances that apply to tobacco, such as the ban on advertising, do not cover e-cigarettes.

We have observed that lots of e-cigarette manufacturers then make use of the lack of legislation to promote their products to young people. We see slogans that we consider to be misrepresentative, such as the use of terms like “safe”, “healthy”, “no cancer-causing materials” and “water vapour”. We do not know if they are safe, but we are certain that e-cigarettes are not as simple as just containing water vapour.

Some e-cigarettes are also designed in different shapes and come in various flavours, which apparently are used to attract young people or female consumers.

In 2016, we commissioned Baptist University for a study on e-cigarettes. We tested 13 different brands of e-cigarettes and found that they contained a carcinogenic substance called polycyclic aromatic hydrocarbons, or PAHs. Another substance called polybrominated diphenyl ethers, or PBDEs, which is associated with thyroid hormone disruption, was also found. So it is fair to say e-cigarettes contain harmful substances.

Do you agree with some suggestions that e-cigarettes or vaping can help smokers quit?

There are many studies with different findings but no conclusive evidence so far showing that vaping can help people quit smoking. The World Health Organisation also does not think that e-cigarettes can be a tool to aid smoking cessation.

It is fair to say e-cigarettes contain harmful substances.

We have observed that those who switch to e-cigarettes to quit smoking end up being dual smokers.

A study by the University of Hong Kong a few years ago on secondary pupils showed that those who used e-cigarettes were less inclined to quit because of their reliance on nicotine. They even had a higher chance of turning to traditional cigarettes.

I will not rule out the possibility of people successfully quitting smoking with e-cigarettes, although, according to WHO advice, this should not be the way.

Under the current Pharmacy and Poisons Ordinance, manufacturers of vaping devices have the right to register their products as aids for smokers to kick the habit, similar to nicotine replacement therapy. Those who want to register need to prove that their products are legitimate and effective. But so far, none of the manufacturers of such products are on the registered list.

What are some of the most touching stories you have heard of smokers quitting?

There was a man in his 80s, who won our smoke-free community campaign contest called Quit to Win. He had been smoking for seven decades. His wife and children had asked him to quit, but he turned a deaf ear to them.

Most quit smoking for health reasons. They realised something was wrong with their bodies

It wasn’t until when his daughter-in-law asked him not to hold her baby because of third-hand smoke (residual nicotine and other substances left on surfaces by tobacco smoke) that he decided to quit.

I think every smoker has a reason to quit smoking, whether it’s about health or financial cost. Our role as Hong Kong’s anti-smoking body is to help them identify the reason.

Ultimately, the choice is theirs, and it depends on how determined they are. Most people give up smoking because of health reasons. They realised something was wrong with their bodies.

In an ideal world, do you think tobacco companies should not exist?

The world is never ideal. But, if I have the power to make it work, I wish Hong Kong could be a smoke-free society. When you look at countries like Ireland and Finland, they have a time frame to reach this goal of 5 per cent or under for smoking prevalence among the population. They also have legislation to pave the way for that goal. Unfortunately, the Hong Kong government only said it was aiming for a single-digit smoking prevalence.

When it comes to smoking, how does Hong Kong compare with other Asian cities such as Singapore?

We have a lower daily smoking rate at around 10 per cent compared with Singapore. In the past year, Singapore’s smoking rate has been between 12 and 14 per cent. But I would say its government is very proactive when it comes to protecting public health, such as the ban on the sale of e-cigarettes.

Policymakers in the Lion City have also been gradually increasing the legal age of purchasing cigarettes. In 2009, the legal age there for buying a pack was 19, compared with the current 21.

Although the sizes of cigarette pack warnings in the country are smaller than those in Hong Kong, I understand that Singapore is considering launching plain packaging (standardised pack designs that may result in bigger graphic images and warnings to deter buyers).

What do you want to say to tobacco companies?

I think it is their basic responsibility to tell the public the harmful effects of smoking, and they should not interfere with health policies on tobacco control. After all, they are selling a product that could kill half of their customers.


Romantic comedies, boarding school and art books

What is the most recent film you have watched?

The Greatest Showman. I enjoyed it very much because I like musicals.

What are your thoughts on the comedy Love in a Puff, which is about romance between strangers over cigarette breaks?

I have watched it but, of course, I am strongly against what the film was trying to portray. But it also reflected Hong Kong’s smoking culture – that people like smoking together around a trash bin, or what we call a “hotpot”.

What was it like studying in a boarding school in Britain?

I was sent to the boarding school by my parents at 13. I didn’t really have a choice back then. My parents said to me that I had to go there after completing Form One in Hong Kong. I had no internet and didn’t know what the school was like until my first day there. My first meal there was a sunny-side up egg and some chips.

What is your favourite travel destination?

Anywhere away from Hong Kong. I have a lot of duties here and it’s a high-pressure and fast-paced environment. When I am away, I don’t feel the urge to check emails right away.

What is your favourite cuisine?

If you look at my size, you can assume I love to eat everything.

What type of books do you read?

I like to read about art. It’s really hard to pinpoint an exact book as my favourite.

Do you have a favourite singer?

Canto-pop singer Phil Lam Yik-hong.