Exposure to E-Cigarette Advertising and Its Association With E-Cigarette Use Among Youth and Adolescents in Two Largest Cities in Vietnam 2020.

BACKGROUND: E-cigarette products have become more popular due to the marketing campaigns on various sources but caused adverse health impacts to users, especially adolescents and youths. This paper aims to describe the situation of exposure to e-cigarette advertisements of youth and adolescents living in two cities of Hanoi and Ho Chi Minh in 2020 and identify the associated factors of e-cigarette marketing with e-cigarettes use in these groups. METHODOLOGY: This was a cross-sectional study. The study participants were 1211 youth and adolescents aged 15-24 living in Hanoi and Ho Chi Minh City during the time of data collection (from January 2020 to September 2020). Two primary outcome variables included the ever e-cigarettes use and the intention to use e-cigarettes. Multivariate logistic regression models were used to assess the association between the outcome variables and e-cigarette marketing exposure. RESULTS: The proportion of participants who ever use e-cigarettes was 7.4% and a proportion of 4.8% have intention to use e-cigarettes. The most popular source of exposure to e-cigarettes advertisements was social network (Facebook, Twitter, Instagram, Youtube, etc.) and this source had positive association with the odds of e-cigarette smoking among youth and adolescents (OR = 3.38, 95% CI: 1.59-7.14). In addition, referral marketers also contributed to making the participants more likely to smoke e-cigarettes (OR = 2.68, 95% CI: 1.03-6.95). Attractive color and free sample of e-cigarettes were also found to be the motivated factors associated with smoking behaviour among youth and adolescents. CONCLUSIONS: New policies should be considered to oppose the impact of youth-oriented e-cigarette advertisements which include regulating and restricting e-cigarette advertisements on social media, as well as through referral marketers.

Zoonotic Flavivirus Exposure in Peri-Urban and Suburban Pig-Keeping in Hanoi, Vietnam, and the Knowledge and Preventive Practices of Pig Farmers.

Mosquito-borne diseases (MBDs), including those caused by flaviviruses, remain human health problems for developing and urbanizing economies. This cross-sectional study examined risks of flavivirus exposure through a survey regarding knowledge and practices of pig farmers, and serological analysis of pigs in peri-urban and suburban Hanoi city. A total of 636 pig sera from 179 pig farms in 4 districts, namely, Chuong My, Dan Phuong, Ha Dong, and Bac Tu Liem, were analyzed by a competitive ELISA designed for flavivirus antibody detection. The results indicated a low level of awareness about MBDs among pig farmers, and a high seroprevalence in pigs at 88.5% (95%CI = 85.8-90.9%). Moreover, common practices of pig owners to prevent mosquitoes at home and farm did not show a significant reduction in flavivirus exposure in pigs. At animal level, significant associations between seropositive pigs and the farms with more than 60 pigs, and the district location were found. Farm-level multivariable analysis did not identify significant risk factors for flavivirus exposure. The study suggests that improving awareness of pig owners about MBDs in Hanoi city may be warranted to reduce the risk for MBD flavivirus infections in both humans and pigs.

The Distribution and Composition of Vector Abundance in Hanoi City, Vietnam: Association with Livestock Keeping and Flavivirus Detection.

BACKGROUND: Dengue virus and Japanese encephalitis virus are two common flaviviruses that are spread widely by Aedes and Culex mosquitoes. Livestock keeping is vital for cities; however, it can pose the risk of increasing the mosquito population. Our study explored how livestock keeping in and around a large city is associated with the presence of mosquitoes and the risk of them spreading flaviviruses. METHODS: An entomological study was conducted in 6 districts with 233 households with livestock, and 280 households without livestock, in Hanoi city. BG-Sentinel traps and CDC light traps were used to collect mosquitoes close to animal farms and human habitats. Adult mosquitoes were counted, identified to species level, and grouped into 385 pools, which were screened for flaviviruses using a pan-flavivirus qPCR protocol and sequencing. RESULTS: A total of 12,861 adult mosquitoes were collected at the 513 households, with 5 different genera collected, of which the Culex genus was the most abundant. Our study found that there was a positive association between livestock keeping and the size of the mosquito population-most predominantly between pig rearing and Culex species (p < 0.001). One pool of Cx. tritaeniorhynchus, collected in a peri-urban district, was found to be positive for Japanese encephalitis virus. CONCLUSIONS: The risk of flavivirus transmission in urban areas of Hanoi city due to the spread of Culex and Aedes mosquitoes could be facilitated by livestock keeping.

Spatial distribution of Culex mosquito abundance and associated risk factors in Hanoi, Vietnam.

Japanese encephalitis (JE) is the major cause of viral encephalitis (VE) in most Asian-Pacific countries. In Vietnam, there is no nationwide surveillance system for JE due to lack of medical facilities and diagnoses. Culex tritaeniorhynchus, Culex vishnui, and Culex quinquefasciatus have been identified as the major JE vectors in Vietnam. The main objective of this study was to forecast a risk map of Culex mosquitoes in Hanoi, which is one of the most densely populated cities in Vietnam. A total of 10,775 female adult Culex mosquitoes were collected from 513 trapping locations. We collected temperature and precipitation information during the study period and its preceding month. In addition, the other predictor variables (e.g., normalized difference vegetation index [NDVI], land use/land cover and human population density), were collected for our analysis. The final model selected for estimating the Culex mosquito abundance included centered rainfall, quadratic term rainfall, rice cover ratio, forest cover ratio, and human population density variables. The estimated spatial distribution of Culex mosquito abundance ranged from 0 to more than 150 mosquitoes per 900m2. Our model estimated that 87% of the Hanoi area had an abundance of mosquitoes from 0 to 50, whereas approximately 1.2% of the area showed more than 100 mosquitoes, which was mostly in the rural/peri-urban districts. Our findings provide better insight into understanding the spatial distribution of Culex mosquitoes and its associated environmental risk factors. Such information can assist local clinicians and public health policymakers to identify potential areas of risk for JE virus. Risk maps can be an efficient way of raising public awareness about the virus and further preventive measures need to be considered in order to prevent outbreaks and onwards transmission of JE virus.

Dogs as Sentinels for Flavivirus Exposure in Urban, Peri-Urban and Rural Hanoi, Vietnam.

Diseases caused by flaviviruses, including dengue fever and Japanese encephalitis, are major health problems in Vietnam. This cross-sectional study explored the feasibility of domestic dogs as sentinels to better understand risks of mosquito-borne diseases in Hanoi city. A total of 475 dogs serum samples from 221 households in six districts of Hanoi were analyzed by a competitive enzyme-linked immunosorbent assay (cELISA) for antibodies to the pr-E protein of West Nile virus and other flaviviruses due to cross-reactivity. The overall flavivirus seroprevalence in the dog population was 70.7% (95% CI = 66.4-74.8%). At the animal level, significant associations between seropositive dogs and district location, age, breed and keeping practice were determined. At the household level, the major risk factors were rural and peri-urban locations, presence of pigs, coil burning and households without mosquito-borne disease experience (p < 0.05). Mosquito control by using larvicides or electric traps could lower seropositivity, but other measures did not contribute to significant risk mitigation of flavivirus exposure in dogs. These results will support better control of mosquito-borne diseases in Hanoi, and they indicate that dogs can be used as sentinels for flavivirus exposure.

Risk factors of dengue fever in an urban area in Vietnam: a case-control study.

BACKGROUND: Dengue is a mosquito-borne flavivirus present in many metropolitan cities of tropical countries. METHODS: During and after the dengue season (September 2018 to January 2019), we conducted a case-control study in order to determine the risk factors for dengue fever in Hanoi city, Vietnam. 98 dengue patients and 99 patients with other acute infections, such as Hepatitis B virus infection, were recruited at Department of Infectious Disease of Bach Mai national hospital in Hanoi. Patients were interviewed using a structured questionnaire covering demographic, housing, environmental factors and knowledge, attitude, and practice on dengue prevention and control. Univariate analysis and multivariable logistic regression were used to determine the risk factors of dengue status. RESULTS: The mean score of knowledge items and practice items was only 7.9 out of total 19 points and 3.9 out of total 17 points, respectively. While the mean score of attitude items was 4.8 out of total 6 points. Multivariable logistic regression indicated that older patients had lesser risk of getting dengue infection as compared to younger adults aged 16-30, and patients living in peri-urban districts were less likely to suffer of dengue fever than patients living in central urban districts (OR = 0.31; 95% CI 0.13-0.75). This study could not find any association with occupation, water storage habit, knowledge, attitude, or practice on dengue prevention. CONCLUSIONS: All patients had a relatively low level of knowledge and practice on dengue prevention and control. However, the attitude of the participants was good. We found that age group and living district were the risk factors correlated with the dengue status. Communication programs on raising dengue awareness should be repeated all year round and target particular groups of adolescents, younger adults, landlords and migrants from other provinces to improve their knowledge and encourage them to implement preventive measures against dengue fever.

Knowledge and practice on prevention of mosquito-borne diseases in livestock-keeping and non-livestock-keeping communities in Hanoi city, Vietnam: A mixed-method study.

Mosquito-borne diseases (MBDs) are causing high morbidity and mortality for humans. Urban livestock keeping is still common in cities around the world. The animals may serve as reservoirs for zoonotic MBDs, which increase the risks for humans. Here we assess the knowledge and practices related to MBDs in households with livestock and without livestock and explore the perceptions of the health care sector about MBDs and livestock keeping in Hanoi city of Vietnam in a cross-sectional study. A quantitative survey was conducted including 513 households with and without livestock-keeping in six districts and complemented with qualitative surveys with four health staff from Hanoi Center of Disease Control and three district health centers. The quantitative survey indicated that the participants possessed basic knowledge on MBDs with an average score of 18.3 out of 35, of which non-livestock-keeping households had a better knowledge than households keeping livestock (p<0.05). Both household categories had low score, 3.5 out of 11, regarding preventive practices against MBDs. The negative binomial model showed that occupation and location of living were factors associated to the knowledge on MBDs. Farmers were likely to have better preventive practices as compared to office workers (p<0.05). Those who had better knowledge also had more adequate preventive practices against MBDs (p<0.001). The qualitative survey revealed that livestock keeping was determined as increasing risks of MBDs due to the increase of mosquito population. It is recommended that community campaigns to raise the awareness and change behavior on MBDs should be organized based on collaboration between the health sector and the veterinary sector for households with and without livestock living in central urban and peri-urban areas. Further studies are needed to confirm the association between urban livestock keeping and potential increasing risks of MBDs such as dengue and Japanese encephalitis.

A Mixed-Methods Approach to Understanding Knowledge of Mosquito-Borne Infections and Barriers for Protection in Hanoi, Vietnam.

Dengue is a growing problem in Hanoi, with cyclical epidemics of increasing frequency and magnitude. In June 2019, we conducted a cross-sectional survey using mixed methods to investigate how inhabitants of Hanoi perceive and respond to the risk of mosquito-borne diseases (MBD). A total of 117 participants recruited using a stratified random sampling method were interviewed in three districts of Hanoi. Knowledge and practices (KP) regarding MBDs were assessed using a pre-tested questionnaire. Inferential statistics were used to identify factors associated with KP scores and describe the relationship between variables. Additionally, a "risk-mapping" exercise was conducted in a subsample through semi-structured interviews and analyzed qualitatively and quantitatively using the System Effects platform. Factors significantly associated with knowledge scores were education and family history of MBDs. While knowledge and practice scores were found to be positively correlated in the statistical analysis, this was not corroborated by our observations on the field. The results also revealed gaps in knowledge about MBDs and vectors and highlighted a general feeling of powerlessness which prevented the adoption of protective behaviors. Therefore, educational interventions which provide concrete tools to empower communities should have a positive impact on improving vector control.

Urban livestock-keeping and dengue in urban and peri-urban Hanoi, Vietnam.

Urban livestock provides an important source of food and income, but it may increase the risks for disease transmission. Vectors, such as mosquitoes, might increase and thereby cause an enhanced transmission of infectious diseases, such as dengue fever; considered the most important mosquito-borne viral disease globally. This cross-sectional study evaluated the awareness of dengue fever and investigated how the presence of dengue vectors is affected by the keeping of livestock in urban households in the city of Hanoi, Vietnam. From February to March 2018, during the season of lowest occurrence of dengue in Hanoi, 140 households were interviewed, of which 69 kept livestock. A general trend was observed; respondents living in the Dan Phuong district, a peri-urban district, had better knowledge and practice regarding dengue as compared to the urban Ha Dong district. In total, 3899 mosquitoes were collected and identified, of which 52 (1.33%) were Aedes species. A significant difference between the two districts was observed, with more households in Ha Dong having Aedes spp. mosquitoes (p = 0.02) and a higher incidence of dengue fever (p = 0.001). There was no significant association between livestock-rearing and the presence of Aedes spp. mosquitoes (p = 0.955), or between livestock-rearing and the incidence of dengue fever (p = 0.08). In conclusion, this study could not find any indication that households keeping livestock were at higher risk of dengue virus infections in Hanoi during the season of lowest occurrence of dengue, but clearly indicated the need of more information provided to urban inhabitants, particularly on personal protection.

Urban transmission of mosquito-borne flaviviruses - a review of the risk for humans in Vietnam.

Vietnam is a tropical country where mosquito-borne diseases are common. This review explores the transmission of mosquito-borne flaviviruses in urban areas of Vietnam. It concludes that urban transmission has mainly been studied for Dengue virus, and so far, much less for Japanese encephalitis virus. Dengue is the most common flavivirus in Vietnam. Due to fast urbanization and favorable climatic conditions, the viral transmission concentrates mainly to large cities with high population density including Ha Noi, Nha Trang and Ho Chi Minh. Human cases of Japanese encephalitis have been controlled by an expanded immunization program. However, this virus is still circulating throughout the country, also in cities due to the pig rearing practices in urban and peri-urban areas. Zika virus is an additional major concern because it has long circulated in the Northern area and is now increasingly diagnosed in urban areas of the Central, Central Highlands and Southern regions using the same mosquito vectors as Dengue virus. There was alarge outbreak of Zika disease from 2016 to early 2017, with most infections observed in Ho Chi Minh city, the largest town in Vietnam. Other flaviviruses circulate in Vietnam but have not been investigated in terms of urban transmission.

Barriers to Engaging Communities in a Dengue Vector Control Program: An Implementation Research in an Urban Area in Hanoi City, Vietnam.

The dengue situation in the urban setting of Hanoi city, Vietnam, is emerging, focusing on inner districts. Previous studies showed that a dengue vector control program in Hanoi was not effective because of the lack of adequate engagement of the local government authorities, health sector, and community. This implementation research aimed to explore barriers to implementing community engagement in a dengue vector control program in an urban district of Hanoi city. Ten in-depth interviews and 14 focus group discussions were conducted at Lang Thuong, Khuong Thuong, Tho Quan, and Kim Lien wards in Dong Da district, Hanoi city. Data collection was implemented from April to June 2017. All discussions were recorded and transcribed verbatim. Data were analyzed using the content analysis approach. Secondary data from the dengue vector control program reports were used to support the qualitative evidence. We found that the barriers to implementing effective community engagement were as follows: 1) lack of interest and an attitude of dependency on action from the health sector of local people's committee, 2) lack of enthusiasm of mass organizations and community leaders, 3) overburdened workloads and lack of communication skills from health sector, 4) low awareness and readiness from community, 5) lack of detailed policy guidelines and low enforcement of related policy, and 6) limited budget. Recommended actions should be made to improve the community engagement in the current resource-limited context of Vietnam by both top-down and bottom-up approaches.