Tobacco Control Policies in Vietnam: Review on MPOWER Implementation Progress and Challenges

Patterns and determinants of tobacco purchase behaviors among male cigarette smokers in Vietnam: A latent class analysis

INTRODUCTION

Understanding smokers' purchasing patterns can aid in customizing tobacco control initiatives aimed at reducing the tobacco smoking prevalence. Therefore, this study identified cigarette purchase behavior among Vietnamese male smokers and associated demographic and consumption factors.

METHODS

We analyzed a secondary dataset of male current tobacco smokers (n=3983) who participated in the Vietnam Global Adult Tobacco Survey in 2015. We applied the latent class analysis (LCA) to identify the classes of purchase behavior among cigarette smokers (n=1241). Multinomial logistic regression was performed to identify demographics (education level, ethnicity, partnership status, and household socioeconomic status) and cigarette consumption variables (smoking years and heavy smoking status) related to purchase behavior classes. The results are reported as an adjusted relative risk ratio (ARRR).

RESULTS

The LCA identified four cigarette purchase behaviors classes: Class 1 (price-insensitive and purchased international brand: 44.4%), Class 2 (price-sensitive and purchased domestic brand: 27.6%), Class 3 (price-sensitive and purchased cigarettes in a street vendor: 18.6%), and Class 4: price-sensitive and purchased loose/carton cigarette: 9.4%). The poorer economic groups were more likely to belong to the three price-sensitive classes. Heavy smokers and those who had smoked for a longer period were more likely to belong to Class 3 (ARRR=2.33; 95% CI: 1.51-3.58 and ARRR=1.02; 95% CI: 1.001-1.05, respectively) and Class 4 (ARRR=2.94; 95% CI: 1.71-5.06 and ARRR=1.05; 95% CI: 1.02-1.08, respectively).

CONCLUSIONS

Varied purchasing behaviors among male cigarette smokers, influenced by divergent price sensitivities and economic backgrounds, underscore the need for comprehensive tobacco control. Future efforts should include targeted policy interventions, behavior modification, and reshaping social norms.

Individual-, social- and policy- factors associated with smoking cessation among adult male cigarette smokers in Hanoi, Vietnam: a longitudinal study

BACKGROUND

Nearly one-in-two Vietnamese men smoke cigarettes placing them among the highest tobacco consumers in the world. Despite the need for smoking cessation to curb the burden of tobacco-related diseases in Vietnam, this rate remains at less than 30%. Therefore, this study examines individual-, social- and policy factors associated with smoking cessation among adult male smokers in Vietnam.

METHODS

We established a longitudinal International Tobacco Control study of male smokers in Hanoi, Vietnam, in September 2018. This paper analyses 1525 men who participated in baseline and one-year follow-up. We applied a weighted multivariable logistic regression to examine the association between smoking cessation and individual-, social- and policy predictors.

RESULTS

At follow-up, 14.8% of participants had quit smoking for at least 30 consecutive days during the last year. Among the persistent smokers, 56.6% expressed intention to quit smoking. Factors associated with smoking cessation included a lower number of cigarettes smoked per day (aOR = 0.96, 95% CI: 0.94, 0.99) and having several attempts to quit smoking (aOR = 2.16, 95% CI 1.13, 4.12). Intention to quit smoking was associated with multiple quit attempts, a chronic condition diagnosis, more tobacco-related knowledge, greater self-efficacy, and more worries about their future health. The perceived impact of smoke-free policy and health warning labels were positively associated with intention to quit at any stage.

CONCLUSIONS

Interventions aimed at increasing smoking cessation should focus on all aspects of individual, social, and policy factors. Persistent smokers are more motivated to quit if they have made multiple quit attempts, more self-efficacy of quitting and worried about their future health, indicating that increasing smokers' beliefs and knowledge may be important for behavioural change. Health warning labels and tobacco taxation policies should be maintained and promoted as they are perceived to be particularly useful for persistent smokers' intention to quit.

Effects of cigarette price and packaging on hypothetical quit-smoking behaviour: a discrete choice experiment among Vietnamese adults who smoke

INTRODUCTION

Raising cigarette prices, increasing graphic health warning label (HWL) coverage and requiring plain packaging could reduce cigarette smoking in Vietnam. This discrete choice experiment estimates the potential impact of these policies on smoking behaviour.

METHODS

In February-May 2022, we conducted a phone-based, cross-sectional survey of 1494 Vietnamese adults who smoke. Participants were randomly assigned to view four individual cigarette pack images, varied on price (15 000 (reference group); 20 000; 30 000 or 40 000 Vietnamese dong (VND)) and packaging (branded pack with 50% graphic HWL (reference group); branded pack with 85% graphic HWL; plain pack with 50% graphic HWL or branded pack without HWL). Participants responded if they would quit or continue smoking if they could only purchase the pack shown. We used binomial logistic regressions to estimate the relative risk (RR) of price and packaging on hypothetical quitting.

RESULTS

Participants were more likely to report they would quit when presented with 30 000 VND (RR 1.20, 95% CI 1.07 to 1.35) and 40 000 VND packs (RR 1.40, 95% CI 1.23 to 1.58) vs the 15 000 VND pack. Participants were also more likely to report they would quit when shown the branded pack with 85% HWL (RR 1.30, 95% CI 1.18 to 1.42) and plain pack with 50% HWL (RR 1.34, 95% CI 1.21 to 1.49) vs the branded pack with 50% HWL coverage. Participants had significantly lower quit likelihood (RR 0.41, 95% CI 0.35 to 0.48) when shown the branded pack without a HWL.

CONCLUSIONS

Results suggest raising cigarette prices to at least 30 000 VND, implementing larger graphic HWLs or plain packaging could decrease smoking rates in Vietnam.

Telephone-Based Smoking Cessation Counseling Service: Satisfaction and Outcomes in Vietnamese Smokers

BACKGROUND

As a method to acknowledge the devastating health and economic impacts of tobacco usage worldwide, telephone-based tobacco cessation counseling services have emerged as a potential tool to aid people in their quitting process. This study explores the satisfaction of smokers who use the QUITLINE service and factors associated with their quit attempts and cessation.

METHODS

A cross-sectional survey of 110 participants was conducted from June to July 2016 at the Respiratory Center at Bach Mai Hospital, Hanoi, Vietnam. Multivariate logistic regression was used, and it was found that the percentage of people quitting smoking increased after using the service.

RESULTS

In total, 65.5% of participants were completely satisfied with the counseling service. The mean score of staff/s capacity/responsiveness, motivation, and service convenience were 4.37 ± 0.78, 4.30 ± 0.81, and 4.27 ± 0.66, respectively. The smoking relapse rate was relatively high at 58.3%, which mainly resulted from cravings and busy work (26.2% and 14.3%, respectively). A higher satisfaction score in "Staffs' capacity and responsiveness" was negatively associated with "ever tried to quit smoking in consecutive 24 h" and actually quit smoking after receiving counseling. Meanwhile, a higher score in the "Motivation" domain was positively associated with both quit attempt indicators as well as actually quitting smoking after receiving counseling (OR = 9.48; 95%CI = 2.27; 39.57).

CONCLUSIONS

These results suggest that it is crucial for decision makers to place more focus on countermeasures for smoking relapse and to strengthen the capacity of staff, especially in motivating clients. Interventions should also be maintained throughout a long period of time to prevent relapse.

Self-reported exposure of Indonesian adolescents to online and offline tobacco advertising, promotion and sponsorship (TAPS)

OBJECTIVES

To quantify tobacco advertising, promotion and sponsorship (TAPS), self-reported exposure from online and offline platforms among adolescents in Indonesia.

METHODS

A cross-sectional school-based survey was conducted in 2017. In total, 2820 students aged 13-18 years were recruited from 22 schools in seven cities. Respondents reported TAPS exposure on online (online news, YouTube, Facebook, Twitter and Instagram), and offline platforms (broadcast media, tobacco industry sponsored events and outdoor advertising). For outdoor advertisements, respondents reported the locations where they were exposed. We used multilevel analysis to assess TAPS exposure by age, gender, smoking status and city.

RESULTS

Online TAPS exposure was high on Instagram (29.6%), and relatively low on Twitter (7.3%). Offline TAPS exposure was high via television (74.0%), billboards (54.4%) and live music events (46.2%), but low on radio (6.9%). In all cities, outdoor advertising was seen particularly on the streets and in minimarkets. Overall, TAPS exposure was higher among older than younger adolescents, boys than girls, and smokers than non-smokers.

CONCLUSIONS

Overall TAPS exposure was high on both online and offline platforms. Banning online tobacco advertising, in addition to complete bans on outdoor and television advertising, is essential to adequately protect Indonesian adolescents from tobacco advertising.

Second-Hand Smoking Prevalence in Vietnamese Population Aged 15 and older: A Systematic Review and Meta-Analysis

Background:

Second-hand smoking (SHS) is associated with many health problems. However, its prevalence in the community population aged 15 years and older in Vietnam is unknown.

Objectives:

To quantify the prevalence of SHS in Vietnamese communities aged 15 and above.

Methods:

This is a meta-analysis that reviewed studies of the prevalence of SHS in Vietnam published in MEDLINE, Scopus, Pubmed and the WHO library database between 1 January 2010 and 31 December 2019. MedCalc was used to perform all the analyses, and publication bias was determined using funnel plots and Egger regression asymmetry tests. Q-test and I2 statistic were used to identify heterogeneity across studies.

Results:

There were 7 articles that met our inclusion criteria 2 surveys at the national level, 3 Cross-sectional studies and 2 Case-control studies) involving 184 921 participants. According to the meta-analysis, the overall random-effects pooled prevalence of SHS was 54.6% (95% CIs: 44.900-64.154) with a high level of heterogeneity ( P = .0001, Q = 2245.60, I2 = 99.73%). It is noteworthy that the pooled prevalence of SHS rose throughout the course of the survey years. Our research found no evidence of publication bias.

Conclusions:

Vietnam has ratified the implementation the WHO Framework Convention on Tobacco Control (FCTC) in 2004, there are still a large number of people who are adversely impacted by SHS. Given the tremendous cost that SHS imposes on health systems, our results underscore the critical need for the Vietnamese government to expedite an implementation of a set of stronger tobacco control practices, thus reducing the incidence of smoking-related illnesses and fatalities.

Cost-Effectiveness of Population-Based Tobacco Control Interventions on the Health Burden of Cardiovascular Diseases in Vietnam

This study sought to assess the cost-effectiveness of population-based tobacco control interventions, which included health promotion and education, smoke-free models, cessation programs, warning on package, marketing bans, and raising tax. Standardized activity-based costing ingredient approach was applied with the provider perspective to calculate interventions cost from 2013 to 2017. The potential health impacts of the aforementioned interventions were calculated through a Microsoft Excel-based modeling adapted from Higashi et al and Ngalesoni et al. All six population-based tobacco control interventions were highly cost-effective with ranges from 1405 VND (Vietnamese Dong) to 135 560 VND per DALY (disability-adjusted life year) averted. It was identified that raising cigarette taxes and applying health warnings on tobacco packages are the most favorable, cost-effective interventions. The results from this study provide a robust message that calls for increased attention and efforts in developing an appropriate policy agenda, which jointly integrates both political and community-based interventions, to maximize intervention impact on tobacco use.

Cost Analysis of Community-Based Smoking Cessation Services in Vietnam: A Cluster-Randomized Trial

The study aimed to estimate the cost for developing and implementing 2 smoking cessation service delivery models that were evaluated in a 2-arm cluster randomized trial in Commune Health Centers (CHCs) in Vietnam. In the first model (4As) CHC providers were trained to ask about tobacco use, advise smokers to quit, assess readiness to quit, and assist with brief counseling. The second model included the 4As plus a referral to Village Health Workers (VHWs) who were trained to provide multisession home-based counseling (4As + R). An activity-based ingredients (ABC-I) costing approach with a healthcare provider perspective was applied to collect the costs for each intervention model. Opportunity costs were excluded. Costs during preparation and implementation phase were estimated. Sensitivity analysis of the cost per smoker with the included intervention' activities were conducted. The cost per facility-based counseling session ranged from USD 9 to USD 11. Cost per home-based counseling session at 4As + R model was USD 4. The non-delivery cost attributed to supportive activities (eg, Monitoring, Logistic, Research, General training) was USD 107 per counseling session. Cost per smoker ranged from USD 6 to USD 451. The study analyzed and compared cost of implementing and scaling community-based smoking cessation service models in Vietnam.

Behaviors and Attitudes Toward Smoking Among Health Care Workers at Health Facilities in 4 Provinces of Vietnam: A Representative Cross-Sectional Survey

Tobacco smoking is a leading cause of premature death. Smoking prevalence in Vietnam ranks among the highest in Southeast Asia. Given the important role of health care workers (HCWs) in promoting and supporting smoking cessation, this project aimed to characterize the prevalence of smoking among HCWs in Vietnam, and their attitudes toward smoking cessation interventions. A cross-sectional survey was conducted among care workers in 4 levels of the health system, within 4 provinces of Vietnam. Descriptive statistics evaluated participant attitudes, perception, behaviors, and knowledge about smoking. Multivariable logistic regression models evaluated risk factors for smoking. Among 3343 HCWs, 7.5% identified as current smokers, comprising 22.2% males and 0.5% of females. Males had substantially greater odds (adjusted odds ratio = 55.3; 95% confidence interval = 29.0-105.6) of identifying as current smokers compared with females. HCWs in urban settings had higher odds of identifying as smokers compared with rural workers (adjusted odds ratio = 1.72; 95% confidence interval = 1.23-2.24). Strong support for smoking cessation policies and interventions were identified, even among staff who smoked. HCWs play an integral role in identifying smokers and supporting smoking cessation interventions for their patients. Efforts to support affordable smoking cessation interventions within health facilities are likely to contribute to a reduction in smoking prevalence in Vietnam.

Burden, prevention and control of tobacco consumption in Nepal: a narrative review of existing evidence

Tobacco consumption is one of the major public health problems in the world. Annually, 27 100 premature deaths are attributed to tobacco-related diseases in Nepal. Despite enacting different policies and strategies, the prevalence of tobacco consumption is still high. This study aims to synthesize prevalence, factors associated with its consumption and the policy initiatives for prevention and control in Nepal. This review includes peer-reviewed studies retrieved from two databases (PubMed and EMBASE) and published from 2000 to 2018, and policy initiatives on tobacco prevention and regulations in Nepal. A total of 32 studies and 5 policy documents were reviewed. Findings suggest that tobacco consumption was higher among men, illiterates, older people, people living in rural and mountainous areas and those who initiated smoking as adolescents. Peer pressure and parental/family smoking were major contributing factors for tobacco initiation. Policy analysis showed that low excise tax, weak monitoring mechanisms, poor compliance to bans on the advertisement and promotion of tobacco, smoke-free zones and insufficient programs on tobacco cessation were the major factors behind weak implementation of tobacco-control policies. Hence, targeted and high-risk group tobacco-cessation interventions, increasing taxation and strict policy implementation are crucial for effective tobacco prevention and control in Nepal.

Barriers and facilitators to smoking cessation among HIV-infected people who inject drugs (PWID) in Hanoi, Vietnam: a qualitative study

INTRODUCTION

In Vietnam, 60% of men living with HIV smoke tobacco, and 92% of HIV-infected people who inject drugs (PWID) smoke tobacco. Tobacco use increases mortality through increased health risks including tuberculosis and malignancy in HIV-infected smokers. However, tobacco use treatment is not widely available in Vietnam. The objective was to examine current barriers and facilitators of smoking cessation and tobacco use treatment for HIV-infected PWID in Hanoi, Vietnam.

METHODS

Native speaking ethnographers conducted semi-structured qualitative interviews about tobacco use and tobacco use treatment with sixteen HIV-infected PWID and eight healthcare providers, recruited from four HIV-Methadone Maintenance Treatment (MMT) clinics in Hanoi, Vietnam. Interviews were recorded, transcribed, and translated for thematic analysis in Dedoose.

RESULTS

Clients and providers had learned the general health risks of smoking from public awareness campaigns. Half had tried to quit previously, often motivated by advice from family members but not by HIV providers' advice. Almost all clients did not want to quit, citing the low price of tobacco, prevalence of smoking in Vietnam, and physical cravings. HIV provider's counseling was brief, inconsistent, and limited by low provider knowledge and competing burdens of HIV and injection drug use. Providers recently trained by NGO-led seminars on tobacco prioritized tobacco use treatment.

CONCLUSIONS

Smoking cessation efforts for people living with HIV/AIDS (PLHA) and PWID smokers in Hanoi, Vietnam could benefit from further community public awareness campaigns, and exploring increased tobacco taxation. Tobacco use treatment at HIV clinics could benefit from involving family and friends in cessation, and training providers in treatment methods.

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.

A qualitative assessment of factors influencing implementation and sustainability of evidence-based tobacco use treatment in Vietnam health centers

Background

Effective strategies are needed to increase implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries (LMICs). Our two-arm cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in commune health center (CHCs) in Vietnam. In this paper, we present findings from a post-implementation qualitative assessment of factors influencing effective implementation and program sustainability.

Methods

We conducted semi-structured qualitative interviews (n = 52) with 13 CHC medical directors (i.e., physicians), 25 CHC health care providers (e.g., nurses), and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. Two qualitative researchers used both deductive (guided by the Consolidated Framework for Implementation Research) and inductive approaches to analysis.

Results

Facilitators of effective implementing of TDT included training and point-of-service tools (e.g., desktop chart with prompts for offering brief counseling) that increased knowledge and self-efficacy, patient demand for TDT, and a referral system, available in arm 2, which reduced the provider burden by shifting more intensive cessation counseling to a trained VHW. The primary challenges to sustainability were competing priorities that are driven by the Ministry of Health and may result in fewer resources for TDT compared with other health programs. However, providers and VHWs suggested several options for adapting the intervention and implementation strategies to address challenges and increasing engagement of local government committees and other sectors to sustain gains.

Conclusion

Our findings offer insights into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, the results illustrate the dynamic interplay between barriers and facilitators for sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems like Vietnam’s. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, and planning for adaptations and subsequent resource allocations in order to meet the World Health Organization’s goals promoting access to effective treatment for all tobacco users.

Trial registration

NCT02564653, registered September 2015

Passive Smoking Exposure and Perceived Health Status in Children Seeking Pediatric Care Services at a Vietnamese Tertiary Hospital

Understanding the predictors of health conditions and exposure to secondhand smoke among children is necessary to determine the severity of the issues and identify effective solutions. Despite the significant prevalence in smoking and child exposure to secondhand smoke, there have been only a few studies focusing on this area in Vietnam, and thus the current study aims to fill in this gap. The questionnaires of 435 children aged between 0 and 6 and their caregivers, who agreed to participate in the research, were collected at the Pediatric Department of Bach Mai hospital, Hanoi, in 2016. Multivariable logistic regression was employed to identify factors associated with perceived health status and exposure to secondhand smoke among children in the last 24 h and the last 7 days from the date of the survey. Our study found that 43% of the respondents had smokers in the family, and 46.4% of children were exposed to passive smoking in the last 7 days. Urban children were most frequently exposed to passive smoking at home and in public, whereas in the rural area, the home and relatives’ houses were the most common places for exposure. Compared to children whose caregivers were farmers, children of non-government workers were more likely to be exposed to passive smoking in the last 7 days. Moreover, children in a family having smoking rules and no smokers were less likely to be exposed to passive smoking in the last 24 h and 7 days than those living in a family allowing smoking and having smokers. In conclusion, our study shows that the government needs to implement better public smoking monitoring and encourage caregivers to implement smoke-free households or smoking rules in their houses.

Projecting Cancer Incidence for 2025 in the 2 Largest Populated Cities in Vietnam

The population size and projected demographics of Vietnam's 2 largest cities, Ho Chi Minh City (HCMC) and Hanoi, will change dramatically over the next decade. Demographic changes in an aging population coupled with income growth and changes in lifestyle will result in a very different distribution of common cancers in the future. The study aimed to project the number of cancer incidence in the 2 largest populated cities in Vietnam for the year 2025. Cancer incidence data from 2004 to 2013 collected from population-based cancer registries in these 2 cities were provided by Vietnam National Cancer Institute. Incidence cases in 2013 and the previous decades average annual percent changes of age-standardized cancer incidence rates combined with expected population growth were modeled to project cancer incidence for each cancer site by gender to 2025. A substantial double in cancer incidence from 2013 to 2025 resulted from a growing and aging population in HCMC and Hanoi. Lung, colorectum, breast, thyroid, and liver cancers, which represent 67% of the overall cancer burden, are projected to become the leading cancer diagnoses by 2025 regardless of genders. For men, the leading cancer sites in 2025 are predicted to be lung, colorectum, esophagus, liver, and pharynx cancer, and among women, they are expected to be breast, thyroid, colorectum, lung, and cervical cancer. We projected an epidemiological transition from infectious-associated cancers to a high burden of cancers that have mainly been attributed to lifestyle in both cities. We predicted that with 16.9% growth in the overall population and dramatic aging with these 2 urban centers, the burdens of cancer incidence will increase sharply in both cities over the next decades. Data on projections of cancer incidence in both cities provide useful insights for directing appropriate policies and cancer control programs in Vietnam.

Cancer Attributable to Tobacco Smoking in Member Countries of Association of Southeast Asian Nations (ASEAN) in Year 2018

South East Asia is one of the world's largest tobacco epidemic regions which tobacco smoking is known increase the risk of various diseases, including cancer. As data from GLOBOCAN 2018 has had released on September 2018, the aim of this study are to calculate the estimated burden of several types of cancer attributable to tobacco smoking in Association of Southeast Asian Nations (ASEAN) 2018 and compare it with established result data in 2012. So it can be highlight what has been achieved and what it needs to be addressed by member countries of ASEAN to strengthen cancer prevention against tobacco smoking. This study was using descriptive epidemiological incidence and prevalence-based research design to estimate the burden of 14 types of cancer attributable to tobacco smoking in member countries of ASEAN, in term of incidence and mortality. The cancer incidence and mortality data gained from GLOBOCAN 2018. According to the estimation, tobacco smoking was responsible for 121,849 new cancer cases in 2018 (106,858 male and 14,991 female cases) in ASEAN 2018. Our findings are mostly lower than previous study in 2012, both for cancer incidence and mortality in male and female. It seems more ASEAN member states are adopting effective policies in the MPOWER suite of interventions such as raising taxes on tobacco, establishing smoke-free areas and implementing graphic health warnings in decreasing number of tobacco smoking. Therefore, ASEAN member countries are strongly encouraged to strengthen the existing tobacco control measure in order to effectively gain a significant decline of tobacco smoking related cancer in the future.

Impact of a Smoking Cessation Quitline in Vietnam: Evidence Base and Future Directions

Smoking is considered the most critical modifiable factor with regard to lung cancer and remains a public health concern in many countries, including Vietnam, which is among those countries with the highest tobacco consumption rates in the world. This study has examined the impact of national telephone counselling for smoking cessation and has identified the factors associated with the impact of the quitline among male callers in Vietnam. A randomized cross-sectional survey of 469 smokers who sought smoking cessation services via the national quitline was performed from September 2015 to May 2016. The primary outcomes were measured by a self-reported quit rate at the time of assessment, 7 day point prevalence abstinence (PA), 6 month prolonged PA, service satisfaction, and level of motivation. Among the participants, 31.6% were abstinent, and 5.1% of participants successfully stopped smoking and did not need to seek quitline support. Most of the clients were satisfied with the quality of service (88.5%), felt more confident about quitting (74.3%), and took early action via their first quit attempt (81.7%); 18.3% reported a more than 7 day abstinence period at the time of survey. The primary reasons for smoking relapse were surrounding smoking environments (51.6%) and craving symptoms (44.1%). Future smoking cessation efforts should focus on improving the quality of quitline services, client satisfaction, and developing a tailored program and counseling targeting smokers with specific characteristics, especially ones experiencing chronic diseases.

Secondhand Smoke Exposure During Pregnancy and Mothers' Subsequent Breastfeeding Outcomes: A Systematic Review and Meta-Analysis

Secondhand smoke exposure of non-smoking women during pregnancy is associated with a higher risk of adverse birth outcomes. However, the available evidence regarding the association between expectant mothers’ secondhand smoke exposure and breastfeeding outcomes remains limited. This systematic review aimed to examine associations between secondhand smoke exposure of nonsmoking women during pregnancy with the initiation, prevalence, and duration or breastfeeding compared to women who were breastfeeding and had not been exposed to secondhand smoke. Women who smoked during pregnancy were excluded. We included case-control, cross-sectional, and cohort studies with a comparison control group. Medline CINAHL, and EMBASE were searched in January 2017. After screening 2777 records we included eight prospective cohort studies. The risk of bias assessment tool for non-randomized studies indicated a high risk of outcome assessment blinding. Meta-analysis of two studies established that the odds of discontinuation of any brestfeeding before six months were significantly increased in the secondhand smoke exposed women (pooled odds = 1.07 [95%CI = 1.01, 1.14], two studies, 1382 women). Therefore, secondhand smoke might be associated with discontinuing any breastfeeding before six months. More research is necessary to understand the association between secondhand smoke and the initiation, prevalence and duration of breastfeeding.

Acculturation and Exposure to Secondhand Smoke in the Home Among Vietnamese Immigrants in Metropolitan Atlanta

This study represents the first effort to examine associations between various measures of acculturation and past 30-day secondhand smoke (SHS) exposure among Vietnamese-Americans in metro-Atlanta, one of the areas with the highest number of Vietnamese-Americans in the U.S. Survey data of 96 Vietnamese-American nonsmoking adults attending health fairs/programs hosted by community-based organizations (2017-2018) were analyzed. Acculturation-related predictors included Vancouver Acculturation Index, language fluency, years in the U.S., and area-level proportion of Asian residents. The sample was an average 37.49 years old and 65.3% female; the average number of years in the U.S. was 18.17 years. Past 30-day SHS exposure was reported by 21.9%. In multiple logistic regressions, the only variable associated with SHS exposure was the number of years living in the U.S. [OR = 0.91, CI = (0.85-0.99), p = 0.02]. Newly-immigrated Vietnamese-Americans have increased SHS exposure risk. Education about smoke-free policies and harmful effects of SHS may benefit this population.

Impact of the WHO FCTC on non-cigarette tobacco products

INTRODUCTION

This paper investigates to what extent Framework Convention on Tobacco Control (FCTC) parties have successfully implemented regulatory measures against non-cigarette tobacco product (NCTP) use, considers the challenges and peculiarities in applying such regulations and proposes effective means.

DATA AND METHODS

This review was based on many sources mainly: International Legal Consortium, International Tobacco Control, Campaign for Tobacco-Free Kids, FCTC, expert group visits and published literature.

FINDINGS AND CONCLUSION

The FCTC provided a framework that applies to all forms of tobacco and this encouraged some parties to adopt control measures against NCTP and to incorporate them into their national tobacco control plans. Although a number of countries have adopted measures specifically targeted towards smokeless and waterpipe tobacco, greater global progress is needed. The strongest achievements have been in protection from exposure to tobacco smoke; controlling advertising, promotion and sponsorship; controlling sales to and by minors; education, communication and public awareness; and packaging and labelling of NCTP. Countries which adopted broad definitions of tobacco products have demonstrated encouraging trends in curbing their use. Future work should address the deep-rooted social acceptance of NCTP, the laxity in their control, their exclusion from regulations in some countries and the failure to subject them to increased taxation. Control measures should also specifically target the initiation risk to youth and adolescents and all factors that contribute to that such as banning flavourings and promotions through social media. Stronger global surveillance of NCTP use, tracking of policy implementation and evaluation of policy impact will provide important evidence to assist parties in fully implementing the FCTC to control their use.

Correlated Factors with Quitting Attempts Among Male Smokers in Vietnam: A QUITLINE-Based Survey

Despite its decreasing prevalence, cigarette smoking remains the second leading cause of preventable death worldwide. In Vietnam, despite recent smoking cessation efforts, the prevalence of tobacco consumption remains high, particularly among males. In this study, we aim to evaluate the self-efficacy in quitting smoking (i.e., quitting confidence), intention to quit, and identifying associated factors among both rural and urban Vietnamese male populations. A cross-sectional study was conducted on 321 patients (52.7% urban and 47.4% rural inhabitants) who utilized QUITLINE services of Bach Mai Hospital (Hanoi, Vietnam). Socio-economic status, smoking history, cigarette usage data, and intent to quit were assessed. Baseline data were correlated with quitting confidence, to identify significant associated factors. The majority (75.9%) of participants were in the planning phase of cessation, yet 90.8% lacked complete confidence in their quitting ability. Older age, fewer cigarettes per day and previous quitting attempts were associated with quitting confidence (p < 0.05) and plans to quit (p < 0.05). Older smokers and previous quitters were more confident in their ability to quit in the near future and more likely to have made plans to quit. Future smoking cessation efforts should focus on improving self-efficacy, particularly among younger and newer smokers.

Customers' Perceptions of Compliance with a Tobacco Control Law in Restaurants in Hanoi, Vietnam: A Cross-Sectional Study

The Tobacco Harm Prevention Law has been promulgated in 2012 in Vietnam, prohibiting smoking in public places such as restaurants except for designated smoking areas. However, currently, evidence about Vietnamese customers’ and restaurants’ compliance with the Law is constrained. This study aimed to explore customers’ perceptions; attitudes and practices towards the compliance with tobacco control regulations in the restaurants in Hanoi, Vietnam. A cross-sectional study was performed in October 2015 with 1746 customers in 176 communes in Hanoi, Vietnam. Data about customers’ perceptions on how restaurants comply with the smoking control law and whether customers smoking actively or experienced SHS in restaurants in the last 30 days were collected. Multivariable mixed effects logistic regression model was used to determine the factors related to smoking in the restaurant. Most customers were aware of the law on Tobacco Harm Prevention (79%; n = 1320) and regulations that prohibited smoking in restaurants (78.4%; n = 1137). While 75.8% (n = 1285) of customers perceived that they did not see or rarely saw no-smoking signs, 17.7% (n = 481) of customers reported that they frequently saw direct marketing of tobacco in visited restaurants. About one-fourth of customers witnessed that the staff reminded customers not to smoke inside restaurants (28.8%; n = 313), and 65% (n = 1135) sometimes or always were exposed to secondhand smoke in their visited restaurants. People who were female (OR = 0.02, 95% CI = 0.01⁻0.05) were less likely to report their smoking in the restaurant than their counterparts. Those having higher age (OR = 1.03; 95% CI = 1.01⁻1.06), high school education (OR = 2.14, 95% CI = 1.07⁻4.26), being office workers (OR = 3.24, 95% CI = 1.33⁻7.92) or unemployed (OR = 4.45; 95% CI = 1.09⁻18.15) had a higher likelihood of reporting to be restaurant smokers than those having lower high education or students, respectively. This study highlighted a low level of perceived compliance with the smoke-free law in Vietnamese restaurants. Improving the monitoring systems for the enforcement of the smoking law in restaurants should be prioritized; restaurant owners should implement 100% smoke-free environments as following the best practice towards the tobacco control law along with educational campaigns to promote the awareness of restaurant owners and customers about the tobacco control law.

Application of the Consolidated Framework for Implementation Research to assess factors that may influence implementation of tobacco use treatment guidelines in the Viet Nam public health care delivery system

Background

Services to treat tobacco dependence are not readily available to smokers in low-middle income countries (LMICs) where smoking prevalence remains high. We are conducting a cluster randomized controlled trial comparing the effectiveness of two strategies for implementing tobacco use treatment guidelines in 26 community health centers (CHCs) in Viet Nam. Guided by the Consolidated Framework for Implementation Research (CFIR), prior to implementing the trial, we conducted formative research to (1) identify factors that may influence guideline implementation and (2) inform further modifications to the intervention that may be necessary to translate a model of care delivery from a high-income country (HIC) to the local context of a LMIC.

Methods

We conducted semi-structured qualitative interviews with CHC medical directors, health care providers, and village health workers (VHWs) in eight CHCs (n = 40). Interviews were transcribed verbatim and translated into English. Two qualitative researchers used both deductive (CFIR theory driven) and inductive (open coding) approaches to analysis developed codes and themes relevant to the aims of this study.

Results

The interviews explored four out of five CFIR domains (i.e., intervention characteristics, outer setting, inner setting, and individual characteristics) that were relevant to the analysis. Potential facilitators of the intervention included the relative advantage of the intervention compared with current practice (intervention characteristics), awareness of the burden of tobacco use in the population (outer setting), tension for change due to a lack of training and need for skill building and leadership engagement (inner setting), and a strong sense of collective efficacy to provide tobacco cessation services (individual characteristics). Potential barriers included the perception that the intervention was more complex (intervention characteristic) and not necessarily compatible (inner setting) with current workflows and staffing historically designed to address infectious disease prevention and control rather than chronic disease prevention and competing priorities that are determined by the MOH (outer setting).

Conclusions

In this study, CFIR provided a valuable framework for evaluating factors that may influence implementation of a systems-level intervention for tobacco control in a LMIC and understand what adaptations may be needed to translate a model of care delivery from a HIC to a LMIC.

Trial registration

NCT02564653. Registered September 2015

Prevalence of tobacco smoking in Vietnam: findings from the Global Adult Tobacco Survey 2015

OBJECTIVES

We report the prevalence of tobacco smoking among adult populations in Vietnam, 2015.

METHODS

The Vietnam GATS 2015 was a nationally representative survey. 9513 households were selected using two-stage random systematic sampling method. Handheld computers were used for capturing data. Data collection was carried-out by National Statistics Office of Vietnam in 2015. Weight was used in all estimates.

RESULTS

The Vietnam GATS 2015 found that the prevalence of smoking in Vietnam was 22.5% overall, 45.3% among men, and 1.1% among women. The overall 2015-2010 reduction in prevalence of any tobacco product was 5.3%. However, the reduction was not statistically significant. The significant reduction in prevalence of tobacco smoking was found for any type of cigarette (-8.4%), and especially for hand-rolled cigarettes (-38.3%). The use of cigarettes significantly decreased in urban areas (-14.7%).

CONCLUSION

The reduction in the prevalence of tobacco smoking in Vietnam during the last 5 years (2010-2015) has not been as high as expected, especially in rural areas. Further efforts are needed to continue to reduce the harms caused by tobacco smoking.

Smoking Initiation and Cessation among Youths in Vietnam: A Longitudinal Study Using the Chi Linh Demographic-Epidemiological Surveillance System (CHILILAB DESS)

Study of smoking initiation and cessation is particularly important in adolescent population because smoking prevention and cessation at this time may prevent several health consequences later in life. There is a very limited knowledge about the determinants of smoking initiation and cessation among youths in Vietnam. This limits the development and implementation of appropriately targeted anti-smoking prevention interventions. This study applied pooled data from 3 rounds of a longitudinal survey in the Chi Linh Demographic—Epidemiological Surveillance System (CHILILAB DESS) in a northern province in Vietnam to analyse the determinants of smoking initiation and cessation among youths. The total of youths in the first round, second, and third rounds was 12,406, 10,211, and 7,654, respectively. The random-effects logit model controlling for both time-variant and time-invariant variables was conducted to explore the associated factors with new smokers and quitters. We found an increase trend of new smokers (7.0% to 9.6%) and quitters (27.5% to 31.4%) during 2009–2013. Smoking initiation and cessation are the result of multifactorial influences of demographic and health behaviours and status. Demographic background (older youths, male, unmarried youths, and youths having informal work) and health behaviours and status (youths who had smoking family members and/or smoking close friends, and had harmful drinking) were more likely to initiate smoking and more difficult to quit smoking. Among these variables, youths who had smoking close-friends had the highest likelihood of both initiating smoking and failed quitting. Our results could represent the similar health problems among youths in peri-urban areas in Vietnam. Further, our findings suggested that anti-smoking interventions should involve peer intervention, integrated with the reduction of other unhealthy behaviours such as alcohol consumption, and to focus on adolescents in their very early age (10–14 years old).