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Thursday, December 11, 2014, 10:14

No smoke without fire

By Hazel Parry in Hong Kong for China Daily
No smoke without fire

Antonio Kwong Cho-shing, chairman of HK Council on Smoking and Health, feels smoking e-cigarettes could, eventually, lead young people to the cancer stick. (Edmond Tang / China Daily)

The teenage girl seems to strike a pose as she lifts the pen-like object to her lips. She throws back her hair like a model in a TV advertisement and inhales from the pen. Her two friends laugh as she blows out a small cloud of smoke in sporadic uneven bursts.

"Pretty cool. Can I try?” I overhear one of them asking as she reaches toward the pen.

The girls, at most 15, are sitting on a bench in a children’s playground in the New Territories. The object of their attention is a sisha or hookah pen: a form of nicotine-free flavored electronic-cigarette.

The girls say they bought the shisha-pen from a newspaper vendor for HK$80. For that price they will get around 500 puffs on the pen.

"It’s okay. It doesn’t have nicotine in it. So it won’t cause cancer,” one tells me.

Potential risk

It is exactly this kind of misperception that worries Antonio Kwong Cho-shing, chairman of the Hong Kong Council on Smoking and Health, a statutory body created in 1987 to raise public awareness of the danger of tobacco. “The truth is we do not know how less toxic e-cigarettes are compared to cigarettes,” said Kwong.

According to him, there are currently two schools of thought regarding e-cigarettes: one that sees them as a means to quit smoking and another that sees them as a potential gateway to start smoking.

"Our main concern is that they are not regulated. Manufacturers do not have to list the ingredients on the packaging. Some studies show they contain flavorings and preservatives and even some toxic substances. But we don’t know what they are.”

Kwong said a recent study by Japan’s National Institute of Public Health found two types of cancer-causing substances in several brands of e-cigarettes.

Hong Kong currently boasts what is believed to be the lowest smoking rate in the world. Only 10.7 percent of the population, or 645,000 people, are smokers. This low rate is the result of a multi-pronged approach to control the marketing, sale and use of cigarettes plus public education.

Kwong, however, fears the trend toward e-cigarettes, and the way they are marketed, could undo some of the good work and make smoking more attractive to younger people.

Catch ‘em young

According to a survey on smoking conducted by the School of Public Health of the University of Hong Kong in 2012-13, about 1 percent of secondary school students had “smoked” an e-cigarette. The Hong Kong government says it has been monitoring the trend, particularly in promotions that appear to target the young.

In response to a call by legislator Kwok Wai-keung for better regulation of e-cigarettes, the Secretary for Food and Health Ko Wing-man promised to take follow-up action. “To gain more understanding of the use of e-cigarettes in Hong Kong, we will include questions related to it in the next round of the Thematic Household Survey,” Ko said.

In October, the World Health Organization (WHO) issued a series of recommendations regarding e-cigarettes’ effects on health, use in public places, advertising and promotion, health warnings and sales to minors.

"They (manufacturers) should be made to list ingredients and include health warnings if they do contain nicotine,” said Antonio Kwong. “Most important of all, retailers should not be able to sell e-cigarettes to minors. It should be in line with the minimum age for purchasing cigarettes, which is 18.”

Check out what’s inside

The e-cigarette works by heating up a solution inside — propylene glycol, possibly glycerol and flavoring agents, including mint and fruit flavors — to produce a smoke which users inhale. Some claim to be nicotine-free while others do contain a small amount. In Hong Kong any e-cigarette containing nicotine has to be registered with the Pharmacy and Poisons Ordinance. Failure to do so could result in prosecution.

Likewise, smoking e-cigarettes in statutory no-smoking public places is considered an offence under the Smoking Ordinance.

Between 2012 to June 2014, the Department of Health (DH) received 35 complaints concerning e-cigarettes with one conviction for the illegal sale of unregistered pharmaceutical products involving nicotine content. A 30-year-old man selling nicotine-containing liquid, of the type used in e-cigarettes, on the Internet was arrested in August.

Kwong acknowledged the government’s concerns, saying imposing regulations on e-cigarettes would take legislation.

In the meantime, the sleek look of shisha pens has caught on with the young generation.

"They are targeting youngsters,” said Kwong. “The fancy packaging we used to see on cigarettes before is coming back with e-cigarettes. There are all sorts of varieties, some light up, some turn fluorescent. The problem is in Hong Kong, youngsters can get them from convenience stores or stationery shops.”

Kwong fears there is no smoke without fire and that the sleek marketing and accessibility may be all it takes to lead those girls on the playground to the highly-dangerous real thing.

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