Aligned with the relentless efforts undertaken by the Hong Kong government as far as tobacco control is concerned, would resorting to increasing taxation on tobacco be an effective means to curb tobacco use—or could there be more which we could do to address this persistent habit?
Last month, the Hong Kong Council on Smoking and Health (COSH) has called on the government to consider increasing the current tobacco duty by 100%. Supported by the World Health Organisation (WHO), this intervention approach in reducing tobacco consumption is considered to be an effective and evidence-backed method—which is well received by the public and policy makers alike.
In response, the Hong Kong government has asserted their commitment to reduce tobacco use through continuous (vigorous) efforts in Hong Kong—“not only taxation; but also legislation, enforcement, education as well as smoking cessation.”
Despite the relatively low prevalence compared to neighboring countries, the government has failed to acknowledge the bottleneck in reducing the numbers of smokers in the past couple of years. Furthering that, the proportion of female smokers have not witnessed significant reduction in prevalence as compared to the male counterparts.
In spite of constant mention of multi-pronged strategies and measures, it is important to incorporate broader aspects that may bring about smoking-related behaviours—e.g. by questioning factors that stem beyond traditional perceptions of smoking as a health hazard only, or to let health professionals tackle the issue, or through fines and warning labels alone.
The importance of tailored educational interventions to specific target groups; for instance, health-related education to less educated and unmarried men. Paradoxically, this indicates that different strategies have to be considered for different groups of smokers.
Nonetheless, it may be more effective to understand the determinants that have led to resistance to cessation from the very beginning.
It may be useful to take a step back and evaluate the bigger picture—how are the broader socio-economic factors of Hong Kong creating an environment that promotes initiation of smoking and reliance on tobacco.
Long working hours and academic stress could also be a source for our persistence in smoking. The development of regular smoking behaviour among youths is often due to the pressure from education study, particularly; whereas for young adults, it is those who aim for high education opportunities or when they enter employment.
The relationship between stress and smoking or smoking cessations has been identified in numerous studies. Researchers like Byrne emphasised the need for stress reduction management in order to prevent initiation of smoking in youth—further iterating that “Public health programs to prevent smoking onset among adolescents—as part of continuing efforts to lower the incidence of CVD in adults—must therefore include components of stress reduction and management in addressing this crucial issue.”
Meanwhile, studies in Hong Kong have further identified the family environment as an important factor; especially, when highlighting the role of family happiness and wellbeing—to affect intentions to smoke and smoking behaviours. As identified by Luk et al, and Wang et al, those who perceived their family relationships or general family wellbeing to be positive observed lower rates of smoking prevalence or smoking intention. The importance of a supportive social environment is clearly a driving factor important for those considering smoking.
The aforementioned examples underlying our attachment to smoking should also be considered in relevance to the use of e-cigarettes. While e-cigarettes are well-received in Hong Kong, we again would like to question whether our tobacco smokers are current or ex-smokers, of which this has been identified in local studies. Jiang et al identified that among adolescent e-cigarette users, 39.3% were former cigarette smokers, while 33.2% were current cigarette smokers. Then, it begs one to wonder whether an increase in taxation could ‘potentially’ contribute to a further surge in the popularity of e-cigarettes amidst insufficient regulatory framework to control its ease of access—particularly, among our younger generations. MIMS
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Health In Action, 20 Dec 2017