Health Promotion Board Research Articles

Consensus statement on Singapore Perinatal Mental Health Guidelines on Depression and Anxiety.

Perinatal depression and anxiety are public health concerns affecting approximately 1 in 10 women in Singapore, with clear evidence of association with various adverse outcomes in mother and child, including low birthweight, preterm birth and negative impact on infant neurodevelopment, temperament and behaviour. A workgroup was formed to develop recommendations to address the perinatal mental health needs of women with depression and anxiety. The approach was broad-based and aimed to incorporate holistic methods that would be readily applicable to the network of care providers supporting childbearing women. The Grading and Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to draw these guidelines. Workgroup members-comprising experts in the field of perinatal mental health and obstetric medicine-deliberated on the public health needs of the target population, and reviewed literature published from 2001 to 2022 that were relevant to improve the well-being of women with depression and anxiety during the preconception and perinatal periods. A consensus meeting was held involving a wider professional network, including family physicians, paediatricians, psychiatrists, social services and the Health Promotion Board in Singapore. Ten consensus statements were developed, focusing on the overall aim of achieving optimal perinatal mental health for women with depression and anxiety. They relate to awareness and advice on preconception mental health, screening and assessment, optimising care and treatment. Special considerations were recommended for women who suffered severe maternal events, tailoring care for adolescents and women with special needs, and addressing infant mental health needs.

Fit for Motherhood: The Glocalization of Maternal Physical Activity in Mother and Baby Magazine

Fit for Motherhood: The Glocalization of Maternal Physical Activity in <i>Mother and Baby</i> Magazine

The global agenda on obesity: what does this mean for Singapore?

The global agenda on obesity: what does this mean for Singapore?

Legislative Journey and Readiness in the Implementation of the Universal Health Care Act

It took nine (9) years for the Philippines to craft and pass a law seeking to address health barriers that have been preventing Filipinos from accessing the needed care towards the country's achievement of Universal Health Coverage through the Republic Act No. 11223 which incorporates the health promotion component, mandating the country's leading health agency to transform its service unit into a bureau to improve health literacy and mainstream preventive care. The study analyzed the UHC policy journey in the Philippines and the organizational readiness of selected agencies in its implementation. Exploratory research was conducted through an in-depth interview, comparative review of secondary data/document and policy content analysis. It shows that the service unit was not ready to undergo transformation and the study recommends that the government should increase the human resources and complement the health facilities’ capacity in delivering health promotion agenda/activity; issue of an Administrative Order (AO) that will form the Philippine Health Promotion Board; and take into consideration the formulated framework that will allow the service unit to facilitate its transformation.

Social Media Health Promotion and Audience Engagement: The Roles of Information Dissemination, Organization-Audience Interaction, and Action Confidence Building

ABSTRACT Social media have become an important platform for health promotion. Based on the Information-Community-Action Framework, we conducted a content analysis of 1,481 Facebook postings by Singapore’s Health Promotion Board. Results showed that organizational information and health benefit information dissemination were positively associated with online audience engagement. Also, organization-audience interaction had a positive relationship with online audience engagement. In addition, messages that help build confidence for health behavior change increased online audience engagement. In addition to these main effects, organization-audience interaction also played a moderating role that strengthened the effects of information dissemination and action confidence building on online audience engagement. This study offers important theoretical contributions to the Information-Community-Action Framework and has practical implications for enhancing the effectiveness of health promotion in this digital era.

Assessment of Dietary, Physical Activity and Sedentary Behaviours of Singapore Schooling Youths

Unhealthy lifestyle behaviors may set youths on the path to developing non-communicable diseases. Singapore schooling youths (n = 235, 67.2% female, age 17.5 (mean) ± 1.0 (SD) years) were recruited to examine the dietary, alcohol use, physical activity, and sedentary behaviors of the Singapore schooling youths. Demographic, anthropometric, and sedentary hours information were collected using structured questionnaires. Physical activity levels and dietary intakes, including alcohol use, were assessed using the validated International Physical Activity Questionnaire - long-form and localized food frequency questionnaire, respectively. The surveyed youths consumed significantly larger daily amounts of energy, sugar, saturated fat, and sodium than the levels recommended by the Singapore Health Promotion Board. They did not achieve the daily amounts of dietary fiber, fruits, and vegetables, and derived unhealthy proportions of daily energy from sugar and saturated fat. They did not exceed the recommended maximum daily alcohol allowance. Close to all the youths (91.2%) failed to adhere to more than five of the nine recommended healthy eating habits. Majority of these youths (73.4%) partook less than 600 MET-minute/ week. A significant number of the youths (38.1%) spent more than eight sedentary hours daily. Physical activity correlated significantly with sedentary behavior levels, but not the dietary scores. Most surveyed youths engaged in low physical activity and high sedentary behavior, and did not comply with most of the healthy eating guidelines proposed by the Singapore Health Promotion Board, specifically on daily energy, sugar, dietary fibers, saturated fat, sodium, and fruit and vegetable intakes.

Evaluation of the Proximity of Singaporean Children's Dietary Habits to Food-Based Dietary Guidelines.

Dietary habits in children may not only impact current health status but could also shape future, lifelong dietary choices. Dietary intake data in Singaporean children are limited. The current study aimed to define the overall diet quality of Singaporean children using an existing cross-sectional dataset and to consider how demographic factors (i.e., body mass index (BMI) status, ethnicity, age, and sex) were associated with these scores. Existing, cross-sectional dietary data (n = 561 children aged 6–12 years, collected in 2014–2015) from duplicate 24-h recalls were assessed for diet quality using an index based on the Singaporean Health Promotion Board dietary guidelines. Total diet quality scores were calculated from ten different components (frequencies of rice and alternatives, whole grains, fruits, vegetables, meat and alternatives, dairy and alternatives, total fat, saturated fat, sodium intake, and added sugars). Association with demographic factors and BMI category was evaluated by one-way multivariate ANOVA (MANOVA) tests, with Bonferroni post hoc analyses. Median (interquartile range) total diet quality scores were 65.4 (57.1–73.0). Median scores for whole grains (0.0, 0.0–33.4), fruits (24.1, 0.0–65.3), vegetables (36.5, 10.4-89.8), and sodium (58.4, 0.0–100.0) intake were frequently sub-optimal. Children of Malay ethnic origin had statistically lower total diet quality scores ((55.3, 47.5–60.3) vs. other ethnic groups (combined median 65.4 (57.1, 73.0); p < 0.001). These findings highlight the need for continuing efforts to improve dietary intake in young Singaporeans and for longitudinal dietary monitoring in this group.

Impact of Knowledge and Attitudes on Lifestyle Practices in Preventing Type 2 Diabetes Mellitus

Diabetes mellitus is a major public health issue in Singapore. To shape healthcare policies for the primary prevention of diabetes, it is crucial to understand Singaporeans' knowledge, attitudes and practices related to diabetes and its prevention. This study aimed to assess the knowledge, attitudes and lifestyles of individuals without diabetes. A cross-sectional household survey was performed between 31 January to 3 February 2019 to examine knowledge, attitudes and practices related to diabetes. Inclusion criteria of the participants included: 1) Singaporeans/permanent residents, 2) between 30 to 64 years old, and 3) who did not have a diagnosis of diabetes. Logistic and linear regression models were used to analyse the association of knowledge and attitudes with physical activity and diet habits, respectively. Among 806 participants, 72.2% did not meet the Health Promotion Board's physical activity recommendation. Physical activity was associated with better diabetes knowledge (odds ratio [OR] 5.38, 95% confidence interval [CI] = 1.65-17.53, P = 0.049), stronger beliefs in diabetes prevention (OR 3.36, 95% CI = 1.02-11.12, P = 0.047) and lower levels of worry about diabetes (OR 0.41, 95% CI 0.17-1.00, P = 0.049). Neither knowledge nor beliefs or worries about diabetes was associated with diet. There is a need to reinforce the importance of physical activity and healthy diet in preventing diabetes. Although improving the knowledge level of diabetes may increase physical activity of the population, it is unlikely to improve dietary choices without effective behavior change interventions.

Barriers towards exercise and physical activity of different ethnic groups in middle-aged female Singaporeans.

The government has collaborated with the Health Promotion Board in coming out a bountiful of initiatives for the citizens to engage in exercise. Despite the initiatives, the obesity rate in middle-aged women is still high. This study seeks to understand and identify the vast barriers that prevent middle-aged women from exercising. Purposive sampling and semi-structured interview were conducted for the participants. The analysis of the interview revealed the significance of barriers in three areas: Priority of Family and Work Commitments, Minimal Promotion of Subsidized Initiatives by the Government, and Discrimination through the Usage of Language. It highlights that racial barriers are minimal and better time management would be appropriate to engage a healthier lifestyle. The study suggested female Singaporeans to incorporate sports in the lifestyle, more aggressive promotion of subsidized initiatives and the use of common languages (English) in the exercise class.

Malaysian health promotion board (MySihat) smoke-free city initiative

Malaysian health promotion board (MySihat) smoke-free city initiative

Smoking cessation program among naval diver trainees in the Republic of Singapore Navy.

Since 2016, the Naval Diving Unit (NDU) of the Republic of Singapore Navy (RSN) has instituted a smoking cessation trial program for their trainees, instituting a blanket ban on smoking during training hours in order to promote smoking cessation and create a smoke-free culture among its servicemen. For the rest of RSN personnel, they would attend a more costly, established Health Promotion Board (HPB) smoking cessation program, which employs social support strategies, while they undergo basic training in the Navy Military Experts Institute (NMI). We examined the outcomes and direct costs of the NDU smoking cessation trial program, compared with the HPB smoking cessation program in NMI. The primary outcome was self-reported smoking cessation at the end of six months. The NDU smoking cessation program led to 50% reduction among smokers with no additional direct costs. It is comparable to a 59% reduction of smokers among trainees in the established HPB program, which costs US$1,955 per course in 2017. The results of both programs are not significantly different (χ2 = 0.34, P-value = 0.56). Neither program?s participants raised any nicotine withdrawal issues throughout. The results of the NDU smoking cessation program suggests that it is not inferior to the established HPB smoking cessation program. More studies should be done to identify factors leading to smoking cessation success among Naval Diver trainees compared to the established program, particularly since the NDU program was less costly and had no engagement with trained counselors.

Lessons from Singapore's national weight management program, Lose To Win.

The prevalence of overweight and obesity in Singapore is lower than in most countries, but it is increasing. There is evidence health complications may appear at lower weights among Asians. We describe the evolution of a national weight management program [Lose To Win (LTW)] organized by the Singapore Health Promotion Board from 2009 to 2013. LTW is a 12-week program comprising nutrition education, physical activity and mental wellbeing sessions and interim assessments. Individuals aged 18-69 years with a body mass index (BMI) between 23 and 37.4 kg/m2 were included. Primary outcomes were change in weight and BMI from baseline to end of 12-weeks. Effectiveness of the weight loss program was assessed using non-randomized control group (delayed intervention) during LTW 2010 and 2012. LTW 2009 enrolled 285 participants from 72 worksites. LTW 2010, expanded to the community, enrolling 952 participants (641 community-based and 311 workplace-based). In LTW 2012 and 2013, 959 and 1412 participants, respectively, were recruited from the community only. Completion rates of the 12-week program varied from 49 to 88%. Average weight loss ranged from 1.3 to 3.6 kg. For rounds including a control group, weight loss was higher in the intervention than in the control group. Competition and incentives were important motivators for participation. The LTW program was well-received and effective in producing short-term weight loss. Enhancements will be done to reinforce success factors in subsequent rounds to boost participation and follow-up rates and to ensure long-term sustainability.

Comparison of Health Related Fitness Variables between Male and Female Youths in Singapore

Physical fitness encompasses health-related fitness (HRF) variables such as cardiovascular fitness (CF), lumbar and lower limb flexibility (LLLF), muscular strength (MS) and body fat percentage (BF%). To date, no large study has been conducted on HRF variables among Singaporean youths. PURPOSE: To compare HRF variables between male and female Singaporean youths. METHODS: One thousand four hundred and fifty-six youths (762 males: age: 13.63 ± 1.35 years, height: 158.36 ± 8.75 cm, weight: 53.82 ± 14.39 kg, BF%: 17.64 ± 10.73 %; and 694 females: age: 13.34 ± 1.21 years, height: 160.73 ± 8.68 cm, weight: 48.82 ± 10.9 kg, BF%: 25.74 ± 7.87 %) from Singapore schools participated in this study. Body Mass Index (BMI) was calculated using standard methods and BF% was measured with a Tanita BC-581 FitPlus Innerscan Scale and Body Composition Monitor. CF, LLLF, and MS were tested using the 15m youth Progressive Aerobic Cardiovascular Endurance Run test (PACER), one-legged sit-and-reach test (SRT), handgrip strength test (HS), and 1-minute sit-up test (SUT) respectively. RESULTS: 76.65% of the youths (males: 77.82%, females: 82.56%) were in the healthy BMI range according to the Health Promotion Board of Singapore. Significant differences were found between males and females for all variables (BF %: Males: 17.64 ± 10.73 %, Females: 25.74 ± 7.87 %, p <0.005; SRT: Males: 52.97 ± 10.04 cm, Females: 55.53 ± 10.03 cm, p <0.005; HS: Males: 28.35 ± 7.98 kg, Females: 20.77 ± 4.11 kg, p <0.005; SUT: Males: 43.26 ± 11.29, Females: 33.24 ± 9.16, p <0.005; PACER: Males: 48.79 ± 24.93 stages, Females: 29.41 ± 12.9 stages, p <0.005). Males were significantly stronger than females, whereas females were significantly more flexible than males. CONCLUSIONS: Generally, youths in Singapore are aerobically fit, with a healthy BF% indicating low obesity rates. If these results of HRF variables are maintained throughout their lifetime, there may be low risk of cardiovascular diseases in Singapore in the future.

Transformative thinking, transformative doing

In recent years, Health Promotion Board (HPB) has made a strategic shift from a traditional health education approach to an eco-systemic approach in health promotion, where the Board engages and harnesses the collective power of the 3 Ps (People, Private, and Public). The procuring of core services is a key enabler to support HPB's focus areas in tobacco control, mental well-being, health screening, obesity prevention, nutrition, dietetic services, chronic disease education, etc. In tandem with the Board's strategic shift, the procurement function has taken on strategic importance and is now functioning as an independent department, reporting to HPB's CEO. Fundamentally, HPB Procurement Department has changed the way it interacts with the business as it stands by the belief that the real procurement value goes beyond compliance (Caldwell & Howard, 2010). “Proper”, “simpler”, “faster”, “closer” and “cheaper” are now its mantra for procurement excellence. The objective of this paper is to highlight the transformation journey that HPB's Procurement Department undertook to deliver the results, impact and value to the stakeholders.

Multisectoral approach for promoting public health.

Multisectoral approach (MSA) refers to deliberate collaboration among various stakeholder groups (e.g., government, civil society, and private sector) and sectors (e.g., health, environment, and economy) to jointly achieve a policy outcome. By engaging multiple sectors, partners can leverage knowledge, expertise, reach, and resources, benefiting from their combined and varied strengths as they work toward the shared goal of producing better health outcomes. Improving public health (PH) is challenging because of the size of its population and wide variation in geography. MSA help in addressing identified health issues in focused way as it helps in pooling the resources and formulating the common objectives. One of the major advantages is optimization of usage of resources by avoiding duplication of inputs and activities which tremendously improve program effectiveness and efficiency. Willingness at the leadership and mandate at the policy level are necessary to plan and execute the successful multisectoral coordination. All the major stakeholders require to share the common vision and perspective. Developing institutional mechanism is utmost requirement as it will standardize the processes of intersectoral coordination (ISC). Creation of PH cadre is strategic move to meet the major health challenges being faced by the health system, and it would be anchor of establishing systematic ISC. There are many national and international examples of MSA applications such as for malaria elimination, tobacco control, HIV/AIDS prevention, Finland's community-based cardiovascular disease prevention project (North Karelia Project), and Singapore's Health Promotion Board. Promotion of MSA within the health system and with other ministries is seen as an important measure for effective implementation and improving efficiency.

Health Promotion Board–Ministry of Health Clinical Practice Guidelines: Obesity

Health Promotion Board–Ministry of Health Clinical Practice Guidelines: Obesity

Whole grain intake, determined by dietary records and plasma alkylresorcinol concentrations, is low among pregnant women in Singapore.

To quantify whole grain intake in pregnant women in Singapore in order to provide the first detailed analysis of whole grain intake in an Asian country and in pregnant women. Analysis of 24-h diet recalls in a cross-sectional cohort study and analysis of a biomarker of whole grain intake (plasma alkylresorcinols) in a subset of subjects. The Growing Up in Singapore Towards healthy Outcomes-mother offspring cohort study based in Singapore. 998 pregnant mothers with complete 24-h recalls taken during their 26-28th week of gestation. Plasma samples from a randomly select subset of 100 subjects were analysed for plasma alkylresorcinols. Median (IQR) whole grain intake for the cohort and the 30% who reported eating whole grains were 0 (IQR 0, 9) and 23.6 (IQR 14.6, 44.2) g/day respectively. Plasma alkylresorcinol concentrations were very low [median (IQR)=9 (3, 15) nmol/L], suggesting low intake of whole grain wheat in this population. Plasma alkylresorcinols were correlated with whole grain wheat intake (Spearman's r=0.35; p<0.01). Whole grain intake among pregnant mothers in Singapore was well below the 2-3 (60-95 g) servings of whole grains per day recommended by the Singapore Health Promotion Board. Efforts to increase whole grain intake should be supported to encourage people to choose whole grains over refined grains in their diet.

Health Promotion Board-Ministry of Health Clinical Practice Guidelines: Obesity.

The Health Promotion Board (HPB) has developed the Clinical Practice Guidelines (CPG) on Obesity to provide health professionals in Singapore with recommendations for evidence-based interventions for obesity. This article summarises the introduction, epidemiology and executive summary of the key recommendations from the HPB-MOH CPG on Obesity for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.hpb.gov.sg/cpg-obesity. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Health Promotion Board-Ministry of Health Clinical Practice Guidelines: Falls Prevention among Older Adults Living in the Community.

The Health Promotion Board (HPB) has developed the Clinical Practice Guidelines (CPG) on Falls Prevention among Older Adults Living in the Community to provide health professionals in Singapore with recommendations for evidence-based assessments and interventions for falls prevention. This article reproduces the introduction and executive summary of the key recommendations from the HPB-MOH CPG on Falls Prevention among Older Adults Living in the Community for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.hpb.gov. sg/cpg-falls-prevention. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

An epidemiological assessment towards elimination of rubella and congenital rubella syndrome in Singapore

ObjectiveIn line with regional and global goals for the elimination of rubella and congenital rubella syndrome (CRS), we reviewed the epidemiological situation in Singapore, based on surveillance reports on rubella and CRS, national immunization coverage and seroprevalence surveys. The aim of our review was to identify current gaps and steps taken to achieve the targets set by the World Health Organization (WHO) Western Pacific Regional Office (WPRO). MethodsEpidemiological data on clinical and laboratory-confirmed rubella cases, including CRS, notified to the Communicable Diseases Division, Ministry of Health, Singapore, from 2003 to 2013 were collated and analyzed. Vaccination coverage against rubella was obtained from the National Immunization Registry and School Health Services of the Health Promotion Board. The changing prevalence of rubella was determined from periodic serological surveys. FindingsThe incidence of indigenous rubella cases per million population decreased from 37.2 in 2008 to 7.6 in 2013 and there had been no indigenous case of CRS in 2012 and 2013. Therapeutic abortions performed due to rubella infections had become uncommon. The annual measles, mumps, and rubella (MMR) vaccination coverage in childhood population remained high ranging from 93% to 96%. The overall susceptibility to rubella in women aged 18–44 years had reduced significantly from 15.8% in 2004 to 11.0% in 2010. The prevalence of IgG antibody against rubella among Singapore children aged 1–17 years was maintained at 87.3% in 2008–2010. ConclusionAll available data indicated that Singapore has made good progress towards the elimination of rubella and CRS. It has attained the targets set by the WHO WPRO for 2015. In preparation for verification of rubella elimination, an enhanced surveillance system has been implemented to ensure that all reported cases are laboratory confirmed, and genotyping of rubella virus strains isolated is carried out to provide evidence for interruption of endemic transmission.