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To help smokers kick their habit, what will be more effective?
 WHICH would have a greater impact on a smoker? A toddler reaching out to touch his mother’s face as she exhales cigarette smoke with the words “Tobacco smoke can harm your children”? Or, a graphic image of a person’s cheek ravaged by cancer?
Singapore uses the latter, but the US Food and Drug Administration (FDA) feels that emotional-laden images that convey the risk of second-hand smoke for babies and children may have more impact. So, last month, it proposed that tobacco companies be required to display such health warnings targeting the risk of second-hand smoke to the family, especially children, on cigarette packs and advertisements. Ten out of its 36 proposed images feature children. For the last 26 years, the warnings have come only in the form of statements which the FDA said was ineffective.
Gory
 Since August 2004, Singapore’s Health Promotion Board (HPB) has been using graphic warning labels of gory images. According to a HPB survey done between November and December in the same year, the images made an impact on smokers. (See report below.) No other such survey has been done by HPB since then.
So would emotional images like those proposed by the US FDA be more effective in getting smokers here to kick the habit? Yes, said two experts The New Paper spoke to. Dr Ong Kian Chung, president of the Chronic Obstructive Pulmonary Disease Association, believes that the impact of gory images would wear off on smokers over time. “At first, they may be scared. But after buying a second or third time, they may start to ignore the pictures,” Dr Ong, who runs his own chest clinic, explained.
In 2004, The New Paper reported that some smokers ripped the pictures off the box. Others simply transferred their cigarettes to be stored in other containers. The existing set of images also depict the long-term effects of smoking. Dr Ong said he has come across many smokers who think they would never become that ill. “The present graphic images attempt to discourage smoking with sensibility. With addiction, there is no sensibility,” he added.
Associate Professor Seshan Ramaswami, a marketing lecturer at Singapore Management University’s School of Business, agreed. If anything, the gory images may worsen the problem, he said. “At best, they serve to be a powerful reminder (of the health risks)... At worst, it may make smokers more anxious and even more prone to smoking,” he said.
A 2007 survey commissioned by Pfizer revealed that 30 per cent of smokers in Singapore surveyed would quit for their children. Two parents we spoke to said their children were the reasons they stubbed it out. (See report below.) But, Dr Ong said, he has come across many smokers who do not, despite having newborn children. So using emotional images may be one way to motivate them to.
A recent Straits Times report said 14.3 per cent of the adults here now smoke daily, up from 12.6 per cent six years ago. The situation is worse among youths (aged 18 to 29) with 16.3 per cent of them smoking daily compared with 12.3 per cent in 2004. Still, Prof Ramaswami said the message targeting the risks to the family may be misconstrued by smokers. He explained: “(People might) get the message that smoking is okay as long as it is not around kids.”
HPB chief executive Lam Pin Woon told The New Paper in an e-mail reply that it would consider the merits of the US FDA warnings to ascertain if they are effective for the local context. “It is important to note that smokers have different motivation for smoking or quitting and these have to be taken into consideration in the choice of our graphic warnings,” he said.
“These warnings are just one aspect of holistic tobacco control and HPB has different strategies and programmes such as legislation, taxation and counselling to help smokers quit the habit.” Australia, Brazil and the UK are some countries that have used or are using both emotional and gory images on their cigarette packs.
Determination is most important factor: Ex-smoker
FOR nine years, she smoked half a pack of cigarettes every day. But when Ms Amanda Xie, 26, found out that she was pregnant, she quit immediately. She gave birth to her daughter in 2006. The housewife said she knew that smoking during pregnancy may cause brain damage and deformities and feared that her child would be born with these conditions.
“I did not want to affect my child’s health, so I stopped the minute I could,” she said. She added that quitting wasn’t hard as she had put her mind to it. “Determination is the most important factor. Otherwise, they can print whatever image they want on the cigarette pack and it won’t work,” she said. She said she has not picked up a cigarette since.
“I don’t want to lose the right to tell my daughter not to smoke when she grows up,” she said. Like Ms Xie, Mr Mohamed Said Sahari, 57, a retiree, also gave up smoking for his family. A smoker for 40 years, he had initially refused to quit even though he suffered from frequent asthma attacks and bad coughs in 2004. He continued to smoke 40 sticks of cigarettes a day, spending up to $400 a month. The former lorry driver soon realised that even walking was strenuous.
Lung disorder
Two years ago , he was diagnosed with chronic obstructive pulmonary disease, a lung disorder which blocks airflow and causes breathing difficulty. He was then warded in the intensive care unit for a week. The doctor told him he had only a 50 per cent chance of living, but he survived. His bills came up to more than $7,000. As he was not working then, his 32-year-olddaughter had to bear the financial burden. “That was when it hit me that I really needed to stop smoking... My daughter was suffering because of me,” said Mr Said.
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