Tobacco and electronic cigarette smoking among in-school adolescents in Vietnam between 2013 and 2019: prevalence and associated factors.

BACKGROUND: Smoking among adolescents in schools is a major global public health concern. There is limited evidence regarding prevalence and associated factors in Vietnam. OBJECTIVE: To compare the prevalence of smoking and associated factors among in-school adolescents aged 13-17 years in Vietnam between 2013 and 2019. METHODS: Data were collected from two rounds of the national representative Vietnam Global School-based Student Health Survey (GSHS) conducted in 2013 (n = 3,331) and 2019 (n = 7,690). Logistic regression was used to identify the factors associated with tobacco and electronic cigarette smoking among in-school adolescents. RESULTS: There was a significant reduction in the prevalence of current smoking (water pipes and cigarettes) from 5.4% (95% CI: 4.0-7.2) in 2013 to 2.8% (95% CI: 2.2-3.6) in 2019. In 2019, 2.6% of the in-school adolescents reported having used electronic cigarette products 30 days prior to the survey. Factors associated with a significantly higher likelihood of current smoking status included gender, loneliness, suicidal ideation, sexual activity, truancy, and alcohol consumption. Similar patterns were observed for e-cigarettes. CONCLUSION: Smoking among in-school adolescents in Vietnam decreased between 2013 and 2019. Follow-up studies are needed to further investigate causal factors so that future policies and communication programmes can be more effectively targeted to reduce smoking in adolescents.

Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019.

BACKGROUND: Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam. METHODS: We analyzed data of 7,541 adolescents aged 13-17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models. FINDINGS: The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 - 0·93; females: OR = 0·69, 95% HDI: 0·47 - 0·98). INTERPRETATION: Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence. FUNDING: The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.

Association between early essential newborn care and breastfeeding outcomes in eight countries in Asia and the Pacific: a cross-sectional observational -study.

OBJECTIVE: To explore the association between early essential newborn care (EENC) policy, practice and environmental interventions and breastfeeding outcomes. DESIGN: Cross-sectional observational study. SETTING: 150 national, provincial and district hospitals implementing EENC in eight countries in East Asia and the Pacific. PARTICIPANTS: 1383 maternal interviews, chart reviews and environmental assessments during 2016 and 2017. MAIN OUTCOME MEASURES: Exclusive breastfeeding (EBF), that is, feeding only breastmilk without other food or fluids since birth and before discharge, and, early breastfeeding initiation, that is, during skin-to-skin contact (SSC) with the mother without separation. RESULTS: Fifty-nine per cent of newborns initiated breastfeeding early and 83.5% were EBF. Duration of SSC showed a strong dose-response relationship with early breastfeeding initiation. SSC of at least 90 min was associated with 368.81 (95% CI 88.76 to 1532.38, p<0.001) times higher early breastfeeding. EBF was significantly associated with SSC duration of 30-59 min (OR 3.54, 95% CI 1.88 to 6.66, p<0.001), 60-89 min (OR 5.61, 95% CI 2.51 to 12.58, p<0.001) and at least 90 min (OR 3.78, 95% CI 2.12 to 6.74, p<0.001) regardless of delivery mode. Non-supine position (OR 2.80, 95% CI 1.90 to 4.11, p<0.001), rooming-in (OR 5.85, 95% CI 3.46 to 9.88, p<0.001), hospital breastfeeding policies (OR 2.82, 95% CI 1.97 to 4.02, p<0.001), quality improvement mechanisms (OR 1.63, 95% CI 1.07 to 2.49, p=0.02) and no formula products (OR 17.50, 95% CI 5.92 to 51.74, p<0.001) were associated with EBF. CONCLUSION: EENC policy, practice and environmental interventions were associated with breastfeeding outcomes. To maximise the likelihood of early and EBF, newborns, regardless of delivery mode, should receive immediate and uninterrupted SSC for at least 90 min.

Secondhand Tobacco Smoke Exposure in Indoor Workplaces in Viet Nam and Associated Factors: Findings from Two Rounds of Global Adult Tobacco Surveys (GATS) 2010 and 2015.

OBJECTIVES: This paper explores changes in the level of secondhand smoke (SHS) exposure at indoor workplaces between 2010 and 2015 in Viet Nam and the association between the exposure and various demographic factors, using data from Viet Nam's Global Adult Tobacco Surveys (GATS) 2010 and 2015. METHODS: Data was pooled from the two GATS surveys and analysed using descriptive and Poisson regression analyses. RESULTS: There was a highly statistically significant reduction in the level of SHS exposure at indoor workplaces from 55.9% to 42.6% (p.

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.

Methodology for the Global Youth Tobacco Use Survey (GYST), Vietnam, 2014.

Viet Nam is a country with the highest rate of adult male smokers in the world. In 2010, the percentage of adult male smokers was 47.4%. Each year in Viet Nam, there are 40,000 lives lost from tobacco-related diseases. The Global Tobacco Youth Survey is an international standardized survey that has been conducted in more than 140 countries. To provide evidence for tobacco control, Viet Nam already conducted two rounds of GYTS in 2003 and 2007. The GYTS in 2014 is the survey's third iteration. This paper aims to document key methodological details and socio-demographic characteristics of the respondents included in the 2014 GYTS in Viet Nam. This survey followed international protocol and was conducted in 13 provinces representative of 6 geographical regions. A total of 3,430 school children, aged 13 to 15 years used a standardized answer sheet to answer 76 questions about seven tobacco-related topics, including prevalence of tobacco use, environmental tobacco smoke, access and availability, media and advertisement, cessation, knowledge and attitudes, tobaccorelated school curriculum. This GYTS provides valid and reliable data for monitoring tobacco use among youth in Vietnam and is recommended to be regularly repeated.

Cigarette Smoking among Adolescents aged 13-15 in Viet Nam and Correlates of Current Cigarette Smoking: Results from GYTS 2014 Data.

The aim of this paper is to report the rate of current and ever cigarette smoking and explore correlates of current cigarette smoking among adolescents aged 13-15 in Viet Nam. This analysis was derived from GYTS survey, which comprised of 3,430 adolescents aged 13-15, conducted in 2014 in 13 cities and provinces of Viet Nam. We calculated the weighted rates of current and ever cigarette smoking and reported patterns of smoking behavior. We also performed logistic regression to explore correlates of current cigarette smoking behavior. The weighted rate of ever cigarette smoking was 9.5% (95% confidence interval (CI): 8.5 %-10.5%), in which the weighted rate among males (15.4%; 95% CI: 13.6%-17.0%) was higher than that among females (4.2%; 95% CI: 3.3%-5.1%). The weighted rate of current cigarette smoking was relatively low at 2.5% (95%CI: 2.0%- 3.0%) with higher weighted rate among males (4.9%; 95% CI: 3.8%-5.9%) compared to the corresponding figure among females (0.2%; 95% CI: 0.0 %-0.5%). Current cigarette smoking was significantly higher among males than females, in students aged 15 versus 13 years old, and in students who had several or all close friends smoking and students with daily observation of smoking at school. For greater smoking reduction outcomes, we recommend that tobacco interventions for adolescents should consider targeting more male students at older ages, establish stricter adherence to school-based banning of cigarette smoking, engage both smoking and nonsmoking adolescents and empower adolescents to resist peer smoking influence as well as changing their norms or beliefs towards smoking benefits.

Tobacco Access and Availability for Vietnamese School Children (aged 13-15): Results from the Global Youth Tobacco Use Survey (GYTS) 2014 in Viet Nam.

Efforts to reduce tobacco use among school children need to be based on understanding of access to cigarettes by these subjects because previous studies indicated that enforcement of laws for controlling tobacco sales seems to not affect teen/school children because they can obtain cigarettes from different sources. This paper aims to describe access to and availability of cigarettes among school students (aged 13-15 years old) according to the data from GYTS Vietnam 2014. In GYTS, a national school-based survey of students of grades 8-10, our findings showed that about 15% school children are current smokers who smoke at home, and that they could easily buy cigarettes from stores (63.2%), or someone else (27.8%), or street vendors (9%). Notably, over 85% of school children answered that they were not refused because of their age. This high percentage was nearly the same in the North (85.7%), the Centre (92.5%), and the South (89.7%) of Viet Nam. These findings show that it is quite easy for school children to obtain cigarettes and this is a crucial challenge for policy makers aiming to reduce tobacco use among youth in general and school-age students in particular.

Access to Anti-smoking Information among School Children and its Potential Impact on Preventing Smoking Initiation: Results from the Global Youth Tobacco Use Survey (GYTS) 2014 in Viet Nam.

Scientific evidence on all aspects of smoking amongst youth is very important for designing appropriate interventions to reduce smoking among this vulnerable population. This paper describes current access to antismoking information among school children aged 13 to 15 years in Vietnam in 2014 and examines its potential impact on preventing smoking initiation. The data used in this paper were obtained from the 2014 Global Youth Tobacco Survey (GYTS) in Vietnam. Students were asked questions about their level of awareness of anti-smoking information from various sources in the past 30 days and about lessons in school regarding the dangers of tobacco use during the last 12 months. Those who have never smoked were asked "whether or not they thought about avoiding cigarettes because of health warnings on cigarette packages" and answers were analyzed in combination with data on access to anti-smoking information from other sources. The prevalence of exposure to antismoking campaigns was high among school children in Viet Nam: 55.3% of current smokers reported thoughts of smoking cessation because of health warnings on cigarette packages; 60.5% of never smokers avoided initiating smoking because of the same health warnings. The potential impact of graphic health warnings to prevent school-aged children from smoking initiation would be stronger if there was concurrent access to anti-smoking programs on the dangers of tobacco use in schools. However, school education for tobacco prevention and control has not been as strong as expected. A more comprehensive school curriculum on tobacco prevention and control is recommended to reinforce antismoking messages among school children.

Knowledge and Attitude Towards Tobacco Smoking among 13-15 Year-Old School Children in Viet Nam - Findings from GYTS 2014.

Studies have shown that smoking is a learnt behavior, often initiated during adolescence. This paper aims to describe tobacco-related knowledge, attitude and associations among school adolescents aged 13-15 with exposure to anti-smoking information. Using data from the Global Youth Tobacco Survey (GYTS) in Viet Nam, 2014, knowledge was measured through 4 questions about tobacco use, and attitude was assessed through 3 questions on personal, social and environmental aspects. Students giving most anti-tobacco responses to all questions were considered as having correct knowledge or appropriate attitude or both. Access to anti-smoking information was determined by exposure to any media messages on tobacco control during the past 30 days and teaching in school about the danger of tobacco use during the past 12 months. A substantial percentage of students thought that being near others who smoke might be harmful to them and smoking is harmful to health (89.4% and 89.6% respectively). However, only 46.4% reported that it is definitely difficult to quit smoking and 66.9% thought that smoking for only 1 or 2 years, once stopped, is harmful to health. Slightly more than half of the respondents reported appropriate attitude that young smokers have fewer friends than others and smoking makes them less attractive and less comfortable at social events. Noticing anti-smoking messages in the media together with having lessons in school about the dangers of tobacco substantially increased the likelihood of having correct knowledge, appropriate attitude and both. Despite relatively high awareness about smoking harms, effective educational communication is still highly needed to improve the level of comprehensive knowledge and an appropriate attitude regarding tobacco use.

Trends in Second-Hand Tobacco Smoke Exposure Levels at Home among Viet Nam School Children Aged 13-15 and Associated Factors.

Second-hand tobacco smoke (SHS) exposure at home, especially among children, is a serious issue in Viet Nam. During the past decade, much effort has been taken for tobacco control in the country, including various prgorammes aiming to reduce SHS exposure among adults and children. This article analysed trends and factors associated with SHS exposure at home among school children aged 13-15 in Viet Nam, using the Global Youth Tobacco Surveys conducted in 2007 and 2014. Descriptive and inferential statistical methods with logistic regression were applied. Overall, there was a significant reduction in the level of exposure, from 58.5% (95%CI: 57.6-59.3) in 2007 to 47.1% (95%CI: 45.4-48.8) in 2014. Of the associated factors, having one or both parents smoking was significantly associated with the highest odds of SHS exposure at home (OR=5.0; 95%CI: 4.2-6.1). Conversely, having a mother with a college or higher education level was found to be a protective factor (OR=0.5; 95%CI: 0.3-0.8).

Exposure to Tobacco Advertising and Promotion among School Children Aged 13-15 in Vietnam - an Overview from GYTS 2014.

Evidence shows that tobacco advertising and promotion activities may increase tobacco consumption and usage, especially in youth. Despite the regulation on prohibiting advertisement of any tobacco product, tobacco advertisement and promotion activities are still common in Vietnam. This article presents current exposure to tobacco advertising and promotion (TAP) among school children aged 13 to 15 years in Vietnam in 2014 and potential influencing factors. Data from the Global Youth Tobacco Survey 2014 in Vietnam covering 3,430 school aged children were used. Both descriptive and analytical statistics were carried out with Stata 13 statistical software. Binary logistic regression was applied to explain the exposure to TAP among youth and examine relationships with individual factors. A significance level of p<0.05 and sampling weights were used in all of the computations. In the past 30 days, 48.6% of the students experienced exposure to at least 1 type of tobacco advertising or promotion. Wearing or otherwise using products related to tobacco was the most exposure TAP type reported by students (22.3%). The internet (22.1), points of sales (19.2) and social events (11.5) were three places that students aged 13-15 frequently were exposed to TAP. Binary logistic results showed that gender (female vs male) (OR = 0.61, 95%CI: 0.52 - 0.71), susceptibility to smoking (OR = 2.12, 95%CI: 1.53 - 2.92), closest friends' smoked (OR = 1.43, 95%CI: 1.2 - 1.7) and parents smoking status (OR = 2.83, 95%CI: 1.6 - 5.01) were significantly associated with TAP exposure among school-aged children. The research findings should contribute to effective implementation of measures for preventing and controlling tobacco use among students aged 13-15 in Viet Nam.

Prevalence of waterpipe tobacco smoking among population aged 15 years or older, Vietnam, 2010.

INTRODUCTION: The prevalence of waterpipe tobacco smoking is increasing globally and is associated with adverse outcomes requiring tobacco control interventions. We estimated the prevalence of waterpipe tobacco use among adult populations in Vietnam in 2010 and examined its association with sociodemographic factors. METHODS: We used data from the Global Adult Tobacco Survey (GATS) conducted in Vietnam in 2010. GATS surveyed a national representative sample of adults aged 15 years or older from 11,142 households by using a 2-phase sampling design analogous to a 3-stage stratified cluster sampling. Descriptive statistical analyses and multivariate logistic regression modeling were conducted. RESULTS: A total of 6.4% of Vietnamese aged 15 years or older (representing about 4.1 million adult waterpipe smokers) reported current waterpipe tobacco smoking. The prevalence of waterpipe tobacco smoking was significantly higher among men than women (13% vs 0.1%). Area of residence (rural or urban), age group, asset-based wealth quintile, and geographic region of residence were significantly associated with waterpipe tobacco smoking among men. The significant correlates of current waterpipe tobacco smoking among men were lower education levels, being middle-aged (45-54 years), lower asset-based wealth levels, living in rural areas, not living in the South East and the Mekong River Delta geographic regions, and the belief that smoking does not causes diseases. CONCLUSION: Rural dwellers who are poor should be targeted in tobacco control programs. Further studies are needed that examine perceptions of the adverse health effects and the cultural factors of waterpipe tobacco smoking.

Exposure to second-hand smoke at home and its associated factors: findings from the Global Adult Tobacco Use survey in Vietnam, 2010.

OBJECTIVE: The paper describes the pattern of exposure to second-hand smoke (SHS) at home among the adult population of Vietnam and examines associated socio-demographic factors. METHODS: A total of 11,142 households were selected for this survey using a two-phase sampling design analogous with three-stage stratified cluster sampling. The dependent variable was the status of exposure to SHS at home. Independent variables included gender, age, occupation, asset-based wealth quintile, ethnicity, marital status, residence. Logistic regression modelling was performed to examine the association with relevant factors of patterns of exposure to second-hand smoke among non-smokers. RESULTS: Of adults aged 15 years and above (representing approximately 47 million people) 73.1% reported they were exposed to SHS at home at least monthly. Considering non-smokers only, the prevalence of exposure to SHS at home was 67.6% (equivalent to approximately 33 million non-smokers). The significant correlates of the status of exposure to SHS at home among non-smokers were female gender, ethnic minority, low education, and lack of smoking restriction at home. CONCLUSION: The study showed that a high percentage of people are exposed to second-hand smoke at home. Disadvantaged people were more likely than the better-off to be exposed to SHS at home.