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World No Tobacco Day 2011 - Facts About Smoking and Tobacco Products

World No Tobacco Day (WNTD), observed around the world every year on May 31, commemorates a 24-hour period of abstinence from all forms of tobacco consumption across the globe.

In Singapore, smoking prevalence has been on the upward trend between 2007 to 2010. Epidemiological data shows that smoking is a contributory factor to lung cancer, heart disease and other diseases. Additionally, local data shows that there is a higher proportion of smokers amongst Acute Myocardial Infarction (AMI also known as heart attack) and cancer patients than in the general population. The gender profile of smokers among Singaporeans with AMI and cancer reflect the gender profile of smokers in the general population. In addition, there is a higher proportion of male smokers among Singaporeans with AMI and cancers.


World No Tobacco Day is observed around the world every year on May 31. It is meant to encourage a 24-hour period of abstinence from all forms of tobacco consumption across the world. Smoking is the most preventable cause of death. It is a global epidemic which kills up to half its users. In 2011, more than 5 million people will die from tobacco-related diseases such as cancers, heart attack, stroke, lung ailment of other diseases and by 2030 the projected death toll could rise to 8 million.



Smoking is addictive. Studies have shown that nicotine dependence develop soon after smoking initiation, before the onset of daily smoking. Occasional tobacco use can trigger nicotine dependence; adolescents develop symptoms of nicotine dependence within days to weeks from the onset of their occasional smoking. These symptoms escalate the frequency of tobacco use.i, ii, iii, iv, v
Smokers carry an additional risk of 10- to 20- folds of developing lung cancer compared to non-smokers (23 times for men and 13 times for women smokers)
The risk of developing coronary heart diseases is 2 to 4 times that of non-smokers.viii
Smoking also causes other diseases such as (list is not exhaustive) cancer(s) of the mouth, oral pharynx (throat), larynx (voice box), oesophagus, bladder, stomach, cervix, pancreas, kidney, leukemia, uterus, pneumonia, cataracts etc.viii, ix, x


Apart from cigarettes, there are other forms of tobacco products such as shisha (also known as water pipes, hookah, narghile), cigars, chewing tobacco and pipe smoking.xi, xii
Studies have shown that shisha contains similar harmful substances as cigarettes and could be as addictive as cigarettes.xiii The use of various forms of tobacco products such as shisha (hookah/ waterpipe/narghile), smokeless tobacco, rolled tobacco and others, is becoming more prevalent especially among the youths globally.
It has been found that as with cigarette smoking, shisha smoking is linked to lung and oral cancers, heart and other diseases.xiv


The smoking prevalence in the local general population in recent years is shown in the graphs below alongside the corresponding figures from the AMI and cancer registries. (Graphs 1 & 2)
The proportion of smokers in the general population has increased between 2007 and 2010. When categorised by gender, males had the highest smoking prevalence rate. A similar observation was found among people with AMI and cancers.
Among people with AMI and cancer, the proportion of smokers was found to be higher than the general population.


Several health benefits result from quitting smoking and the effects of quitting start from as early as 12 hours of quitting. However, quitting smoking is not easy. Upon reduction or cessation of smoking, smokers start to experience nicotine withdrawal symptoms within a few hours. These symptoms peak 24 to 48 hours after quitting smoking. A regular smoker could have nicotine or its by-products present in his/her body for 3 to 4 days after quitting. Withdrawal symptoms include tobacco craving, desire for sweets, increased coughing and impaired performance on tasks that require concentration. Most symptoms last of about a month, but hunger and craving can last 6 months or longer.

Benefits that can be reaped from quitting smoking are summarised in the timeline below:


The Health Promotion Board is the national coordinating agency for tobacco control in Singapore. The Board drives the National Tobacco Control Programme (NTCP) to reduce the smoking rates in Singapore. As part of its efforts to encourage smoking cessation and prevent smoking initiation, a multi-pronged approach is used including:

1) Public education
2) Provision of smoking cessation services/ support
3) Fiscal policies
4) Legislation
5) Partnerships


i. World Health Organization. Tobacco Free Initiative, World No Tobacco Day 2011

ii. World Health Organization. Media Centre. Tobacco Fact Sheet No339, February 2011.

iii. DiFranza, Joseph R., Judith A. Savageau, Kenneth Fletcher, Jeniifer O Loughlin, Judith K. Ockene, Ann D. McNeill, Jennifer Hazelton, Karen Friedman, Gretchen Dussault, Connie Wood and Robert J. Wellman. 2007. Symptoms of Tobacco Dependence after Brief Intermittent Use: the Development and Assessment of Nicotine Dependence in Youth-2 Study. Archives of Pediatrics and Adolescent Medicine 161(7): 704-710.

iv. DiFranza, Joseph R., Nancy A. Rigotti, Ann D. McNeill, Judith K. Ockene, Judith A. Savageau, Dorothy St Cyr and Mardia Coleman. 2000. Initial; Symptoms of Nicotine Dependence in Adolescents. Tobacco Control 9(3): 313-319.

v. Gervais, Andr , Jennifer O Loughlin, Garbis Meshefedjian, Christina Bancej and Mich le Tremblay 2006. Milestones in the Natural Course of Cigarette Use Onset in Adolescents. Canadian Medical Association Journal 175(3): 255-261.

vi. Kandel, Denise B., Mei-Chen Hu, Pamela C. Griesler and Christine Schaffran. 2007. On the Development of Nicotine Dependence in Adolescence. Drug Alcohol Dependence 91(1): 26-39.

vii. Doubeni, Chyke A., George Reed and Joseph R. DiFranza. 2010. Early Course of Nicotine Dependence in Adolescent Smokers. Pediatrics 125(6): 1127-1133.

viii. Centres for Disease Control and Prevention, Smoking & Tobacco Use, Health Effects of smoking.

ix. Boyle P. Tobacco smoking and the British doctor s cohort. (Editorial) Br J Cancer 2005, 92:419 - 420.

x. U.S. Department of Health and Human Services. 2004. The Health Consequences of Smoking. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

xi. World Health Organization, International Agency for Research on Cancer, IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Vol. 83. Tobacco Smoke & Involuntary Smoking, Summary of Data Reported and Evaluation.

xii. Khalil J., Heath R., Nakkash R. & Afifi R. The tobacco health nexus? Health messages in narghile advertisements. Tobacco Control 18 (5): 420-421

xiii. Mayo Clinic. Hookah Smoking: Is it safer than cigarettes?

xiv. Epidemiology and Disease Control Department, Ministry of Health. National Health Surveillance Survey 2007.

xv. Epidemiology and Disease Control Department, Ministry of Health. National Health Survey 2010 [personal communication].

xvi. Centres for Disease Control and Prevention, Smoking & Tobacco Use, Poster: Benefits of Quitting.

xvii. Smoking Cessation Guidelines For Australian General Practice, Practice Handbook, 2004 Edition, 3.Smoking and Health.

xviii. Hughes and Hatsumkami. The nicotine withdrawal syndrome: A brief review and update. International Journal of Smoking Cessation. 1992 1:21-26.

xiv. Hughes, Higgins and Hatsukami. Effects of abstinence from tobacco: a critical review, in Research Advances in Alcohol and Drug Problems, vol 10. Edited by Kozlowski LT, Annis HM, Cappell HD, Glaser FB, Goodstadt MS, Israel Y, Kalant H, Sellers EM, Vingilis ER. New York, Plenum, 1990, pp 317-398.