Smoking Cessation
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​Last updated on 19 December 2023


Smoking is a major risk factor, with 13.1% of deaths in Singapore attributed to smoking, both active and passive.1

While a reduction in smoking results in lower mortality risk, complete cessation is much more beneficial.2, 3

Target group: all smokers,2-5 especially patients with cardiovascular disease, respiratory disease (asthma/chronic obstructive pulmonary disease [COPD]), chronic kidney disease.

Target: 0 sticks per day.​


2A Approach to Smoking Cessation

  • Ask about smoking - systematically identify all tobacco users at every visit
  • Act to help all tobacco users quit


For more information on the stages of change, click here .

For the Fagerstrom score, click here .

Non-Pharmacological Intervention​

  1. ​​​Motivational Interviewing (MI) 
  2. ​Cognitive Behavioural Therapy (CBT) 

GPs should re-assess the stage of change and re-perform the steps within the “Act" section of the approach to smoking cessation for patients who have either returned to smoking after previously quitting or have failed a smoking cessation programme.​

​Pharmacot​herapy​

​​Pharmacotherapy has been shown to be cost beneficial for smokers who are assessed to have nicotine dependence and keen to quit, provided there are no contraindications.6,7​​

To note, smokers with very low nicotine dependence (Fagerstrom score <3) will not be eligible for MAF subsidies at Public Healthcare Institutions. 

  1. Nicotine Replacement Therapy (NRT)  – can be obtained from a pharmacist at the pharmacy
  2. Vareni​cline  – requires a doctor's prescription

Licensing for Bupropion for smoking cessation under the Zyban® brand has been discontinued. The existing brand of Bupropion, Wellbutrin®, is only approved for treatment of major depressive disorder.

There are plans to make available subsidies for NRT and Varenicline to Healthier SG GPs for enrolled patients (exact date to be confirmed). Prescribing guidance will be released to guide appropriate prescription of NRT and Varenicline for the purpose of subsidies.​​


Referral Resources

For patients who are prepared to quit (preparation stage) or who wish to seek further professional advice, GPs may encourage them to sign up for HPB I Quit, the national programme for smoking cessation, for counselling. 

MOH will work on linking GP CMSes to Healthier SG modules, where GPs can receive regular updates on the status of their patients who are enrolled in I Quit, and their quit outcomes via CMS.

GPs may also wish to contact their PCN to check if PCN nurses are able to provide structured counselling support.​​

​
The following data fields should also be documented in GPs' case notes as part of good clinical practice for all patients enrolled to their practice.

Submission of data fields marked with asterisks* is required for subsidy claims and Healthier SG payments. 


Smoking History

  1. Smoking status*:​​

    • ​​Never-smoker
    • ​​Ex-smoker (defined as a person who does not currently smoke tobacco, and has not smoked for the last 30 days, but has smoked at least 100 cigarettes in his/her lifetime)
    • ​Current smoker

  2. Year started smoking (if smoker) – if patient quit and relapsed, to indicate the first time that patient ever smoked

  3. Number of sticks smoked/day* (if smoker) – if patient smokes less than 1 cigarette a day, to still indicate as 1 stick/day

  4. Stage of change – (i) Pre-contemplation, (ii) Contemplation, (iii) Preparation, (iv) Action, or (v) Maintenance


  5. Fagerstrom Score – ​For patie​nts who are prepared to quit and are actively participating in a structured smoking cessation counselling programme, GPs can consider administering the Fagerstrom test  to determine degree of nicotine dependence. GPs may direct their patients to complete the quiz in HealthHub and submit the score to them. A suggested classification of Fagerstrom Test Scores is as follows^:
    • 0–2: Very low dependence
    • 3–4: Low dependence
    • 5–7: Moderate-high dependence
    • ​8–10: Very high dependence​​

    ^The Fagerstrom score classifications are not universal and the categorisation of numerical scores may vary.​


    1. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019. Seattle, United States: Institute of Health Metrics and Evaluation (IHME). 2019.

    2. Inoue-Choi M, Christensen CH, Rostron BL, Cosgrove CM, Reyes-Guzman C, Apelberg B, Freedman ND. Dose-response association of low-intensity and nondaily smoking with mortality in the United States. JAMA network open. 2020 Jun 1;3(6):e206436.

    3. Rigotti NA, Kathuria H. Benefits and consequences of smoking cessation. UpToDate. Waltham (MA): UpToDate. 2020.

    4. Chan K, Chandler J, Cheong K, Giam PE, Kanagalingam D, Lee LL, Leong JJ, Ng Y, Oh C, Shi M, Tan AS. Health promotion board-ministry of health clinical practice guidelines: treating tobacco use and dependence. Singapore Med J. 2013 Jul 1;54(7):411–416.

    5. American Dental Association. Tobacco Use and Cessation. 2021 Oct. [In​ternet]​

    6. Varenicline for smoking cessation. National Institute for Health and Care Excellence. 2007 Jul. [Internet]​

    7. K Tran, K Asakawa, K Cimon, K Moulton, D Kaunelis, A Pipe, P Selby. Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses. CADTH Technology Overviews. 2012 Sep 1, 2012;2(3):e2303.

    8. National Health Group Polyclinics. Smoking Cessation Clinical Practice Guidelines. 2020.