1 YOUTH SMOKING IN HONG KONG Lam TH, Ho SY, Lai MK Department of Community Medicine, Faculty of Medicine, The University of Hong Kong

2 Introduction 3 Youth Smoking Surveys commissioned by the Hong Kong Council on Smoking and Health in 1994, 1999 and 2003 Study smoking prevalence, factors associated with smoking, respiratory symptoms, quitting Monitor smoking trends Incorporated the Global Youth Tobacco Survey in the 2003 survey

3 Methods Two-stage cluster sampling –Territory-wide non-international secondary schools were randomly selected –2 classes from each of form1 to form 3 were further selected randomly All students in selected classes completed a self administered, anonymous and structured questionnaire in the classroom in the absence of teachers

4 Participants 1994: 6304 students from 61 schools 1999 vs 1994: 8737 vs 4539 students from the same 45 schools 2003: students from about 90 schools by mid 2004 (8863 Form 1 students surveyed in 1999 are followed up) (2003 survey in progress and 1999 results will be presented)

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6 Cough & Smoking * Adjusted for age, gender, area of residence and type of housing Source: Lam, et al. Int J Epidemiol 1998;27(1):41-8. p for trend < 0.001

7 Phlegm & Smoking * Adjusted for age, gender, area of residence and type of housing Source: Lam, et al. Int J Epidemiol 1998;27(1):41-8. p for trend < 0.001

8 Throat problems / Wheezing & Smoking * Adjusted for age, gender, area of residence and type of housing Source: Lam, et al. Int J Epidemiol 1998;27(1):41-8. p for trend < 0.001

9 Cough & Passive Smoking * Adjusted for age, gender, area of residence and type of housing Source: Lam, et al. Int J Epidemiol 1998;27(1):41-8. p for trend < (except cough, past 3 months)

10 Phlegm & Passive Smoking * Adjusted for age, gender, area of residence and type of housing Source: Lam, et al. Int J Epidemiol 1998;27(1):41-8. p for trend < (except phlegm, past 3 months, p = 0.03)

11 Throat Problems / Wheezing & Passive Smoking * Adjusted for age, gender, area of residence and type of housing Source: Lam, et al. Int J Epidemiol 1998;27(1):41-8. p for trend < 0.05 for throat problems only

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13 Factors Associated with Ever Smoking * Adjusted for age, gender, area of residence and type of housing Source: Lam, et al. Am J Prev Med 1998;14(3):

14 Overestimation of Smoking Prevalence in Adolescents Overestimation predicts smoking initiation and associated positively with future smoking in the West COSH Survey: Out of 100 students of your age in Hong Kong, how many of them smoke cigarettes? (1 / 5 / 10 / 15 / 20 / 25 / 30 / 35 / 40 or above / Don't know) Students who overestimated their age-specific smoking rate were classified as overestimation.

15 Overestimation of Smoking Prevalence  2x

16 Odds Ratios of Smoking by Overestimation in Boys * Adjusted for age, gender, area of residence, type of housing, etc. p for trend < 0.05 except ever smoker

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21 Intention to Quit Smoking

YSS Incorporated items from the questionnaires of previous YSS survey the GYTS survey Standardised questionnaire, questionnaire administration, procedures and data analyses A cross-sectional and prospective study By January 2004, about questionnaires from 68 schools have been collected

23 Conclusions The prevalence of smoking in youth has been increasing. Adverse health effects of smoking and passive smoking are found with high excess risks in Hong Kong. Many avoidable risk factors of smoking are identified.

24 Conclusions A regular series of smoking surveys using standardised methods are essential to study risk factors and adverse effects of smoking and to monitor trends. Such surveys should be done more frequently.

25 Youth Smoking Prevention (YSP)

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31 Voluntary or self regulation Health education: on risks Banning of sales to minors Youth Smoking Prevention (YSP) (130 YSP programmes in more than 70 countries) funded by tobacco industry ( Interventions Supported by the Tobacco Industry

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33 究底 尋真 煙草業 防止青少年 吸煙計劃 之真相

34 Introduction Published by World Health Organization The Traditional Chinese version is translated and published by HK Council on Smoking & Health The tobacco industry offered money, expert consultants and support services to governments and civic organizations –Japan, Philippines, Australia, Malaysia etc.

35 Comprehensive multisectional national tobacco control strategies, plans and programmes: Price and tax Protection from exposure to tobacco smoke Regulation of contents and disclosures of tobacco products Packaging and labelling (50% or more areas) Education, communication, training and public awareness WHO Framework Convention 2003:

36 Comprehensive ban of advertising, promotion and sponsorship Cessation and treatment for tobacco dependency Elimination of illicit trade Prohibit sales to and by minors Economically viable alternatives Liability: criminal and civil Research, surveillance, exchange of information Cooperation

37 WHO Framework Convention Has your country signed? What has been done? What will be done?