Next stage in battle to stub out smoking

HPB looking at steps such as raising age limits, more stringent rules for cigarette packaging

In Australia, cigarettes come in drab brown packages. Their sides are plastered with pictures warning of the dire consequences of smoking, and one can barely make out the brand.

And in Brazil, all flavoured tobacco - from cherry to chocolate and even the ubiquitous menthol - has been banned since 2012.

As Singapore mulls over ways to bring down smoking rates, it is looking at these countries that have gone full steam ahead with efforts to stop people from lighting up.

"The concern really is that the (smoking) prevalence now is plateauing," said Ms Vasuki Utravathy, who is the deputy director of the Health Promotion Board's (HPB) strategic planning and collaborations department.

Two years ago, the board announced that it was aiming to get smoking rates down to 12 per cent by 2020.

But that is easier said than done. "We know that for the past six or seven years, the smoking rate has always been between 13 per cent and 14 per cent," Ms Vasuki said.


The Health Promotion Board has mooted four proposals for public discussion, including banning additives in tobacco products. ST PHOTO: KUA CHEE SIONG

Last December, HPB mooted four tobacco control proposals for public discussion.

AGE MAKES A DIFFERENCE

We know that people who do not start smoking before the age of 21 are unlikely to ever begin... The younger children are when they first start smoking, the more likely they are to become regular smokers.

PROFESSOR LEE HIN PENG, from the Saw Swee Hock School of Public Health, citing a 2008 World Health Organisation report.

Two are "hard" measures: raising the minimum legal age for smoking, and, like Brazil, banning additives in tobacco products.

The two other proposals aim to reduce the appeal of cigarettes by selling them in generic packages and enlarging the graphic health warnings on their packaging.

Last Friday, Senior Minister of State for Health Amy Khor held an online chat about the issue, during which some people suggested banning smoking for those born after a certain year.

One supporter of the proposal to raise the minimum smoking age is former smoker Tan Ho Guan, 33, who is self-employed.

He picked up the habit at 18, but managed to quit for good last year after many unsuccessful attempts. The birth of his second child was the driving factor. Still, he said, it would have been better if he had never started at all.

"I was young, and all my friends around me were smoking," he said. "If you weren't doing it, you were the odd one out."

Mr Tan added that he believes young people are less susceptible to peer pressure at 21 - the proposed new minimum smoking age - and, therefore, less likely to pick up smoking. "Your thinking between 18 and 21 becomes very different," he said. "I believe that many smokers want to quit, but if you don't start, you won't have that problem."

There is solid scientific evidence to back this, said Professor Lee Hin Peng from the Saw Swee Hock School of Public Health at the National University of Singapore.

Citing a World Health Organisation report from 2008, he said: "We know that people who do not start smoking before the age of 21 are unlikely to ever begin. The younger children are when they first start smoking, the more likely they are to become regular smokers."

A town called Needham, in Massachusetts in the United States, raised the minimum age for buying tobacco from 18 to 21 over three years. Teen smoking rates subsequently fell by half, from 13 per cent to 7 per cent.

Both the US and European Union have also passed laws that ban the addition of flavours to tobacco - the EU as recently as in 2014.

Typically, unadulterated cigarette smoke irritates the throat, and can turn younger smokers off.

Ms Vasuki said: "If you talk to anybody who has had their first puff, they will say something like: 'I started off with a Marlboro Red and I coughed - I couldn't take it because it was very harsh on my throat.'"

But cigarettes laced with the flavours of vanilla, chocolate and menthol go down more easily, making it easier for the first-time smoker to get hooked.

These sweet flavours tend to be especially popular among younger smokers and women, Ms Vasuki said, although smokers in Singapore are typically male.

She added that such flavours often mislead people into thinking they are not as bad as regular cigarettes.

"When things are easier to smoke, the tendency is to think that this cannot be as harmful as anything else," she said.

In many countries, generic packaging and gory pictures are designed to make cigarette packets as nondescript or unappealing as possible.

Australia was the first country to implement plain packaging in 2012, after which calls to Quitline - its phone service for people who want to kick the habit - increased by 78 per cent.

Its graphic health warnings are also the second-largest in the world - after Thailand - and cover three-quarters of the front and nearly all of the back of the packaging.

Apart from alerting smokers to the possible impact on their health, larger warnings also mean less space for company logos and other marketing gimmicks, Ms Vasuki said.

In Singapore, these graphic pictures, which have been printed on cigarette packets since 2004, are rotated every few years, so that they do not lose their impact.

If standardised packaging is also implemented here, all tobacco companies would have to repackage their cigarettes uniformly, with different brands adopting the same colours.

Dr Jimmy Wong, who is a senior lecturer in the marketing programme at SIM University, said the impact of such measures in Singapore could be limited as smokers tend to disregard the packaging. "In perceptual studies, humans are very capable of blocking out images they do not want to see," he said.

And, sometimes, smoking is associated with attractive lifestyles. Then, no amount of graphic pictures on cigarette boxes can reduce smoking among the young, he said.

But Ms Vasuki said the measures are not just to deter those who are already smokers, but also to stop people from picking up the habit in the first place.

"Such things reduce the attractiveness and appeal of tobacco products - both to the consumers and to the people who may be thinking of experimenting," she said.

A version of this article appeared in the print edition of The Straits Times on March 08, 2016, with the headline 'Next stage in battle to stub out smoking'. Print Edition | Subscribe