Vaping could soon be all but banned in Hong Kong.
Under a change to the law set to face its first reading at the Legislative Council next Wednesday, anyone who imports, makes, sells or promotes new smoking products, including e-cigarettes, could be jailed for six months or fined HK$50,000 (US$6,370).
It will still be legal for the 5,700 Hongkongers who, according to a 2017 government survey, vape daily, to use the products, even if their supply will be completely outlawed.
The research we have now is not enough to draw conclusions, but what we do know is that the chemicals present in e-cigarettes are carcinogenic
Dr William Li, HKU
That figure was a big change on 2015, when there was no significant number of daily e-cigarette users. And with a surge in the products’ popularity globally, more studies and reports have surfaced on their benefits, and harms.
A recent study published in the New England Journal of Medicine suggests e-cigarettes are almost twice as effective at getting people to quit smoking than nicotine replacements such as chewing gum or patches.
Other studies have drawn the same conclusion. But doctors say any serious claims about the safety of e-cigarettes would be premature.
“They’re too new,” says Dr William Li Ho-cheung, who heads the smoking cessation team at HKU’s school of nursing.
“Conventional tobacco products have been around for more than a century, and researchers have had time to study them and conclude that they’re bad for you. The research we have now is not enough to draw conclusions, but what we do know is that the chemicals present in e-cigarettes are carcinogenic.”
Specifically, e-cigarette liquids typically contain propylene glycol, which when heated is known to produce formaldehyde, a carcinogen.
Cancer-causing substances aside, a recent study published in the American Journal of Preventive Medicine showed daily e-cigarette users were almost twice as likely to have a heart attack as people who had never vaped.
And in late January a 24-year-old Texan died after his vape pen exploded.
But ex-smoker Peyton Chan says, from his own experience, that e-cigarettes can help people struggling to quit cigarettes.
The 39-year-old, who became a habitual smoker after joining the financial sector almost two decades ago, recalls: “I smoked to relieve stress and to stay awake when I felt tired. Smoking also gave me the opportunity to interact informally with my bosses and colleagues.”
One day Chan tried to quit smoking. He says he didn’t find it enjoyable, and was bothered by the smell. But giving up was not easy.
“I’ve lost count of the number of times I’ve tried to quit, and picked it up again,” he says.
Chan tried to fight his cravings with exercise, but steered clear of nicotine-replacement products such as patches and gum.
“Like many smokers, I associate smoking with something, like social drinking. It’s like wanting dessert even after a big meal,” he says. “Even if you can address the biochemical aspect of addiction, it’s hard to address the psychological.”
Then, about two years ago, a friend introduced him to his first e-cigarette. Chan admits his first puff left him disappointed, but he came to realise it was good enough.
Chan argues that in addition to being tar-free and available in multiple flavours, e-cigarettes are ideal for people trying to quit smoking.
If a smoker’s ultimate aim is to get healthy, they should quit all smoking products, both old and new
Helen Chan, Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation
“With cigarettes, you feel the urge to finish them,” he says. “But with vaping, you can take only one puff, or more if you wish.”
After a couple of months of vaping, Chan lost his desire for cigarettes. He says he has not smoked a cigarette in almost a year, and rarely even vapes any more.
But vaping can be addictive in itself, says Helen Chan Ching-han, supervisor at the Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, who cites an increase in the number of people getting help for e-cigarette addiction since 2017.
From April to December last year, 133 people sought help for vaping addictions, accounting for about 5 per cent of all cases during the period. More than half of them were people in their 20s to 40s who smoked cigarettes and vaped.
“Most of them smoked cigarettes first,” she says. “We believe they then switched to e-cigarettes because they thought it was a healthier option, but ended up getting hooked anyway.”
But among teens, the situation seems to be the reverse. In a recent survey of about 41,000 local students aged 11 to 18, HKU researchers found that youngsters may be using e-cigarettes as a gateway to conventional cigarettes.
Dr Daniel Ho Sai-yin, from the University of Hong Kong’s School of Public Health, one of the researchers, says: “Most students know smoking is bad, so they might want to try e-cigarettes first to test the waters, which might give them the confidence to smoke regular cigarettes later on.”
Students who went on to smoke both became more addicted to nicotine, he adds, with some feeling they needed to take a drag first thing in the morning.
Li says young people might even resort to smoking conventional cigarettes for the “hit” that e-cigarettes fail to provide.
Under current Hong Kong law, e-cigarettes that contain nicotine, an addictive substance, must be registered with the Pharmacy and Poisons Board before sale or distribution.
Helen Chan suspects many e-cigarettes on sale contain nicotine, and the varying levels of nicotine in e-cigarette liquids are one reason why she believes e-cigarettes are not an effective way to help smokers kick the habit.
Citing recommendations by the World Health Organisation and the US Food and Drug Administration, she says: “E-cigarettes aren’t scientifically proven to be able to help people quit smoking. But nicotine patches, for example, come in different dosages, which can be administered over a course of eight to 12 weeks.”
While nicotine patches and gum are available at pharmacies across Hong Kong, they can be more expensive than e-cigarettes. A week’s supply of patches can cost more than HK$320, and three dozen pieces of gum cost more than HK$170.
Meanwhile, vaping products found in trendy shopping malls in areas such as Mong Kok and Causeway Bay cost between HK$100 and HK$500.
Medical experts say smokers who want to quit should use cessation services provided by organisations such as HKU’s School of Nursing and Tung Wah Group of Hospitals, instead of switching from cigarettes to vaping.
“Through counselling, we address our clients’ psychological dependence, and through medical intervention and therapy we help wean clients off nicotine,” says Dr Raymond Ho Kin-sang, medical officer at the Tung Wah Group’ smoking cessation centre.
Helen Chan, who works at the centre, adds: “If a smoker’s ultimate aim is to get healthy, they should quit all smoking products, both old and new. We hope smokers realise there are ways other than smoking e-cigarettes to quit the habit, and we provide the help for free.”
And, even if vaping does get people off tobacco cigarettes, experts warn it could do more harm than good if left uncontrolled.
Daniel Ho says that while the government continues to discourage smoking cigarettes with taxes and warnings, new smoking products should not be allowed onto the market.
“Eventually, all tobacco products should be banned too, but it will be a slower process because by the time we discovered the dangers of cigarette smoke they had become very popular,” he says. “The government couldn’t just ban them overnight.”
This echoes what the government has said on the ban. Deputy Secretary for Food and Health Amy Yuen Wai-yin said this week that officials hoped to to nip the habit in the bud.
Li agrees, saying: “If we let e-cigarettes go mainstream, the number of people who pick up the habit will far outnumber the few who are able to use e-cigarettes to kick the habit. It’s just not worth it.”
This article E-cigarettes, facing Hong Kong ban: a healthy way to quit tobacco or a risk in themselves? first appeared on South China Morning Post
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