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In this Explainer, find out...
How severe is the issue of smoking in Singapore today?
What are the general approaches used to inuence positive behaviours?
How have these approaches been applied to Singapore’s anti-smoking policies?
Introduction
It is obvious that smoking is bad for us. After all, the secret to happiness and health is “no cigarette”. There is a lot of scientific evidence proving that smoking is harmful to our health. Yet there are still some Singaporeans who smoke. To reduce this number, the Government has been taking action through anti-smoking policies. This set of policies aims to prevent non-smokers from picking up smoking in the first place while encouraging smokers to quit smoking.
Smoking has many negative health effects for non-smokers, including an increased risk for heart and lung disease.¹ However, smoking does not just affect smokers themselves because of the negative externalities of smoking, such as the impact of second-hand smoke. Non-smokers who breathe in large amounts of second-hand smoke can suffer similar outcomes as smokers.² Family members of smokers who suffer from illnesses due to smoking also have to deal with the financial cost of paying for medical bills and the loss of income from being unable to work.
Smoking Trends in Singapore
The rate of smoking in Singapore has decreased over time, with a decrease in daily smoking rate from 13.3% to 10.4% from 2007 to 2021 (see Figure 1).³ However, this is still a high number, and the Government is still working on reducing this number to zero.
Figure 1: Daily Smoking Rate by Gender from 2007 to 2021⁴
Carrots, Sticks and Information
Anti-smoking policy is a game of trying to help Singaporeans behave in the “correct way” and avoid smoking. This may seem complicated but the core concept is something we have all experienced before. Think about when your mother wants to make you do your homework (elicit a behaviour change). There are generally two approaches to this.
First, your mother can promise to reward you upon doing your homework. She can offer to buy you ice cream or bring you out to a movie if you finish it. These types of policies that dispense rewards for doing the “right action” are called “Carrots”.
Second, your mother can threaten you with punishment. Whether it is with a caning or by taking away your favourite toys, your mother can make “not doing your homework” painful for you, so you choose to do your homework to avoid punishment. These types of policies that dispense punishments or penalties are called “Sticks”.
The “Information” approach is an alternative approach. This is where your mother talks sense into you by giving you clear information about the consequences of your actions. By telling you that you can get into your dream school if you always do your homework, you are given information about the benefits or costs of your actions. With this information, you are more likely to make the right choice.
In the context of anti-smoking policies, the Government can choose to have “carrots” that reward people for quitting smoking, “sticks” that punish people who do smoke, or “information” that guides people to make the right choices. With a combination of these, the Government can help encourage Singaporeans to avoid smoking.
Anti-Smoking Policies
“Carrots” to Encourage Quitting
The following anti-smoking policies are “carrots”, where various incentives are used to drive abstinence from tobacco.
I Quit Programme
The I Quit Programme aims to help people quit smoking by breaking it into small, doable steps.⁵ There are three progressive stages to the Health Promotion Board (HPB)’s intervention programme:⁶
Triage survey: The survey evaluates a smoker’s extent of nicotine dependence and personal preferences.
Personalised 28-day quitting journey: Support includes phone counselling via QuitLine, and a face-to-face counselling programme at local pharmacies (see Figure 2).
Follow up: QuitLine checks in with a monthly call for 6 months to prevent relapse.
Participants can redeem an HPB eVoucher worth S$50 after 28 days of staying on the smoke-free programme (end of stage two) and more eVouchers worth S$30 and S$20 after 3 months and 6 months respectively.⁷ The vouchers can be used with partnered brands, such as Liho, Fairprice, and Guardian.⁸
This programme offers positive reinforcements to encourage individuals to actively engage in and persist with the quitting journey, thereby promoting healthier behaviours via incentives (i.e., carrots).
Figure 2: Location of Face-to-Face Counselling Services (click on the image to access the interactive dashboard)⁹
Food Incentives
Food-based incentives have also been used to encourage Singaporeans to quit smoking. In 2019, HPB partnered with 22 mosques to set up “Puff for a puff” booths where smokers could give up “puffing on a cigarette” by surrendering a box, in exchange for a curry puff.¹⁰ In 2023, embracing a ground-up spirit, a hawker chain in Singapore decided to contribute to anti-smoking efforts in a similar fashion. For a limited time, smokers could visit any of the OK Chicken Rice or HumFull Prawn Laksa hawker stalls, and receive 10 vouchers worth S$30 for pledging to quit nicotine.¹¹ These incentives target Singaporeans' love for food, cleverly using the allure of a local favourite to encourage smokers to kick the habit.
“Sticks” to Discourage Smoking
Anti-smoking policies may also take the form of “sticks”, using the threat of punishment to discourage the undesirable habit of smoking.
No Smoking in Public Places
The Smoking (Prohibition in Certain Places) Act bans smoking in public places (e.g., public transport, food establishments, schools).¹² This law has been gradually expanded to include more public spaces (see Figure 3).
Figure 3: Expansion of Smoking Ban Over Time¹³
Those who flout this law may face a composition fine of S$200 (or a fine of up to S$1,000 if one fails to comply with the initial S$200 fine).¹⁴ By limiting legal areas for smoking, the exposure of the public to second-hand smoke is reduced. Furthermore, such measures hope to promote a smoke-free lifestyle in Singapore.¹⁵
Minimum Legal Age for Tobacco
Besides placing restrictions on smoking areas, the Government has also imposed a Minimum Legal Age of 21 years for tobacco. Those under the minimum age may not possess, sell or supply tobacco.¹⁶ It aims to deter young individuals from picking up smoking by restricting access to tobacco products and stigmatising smoking.¹⁷ Those who violate the law face hefty fines (see Figure 4).
Figure 4: Violation and Penalties for Stakeholders¹⁸
Tax on Tobacco
Many countries around the world, Singapore included, impose a tax on tobacco. In 2023, the Government raised taxes on all tobacco products by 15%. This means buyers will have to pay 49.1 cents for every cigarette, up from the previous tax of 42.7 cents per stick.¹⁹ The higher prices serve as a “stick”, by making cigarettes less affordable. This effect is particularly pronounced among those with less money, such as young people, as they may find it more challenging to sustain the habit due to increased costs.²⁰
Information-Related Measures to Influence Public Perspective
The following anti-smoking policies are neither carrots nor sticks, but wield “information” as a tool to shape public awareness and attitudes towards smoking.
Tobacco (Control of Advertisements and Sale) Act
Under the Tobacco (Control of Advertisements and Sale) Act established in 1993, Singapore prohibits any promotions (e.g., gifts, media advertisements) relating to tobacco products.²¹ Furthermore, in 2020, the Standardised Packaging measure was implemented. Since then, all tobacco products have been required to adhere to standardised packaging (e.g., no logos, colours, images, promotional information) and enlarged graphic health warnings (at least 75% of the surface)²² (see Figure 5). This policy aims to minimise misleading information about the consequences of smoking (e.g., misrepresenting relative harm associated with different brands) and emphasise the risk of tobacco use.²³
Figure 5: Required Design for Tobacco Product Packaging²⁴
Educating Youths on Harmful Effects
HPB works closely with the Ministry of Education (MOE) to incorporate anti-tobacco education in the curriculum. In upper primary Physical Education, students learn about the negative impacts on their fitness and stamina as well as laws concerning smoking. Meanwhile, secondary Science classes delve into specific substances in tobacco smoke and their effects on various bodily systems. Character and Citizenship Education also shares strategies for self-control and managing peer pressure.²⁵ This instils an understanding of the physical, mental, and societal consequences of smoking from an early age.
Recently, there has been an uptick in underage vaping, as vapes are more accessible (cheaper), easily concealable, and attractive (colourful and flavoured).²⁶ In response, HPB has begun working with MOE to step up anti-vaping messaging in schools.²⁷
The Effectiveness of Anti-Smoking Policies
As discussed earlier, the number of smokers in Singapore is gradually decreasing. This directly shows that anti-smoking measures help reduce the overall number of smokers.
While these measures have proven effective, the Government cannot declare victory just yet. Tweaks to anti-smoking policies are still needed periodically, in response to the changing profile of smokers who respond to different policies in different ways. One important nuance to consider is the careful balance of using “carrots”, “sticks”, and “information” to achieve the best outcome. While evidence suggests that punishments are the most effective approach to encouraging smokers to quit, there are problems with pure reliance on punishments.²⁸
Problems with a “Pure Sticks” Approach
Recalling the example of your mother threatening you with punishments for not doing your homework, we can see that there are problems if punishments are the only approach used to encourage behaviours.
Let us consider the case where your mother stops giving you ice cream if you do not complete your homework. This may be punishing, but what if you happen to have enough pocket money to buy ice cream without having to rely on your mother? Then you are not likely to complete your homework because the punishment loses its effect.
Consider another case. What if you did not have pocket money but could not complete your homework for whatever reason (maybe it was too difficult)? As a person who loves ice cream but now does not have any way to access it, you are more likely to want to steal that ice cream or find some other bad way to get ice cream for a lower price.
This is precisely the effect that increasing taxes has on smoking if it is the only action done. Rich people do not care if the price of cigarettes increases because the price increase is too small of a punishment to matter to them. Whereas those who do not have the means to pay are unable to afford the price of cigarettes and suffer. They may also turn to illegal means of finding cigarettes if they are desperate to smoke. These actions can come in the form of stealing cigarettes, importing duty-unpaid cigarettes at cheaper prices, or buying cigarettes from improper sources which may contain dangerous ingredients.²⁹
This runs into dangerous territory where anti-smoking policies discriminate against smokers based on their wealth. It should not be the case that anti-smoking policies barely affect the rich, but greatly harm the poor to the point where they are forced to consider breaking the law.
A fully “stick”-based approach is thus not the ideal for crafting anti-smoking policies. Instead, “information” approaches need to be used to first make smokers aware that smoking is harmful to them and that quitting is possible. We also know that quitting smoking is difficult and requires a lot of mental effort, so “carrots” need to be used to reward smokers on their quitting journey.³⁰ This will ensure that smokers feel encouraged and are motivated to quit smoking throughout the painful quitting process.
Conclusion
Singapore’s strong stance against smoking has seen success and lends us confidence in a tobacco-free future one day. However, both the Government and community are aware that the true essence lies in individuals willingly deciding to quit smoking. It is a matter of personal choice and a journey of determination rather than mere compliance with legal requirements. Thus it will require not only political will but also public consensus to further reduce smoking in Singapore.
This Policy Explainer was written by members of MAJU. MAJU is an independent, youth-led organisation that focuses on engaging Singaporean youths in a long-term research process to guide them in jointly formulating policy ideas of their own.
By sharing our unique youth perspectives, MAJU hopes to contribute to the policymaking discourse and future of Singapore.
"At the same time, our PEs aim to spotlight innovative policies from other countries and consider how such policies may be applied in the Singapore context. " Why no discussion about other countries here? New Zealand is banning smoking for the next generation entirely. How about that?
"While these measures have proven effective, the Government cannot declare victory just yet." Are you concluding "proven effective" based on Figure 1?? Does Figure 1 consider vaping? I do not think the Government is very effective with managing smoking ya...