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This article has been archived and will not be updated. For the latest information about our programmes and initiatives, please refer to www.hpb.gov.sg or www.healthhub.sg.

Did you know that smoking-related diseases cost Singapore over $800 million per year? Although some may see smoking as an individual choice, the impact of smoking on employers in terms of healthcare costs, absenteeism and productivity is significantly increasing and has resulted in more companies implementing comprehensive and sustainable smoking control programmes to help employees quit smoking.

If you want to improve your bottom line and display your care and concern for your employees, the Health Promotion Board (HPB) can help you. Through an effective and systematic approach tailored to your needs, HPB can work with you to achieve a smoke-free workplace and improve the health and productivity of your employees.

What is a workplace smoking control programme?
A workplace smoking control programme consists of 5 key elements. Each element offers simple steps which can be customised for both companies who are new to smoking control programmes and for companies who are dealing with more matured programmes.

The 5 key elements at a glance

The Benefits
A successful workplace smoking control programme benefits both the employers and employees.

The programme improves presenteeism - the ability of employees to concentrate at work and to achieve desired outcomes without distractions from health problems, and reduces absenteeism from work due to smoking and passive smoking related illnesses. This leads to higher productivity and performance standards. Employees' morale and staff retention rates are improved, while medical leave, work time lost and healthcare costs are reduced.

Having a successful workplace smoking control programme also helps to create a safer and cleaner environment for the majority of staff and visitors who do not smoke. Building a body of healthier staff also contributes to a healthier corporate image for the company.

Getting started

Assess the Needs
Needs assessment helps you measure and identify your companies' smoking rate, smokers' profile, their readiness and their motivation level to quit. It also helps you gather feedback from smoker employees on their preferred activities which is critical information to help you tailor the programme activities according to their interests. This will ensure good participation and success rates.

Needs assessment also helps you establish the baseline data needed for future programme planning, to secure management support and to ensure your resources are utilised cost effectively.

Design the programme
This is the stage where ideas are generated, potential problems are examined and a brief programme outline / framework is put together based on the needs assessment data. The outline / framework should state:

• the current problem
• clear programme objectives
• programme strategies
• the resource required

Remember to set SMART objectives:
S = Specific
M = Measurable
A = Achievable
R = Relevant
T = Time-frame

Here are some examples of good and bad objectives:
GOOD

• Bring down the smoking prevalence rate from 15% to 13%
• Conduct at least 3 smoking control activities
• At least 70% of smokers attend at least one smoking control activity

BAD

• Bring down the smoking prevalence rate
• Conduct smoking control activities
• Smokers to attend smoking control activities

Get management support
Management support can help transform thinking and behaviour at all levels within the organisation. This helps to ensure that your smoking control programme receives the resources necessary for a successful programme.

There are different ways to secure management support. Be prepared that management support might not be achieved in one single meeting, so be persistent!

Here are some suggestions:

Step 1:
Give clear and factual background information on the harmful effects of smoking, benefits of quitting and the impact smoking has on the company in terms of image, productivity and costs.

Step 2:
Provide a clear picture of the smoking problem in the company, based on the needs assessment conducted.

Step 3:
Present your programme outline / framework, stating clear objectives and the budget required. Highlight the benefits the programme will offer to your company, in particular, explain how the initiative contributes towards fostering greater partnership and cooperation between employees and their unions, while fulfilling the need for 'shared responsibility' between the company and its employees in developing & making healthy work life choices, which impacts on the company's bottom line.

Step 4:
Obtain approval / feedback on whether the management is agreeable to the objectives and what kind of results will be needed for them to commit the necessary resources to you.

Should you experience difficulty obtaining management support, it is still possible for your company to carry out effective activities to give your smoker employees a helping hand. 

Set up a smoking control working committee (SCWC)
Gather colleagues who are passionate about smoking control. They are likely to make the best out of the opportunities. Include both management and non-management staff, as buy-in from all quarters is equally important. Find a member from the senior management to champion the initiatives. Workplace initiatives have better success rates when there is a senior executive championing it.

An effective committee can help to:

• develop strategies and programmes
• publicise the programme
• implement the smoke-free policy
• follow-up and monitor the policy implementation in terms of employees' compliance and participation in activities
• evaluate both short-term and long-term outcomes
• revise policy based on evaluation results
• maintain the smoke-free policy
• sustain and innovate the programme

Plan the programme activities
To ensure the smooth running of the programme, it is important to determine what needs to be done, by whom, by when, the resources involved and the desired outcome. By doing so, the SCWC members are more likely to stay involved and take ownership of the programme.

Here are some important factors to consider during the planning process:

• Members of the committee should all agree on the task allocation.
• The work description should be easy to understand and all tasks should have clearly defined start and end dates.
• Think ahead and schedule activities to spread out for at least the next 6 to 12 months.
• Stick as closely as possible to the allocated budget, but consider seeking additional resources through sponsorships and grants.

Draft a corporate smoking control policy
Corporate smoking control policies include smoking prohibition or restrictions, prohibition of tobacco product sales within the company premises and incentives and subsidies for quit smoking therapy and pharmacotherapy aids (such as nicotine replacement patches and gum).

Prior to developing any smoking control policies, the SCWC should inform and consult the employees to get their opinions and feedback.

• Informing - It is vital that the Committee spends time informing employees about the health hazards associated with smoking and second-hand smoke, as well as the benefits of quitting smoking. By doing so, employees will be more receptive to the implementation of the policies.
• Consulting - The feedback and opinions of the employees are important in the implementation of any company policy. Employees can express their views via a questionnaire.

Smoke-free policy
Studies show that smoke free workplaces encourage more smokers to quit or reduce the number of cigarettes smoked.

All air-conditioned workplaces (including retail malls and restaurants, and upcoming for entertainment outlets) in Singapore are legislated as smoke-free zones. However, non-air conditioned and open areas outside office buildings or compounds are not legislated. Smoking restrictions beyond the legal requirements are now increasingly common in the workplace.

There are two commonly used smoke-free policies:

1. Total smoke-free policy
   Smoking is not allowed inside or outside any building or compound belonging to the organisation. This includes all non-air conditioned areas.
2. Partial smoke-free policy
   Smoking is allowed in dedicated rooms in the building which are separately ventilated or certain limited designated outdoor locations.

The aim of this policy is to provide a healthy and conducive work environment, and not to stigmatise employees who smoke. Quit smoking support can be offered to employees who smoke while other supporting policies such as subsidy for pharmacotherapy can be in place to help smokers cope with withdrawal symptoms and nicotine cravings.

Running the programme
Market your programme and tailor to maximise attendance
Marketing a smoking control programme is very different from marketing a product because it involves selling intangibles like health, attitudes and lifestyle changes. The challenge is how to sell these intangibles to your smoker employees.

Implementing your policy and programme
The implementation phase can be daunting especially if you are running a programme in a large organisation.

Am I on track?

Why evaluate
Evaluation is a systematic process used to measure the success of your programme. Here are some reasons why it is important to evaluate your workplace smoking control programme:

• To collect information on the effectiveness and impact
• To account to the management and fellow employees
• To identify ways to improve the programme
• To assess the efficiency of the initiative (cost Vs benefit)

What to evaluate
The working committee may evaluate the success of the programme over one or more years using the following criteria:

• Did activity participation reach your target?
• Is there a change in smoker employee's desire to quit smoking?
• What is the quit rate and smoking reduction rate among employees who attended quit smoking consultations or support group sessions?
• Is there a change in the number of employees who smoke?
• Is there an improved employee attitude towards health?
• Is there a reduction in absenteeism and health care costs?
• Is there a reduction in the turnover rate of staff?

How to evaluate
Evaluation can be done via:

• One to one interviews
  This can be conducted by telephone or face to face. Face to face interviews engages the employee better, offers immediate response and gives opportunities to clarify the employees' thoughts. This technique will have a good response rate but is time consuming.
• Group discussion
  Gather a group of employees who have undergone your workplace smoking control activities and ask them for their feedback. This method is less time consuming. However, it may be difficult trying to arrange for a meeting to suit everyone. Some employees also may not be comfortable to share more sensitive thoughts in a group.
• Questionnaires / surveys
  Simple questionnaires or surveys can be distributed to employees by hard copies or by emails. This method is the most flexible and is useful for employees working in shifts or at different locations. However, the participation rate may be lower compare to the other two techniques.

Understanding your employees
The workplace provides a unique opportunity to offer interventions for all smoker employees. However, most intervention programmes attract only smokers who are motivated to quit, which often results in low participation rates. This is because some smokers may have no intention to quit or are merely thinking about it. To increase participation rates, it is important to understand your employees and, based on their readiness to quit smoking, tailor the programmes to cater to their needs. This involves having a different set of interventions for employees in the different stages of change.

It is important to maintain regular communication with them throughout the year as smokers usually move between the various stages of change regularly.

Here are some tips on how to reach smoker employees in different stages of change:

Those who have not thought about quitting
Employees who are not ready to quit or have not thought about quitting are in the "Pre-contemplation stage". Pre-contemplators are typically more receptive to awareness based initiatives and information on harmful effects on smoking.

You may consider:

• Conducting group motivational talks and highlight the harmful effects of smoking.
• Conducting awareness based activities to consistently remind smokers of the harmful effects of smoking and benefits of quitting (e.g. exhibits, health fairs, online quiz, newsletters).
• Providing relevant resource materials on the harmful effects of smoking (e.g. pamphlets, booklets, posters, e-mailers)

Those who have thought about quitting
Employees thinking about quitting smoking and are ready to do so in the next 6 months are in the "Contemplation stage". Contemplators are usually more receptive to motivational initiatives and information on benefits of quitting and how to overcome barriers to quitting.

You may consider:

• Arranging for service providers to conduct in-house quit smoking intervention sessions (group or individual) at the company's premises. This helps to motivate them into the "Action stage".
• Providing information on QuitLine (1800 438 2000) and other face-to-face quit smoking services.
• Providing resource materials on the benefits of quitting smoking and barriers to quitting.
• Following-up regularly through emails to give them the necessary support and encouragement to try quitting.

Those who are currently taking action to quit smoking
Employees who are in the process of quitting are in the “Action stage” and often face the most critical period. They need timely support, motivation and encouragement. They are most likely to succeed if they receive professional quit smoking advice and resource materials on coping strategies.

You may consider:

• Arranging for service providers to conduct in-house quit smoking intervention sessions (group or individual) at the company's premises to offer support and practical tips. Through emails, support the employee's decision to quit and offer praise or small rewards / recognition for every week / month the employee stays quit.
• Introducing a buddy system where ex-smokers can provide support and encouragement to the smoker who is trying to kick the habit.
• Providing resource materials on tips on quitting, stress and weight management, and most importantly the contacts for QuitLine & Quit Smoking Services.

To determine their level of nicotine dependence, the Workplace Health Facilitator can use the Karl Fagerstrom Nicotine Tolerance Questionnaire, to assess if there is a need for Nicotine Replacement Therapy (NRT) or bupropion administration. Workplace Health Facilitator can also refer them to quit advisors, if necessary.


Those who have quit smoking for at least 1 month
Employees who have quit smoking and want to remain smoke-free are in the “Maintenance stage”. This group has a good chance of remaining smoke-free for good through positive reinforcement and relapse prevention advice.

You may consider:

• Offering encouragement through emails to support the employee's decision to quit and to offer praise or small rewards to those who have remained smoke-free.
• Introducing a buddy system - where ex-smokers act as “quit buddies” and share their experiences on how they managed to quit smoking in informal group support session.
• Providing resource materials on relapse prevention, stress and weight management.
• Organising special activities e.g. yoga or aerobic classes, weight management talks, badminton or jogging sessions to help them manage their stress (a key reason why many ex-smokers relapse!) and stay occupied.

Bear in mind that behavioural change can be difficult and often takes time and persistent efforts. Most smokers quit successfully only after several attempts. The key message is “Never give up trying!”