University of Massachusetts Medical School eScholarship@UMMS Open Access Articles Open Access Publications by UMMS Authors 2019-03-29 Smoke-free environment policy in Vietnam: what did people see and how did they react when they visited various public places Vinh H. Nguyen University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/oapubs Part of the Behavior and Behavior Mechanisms Commons, Community Health and Preventive Medicine Commons, Environmental Public Health Commons, Health Policy Commons, and the Preventive Medicine Commons Repository Citation Nguyen VH, DO DA, DO TT, Dao TM, Kim BG, Phan TH, Doan TH, Luong NK, Nguyen TL, Hoang VM, Pham TQ, Nguyen TQ. (2019). Smoke-free environment policy in Vietnam: what did people see and how did they react when they visited various public places. Open Access Articles. https://doi.org/10.15167/2421-4248/ jpmh2019.60.1.942. Retrieved from https://escholarship.umassmed.edu/oapubs/3802 This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Open Access Articles by an authorized administrator of eScholarship@UMMS. For more information, please contact [email protected]. J PREV MED HYG 2019; 60: E36-E42 ORIGINAL ARTICLE Smoke-free environment policy in Vietnam: what did people see and how did they react when they visited various public places? V.H. NGUYEN1, 2, D.A. DO3, T.T.H. DO4, T.M.A. DAO2, B.G. KIM5, T.H. PHAN6, T.H. DOAN6, N.K. LUONG7, T.L. NGUYEN8, V.M. HOANG9, T.Q.N. PHAM8, T.Q. NGUYEN10 1 Department of Health Management and Organization, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Vietnam; 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School, USA 3 Department of International Cooperation, Ministry of Health, Hanoi, Vietnam; 4 National Hospital of Dermatology and Venereology, Vietnam; 5 Institute for Preventive Medicine and Public Health, Hanoi Medical University, Vietnam; 6 Vietnam Steering Committee on Smoking and Health (VINACOSH), Hanoi, Ministry of Health, Vietnam; 7 Medical Services Administration, Ministry of Health, Hanoi, Vietnam; 8 WHO Office, Hanoi, Vietnam; 9 Hanoi University of Public Health, Hanoi, Vietnam; 10 General Statistics Office, Hanoi, Vietnam Keywords GATS (Global adults tobacco survey) • SHS (Secondhand smoke) • Smoke-free environment policy • Smoke-free regulations • MPOWER • Vietnam Summary Introduction. Since Vietnam has signed WHO framework on universities (36.70%), government buildings (31.12%), public trans- tobacco control (FCTC) in 2003 and has issued tobacco control port (20.04%), healthcare facilities (17.85%) and schools (15.84%). law in 2013, there has been little research concerning about what 13.23% of respondents saw smokers violate smoke-free regulations. impacts smoke-free regulations have had on public compliance. Among those who saw them violate smoke-free regulations, just one- The objective of this study was to assess public exposure to sec- third cautioned them to stop smoking. Strikingly, a higher rate of ondhand smoke and reaction toward smoke-free policy regula- cautioning smokers to stop smoking was observed among the older, tions in Vietnam and the associated factor. married, and better educated respondents. Respondents who were Methods. Using the design of GATS (Global Adult Tobacco Sur- married, better educated and in lower economic status were more vey), a nationally representative sample of 8,996 adults were likely to remind smokers to stop smoking. approached for data collection. Logistic regression was used to Conclusions. The study has called for strengthening two of the examine the associated factor. six MPOWER (Monitor, Protect, Offer, Warn, Enforce and Raise) Results. The study revealed that the prevalence of respondents components of the tobacco free initiative introduced by WHO, exposed to secondhand smoke was much higher in bars/café/tea shops Monitoring tobacco use and prevention policies and Protecting (90.07%) and restaurants (81.81%) than in any other public places, people from tobacco smoke. Introduction regulations [7]. The Article 8 of WHO FCTC and the letter “P” in MPOWER encourage states and nations Smoke-free policies are one of the most important to take action to protect their people from exposure to initiatives to protect people from exposure to sec- secondhand smoke in their work places, public trans- ondhand smoke, help smokers quit and reduce youth port and indoor public places. smoking [1]. Of the 195 members enrolling the WHO Although many countries have been trying different ap- FCTC, 118 states (60%) have implemented the reg- proaches to applying the smoke-free regulations on na- ulations of smoke-free environment policies from tional scale, only 18% of the world’s population is pro- minimal to complete level [2]. In addition to raised tected with comprehensive and national laws which ban tobacco taxation rates, smoke-free policies have been tobacco smoke in workplaces and public places, such as found as one of the most effective tobacco control restaurants and pubs [2, 8, 9]. However, many smoke- measures [3-5]. Many studies have shared best prac- free regulations are still implemented successfully at tices in adopting smoke-free policies and proved health economic outcomes of these policies in the world de- local level and multiplied in different places - outdoor spite the opposition and obstruction from public and areas and in shared housing settings [6, 8, 10, 11]. In tobacco industries [6]. The outstanding example is Tur- any circumstances, not only is it non-smokers who take key, the nation with the highest rate of adults smoking benefits from smoke-free regulations by being protected in Europe with 40.0% in 2006. After six years of policy from exposure, but also smokers who want to quit. It release, it had achieved the rate of 13.4% by applying has been found in several industrialized countries that the MPOWER (Monitor, Protect, Offering, Warn, En- smoke-free policies in work places reduced total tobacco force, Raise), especially the smoke-free environment consumption among workers by an average of 29% [1]. E36 https://doi.org/10.15167/2421-4248/jpmh2019.60.1.942 ADHERENCE TO SMOKE-FREE ENVIRONMENT POLICY IN VIETNAM Vietnam is among the countries with the highest smok- Sample and sampling. The survey was taken on a na- ing rate and its government has early recognized the tionally representative sample of 8,996 adults, including burden of tobacco use as well as the high need of to- all men and women age 15 years old or older, in con- bacco control policies in which smoking bans indoor formity with the GATS design. This target population in- and outdoor locations are of top priorities [12]. Prior to cluded all people whose country of residence is Vietnam. the adoption of WHO FCTC, the Government of Viet- This included those individuals residing in Vietnam even nam had enacted the National Tobacco Control Policy though they may not be considered a citizen of Vietnam. 2000-2010 which prohibited smoking in theaters, offic- The sampling did not comprise those who were visitors es, health facilities, schools and other public areas [13]. (e.g. tourists), institutionalized in hospitals, or residing After having signed the WHO FCTC in 2003, the Prime in an assisted living facility/nursing home, on a military Minister and the Government have shown a strong com- base, and others. To reach a complete sample, the General mitment to strictly ban smoking from indoor workplaces Statistics Office developed a master sample, which con- and public places through Directive 12/2007/CT-TTg on sisted of 15% of population-based 2009 Census. It was strengthening tobacco control activities and the Deci- sampled with the stratified two-stage random systematic sion No. 1315/QĐ-TTg on the Ratification of the Plan sampling method. The sample contained 25,500 enumer- for the Implementation of the Framework Convention ation areas (EAs) from 706/708 districts of Vietnam (2 on Tobacco Control [14, 15]. Since 2013, the National island districts were excluded from the GSO master sam- Assembly has ratified the Law on Prevention and Con- ple frame). The sample was eligible if it met 1) random trol of Tobacco Harms [16]. This is the official docu- selection which was used in each sampling stage so that ment with the highest legal validity on tobacco control every member of the target population had a non-zero in Vietnam. In article 11, public places where smoking chance of being selected into the sample, and 2) the prob- are completely prohibited include health facilities; edu- ability of selection for every unit (household and person) cation facilities; child care facilities and entertainment selected at each stage of the design was known and re- tained on the final analytic files for the study. area designated for children; areas with high risk of fire Data collection was conducted during August to Octo- and explosion; workplaces; universities and colleges; ber, 2015 in all 63 provinces of Vietnam. The pre-test took academic institutes and public means of transport (au- place before the main survey. The pre-test showed that it tomobiles; air planes; sky train/metro). Article 12 of the was technically feasible for the main survey as it met the law indicates areas where indoor smoking is prohibit- criteria of face validity and content validity. The main ed, but allowed for separate designated smoking areas, survey was then done by the General Statistics Office by such as airports segregation areas (waiting areas before using electronic data collection (tablet PC) involved by boarding the plane); bars, karaoke lounges, discos ho- 20 data collection teams, consisting of a total of 100 in- tel and guesthouses; on the public means of vehicle that terviewers.