Smokers and medical experts fails to reach a common ground

E-cigarette smokers are not convinced by the the official reason government listed in the policy address of banning e-cigarette.

Reported by: Fifi and Maisy Edited by: Kenji

Smokers huffed and puffed on the newest ban for all sales activities of e-cigarettes in Hong Kong. While the e-cigarette smokers felt ignored by the government, local medical experts applauded for the prohibition.

“Why only the health of adolescents matters, yet the health of adult smokers can be ignored? Are their lives more valuable than ours?” Joe Lo, the petitioner of “Yes to IQOS regulation; No to choice deprivation” said.

Hong Kong’s chief executive Carrie Lam proposed a ban of import, manufacture, sale, distribution and, advertisements of e-cigarette and new smoking products in 2018.

In the past, the government has introduced various measures to reduce smoking pervasion. Such as expanding the non-smoking areas, increasing the tobacco duty periodically. With concerted efforts, smoking prevalence among aged 15 or above has significantly dropped from over 20% in the 1980s to 10% at present.

“Usually smokers get e-cigarette through friends or dealers from dubious background,” Lo said. “ I believe that even if it (e-cigarette) is completely banned, black market transactions will continue or even expand.”

Pong Oi Lan, the president of Pharmaceutical Society of Hong Kong, acknowledged the possibility of continuation in black market transactions but the ban serves a strong signal that e-cigarette is neither recognised nor encouraged.

“ If they get it from the dealers, it is like illegal dealers. Just like getting Ketamine.” Pong said, “This (the ban) is one strong signal or indication to tell people that this is not the way to go.”

In hopes to reach a new low of smoking prevalence in 2025, the government was particularly concerned about the effect of e-cigarettes on children and adolescents.

“I do believe these policies are useful, it will be a big challenge to execute the whole issue.” Dr Kelvin Wang, an assistant professor at the School of Nursing at the University of Hong Kong, focuses on smoking research. He believes Hong Kong should eliminate smoking habits as soon as possible, to avoid negative impact on the next generation.

According to a study conducted by Hong Kong University in 2016, 3% of the local students (1694 out of the 45857) from grade seven to twelve are current smokers and 1.1% were e-cigarette smokers.

“From the past ten years, we know that the e-cigarette companies are using marketing strategy to target on youth sector,” Pong Oi Lan, the president of Pharmaceutical Society of Hong Kong, said.

She added that e-cigarette companies have been using social media to promote their products, hence children and adolescents might not be able to identify misleading information of tobacco products from the internet which makes them easier to attempt smoking e-cigarette.

Surveys conducted in the UK and Hong Kong reflected a close link between e-cigarette and smoking behaviour. In Hong Kong, among the students who are e-cigarette smokers, most of them are former cigarette smokers (39.3%) and the minority (11.7%) never tried conventional cigarette before.

“How many teenagers would actually spend more than a thousand dollars just to try a whiff of e-cigarette?” Lo said.

The petition on resistance from the ban of e-cigarette that Lo started, has collected 8005 signatures until 28th November 2018. From his observation, most of the people who have signed the petition were mostly adults.

Lo added that adult conventional smokers switched to IQOS (a tobacco heated system) is because there are researches that recognised it was less harmful than conventional cigarette.

“If the government really want their citizens to have healthier lives, why would they only ban e-cigarette but not conventional cigarette? Conventional cigarette is even more detrimental to our health.” Leung Pak-Hin said, an electronically burned tobacco user.

Leung was once a conventional cigarette user but he changed his smoking habit from conventional cigarette to electronically burned tobacco. “Electronically burned tobacco is healthier and more convenient. I can quit smoking soon by changing to an electronically burned tobacco user as the first step,” he added.

Public Health England published an evidence review in 2015 that e-cigarette is 95% less harmful than smoking because of the chemicals that pose threat to smoke-related disease are absent in e-cigarette, such as tar.

“They could be paid by tobacco industry,” Pong said. With lots of researches conducted to investigate the impact of e-cigarette, she doubted the validity of some of the studies that are in favour of e-cigarettes.

“The smokers who use both cigarettes have a low chance to quit smoking. They even have a lower intention and attempt to quit smoking,” said Dr Kelvin Wang. He believes that e-cigarette users would not only fail to quit smoking, but also e-cigarette slows down their attempt to quit.

“The process of heating the vapour generates ultra-fine particles and get into our air sac when we inhaled and even leads to “Popcorn Lung”. Dr Wang said.

The output of the harmful substances inside e-cigarette is far less than conventional cigarette, it may not be as harmful as the conventional cigarette. Yet, more and more research indicates that substances inside e-cigarette are carcinogenic and would affect cardiovascular health.

Apart from the health concern, Lo said, from his personal point of view, users cough less and do not feel the dryness in their throat because IQOS created less discomfort to their respiratory system.

He mentioned that people around e-cigarette smokers found the scent-less IQOS more acceptable than regular cigarette because its taste is less strong.

“It’s rare to have an alternative with a lower harmful effect to themselves and to others. How could they (the government) ignore these people's goodwill?” Lo said. He also suggested on the petition page that the government should forbid selling e-cigarette to teenagers instead of a ban on it.

The government did consider smokers’ needs, Pong added, but they should not sacrifice children and adolescents health to conform to smokers. She said that Lo’s suggestion will not work in Hong Kong as The US and UK made a similar mistake.

In the US, people under 18 were not allowed to purchase e-cigarette and yet there were a ten times raise of high school e-cigarette smokers from 1.5 percent to 11.7 percent, according to The Food and Drug Administration in 2018.

“Instead of following the footsteps of the US to generate a nicotine-addicted generation, Hong Kong should have a fresh start.” Pong said.

“The smokers who use both cigarettes have a low chance to quit smoking. They even have a lower intention and attempt to quit smoking,” said Dr Kelvin Wang, an assistant Professor at the School of Nursing of the University of Hong Kong, research in smoking.