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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
Smoking Kills
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Non-Communicable Diseases Watch May 2019
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
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Non-Communicable Diseases Watch May 2019
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.
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Non-Communicable Diseases Watch May 2019
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.
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Non-Communicable Diseases Watch May 2019
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
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Non-Communicable Diseases Watch May 2019
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.
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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 Watch May 2019
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Please send all comments and/or questions to [email protected].
Editor-in-Chief
Dr Rita HO
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