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COSH and Health Professionals Strongly Request for a Total Ban of Electronic Cigarettes
Hong Kong Council on Smoking and Health (COSH), The Hong Kong Medical Association, Hong Kong Dental Association and The Federation of Medical Societies of Hong Kong held a joint press conference today (27 September) to strongly request for a total ban of electronic cigarettes and other new tobacco products, as well as a timeline for total ban of smoking.

The Food and Health Bureau proposed to regulate the sale of electronic cigarettes and new tobacco products (electronic cigarettes) in June 2018. This would mean that these products would be on sale legally. The medical profession and other sectors, together with parents and teachers, have responded by advocating strongly for a total ban of these products for the protection of children and young people and for public health. The Hong Kong SAR Government remains elusive in her position.

With LegCo about to resume sessions, we are extremely worried that legislating for a mere restriction of the sale of electronic cigarettes to adults is no different from allowing teen vaping to bubble into an epidemic of colossal scale. The eventual detriment to the health of generations of youths to come is predictably grave, let alone the healthcare cost and loss of productive workforce that give Hong Kong a triple slash.

Our worry is based on facts: US Laws prohibit the sale of electronic cigarettes to minors. Ironically, such prohibition has turned out to facilitate a teen vaping epidemic.

30.6% Middle and High School Students in US who are Electronic Cigarette Users have used Cannabis in their Electronic Cigarettes

KF Trivers reported their research results in JAMA Pediatrics (2018), drawing data from the 2016 National Youth Tobacco Survey of US grade 6 - 12 students, that out of 20,674 subjects, 8.9% have used cannabis. Prevalence was significantly higher in electronic cigarette users (30.6%) and those using other tobacco products. Among electronic cigarette users, nearly 1 in 3 high school students (1.7 million) and nearly 1 in 4 middle school students (425,000) had used cannabis in electronic cigarettes (1).

Hong Kong is Not Immune

The Customs Department on 14 September 2018 seized a parcel claiming to be food products which in fact contained 249 Cannabis containing e-liquid. A 21 year old man was arrested. (2) This indicates that other illicit drugs or substances could have entered Hong Kong via e-cigarettes and e-liquid.

US FDA: An Epidemic of Nicotine Addicts! Any Potential Benefit for Smokers Must Not Come at the Expense of Kids

On 12 September 2018, Scott Gottlieb, Commissioner of US Food and Drug Administration (FDA) said in his statement, that “But let me be clear that nicotine isn’t a benign substance.

This is especially true when it comes to children, and the effects that nicotine has on a developing brain.” (3,4)

With the benefit of hindsight scrutinising the effect of their electronic cigarette regulation, as Gottlieb put it, he said, “Unfortunately, I now have good reason to believe that it’s reached nothing short of an epidemic proportion of growth.” (3,4)

Gottlieb went on to say, “I use the word epidemic with great care. E-cigs have become an almost ubiquitous ‒ and dangerous ‒ trend among teens. The disturbing and accelerating trajectory of use we’re seeing in youth, and the resulting path to addiction, must end. It’s simply not tolerable. I’ll be clear. The FDA won’t tolerate a whole generation of young people becoming addicted to nicotine as a tradeoff for enabling adults to have unfettered access to these same products.” (3,4)

US FDA has sent more than 1,300 warning letters to retailers for the illegal sale of electronic cigarettes to minors and required 5 electronic cigarette manufacturers to provide within 60 days solid plans to curb the access of their products to minors. (3,4)

Regarding the “less harm” claim of electronic cigarettes in comparison with combustible cigarettes, FDA warns that “such products may still pose health risks, including possibly releasing some chemicals at higher levels than conventional cigarettes, and these potential risks require closer scrutiny”. (3,4)

In his statement, Gottlieb went on to say, “We know that the flavors play an important role in driving the youth appeal. And in view of the trends underway, we may take steps to curtail the marketing and selling of flavored products.” (4)

3 Million High School Students in US use Electronic Cigarettes, 75% increase from 2017, and Mostly NOT to Quit Smoking

The Wall Street Journal cited on 20 September 2018 federal data that teen use of electronic cigarettes has soared by 75% in 2018 compared to 2017, which would equate to 3 million or 20% of high school students. (5)

Another survey conducted by the Wall Street Journal together with research firm Mercury Analytics showed that nearly 1/3 of 13 - 18 year-olds said they vaped. Most of the teens who vaped did so for reasons other than to quit smoking. Teens were attracted by the flavours of electronic cigarettes such as mango, cucumber and creme, thought it was fun, and believed it was compatible with a healthy living. (5)

An Endgame target to cigarettes, electronic or traditional

Time and again we see that familiar grin – almost a sneer on the face of those criticizing the request for a total ban of electronic cigarettes and new tobacco products as inconsistent, disproportionate or even hypocritical because nothing has been said of the more harmful traditional cigarettes. Little do they know, or some knowingly omit, that countries around the World have targets set for an endgame to traditional cigarettes. The Government of New Zealand has set the endgame target to 2025 (6), Finland set it to 2030 (7), Scotland set it to 2034 (8), Ireland 2025 (9), Denmark set it to 2030 (10) and Canada 2035 (11).

The Hong Kong SAR Government has set the target of a 7.8% smoking prevalence by 2025, and COSH advocates for a reduction to 5% by 2027. The aim has always been a smoke-free Hong Kong. If we could do it tomorrow, so much the better. The very fact that it cannot be banned overnight testifies to the fact that once the door is opened to an addictive commodity driven by enormous and expanding profits of the industry, it becomes extremely difficult, if at all possible, to close the door again. Any control measures prompted by hindsight are too late, and the irreversible harms will continue to expand for decades. Traditional cigarettes have been here for over a century and 615,000 Hong Kong people are smoking. Had it been a new commodity applying for import into Hong Kong today, no governments in their sound mind would approve.

The first step to ban cigarettes is to disallow any further import of addictive cigarette and related products.

Love our Children, Love Hong Kong, Say No to Electronic Cigarettes and New Tobacco Products

The futility of any law to “prohibit” the sale of electronic cigarettes to minors is glaring at us. If regulation instead of a total ban is what Hong Kong SAR Government intends to legislate, Hong Kong will only follow down the drain like the US where the epidemic is out of control. It is clear, from the strong advocacy for a total ban in the past 3 months, that regulation and legalization is not what parents, teachers, doctors, dentists, nurses and all other health professionals and indeed all conscientious Hong Kong citizens want to see, it is high time we make it crystal clear that only a TOTAL BAN OF ELECTRONIC CIGARETTES AND NEW TOBACCO PRODUCTS will save our teens, and the many generations of youth to come.

We call for the FHB to legislate NOTHING SHORT OF A TOTAL BAN for electronic cigarettes and new tobacco products. It is also high time for Hong Kong to set an endgame target with a clear timeline for banning smoking of all forms of tobacco and related products.

We call for all fellow professionals, parents and teachers, young people and other Hong Kong citizens to join in our appeal to urge the Government to proceed with a total ban without further delay.

This is a matter of conscience versus evil, public health versus unscrupulous business. There can be no compromise.

To protect the health of the next generations, COSH, The Hong Kong Medical Association, Hong Kong Dental Association and The Federation of Medical Societies of Hong Kong strongly requested for a total ban of electronic cigarettes and other new tobacco products, as well as a timeline for total ban of smoking.

1. Trivers KF, Phillips E, Gentzke AS et al: Prevalence of Cannabis Use in Electronic Cigarettes Among US Youth. JAMA Pediatr. Published online 17 September 2018 doi:10.1001/jamapediatrics.2018.1920
2. 大麻電子煙混食品寄港 海關截加拿大毒郵包拘收件男. 香港01. 21 September 2018
3. FDA News Release: FDA takes new steps to address epidemic of youth e-cigarette use, including a historic action against more than 1,300 retailers and 5 major manufacturers for their roles perpetuating youth access. 12 September 2018
4. FDA Statement: Statement from FDA Commissioner Scott Gottlieb, M.D., on new steps to address epidemic of youth e-cigarette use. 12 September 2018
5. Youth Vaping has Soared in 2018, New Data Show. The Wall Street Journal (Asian Edition) 21 September 2018
6. Government Response to the Report of the Māori Affairs Committee on its Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori (Final Response), New Zealand House of Representatives
7. Dan Naumov: Finland is set to become the first country to eradicate smokers. Business Insider Nordic. 18 Jan 2017
8. Matheson M (Minister for Public Health, Scotland) Creating a Tobacco Free Generation – A Tobacco Control Strategy for Scotland. The Scottish Government, Edinburgh 2013
9. Dr James Reilly T.D. Minister for Health: Tobacco Free Ireland - Report of the Tobacco Policy Review Group. Oct 2013
10. RT Report: Tata, tobacco! Denmark aims for 1st smoke-free generation by 2030. 25 Aug 2016
11. Health Canada: Government of Canada Launches Public Consultation on the Future of Tobacco Control in Canada. 22 Feb 2017
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