Smoke gets in your eyes

Encouraging news from the Health Promotion Board (HPB):


Smokers heed graphic warnings on cigarette packs: HPB
By S Ramesh, Channel NewsAsia

SINGAPORE : Graphic warnings introduced on cigarette packaging since August 2004 seem to have had an effect on smokers, according to a survey by the Health Promotion Board.

Nearly half (47 percent) said they smoked less frequently after seeing the health warnings, while 57 percent said they became more concerned about the health effects of smoking.

The survey covered some 1,300 smokers and non-smokers from the ages of 18 and 69.

It was conducted between November and December 2004, a few months after the health warnings were introduced on cigarette packaging.

The survey also showed that the labels were effective in reinforcing health messages among smokers. Seventy-one percent said they knew more about the health effects of smoking as a result of the warnings, while a quarter said they were motivated by the warnings to quit smoking.

The warnings also helped kick-start the quitting process among smokers -- 28 percent said they smoked fewer cigarettes; 14 percent said they made it a point to avoid smoking in front of children; 12 percent said they avoided smoking in front of pregnant women; and 8 percent said they smoked less at home.

Among non-smokers, 46 percent said they had advised smokers to quit smoking after seeing the health warning labels; 17 percent of them were wives who had advised their husbands to quit smoking.

The Health Promotion Board said it was looking at introducing a new set of graphic health warnings by the end of the year.

(You can also see the text of the Press Release from HPB here.)


angry doc is all for public health measures to reduce smoking, but this report has brought a few questions to my mind.

I wonder why, if the survey was done almost 18 months ago, that they waited so long to release the findings.

The sample size of 1300 is not really very big, considering that Singapore has a population of 4 million, and 24.9% of men and 4.1% of women are smokers. The report does not state percentage of smokers in the 1300 persons interviewed, so it's hard to see how representative the survey is.

Also, being a survey, the study relied on responses from those interviewed rather than objective parameters - and in angry doc's experience every smoker he has had the privilege to know smokes 'very little', or has been 'cutting down', or 'has stopped smoking' (usually just prior to admission to the hospital or arrival at the clinic).

The report and the press release do not actually tell you how many smokers had managed to successfully quit smoking as a result of the graphic health warnings. Granted the survey may have been a once-off questionnaire, but as we all know quitting is a (long) process, and an indication of a desire to quit smoking may sometimes be just that - a desire. A follow-up survey would have provided more information.

More importantly, when conducting a health study, one should really keep the objective in mind. In this case, the real question should not be how people feel about the graphic warnings, but whether they do achieve their purpose of cutting down smoking-related illnesses through cutting down smoking.

Now since the ill-effects of smoking may not manifest themselves for many years, a good surrogate and a more accurate way to assess the effects would be simply to look at whether cigarette sales per capita has dropped since the introduction of the graphic warnings. Certainly there may be other factors influencing smoking patterns (such as the rise in price of cigarettes and the banning of smoking in certain public areas), but at the end of the day it's the end results we are interested in, isn't it?

( I am willing to bet, however, that the sales of cigarette cases have increased since the introduction of graphic warnings on cigarette packets.)

Still, I suppose the public likes to see a survey with lots of numbers and percentages.

More than pictures of diseased organs anyway.