non-communicable diseases watch may 2019 - smoking kills · non-communicable diseases watch may...

Non-Communicable Diseases Watch May 2019

Smoking Kills

This publication is produced by the Surveillance and Epidemiology Branch, Centre for Health Protection of the Department of Health

18/F Wu Chung House, 213 Queen’s Road East, Wan Chai, Hong Kong http://www.chp.gov.hk All rights reserved

Key Messages

※ Tobacco use is the world‟s leading killer, driving an epidemic of cancer, cardiovascular diseases,

chronic lung diseases and other non-communicable diseases. However, there were 1 114 million

(939 million males, 175 million females) current smokers worldwide in 2015.

※ To safeguard public health, the Hong Kong Government has been progressively stepping up

tobacco control efforts. Current policies on tobacco control have full regard to the provisions of

Framework Convention on Tobacco Control of the World Health Organization. Correspondingly,

the percentage of daily cigarette smokers aged 15 years and above dropped steadily from 23.3%

in 1982 to 10.0% in 2017.

※ In May 2018, the Hong Kong Government launched “Towards 2025: Strategy and Action Plan to

Prevent and Control Non-communicable Diseases in Hong Kong” with a list of committed actions

and 9 local NCD targets to be achieved by 2025, including Target 5: A 30% relative reduction

in the prevalence of current tobacco use in persons aged 15 years and above.

※ To reduce tobacco use, the Government has further expanded the statutory non-smoking areas to

include more public facilities and adopted new initiatives to enhance smoking cessation services

and help smokers quit smoking. The Government will continue to monitor the proportion of tobacco

duty to retail price and raise taxes as necessary. The Government also plans to legislate a ban on

the import, manufacture, sale, distribution and advertisement of e-cigarettes and other alternative

smoking products.

※ To create a smoke-free Hong Kong requires every sector in the community to say NO to smoking.

For themselves and others, smokers are encouraged to quit smoking. For professional help, please

call the Integrated Smoking Cessation Hotline of the Department of Health at 1833 183.

Target 5: A 30% relative reduction in the prevalence of

current tobacco use in persons aged 15 years and above

http://www.chp.gov.hk/

Smoking Kills


Tobacco use is the world‟s leading killer, driving an

epidemic of cancer, cardiovascular diseases, chronic

lung diseases and other non-communicable diseases.

Each year, smoking kills over 7 million people

globally. While more than 6 million of those deaths

are the result of direct tobacco use, around 890 000

are the result of non-smokers being exposed to

secondhand smoke.1 Yet, the negative effects of

smoking extend well beyond individual and

population health. In 2017, the U.S. National Cancer

Institute and the World Health Organization (WHO)

jointly estimated that tobacco smoking costs the

global economy more than US$ 1.4 trillion annually

in healthcare expenditure and lost productivity.2

Environmentally, tobacco cultivation, production,

distribution, consumption and disposal are major

sources of pollution.3 In many tobacco growing

countries, evidence indicates irreparable ecological

damage from tobacco agriculture due to deforesta-

tion and soil degradation from tobacco growing.

While smoking pollutes the air, millions of kilo-

grams of non-biodegradable cigarette butts and other

tobacco product waste items are discarded every

year.4

Global Response and Situation

In response to the global tobacco epidemic, the

WHO Framework Convention on Tobacco Control

(WHO FCTC)5 was developed under the auspices

of the WHO and entered into force in 2005. It is

the first global public health treaty, providing the

principles and context for policy development,

planning of interventions and mobilisation of

political and financial resources for tobacco control.

To help countries implement the treaty and turn

the global consensus into a global reality, WHO

introduced the MPOWER in 2008 with a set of 6

proven tobacco control measures: Monitor tobacco

use and prevention policies; Protect people from

tobacco use; Offer help to quite tobacco use;

Warn about the dangers of tobacco; Enforce bans

on tobacco advertising, promotion and sponsorship;

and Raise taxes on tobacco.6 At present, nearly two

thirds of countries (121 of 194) have introduced at

least one MPOWER measure at the highest level to

protect people from smoking, and eight have four

or more measures in place.7

Since the WHO FCTC came into force, the age-

standardised prevalence of tobacco smoking (any

type of tobacco, smoked or smokeless) by people

aged 15 years and above globally decreased from

24.3% (39.6% of males, 9.0% of females) in 2005 to

20.2% (34.1% of males, 6.4% of females) in 2015.

Still, there were 1 114 million (939 million males,

175 million females) current smokers worldwide

in 2015. Among adolescents, WHO conservatively

estimated that 6.8% (9.3% of boys, 4.2% of girls) or

24.1 million (17.0 million boys, 7.1 million girls)

adolescents aged 13-15 years smoked cigarettes.8

Furthermore, the emergence of novel tobacco prod-

ucts such as electronic-cigarettes (“e-cigarettes”)

presents new public health challenges. Since their

introduction to the market in the early 2000‟s,

e-cigarette use has increased at an alarming rate,

especially by youth and young adults.9 Among

Europeans aged 15 years and above, the prevalence

of ever use of e-cigarettes increased from 7.2%

in 2012 to 11.6% in 2014.10 In 2017, 63 million

Europeans aged 15 years and above had ever used

e-cigarettes and 7.6 million were regular e-cigarette

users.11 In the U.S., e-cigarettes are the most

commonly used tobacco product by youth. In 2017,

11.7% (or 1.73 million) of high school students

and 3.3% (or 0.39 million) of middle school students

reported e-cigarette use in the past 30 days.12


Local Situation and Progress

To safeguard public health, it is the established

policy of the Hong Kong Government to discourage

smoking, contain the proliferation of tobacco use,

and protect the public from exposure to secondhand

smoke as far as possible. Over the past decades,

Hong Kong has been progressively stepping up

tobacco control with full regard to the provisions

of WHO FCTC and adopted the WHO recommended

„best buys‟ and other recommended interventions

for reducing tobacco use (Table 1).13

Table 1: Overview of Hong Kong Situation vis-à-vis WHO recommended interventions for reducing

tobacco use

WHO recommended

Interventions

Local Status

‘Best buys’

Enact and enforce comprehensive bans

on tobacco advertising, promotion and

sponsorship

● Adopted. All cigarettes advertising and sponsorship in the electronic media was

banned in 1990 and subsequently all print and display tobacco advertising was

banned in 1999.

Eliminate exposure to second-hand

tobacco smoke in all indoor work-

places, public places, public transport

● Adopted. The Smoking (Public Health) Ordinance (Cap. 371) was amended in 2006

to, inter alia, extend the statutory smoking ban to cover all indoor working places

and public places as well as many outdoor places.

Implement plain/standardised packag-

ing and/or large graphic health warn-

ings on all tobacco products

● Adopted. Graphic health warnings have appeared on tobacco products since 2007.

Implement effective mass media

campaigns that educate the public

about the harms of smoking/tobacco

use and second-hand smoke

● Adopted. The Tobacco and Alcohol Control Office (TACO) of DH and the Hong

Kong Council on Smoking and Health have implemented various mass media

campaigns to inform and educate the public on smoking and health matters.

Increase excise taxes and prices on

tobacco products

● Partially adopted. The duty on tobacco products was last increased by about 41.5%

and about 11.7% in 2011 and 2014 respectively to tie in with the Government‟s to-

bacco control measures.

Effective intervention

Provide cost-covered, effective and

population-wide support (including

brief advice, toll-free quit line ser-

vices) for tobacco cessation services to

all those who want to quit

● Adopted. DH operates an integrated Smoking Cessation Hotline (Quitline: 1833 183)

to provide general professional counselling and information on smoking cessation,

and arrange referrals to various smoking cessation services in Hong Kong.

Other recommended interventions

Implement measures to minimise

illicit trade in tobacco products

● Adopted. To protect revenue from dutiable commodities stipulated in the Dutiable

Commodities Ordinance, Chapter 109, Laws of Hong Kong, the Illicit Cigarette

Investigation Division under the Revenue and General Investigation Bureau of the

Customs and Excise Department takes sustained and vigorous enforcement actions

in combating illicit cigarettes.

Provide mobile phone based tobacco

cessation services

● Adopted. A mobile Quit Smoking App has been launched by TACO of DH to assist

smokers to overcome tobacco dependence.

Ban cross-border advertising,

including using modern means of

communication

● Partially adopted. Enforcement on cross-border advertising (e.g. online advertising

on Facebook) is only possible for cases that happened within but not outside

Hong Kong.


After more than 30 years of efforts in tobacco

control through education, community promotion

and legislation, the percentage of daily cigarette

smokers aged 15 years and above dropped steadily

from 23.3% in 1982 to 10.0% in 2017 which was

among the lowest in the world. Of 620 600 daily

smokers in 2017, some of them might have habits

of consuming more than one form of tobacco and

related products. Yet, majority (99.1%) of daily

smokers were cigarette smokers. While 0.9% were

daily smokers who consumed e-cigarettes, 0.6%

were daily smokers who consumed other forms of

tobacco products (including cigar, hand rolled

cigarette, water pipe and pipe smoking). Adding

46 900 non-daily smokers, Hong Kong has around

667 500 current smokers (Table 2) who subject

millions of non-smokers to the harmful effects of

smoking.14

Among adolescents, a school-based survey on smok-

ing among students conducted during November

2016 to June 2017 observed that the prevalence rates

of ever smoking and current smoking (i.e. any

smoking in the past 30 days) among primary 4 to

primary 6 (P4 to P6) students were 2.1% and 0.1%

respectively. The corresponding rates among

secondary 1 to secondary 6 (S1 to S6) students were

12.7% and 2.5% respectively. While 1.4% of P4

to P6 students reported ever used e-cigarette, the

prevalence rates of ever and current e-cigarette use

among S1 to S6 students were 8.7% and 0.8%

respectively.14

Reduce Tobacco Use

Reducing tobacco use and related harm has been

accorded primary importance in the prevention

and control of non-communicable diseases (NCD).

In May 2018, the Hong Kong Government launched

“Towards 2025: Strategy and Action Plan to Prevent

and Control Non-communicable Diseases in Hong

Kong” (SAP) with a list of committed actions and

9 local NCD targets to be achieved by 2025 (Box 1),

including Target 5: A 30% relative reduction in

the prevalence of current tobacco use in persons

aged 15 years and above (when compared to the

baseline prevalence in 2010).13

Table 2: Distribution of smoking status among persons aged 15 years and above in 2017

Smoking Status Number of persons Percentage

Current smokers a 667 500 10.8%

Daily smokers 620 600 10.0%

Non-daily smokers 46 900 0.8%

Ex-smokers b 305 600 5.0%

Non-smokers 5 180 200 84.2%

Overall 6 153 300 100.0%

Notes: a Refers to those persons who had a smoking habit (regardless of the forms of tobacco or related products they

consumed and their smoking pattern) at the time of enumeration; b Includes ex-daily and ex-non-daily smokers of all

forms of tobacco and related products.

Source: Thematic Household Survey Report No. 64, Census and Statistics Department.


To achieve the target, the Government has further

expanded the statutory non-smoking areas to include

more public facilities to protect the public from

the harm of second-hand smoke exposure. Since 31

March 2016, eight bus interchanges at tunnel portal

areas had been designated as statutory non-smoking

areas. On 31 August 2018, the Government extended

the smoking ban to three additional bus interchanges

leading to expressways or tunnels. As smoking

cessation is an integral and indispensable part of

tobacco control policy, the Government has adopted

new initiatives to enhance smoking cessation services,

such as Public-Private Partnership Programme on

Smoking Cessation to engage private primary care

doctors offer counselling and help smokers quit

smoking. Besides, the Government will continue to

monitor the proportion of tobacco duty to retail

price and raise taxes as necessary. Seeing that the

emergence of e-cigarettes and other alternate smoking

products has posed new health risk, the Government

plans to legislate a ban on the import, manufacture,

sale, distribution and advertisement of alternative

smoking products, including e-cigarettes, heat-not-

burn products and herbal cigarettes.

Box 1: 9 local NCD targets by 2025


To create a smoke-free Hong Kong requires every

sector in the community to say NO to smoking.

In fact, all tobacco and related products are harmful

irrespective of their forms (e.g. conventional ciga-

rettes or alternate smoking products), disguise

(such as „light‟ or „low tar‟) or flavours (such as

„menthol‟ or „fruit‟ flavour). Tobacco users on

average lost 15 years of life. Up to half of all

tobacco users will die of tobacco related causes.

Thus, quitting smoking is the single best thing

smokers can do for themselves and others.

Smokers are encouraged to seriously think about

the harms of smoking and appreciate how much

there is to gain from quitting smoking. In Hong

Kong, there are a number of services providing

professional counselling and drug therapies to

help smokers to quit. For more information

about smoking cessation and related services,

please visit the website of the TACO of DH at

https://www.taco.gov.hk/. For details concerning

the Government key initiatives and specific actions

to reduce tobacco use in Hong Kong, please refer

to the SAP which can be found at the

Change for Health Website of DH https://

www.change4health.gov.hk/en/saptowards2025/.

References

1. Tobacco. Geneva: World Health Organization, 9 March

2018.

2. Ten Years in Public Health 2007-2017. Report by Dr

Margaret Chan, Director-General. Geneva: World Health

Organization, 2017.

3. Hopkinson NS. Tobacco smoke and environmental

injustice. BMJ 2018(363):k4201 doi:10.1136/bmj.k4201.

4. Tobacco and its Environmental Impact. An Overview.

Geneva: World Health Organization, 2017.

5. WHO Framework Convention on Tobacco Control. Geneva:

World Health Organization, 2003, updated reprint 2004,

2005.

6. WHO Report on the Global Tobacco Epidemic, 2008. The

MPOWER Package. Geneva: World Health Organization,

2008.

7. WHO Report on the Global Tobacco Epidemic, 2017.

Monitoring Tobacco Use and Prevention Policies. Geneva:

World Health Organization, 2017.

8. WHO Global Report on Trends in Prevalence of Tobacco

Smoking 2000-2025 (Second edition). Geneva: World

Health Organization, 2018.

9. E-Cigarette Use among Youth and Young Adults. A Report

of the Surgeon General. Rockville, MD: U.S. Department of

Health and Human Services, 2016.

10. Filippidis FT, Laverty AA, Gerovasili V, Vardavas CI. Two

-year trends and predictors of e-cigarette use in 27 European

Union member states. Tob Control 2017; 26(1):98-104.

11. Laverty AA, Filippidis FT, Vardavas CI. Patterns, trends

and determinants of e-cigarette use in 28 European Union

member states 2014-2017. Prev Med 2018; 116: 13-8.

12. Wang TW, Gentzke A, Sharapova S, et al. Tobacco Product

Use among Middle and High School Students—United

States, 2011-2017. MMWR Morb Mortal Wkly Rep 2018;

67(22):629-633.

13. Towards 2025: Strategy and Action Plan to Prevent and

Control Non-communicable Diseases in Hong Kong. Hong

Kong SAR: Food and Health Bureau, May 2018.

14. Thematic Household Survey Report No. 64. Pattern of

Smoking. Hong Kong SAR: Census and Statistics

Department.

https://www.taco.gov.hk/

https://www.change4health.gov.hk/en/saptowards2025/

World No Tobacco Day

Every year, on 31 May, the World Health Organization (WHO) and global partners celebrate World No

Tobacco Day. The annual campaign aims to raise awareness on the harmful and deadly effects of tobacco

use and second-hand smoke exposure, and to discourage the use of tobacco in any form. The theme of

World No Tobacco Day 2019 is “Tobacco and lung health”.

The exposure to tobacco would affect the health of people‟s lungs and induce various related diseases,

including lung cancer, chronic obstructive pulmonary disease, asthma, tuberculosis, pneumonia, bronchitis

and lower respiratory infections, etc. The most effective measure to improve lung health is to reduce

tobacco use and second-hand smoke exposure. WHO calls for effective policies to reduce tobacco

consumption and urges stakeholders across multiple sectors in the fight for tobacco control, including

● Government and communities worldwide should prioritise tobacco control in order to achieve the

Sustainable Development Goal (SDG) target of a one-third reduction in non-communicable diseases

premature mortality by 2030.

● Countries should fully implement MPOWER tobacco control measures contained in the WHO

Framework Convention for Tobacco Control (WHO FCTC).

● Parents and other members of the community should also take measures to promote their own

health, and that of their children, by protecting them from the harms caused by tobacco.

To know more about World No Tobacco Day 2019, please visit https://www.who.int/news-room/events/

detail/2019/05/31/default-calendar/world-no-tobacco-day. For live updates, follow #NoTobacco.


Non-Communicable Diseases (NCD) WATCH is dedicated to

promote public’s awareness of and disseminate health information

about non-communicable diseases and related issues, and the

importance of their prevention and control. It is also an indication of

our commitments in responsive risk communication and to address

the growing non-communicable disease threats to the health of our

community. The Editorial Board welcomes your views and comments.

Please send all comments and/or questions to [email protected].

Editor-in-Chief

Dr Rita HO

Members

Dr Thomas CHUNG Dr Ruby LEE

Dr Cecilia FAN Dr Eddy NG

Dr Anne FUNG Dr Lilian WAN

Mr Kenneth LAM Dr Karine WONG

Dr Karen LEE

https://www.who.int/news-room/events/detail/2019/05/31/default-calendar/world-no-tobacco-day

non-communicable diseases watch may 2019 - smoking kills · non-communicable diseases watch may...

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