Tobacco Statistics and Impact

• Tobacco is responsible for a preventable epidemic of non-communicable diseases (NCDs).
• In 2008, NCDs caused 36 out of 57 million deaths, representing 63% of all deaths.
• Over a quarter of NCD-related deaths (9 million) occurred before the age of 60.
• The four main NCDs include cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.
• By 2030, NCD deaths could reach 52 million.
• Key risk factors for NCDs are tobacco use, unhealthy diet, physical inactivity, and harmful alcohol use.
• Population-wide interventions focused on these risk factors are crucial for effective and low-cost prevention.
• About half to two-thirds of smokers are killed by smoking.
• Smoking can reduce life expectancy by approximately 10 years, or even more if started at a young age.

Tobacco Statistics and Impact

• Tobacco use can kill up to half of its users.
• Over 8 million people die each year due to tobacco use, including 1.3 million from second-hand smoke.
• In 2020, 22.3% of the global population used tobacco, with 36.7% of men and 7.8% of women being users.
• Approximately 80% of the world's 1.3 billion tobacco users live in low- and middle-income countries.
• All forms of tobacco products are harmful, and there is no safe level of consumption.
• Tobacco caused around 5,720 deaths in Hong Kong in a study.
• In Hong Kong, tobacco is estimated to kill about 16 people per day.
• Tobacco smoking is classified as a Group 1 carcinogen, meaning it is a confirmed human carcinogen.
• Smoking causes cancers of the lung, oral cavity, pharynx, larynx, esophagus, pancreas, urinary bladder, and renal pelvis.
• Involuntary smoking is also a Group 1 carcinogen.
• Exposure to second-hand smoke from a spouse increases lung cancer risk by 20% for women and 30% for men.
• Workplace exposure to second-hand smoke increases lung cancer risk by 16-19%.
• Smoking harms nearly every part of the body.

Economic Costs of Tobacco

• In Hong Kong in 2011, tobacco-related deaths totaled 6,826 (6,154 active smokers and 672 from second-hand smoke).
• The economic cost of tobacco use in Hong Kong was US$716 million (0.3% of GDP), including healthcare, long-term care, and productivity losses.
• Including the value of lives lost, the total cost was HK$36 billion.
• In 2021, active smoking accounted for 26.5% of deaths in Hong Kong among those aged 35 or above.
• Health care costs in Hong Kong due to active smoking were US$342 million and US$45 million due to second-hand smoke.

Tobacco Control Measures and Prevention

• Hong Kong expanded smoke-free places to include all indoor workplaces and many public areas.
• Health warnings on tobacco products in Hong Kong cover 85% of the packaging.
• Quitting smoking prevents more deaths more quickly than preventing youth from starting.
• Reducing adult smoking by 50% could prevent 180 million deaths by 2020, while reducing youth smoking by 50% could prevent 20 million deaths.
• The WHO Framework Convention on Tobacco Control (FCTC) is a binding international law on comprehensive tobacco control measures.
• The FCTC went into effect on February 27, 2005, and China ratified it on October 11, 2005.
• As of August 2023, 183 parties had ratified the FCTC, covering over 90% of the world population; the USA and Indonesia have not ratified.
• The WHO's MPOWER strategy outlines six effective policies for tobacco control.
• Monitor tobacco use and prevention policies.
• Protect people from tobacco smoke.
• Offer help to quit.
• Warn about the dangers.
• Enforce bans on advertising, promotion, and sponsorship.
• Raise taxes on tobacco.
• Tobacco is highly addictive due to both physiological nicotine addiction and social/psychological factors.

Benefits of Quitting Tobacco

• Within 20 minutes of quitting, blood pressure and heart rate drop to normal.
• After 12 hours, carbon monoxide levels in the blood return to normal.
• Within 48 hours, sense of smell and taste improve.
• Circulation and lung function improve within 2 to 12 weeks.
• Coughing and shortness of breath decrease within 1 to 9 months.
• After one year, the risk of coronary heart disease is halved.
• Risk of stroke is reduced to that of a non-smoker within 5 to 15 years.
• After 10 years, the risk of dying from lung cancer is about half that of a smoker.
• Within 15 years, the risk of coronary heart disease is similar to that of a non-smoker.
• Quitting by age 40 reduces the risk of premature death by about 90%.
• Quitting by age 60 reduces the risk by 40%.

Nicotine Replacement Therapy (NRT) and Medications

• NRT doubles the cessation rate and is safe with minimal side effects.
• Adherence to NRT is often low, and it should be used with counseling.
• Bupropion and varenicline are effective drugs for quitting, but varenicline is underused.

Key Findings of the US Surgeon General's 2020 Report

• Smoking cessation is beneficial at any age, improves health, and enhances quality of life.
• Quitting reduces the risk of premature death (adds 10 years of life) and lowers financial burdens.
• Smoking cessation medications and behavioral counseling are cost-effective.
• E-cigarettes have inadequate evidence to support their use for smoking cessation.
• Raising prices, implementing smoke-free policies, conducting mass media campaigns, using pictorial health warnings, and establishing comprehensive tobacco control programs increase smoking cessation rates.

Tobacco Control Challenges in Hong Kong

• There are approximately 600,000 daily smokers in Hong Kong.
• There are no penalties for venue management or owners who fail to stop smoking in smoke-free places.
• Second-hand smoke infiltrates indoor areas from outdoor smoking.
• Smoking occurs at bus stops and other queuing areas.
• Cigarettes are openly displayed, acting as a form of advertisement.
• Cigarette prices are too low, with taxes at 65% of the price, whereas the WHO recommends at least 75%.
• Thirdhand smoke is an emerging concern.

New Tobacco Products and Challenges

• New challenges include law enforcement against alternative products like e-cigarettes, heated tobacco, and flavored products.
• The tobacco industry and its allies are powerful and influential.
• Patients expect doctors to ask about and advise on smoking.
• The AWARD approach (Ask, Warn, Advice, Refer, Do it again) is a minimal intervention that takes less than 10 seconds.
• Plain packaging, which removes all branding from tobacco products, is used in more and more countries, starting with Australia in 2012.
• Medical students can be tobacco control advocates through public health advocacy, policy changes, and educational sessions.
• Electronic cigarettes (e-cigarettes) are electronic nicotine delivery systems (ENDS) that vaporize a solution for inhalation.
• Heated tobacco products (HTP) heat tobacco to generate an aerosol containing nicotine.
• New products attract youth and non-smokers with appealing designs and flavors.
• All new tobacco and nicotine products (except NRT) are harmful.
• Harm reduction from switching to new products is uncertain, but promoted by the industry.
• Children should not be sacrificed for smokers who refuse to quit.

Environmental Impact

• The tobacco industry has a significant negative impact on the environment.
• 600 million trees are chopped down to make cigarettes.
• 84 million tonnes of CO2 emissions are released into the air.
• 22 billion tonnes of water are used to make cigarettes.
• Tobacco kills over 8 million people every year and harms the environment.

Tobacco Endgame

• The tobacco endgame aims to reduce smoking prevalence to 5%.
• Some countries promote e-cigarettes in their tobacco endgame strategies, while others ban them.
• The HKSAR Government aims to reach 7.8% smoking prevalence by 2025.
• Banning only conventional tobacco products is not enough to end the harms from smoking, the government should ban all forms of nicotine.
• Smoke-free Generations (SFG) proposes banning the sale of tobacco to people born after a specified year.
• Strong tobacco control policies are needed, despite objections from the tobacco industry.
• Medical students can save lives and the planet by advocating for zero tobacco and nicotine harms.