Electronic cigarettes (e-cigarettes) and vapes have become increasingly popular among young people in Hong Kong since they gained a foothold in the marketplace around 2008. For many people, e-cigarette and vaping became a getaway tool to quit smoking the traditional tobacco cigarette, for others, it is curiosity that drove them to take a puff of the multi-flavored e-cigarette vape pens.
The rising trend of consuming and smoking these new tobacco products (NTPs) can be seen among the young people in Hong Kong due to the various characteristics. More teenagers have commenced smoking e-cigarettes owing to their accessibility and ease of purchase. Moreover, since vape pens are easily concealed and hard to be discovered by parents, young people find it convenient to sneak them into their homes without a hassle.
However, seeing the increasing usage of these NTPs and the obstruction caused in achieving a smoke-free city, the Hong Kong government decided to pass a bill that bans the import, sale, advertisement, and manufacture of e-cigarettes and heated tobacco products in Hong Kong. After years of stalling and delaying, lawmakers have finally come to the decision of implementing this bill by mid-2022. While the third hearing of the bill was conducted with 32 lawmakers voting for the bill, some opposed it with their reservations.
The current situation in Hong Kong
According to the figures from the Hong Kong government, the percentage of daily cigarette smokers aged 15 and above among the local population was 10.2 percent in 2020, which was around 640 0000 regular smokers in total. Still, a vast number of people smoke normal cigarettes or alternative tobacco products irregularly, especially during parties and gatherings. This phenomenon has been pervasive among teenagers aged 10 to 25, according to the research conducted in April from The University of Hong Kong revealed that nearly 1,500 primary school and 7,500 secondary school students had used NTPs from 2018 to 2019. A majority of the young adults deemed those products as less addictive and detrimental to health than cigarettes, which is indeed a false perception.
“I was a regular traditional cigarette smoker but I shifted to e-cigarettes 3 years ago because the flavors are far more refreshing and diverse. There are flavors such as lemon tea, apple green tea, and peach. I smoked the most during alcoholic parties or birthday celebrations,” said Miss Tang, a 25-year-old daily e-cigarette smoker.
Despite student smokers, a tremendous amount of adult smokers have transitioned from smoking cigarettes to e-cigarettes because of the wide variety of flavors available and low costs.
Not only are young people more prone to trying out the NTPs due to the above attractive points, but many are also blindsided by the sugarcoating done by the sellers. Many sellers would label e-cigarettes as less harmful than traditional tobacco products and leading to the misconception that e-cigarettes contain less nicotine and are less harmful.
The current lack of research on the content and impacts of consuming e-cigarette is also another factor that lures people to smoke vape products. There are many existing myths about vapes that mislead consumers and young people. Some of the misconceptions include perceiving e-cigarettes as less addictive and less harmful. However, these myths are incorrect. Since most manufacturers are not required to disclose the chemicals contained in their products, it is uncertain to impose that e-cigarettes are not harmful. Additionally, some vapes typically contain certain amounts of nicotine which is a highly addictive substance.
Taking this into consideration, it is seen that the current misinformation and unethical promotion are the contributing factors to the rise and increasing usage of e-cigarettes. This, therefore, prompted lawmakers to take a stand against these NTPs.
What has been happening with the e-cigarette bill and what does it entail?
The government first proposed the bill to ban e-cigarette in 2015, and in 2019, the bill was brought to discussion in the Legislative Council. However, facing opposition from tobacco companies and other interest parties, a stalemate was put on further discussions on the ban.
In those years, much opposition to these devices was raised by different stakeholders which also include principals of schools who urged the government to take action as the devices were becoming more popular among teenagers, affecting their mindset as e-cigarettes would encourage them to smoke tobacco cigarettes too.
The bill had been stalled for a while until it was reintroduced to the Legco this year in early September and is aimed to come into full force in April 2022. By 2025, authorities are targeting to lower the smoking rate to 7.8 in hopes of achieving tobacco endgame.
Now that the bill is passed by the lawmakers, the bill will outlaw all kinds of promotion, import, and sales of e-cigarettes and other NTPs. This will lead to the inaccessibility of e-cigarettes, thus lowering the chances of exposure to such devices.
Who will gain and who will lose?
The proposed blanket ban on NTPs will bring different impacts to the various stakeholders involved. Some of them may gain from the ban, while others may lose out.
“We don’t want these new products to interfere with the current tobacco control policies. Public health is one of the important considerations of this ban and once it is imposed, the public will benefit because of the government’s continuous efforts,” said Dr. Cheung, Yee Tak Derek, an assistant professor at the School of Nursing in HKU and key investigator of several tobacco-related projects in Hong Kong.
Understandably, the government is putting public health as the first priority. Through this ban, the previous efforts in tackling the smoking problem in Hong Kong will not go down the drain. Sophia Chan, Secretary for Food and Health, has set the target to achieve a 7.8% smoking rate by 2025, and a long-term goal of making Hong Kong a smoke-free city.
“The only agenda being forwarded is the importance of public health and nothing else. It is prime time for the government to put forward this policy regarding these products when the prevalence is not that high,” said Dr. Cheung.
Since this prohibitive measure is expected to reduce the sales, advertisement, exposure, and consumption of e-cigarettes, this would create a negative impact on the businesses that thrive from the sales of vapes and other NTPs.
Miss Lau, one of the shopowners of a shop located in Kingswood Richly Plaza in Locwood (Tin Shui Wai) which sells a wide range of NTPs talked about how the upcoming ban may lead to her shop being closed down soon.
“It is difficult for us. We know it will become illegal to sell these products soon and we have to think of something else (to sell) for survival,” said Miss Lau.
Not only are businesses affected, but current NTPs smokers may also be posed with a detrimental effect as well. The regulation can presumably trigger a reduction in the possibility of youngsters switching to standard tobacco cigarettes once they dabble in alternative forms. There are suspicions about the effectiveness of this policy.
“To be honest, the prohibition doesn’t matter a lot to me since I will opt for normal cigarettes if no shops are selling e-cigarettes anymore,” said Miss Tang, originally a smoker of regular tobacco cigarettes.
Intensification of the black-market activities might emerge. Some e-cigarette users will convert to smoking tobacco cigarettes, which is even more destructive to their health.
Still, some representatives from different sectors have remained susceptible to the effectiveness of the prohibition since the sale of conventional cigarettes is still allowed, which is in fact more prevalent in Hong Kong. It is deemed an illogical ban on e-cigarettes as conventional tobacco cigarettes are still sold and consumed by many. Despite the health secretary mentioning the health impacts of an e-cigarette to be far greater and harmful than a tobacco cigarette, other lawmakers have some reservations. Opposition lawmakers fighting against the proposed ban believe it to be irrational due to the unfairness created for the businesses and manufacturers. Banning e-cigarettes instead of traditional tobacco cigarettes entails a lack of logic as traditional tobacco cigarettes are more harmful to health and the environment as per existing research.
According to Dr. Cheung however, he states the occurrence of the gateway hypothesis, which refers to the introduction of a drug substance is related to subsequent drug use, is not a big issue, especially when the usage among Hongkongers is quite low. He emphasizes the importance of implementing this ban earlier than later to reduce further harm.
How do other countries deal with e-cigarettes?
The popularity of e-cigarettes has been soaring significantly around the globe, especially among the younger generation. Different countries have imposed distinct regulations and policies on e-cigarettes and NTPs, varying from a complete ban to zero restrictions.
The sale of e-cigarettes is currently banned in 46 countries including Australia, Brazil, Japan, Thailand, Turkey, etc. Hong Kong will be the 47th territory having an out-and-out ban. The US is reported to be one of the countries with the most frequent e-cigarette use among the population. It has imposed bans on all “flavored tobacco” at state and local levels and a minority of Californian cities have also forbidden its sales.
At the same time, a significant number of countries in the EU, Canada, and Israel permit sales of NTPs while restricting the concentration of nicotine contained in e-cigarettes to 20mg/mL, as well as limiting the use of other ingredients that are destructive to health in nicotine-containing e-liquid.
What should the Hong Kong government do to encourage smoking cessation?
Despite the long-term goals set by the government to cease tobacco use in Hong Kong, not much has been done explicitly to discourage smoking in recent years. Previous measures of increasing tax have proven to be efficient but more can be done by the Hong Kong government.
Below is a suggestion made by Dr. Cheung. He mentions reintroducing the increased tax on purchasing tobacco cigarettes which was implemented seven years ago in Hong Kong. Taxing tobacco cigarettes can help reduce the incentive of people to purchase tobacco products.
The government always puts public health forward whenever such policies are proposed. This time, the Hong Kong government is doing the same to safeguard public health and achieve health and environmental goals. Nevertheless, there are bound to be opposing voices to any proposed legislation but it is crucial to understand the objectives behind such bills.