Smoking Cessation
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Last updated on 9 April 2025

  • Updated to align with 2025 ACE Clinical Guidance on 'Promoting smoking cessation and treating tobacco dependence'



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.​

Vaping is increasingly prevalent and often misconstrued by patients as a means to aid smoking cessation. Approach to vaping cessation is similar to smoking cessation. Patient can be also referred to HPB I Quit Programme. Dosing for combination NRT in smoking cessation can be extrapolated for vaping cessation. While vaping is illegal in Singapore, healthcare workers are not obligated to report these cases to authorities.​


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) 
  3. Refer to HPB I Quit / other suitable smoking cessation programmes, or nurse counsellor for follow-up support.
Consider interventions to prevent relapse, such as advising on coping strategies to overcome withdrawal symptoms.

​ ​​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. 

Involving the patient in decision-making will enhance adherence and commitment to quit plan.

  1. Nicotine Replacement Therapy (NRT)  – can be obtained from a pharmacist at the pharmacy

    1. ​Recommended combination of long and short-acting NRT

      • ​​​Combination NRT is 27% more effective than single-form NRT with minimal differences in risks of serious adverse effects.

      • Choice of short-acting NRT should be decided through shared decision-making process with patient based on their values and preferences. ​​​​​​​

  2. Vareni​cline*  – requires a doctor's prescription ​

*Note that Varenicline stock is not currently available for supply in Singapore

Follow up & Special Groups
Patients should be followed up within 1-2 weeks  (or up to 4 weeks if not feasible to do so earlier), with priority for earlier follow-up for high-risk relapse cases.

When patients have successfully quit smoking (whether or not they are on NRT), consider reviewing doses of their chronic medications, e.g. warfarin, clopidogrel, clozapine, olanzapine.

Additional considerations may be required when providing guidance for specific subgroups of smokers:

  1. Patients with unsuccessful quitting attempts or relapse

  2. Pregnant patients

  3. Adolescents ≤18years old who smoke

 
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.


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. 

​From 28 April 2024, I Quit-related information pertaining to cessation journey and quit status of patients enrolled in I Quit have been made accessible via Healthier SG-compatible GP CMSes. GPs may access this information for oversight over their enrollees' cessation journey. ​

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 (For never smoker or ex-smoker, input 0)*

  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​

  6. Date of Smoking Assessment

    ^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.​

    9. ​Agency for Care Effectiveness (ACE). Promoting smoking cessation and treating tobacco dependence.  Appropriate Care Guide (ACG), Ministry of Health, Singapore. 2025.​