Observing World No Tobacco Day – The SAF Experience

Clive Tan, Jonathan Pong, Tan Chiew Hoon

World No Tobacco Day (WNTD) is an international event established by the Member States of the World Health Organization (WHO) in 1988, and observed annually by countries, cities and organisations across the globe on 31 May. WHO has consistently stated that tobacco use is the largest cause of death and disease as it causes many types of cancers, as well as cardiovascular conditions, lung disease and other health problems. In Singapore, the Health Promotion Board and the Singapore Cancer Society plan their media campaigns to coincide with WNTD, with other organisations and government agencies running their own campaigns. The Singapore Armed Forces (SAF) has been observing WNTD for four consecutive years since 2018. The SAF continued to observe and commemorate WNTD amid the COVID-19 pandemic, leveraging on technology and the population's familiarity with virtual events in 2020 and 2021.

A platform for public messaging and advocacy

Smoking is an unhealthy lifestyle habit and a well-established risk factor for many disease conditions. This habit often starts young, and tends to be more prevalent in certain high-risk groups and vulnerable populations. Military forces around the world have traditionally been associated with high smoking rates, along with being an environment where smoking is associated with forging camaraderie among soldiers. One factor in the prevalence of smoking within the military is due to deliberate and aggressive tobacco marketing in the 20th century. For example, US military camps provided soldiers with tax-free cigarettes and tobacco products, which kept prices artificially low and made cigarettes more accessible to soldiers. Another factor is that of peer pressure on young soldiers of legal age to smoke during a susceptible period of their life where new habits (both good and bad) can form. It is thus important that the SAF helps to ensure our young men pick up the right life habits (such as a physically active lifestyle) and not unhealthy habits such as smoking.

The SAF has had several strict smoking regulations in place since the 1980s to control cigarette consumption in the military, and more have been added over the past decade. These include general disciplinary measures, such as disallowing smoking in public while in uniform, banning of smoking in SAF camps except in selected designated areas, and banning the sale of tobacco products on all SAF premises. In addition, some superiors at the unit level also set limits on the number of daily smoke breaks one is allowed and the number of cigarettes one can bring into camp. Additionally, to further support our servicemen going through smoking cessation, the SAF also established a network of Smoking Cessation Outreach (SCORE) Ambassadors in 2011, who help colleagues on their journey to quit smoking through peer motivation and support. Our medical centres also provide nicotine replacement therapy in the form of nicotine patches to suitable patients.

Last but not least, the WNTD commemorations provide advocacy on both internal and public platforms for smoking cessation within the SAF.

Ground-up initiatives and top-down leadership emphasis

In 2018, the SAF organised our first WNTD commemoration. It aimed to increase public awareness on the harmful and deadly effects of tobacco use and second-hand smoke exposure, discourage the use of tobacco among our people, and serve as a call to action for more emphasis on smoking cessation within the SAF. It was a ground-up initiative, coordinated by a small team at the SAF Medical Corps, and was marked by a series of voluntary, self-organised and independent events held in various military units and camps across Singapore. It was anchored by the cadre of SCORE Ambassadors and unit-level healthy lifestyle advocates, with support from their unit commanders.

It was important that this call to action was voluntary and provided a new platform to empower the units to take a stance against tobacco usage within their own command and camp. For that inaugural event, the team came up with the idea of a pledge towards being smoke-free as a way for us to assess how this idea would be received by our soldiers. Through the unit events and outreach by the SCORE Ambassadors, soldiers may pledge towards abstaining from smoking through an online platform. Innovative and unique WNTD memorabilia were given out to personnel who pledged. In 2018, it was a finger band that would symbolically restrict the wearer's ability to hold a cigarette, as a physical reminder to stay smoke-free. This was well received, and the team continued to distribute innovative and unique WNTD memorabilia each year. In 2019, refrigerator magnets with the theme "Don't Light Up" bearing the uniform colours of the Army, Navy and Air Force were given out. In 2020, during the COVID-19 pandemic, a total of 3,000 reusable face masks were given to servicemen who made the online pledge to be "smoke-free".

Both traditional media and social media platforms were used to enhance the reach of these information and outreach campaigns to the public, to garner support and raise awareness and engagement for our commemorations. This sends a strong signal to the public regarding our focus on smoking cessation within the SAF.

Over the years, this ground movement matured into an enterprise-level event that has been held annually. In 2018, it was encouraging that we had 12 units participating in this WNTD observance, and from 2019 to 2021, the number of participating units have increased to more than 25 each year. In 2020 and 2021, the WNTD event was expanded to a World No Tobacco Week to allow for a longer period of engagement using social media and messaging platforms, and time for our advocates to take actions such as closing of designated smoking points in these camps.

In terms of organisation, the theme for each WNTD is centrally planned, while the execution is decentralised. Suggestions, funds and educational materials are provided to units and event organisations, which also include recommendations to close designated smoking areas for the duration of the commemoration, and plans for workshops and lectures for soldiers to participate and learn about smoking cessation. Our leadership also supports these events through their participation and leadership messages, as seen in the excerpt of the Chief of Defence Force's message for World No Tobacco Day 2021.

A continuing effort

For us, WNTD has been a useful platform for generating awareness, advocacy and creating a ground movement for tobacco cessation efforts in a highly visible but unobtrusive manner. Motivating smokers to quit smoking remains challenging, and efforts to prevent young non-smokers from picking up the habit must continue to be emphasised. We encourage hospitals, polyclinics and other healthcare organisations in Singapore to also consider having their own commemorations for WNTD to help our population stay healthy and smoke-free, and we look forward to a vibrant WNTD on 31 May 2022.

Clive Tan is a public health physician. He has three children, and one of his biggest fears is that his children may pick up smoking, hence his strong advocacy and efforts in this space.

Jonathan Pong just graduated from medical school, and as a house officer, he can be found rushing through the hospital corridors typing down changes during rounds or up at night on call seeing patients. Medicine is so much more than he expected!

Tan Chiew Hoon is always found tinkering with healthcare engagement projects, be it a health promotion campaign or planning for the next one. In between, she chills with friends, movies and Netflix.