Article Text

Download PDFPDF
What measures are needed to achieve a tobacco endgame target? A Singapore-based simulation study


Background An increasing number of countries are pursuing a tobacco ‘endgame’. We sought to determine the combination of measures it would take to achieve a tobacco endgame in the city-state of Singapore.

Methods Using an open-cohort microsimulation model, we estimated the impact of existing measures (quit programmes, tobacco taxes, flavours ban) and more novel measures (very low nicotine cap, tobacco-free generation, raising the minimum legal age to 25 years), and combinations thereof, on smoking prevalence in Singapore over a 50-year horizon. We used Markov Chain Monte Carlo to estimate transition probabilities between the states of never smoker, current smoker and former smoker, updating each individual’s state across each year with prior distributions derived from national survey data.

Results Without new measures, smoking prevalence is expected to rebound from 12.2% (2020) to 14.8% (2070). The only scenarios to achieve a tobacco endgame target within a decade are those combining a very low nicotine cap with a flavours ban. A nicotine cap or tobacco-free generation alone also achieve endgame targets, but after 20 and 39 years, respectively. Taxes, quit programmes, a flavours ban and minimum legal age increase do augment the impact of other measures, but even when combined are insufficient to achieve a tobacco endgame target within 50 years.

Conclusion In Singapore, achieving a tobacco endgame within a decade requires a very low nicotine cap coupled with a tobacco flavours ban, although this target can also be achieved in the long term (within 50 years) with a tobacco-free generation.

  • end game
  • global health
  • prevention
  • public policy

Data availability statement

Data are available in a public, open access repository. Data may be obtained from a third party and are not publicly available. No data are available. A mixture of data sources was used to build the microsimulation model. Some of these are publicly available (eg, national smoking prevalence statistics); others are not publicly available but may be available on request from a third party (eg, Ministry of Health); others are not available due to ethics reasons (eg, survey of flavoured cigarette use).

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.