Alcohol and drinking cultures in Vietnam: A review

Sex Differences in Clustering Unhealthy Lifestyles Among Survivors of COVID-19: Latent Class Analysis

BACKGROUND

The COVID-19 pandemic has underscored the significance of adopting healthy lifestyles to mitigate the risk of severe outcomes and long-term consequences.

OBJECTIVE

This study focuses on assessing the prevalence and clustering of 5 unhealthy lifestyle behaviors among Vietnamese adults after recovering from COVID-19, with a specific emphasis on sex differences.

METHODS

The cross-sectional data of 5890 survivors of COVID-19 in Vietnam were analyzed from December 2021 to October 2022. To examine the sex differences in 5 unhealthy lifestyle behaviors (smoking, drinking, unhealthy diet, physical inactivity, and sedentary behavior), the percentages were plotted along with their corresponding 95% CI for each behavior. Latent class analysis was used to identify 2 distinct classes of individuals based on the clustering of these behaviors: the "less unhealthy" group and the "more unhealthy" group. We examined the sociodemographic characteristics associated with each identified class and used logistic regression to investigate the factors related to the "more unhealthy" group.

RESULTS

The majority of individuals (male participants: 2432/2447, 99.4% and female participants: 3411/3443, 99.1%) exhibited at least 1 unhealthy behavior, with male participants being more susceptible to multiple unhealthy behaviors. The male-to-female ratio for having a single behavior was 1.003, but it escalated to 25 for individuals displaying all 5 behaviors. Male participants demonstrated a higher prevalence of combining alcohol intake with sedentary behavior (949/2447, 38.8%) or an unhealthy diet (861/2447, 35.2%), whereas female participants tended to exhibit physical inactivity combined with sedentary behavior (1305/3443, 37.9%) or an unhealthy diet (1260/3443, 36.6%). Married male participants had increased odds of falling into the "more unhealthy" group compared to their single counterparts (odds ratio [OR] 1.45, 95% CI 1.14-1.85), while female participants exhibited lower odds (OR 0.65, 95% CI 0.51-0.83). Female participants who are underweight showed a higher likelihood of belonging to the "more unhealthy" group (OR 1.11, 95% CI 0.89-1.39), but this was not observed among male participants (OR 0.6, 95% CI 0.41-0.89). In both sexes, older age, dependent employment, high education, and obesity were associated with higher odds of being in the "more unhealthy" group.

CONCLUSIONS

The study identified notable sex differences in unhealthy lifestyle behaviors among survivors of COVID-19. Male survivors are more likely to engage in unhealthy behaviors compared to female survivors. These findings emphasize the importance of tailored public health interventions targeting sex-specific unhealthy behaviors. Specifically, addressing unhealthy habits is crucial for promoting post-COVID-19 health and well-being.

Applying the WHO INSPIRE Framework to Ending Violence Against Pregnant Women and Unborn Children: A Case Study in Vietnam

This article adapted the INSPIRE framework, developed by the World Health Organization to prevent violence against children, to the systematic analysis of city-level healthcare services for pregnant women who experienced intimate partner violence. A mixed-methods study conducted in-depth interviews with 22 health and social care professionals and 140 pregnant women in Vietnam. The women were more likely to report limited system-level support for partners regarding violence and mental health, while the professionals perceived more weaknesses in policies and management of services. Traditional values tend to isolate abused women from receiving social services. The INSPIRE framework is innovative and could be applied in other contexts.

Longitudinal Trajectories of Alcohol Use in Vietnamese Adults with Hazardous Alcohol Use and HIV

A three-armed drinking cessation trial in Vietnam found that both a brief and intensive version of an intervention effectively reduced hazardous drinking in people living with HIV. We used group-based trajectory modeling (GBTM) to assess the extent to which findings may vary by latent subgroups distinguished by their unique responses to the intervention. Using data on drinking patterns collected over the 12 months, GBTM identified five trajectory groups, three of which were suboptimal ["non-response" (17.2%); "non-sustained response" (15.7%), "slow response" (13.1%)] and two optimal ["abstinent" (36.4%); "fast response" (17.6%)]. Multinomial logistic regression was used to determine that those randomized to any intervention arm were less likely to be in a suboptimal trajectory group, even more so if randomized to the brief (vs. intensive) intervention. Older age and higher baseline coping skills protected against membership in suboptimal trajectory groups; higher scores for readiness to quit drinking were predictive of it. GBTM revealed substantial heterogeneity in participants' response to a cessation intervention and may help identify subgroups who may benefit from more specialized services within the context of the larger intervention.

Investigating the association between alcohol intake and male reproductive function: A current meta-analysis

Background

Alcohol use and alcohol-related health problems are on the rise in developing countries. This meta-analysis was conducted to determine the effects of alcohol consumption on human male reproductive function through semen parameters, antioxidants in semen, sperm DNA fragmentation, and sex hormones.

Methods

Studies regarding the effects of alcohol consumption on male reproductive function were searched on databases. Based on the random-effects model, STATA software was used to analyze and synthesize the selected studies. Alcoholics, moderate alcoholics, heavy alcoholics, and no alcoholics values were compared using the standard mean difference. Publications were assessed for publication bias by the Egger test.

Result

Forty studies were selected from databases examining the effect of alcohol consumption on male reproductive health in 23,258 people on five continents of the world. The meta-analysis revealed that alcohol intake reduced semen volume during each ejaculation (SMD = -0.51; 95% CI -0.77, -0.25). However, there were no significant associations with other semen indicators such as density, mobility, and normal and abnormal sperm count from this analysis. In addition, drinking alcohol lowered antioxidant enzymes in semen (SMD = -7.93; 95% CI -12.59, -3.28) but had no effect on sperm DNA fragmentation. Finally, the results showed a decrease in general testosterone levels (SMD = -1.60; 95% CI -2.05, -1.15), Follicle Stimulating Hormone (SMD = -0.47; 95% CI -0.88, -0.05), Luteinizing Hormone (SMD = -1.35; 95% CI -1.86, -0.83), but no effect in other sex hormones named as estradiol, Inhibin B and Sex Hormone-Binding Globulin. Furthermore, when analyzing subgroups at different drinking levels, the results showed that the moderate alcoholic group (less than 7 units/week) had no change in the semen index. Meanwhile, the group of heavy alcoholics (more than 7 units/week) harmed the semen index and sex hormones, especially by increasing estradiol.

Conclusion

There is evidence that alcohol consumption affected semen volume and antioxidant, reproductive hormones thus negatively affecting male reproductive function. This study might be necessary to make recommendations regarding alcohol consumption for men.

Changes in alcohol-related perceptions and behavior among Vietnamese early career doctors after graduation

BACKGROUND: Vietnamese medical students believe becoming “strong” drinkers is important for their future careers working as doctors. However, it is unclear if this is a temporary behaviour associated with life as a student, or a phenomenon associated with the transition to working as a medical practitioner. OBJECTIVE: This study explored changes in alcohol-related perceptions and behaviour among Vietnamese early career doctors working after graduation. METHODS: In-depth interviews were conducted with 15 Vietnamese early career doctors in Hanoi city. Thematic analysis was used to analyse the qualitative data. RESULTS: Vietnamese early career doctors perceived binge drinking as common among doctors, especially male doctors, surgeons, and preventive medicine doctors. This perception was different from when they were medical students because, at that time, they believed doctors would not drink alcohol at hazardous levels. Additionally, Vietnamese early career doctors’ drinking behaviour changed in the frequency and quantity of alcohol consumption after graduation due to peer pressure, job stress, working collaborations, and working environment. CONCLUSIONS: Vietnamese early career doctors changed their alcohol-related perceptions and behaviour after graduation. Gender, mental health (stress), factors related to the working environment, and the role of professional relationships should be considered in strategies to reduce risky alcohol consumption among Vietnamese early career doctors.

The influence of childhood abuse and prenatal intimate partner violence on childbirth experiences and breastfeeding outcomes

BACKGROUND

Despite the detrimental effects and life-course health consequences of violence exposure, relatively few studies have adequate capacity to investigate the evolution of violence from childhood to motherhood.

OBJECTIVE

This study aims to examine the cyclical nature of childhood abuse and prenatal inter-partner violent victimization (p-IPV) and its adverse impact on childbirth trauma and exclusive breastfeeding (EBF) practice in Vietnam.

METHOD

Using a prospective birth cohort, 150 pregnant women were recruited in the third trimester of pregnancy in Hue city in central Vietnam (Wave 1-Baseline) and re-interviewed approximately three months after delivery (Wave 2-Follow-up). The direct and indirect effects of violent victimization on subsequent childbirth experience (measured by Birth Memories and Recall Questionnaire) and EBF practice were estimated by using augmented-inverse-probability-weighted models, sensitivity analysis, and structural equation model.

RESULTS

Detrimental and prolonged effects of the inter-generational cycle of violence transverse childhood to motherhood. Women who experienced either childhood abuse or p-IPV violence were more likely to experience negative emotional childbirth memories [ARR 1.21, 95 % CI (1.04, 1.39)]. Evidence also suggested that not continuing to exclusively breastfeed at 3 months post-partum was strongly associated with prenatal depression, young age, and perceived low social status during pregnancy. Perceived strong connectedness among extended family members and social networks (i.e. nexus among family, friends, and neighborhood) provided a buffering effect by preventing EBF termination.

CONCLUSION

This research provides insights into the protective role of social connectedness in improving breastfeeding practice. It is vital to establish wholistic antenatal care and social service system to offer specialized support and response for victims of violence and mitigate the long-term sequelae of traumatic events.

Trends in, projections of, and inequalities in non-communicable disease management indicators in Vietnam 2010-2030 and progress toward universal health coverage: A Bayesian analysis at national and sub-national levels

BACKGROUND

Movement towards Universal Health Coverage (UHC) can improve health services, risk factor management, and inequality in non-communicable diseases (NCD); conversely, prioritizing and monitoring NCD management can support pathways to UHC in resource-limited settings. We aimed to estimate trends in NCD management indicators in Vietnam from 2010, and projections to 2030 at national and sub-national levels; compute the probability of reaching UHC targets; and measure inequalities in NCD management indicators at demographic, geographic, and socio-economic levels.

METHODS

We included data of 37,595 households from four nationally representative surveys from 2010. We selected and estimated the coverage of NCD health service and risk management indicators nationally and by six sub-national groups. Using Bayesian models, we provided trends and projections and calculated the probability of reaching UHC targets of 80% coverage by 2030. We estimated multiple inequality indices including the relative index of inequality, slope index of inequality, and concentration index of inequality, and provided an assessment of improvement in inequalities over the study period.

FINDINGS

Nationally, all indicators showed a low probability of achieving 2030 targets except sufficient use of fruit and vegetables (SUFV) and non-use of tobacco (NUT). We observed declining trends in national coverage of non-harmful use of alcohol (NHUA), sufficient physical activity (SPA), non-overweight (NOW), and treatment of diabetes (TOD). Except for SPA, no indicator showed the likelihood of achieving 2030 targets at any regional level. Our model suggested a non-achievement of 2030 targets for all indicators in any wealth quintile and educational level, except for SUFV and NUT. There were diversities in tendency and magnitude of inequalities with widening gaps between genders (SPA, TOD), ethnic groups (SUFV), urban-rural areas (TOH), wealth quintiles, and educational levels (TOD, NUT, NHUA).

INTERPRETATION

Our study suggested slow progress in NCD management at the national level and among key sub-populations in Vietnam, together with existing and increasing inequalities between genders, ethnicities, geographic areas, and socioeconomic groups. We emphasised the necessity of continuously improving the healthcare system and facilities, distributing resources between geographic areas, and simultaneously integrating economic, education, and gender intervention and programs.

FUNDING

None.

The first years of liver transplantation: experiences at a single center

Background

The aim of this study was to analyze the first stages of progress in liver transplantation (LT) at a single center in Vietnam.

Methods

This study analyzed data from patients and donors who participated in the LT program between August 2018 and December 2021 at University Medical Center, Ho Chi Minh City. Study measures included any difficulties encountered, as well as the post-LT outcomes for living donor LT (LDLT) and deceased donor LT (DDLT). The chi-square test and Kaplan Meier survival analysis were used to test the factors that influenced the outcomes.

Results

A total of 18 adult recipients with LT (LDLT, n=16; DDLT, n=2) were included (mean age, 55.2±2.6 years; male, 88.9%). The most common post-LT complications were middle hepatic venous stenosis (20%) and graft rejection (22.2%). These complications were observed in LDLT patients. For DDLT, graft rejection (50%) was the only complication recorded. The survival rates for recipients at 3 months, 6 months, and 1 year were 100%, 88.9%, and 88.9%, respectively. The LDs had their right livers without the middle hepatic veins harvested, and biliary leakage (6.25%) was the only complication observed. There were no deaths among recipients or LDs during the operations or hospital stays.

Conclusions

This study provides key details about the process of LT, and these positive outcomes support LT as an important therapy for end-stage liver disease and early hepatocellular carcinomas.

"I refused to drink but they still forced me": A mixed-methods approach to understanding the pathways to reduce alcohol use among Vietnamese people with HIV

AIMS

This study explores the effects of two evidence-based alcohol reduction counseling interventions on readiness to change, alcohol abstinence self-efficacy, social support, and alcohol abstinence stigma among people with HIV (PWH) who have hazardous alcohol use in Vietnam.

METHODS

PWH receiving antiretroviral therapy (ART) were screened for hazardous drinking and randomized to one of three study arms: combined intervention (CoI), brief intervention (BI), and standard of care (SOC). A quantitative survey was conducted at baseline (N = 440) and 3-month post-intervention (N = 405), while in-depth interviews were conducted with a subset of BI and CoI participants at baseline (N = 14) and 3 months (N = 14). Data was collected from March 2016 to August 2017. A concurrent mixed-methods model was used to triangulate quantitative and qualitative data to cross-validate findings.

RESULTS

At 3 months, receiving the BI and CoI arms was associated with 2.64 and 3.50 points higher in mean readiness to change scores, respectively, compared to the SOC group (BI: β = 2.64, 95% CI: 1.17-4.12; CoI: β = 3.50, 95% CI 2.02-4.98). Mean alcohol abstinence self-efficacy scores were 4.03 and 3.93 points higher among the BI and CoI arm at 3 months, compared to SOC (BI: β = 4.03, 95% CI: 0.17-7.89; CoI: β = 3.93, 95% CI: 0.05-7.81). The impacts of the interventions on social support and alcohol abstinence stigma were not significant. Perceived challenges to refusing drinks at social events remained due to strong alcohol abstinence stigma and perceived negative support from family and friends who encouraged participants to drink posed additional barriers to reducing alcohol use.

CONCLUSIONS

Both the CoI and BI were effective in improving readiness to change and alcohol abstinence self-efficacy among PWH. Yet, participants still faced significant barriers to reducing their drinking due to social influences and pressure to drink. Interventions at different levels addressing social support and alcohol abstinence stigma are warranted.

The 'big four' health risk behaviors among Vietnamese adolescents: co-occurrence and socio-cultural risk factors

Background

Health Risk Behaviors (HRBs) represent significant health threats for adolescents. However, there has been relatively little research on multiple HRBs in low-and-middle-income countries (LMIC), where the majority of the world’s youth reside. This study’s objective was to investigate common HRB, their co-occurrence, and socio-demographic risk and protective factors among Vietnamese adolescents.

Methods

A cross-sectional self-report survey examined four major HRBs (tobacco use, alcohol consumption, physical inactivity, unhealthy diet) among 431 adolescents aged 15–17 years in five Vietnam provinces. Key HRB risk and protective factors assessed included perceived social norms, parental monitoring of adolescents’ behavior, and health behavior literacy.

Results

Forty-one percent of participants reported no HRB, 39% reported one, and 20% reported two or more HRBs. The four HRBs appeared to be independent, with an exploratory factor analysis indicating no common factors. The most prevalent HRB was unhealthy diet (45%), the least prevalent smoking (1%). The most frequent co-occurring HRBs were unhealthy diet and physical inactivity. Adolescents’ perceptions of norms regarding HRBs and related healthy behaviors were the most consistent risk factor for the HRB. Diet was the HRB most influenced by the social variables perceived norms, monitoring, and health literacy.

Conclusions

Results highlight the importance of future research identifying the temporal order of co-occurrence of multiple HRB, how differing conceptualizations of socio-cultural roles impact on HRB, and health-related effects of HRB co-occurrence. Such information will be useful for maximizing the efficiency and effectiveness of prevention and intervention programs in LMIC.

Alcohol and Alcohol Combined with Texting: Evaluation of Driving Impairment Effects in a Closed-Course Section

OBJECTIVE

Examine the driving impairment effects of alcohol alone and of alcohol combined with texting.

METHODS

Fifteen drivers (nine male, six female; mean age: 31.1 ± 6.9 years, range: 23 to 43 years) with similar drinking habit (i.e., social drinkers) completed a lap in a closed-course section in six different situations: (I) sober; (II) sober and while texting; (III) 30 minutes after ingesting a moderate dose of ethanol (0.50 g/kg); (IV) 30 minutes after drinking and while texting; (V) 60 minutes after drinking, (VI) 60 minutes after drinking and while texting. Driving performance was analyzed by means of maximum and mean speed, braking time and braking distance; and ability to control the car (i.e., evaluating if the drivers hit a traffic cone or exceeded the boundaries of the course). P values of < 0.05 were considered significant.

RESULTS

Pre and post-alcohol consumption results show a significant increase concerning the drivers' mean and maximum speed after drinking (p < 3.2x10^-8). However, neither alcohol nor texting had significant effects on braking parameters (p > 0.05). Traffic cones were knocked down only in texting experiments. In addition, when using the cell phone drivers tended to reduce the speed, and to accelerate abruptly right after they finish texting.

CONCLUSION

Our findings strengthen the hypothesis that even moderate alcohol doses may significantly impair the driving performance. Additionally, alcohol and texting have complementary effects on driving impairment, and their combination represents a significant risk factor for crashes.

Existential vulnerability: an ethnographic study of everyday lives with diabetes in Vietnam

This article asks: how can the concept of existential vulnerability help us to comprehend the human impact of chronic disease? Across the globe, the prevalence of chronic health conditions is rising dramatically, with wide-ranging consequences for human lives. Taking type II diabetes in northern Vietnam as its ethnographic case, this study explores how chronic health conditions are woven into everyday lives, altering subjectivities and social relations. Applying the notion of existential vulnerability as its analytical prism, the article explores three different dimensions of vulnerability: physical, emotional, and social. The analysis highlights the importance of a focus on social connectedness for comprehending the everyday impact of chronic disease and for the development of health care interventions in this domain.

Use of methamphetamine and alcohol among people with opioid use disorder and HIV in Vietnam: a qualitative study

BACKGROUND

Heroin use continues to drive HIV transmission in Vietnam, but methamphetamine and alcohol use are growing rapidly and, as in other countries, polysubstance use is widespread. The objective of this study was to understand the interplay between heroin, methamphetamine, and alcohol use among people with opioid use disorder (OUD) and HIV in Vietnam.

METHODS

We conducted 44 in-depth, face-to-face qualitative interviews with people with OUD and HIV who participated in the BRAVO trial of buprenorphine versus methadone in five Vietnam HIV clinics. Interviews probed participants' experiences of heroin, methamphetamine, and alcohol use and their interplay with HIV/OUD treatment. Interviews were professionally transcribed and analyzed using a thematic analysis approach.

RESULTS

Of 44 participants interviewed 42 were male, on average 38.8 years of age, with 30 reporting a history of methamphetamine use and 33 reporting a history of alcohol use. Several themes emerged: 1) Methamphetamine and alcohol were perceived to have lower addiction potential than heroin 2) Social settings were key facilitators of alcohol and methamphetamine use 3) Some participants, but not all, used methamphetamine to help quit heroin 4) Consuming alcohol blunted the effects of heroin, while paradoxically serving as a catalyst for heroin use 5) Use of methamphetamine was perceived by many participants to be incompatible with treatment for HIV.

CONCLUSIONS

Participant experiences reflected a significant impact of polysubstance use on treatment of HIV and OUD. Patterns of polysubstance use are subject to common preconceptions of alcohol and methamphetamine as having a low addictive potential, and these substances are deeply enmeshed in the social life of many people with OUD in Vietnam. Interventions to address complex social norms and potential harms of polysubstance use are urgently needed as the population of people receiving medication for OUD (MOUD) increases in Vietnam and globally.

TRIAL REGISTRATION

BRAVO - NCT01936857 , September 2013.

Smoking and Drinking Behaviors among Older Adults: A Comparative Analysis of Three Southeast Asian Countries

Studies on the two major health-risk behaviors of smoking tobacco and drinking alcohol among older populations, particularly in Southeast Asia, are limited. This paper provides comparative analyses of the prevalences and correlates of smoking tobacco and drinking alcohol among older people in Myanmar, Vietnam, and Thailand, using data from the latest available national aging surveys in the three countries. The analyses were conducted within a multivariate framework. Gender-specific results show that smoking tobacco and drinking alcohol are more common among older men than women in all three countries. However, the prevalence of smoking and drinking among men declines at older ages. The multivariate analyses reveal that a higher level of education has a significant negative association with smoking and drinking in all three settings, but the magnitude and the direction of associations vary considerably between countries and genders. Area of residence is correlated with smoking among men in all three countries, whereas co-residential arrangements with spouse, children, or both significantly reduce alcohol consumption among men in Myanmar and among men and women in Thailand. In all three settings a significant complementary relationship between smoking and drinking is observed. From a policy perspective this implies that a successful reduction in smoking could be achieved through anti-drinking campaigns and vice versa.

A Multiple Logistic Regression Model Based on Gamma-Glutamyl Transferase as a Biomarker for Early Prediction of Drug-Induced Liver Injury in Vietnamese Patients

The discovery of new biomarkers and the causality of drug-induced liver injury (DILI) is a major focus in modern medicine. Alcoholism is considered a risk factor for DILI. However, the extraction and assessment of alcohol history are difficult due to noncooperation by patients and intermittent management. Therefore, we conducted a case-control study of 1277 patients diagnosed with DILI according to the Roussel Uclaf Causality Assessment Method scale to evaluate gamma-glutamyl transferase (GGT) as a biomarker for predicting DILI in Vietnamese patients, where the proportion of alcoholism is quite high. Further, we built and validated a logistic regression model to predict the risk of DILI in hospitalized patients. The risk of DILI increased by 10% for 1 UI/L higher levels of GGT before prescription (odds ratio [OR], 1.01; 95% confidence interval [CI], 1.00-1.01). A history of alcoholism was not a risk factor for DILI occurrence (OR, 1.83; 95%CI, 0.99-3.04; P = .057). A logistic regression model was successfully built and validated based on age; sex; initial levels of alanine aminotransferase, alkaline phosphatate, GGT, likelihood score of the suspected drug, and history of liver disease; the area under the receiver operating characteristic curve of the model was 0.883 (95%CI, 0.868-0.897). Our results thus suggest the necessity of exercising caution when prescribing to patients without a history of alcoholism but having high GGT levels. This model can be applied clinically to assess the risk of DILI before prescribing to reduce the risk of DILI in the patient.

Prevalence and risk factors associated with alcohol consumption among indigenous people in Sabah Borneo Island

OBJECTIVES

In this study, we aimed to determine the prevalence and risk factors of alcohol use among a cohort of population in Sabah.

DESIGN

This is a prospective, cohort study involving rural community residents.

SETTING

Rural community resident at Bingkor, Keningau, Sabah.

PARTICIPANTS

363 individuals aged 13 years old and above.

INTERVENTION

Community-based participatory research to determine the prevalence and risk factors associated with alcohol use.

MAIN OUTCOME MEASURES

Measurement of alcohol use using Alcohol Use Disorders Identification Test (AUDIT) and assessment of psychiatric morbidity using Mini International Neuropsychiatric Interview (MINI) questionnaires.

RESULTS

Most alcohol drinkers aged between 36-45 years old, followed by 26-35 years old and 46-55 years old. Interestingly, there are almost similar female to male ratio. Most were Kadazan-Dusun ethnic, non-Muslims, and married. Although only less than a third of the participants received tertiary education, the majority were working. Based on the findings, being a male, non-Muslim and having an obsessive-compulsive disorder (OCD) (current) posed a significantly higher risk of alcohol consumption.

CONCLUSION

A worryingly high prevalence of hazardous alcohol consumption among the locals is reported. There is a need for population-wide intervention towards preventive measures based on the identified risk factors for hazardous alcohol use.

The longitudinal association between depression, anxiety symptoms and HIV outcomes, and the modifying effect of alcohol dependence among ART clients with hazardous alcohol use in Vietnam

INTRODUCTION

Mental health disorders may negatively impact HIV outcomes, such as viral suppression (VS) and antiretroviral (ART) adherence among people with HIV (PWH) with hazardous alcohol use. This study evaluates the longitudinal association between depression, anxiety symptoms, VS and complete ART adherence among ART clients with hazardous alcohol use in Vietnam; and examines alcohol dependence as a modifier in this association.

METHODS

This was a secondary data analysis of a trial for hazardous drinking ART clients in Thai Nguyen, Vietnam. From March 2016 to May 2018, 440 ART clients with an Alcohol Use Disorders Identification Test-Concise (AUDIT-C) score ≥4 for men and ≥3 for women were enrolled. Individuals were randomized to either a combined intervention, a brief intervention or a standard of care. Data on sociodemographics, depression, anxiety symptoms, alcohol use, VS and ART adherence were collected at baseline, three, six, and twelve months. Generalized estimating equation models controlling for intervention exposure were used to estimate time-lagged associations. Risk ratios were estimated using Poisson regression with robust variance estimation.

RESULTS

The mean age of participants was 40.2. The majority was male (96.8%), had at least some secondary school education (85.0%) and had a history of injection drug use (80.9%). No overall effect of depression and anxiety symptoms on VS was observed. When stratified by time, increased anxiety symptoms at six months were associated with VS at 12 months (adjusted risk ratio (aRR) = 1.09; 95% CI 1.02 to 1.17). An increase in depression or anxiety symptoms was associated with a decreased probability of complete ART adherence (depression symptoms: aRR = 0.95; 95% CI: 0.91 to 0.99; anxiety symptoms: aRR = 0.93; 85% CI: 0.88 to 0.99). The negative effects of anxiety symptoms on ART adherence were stronger among participants with alcohol dependence, compared to those without.

CONCLUSIONS

Depression and anxiety symptoms had no overall effect on VS, although they were associated with a lower probability of complete ART adherence. Interventions focusing on mental healthcare for PWH with hazardous alcohol use are needed, and integration of mental healthcare and alcohol reduction should be implemented in HIV primary care settings.

Intimate partner violence during pregnancy in Vietnam: role of husbands

Intimate partner violence (IPV) perpetrators are often husbands. Understanding factors pertaining to women's male partners is essential for programming interventions against IPV. The objective of the study was to describe husband-related social and behavioural risk factors and assess how they are associated with IPV during pregnancy. Cross-sectional data were collected among 1309 pregnant women with husbands in Dong Anh district, Vietnam. Information on sociodemographic characteristics of husbands, the husband's behaviour and the husband's involvement in pregnancy care was indirectly collected via women's report at first antenatal care visit. Data on exposure to intimate partner violence during pregnancy were collected when the women returned for antenatal care in 30-34 gestational weeks. Logistic regression analyses were used to measure the relationships between IPV during pregnancy and risk factors from the husband. Pregnant women who had husbands who were younger or blue-collar worker/farmer/unemployed had more likelihood to be exposed to IPV. Women with husbands who drank alcohol before sexual intercourse and gambled were more likely to be exposed to IPV repeated times. Those with husbands who had intentions of having a child had over three times increased OR to be exposed to IPV once (AOR = 3.2, 95% CI 1.1-9.7). If the husband had a preference for sons, the woman had 1.5 times increased OR (AOR = 1.5; 95% CI 1.1-1.9) to be exposed to IPV repeated times during pregnancy. This study highlights significant associations between IPV and maternal perceptions of husbands' behaviours and involvement in pregnancy. Findings may help to identify at-risk pregnant women to IPV and guide the development of targeted interventions to prevent IPV from husbands.

Implementation of two alcohol reduction interventions among persons with hazardous alcohol use who are living with HIV in Thai Nguyen, Vietnam: a micro-costing analysis

BACKGROUND

Hazardous alcohol use is detrimental to persons with HIV (PWH), impacting medication adherence and liver function, yet globally resources to target alcohol use behavior in this population are limited. Few studies have identified the costs of integrating alcohol reduction interventions into HIV care.

OBJECTIVE

To estimate the costs of implementing and delivering two evidence-based behavioral counseling interventions targeting hazardous alcohol use among persons with HIV and to estimate the costs of scale-up in ART clinics in Thai Nguyen, Vietnam.

METHODS

We undertook a micro-costing approach to determine the costs of delivering two adapted evidence-based interventions to reduce alcohol use: an intensive combined cognitive behavioral therapy and motivational enhancement therapy-informed intervention (CoI) and an abbreviated brief alcohol intervention (BI). A total of 294 participants with hazardous alcohol use were identified through a brief screening tool and received the CoI (n = 147) and the BI (n = 147) over 3 months. We estimated costs using time and motion studies, budget analysis, staff interviews, and participant questionnaires. Data were collected from 2016 to 2018 in VND and converted to USD.

RESULTS

The total cost of implementation and administration of the intervention to 147 participants receiving the CoI was $13,900 ($95 per participant) and to 147 participants receiving the BI was $5700 ($39 per participant). Implementation and startup costs including training accounted for 27% of costs for the CoI and 28% for the BI. Counselor costs accounted for a large proportion of both the CoI (41%) and the BI (30%).

CONCLUSIONS

Implementing and delivering alcohol reduction interventions to people with HIV in Vietnam with appropriate fidelity is costly. These costs may be reduced, particularly counselor labor costs, by using an evidence-based brief intervention format. Future research should explore the budgetary impact of brief and combined interventions to reduce hazardous alcohol use, particularly among vulnerable populations.

Driving after alcohol consumption: A qualitative analysis among Chinese male drunk drivers

In China, alcohol-related impaired driving has been perceived as a crucial contributor to traffic accidents. However, the topic of driving after alcohol consumption is still understudied in the country. To fill this void, the aim of this study was to find out male drivers' unique experiences of drunk driving in China. A qualitative analysis was adopted based on semi-structured interviews with 38 Chinese male drunk drivers who were serving community corrections. The findings of this study revealed that, being regular alcohol consumers, Chinese male drunk drivers had very little knowledge of the impairment caused by alcohol intake on driving. They mostly underestimated alcohol's negative influence on their driving ability and were overconfident that they would have a safe drive and would not be involved in any traffic accidents after consuming alcohol. In addition, most participants of this study reported that there was very little possibility that they would be arrested after fully assessing the situation and implementing strategies to avoid detection by traffic police. All these reasons affected these men's decision to drive drunk. Several criminological theories are applied to explain the findings and implications are finally recommended to reduce the possibility of drunk driving among Chinese men.

Alcohol use, depressive symptoms, and intimate partner violence perpetration: A longitudinal analysis among men with HIV in northern Vietnam

Background

While the link between alcohol use and male-perpetrated intimate partner violence (IPV) has been well-established, research is needed to test whether psychosocial factors interact with alcohol use to exacerbate IPV perpetration. We tested whether depressive symptoms influenced the strength and/or direction of the alcohol-IPV relationship among men with HIV in Vietnam.

Methods

This study is a secondary analysis using data from a randomized controlled trial conducted in Thai Nguyen, Vietnam. Participants were clinic patients with HIV and hazardous alcohol use. Questionnaires were administered at baseline, three, six, and 12 months. Alcohol use was assessed as proportion of days alcohol abstinent. Analyses were restricted to males who reported being married/cohabitating at baseline (N = 313). Multilevel growth models were used to test whether time-varying depressive symptoms modified the time-varying effect of alcohol use on IPV perpetration.

Results

Time-varying depressive symptoms modified the effect of proportion of days alcohol abstinent on IPV perpetration. However, the pattern of effect modification was not as expected, as reporting depressive symptoms weakened the alcohol-IPV relationship. At times when participants screened negative for depressive symptoms, those who reported higher proportion of days alcohol abstinent than usual had significantly lower odds of IPV perpetration (Odds Ratio [OR] = 0.17, 95% Confidence Interval 0.06, 0.45, p = 0.0004). At times when participants screened positive for depressive symptoms, there was no observed effect of alcohol use on IPV perpetration (OR = 4.28, 95% CI 0.80, 22.78, p = 0.09).

Conclusion

The findings highlight the complex nature of the alcohol-IPV relationship and the need to investigate the intersection between hazardous drinking, mental health, and IPV. Men who concurrently report depressive symptoms and heightened alcohol use may be socially isolated from an intimate partner or experiencing fatigue, leading to less alcohol-related IPV perpetration. Mental health interventions addressing depression and alcohol misuse integrated into HIV services may reduce IPV perpetration.

Social support modifies the association between hazardous drinking and depression symptoms among ART clients in Vietnam

INTRODUCTION

Hazardous drinking is widespread among people with HIV (PWH). PWH are also vulnerable to depression due to HIV-related social stigma, and social support can play an important role in improving mental health for this population. No studies have explored whether social support modifies the association of hazardous drinking and depressive symptoms among PWH.

METHODS

We used baseline data from a randomized controlled trial of two evidence-based alcohol reduction interventions among antiretroviral therapy clients in Vietnam. Hazardous alcohol use was defined as having a score ≥8 for men and ≥ 7 for women on the Alcohol Use Disorders Identification Test. The presence of depression symptoms was defined as a score ≥ 5 on the Patient Health Questionnaire-9. Social support was measured with a 5-question modified version of the Medical Outcomes Study Social Support Instrument. Crude (CPRs) and adjusted prevalence ratios (aPRs) of the association were presented.

RESULTS

Hazardous drinking was significantly associated with increased likelihood of having depressive symptoms (aPR = 1.26;95%CI 1.04-1.52). Hazardous drinking and depression symptoms were not associated among those with high social support (aPR = 1.01;95%CI 0.76-1.35), but were associated among those with medium (aPR = 1.24;95%CI 0.92-1.69) and low social support (aPR = 1.71;95%CI 1.25-2.34).

CONCLUSIONS

Social support significantly modified the association between hazardous drinking and depression symptoms among ART clients in Vietnam. Interventions to decrease hazardous alcohol use are broadly indicated for PWH in Vietnam and other low-resource settings, but special attention or modifications may be needed to support mental health among those with lower levels of social support.

Alcohol abstinence stigma and alcohol use among HIV patients in Thai Nguyen, Vietnam

Background

Hazardous alcohol use is prevalent among people living with HIV (PWH), leading to sub-optimal HIV treatment outcomes. In Vietnam, alcohol use is highly normative making it socially challenging for PWH to reduce or abstain. We used mixed methods to develop a quantitative scale to assess alcohol abstinence stigma and examined the association between alcohol abstinence stigma with alcohol use among PWH in Vietnam.

Methods

We conducted qualitative interviews with 30 PWH with hazardous alcohol use from an antiretroviral therapy (ART) clinic in the Thai Nguyen to inform item development. Alcohol use was assessed using the Alcohol Use Disorders Identification Test. We tested items in a survey of 1,559 ART clinic patients to assess internal consistency and structural validity. We used log binomial modeling to estimate associations between any reported alcohol abstinence stigma and alcohol use.

Results

Using the results from the qualitative interview data, we developed the alcohol abstinence stigma scale with seven final items with scores ranging from 0 (no stigma) to 28 (high stigma). The scale had good internal consistency (α = 0.75). Exploratory factor analysis suggested the presence of three factors: internalized, experienced, and anticipated stigma that explained 56.9% of the total variance. The mean score was 2.74, (SD = 4.28) and 46% reported any alcohol abstinence stigma. We observed a dose-response relationship between alcohol abstinence stigma and alcohol use. PWH who reported any alcohol abstinence stigma had greater hazardous alcohol use (aPR = 1.32, 95% CI: 1.12, 1.56), harmful alcohol use (aPR = 2.26, 95% CI: 1.37, 3.72), and dependence symptoms (aPR = 3.81, 95% CI: 2.19, 6.64).

Conclusion

Alcohol abstinence stigma is associated with increased alcohol levels of alcohol use among PWH in Vietnam, signaling challenges for alcohol reduction. Consideration of alcohol abstinence stigma will be essential for the design of effective alcohol reduction interventions and policy efforts to prevent adverse health consequences of alcohol use among PWH.

Tobacco and Alcohol Use Among Ethnic Minorities in Vietnam

This study investigates the prevalence of tobacco and alcohol uses and associated factors among 12 ethnic minorities in Vietnam in 2019. A cross-sectional survey was conducted among 5172 people aged ≥15 years. The prevalence of smoking and drinking was 19.7% and 29.9%, respectively, and significantly higher among men than women. These numbers were heterogeneous across ethnic minorities. Smoking prevalence was high among Ba Na (25.9%), Cham An Giang (22.3%), Khmer (23.5%), La Hu (26.3%), Ta Oi (30.7%), and Bru Van Kieu (29.6%) ethnicities whereas that of Gie Trieng and Mnong ethnicities was low (3.7% and 9.5%, respectively). Drinking prevalence ranged from 1.4% in Cham An Giang ethnicity to 68.6% in Ba Na ethnicity. A wide ethnic disparity on tobacco and alcohol use could be explained by the ethnic variation of lifestyles, social norms, and cultural features. Our findings suggest the need to develop ethnic-specific interventions to mitigate the smoking and drinking prevalence.

Effect of 2 Integrated Interventions on Alcohol Abstinence and Viral Suppression Among Vietnamese Adults With Hazardous Alcohol Use and HIV: A Randomized Clinical Trial

IMPORTANCE

Hazardous and heavy alcohol use is common among people living with HIV and may decrease antiretroviral therapy (ART) adherence, but limited data exist from randomized clinical trials about the effects of interventions on viral load.

OBJECTIVE

To compare the efficacy of 2 scalable ART clinic-based interventions on alcohol use and viral suppression.

DESIGN, SETTING, AND PARTICIPANTS

This 3-group randomized clinical trial was conducted among 440 adults with HIV who were being treated at 7 ART clinics in Thai Nguyen, Vietnam. Adults receiving ART with hazardous alcohol use (Alcohol Use Disorders Identification Test-Consumption score ≥4 for men or ≥3 for women) and no plans to leave Thai Nguyen were included. Data were collected from March 2016 to May 2018 and analyzed from June 2018 to February 2020.

INTERVENTIONS

Participants were randomly assigned (1:1:1) to standard of care (SOC), a combined intervention of motivational enhancement therapy and cognitive behavioral therapy (6 in-person sessions of 1 hour each and 3 optional group sessions), or a brief intervention with similar components as the combined intervention but consisting of 2 shorter in-person sessions and 2 telephone sessions.

MAIN OUTCOMES AND MEASURES

The primary study outcomes were percentage of days abstinent from alcohol, confirmed using the alcohol biomarker phosphatidylethanol, and viral suppression at 12 months after enrollment.

RESULTS

A total of 440 eligible individuals (mean [SD] age, 40.2 [5.8] years; 426 [96.8%] men) were enrolled; 147 (33.4%) were assigned to the combined intervention, 147 (33.4%) to the brief intervention, and 146 (33.2%) to SOC. In the combined intervention group, 112 participants (76.2%) attended all 6 sessions, and in the brief intervention group, 124 (84.4%) attended all 4 sessions; in the whole sample, 390 (88.6%) completed 12 months of follow-up. At 12 months, the mean (SE) percentage of days abstinent was 65% (3.1%) among those in the combined intervention group, 65% (3.2%) among those in the brief intervention group, and 50% (3.4%) among those in the in the SOC group (Cohen d for combined intervention vs SOC and brief intervention vs SOC: 39%; 95% CI, 15% to 64%). Viral suppression (ie, <20 copies of HIV-1 RNA per milliliter) at 12 months was higher after the brief intervention than SOC (difference, 11%; 95% CI, 2% to 20%), but the difference between the combined intervention and SOC was not significantly different (difference, 5%; 95%, CI, -5% to 15%).

CONCLUSIONS AND RELEVANCE

In this study, the brief intervention resulted in a significant increase in percentage of days abstinent from alcohol and a significant increase in viral suppression after 12 months. Future implementation science studies evaluating scale-up of the brief intervention are needed.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02720237.

Cultural Adaptation of 2 Evidence-Based Alcohol Interventions for Antiretroviral Treatment Clinic Patients in Vietnam

In Vietnam where alcohol use is culturally normative and little treatment is available, persons living with HIV (PLWH) who consume alcohol at unhealthy levels are at greatly increased risk for negative health outcomes. We describe the first systematic adaptation of 2 evidence-based alcohol interventions for use in Vietnam: a combined motivational enhancement therapy/cognitive behavioral therapy and a brief alcohol intervention. Using the situated information, motivation and behavioral skills model, and systematic procedures for tailoring evidence-based treatments, we identified core intervention content to be preserved and key characteristics to be tailored for relevance to the clinical setting. We describe the use of in-depth interviews with antiretroviral treatment clients and providers, expert input, and counselor training procedures to develop tailored manuals for counselors and clients. Adapting evidence-based alcohol treatments for global settings is facilitated by the use of a model of behavior change and systematic procedures to operationalize the approach.

Longitudinal analysis of alcohol use and intimate partner violence perpetration among men with HIV in northern Vietnam

BACKGROUND

Alcohol use is a known risk factor for male-perpetrated intimate partner violence (IPV), although few studies have been conducted globally and among men with HIV (MWH). We estimated the longitudinal effects of alcohol use on IPV perpetration among MWH.

METHODS

This study is a secondary analysis of randomized controlled trial data among male and female antiretroviral treatment patients with hazardous alcohol use in Thai Nguyen, Vietnam. Analyses were restricted to male participants who were married/cohabitating (N = 313). Alcohol use was assessed as proportion days alcohol abstinent, heavy drinking, and alcohol use disorder (AUD) using the Timeline Followback and Mini International Neuropsychiatric Interview questionnaire. Multilevel modeling was used to estimate the effects of higher versus lower average alcohol use on IPV perpetration (between-person effects) and the effects of time-specific deviations in alcohol use on IPV perpetration (within-person effects).

RESULTS

Participants with higher average proportion days alcohol abstinent had decreased odds of IPV perpetration (adjusted Odds Ratio [aOR] = 0.43, p = 0.03) and those with higher average heavy drinking and AUD had increased odds of IPV perpetration (Heavy drinking: aOR = 1.05, p = 0.002; AUD: aOR = 4.74, p < 0.0001). Time-specific increases in proportion days alcohol abstinent were associated with decreased odds of IPV perpetration (aOR = 0.39, p = 0.02) and time-specific increases in AUD were associated with increased odds of IPV perpetration (aOR = 2.95, p = 0.001). Within-person effects for heavy drinking were non-significant.

CONCLUSIONS

Alcohol use is associated with IPV perpetration among Vietnamese men with HIV. In this context, AUD and frequent drinking are stronger correlates of IPV perpetration as compared to heavy drinking.

Alcohol dependence and the psychological factors leading to a relapse: a hospital-based study in Vietnam

Purpose

To study the situation of alcohol relapse and to investigate the relationship between psychological factors and alcohol relapse in persons with alcohol dependence in Thai Nguyen hospitals, Vietnam.

Design/methodology/approach

A correlation study was conducted among 110 patients. Data were collected through structured interviews and were analyzed using descriptive statistics and Spearman's correlation coefficient (rs).

Findings

More than two-thirds of the participants were found to relapse more than once (X¯ = 2.04, SD = 0.86). Positive outcome expectancies, cravings, negative emotional states, and maladaptive coping were positively associated with relapse (rs = 0.550, 0.522, 0.497; p = 0.000 and rs = 0.217, p < 0.05, respectively). While, motivation to change with three subscales had a negative correlation to relapse including recognition (rs = −0.199, p < 0.05), ambivalence (rs = −0.331, p = 0.000), and taking steps (rs = −0.606, p = 0.000). Adaptive coping, self-efficacy, and social support were also found to be negatively correlated to relapse (rs = −0.535, −0.499, −0.338; p = 0.000, respectively). However, negative outcome expectancies (rs = −0.024, p = 0.805) and positive emotional states (rs = 0.081, p = 0.399) were not significantly related to relapse.

Practical implications

The findings of this study are significant implications for relapse prevention strategies. It suggests that the essential parts of relapse prevention are through: changing alcohol expectations, increase drinking refusal self-efficacy, coping skills training, enhancing motivation to change, managing alcohol craving and expanding social support.

Originality/value

This is the first study in Vietnam which investigated the relationship between psychological factors and alcohol relapse in individuals with alcohol dependence.

Explanatory variables for women's increased risk for mental health problems in Vietnam

PURPOSE

The United Nations Sustainable Development Goals include gender equality for women, including health, as one of seventeen targets. Within this broad domain, a wide range of research indicates that being female is associated with increased risk for mental health problems, particularly in low- and middle-income countries (LMIC). What is less clear are the trans-diagnostic demographic and environmental risk factors in LMIC that may underlie this increased risk. The purpose of the present study was to identify socio-economic and related disadvantages potentially underlying increased risk for women for mental health-related problems in the Southeast Asian LMIC of Vietnam.

METHODS

Nine hundred and seventy-seven adults were randomly selected from five provinces in central coastal Vietnam. Individuals were assessed cross-sectionally for depression (PHQ-9), anxiety (GAD-7), post-traumatic stress disorder symptoms (PDS), somatic syndrome (SCL-90-R), alcohol dependence (ICD-10), functional impairment (PDS life functioning section), and self-perceived general physical health (SF-36). Trans-diagnostic risk factors assessed included financial stress, education level, exposure to traumatic events, and others.

RESULTS

At the multivariate level, gender explained approximately 5% of the variance in mental health symptoms, with women significantly higher in all mental health domains except alcohol dependency. The trans-diagnostic risk factors explained slightly over half of this variance, with financial stress and lower education levels the two strongest individual explanatory variables for women's increased risk for mental health problems.

CONCLUSIONS

These results suggest that support for gender equality including in regard to economic stability and education may be critical for reducing broad gender disparities in mental health functioning.

Longitudinal Analysis of Depressive Symptoms, Perceived Social Support, and Alcohol Use among HIV-Infected Men Who Inject Drugs in Northern Vietnam

Background: Limited research examines depressive symptoms, alcohol use, and social support among HIV-infected people who inject drugs. Objectives: Using longitudinal data, we investigated whether perceived social support moderates the relationship between depressive symptoms and alcohol use among HIV-infected men who inject drugs in Vietnam. Methods: Data were collected from participants (N = 455; mean age 35 years) in a four-arm randomized controlled trial in Thai Nguyen, Vietnam. Data were collected at baseline, 6, 12, 18, and 24 months with 94% retention excluding dead (N = 103) or incarcerated (N = 37) participants. Multilevel growth models were used to assess whether: (1) depressive symptoms predict when risk of alcohol use is elevated (within-person effects); (2) depressive symptoms predict who is at risk for alcohol use (between-person effects); and (3) within- and between-person perceived social support moderates the depressive symptoms-alcohol relationship. Results: Participants reported high but declining levels of depressive symptoms and alcohol use. Participants with higher depressive symptoms drank less on average (B = -0.0819, 95% CI -0.133, -0.0307), but within-person, a given individual was more likely to drink when they were feeling more depressed than usual (B = 0.136, 95% CI 0.0880, 0.185). The positive relationship between within-person depressive symptoms and alcohol use grew stronger at higher levels of within-person perceived social support. Conclusions: HIV-infected men who inject drugs have increased alcohol use when they are experiencing higher depressive symptoms than usual, while those with higher average depressive symptoms over time report less alcohol use. Social support strengthens the positive relationship between within-person depressive symptoms and alcohol use.

Binge drinking among male medical students in Viet Nam: a qualitative exploration of norms

Alcohol is a commonly used substance among Vietnamese medical students, especially males. Vietnamese male medical students drink more alcohol, report more intentions to binge drink, and experience more alcohol-related problems than females. As medical students' alcohol consumption may influence their attitudes and medical practice relating to alcohol counseling and prevention, research about the cultural and drinking norms underlying the drinking behavior of Vietnamese male medical students is warranted. This study aims to explore the norms underlying drinking behavior of Vietnamese male medical students. A qualitative study including 32 in-depth interviews with Vietnamese male medical students at a medical university. Thematic analysis was used to analyze the data. This study found Vietnamese male medical students considered alcohol consumption as a way to show their masculinity and become accepted by groups. Given these beliefs and adherence to norms, they followed rules to force others to consume more alcohol or be intoxicated in drinking occasions among medical students. This study showed the importance of gender and group norms in influencing Vietnamese male medical students' alcohol consumption. These norms should be considered in future research and interventions addressing alcohol use among this target population.

Patterns of drinking alcohol and intentions to binge drink among medical students in Vietnam

Alcohol use is common among Vietnamese students. Previous qualitative findings showed Vietnamese medical students believed they were not binge drinkers while reporting many binge drinking occasions they participated in or witnessed. This dichotomy warrants examination. This study aims to establish drinking patterns and examine the factors underlying Vietnamese medical students' binge drinking intention and behaviour. This study used a prospective-correlational design, with two waves of data collection, drawing from established health behaviour models. At Time 1, 206 students completed the Alcohol Use Disorder Identification Test, the standard Theory of Planned Behaviour measures (attitude, subjective norm and perceived behavioural control) and their underlying beliefs, as well as group norm, role identity, drinking culture and past binge drinking behaviour. At Time 2, 156 medical students reported their binge drinking behaviour 2 weeks later. Only 6.8% of participants were classified as problematic drinkers and few participants reported binge drinking occasions at the 2-week follow-up. Perceived behavioural control, friends' group norms, role identity as future doctors, and past behaviour significantly predicted binge drinking intentions and key beliefs were identified. This study indicated Vietnamese medical students' limited engagement with binge drinking and identified key factors to address for those with risky drinking behaviour intentions.

Alcohol use disorder and alcohol withdrawal syndrome in Vietnamese hospitalized patients

AIMS

To identify the extent to which patients admitted to a general hospital in Vietnam meet the criteria for risky alcohol drinking, alcohol use disorder (AUD), and alcohol withdrawal syndrome (AWS), describe problems and behavior of alcohol use such as types and quantity of alcohol drinking in a hospitalized population in Vietnam, and investigate the association among age, disease-related factors, and alcohol consumption with AWS.

METHODS

This study was conducted prospectively in 1340 patients admitted to a general hospital. All patients were screened for risky alcohol drinking. Risky alcohol drinkers were assessed by using the Alcohol Use Disorder Identification Test (AUDIT) to identify AUD patients. The diagnosis of AWS was based on criteria defined by Diagnostic and Statistical Manual of Mental Disorders, version 5. The AWS scale was used to quantitate AWS severity level.

RESULTS

Prevalence of risky alcohol drinkers, AUD patients, and AWS patients among hospitalized patients was 15.5%, 13.1%, and 7.3%, respectively. All of the AUD and AWS patients were male. The majority of risky alcohol drinkers, patients with AUD, and patients with AWS were 40-60-year-old men. Almost all patients (98.3%) drank homemade alcohol. Hospitalized patients were more likely to develop AWS if they had liver disease or past experience with AWS.

CONCLUSIONS

AUD and AWS are common in hospitalized patients. Formulating a protocol to identify and care for patients with alcohol-related disorders is urgent.

Alcohol Use Disorder among Patients Suffered from Road Collisions in a Vietnamese Delta Province

Traffic collisions have continuously been ranked amongst the top causes of deaths in Vietnam. In particular, drinking has been recognized as a major factor amplifying the likelihood of traffic collisions in various settings. This study aims to examine the relationship between alcohol use and traffic collisions in the current context of Vietnam. A cross-sectional study was conducted on 413 traffic collisions patients in six health facilities in the Thai Binh Province to investigate the level of alcohol consumption and identify factors influencing alcohol use among these patients. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scale was used to determine the problematic drinking behavior of the participants. The percentage of patients having problematic drinking was more than 30%. Being male, having a high household income, and working as farmer/worker were risk factors for alcohol abuse. People causing accidents and patients with a traumatic brain injury had a higher likelihood of drinking alcohol before the accidents. This study highlights the necessity of more stringent laws on reducing drink-driving in Vietnam. In addition, more interventions, especially those utilizing mass media like educational campaign of good behavior on social networks, are necessary to reduce alcohol consumption in targeted populations in order to decrease the prevalence and burden of road injuries.

Global research mapping of substance use disorder and treatment 1971-2017: implications for priority setting

Background

Globally, substance use disorders are prevalent and remain an intractable public health problem for health care systems. This study aims to provide a global picture of substance use disorders research.

Methods

The Web of Science platform was used to perform a cross-sectional analysis of scientific articles on substance use disorders and treatment. Characteristics of publication volume, impact, growth, authors, institutions, countries, and journals were examined using descriptive analysis and network visualization graphs.

Results

Thirteen thousand six hundred eighty-five papers related to illicit drugs (5403), tobacco (4469), and alcohol (2137) use disorders and treatment were published between 1971 and 2017. The number of publications on Mindfulness and Digital medicine topics had the highest increase with more than 300% since 2003–2007 despite later presence than other methods. The number of papers on other non-pharmaceutical therapies (behavioral therapy, cognitive behavioral therapy, skills training or motivational interviewing) grew gradually, however, the growth rate was lower every 5-year period. The United States is the substance use disorder research hub of the world with the highest volume of publications (8232 or 60.2%) and total citations (252,935 or 65.2%), number of prolific authors (25 of top 30 or 83%) and institutions (24 of top 26 or 92%), formed the most international research partnerships (with 96 distinct countries). The international collaboration followed a pattern based on geographic proximity and cultural similarity.

Conclusions

This study offers a comprehensive picture of the global trend of publications of substance use disorder. Findings suggest a need for research policy that supports the examination of interventions that culturally adhere to different local contexts to address substance use disorder in communities.

Electronic supplementary material

The online version of this article (10.1186/s13011-019-0204-7) contains supplementary material, which is available to authorized users.

Harm from Known Others' Drinking by Relationship Proximity to the Harmful Drinker and Gender: A Meta-Analysis Across 10 Countries

BACKGROUND

Drinking is a common activity with friends or at home but is associated with harms within both close and extended relationships. This study investigates associations between having a close proximity relationship with a harmful drinker and likelihood of experiencing harms from known others' drinking for men and women in 10 countries.

METHODS

Data about alcohol's harms to others from national/regional surveys from 10 countries were used. Gender-stratified random-effects meta-analysis compared the likelihood of experiencing each, and at least 1, of 7 types of alcohol-related harm in the last 12 months, between those who identified someone in close proximity to them (a partner, family member, or household member) and those who identified someone from an extended relationship as the most harmful drinker (MHD) in their life in the last 12 months.

RESULTS

Women were most likely to report a close male MHD, while men were most likely to report an extended male MHD. Relatedly, women with a close MHD were more likely than women with an extended MHD to report each type of harm, and 1 or more harms, from others' drinking. For men, having a close MHD was associated with increased odds of reporting some but not all types of harm from others' drinking and was not associated with increased odds of experiencing 1 or more harms.

CONCLUSIONS

The experience of harm attributable to the drinking of others differs by gender. For preventing harm to women, the primary focus should be on heavy or harmful drinkers in close proximity relationships; for preventing harm to men, a broader approach is needed. This and further work investigating the dynamics among gender, victim-perpetrator relationships, alcohol, and harm to others will help to develop interventions to reduce alcohol-related harm to others which are specific to the contexts within which harms occur.

Drinking patterns vary by gender, age and country-level income: Cross-country analysis of the International Alcohol Control Study

INTRODUCTION AND AIMS

Gender and age patterns of drinking are important in guiding country responses to harmful use of alcohol. This study undertook cross-country analysis of drinking across gender, age groups in some high-and middle-income countries.

DESIGN AND METHODS

Surveys of drinkers were conducted in Australia, England, Scotland, New Zealand, St Kitts and Nevis (high-income), Thailand, South Africa, Mongolia and Vietnam (middle-income) as part of the International Alcohol Control Study. Drinking pattern measures were high-frequency, heavier-typical quantity and higher-risk drinking. Differences in the drinking patterns across age and gender groups were calculated. Logistic regression models were applied including a measure of country-level income.

RESULTS

Percentages of high-frequency, heavier-typical quantity and higher-risk drinking were greater among men than in women in all countries. Older age was associated with drinking more frequently but smaller typical quantities especially in high-income countries. Middle-income countries overall showed less frequent but heavier typical quantities; however, the lower frequencies meant the percentages of higher risk drinkers were lower overall compared with high-income countries (with the exception of South Africa).

DISCUSSION AND CONCLUSIONS

High-frequency drinking was greater in high-income countries, particularly in older age groups. Middle-income countries overall showed less frequent drinking but heavier typical quantities. As alcohol use becomes more normalised as a result of the expansion of commercial alcohol it is likely frequency of drinking will increase with a likelihood of greater numbers drinking at higher risk levels.

"[Drinking is] Like a Rule That You Can't Break": Perceived Barriers and Facilitators to Reduce Alcohol Use and Improve Antiretroviral Treatment Adherence among People Living with HIV and Alcohol Use Disorder in Vietnam

BACKGROUND

Alcohol use, a highly normative behavior in Vietnam that is associated with high rates of HIV infection and lower antiretroviral treatment (ART) adherence, has been largely overlooked by HIV prevention efforts.

OBJECTIVES

Using the risk environment framework, this qualitative study aims to explore the perceived microenvironmental (community-level) and endogenous (individual-level) barriers and facilitators to alcohol reduction among people living with HIV (PLHIV) with alcohol use disorders (AUDs) in Vietnam.

METHODS

From June-July 2014, semi-structured interviews were conducted with thirty PLHIV (18 men; 12 women) recruited from an outpatient ART clinic in Thai Nguyen province, Vietnam. All participants had scores of ≥8 on the Alcohol Use Disorders Identification Test and ten of the 30 participants were currently using injection drugs. Interviews were transcribed, translated, and analyzed to identify perceived barriers and facilitators to alcohol reduction.

RESULTS

Most participants reported a spike in alcohol consumption at the time of HIV diagnosis. Most perceived barriers existed at the microenvironmental level, including perceived inability to refuse alcohol in the context of community-level social norms and lack of alcohol treatment programs. Two commonly mentioned endogenous barriers were compensatory behaviors when reducing injection drug use and using alcohol as a coping strategy for HIV-related sadness. Those who were able to successfully reduce alcohol use and adhere to ART reported having social support to buffer community-level social pressure and cope with sadness.

CONCLUSIONS

It may be effective to introduce targeted alcohol reduction interventions in health care centers to address individual risk practices and microenvironmental social norms.

Vietnamese medical students and binge drinking: a qualitative study of perceptions, attitudes, beliefs and experience

OBJECTIVES

To explore the perceptions, attitudes, beliefs, and experiences related to Vietnamese medical students' binge drinking.

DESIGN

A qualitative study comprising semi-structured focus groups/interviews with medical students and semi-structured interviews with key informants. Thematic analysis of data.

SETTING

Participants were a convenience sample of usual volunteers from a medical university in Viet Nam.

PARTICIPANTS

19 medical students from year 1 to 6 and 4 key informants agreed to participate in the study.

RESULTS

The study found participants believe medical students drink less than other students and are not binge drinkers yet they experience and/or witness many binge drinking occasions among medical students. Participants consider alcohol use as culturally acceptable in Vietnamese society and a way for medical students to create and improve relationships with their friends, teachers, or work colleagues. Group affiliation and peer pressure to drink excessive alcohol are identified among medical students, especially male students.

CONCLUSION

The culture of drinking behaviour was explored among medical students in Viet Nam. This study reveals a dichotomy between the belief of not being binge drinkers and the experience of many binge drinking occasions among medical students. This tension suggests future research about binge drinking behaviour of Vietnamese medical students is required.

Factors Associated with Cigarette Smoking and Motivation to Quit among Street Food Sellers in Vietnam

Since 2013, smoke-free signs in public places, including in restaurants and food stores, have been introduced in Vietnam, aiming to prevent passive smoking. Although extensive research has been carried out on second-hand smoking among clients in public places (e.g., hospitals, restaurants) in Vietnam, no single study exists which captures the current practice of smoking among street food outlets. This study aims to estimate the prevalence of smoking and identify factors associated with smoking status and cessation motivation amongst food sellers in Vietnam. A cross-sectional study involving 1733 food providers at outlets was conducted in 29 districts in Hanoi capital, Vietnam, in 2015. The prevalence of smoking amongst food sellers was determined to be 8.5% (25% for men and 0.8% for women). The enforcement of the smoke-free policy remains modest, since only 7.9% observed outlets complied with the law, providing a room designated for smokers. Although approximately 80% of the participants were aware of the indoor smoke-free regulations in public places, such as restaurants and food stores, 40.2% of smokers reported no intention of quitting smoking. A percentage of 37.6% of current smokers reported that despite having intentions to quit, they did not receive any form of support for smoking cessation. Being male and having hazardous drinking habits and a poor quality of life were all factors that were significantly associated with smoking status. Additionally, having awareness of smoking’s adverse effects and being frequently supervised by the authority were associated with a greater motivation to quit. This study highlights the importance of an accompanying education and smoking cessation program in addition to the frequent inspection and reinforcement of smoke-free policy in food stores. This research extends on our knowledge of smoking prevalence and its factors related to smoking events and motivation to quit among street food outlets. Overall, this study strengthens the idea that more government efforts towards preventing passive smoking and smoking cessation education are necessary in restaurants and other street food outlets.

Alcohol and tobacco use among methadone maintenance patients in Vietnamese rural mountainside areas

Introduction

The expansion of methadone maintenance treatment (MMT) program requires more data about the factors affecting the effectiveness of treatment, especially behavioral data such as smoking and alcohol use among patients. This study aimed to examine the prevalence of tobacco and alcohol consumption and identify related factors among MMT patients in the Vietnamese rural mountainside.

Methods

We interviewed 241 MMT patients in two clinics in Tuyen Quang, a mountainous province in Vietnam. Patients were asked to report the smoking status (current smoker or not), nicotine dependence (by Fagerström test for nicotine dependence - FTND) and alcohol use (by using the Alcohol Use Disorders Identification Test – AUDIT-C). EuroQol-5 dimensions-5 levels (EQ-5D-5L) and EQ-Visual analogue scale (EQ-VAS) were employed to measure health-related quality of life. Multivariate logistic and Tobit regressions were used to identify the associated factors.

Results

The majority of respondents were current smokers (75.7%) and a low proportion were hazardous drinkers (18.3%). People receiving treatment in a rural clinic (OR = 0.45; 95%CI = 0.22–0.92) and had problems in usual activities (OR = 0.20; 95%CI = 0.06–0.70) were less likely to be smokers. Q-VAS score (Coef. = 0.03; 95%CI = 0.02–0.05) and having problems in mobility (Coef. = 0.72; 95%CI = 0.03–1.42) was found to be associated with the increase of nicotine dependence. In terms of alcohol drinking, people with other jobs were more likely to drink hazardously compared to unemployed patients (OR = 2.86; 95%CI = 1.20–6.82). Similarly, patients having higher duration of MMT had higher likelihood of being hazardous drinkers (OR = 1.07; 95%CI = 1.01–1.13).

Conclusions

This study highlights the low rate of alcohol abusers but a considerably high proportion of current smokers among MMT patients in the rural mountainside area. Alcohol and tobacco counseling programs combined with social and family support also play an essential role in alcohol and tobacco control. In addition, implementing mass community-based behavioral change campaigns to reduce drug addiction-related stigmatization should also be prioritized.

•

Rates of tobacco and alcohol use w​ere high among MMT patients in the rural mountainside area.

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The bi-directional association existed between being at risk of hazardous drinking and MMT duration.

•

A comprehensive MMT approach is needed to improve both physical and mental health outcome, which facilitates MMT patients to quit smoking and alcohol use.

•

Alcohol and tobacco counseling programs combined with social and family support are necessary.

Intravenous heroin use in Haiphong, Vietnam: Need for comprehensive care including methamphetamine use-related interventions

BACKGROUND

The aim of this study was to describe patterns among people who inject drugs (PWID), risk-related behaviours and access to methadone treatment, in order to design a large-scale intervention aiming to end the HIV epidemic in Haiphong, Vietnam.

METHODS

A respondent-driven sampling (RDS) survey was first conducted to identify profiles of drug use and HIV risk-related behaviour among PWID. A sample of PWID was then included in a one-year cohort study to describe access to methadone treatment and associated factors.

RESULTS

Among the 603 patients enrolled in the RDS survey, 10% were female, all were injecting heroin and 24% were using methamphetamine, including 3 (0.5%) through injection. Different profiles of risk-related behaviours were identified, including one entailing high-risk sexual behaviour (n=37) and another involving drug-related high-risk practices (n=22). High-risk sexual activity was related to binge drinking and methamphetamine use. Among subjects with low sexual risk, sexual intercourse with a main partner with unknown serostatus was often unprotected. Among the 250 PWID included in the cohort, 55.2% initiated methadone treatment during the follow-up (versus 4.4% at RDS); methamphetamine use significantly increased. The factors associated with not being treated with methadone after 52 weeks were fewer injections per month and being a methamphetamine user at RDS.

CONCLUSION

Heroin is still the main drug injected in Haiphong. Methamphetamine use is increasing markedly and is associated with delay in methadone initiation. Drug-related risks are low but sexual risk behaviours are still present. Comprehensive approaches are needed in the short term.