Determinants of Hardcore Smoking in a MULTI-ETHNIC Study of Cigarette Smokers in Singapore

ABSTRACT

Smokers who are resistant to quitting are not well studied in Asia, particularly in multi-ethnic populations. We compared the characteristics of hardcore smokers in Singapore, a multi-ethnic Asian population, with other daily smokers, and investigated the role of ethnicity as an effect modifier on identified determinants, including cigarette flavor preferences, using cross-sectional data from Singapore Smokers’ Survey (n = 1,501). Multivariable logistic regression was used to assess the association. 22.8% of adult daily smokers were hardcore smokers. Novel findings on hardcore smokers’ preference for regular flavored cigarettes (AOR = 1.54; 95%CI: 1.14, 2.07) suggest there is room for interventions among hardcore smokers through regulation of cigarette flavors and nicotine content. Although ethnicity was not a significant factor, it was an effect modifier with peers’ disapproval of smoking (p-value for interaction = 0.024), significantly lowering odds of Malays being hardcore smokers (stratified odds ratio, AOR stratified, Malay = 0.35; CI: 0.17, 0.71), but not Chinese (AOR stratified, Chinese = 1.27; CI: 0.70, 2.42) and Indian smokers (AOR stratified, Indian = 0.62; CI: 0.18, 2.28), suggesting that smoking cessation policies utilizing social norm change strategies may be more effective when tailored to the differing roles of peer norms among different ethnic groups, in Singapore and other multi-ethnic Asian populations.

KEYWORDS:

• Hardcore smoking
• daily smokers
• addiction
• Singapore
• multi-ethnic population

Acknowledgments

The authors would like to express their gratitude to the Singapore Population Health Studies (SPHS) operations team for their assistance in this project. The authors are also grateful for support from Associate Professor Alex Cook, Vice Dean (Research) at the Saw Swee Hock School of Public Health, National University of Singapore.

Contributorship

Zilu Feng: Formal analysis, Writing – original draft preparation, Methodology; Chuen Seng Tan: Supervision, Methodology, Writing- Reviewing and Editing; Jeong Kyu Lee: Conceptualization, Supervision, Methodology, Writing- Reviewing and Editing

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author, JKL, upon reasonable request.

Additional information

Funding

This work was supported by funding from the Population Health Metrics and Analytics (PHMA) from the Saw Swee Hock School of Public Health, National University of Singapore Start-up Grant (R-608-000-179-133 / R-608-000-179- (SSHSPH, NUS). SSHSPH, NUS had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication;Population Health Metrics and Analytics, National University of Singapore [NA];