World Health Organization Collaborating Centre for Smoking Cessation and Treatment of Tobacco Dependence

Best Practices of Smoking Cessation in the Western Pacific Region


Brunei Darussalam

The World Health Organization has reported that most smokers start smoking before the age 18, and almost a quarter of these individuals begin using tobacco before the age of 10.  Currently there is an estimated of 1.3 million people smoke worldwide and 84% of these smokers live in developing countries.

Smoking has been associated with increased mortality from several diseases.  It is known to be responsible for 90% of all lung cancer cases, 75% of chronic bronchitis and emphysema and 25% of ischemic heart disease globally.

The prevalence of tobacco smoking in Brunei Darussalam is among the highest in high income countries.

Population Census Survey (2001 & 2011)

Population Census Survey (2001 & 2011)

In 2001, 17.5% of the adult population aged 15 years and above use tobacco, in which 31.8% of males and 2.9% of females were smokers.  In 2011, the smoking prevalence had decreased to 15.2% in which 27.5% of males and 2% of females were smokers.

Global Youth Tobacco Survey, 2013

Global Youth Tobacco Survey (2013)

The Global Youth Tobacco survey (GYTS) was conducted in 2013 by Ministry of Health, Brunei Darussalam. The survey has shown that;

  • 15.5% of boys, 5.6% girls, and 10.6% of youth currently smoked tobacco
  • 13.4% of boys, 3.4% of girls, and 8.5% of youth currently smoked cigarettes
  • 17.1% of boys, 6.7% of girls, and 12.0% of youth currently used any tobacco products

The Ministry of Health has developed a National Multisectoral Action Plan on Non-communicable Diseases (BruMAP-NCD) in 2013 to prevent and control NCDs through enabling healthier environments as well as reducing risk factors and better management of NCDs in Brunei Darussalam. One of the objective in the strategic action plans is to reduce tobacco use by a 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years and all public places to be smoke-free by 2018.

To help achieve this target, Health Promotion Centre under the Ministry of Health Brunei Darussalam has set up the ‘Tobacco Free 4 Life’ Programme in 2013 with the following targets;

  • To reduce the prevalence of smokers to 12% by 2018
  • To prevent uptake of smoking by youth
  • To increase public awareness on the danger of tobacco and smoking
  • To reduce the number of children aged 5 and below exposed to secondhand smoke at home

Smoking Cessation Services falls under the ‘Tobacco Free 4 Life’ Programme, Health Promotion Centre. The community smoking cessation services were first established in 4 different community health centres in 2005 to provide support services for smokers who wish to quit smoking through group and individual counseling and pharmacotherapy when necessary. The Tobacco Free 4 Life programme has been organizing Smoking Cessation Counseling Workshops for health professionals and other relevant ‘stakeholders’ annually, to:

  • Increase their knowledge on various aspects of smoking cessation
  • Improve their skills and competencies to deliver standardized smoking cessation advice, support and services
  • Share information on the global tobacco epidemics and its impact on health
  • Discuss on the tobacco control measures in Brunei Darussalam
  • Update health professionals on current effective pharmacotherapies that are available for smoking cessation.

At present (2014), the community smoking cessation services are available in 16 community health centres, 1 National Dental Centre and Pengiran Isteri Hajah Mariam Hospital in Temburong district. Most of the services are nurse-led by a ‘Smoking Cessation Counselor’ or SCC (nurses who have been trained to provide cessation services), with prescription for pharmacotherapy by a general practitioner or a physician, when required. The services provide an intensive smoking cessation program which runs for 6 months including free counseling / consultations and pharmacotherapy namely Nicotine patch, Nicotine Lozenges and Varenicline. The success rate for smoking cessation services since 2005 to 2013 is 20-30%.

Nurse-led Smoking Cessation Clinic Health talks for students at health galleria, Health Promotion Centre
Nurse-led Smoking Cessation Clinic Health talks for students at health galleria,
Health Promotion Centre

The 2005 Clinical Practice Guideline on Smoking Cessation for Health Professionals has also been revised in 2014 and has been distributed to all health centres. The revised guideline provide updated evidence-based recommendations on interventions to treat tobacco use and dependence.  The objective of this guideline is to assist all health professionlas to identify and assess the tobacco use status of every patient and to deliver evidence-based effective tobacco use and dependence treatments.

The ‘Tobacco Free 4 Life Programme’ also carry out “Tobacco-Free Youth Camp” for secondary school students, to:

  • Educate the students on the dangers of the use of tobacco and smoking through islamic perspective, health and laws.
  • Make the students understand the reasons for uptake of smoking among youth and its consequences.
  • Practise avoidance techniques from peer pressure
  • Teach the students on ways to quit smoking and lead a healthy life

As part of initiatives in promoting the smoking cessation services, this year the Health Promotion Centre has developed a “Quit2Win Campaign” to increase the rate of smokers quitting through an intensive program under the smoking cessation services and then to reward the successful quitters who are able to abstain for 6 months. The participants who have registered for the ‘Quit2Win Campaign’ are followed-up throughout the 6 months by smoking cessation counselors at their nearest health centres. The final evaluation for this campaign will be done in December 2014, with a target of a third of the participants able to successfully quit throughout the 6 months.

Quit2Win Campaign 2014 Quit2Win Campaign 2014
Quit2Win Campaign 2014

In 2015, Health Promotion Center through the “Tobacco Free 4 Life Programme” is planning to start a proactive “Quitline” service, in which trained nurses are able to give brief 5 ‘A’s smoking cessation advice for adults or youth who are caught smoking by the Health Enforcement Unit in non-smoking public areas over the phone and then to refer them to a smoking cessation counselor at their nearest health centres for further counseling sessions and pharmacotherapy when necessary.