Rohith Srinivas (18S03G)

Project Work Preliminary Idea

2017 A Level Project Work Task 2: Investment

Investment in youth tobacco control Dealing with the prevalence of smoking amongst 18 21-year-
olds in Singapore

Smoking in Singapore
Percentage of adult smokers plateaued to 13.3% in 2013 (Bee Wah, 2013)
o Effective cessation campaigns: NTCC1 (HPB2)
o Effective anti-tobacco legislature: TCASA3
o Effective anti-tobacco health education (HPB)
YET
Increased smoking prevalence: Age Group 18 to 21, from 12.3% in 2004 to 16.3% in 2010 (NHS4,
2010)

MOH: 45 % of regular tobacco use in Singapore established between 18-21 years-of-age (Hui, 2017)

Choice of Topic: Impacts -

Individual

o High morbidity rate and health risks5

o Reduction of individual disposable income6

Society/Economy

o Increased costs from healthcare and productivity loss7

o Increased health risks from second-hand smoke

Target Group
Target group: 18 to 21 years-old existing smokers
(WHO, 2008): If regular tobacco use is not established between 18 to 21 -> unlikely to continue in
later years

Legal enforcement: ineffective deterrent for smoking (Balogh, 2013)

o Current methods are ineffective -> new approaches needed

1 National Tobacco Control Campaign: Joint anti-tobacco campaign by HPB and Ogilvy & Mathers that achieved 3 times
international success rate amongst smoking adults in Singapore
2 Health Promotion Board
3 Tobacco Control of Advertisements and Sales Act: Prohibits point-of sale display of tobacco products, obligation to use
plain, undecorated storage devices for tobacco products within their premises
4 National Health Survey
5 Smokers are prone to higher risk of lung cancer, stroke, heart disease (WHO, 2017) and in Singapore, 2,500 smokers die
prematurely from smoking-related diseases yearly (MOH, 2013)
6 Average smoker spends around $5000 annually on cigarettes and over 2 million SGD over 40 years (Singsaver, 2017)
7 Smoking costs Singapore $700 million - $800 million a year for healthcare, absenteeism and loss of productivity
(Naganathan, 2013)
Target Group Traits

Trait 1: Comfortable seeking adult guidance (Stewart, 2013)

Trait 2: Rationalize new adult responsibilities with understanding of long-term goals (Stewart, 2013)
(Bowman, 2001)

Underlying Causes
Primary Cause 1: Smokers unable to overcome nicotine addiction and quit smoking
o (SAMHSA, 2016): Adolescents highly vulnerable to nicotine addiction

o (NIDA, 2012): Smokers use tobacco regularly -> addicted to nicotine, need support to quit
smoking

Primary Cause 2: Smokers underestimate extent of long-term consequences of tobacco use

o (Lai, 2017): Adolescents often misjudge "the long-term effects of smoking
o (Slovic, 2001) Young adults underestimate their personal health and financial risks from
smoking
Approaches:
Approach 1: Help TG overcome nicotine addiction

o Specifically, establishing strong support groups for quitting

(Schwartz, & Benowitz, 2010): Adolescents more likely to overcome nicotine

addiction with support groups

Approach 2: Change TGs mindset about severity of long-term consequences of smoking

o Specifically, change mindset about financial consequences

Health risks covered extensively in HPB health education programmes -> Gap in
measure: non-health consequences are neglected

Project Objective: Reduce the prevalence of smoking amongst local 18-21-year-old youth through cessation
assistance and education about long-term financial consequences of smoking

Solution 1: SG Anti-Smoking YSG8 (Approach 1)

Anonymous support groups (anonymity = smokers open up) open to all 18-21 years-old smokers

Weekly meetings: Volunteers from I Quit programme (experienced in quitting) will have weekly
meetings (mentors monitor smokers progress weekly)

o Held at tertiary institutions JCs, polytechnics, ITE campuses (large outreach to target group)

Buddy System: Participants choose a buddy from the group to stay accountable

o Participate together in sport of their choice (reduces time spent alone smokers wont
smoke out of loneliness, boredom + buddy keeps check)

8 Youth Support Group

 Innovative Aspect: Participants start a daily log with hashtag unique to support group (keep track of
impulses to smoke and daily feelings)

o Medium: Instagram (Widely used by young adults = large outreach)

o Logs shared using hashtag #28daystofreedom to inspire others (Ceasing smoking for 28 days
will trigger successful quitting)

Volunteers will teach smokers to manage nicotine withdrawal symptoms based on their own
experiences (volunteers have first-hand information)

Solution 2: Quit Smoking: Save your Wallet App (Approach 2)

HPB and MOF- designed app (collaborative effort with HPB) will depict consequences of smoking on
your finances

o Impactful as maintaining finances is important to young adults who are gaining

independence and will start employment and getting paid

Outreach: App introduction in local tertiary institutions &NTCC (well-known public campaign = large
outreach)

Custom: Users input salaries/allowances, health, tobacco consumption information

o App can forecast future costs based on government statistics on the cost of smoking as well
as potential medical and insurance costs (e.g. SingSaver Data)
Example of App
Interface:

App calculates cost of smoking

for any timeperiod

App forecasts future insurance

and healthcare costs of
smoking (based on user
submitted health data)

App acts as an accounting

mechanism to allow smokers
to keep track of money spent
buying cigarettes
Limitations Solution to Limitations
Limited interest in application/support group Advertisements on media platforms/campaigns

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. Bee Wah, L. (2013). Increase in Smoking Prevalence | Ministry of Health. Moh.gov.sg.

Retrieved 23 April 2017, from
https://www.moh.gov.sg/content/moh_web/home/pressRoom/Parliamentary_QA/2013/inc
rease-in-smoking-pravalence.html

3. Bowman, S. (2001). Middle Childhood and Adolescent Development. Corvallis, OR: Oregon
State University Extension Service.

4. HUI, P. (2017). Raising minimum legal age for smoking: Making it harder for youth to light
up. The Straits Times. Retrieved 10 April 2017, from
http://www.straitstimes.com/singapore/health/raising-minimum-legal-age-for-smoking-
making-it-harder-for-youth-to-light-up

5. Janelle, S. (2013). 18- to 19-year-olds: Ages and stages of youth development. MSU
Extension. Retrieved 23 April 2017, from
http://msue.anr.msu.edu/news/18_to_19_year_olds_ages_and_stages_of_youth_developm
ent

6. 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

7. 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].
8. National Health Survey 2010. (2010) (1st ed., pp. 32 - 35). Singapore. Retrieved from
https://www.moh.gov.sg/content/dam/moh_web/Publications/Reports/2011/NHS2010%20-
%20low%20res.pdf

9. NIDA: (2012). Is Nicotine Addictive?. Drugabuse.gov. Retrieved 23 April 2017, from

https://www.drugabuse.gov/publications/research-reports/tobacco/nicotine-addictive

10. 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.

11. Slovic, P. (2001). Smoking (1st ed.). Thousand Oaks, CA: Sage Publications.

12. 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.

13. 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/

14. Stead, L. F., Perera, R., & Lancaster, T. (2006). Telephone counselling for smoking
cessation. The Cochrane Library.

15. 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/