Systems and policies to reduce secondhand smoke in multiunit housing in Singapore: a qualitative study.

BACKGROUND: Multiunit housing residents are often exposed to neighbours' secondhand smoke (SHS). Little is known on the current systems available to protect residents in places not covered by a residential smoking ban, or what constitutes an appropriate policy approach. This study explores relevant systems and policies in Singapore, a densely populated city-state where the vast majority live in multiunit housing and discussions on regulating smoking in homes are ongoing. METHODS: In-depth interviews with 18 key informants involved in thought leadership, advocacy, policy or handling SHS complaints, and 14 smokers and 16 non-smokers exposed to SHS at home. RESULTS: The current system to address neighbours' SHS comprises three steps: moral suasion, mediation and legal dispute. Moral suasion and mediation are often ineffective as they depend on smokers to willingly restrict their smoking habits. Legal dispute can yield a court order to stop smoking inside the home, but the process places a high evidence burden on complainants. While setting up designated smoking points or running social responsibility campaigns may help to create no-smoking norms, more intractable cases will likely require regulation, a polarising approach which raises concerns about privacy. CONCLUSIONS: Without regulations to limit SHS in multiunit housing, current systems are limited in their enforceability as they treat SHS as a neighbourly nuisance rather than a public health threat.

Residential secondhand smoke in a densely populated urban setting: a qualitative exploration of psychosocial impacts, views and experiences.

BACKGROUND: People remain exposed to secondhand smoke, a serious health hazard, inside their home as households face challenges in setting no-smoking rules or are exposed to secondhand smoke drifting in from neighbouring homes. This study explores the psychosocial impacts, views, and experiences with residential secondhand smoke in a densely populated urban setting.  METHODS: In-depth online or face to face interviews with 18 key informants who had been involved in public discourse, policy, advocacy or handling complaints related to residential secondhand smoke, 14 smokers, and 16 non-smokers exposed to secondhand smoke inside their home. All participants were residents of Singapore, a densely populated, multi-ethnic city-state. Interview transcripts were coded in NVivo using a deductive and inductive coding process. FINDINGS: Secondhand smoke has wide-reaching impacts on physical and psychosocial wellbeing, even if smokers tried to minimise secondhand smoke. Feelings of anxiety and stress are generally tied to feeling discomfort in one's personal space, a perceived lack of control over the situation, resentment towards smokers, and concerns over the health effects. Family, community, and cultural dynamics add complexities to tackling the issue, especially in patriarchal households. Secondhand smoke exposure from neighbours is considered a widespread issue, exacerbated by structural factors such as building layout and the COVID-19 pandemic. Resolving the issue amicably is considered challenging due to the absence of regulations and a reluctance to stir up conflict with neighbours. While smokers took measures to reduce secondhand smoke, these were described as ineffective by other participants. Smokers appeared to have contrasting views from other participants on what it means to smoke in a socially responsible manner. CONCLUSION: Given the wide-reaching psychosocial impacts of residential secondhand smoke, there is a case for stronger interventions, especially in densely populated urban settings where it is more difficult to avoid.

"The Menthol One Is More Friendly": Young Singaporeans' Perspectives on Flavored Cigarettes.

Over half of the cigarettes sold in Singapore contain added flavors such as menthol. We conducted nine focus group discussions (n = 46) with young (aged 20-25) current smokers in Singapore to understand the role of flavors in smoking initiation. We found that flavors triggered the curiosity to experiment with tobacco and e-cigarette products and played an important role in the formation of early cigarette preferences. Menthol-flavored cigarettes were the most appealing to participants due to their smoothness and cooling sensation, described as pleasant against Singapore's hot and humid climate. While some participants believed that flavored and nonflavored cigarettes were equally harmful, others believed that flavored variants had a lower nicotine content and were therefore less harmful, or that the added chemicals in flavored cigarettes could result in higher toxicant exposures. Thus, among young people in Singapore, flavors appear to play an important role in smoking initiation and there appear to be various misperceptions regarding their harmfulness.