E-cigarette
What is E-cigarette?
E-cigarette is an electrically powered device in which a coil is used to heat a chemical mixture, which is commonly in the form of solution (“e-liquid”), to generate aerosol for inhalation by the user.
E-cigarettes come in various types and shapes. Some mimic traditional tobacco products such as cigarettes or cigars, and some look like daily household products such as pens and USB memory sticks.
Emission of E-cigarettes and Health Hazards
E-liquids may come in pre-filled cartridge/tank or refill bottles. They typically contain nicotine, chemical solvents (e.g. propylene glycol, glycerine) and flavourings. By heating the e-liquids, they are aerosolized, forming harmful products from thermal degradation, such as aldehydes (carcinogens), acrolein (an irritant), and benzene (a carcinogen). Metals (e.g. chromium, nickel) can be released from the heating coil when the device is used at high power.
Nicotine-containing e-cigarettes (or electronic nicotine delivery systems, “ENDS”) are highly addictive and have resulted in the rapid growth in youth use in some countries such as the United States. Some ENDS can deliver the same or even higher amount of nicotine at the similar rate as cigarettes.
The flavouring used in e-cigarettes are primarily food additives but their safety for inhalation purpose has not been proven. Moreover, some of these additives are identified to be toxic, such as diacetyl (buttery flavour), which causes bronchiolitis obliterans, and cinnamaldehyde (cinnamon flavour), which causes lung inflammation.
The composition of the aerosol depends on the device power, the users’ puffing behaviour, and the variety/concentration of chemicals present in the e-liquid.
Gateway and Renormalisation Effects
E-cigarettes are often colourfully packaged and flavoured (flavours such as bubble gum, fruit and candy) to increase their appeal to youngsters, and are promoted as being cool and fun. Use of e-cigarettes simulates the behavioural and sensory characteristics of conventional cigarette smoking. Studies showed that adolescents who used e-cigarettes were associated with a higher risk of initiating cigarette smoking later on, when compared to non-users.
Ban on Alternative Smoking Products
From 30 April 2022, no person may import, promote, manufacture, possess for commercial purposes or sell alternative smoking products, including electronic cigarette products; no person may use alternative smoking products in statutory no smoking areas.
Click here for more information.
Pharmacy and Poisons Ordinance (Cap. 138)
In Hong Kong, nicotine-containing e-cigarette (excluding tobacco products) is considered pharmaceutical products under the Pharmacy and Poisons Ordinance (Cap. 138). Products which fall within the definition of “pharmaceutical product” must meet the standards of safety, efficacy and quality and be registered with the Pharmacy and Poisons Board before they can be sold or distributed in Hong Kong. All registered pharmaceutical products should carry a Hong Kong registration number on the package in the format of “HK-XXXXX”. Those unregistered products have not been evaluated, and their safety, quality and efficacy could not be guaranteed.
Besides, nicotine (except tobacco) is categorised as a Part I poison under Cap. 138. Illegal possession or sale of Part I poisons or unregistered pharmaceutical products constitutes an offence. The maximum penalty for each offence on conviction is a fine of $100,000 and two years’ imprisonment.
Further, import or export of pharmaceutical products is controlled under the provisions of the Import and Export Ordinance (Cap. 60). Importation / Exportation of these products must be covered by an import / export licence. Any person importing or exporting of pharmaceutical products without a licence may commit an offence. The person who is found guilty shall be liable to a fine at HK$500,000 and to imprisonment for 2 years.
The ban on E-cigarette under The Smoking (Public Health) (Amendment) Ordinance 2021 will not preclude the registration of E-cigarette that are pharmaceutical products with the Pharmacy and Poisons Board, provided that the requirements on safety, quality and efficacy under Cap. 138 are met. Upon successful registration with the Pharmacy and Poisons Board, such products will be excluded from the ban under Cap. 371, and the requirements under Cap. 138 should be followed instead.
Smoking Cessation Services
At present, there are a number of smoking cessation services provided by the Department of Health (DH), the Tung Wah Group of Hospitals, the United Christian Nethersole Community Health Service, the Pok Oi Hospital, the Hospital Authority and various organisations. Some family doctors and private hospitals also provide smoking cessation services. Members of the public can call the DH's Integrated Smoking Cessation Hotline at 1833 183 or click here for more information.
Smoking is the major preventable cause of death. For yourself and your family’s health, quit smoking now.
Information Sheets:
E-cigarette—for healthcare professionals
Related Video:
1. National Academies of Sciences Engineering, and Medicine. Public health consequences of e-cigarettes Washington, DC: The National Academies Press; 2018.
2. U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016.
3. Primack BA, Soneji S, Stoolmiller M, Fine MJ, Sargent JD. Progression to traditional cigarette smoking after electronic cigarette use among US adolescents and young adults. JAMA Pediatrics. 2015;169(11):1018-1023.
4. Conner M, Grogan S, Simms-Ellis R, Flett K, Sykes-Muskett B, Cowap L, et al. Do electronic cigarettes increase cigarette smoking in UK adolescents? Evidence from a 12-month prospective study. Tobacco Control. 2018;27(4):365-72.
5. WHO Study Group on Tobacco Product Regulation. Report on the scientific basis of tobacco product regulation: seventh report of a WHO study group. Geneva: World Health Organization; 2019 (WHO Technical Report Series, No. 1015). Licence: CC BY-NC-SA 3.0 IGO.
6. Gotts JE, Jordt SE, McConnell R, Tarran R. What are the respiratory effects of e- cigarettes? BMJ 2019;366:l5275.
7. Brown CJ, Cheng JM. Electronic cigarettes: product characterisation and design considerations. Tobacco Control. 2014;23:ii4-ii10.
8. Williams M, Bozhilov K, Ghai S, Talbot P. Elements including metals in the atomizer and aerosol of disposable electronic cigarettes and electronic hookahs. PLoS ONE. 2017; 12(4): e0175430. https://doi.org/10.1371/journal.pone.0175430
9. World Health Organization. WHO study group on tobacco product regulation: report on the scientific basis of tobacco product regulation: eighth report of a WHO study group. Geneva; 2021.