Evaluating an HPB intervention to reduce youth smoking rates in Singapore

A burning cigarette

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Last week, the headline of an article from a Malaysia-based website screamed: “How Singapore cut youth smoking with this one weird trick”. And given growing public policy interest in nudges – the behavioural-psychology idea that changes to seemingly small details can have major impacts on people’s behaviour – the finding that Singapore’s Health Promotion Board (HPB) was able to cut smoking rates at juvenile detention centres by 30 percentage points was impressive. The article read:

“The collaboration trained people from various racial and ethnic backgrounds for the project. Young participants were attracted to weekly meetings through programming such as a futsal clinic that showed how smoking affected one’s stamina during a game.

The project resulted in the reduction of smoking rates in the cohort from 40 per cent to 10 per cent in six months”.

The article was based off a report – published by the Health Research Institute of professional services network PricewaterhouseCoopers (PwC) – focused on the social determinants of health. In addition to the aforementioned “impact” of a 30-percentage point reduction in smoking rates among juveniles, PwC provided details of HPB’s partners:

“The project was a natural fit for Singapore Boys and Girls homes, residential centres for youth, which were eager to reduce smoking violations. HPB also involved two organisations that worked on improving education, Mendaki and the Singapore Indian Development Association (SINDA), to create a partnership addressing youth smoking”.

A major limitation, however, was that information about and evaluation of the intervention were based solely on an interview with HPB senior deputy director Vasuki Utravathy, with no additional information on the design of the intervention or the research methodology and findings. Even as a case study, details like these – with a healthy dose of scepticism and with the critical intent to problematised – should have been sought by both PwC and the website which ran the article.

Some of the questions to HPB could potentially include:

The design of the intervention: How long were the weekly meetings and how long did the overall programme or intervention last? To what extent does the programme or intervention compare to other HPB or non-HPB endeavours? And which features of the meetings were the most significant in changing the minds of the juveniles: Demonstrations of the effect of smoking on stamina (also, how was this precisely done or communicated?) or a combination of peer pressure and being surrounded by peers or mentors who did not smoke?

In the language of social service research in Singapore, what are the theories of change and logic model(s)?

Measurement: How were pre- and post-smoking rates measured, if not through self-report data (in the context of cigarettes, to what degree would self-report data be reliable)? In the first place, how do the residents gain access to cigarettes? And within the Singapore Boys and Girls Homes, are there existing restrictions on whether residents could smoke or the number of cigarettes they are allowed access, per day?

Research design and findings: How big was the sample? Are there gender differences or variations across other demographic or socio-economic variables? How confident is the HPB that the reduction of smoking rates is the result of the intervention per se, and not the result of other factors? And if there is confidence, among those who stopped smoking after the programme or intervention, how many kicked the habit permanently? In other words, how sustainable was the effect?

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