The Ministry of Health will be issuing a simple five-steps plan to provide healthcare personnel a new working tool to help smokers to quit smoking. With the 5As Approach - ASK, ADVISE, ASSESS, ASSIST AND ARRANGE, doctors and other healthcare providers such as dentists, nurses, psychologists and pharmacists can now hope to score greater successes with smokers. The clinical practice guidelines were formulated by a workgroup comprising primary care doctors, health educators, specialists and a clinical psychologist.

This set of guidelines highlights effective treatments that can produce long term or even permanent abstinence from smoking. A first in Singapore, the 5As approach consists of readily applicable steps, which a healthcare practitioner can follow, in assisting a smoker to quit smoking. The steps include

• Ask - Ask and identify the tobacco use of the patient
• Advise - Advise the patient in a strong and personalised manner to quit
• Assess - Determine the patient’s stage of readiness to change
• Assist - Assist the patient using motivational intervention and coming up with a quit plan.
• Arrange - Arrange for follow up visits.

Smoking is the most important preventable cause of ill health and death in Singapore and all over the world. Smoking is the common, key risk factor for three leading causes of death in Singapore – Cancer, Heart Disease & Stroke which together account for close to two-thirds (62.5%) of all deaths in 2000. Smoking is also a major risk factor for chronic obstructive lung disease. The World Health Organisation (WHO) has identified cigarette smoking as the single most avoidable cause of death. On a global scale, tobacco was estimated by the WHO in the 1990s to kill one person every 10 seconds.

The National Health Surveillance System (NHSS) Survey conducted by MOH in 2001 showed that 14% of Singaporeans adults aged 18 to 64 were daily smokers. The NHSS 2001 also revealed that more men than women were daily smokers, with 24% of men and 4% of women being daily smokers. The daily smoking habit was also found to be most prevalent among Malays, at 23%, followed by the Chinese at 13% and Indians at 9%. Overall, the statistics for NHSS ’01 shows a one-percentage point decrease in smoking prevalence among Singaporeans from 1998. However, the prevalence for smoking among women has inched upwards by 0.4 percentage point. There were more female smokers in the age group 18-24 in 2001 than in 1998. Please refer to Annex A for the figures on the prevalence of daily smoking by gender, ethnic group and age.

Daily smoking was most prevalent in the age group 18-24 years. The most common reasons cited by this group of young daily smokers were to feel relaxed, to relieve stress or as a way of coping with problems. They also cited that it would be unbearable if they did not smoke and smoking is enjoyable and allows them to impress colleagues and friends.

Healthcare practitioners can play an extremely important role in helping their patients who are smokers to quit smoking. Intervention in the form of provision of brief advise by healthcare practitioners results in a 2% cessation rate at 6 or more months, and increases to 8% if this were combined with intensive and pharmacological support.

Smokers at any age will find it beneficial to stop smoking as the health benefits increase with the period of smoking cessation. In particular, the risk of lung cancer is reduced significantly by 50-70% after 10 years of abstinence from smoking.

The Clinical Practice Guidelines on Smoking Cessation will be formally launched by Prof Tan Chorh Chuan, Director of Medical Services, Ministry of Health on 24 May 2002 at the Fullerton Hotel. Please refer to the media invite issued by the Health Promotion Board on 22 May 2002 for further details of the event.

MINISTRY OF HEALTH

23 MAY 2002

For media queries, please contact:

Ms Sathya Bama

Ministry of Health

Tel: 6325 9066

Fax: 6325 1686

Source: National Health Surveillance System Survey 2001