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.

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 $0.352 per stick of 1g or below, and an additional $0.352 per stick of 1g for each additional 1g or part thereof.

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:

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

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. The proposed amendments aim to strengthen Singapore s tobacco control efforts and include:

For more information on the Amendment Bill, please refer to the Second Reading Speech and Closing Speech by the Minister for Health, Mr Khaw Boon Wan.

2. The Prohibition on Smoking 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:

The smoking ban has recently been further extended in January 2009 to include non air-conditioned indoor places such as factories, underground and multi-storey carparks; and some outdoor places such as children's playgrounds, exercise areas, markets, ferry terminals and jetties.

Public education is intended for prevention of initiation of smoking, as well as for 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 the annual month-long smoking control campaign, held in conjunction with World No Tobacco Day on 31st May. On this day, 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 targeted at specific subgroups of at-risk adults.

To curb the increasing trend of smoking among young women (18-29 years), HPB launched Fresh Air For Women, in August 2004. This on-going programme provides women smokers with the relevant information and social support network to help them quit smoking. Adopting an integrated approach, this programme incorporates marketing, public relations and partnerships to reach the young women with educational, motivational and empowerment messages.

To tackle the smoking rates among the Malay community, HPB partners with mosques and Malay/Muslim organisations to implement customised educational initiatives and intervention programs. 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 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.

Healthcare professionals are a major partnership group for HPB. Evidence-based programmes include hospital in-patient services that offer bedside brief advice to patients who are smokers. HPB provides smoking cessation counselling to women smokers attending antenatal and postnatal clinics at Singapore s dedicated women s and children s public hospitals.

HPB also trains pharmacists, General Practitioners, optometrists and dentists 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 therapy standards among HPB s service providers and healthcare partners.

Workplaces are excellent platforms to develop comprehensive and sustainable health promotion programmes to address issues affecting the health and health behaviours of the working population. HPB provides consultancies to help workplaces set-up workplace smoking cessation programs. Training is conducted regularly to equip health promotion facilitators with advocacy skills to secure management buy-in and programme planning skills to implement in-house cessation interventions and year-long educational activities.

In addition, HPB also works with the various uniformed groups to implement smoking control programmes. Via these partners, HPB has put in place several measures such as partial smoking bans within army camps, health awareness talks and 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 non-governmental organisations such as the Singapore Cancer Society, Singapore Heart Foundation, Youngberg Wellness Centre and retail pharmacy chains, providing a wide network of accessible smoking cessation services for smokers.

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.

Smoking is an addictive behaviour which is mostly picked up during adolescence. The prevalence of smoking on at least one day in past 30 days declined from 11% in 2000 to 9% in 2006 to 6% in 2009. Youth pick up smoking easily, for example due to peer influence or simply out of curiosity.

HPB implements a variety of tobacco control programmes for children, teenagers and youth. Besides targeting the general youth population, programmes are also tailored to suit specific youth groups. In addition, teachers, parents and counsellors are engaged to help youth lead smoke-free lives.

HPB organises a variety of activities aimed at raising youth's awareness about benefits of leading a tobacco-free lifestyle, dispelling common misconceptions of smoking (e.g. I can quit smoking anytime; Smoking helps me to lose weight, etc) and equipping youth with life skills (e.g. self-esteem, decision-making) to refuse cigarette offers.

Interactive programmes such as skits, Too Tuff To Puff Sports Programme and ‘Live It Up’ tobacco prevention module are some examples of the school-based initiatives coordinated for youth studying in pre-schools, primary schools, secondary schools, pre-universities and Institutions of Higher Learning.

HPB also works with youth groups to develop and implement creative initiatives to promote a tobacco-free lifestyle among their peers. This includes programmes under the Youth Advolution for Health (YAH) Programme*. A signature event under the YAH Programme is the commemoration of World No Tobacco Day.

HPB also engages teachers, youth workers, counsellors and parents in promoting a smoke-free lifestyle among the young. Regular workshops are conducted to keep them updated on youth smoking issues and equip them with skills to discuss related issues to help youth lead a smoke-free lifestyle.

HPB also arranges for parenting workshops, entitled ‘Parents, You Can Make A Difference: Raising Smoke-Free Teens’, at FSCs and schools.

HPB adopts a targeted approach by collaborating with schools, Family Service Centres (FSCs) and various youth and public organisations to hold activities to help at-risk youth embrace a smoke-free lifestyle. Activities include social etiquette-cum-grooming courses and soccer clinics where smoking control education is presented in refreshing ways.

HPB also organises training sessions for youth facilitators and counsellors who work with at-risk youth, to equip them with knowledge and skills to help the young stay away from tobacco.

Smoking cessation services are available for youth smokers in schools and most polyclinics. HPB trains teachers or counsellors to equip them with knowledge and skills to help students who smoke to kick the habit.

Face-to-face smoking cessation counselling is supplemented by a web-based smoking cessation programme, available at www.breakfree.sg. This programme will provide additional online guidance and support for today s net-savvy youth.

Parental smoking can result in children picking up smoking. The Student Health Survey 2009 conducted by the Health Promotion Board (HPB) showed that 50% of youth smokers had at least one parent who smoked. Similarly, a study by researchers at Dartmouth College revealed that children with parents who smoked were 4 times more likely to purchase cigarettes, as compared to children with non-smoker parents.

Since 2009, HPB has stepped up programmes to encourage smoker parents to kick the habit. These include promoting positive parental role modelling and engaging healthcare professionals to reiterate to parents the importance of being tobacco-free.

HPB is always seeking to work with relevant partners to incorporate tobacco-control messages in their premises, products, programmes or events. If you have a proposal to share with us, please contact Miss Diana Sim at [email protected]

Youth below the age of 18 years are prohibited by law to smoke or purchase any tobacco products. HPB works with the Tobacco Regulation Unit, Health Sciences Authority to put in place restrictions and develop resources to enable retailers to refuse sale of tobacco products to youth below 18 years of age.

Non-traditional and youth-centric media such as internet blogs, websites, radio, ZoCards and youth magazines are extensively used to reach out to the young to promote a tobacco-free lifestyle.

The I Quit mobile app developed by Health Promotion Board helps you identify your smoker profile type to tailor the most effective approach to quit smoking. With progress tracking, the I Quit mobile app shows how long you've gone without a cigarette and even things you can now afford with the money saved through a simple interactive calculator.

Still crave a cigarette sometimes? It's alright. The I Quit mobile app will offer you tips and coping strategies to manage that craving. It also links directly to QuitLine and Quit Centres to give you the support and advice you need, right on your phone!

It's a great app to help smokers who've decided to take that step forward by saying "I Quit".

It's never easy to say I Quit. Come join us on our Facebook page as we celebrate this life-changing decision and support one another on this quit journey. The I Quit Club facebook page is a place to unite all smokers who want to quit, and provide them with the support from loved ones and even ex-smokers as well. If you know of anyone who is starting in their quit journey, share this page with them to empower them with coping strategies, support tools and tips to quit smoking. Make a difference today by showing them this support!