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.

Violence and non-fatal injuries among Vietnamese in-school adolescents: national prevalence estimates and associated factors.

School violence and injury are major public health problems worldwide. The data of this study were from the Viet Nam Global School-based Student Health Survey (GSHS) - a nationally representative survey conducted in 2019, with a sample size of 7690 students aged 13-17 years old. We found the prevalence of violence and non-fatal injury to be 14.5% and 21.4%, respectively. Factors related to higher odds of violence and non-fatal injuries in both sexes included smoking cigarettes, drinking alcohol, having mental health problems (loneliness, worrying and suicidal thinking), and truancy. In contrast, parental monitoring was associated with lower odds of violence, and parental respect was a protective factor of both violence and non-fatal injuries. Students who experienced violence had a higher likelihood of having non-fatal injuries in both sexes. Future policies should consider individual factors and parent-child bonding, to mitigate the burden of violence and injury among in-school adolescents in Viet Nam.

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.

Improvement in Compliance With Smoke-Free Environment Regulations at Hotels and Restaurants in Vietnam After an Administrative Intervention.

INTRODUCTION: Vietnam is among the countries with the highest smoking prevalence among male adults, as well as high prevalence of secondhand smoke exposure at indoor places. In many countries, including Vietnam, exposure to tobacco smoking is greatest in restaurants/bars and hotels. This study aims to analyze the compliance of hotels and restaurants to smoke-free environment regulations before and after an intervention. METHODS: Direct observations were done at the receptions, conference rooms, designated smoking areas, restaurants, and lobbies of 140 hotels and the dining rooms, kitchens, and toilets of 160 restaurants before and after an intervention. The intervention was a training course conducted by police officers followed by 3 monthly supervision visits by police officers. Compliance with smoke-free enviornment regulations was observed and assessed to generate a compliance score for each location and overall. Tobit regression was used to examine the relationship between compliance scores and the intervention and other variables such as hotel and restaurant characteristics. RESULTS: Before the intervention, the highest compliance rates were found for "no tobacco advertisement" and "no cigarette selling" regulations (95%-100%) in almost all sites in hotels and restaurants. The lowest compliance rates were found for "having nonsmoking signs." The rate of compliance with all regulations was only 5% for hotels and 0.06% of restaurants. Improvement after intervention was clearly observed, in the rate of compliance with all regulations by more hotels (15.7%) and overall compliance scores of hotels and restaurants. CONCLUSIONS: The intervention with participation of the police officers proved to be effective in improving compliance with smoke-free regulations. It is recommended to continue this intervention in the same areas as well as to expand the intervention to other areas.

Estimating health plan costs with the OneHealth tool, Cambodia.

OBJECTIVE: To do resource and cost projections for the entire Cambodian health sector using the OneHealth tool, during the development of the third national health strategic plan 2016-2020. METHODS: Through a consultative process, the health ministry estimated the needed and available resources to implement the strategic plan. The health ministry used the OneHealth Tool to estimate costs of expanding public sector service provision and compared these to estimates of projected available financing. Cost estimates covered implementation of health programmes including commodities and programme management costs, and six cross-cutting health system strengthening components. The tool is populated with local demographic, epidemiological, programmatic and unit cost data. We present costs in constant 2015 United States dollars (US$). FINDINGS: We estimated the five-year cost of the strategic plan to be US$ 2973.8 million. Costs are split between health systems strengthening components (US$ 1516.3 million) and investments in individual disease or public health programmes (US$ 1457.5 million). Health programmes for maternal and neonatal health (US$ 367 million), child health and immunization (US$ 197 million) and noncommunicable disease (US$ 157 million) have the highest costs. Although projected resource needs increase over time, a financial space analysis with ambitious projected increases in government funding indicates that government and donor funding jointly could be sufficient to cover the cost of the strategic plan from 2018 to 2020. CONCLUSION: The results both informed development of the strategic plan, and contributed to the evidence base for improved budgeting, resource mobilization strategies and stronger overall public sector financial planning.

[The Japanese health system: lasting reform is impossible]. / Le système de soins japonais: l'impossible et permanente réforme.

This article analyses the main features of the Japanese health care system. It also analyses its recent changes facing the aging of the population, the need to improve quality of care and the necessity to contain cost. As far as the main characteristics are concerned, the accent is first put on the information asymmetry in the physician-patient relationships. Then the so-called "clinics" are described as the symbol of the coexistence of private and public health service provision. Finally, the "fee schedule" is presented as one of the main regulation tools. As for the recent reforms, it is shown that they are implemented in an incremental way. That is to say that the recent changes maintain the core of the health care system. They comfort the main value (such as equity) and the main institutions involved in the regulation process (such as the central administration or the Japanese Medical Association). They also maintain the regulation process (i.e. the continuous negotiation). As examples of such reform strategies, the article deals with the creation of a new insurance for aged people (named long term care insurance), the changes in the health seeking behavior, the division of labor between health care providers and some preparative steps for possible unification of multiple insurance. It is for example shown that the collective management of the "fee schedule" leads to an actual incentive. It pushes forward some medical practices (such as the use of high technology screening) or slow down others (such as selling drugs). But it is also a symbol of the regulation process itself. In effect, as this list is regularly revised, it gives to all the partners the opportunity to meet each other, to build a rather broad consensus and, thus, to enhance the strength of the whole system. As a result it is shown that the market logic that many western countries try to implement, through managed care techniques, do not fit the Japanese system and must be seen as inefficient.