Safeguarding public health – Call for a total ban on flavoured tobacco and possession of alternative smoking products
- A recent tobacco-related survey found that nearly 90 percent of female smokers in Hong Kong aged 15-29 use flavoured cigarettes. The data also shows that flavoured tobacco increases smokers’ addiction level, making it harder for them to quit. Over 70 percent of the public support banning flavoured tobacco products, and this percentage continues to rise.
- Hong Kong Council on Smoking and Health recommends a total ban on all flavoured tobacco products, including all flavours such as menthol, and any accessories that could add flavours to cigarettes. Possession of alternative smoking products (ASPs) in any form is also recommended to be prohibited.
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Hong Kong Council on Smoking and Health (COSH) and academics from The University of Hong Kong released new tobacco control surveys which show a higher rate of flavoured cigarette use among teenagers and women. Mr Henry TONG Sau-chai, COSH Chairman, said, “Menthol, fruit, and other tobacco flavours added by the tobacco industry are a significant factor that encourages teenagers and women to first try and then continue smoking. Flavoured tobacco does harm to our next generation by increasing addiction levels among young people, making it harder for them to quit.”
“In the long term, flavoured tobacco poses a major obstacle to decreasing the prevalence of smoking in Hong Kong and undoubtedly raises public health concerns.” Mr TONG said. “COSH urges the Government to institute a total ban on flavoured tobacco as soon as possible and to implement multiple short, medium, and long-term tobacco control measures to protect the health of Hong Kong residents by curbing this resurgent area of tobacco-related harm.”
Higher flavoured cigarette smoking rates in young adults and women
The Tobacco Control Policy-related Survey commissioned by COSH and conducted by The University of Hong Kong from January to May 2024 found that nearly half of current smokers use flavoured cigarettes, with higher rates among teenagers and women. Over 86 percent of female smokers aged 15-29 are using flavoured cigarettes, the highest among all age groups. Flavoured cigarettes have increased levels of addiction among young smokers, offering an easy lure for teenagers to fall into nicotine addiction. The survey found that nearly 40 percent (36.2 percent) of teenagers who use flavoured cigarettes are moderately to severely addicted, which is twice the rate of those using non-flavoured cigarettes (16.7 percent). The survey also indicated that young smokers of flavoured cigarettes are more likely to also be using alternative smoking products (including e-cigarettes and heated tobacco products) and waterpipes.
Professor Kelvin WANG Man-ping, Professor, The School of Nursing, The University of Hong Kong, said, “Teenagers and women are increasingly attracted to flavoured tobacco products, with preferences for particular flavours and brands. This phenomenon makes it more likely they will take up smoking, develop an addiction, and continue smoking as a habit. Certain flavourings (such as menthol, cocoa, sweeteners, etc.) used in flavoured cigarettes can promote the absorption of nicotine and enhance nicotine’s effects on the brain, thus exacerbating the addiction, leading smokers to smoke more frequently and for longer periods of time, and making it more difficult to quit the habit. According to the survey, over 70 percent of the public support banning flavoured tobacco products, and this percentage continues to rise – a clear indication of societal support for a ban on flavoured tobacco and of the urgent need for legislation.”
Flavoured tobacco leads to addiction in teenagers
According to a survey of flavoured smoking product use among primary and secondary school students in Hong Kong during the 2022-2023 academic year conducted by The University of Hong Kong, flavoured tobacco makes it easier for teenagers to continue smoking. Students whose first cigarette was flavoured were 2.7 times more likely to become daily smokers than those whose first cigarette was non-flavoured. Professor Derek CHEUNG Yee-Tak, Assistant Professor, The School of Nursing, The University of Hong Kong, stated, “The results clearly show that flavoured tobacco leads to addiction in adolescents, increasing their chances of becoming daily smokers in the future. If the Government does not intervene promptly, the situation may continue to deteriorate, putting youth at risk. The Government needs to protect the next generation by implementing a comprehensive ban on flavoured tobacco.”
High levels of harmful compounds contained in waterpipes
Further research included Hong Kong’s first study on the harmful substances contained in waterpipes. Flavoured waterpipes come in a wide variety of tastes and are increasingly popular among young people and women. Most waterpipe smokers use flavoured tobacco, which contains more harmful compounds, including fine particulate matter (PM2.5), carbon monoxide, nicotine, and carcinogens. The study visited five popular bar areas for waterpipe smoking and found that, regardless of weekdays or weekends, the levels of PM2.5 in bars that offer waterpipes exceeded safe limits. On weekends, the average was 1,247 micrograms per cubic meter (with a maximum of 5,331 micrograms), which is nearly four times higher than the harmful level defined by the U.S. Environmental Protection Agency (225.5 micrograms per cubic meter), and in some cases over 22 times higher. Additionally, in bars that offer waterpipes, the levels of particulate matter measured were on average 11 to 45 times higher than in bars that do not offer waterpipes, whether on weekdays or weekends. Long-term exposure to carcinogenic particulate matter can lead to respiratory and cardiovascular diseases.
Professor Jay LEE Jung-Jae, Assistant Professor, The School of Nursing, The University of Hong Kong, stated, “The research found that the air in waterpipe bars surveyed on both weekdays and weekends contains high levels of carcinogenic chemicals, including polycyclic aromatic hydrocarbons (PAHs) and formaldehyde. The PAHs with the strongest carcinogenicity, benzo[a]pyrene, was found at concentrations exceeding the EU air quality standards by 12 to 27 times. Long-term exposure to harmful environments increases the chances of respiratory diseases, lung cancer, skin cancer, cardiovascular diseases, and infectious diseases among waterpipe smokers. In addition to harming their own health, waterpipe smokers also negatively impact the health of bar staff. Another survey also found that the levels of benzo[a]pyrene in the urine of bar staffs were more than four times higher than those of waterpipe smokers themselves.”
Ms Vienna LAI Wai-yin, COSH Executive Director remarked, “Over 40 countries and places (including Canada, the UK, and EU countries) ban menthol and other flavours in cigarettes. In some countries, such as the UK, which have already banned flavoured tobacco, the tobacco industry has introduced tobacco flavour accessories that enable smokers to add and customise different flavours to attract specific groups such as teenagers. COSH recommends the Government ban flavoured tobacco, covering all flavoured smoking products, including all flavours such as menthol, as well as any accessories that can add flavours to rolled cigarettes, in order to end all tobacco harm.”
The Government has announced 10 short-term tobacco control measures and is exploring various medium to long-term options. COSH supports these efforts and encourages societal collaboration to strengthen tobacco control measures. COSH hopes the measures will be implemented promptly to prevent teenagers from starting to smoke and to reduce smoking prevalence, aiming for a tobacco-free Hong Kong.