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IntroductionHealth information about COVID-19 has been circulating in social networking sites, including unproven claims that smoking and alcohol drinking could protect against COVID-19. We examined if exposure to such claims was associated with changes in tobacco and alcohol consumption.MethodsWe conducted a population-based, landline and mobile phone survey of 1501 randomly sampled adults aged 18 years or older (47.5% male) in Hong Kong in April 2020. Respondents reported if they had ever seen claims that ‘smoking/alcohol drinking can protect against COVID-19’ from popular social networking platforms. Current tobacco and alcohol users reported if they had increased or reduced their consumption since the outbreak. Prevalence data were weighted by sex, age and education of the general adult population.Results19.0% (95% CI 16.8% to 21.4%) of all respondents reported having seen claims that ‘smoking/alcohol drinking can protect against COVID-19’ from social networking sites. Multinomial logistic regression showed that exposure to the claims was significantly associated with increased tobacco use (OR 2.37, 95% CI 1.08 to 5.20) in current tobacco users (N=280) and increased alcohol use (OR 4.16, 95% CI 2.00 to 8.67) in current drinkers (N=722), adjusting for sex, age, education level, alcohol/tobacco use status, home isolation, anxiety and depressive symptoms, and survey method.ConclusionOur results first showed that exposure to health misinformation that smoking/alcohol drinking can protect against COVID-19 was associated with self-reported increases in tobacco and alcohol consumption in Chinese during the pandemic.

BackgroundIndependent studies on exhaled carbon monoxide (CO) and saliva cotinine levels in regular heated tobacco product (HTP) users, and how they compare with conventional cigarette (CC) smokers, are lacking.MethodsA total of 3294 current users of CCs, HTPs or electronic cigarettes (ECs) from a household survey and a smoking hotspot survey were classified into seven groups: exclusive users of CCs, HTPs, ECs; dual users of CCs and HTPs, CCs and ECs, HTPs and ECs; and triple users. We measured exhaled CO level using the piCo Smokerlyzer (n=780) and saliva cotinine using NicAlert cotinine test strips (n=620). Among the seven groups, the differences in (1) CO and cotinine levels were examined using Kruskal-Wallis test, and (2) the average daily tobacco consumption in the past 30 days was examined using multivariable linear regression.ResultsBoth exclusive and dual users of CCs had a higher CO level than exclusive HTP or EC users (pConclusionsHTP or EC use showed lower exhaled CO but similar saliva cotinine levels compared with CC use. Dual users of CCs and HTPs/ECs smoked fewer CCs than exclusive CC users, but consumed more tobacco in total.

BackgroundHong Kong has proposed banning the sale of heated tobacco products (HTPs). Perceptions of reduced harms and effectiveness for quitting combustible cigarettes (CCs) of HTPs due to their promotions may erode public support for regulations. We assessed the associations between perceptions of HTPs and support for regulations in Hong Kong.MethodsIn two population-based landline surveys conducted in 2018–2019, 1985 respondents (51.4% male; 22.7% aged 60+ years) reported perceived relative harm of HTPs to CCs and effectiveness for quitting CCs, and support for five HTP regulations (ban on promotion and advertisements, use in smoke-free areas, sales to minors, registration before sale, sale licence) and a total ban on sale. Current and former smokers were oversampled due to low prevalence. Descriptive statistics were weighted to the general population. Associations were analysed, adjusting for sociodemographic characteristics, smoking status and ever HTP use.Results27.4% (N=515) of respondents perceived HTPs as less harmful, and 18.8% (N=1299) perceived them as effective for quitting CCs. Support was generally high (at least one regulation, 99.1%, N=1959; all five regulations, 66.8%, N=1114; total ban, 63.5%, N=946). Perceptions of reduced harm were associated with lower support for all five regulations (adjusted risk ratio 0.85, 0.75 to 0.96) and a total ban on sale (0.58, 0.51 to 0.66). Results were similar for perceptions of effectiveness for quitting.ConclusionsLower support for HTP regulations and a total ban on sale were associated with perceptions of reduced harm and effectiveness for quitting CCs of HTPs in Hong Kong.

IntroductionWe investigated heated tobacco products (HTPs) use and associated factors in Chinese adults in Hong Kong where HTPs are not formally marketed yet, and cigarette smoking prevalence was the lowest in the developed world.MethodsA population-based landline telephone survey in 2017 interviewed 5131 (45.2% male; 26.7% aged ≥60) adults to collect information on awareness, intention to use, ever use of HTPs, cigarette smoking status and sociodemographic characteristics. Descriptive statistics were weighted by the age, sex and smoking status of the Hong Kong adult population. Sociodemographics were mutually adjusted in logistic regression to yield adjusted ORs (AORs) for awareness of HTPs, controlling for smoking status.ResultsOverall, 11.3% (95% CI 10.0% to 12.7%) were aware of HTPs and 1.0 % (0.8%–1.2%) had ever used it. Awareness was associated with aged 40–49 years (AOR 1.37, 95% CI 1.01 to 1.87) or 30–39 years (2.03, 1.41–2.91) (vs ≥60 years), born in Hong Kong (1.37, 1.11–1.68) and higher monthly household income (p for trend 0.001). Ever HTP users had higher educational attainment and monthly household income, and more were aged 30–39 and economically active (all pConclusionHigher socioeconomic status was associated with HTP use and intention to use. Public health education on HTPs is needed especially for this high-risk group.

China produces 41% and consumes >38% of the world's cigarettes.1 It is also a global production and export centre of the electronic cigarette (e-cigarette) industry. Around 95% of the world's e-cigarettes are manufactured in China, mainly in the southeastern metropolis of Shenzhen,2 but the market share of e-cigarettes is tiny within the country.2 According to the most recent data of the International Tobacco Control Survey, only 2% of adult current or former smokers in China had ever used e-cigarettes in 2009.3 However, e-cigarette use has become increasingly popular, particularly among young people.4 The large smoker population and the hardening tobacco control measures (many cities have enacted local smoke-free laws,5 and a nationwide smoke-free law has been drafted6) create a huge potential for the e-cigarette market in the country. …

To investigate the effect of comprehensive smoke-free legislation in 2007 on the exposure of children to secondhand smoke (SHS) in Hong Kong.Two cross-sectional questionnaire surveys were conducted, before (2006) and after (2008) the implementation of smoke-free legislation, among primary 2-4 students (equivalent to US grades 2-4) from 19 and 24 randomly selected schools, respectively. Adjusted ORs for SHS exposure at home and outside home post-legislation compared with pre-legislation were calculated. The strength of the association between SHS exposure and respiratory symptoms in each survey was used as an indirect indicator of the intensity of exposure.Among 3243 and 4965 never smoking students in the 2006 and 2008 surveys, the prevalence of SHS exposure in the past 7 days increased both at home (from 10.2% to 14.1%) and outside home (from 19.8% to 27.2%). Post-legislation, students were 56% more likely (p0.01) to report SHS exposure at home coupled with an insignificantly stronger association between SHS exposure and respiratory symptoms. Similarly, students were 60% more likely (p0.001) to report SHS exposure outside home in 2008, but the association between SHS exposure and respiratory symptoms became insignificantly weaker. Parental smoking rates were similar before and after legislation.The prevalence of exposure to SHS at home and outside home have both increased among primary school students in Hong Kong post-legislation. Comprehensive smoke-free legislation without strong support for smoking cessation might have displaced smoking into the homes of young children.

Smoking scenes in movies, exploited by the tobacco industry to circumvent advertisement bans, are linked to adolescent smoking. Recently, a Hong Kong romantic comedy Love in a puff put smoking at centre stage, with numerous smoking scenes and words that glamourise smoking. Although WHO has issued guidelines on reducing the exposure of children to smoking in movies, none is adopted in Hong Kong. Comprehensive tobacco control strategies are urgently needed to protect young people in Hong Kong from cigarette promotion in movies.