Word Count: 500 without in-text citations, symbols, citations, diagram illustrations and this sentence.

Investment in youth tobacco control Dealing with the prevalence of underage smoking in
Singapore
Smoking in Singapore
Percentage of adult smokers plateaued to 13.3% in 2013 (MOH 1, 2013)
o Effective cessation campaigns
E.g. NTCC2 2015 HPB3
o Effective legislature (e.g. 10% tax hike for tobacco products, ban of open cigarette
displays)
Problem
Rising prevalence of underage smoking: 17% more underage smokers were caught in 2014
than 2013 (Pei Shan, & Pearl, 2017).
o Despite existing in-campus HPB programmes (e.g. Too-Tuff-to-Puff programme,
PAL4 smoking-prevention programme)

General conclusion: more investment into youth tobacco control needed

Choice of Topic
Health Risks of Smoking

o Increased risk of lung cancer, stroke, heart disease (WHO 5, 2017)

o Approximately 2,500 smokers and 250 non-smokers die prematurely due to smoking-
related diseases yearly (MOH, 2013)

Social Costs of Smoking

o Increased medical fees

o Reduced productivity + real income
o The social cost of smoking in 1997 was about S$839 million (Quah, 2002)

Target Group

Smoking is prevalent amongst all age groups in Singapore, yet -

Youth are more prone to risk-taking behaviour legal enforcement does not effectively
deter students when it comes to smoking (Balogh, 2013)

Adolescents particularly vulnerable to the addictive effects of nicotine (SAMHSA, 2016)

Youth are especially vulnerable to tobacco usage target group for investment in tobacco control
will be the youth.

1 Ministry of Health
2 National Tobacco Control Campaign
3 Health Promotion Board
4 Peer-Assisted Learning
5 World Health Organization
Word Count: 500 without in-text citations, symbols, citations, diagram illustrations and this sentence.

Underlying Causes

Primary Cause 1: Smokers struggle to quit smoking lack of willpower to overcome

nicotine addiction (Schwartz, & Benowitz, 2010)

o Underage smokers extremely vulnerable to nicotine addiction (Schwartz, &

Benowitz, 2010)

Primary Cause 2: Perception that long-term health consequences are irrelevant now

o Unable to perceive intangible long-term consequences

o "the long-term effects of smoking are not always immediately apparent to a young
smoker"6 (Lai, 2017)

Solution 1: Mentoring and Therapy with I Quit Campaign Volunteers

Volunteers from the I Quit programme (experienced in cessation) will have weekly
meetings at their respective schools (mentors continually monitor progress of smokers +
convenient location for offenders)

Mentors will have daily phone-call sessions with flagged underage smokers

o offers accessibility and convenience to smokers (Stead, 2006) mentors can keep
track with daily journey to prevent relapses

o collaboration with HSA7 & SPF8 to work with underage smokers

Volunteers will aid in rehabilitation by enhancing motivation (directly addresses primary cause
1) and teaching smokers to identify and manage nicotine withdrawal symptoms based on
their own experiences (volunteers can give primary first-hand information)

6 Quoted by Dr Abraham, Sata CommHealth chief executive in (Lai, 2017)

7 Health Sciences Authority
8 Singapore Police Force
Word Count: 500 without in-text citations, symbols, citations, diagram illustrations and this sentence.

Solution 2: Save-Face App

HPB-designed app (collaborative effort with HPB) will depict the effects of smoking on your
facial appearance

o Impactful as youth are concerned about their appearance

Students will be able to juxtapose their own faces onto the characters.

o customization for individual student

o consequences of smoking become tangible and real = large impact

Students will be introduced to this app during a mandatory HPB assembly.

o Appeal to youth through new media

o Increased app
outreach

Example of App
Interface:

Brittle Hair

Paper-like Skin

Eye Bags

Wrinkles

Breath Odour,
Plaque,
Discoloured
Teeth

Acne
YOUR FACE AFTER SMOKING
Psoriasis
QUIT SMOKING NOW!
Word Count: 500 without in-text citations, symbols, citations, diagram illustrations and this sentence.

Limitations Solution to Limitations

Solutions do not interdict youth access to
cigarettes.
Limited interest in Save-Face
Application/mentorship sessions
Lack of experience amongst I-Quit Volunteers
Solutions will complement current legislation and
programmes
Advertisement campaigns + youth challenges +
Instagram features -> increase appeal to youth
Mentorship training by HPB

Citations:
1. Balogh, K. N., Mayes, L. C., & Potenza, M. N. (2013). Risk-taking and decision-making
in youth: Relationships to addiction vulnerability. Journal of behavioral addictions, 2(1),
1-9.
2. LAI, L. (2017). Curbing teen smoking 'must go beyond raising minimum age'. The
Straits Times. Retrieved 26 March 2017, from
http://www.straitstimes.com/singapore/health/curbing-teen-smoking-must-go-
beyond-raising-minimum-age
3. Ministry of Health. World No Tobacco Day Information Paper. (2017). 1st ed. [ebook]
Singapore: National Registry of Diseases Office, p.1. Available at:
https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/nrdo-
wntd-info-paper-2015.pdf?sfvrsn=0 [Accessed 26 Mar. 2017].
4. Pei Shan, H., & Pearl, L. (2017). More students caught smoking; schools install
detection devices. The Straits Times. Retrieved 21 March 2017, from
http://www.straitstimes.com/singapore/health/more-students-caught-smoking-
schools-install-detection-devices
5. Quah, E., Tan, K. C., Saw, S. L. C., & Yong, J. S. (2002). The social cost of smoking in
Singapore. Singapore Med J, 43(7), 340-344.
6. Substance Abuse and Mental Health Services Administration (SAMHSA), HHS, Results
from the 2015 National Survey on Drug Use and Health, NSDUH: Detailed Tables,
2016. http://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-
2015/NSDUH-DetTabs-2015/NSDUHDetTabs-2015.pdf.
7. Schwartz, R., & Benowitz, N. (2010). Nicotine Addiction. National Center for
Biotechnology Information. Retrieved 26 March 2017, from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928221/
8. Stead, L. F., Perera, R., & Lancaster, T. (2006). Telephone counselling for smoking
cessation. The Cochrane Library.
9. WHO | Health effects of smoking among young people. (2017). Who.int. Retrieved 25
March 2017, from http://www.who.int/tobacco/research/youth/health_effects/en/