Territory-wide Study on Smoking Exposure in Adolescents and Children Hong Kong Paediatric Foundation – 20th Anniversary Conference Summit on Child Health and the Environment 2014 11 October 2014 Dr Daniel SY Ho School of Public Health University of Hong Kong 1
Acknowledgements Colleagues • Lam TH, Wang MP, Lo WS, Mak KK, Lai HK, Lai MK, Leung LT, Chen JJ, Au WM, Wang Y, Huang R, Lin HC, Ruan RL, Yung D, Lai KL Funding • Hong Kong Council on Smoking and Health • Food and Health Bureau • Department of Health • Health Care and Promotion Fund • University Research Committee, HKU
2
Preamble It is outright ridiculous that smoking is still not totally banned in civil societies now in the 21st century
3
Smoking trends
4
Smoking surveys in secondary schools
1994
1999
2003
2006
2008
2011
2013
4,539
8,737
36,612
24,726
18,278
61,127
45,857
Form
1-3
1-3
1-5
1-5
1-5
1-7
1-6
No. of schools
61
64
85
43
32
79
75
Survey
Smoking
Smoking
Smoking
HKSOS
HKSOS
Smoking
Smoking
COSH
COSH
COSH/DoH
HKU
HKU
FHB
FHB
No. of students
Funding
COSH: HK Council on Smoking and Health DoH: Department of Health HKU: University of Hong Kong FHB: Food and Health Bureau
5
Source: COSH Report No. 7
6
Source: COSH Report No. 7
7
Source: COSH Report No. 7
8
Prevalence of current smoking among Secondary 1-5 students (2003-2013) All
14
Boys
Girls
13.2 12
Prevalence (%)
11.5 10 9.6
8
10.1
9.5
↓ 12% smoking prevalence ↓ 1376 current smokers Avoid at least 688 future deaths*
6.9 7.6
6
6.0 4.0 3.4 2.8
4
3.8
2
3.3 3.0 2.7
0 2002 Year
2003
2004
2005
2006
2007
2007: smokefree law implementation
2008
2009
2010
2011
2009: 50% increase in tobacco tax
2012
2013
2014
2011: 41.5% increase in tobacco tax
*Based on death risk of 2/3 for youth smoking, 917 future deaths will be avoided. School-based Survey on Smoking among Students 2003/4, 2010/11 and 2012/13 Youth Education and Health Project 2006 and 2008
Smoking surveys in primary schools • Council on Smoking and Health: 1999-2009
• Food and Health Bureau: 2011-2013
Number of primary school students by year Year Grade
1999
2001
2006
2008
2009
2011
2013
768
1,538
658 7278
5143
5
8314
5525
6
8169
5648
23,761
16,316
1
2
137
3
130
155
1,377
1,830
775
4
805
3,403
1,363
2,180
353
Total
1,072
3,558
3,508
5,548
1,786
10
Prevalence of current smoking among Primary 4 students (1999-2013) All
Boys
Girls
1.20
↓ 45% smoking prevalence ↓ 67 current smokers Avoid at least 34 future deaths*
1.05
Prevalence (%)
1.00 0.97 0.73
0.75
0.80
0.67 0.60
0.63
0.79 0.62
0.57
0.62
0.40
0.40 0.27
0.20
0.67
0.50
0.32
0.36 0.29 0.23
0.30 0.16
0.00 0.00 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Year
2001: 5% increase in tobacco tax
2009: 50% increase in tobacco tax
2011: 41.5% increase in tobacco tax
*Based on death risk of 2/3 for youth smoking, 45 future deaths will be avoided. School-based smoking survey (anti-smoking theatre evaluation) 1999, 2000, 2006, 2008, 2009 School-based Survey on Smoking among Students 2010/11 and 2012/13
Secondhand smoke exposure in adolescents and children
12
(Ho et al. Tob Control 2010)
13
14
15
16
17
Prevalence of SHS exposure 2012-13 At home 60
Outside home
53.9 49.5
50 40 % 30
24.5
23.3
20 10 0 P4-6
S1-6 P4-6 N=16,316 S1-6 N=45,857
SHS exposure at home from different sources in 2010-11 Adolescents
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Table 3.8.5 Number of days exposed to residual cigarette smoke at home in the past 7 days among primary school students Days
N('000)
%
(95% CI)
0
133.0
82.6
(82.0-83.2)
1
10.0
6.2
(5.2-6.6)
2
5.0
3.1
(2.8-3.4)
3
2.4
1.5
(1.3-1.7)
4
1.6
1.0
(0.9-1.2)
5
0.9
0.6
(0.5-0.7)
6
1.0
0.6
(0.5-0.8)
7
7.2
4.4
(4.1-4.8)
Any
28.0
17.4
(16.8-18.0)
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Table 4.12.6 Number of days exposed to residual cigarette smoke at home in the past 7 days among secondary school students Days
N('000)
%
(95% CI)
0
342.7
82.2
(81.8-82.5)
1
18.7
4.5
(4.3-4.7)
2
14.3
3.4
(3.3-3.6)
3
10.3
2.5
(2.3-2.6)
4
6.2
1.5
(1.4-1.6)
5
4.2
1.0
(0.9-1.1)
6
2.6
0.6
(0.5-0.7)
7
18.0
4.3
(4.1-4.5)
Any
74.2
17.8
(17.5-18.2) 21
Risk factors of smoking
22
(Lai et al, Addiction 2004)
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24
Overestimation of prevalence of peer smoking is associated with smoking initiation among children.
Journal of Adolescent Health; 2011; 48(4): 418-420
25 25
Parental smoking has effect on smoking initiation among young children through secondhand smoke. Nicotine & Tobacco Research; 2011; 13(9): 827-832
28 28
Adolescent smokers with secondhand smoke exposure at home were more likely to show nicotine dependence Morning smoking Heavier smoking Addictive Behaviors; 2012; 37(6): 746-746
31 31
34
35
36
(Mak et al. BMC Public Health 2010)
37
38
39
40
41
42
(Lam et al. Addiction 2005)
43
Bidirectional prospective associations between smoking & depressive symptoms in adolescents
OR for T2 ever-smoking 1.48 (1.07-2.05)
OR for T2 high depressive symptoms 2.17 (1.40-3.36)
44
45
46
47
48
49
Family pro-smoking practices and adolescent current smoking Current smoking
Pro-smoking practices Buy cigarettes for family members
Hand cigarettes to family members
Light a cigarette for family members Clean the ashtray for family members
n
%b
AOR (95% CI) a
No
3227
10.7
1
1
Yes
307
46.9
7.52 (6.40-8.85) ***
5.59 (4.68-6.67) ***
No
3154
10.6
1
1
Yes
380
32.8
4.10 (3.60-4.47) ***
3.75 (3.25-4.32) ***
No
3290
10.8
1
1
Yes
244
58.8
12.14 (9.83-15.01) ***
10.3 (8.17-13.02) ***
No
2963
10.1
1
1
Yes
571
38.0
5.35 (4.77-5.99) ***
4.43 (3.91-5.03) ***
1
1
Crude OR
Easily see packages of cigarettes of family No members at home
2248
Yes
1286
19.3
2.34 (2.17-2.53) ***
2.10 (1.94-2.28) ***
No
969
5.7
1
1
Any
2565
18.3
3.81 (3.54-4.10) ***
3.13 (2.88-3.41) ***
No
1462
6.8
1
1
Any
2072
22.0
3.72*** (3.44-4.03)
3.23 (2.99-3.50) ***
Having a smoking family member
Exposure to SHS at home
AOR=Adjusted odds ratio. a. Adjusting for age, sex, highest parental education level, housing type and school clustering effect. b. Column percentage. Percentages may exceed 100% due to rounding. ***p
