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.

Healthcare infrastructure capacity to respond to severe acute respiratory infection (SARI) and sepsis in Vietnam: A low-middle income country.

PURPOSE: This study investigated the availability of relevant structural and human resources needed for the clinical management of patients with severe acute respiratory infections and sepsis in critical care units in Vietnam. MATERIAL AND METHODS: A questionnaire survey was conducted by purposive sampling of 128 hospitals (36% of total hospitals in surveyed provinces), including 25 provincial and 103 district level hospitals, from 20 provinces in Vietnam. Data on availability of hospital characteristics, structural resources and health care workers was then analyzed. RESULTS: Most hospitals (>80%) reported having 60% of the relevant structural resources. Significant differences were observed between provincial hospitals when compared to district hospitals in regards to availability of central oxygen piping system (78.3% vs 38.7%, p=0.001) mechanical ventilation (100.0% vs 73.6%, p=0.003), mobile x-rays (80.0% vs 29.8%, p<0.001), carbapenem antibiotic (73.9% vs 17.4%, p<0.001) and norepinephrine (95.8% vs 56.3%, p<0.001). There was a limited availability of arterial blood gas analyzers (13.7%), oseltamivir (42.2%) and N95 respirators (54.6%) across all hospitals surveyed. CONCLUSIONS: The limited availability of relevant structural and human resources in critical care units around Vietnam makes the implementation of quality critical care to patients with SARI and sepsis, according international guidelines, not universally possible.

A Multilevel Study of Students in Vietnam: Drinking Motives and Drinking Context as Predictors of Alcohol Consumption.

BACKGROUND: This study used multi-level analysis to estimate which type of factor explains most of the variance in alcohol consumption of Vietnamese students. METHODS: Data were collected among 6011 students attending 12 universities/faculties in four provinces in Vietnam. The three most recent drinking occasions were investigated per student, resulting in 12,795 drinking occasions among 4265 drinkers. Students reported on 10 aspects of the drinking context per drinking occasion. A multi-level mixed-effects linear regression model was constructed in which aspects of drinking context composed the first level; the age of students and four drinking motives comprised the second level. The dependent variable was the number of drinks. RESULTS: Of the aspects of context, drinking duration had the strongest association with alcohol consumption while, at the individual level, coping motive had the strongest association. The drinking context characteristics explained more variance than the individual characteristics in alcohol intake per occasion. CONCLUSIONS: These findings suggest that, among students in Vietnam, the drinking context explains a larger proportion of the variance in alcohol consumption than the drinking motives. Therefore, measures that reduce the availability of alcohol in specific drinking situations are an essential part of an effective prevention policy.

Direct and indirect effects of alcohol expectancies through drinking motives on alcohol outcomes among students in Vietnam.

OBJECTIVE: To investigate whether the links between alcohol expectancies (tension reduction; global positive change; improved cognitive and motor abilities; and change in social behavior) and alcohol outcomes (drinking volume, 6+ drinks, alcohol problems, and symptoms of alcohol dependence) are mediated by drinking motives (social, enhancement, conformity, and coping). METHOD: A multi-stage sampling strategy was used in four Vietnamese provinces, resulting in a final sample of 4756 students (43.2% females) with mean age 20.6 (SD 1.8) years. Structural equation models, including indirect effects, were estimated for women and men separately. RESULTS: Overall, there were many cases of full mediation (indirect effects range from -0.006 to 0.083 and p-values from <0.05 to <0.001) and little indication of partial mediation (indirect effects range from -0.009 to 0.025 and p-values from <0.05 to <0.001). In both men and women, coping motives most frequently mediated the influence of expectancies on alcohol outcomes. Among men, enhancement motives and, to a lesser extent, social motives also played a role in mediating the effects of expectancies on alcohol outcomes. Among women, full mediation was found far less often and less consistently. CONCLUSION: By confirming that, in Vietnam, motives mediate the link between expectancies and drinking behavior, this study supports the cultural robustness of a key assumption of the motivational model (i.e. that drinking motives are more closely associated with alcohol use than expectancies). Enhancement, coping and social motives are most frequently found as mediators among male students whereas coping motive only is most frequently found as a mediator among female students. As most of the effects of expectancies were mediated by motives, drinking motives appear to be a promising factor for interventions.

Secondhand effects of alcohol use among students in Vietnam.

BACKGROUND: In many countries worldwide, heavy drinking can cause harm not only to drinkers but also to those around them. OBJECTIVE: To examine the prevalence and predictors of secondhand effects of alcohol use among students in Vietnam. DESIGN: In this cross-sectional study, a multistage sampling strategy was used to select 6,011 students (from the first to final study year) of 12 universities/faculties in four provinces in Vietnam. During class, students filled in a questionnaire asking for demographic information, and about alcohol-related problems and details of secondhand effects of alcohol during the past year. Exploratory factor analysis of the secondhand effects indicated two factors: non-bodily harm and bodily harm. A logistic regression model was used to explore the association between predictors and non-bodily harm and bodily harm. RESULTS: The prevalence of secondhand effects of alcohol is high among students in Vietnam: 77.5% had non-bodily effects and 34.2% had bodily effects. More than 37% of the population reported three to four non-bodily effects and more than 12% reported two to three bodily harms due to the drinking of others. However, most respondents who reported secondhand effects experienced these less than once per month. Factors most strongly associated with the yearly non-bodily harm were the weekly drinking habits of the people the respondents live with, and living in a smaller city; the factor most strongly associated with the yearly bodily harm was the respondent's own alcohol-related problems. Moreover, weekly drinking habits of the people the respondents live with, and respondent's own alcohol-related problems are strongly associated with the frequent experience of non-bodily and bodily effects of alcohol. CONCLUSIONS: In addition to dealing with alcohol-related harm of drinkers themselves, preventing secondhand effects should also be a major focus of prevention policy.

Alcohol-related harm among university students in Hanoi, Vietnam.

INTRODUCTION AND AIM: This study examines the prevalence of and risk factors for alcohol-related harm and types of harm among medical students from Hanoi Medical University (Vietnam). Risk factors include aspects of drinking patterns and relevant socio-demographic variables. STUDY DESIGN AND METHODS: A cross-sectional study involving 1st to 6th year students (N=1216; response rate 96.5%). Of these, 210 students from each academic year were randomly selected from a sampling frame covering all students from each academic year. Data were collected using a questionnaire distributed in class by researchers. Drinkers completed 23 questions on alcohol-related harm categorized into: 1) 'negative influence on daily activities'; 2) 'social conflict'; 3) 'loss of control, acute consequences, and withdrawal'; 4) 'mental health conditions'; and 5) 'physical and medical health problems'. Logistic and Poisson regression models were used to identify the predictors of alcohol-related harm and the amount of harm, respectively. RESULTS: The prevalence of alcohol use associated with at least one or more of the five types of harm was higher in men (81.8%) than in women (60.4%). In female and male students, the most common harm category was 'loss of control, acute consequences, and withdrawal' (51.8 and 75.6%, respectively), followed by 'negative influence on daily activities' (29.4 and 55.8%, respectively). Age, living away from home, and average number of standard drinks per occasion among male drinkers, and age and frequency of drinking per week among female drinkers were associated with alcohol-related harm. CONCLUSIONS: These data suggest that alcohol-related harm represents a serious public health problem among young educated individuals in Vietnam. The risk factors indicate that prevention should be aimed at aspects of drinking patterns and specific subpopulations defined by gender, age, and (for men only) type of living situation.