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Background of the National Tobacco Control Programme

The National Tobacco Control Programme (NTCP) was formed to develop and implement smoking control programmes to reduce the smoking rates in Singapore. The NTCP utilises a multi-pronged approach to combat smoking. Strategies include taxation, tobacco control legislation, public education, collaborative partnerships and provision of smoking cessation services to combat smoking by reducing the supply and demand of tobacco.

Tobacco taxation

The Health Promotion Board plays an active role in advocating and recommending tobacco taxation strategies, and works in partnership with the Ministry of Health and Ministry of Finance on a regular basis. Taxation has been shown to be a cost-effective strategy to reduce smoking prevalence rates. A study by the World Bank showed that for every 10% increase in the real inflation-adjusted price, there will be a decrease in the consumption of cigarettes by 2% - 8%. Local data has shown that increasing cigarette prices correspond to a decreasing per capita consumption.

Tobacco tax has increased regularly since 1987 to discourage non-smokers from picking up the smoking habit, and to encourage current smokers to stop or smoke less. The current cigarette tax is $0.427 per stick of 1g or below, and an additional $0.427 per stick of 1g for each additional 1g or part thereof.

Tobacco control legislation

Legislative measures, started in the early 1970s, undergo regular reviews to incorporate the best international practices, as well as to keep up with social behaviour trends among Singaporeans. The two main legislation instruments are:

1. The Smoking (Control of Advertisements and Sale of Tobacco) Act (enforced by the Health Sciences Authority), which includes:

  • Prohibiting tobacco advertisements and promotion.
  • Mandatory rotation of graphic health warnings on tobacco products.
  • Limiting the tar and nicotine levels of cigarettes sold locally.
  • Prohibiting the use of tobacco products by persons below 18 years of age.
  • Prohibiting the sale/supply of tobacco to these under-aged youths.

In July 2010, the Parliament passed the Amendment Bill to the Smoking (Control of Advertisements and Sale of Tobacco) Act which was subsequently renamed as the Tobacco (Control of Advertisements and Sale) Act. Recent amendments aim to strengthen Singapore's tobacco control efforts include:

  • In 2013, Singapore banned misleading descriptors such as “mild”, “low tar” and “ultra-light”.
  • In 2017, Singapore implemented a point-of-sale display ban for tobacco products, and banned the purchase, use and possession of imitation tobacco products.
  • From 2019 onwards, Singapore will be progressively raising the minimum legal age at which tobacco products can be purchased from 18 years to 21 years of age.
  • From 1 July 2020, all tobacco packaging will be required to come in standardised packaging.

2. The Smoking (Prohibition in Certain Places) Act (enforced by the National Environment Agency) prohibits smoking in public places. To date, the Act has been extended progressively to include all public transport, air-conditioned indoor workplaces and restaurants, non-air-conditioned indoor places; hospitals and educational facilities, pubs and bars; and some outdoor places.

Places under the ambit of the smoking ban include:

  • Public transport, clinics, hospitals, maternity homes, nursing homes.
  • Public libraries, libraries in institutions of higher learning, public museums, art galleries, government workplaces.
  • Rooms used for public functions, public areas in banks, indoor sports stadium, bowling alleys, billiards saloons, gymnasiums, aerobic and fitness centres, fast food centres, air-conditioned restaurants, mini supermarkets, supermarkets, departmental stores, coffee shops and hawker centres.
  • All air-conditioned workplaces, Changi International Airport, all air-conditioned shopping centres, public queues, public toilets, swimming pools, stadium and pedestrian underpasses.
  • All schools, junior colleges, polytechnics, training institutes, air-conditioned and enclosed areas in Universities.
  • Air-conditioned and enclosed areas in private clubs, and air-conditioned shops in town centres, hotels and petrol stations.
  • All hawker centres, coffee shops and al fresco eating establishments.
  • All entertainment outlets, including pubs, bars, discos and lounges.

The smoking ban has been further extended over the years and a recent extension in 2019 included a no-smoking zone on Orchard road.

Public education

Public education is intended for the prevention of initiation of smoking, as well as for the provision of information to both smokers and non-smokers.

HPB works with community organisations and organises roadshows with Quit Advisors on-site to provide advice to both smokers and non-smokers. Efforts to raise awareness of smoking-related issues among the general public also include an annual smoking control campaign.

On World No Tobacco Day, 31st May, through HPB's efforts, many tobacco retailers cease sales of cigarettes and cigars in an extraordinary show of support. Some of the past campaigns include the Chronic Obstructive Lung Disease (COLD) campaign held in May 2008 and the hard hitting Oral Cancer campaign, which was adapted from Australia, in 2007.

Extending beyond public education, HPB has also developed programmes to tackle the higher smoking rates among the Malay community. HPB partners with mosques and Malay/Muslim organisations to implement customised awareness drives and intervention programmes. An example of a programme that weaves in religious and cultural practices is the Muharram Challenge, which is an intensive one-month programme to encourage Malay smokers to quit smoking at the start of the Muslim calendar year.

Partnerships

Partnerships are key to the successful implementation of HPB's programmes. HPB actively engages educational institutions, private workplaces, the uniformed groups, healthcare professionals, youth organisations, community and religious groups, and parents, to promote a smoke-free lifestyle.

To encourage youths to stay smoke free, the programmes aim to prevent youths from initiating smoking and to provide assistance to those who have tried smoking to stop as soon as possible.

To raise awareness about the benefits of leading a tobacco-free lifestyle and discourage youth from experimenting with tobacco products, HPB works with the Ministry of Education and Institutes of Higher Learning (IHLs) to incorporate anti-tobacco messages into the school curricula and co-curricular activities. These efforts are complemented with interactive programmes, such as assembly skits and workshops, to raise awareness amongst youth about the benefits of leading a tobacco-free lifestyle and discourage experimentation with tobacco products.

Healthcare professionals are a major partnership group for HPB. Evidence-based programmes include hospital in-patient services that offer bedside bite-sized advice to patients who are smokers.

HPB also trains pharmacists and General Practitioners to provide opportunistic smoking cessation advice to patients. Capacity building for smoking cessation counselling is conducted through various training courses such as the Certification for Quit Smoking Consultants (CQSC) Program, launched in 2005. The CQSC course aims to enhance and maintain high therapy standards among HPB's service providers and healthcare partners.

Workplaces are excellent platforms to implement comprehensive and sustainable health promotion programmes to address issues affecting the health and health behaviours of the working population. HPB provides consultancy services to help workplaces set-up smoking cessation programmes for their employees. These include motivational talks, educational roadshows, and multi-session group counselling. Training is conducted regularly to equip health promotion facilitators with advocacy skills to secure management buy-in for year-round educational activities.

In addition, HPB also works with the various uniformed groups to implement smoking control programmes. For example, HPB has put in place deterrent measures such as partial smoking bans within army camps via these partners. These measures are supplemented with health awareness talks and smoking cessation services.

Provision of smoking cessation services

One of the key strategies of the NTCP is to offer smoking cessation services that are affordable and accessible to smokers.

Since the 1990s, smoking cessation services have been integrated into the primary healthcare settings such as the hospitals and polyclinics. These services are also now available in retail pharmacy chains, providing a wide network of accessible smoking cessation services for smokers.

HPB also offers help to youth smokers to quit smoking at schools. Student Health Advisors are deployed at various institutions to provide support and counselling to students on health issues which include tailored counselling for youth smokers in schools. The sessions help youth to understand the harms of smoking and equip them with strategies to cope with withdrawal symptoms and quit the habit.

HPB also manages a QuitLine (1800 438-2000) to provide personalised advice by trained Quit Advisors on how to quit smoking. Through this toll-free hotline, the public can also request for free self-help print resources to be mailed to them.