It is no secret that smoking has profound public health implications across the globe. According to the World Health Organization, there are over one billion smokers in the world, with tobacco use being responsible for the deaths of around six million people a year. It is the only known product that can potentially cause up to half of its users to die prematurely, by an average of 15 years.1
To put an end to this infliction, many countries have put in place measures to control tobacco, such as taxation, advertising bans, public education and cessation programmes, and sales control. In Singapore, this is no different.
Singapore recently announced that the minimum legal age for smoking will be raised from 18 to 21. Countries such as the US, Malaysia and most recently, Thailand, have also made similar moves to raise their minimum legal age. With statistics showing that 95 per cent of smokers in Singapore had their first cigarette before the age of 21,2 increasing the legal age was done with the aim of reducing youths' exposure to tobacco products at a juncture in their lives when they are more susceptible to peer pressure and nicotine dependency.
While policy measures are useful in deterring one from picking up his/her first cigarette, focus also needs to be placed on helping those looking to quit the habit.
Supporting attempts to quit
In Singapore, the Health Promotion Board's (HPB) I Quit programme has been offering smokers a support network to help them quit smoking. By rallying a community of supporters, a boost of confidence is given to smokers to take the first step to quitting – taking a pledge to go smoke-free. The focus on building a support network is a shift from the scare tactics used in previous anti-smoking campaigns.
The first few weeks are generally the most difficult part of a smoker's quit journey. During this time, there is a constant struggle against the urge to slip back for another cigarette. The I Quit 28-Day Countdown programme helps to break down the process into daily actionable steps. This community-based but personalised approach has reaped success. According to HPB, more than 16,000 smokers signed up for the I Quit 28-Day Countdown programme in 2016. One in five smokers successfully stayed smoke-free over the 28-day period, which is a ten per cent increase from 2013.
The 28-day programme uses tools such as a countdown calendar that provides daily tips and encouragement, as well as a supporters' guide to assist the smokers in their quit journey. Several of my patients have successfully gotten through the first few weeks with these aids, which include daily motivational exercises, such as getting them to write down their reasons for wanting to quit and having family members organise activities together to distract them.
It also helps that I Quit offers several other support services. With the QuitLine service, daily SMS reminders providing tips and motivation, and a Facebook community club for smokers and ex-smokers to share advice and success stories, the quit journey can be made less daunting. HPB has also worked with the healthcare community to offer free advice at over 280 locations across Singapore so that smokers can access such support easily.
The role of GPs
I Quit is evidence that public education efforts can go a long way in reducing smoking rates in our nation. As GPs, we have an opportunity to play an active role to complement this effort.
GPs are often seen as a reliable and knowledgeable source of health information. We should leverage on our doctor-patient relationship to positively influence and educate our patients on the benefits of a smoke-free lifestyle. An example would be to incorporate smoking cessation advice as part of our consultation with patients.
I have met many smokers who want to quit but are often daunted by the process. I find it useful to get a thorough understanding of the smoker's profile and the motivation behind his/her reason for wanting to quit. This allows me to customise my smoking cessation advice and tips according to the challenges they face.
I recall a story of a 35-year-old patient who had tears in his eyes as he recounted how he found out that he had a large tongue ulcer two weeks prior. He consulted an ear, nose and throat specialist and had to do a biopsy as the ulcer was suspected to be cancerous. He decided to stop smoking because of the incident. However, he kept the incident from his wife as he did not want her to worry and because of this, he felt isolated and frustrated in the early days of his quit journey. I felt both encouraged and worried for him at the same time. I was encouraged because of his strong desire to quit, but worried that he might find it too difficult and give up. I drew up a quit plan with him, taking into account his motivation and social support. By assuring him that mood changes were common and that pharmacological agents are available to relieve his withdrawal symptoms, he felt more at ease and had a renewed determination to continue on his quit journey.
Quitting can be a great challenge for those who have been smoking for a long time. Studies have shown that it takes a smoker an average of six to seven attempts before they can successfully quit smoking, with many smokers citing a lack of motivation or self-confidence as reasons why they gave up their quit attempts.3
HealthQuay Medical, a holistic medical clinic, leverages on the I Quit programme to guide and support smokers who want to quit. Patients who are looking to start their quit journey are encouraged to sign up for the I Quit 28-Day Countdown by calling the QuitLine at 1800 438 2000.
The decision to stop smoking is a personal and difficult one. Smokers will need strong support from their loved ones and medical professionals, as well as public education programmes such as I Quit, to increase their chances of quitting.