A recent study in Britain found that graphic warnings on cigarette packs do not deter young smokers. Singaporeans say they could have told the British that.
Nearly all of the 100 people polled by The Sunday Times last week were not surprised by the findings. Smokers said they were not put off by the gory images on cigarette packs, and non-smokers said they chose not to smoke for health reasons and not because of the sight of diseased body parts.
Graphic images first appeared on cigarette packs here in August 2004, making Singapore the third country in the world to have them after Canada and Brazil, said Mr Chris Cheah, deputy director of substance abuse at the Health Promotion Board (HPB). But the pictures of blackened teeth, diseased lungs and a stroke victim's clotted brain, among others, do little to scare off smokers, said those polled.
"The pictures don't scare me, I'm aware of what I'm getting myself into," said auditor Low Read Learn, 28, who has been smoking for a year.
The British study, done by Stirling University in Scotland and published by the Tobacco Control journal, found that graphic images introduced in 2008 had almost no effect on children aged between 11 and 16. One in 10 of those quizzed was a smoker, while the others were either non-smokers or children who had experimented with smoking.
The Sunday Times sought the views of smokers and non-smokers aged 18 to 60, both face-to-face and via social media.
Smokers and non-smokers alike felt the gory images did not work.
Some like Mr Ein Chang, even said they were desensitised to the pictures. "It just feels like another advertisement," said the architectural assistant who kicked his five-year smoking habit two weeks ago. "It becomes like a scare tactic and does not create any immediate emotional impact."
The 26-year-old added that his decision to quit smoking had nothing to do with the graphic images.
Non-smoker Koh Chiat Ying, 26, a senior executive, said: "The pictures are quite gross, but I don't smoke because it's unhealthy, and not because of the gory images."
Her view was echoed by Mr Shem Leong, who is unemployed. He said it was his family and what he learnt in school that were more decisive in keeping him off cigarettes. "The images just add to my belief that I shouldn't smoke," said the 24-year-old.
Psychologist Daniel Koh agreed, saying that it would take a lot more than nasty pictures on a pack to dissuade people from smoking: "The whole fear factor concept does not work. The more people see it, the less effective it will be."
Mr Cheah from the HPB said the images were changed from time to time to "maintain the effectiveness". The first revision was in 2006, while the second was in March this year, with six new gruesome images including a baby's face getting pierced by a hook.
A small handful of those polled, however, said they were moved by the images even though that was not enough to make them quit.
"The black organs and babies make me think twice," said technical officer Hussein Ishak, 55, who has been smoking about 15 cigarettes a day for the past 30 years. "I've been wanting to quit, but my willpower is not strong enough."
The National Health Survey in 2010 showed that Singapore has a smoking prevalence of 14.3 per cent, one of the lowest in the world, said Dr K. Vijaya, director of HPB's Youth Health Division.
Young adults aged 18 to 29 and adults aged 30 to 39 smoke the most, with a prevalence of 16.3 per cent and 16.4 per cent respectively.
The figure for the younger group aged 18 to 29 was markedly up from 12.3 per cent in 2004, when the graphic images were introduced.
A few of those polled felt that the only ways to discourage smoking were to raise tobacco taxes and give smokers even fewer smoking zones.
Some other ideas are in the air too.
A pilot project by the HPB and National Environment Agency is under way to make Nee Soon South in Yishun the first "100 per cent smoke-free" constituency.
The Health Ministry has also done a public consultation on whether to ban shops from displaying cigarettes. If that comes to pass, the gruesome images on cigarette packs would go out of sight.
Additional reporting by Walter Sim and Nur Asyiqin Mohamad Salleh