The impact of cigarette prices on smoking onset and cessation: evidence from Vietnam.

BACKGROUND: Vietnam is a country with very high smoking rates among men. According to a Global Adult Tobacco Survey (GATS) conducted in 2015, the daily smoking prevalence among Vietnamese men was 39%. METHODS: We used data from the 2010 and 2015 Vietnamese GATSs and cigarette price data from General Statistics Office of Vietnam. Since smoking prevalence is low among women, we only considered men. Using discrete-time hazard models, we estimated the effect of cigarette prices on smoking onset and cessation. Sensitivity analyses are conducted using different model specifications. RESULTS: We find that higher cigarette prices reduce the probability of smoking onset. A 1% increase in the cigarette price reduces the hazard of smoking onset by 1.2% (95% CI -2.12% to -0.28%). This suggests that increases in tobacco taxation, which translate to price increases, can reduce smoking onset. We did not find evidence that cigarette prices impact smoking cessation among men in Vietnam. CONCLUSION: Vietnam should continue to increase excise taxes on tobacco products to reduce smoking onset. Since smokers are resilient to excise tax increases, other tobacco control policies, such as smoke-free areas and tobacco advertisement bans, should be better enforced to encourage people to quit. Other policies not yet implemented, such as plain packaging of tobacco products, may also encourage smokers to quit.

Inequality in electricity consumption and economic growth: Evidence from a small area estimation study.

Our study uses a small area estimation method to estimate the average and inequality of per capita kWh consumption for small areas in Vietnam. It shows evidence of a large spatial heterogeneity in the electric power consumption between districts and provinces in Vietnam. Households in the mountains and highlands consumed remarkably less electricity than those in the delta and coastal areas. Notably, we find a U-shaped relationship between the inequality of electricity consumption and economic levels in Vietnam. In poor districts and provinces, there is very high inequality in electricity consumption. Inequality is lower in middle-income districts and provinces.

Coverage of safely managed water, sanitation and hygiene: An application of small area estimation.

Disaggregated information on welfare indicators is useful for targeted policies. This study constructs geographic maps of water, sanitation, and hygiene (WASH) for provinces and districts in Vietnam (which has 63 provinces and 712 districts). The study finds that poorer provinces and districts tend to have remarkably lower access to safely managed sanitation and water. Provinces in the Northern Midlands and Mountain Areas, and Central Highlands have the lowest level of access to safely managed sanitation and drinking water. There is a great variation in the availability of WASH facilities between districts within the same provinces. Additionally, the study highlights that districts with a higher population of ethnic minorities tend to experience lower rates of access to safely managed sanitation and drinking water. Even within the same district, moreover, ethnic minorities face greater challenges in accessing safely managed sanitation and drinking water compared to the majority Kinh population.

The Crowding-out Effect of Tobacco Expenditure on Health Expenditure: Evidence From a Lower-Middle-Income Country.

INTRODUCTION: Poor people have remarkably lower health expenditures than rich people in Vietnam. According to the 2016 Vietnam Household Living Standard Survey (VHLSS), per capita health expenditure of the top quintile households is around 6 times higher than that of the bottom quintile households. AIMS AND METHODS: We analyze economic inequalities in health expenditure using the concentration index approach and data from the VHLSS 2010-2016. Next, we use the instrumental-variable regression analysis to examine the crowding-out effect of tobacco expenditure on health expenditure. Finally, we use decomposition analysis to explore whether economic inequality in tobacco expenditure is associated with an economic inequality in health expenditure. RESULTS: We find a crowding-out effect of tobacco expenditure on health expenditure of households. The share of health expenditure of households with tobacco spending is 0.78% lower than that of households without tobacco spending. It is estimated that a one-VND increase in tobacco expenditure results in a 0.18 Vietnamese Dong (VND) (95% CI: -0.30 to -0.06) decrease in health expenditure. There is a negative association between economic inequality in tobacco expenditure and economic inequality in health expenditure. This means that if the poor consume less tobacco, their expenditure on health can be increased, resulting in a decrease in inequality in health expenditure. CONCLUSIONS: Findings from this study suggest that reducing tobacco expenditure could improve health care of the poor and reduce inequality in health care in Vietnam. Our study recommends that the government continuously increase the tobacco tax in order to effectively reduce tobacco consumption. IMPLICATIONS: Empirical studies show mixed results on the effect of tobacco expenditure on health expenditure. We find a crowding-out effect of tobacco expenditure on health expenditure of poor households in Vietnam. It implies that if the poor reduce their expenditure on tobacco, economic inequality in health expenditure can be reduced. Our findings suggest that reducing tobacco consumption in poor households can increase their health expenditure, therefore, decreasing inequality in health expenditure. Different policies to reduce tobacco consumption such as tobacco taxation, smoke-free areas, and tobacco advertisement bans should be strengthened.

Acute and sub-acute toxicity evaluation of Merremia tridentata (L.) stem extract on mice.

The acute and sub-acute toxicity studies were performed in male and female Swiss albino mice as per the guidelines mentioned in OECD. The oral administration of M. tridentata stem extract (MSE) showed no treatment-related mortality and body weight change in mice up to the single dose of 30,000 mg/kg body weight in the acute toxicity study and up to a dose of 30,000 mg/kg/day body weight in the sub-acute toxicity study. Moreover, the clinical signs, body weight, gross pathology, organ weight, hematology (except for platelet count), biochemical analysis, and histopathology did not show significant variation at a medium dose of 15,000 mg/kg/day body weight compared to the control group. However, toxicological signs in behavior, very mild interstitial nephritis, as well as significant variation in platelet count and total protein parameters were observed at a dose of 30,000 mg/kg/day in the 28-day oral toxicity study. Thus, the no-observed-adverse-effect level was determined at a dose of 15,000 mg/kg/day body weight. Based on study results, it is concluded that MSE showed LD50 of greater than 5000 mg/kg/day body weight. Hence, this could be a potential candidature as a future safe pharmaceutical product.

The impact of cold waves and heat waves on mortality: Evidence from a lower middle-income country.

We estimate the impact of temperature extremes on mortality in Vietnam, using daily data on temperatures and monthly data on mortality during the 2000-2018 period. We find that both cold and heat waves cause higher mortality, particularly among older people and those living in the hot regions in Southern Vietnam. This effect on mortality tends to be smaller in provinces with higher rates of air-conditioning and emigration, and provinces with higher public spending on health. Finally, we estimate economic cost of cold and heat waves using a framework of willingness to pay to avoid deaths, then project the cost to the year 2100 under different Representative Concentration Pathway scenarios.

Did a successful fight against COVID-19 come at a cost? Impacts of the pandemic on employment outcomes in Vietnam.

Despite its low middle-income status, Vietnam has been widely praised for its success in the fight against early waves of the COVID-19 pandemic, with a low mortality rate of approximately 100 deaths out of a population of less than 100 million by the end of 2020. We add to the emerging literature on COVID-19 effects on the labor market for poorer countries by analyzing rich individual-level data from Vietnam's Labor Force Surveys spanning 2015 to 2020. We find post-pandemic increases in unemployment and temporary layoff rates alongside decreases in employment quality. Monthly wages declined even as the proportion of workers receiving below-minimum wages substantially increased, contributing to sharply rising wage inequality. Our findings suggest that more resources should be allocated to protect vulnerable workers, especially as the pandemic continues to cause increasingly severe damage to the global economy.

Inequality and support for government responses to COVID-19.

Despite a deep literature studying the impact of inequality on policy outcomes, there has been limited effort to bring these insights into the debates about comparative support for government responses to the COVID-19 pandemic. We fill this gap by analyzing rich survey data at the beginning of the pandemic in April 2020 from six countries spanning different income levels and geographical locations-China, Italy, Japan, South Korea, the United Kingdom, and the United States. We find that poorer individuals are less supportive of government responses. Furthermore, poorer individuals residing in more economically unequal countries offer even less government support. We also find that both economic and non-economic factors could affect the poor's decisions to support stringent government policies. These findings suggest that greater transfers to the poor may offer an option to help increase support for strict policies and may reduce the potential deepening of social inequalities caused by the pandemic.

The effect of preschool attendance on Children's health: Evidence from a lower middle-income country.

In this study, we find that children in Vietnam who were born in December of a given year have better health outcomes than those born in January of the following year. Children born in December are taller, heavier, and less likely to be underweight and suffer from stunted growth than those born in January of the following year, though these two groups of children differ in age by only 1 month. We argue that the effect of being born in December compared to January on children's health is translated through early preschool attendance. In Vietnam, children born in December are more likely to start preschool as well as primary school 1 year earlier than those born in January of the following year. Thus, the health benefit for a child born in December would come from earlier and longer exposure to preschool. Importantly, we find that the positive effect of preschool persists over time as children grow. A possible major reason why preschool attendance improves health is the nutrition provided for children in preschools.

In vitro and in vivo antidiabetic activity, isolation of flavonoids, and in silico molecular docking of stem extract of Merremia tridentata (L.).

The antidiabetic activity of stem-ethanol extract (SE) and the flavonoid-rich fraction (FF) of Merremia tridentata (L.) were investigated on alloxan-induced diabetic mice. Apigenin, cosmosiin, and quercitrin are flavonoids isolated for the first time from stem extracts. In addition, cynaroside was found to be at the highest level in SE and FF with a percentage of 4.375% and 58.430%, respectively. The administration of SE (100 mg/kg) and FF (50, 75 mg/kg) daily for 20 days resulted in a better hypoglycemic effect than the reference drugs, glibenclamide (5 mg/kg), and metformin (10 mg/kg). Furthermore, SE and FF were shown to significantly improve the plasma lipid profiles at the end of the study. Docking's study suggests that cynaroside, cosmosiin, and quercitrin are the most desirable compounds for hypoglycemic effects in many antidiabetic targets. Especially, SE and FF showed strongly α-amylase and α-glucosidase inhibitory activities (IC50 = 1.61-1.72 mg/mL on α-amylase and IC50 = 0.24-0.44 mg/mL on α-glucosidase). Therefore, SE and FF of Merremia tridentata is a potential drug with antidiabetic and hypoglycemic action as indicated by in vivo, in silico, and in vitro studies.

The impact of voluntary health insurance on health care utilization and out-of-pocket payments: new evidence for Vietnam.

Vietnam aims to achieve full coverage of health insurance in 2015. An increasing type of health insurance in Vietnam is voluntary health insurance. Although there are many studies on the implementation of voluntary health insurance in Vietnam, little is known on the causal impact of voluntary health insurance. This paper measures the impact of voluntary health insurance on health care utilization and out-of-pocket payments using Vietnam Household Living Standard Surveys in 2004 and 2006. It was found out that voluntary health insurance helps the insured people increase the annual outpatient and inpatient visits by around 45% and 70%, respectively. However, the effect of voluntary health insurance on out-of-pocket expenses on health care services is not statistically significant.