In Hong Kong, smokers are butting out in record numbers
Janet Rae Brooks
CMAJ 1997;156(2):1441-3
[ en bref ]
Janet Rae Brooks is a Canadian freelance writer based in Hong Kong.
© 1997 Janet Rae Brooks
In brief
Thanks to a partial ban on tobacco advertising and a concerted effort by antismoking advocates and hospitals, more than 100 000 people have quit smoking in Hong Kong in the last 3 years, giving the British territory one of the world's lowest smoking rates. This article examines initiatives behind the successful trend and identifies how Hong Kong is addressing the challenge of reducing smoking rates among youth, women and poor people.
En bref
Grâce à une interdiction partielle de la publicité sur le tabac et à un effort concerté de militants anti-tabac et d'hôpitaux, plus de 100 000 personnes ont cessé de fumer à Hong Kong depuis trois ans : le territoire britannique a maintenant un des taux de tabagisme les plus bas au monde. On examine dans cet article des initiatives à l'origine de cette réussite et décrit comment Hong Kong relève le défi qui consiste à réduire les taux de tabagisme chez les jeunes, les femmes et les pauvres.
Four smokers -- a doctor, 2 business executives and a new mother -- are sitting in a small room on the 29th floor of a Hong Kong high-rise, smoking the last cigarette of their lives.
For the last 4 hours they have been listening to a former 3-pack-a-day smoker's persuasive arguments on why life is better as a nonsmoker. Quitting will release them from the tyranny of their addiction to nicotine, they are told. Quitting can be an enjoyable and invigorating experience. What is so wonderful about being a smoker anyway? They have squirmed, nodded in agreement and often reached for another cigarette.
The Allen Carr Stop Smoking Clinic is just one of the many venues to which Hong Kong smokers are turning in order to free themselves from nicotine addiction. More than 100 000 people have stopped smoking in Hong Kong in the past 3 years, according to the Hong Kong Council on Smoking and Health. The British territory, which is soon to be engulfed by China, now has one of the lowest smoking rates in the world. Only 14.8% of people over age 15 smoke, compared with 23.3% in 1982.
Smoking still kills 3500 people here annually, more than die from alcohol abuse, murder, suicide, drowning, death on the roads, industrial accidents and AIDS combined.
And more women and teenagers smoke. The smoking rate for women has risen from 2.7% in 1993 to 3.1% today, the government says. Almost 6% of teenage boys admitted they smoked, but Johnson Wong, the council's executive director, said the actual number is probably closer to 10% because of under-reporting while in the presence of parents. "Although the overall trend is encouraging, we are very much on the alert over the rising smoking rates among young people and women."
Hong Kong has enacted legislation to decrease the impact of the tobacco industry's seductive messages. Cigarette advertising on television was banned in 1990, radio advertising was eliminated in 1991 and cinema ads the following year.
But in 1996 proposed legislation for a total ban on tobacco advertising was twice sent back to the drawing board by Hong Kong's Executive Council because some members said the measures were too drastic. A draft bill had originally proposed a ban on all tobacco advertising in print media and on billboards, to take effect within 2 years. Billboards grab the largest share of tobacco advertising revenue in Hong Kong.
The territory's tobacco lobby threatened to sue the government if it proceeded. The reasons sound ominously like those heard in Canada: lobbyists charge that such a bill would contravene the freedom of expression guaranteed under the Hong Kong Bill of Rights. The industry's belligerent response is a useful litmus test, said Dr. Judith Mackay, director of the Asian Consultancy on Tobacco Control. "If the tobacco industry screams," she said, "it's the right thing to do."
While the tobacco industry claims it advertises only to secure or enforce brand loyalty among confirmed smokers, government data show that almost half of Hong Kong smokers began smoking before age 20. Another 30.7% started between ages 20 and 24. Only 14% began after age 25. Young customers are also much less likely to quit. Only 6.9% of Hong Kong residents who have stopped smoking were under 30; more than 80% were 40 or older.
Shut out of television, radio and cinemas, tobacco advertisers have moved into unregulated areas such as sponsorship of music and sports events, which target young people. Marlboro cigarettes takes matters a step further -- it markets itself through a chain of franchised "Marlboro Classic" stores that sell rugged Western-style clothing and fashion accessories.
The Council on Smoking and Health has struck back by targeting youth and women in a series of antismoking commercials in Cantonese and English; the first ones aired almost 2 years ago on government-run television stations. The council has also sponsored an educational drama about tobacco at more than 80 secondary schools, and is preparing to launch a television campaign about the dangers of passive smoking.
Hong Kong's 740 000 smokers come overwhelmingly from the lower socioeconomic classes. Only 23% of Hong Kong smokers are managers and professionals -- the rest are clerks, shop and manual workers, machine operators or unskilled labourers.
More than 40% of Hong Kong smokers surveyed by the government in 1995 had tried to give up smoking and failed. About 6% had not tried but wanted to quit, and slightly more than half didn't want to quit.
Ex-smokers account for 8.6% of Hong Kong's total adult male population. More than one-third quit for health reasons, and another one-third followed advice from their doctors. About 13% quit at their family's request and 12% because of the high price of cigarettes, which cost just under $5 for a pack of 20.
Several programs exist for those who want to quit. The Council on Smoking and Health offers a free pamphlet, Quick tips to quit smoking. "Congratulations!" it says. "Your body is thrilled that you are quitting!" It suggests that smokers replace their ashtrays with a bowl of goldfish to reinforce the lifestyle change they are making, and "set a goal for each hour of every day so that no spare moments can be tempting 'smoking times.' "
Many hospitals offer stop-smoking programs. The Adventist Hospital's Quit Now! program, the longest-running in Hong Kong, costs $60 and has an initial quit rate of 90% that slips to 30% after 6 months.
"We don't have to spend time convincing people of the risks of smoking," said Dr. William Andress, the hospital's director of health promotion. "We concentrate on teaching smokers how to manage living without cigarettes because it does involve learning some new skills."
Since March, doctors at Hong Kong's public hospitals have been required to ask outpatients if they smoke. "It's as important as someone's blood pressure or pulse or whatever," said Hospital Authority spokesperson Elaine Scullion.
Depending on their readiness to quit, smokers are given stop-smoking literature or smoking-cessation classes. The Hospital Authority's goal is to question 500 000 patients about their smoking status within 2 years.
Back on the 29th floor of the Hong Kong high rise, the 4 people who paid $350 each to attend the Allen Carr stop-smoking program are silently smoking their last cigarette. "Do we have to?" one of the business executives asked when they were instructed to light up one last time.
For 4 hours the messages had been relentless:
- Ask yourself: What makes me think I have to spend the rest of my life buying these things, sticking them in my mouth, setting fire to them and breathing in smoke?
- There is nothing to give up.
- The real reason I smoke is because I'm trying to feel as relaxed and comfortable as a nonsmoker.
- The real reason we smoke is to end the physical craving from the last cigarette, which creates a craving for the next cigarette.
Carr cured himself of his own 100-cigarette-a-day habit by changing the way he thought about smoking. He said this paradigm shift let him quit smoking immediately after 32 years in "nicotine prison."
His book, The Allen Carr Method, has sold more than a million copies and been translated into 17 languages; the program is now running in the US, Australia, Israel and throughout Europe. The Hong Kong clinic is the first of a planned network to be extended throughout Asia and China during the next 5 years.
The smokers puff at their last cigarette and listen to more powerful words that encourage their determination and commitment. After a 20-minute relaxation session, they make what they hope will be their last gesture with tobacco: they toss their cigarette packets on to the growing heap at the front of the room.
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