Knowledge of the health consequences of tobacco smoking: a cross-sectional survey of Vietnamese adults.

0.11 MB·English

by  Minh An, Dao Thi

(cid:2)PUBLIC HEALTH IN VIETNAM: HERE’S THE DATA, WHERE’S THE ACTION?
Knowledge of the health
consequences of tobacco smoking:
a cross-sectional survey of
Vietnamese adults
Dao Thi Minh An1*, Hoang Van Minh1, Le Thi Huong1,
Kim Bao Giang1, Le Thi Thanh Xuan1, Phan Thi Hai2,
Pham Quynh Nga3 and Jason Hsia4
1Department ofEpidemiology, Institute forPreventive Medicine and Public Health,Hanoi
MedicalUniversity, Hanoi,Vietnam; 2The Vietnam SteeringCommittee onSmoking and Health,
Hanoi,Vietnam;3WorldHealthOrganizationOfficeinVietNam,Hanoi,Vietnam;4CenterforDisease
Control and Prevention, Atlanta, USA
Background: Although substantial efforts have been made to curtail smoking in Vietnam, the 2010 Global
AdultTobaccoSurvey(GATS)revealedthattheproportionofmaleadultscurrentlysmokingremainshighat
47.4%.
Objectives: To determine the level of, and characteristics associated with, knowledge of the health
consequences ofsmoking among Vietnamese adults.
Design:GATS2010wasdesignedtosurveyanationallyrepresentativesampleofVietnamesemenandwomen
aged 15 and older drawn from 11,142 households using a two-stage sampling design. Descriptive statistics
were calculated and multivariate logistic regression was used to examine associations between postulated
exposurefactors (age, education, accessto information,ethnic groupetc.) andknowledge on healthrisks.
Results:Generalknowledgeonthehealthrisksofactivesmoking(AS)andexposuretosecondhandsmoke
(SHS) was good (90% and 83%, respectively). However, knowledge on specific diseases related to tobacco
smoking(stroke,heartattack,andlungcancer)appearedtobelower(51.5%).Non-smokershadasignificantly
higherlikelihoodofdemonstratingbetterknowledgeonhealthrisksrelatedtoAS(OR1.6)andSHS(OR1.7)
thansmokers.Adultswithsecondaryeducation,collegeeducationorabovealsohadsignificantlyhigherlevels
knowledgeofAS/SHShealthrisksthanthosewithprimaryeducation(AS:ORs1.6,1.7,and1.9,respectively,
andSHS:ORs2.4,3.9,and5.7respectively).Increasingagewaspositivelyassociatedwithknowledgeofthe
healthconsequences of SHS, and accessto information wassignificantlyassociatedwith knowledge of AS/
SHS health risks (ORs 2.3 and 1.9 respectively). Otherwise, non-Kinh ethnic groups had significantly less
knowledgeonhealthrisksofAS/SHSthanKinhethnicgroups.
Conclusions: It may be necessary to target tobacco prevention programs to specific subgroups including
currentsmokers,adultswithloweducation,non-Kinhethnicsinordertoincreasetheirknowledgeonhealth
risksofsmoking.Comprehensivemessagesand/orimagesaboutspecificdiseasesrelatedtoAS/SHSshouldbe
conveyedusingofdifferentchannelsandmodesspecifictolocalculturestoincreaseknowledgeonsmoking
healthconsequencesforgeneralpopulation.
Keywords: knowledge;smoking;healthconsequences;globaladulttobaccosurvey;Vietnam
Received:7 May 2012; Revised:11 December 2012; Accepted:17 December 2012; Published:31 January 2013
Over the past 10 years, Vietnam had made issuedofficialdirectivesfortheimplementationofasmoke-
substantial efforts on tobacco control. In 2005, free policy. At the same time, levels of smoking remain
Vietnam ratified the Framework Convention on high in Vietnam. In 2001(cid:2)02, 69.1% of men smoked
TobaccoControl(FCTC),andinAugust2009,thePrime cigarettes; 23.2% of men smoked water pipe tobacco.
Minister’s Decision No. 1315/Q D-TTg approved a plan In addition, 63%of households had at leastone smoker,
toimplementFCTC.TheMinistryofHealth,Ministryof and71%ofchildrenunderage5livedinhouseholdswith
Education & Training, and Ministry of Transport also atleastonesmoker(1).In2003,nearly60%ofschool-age
GlobHealthAction2013.#2013DaoThiMinhAnetal.ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttribution- 1
Noncommercial3.0UnportedLicense(http://creativecommons.org/licenses/by-nc/3.0/),permittingallnon-commercialuse,distribution,andreproduction
inanymedium,providedtheoriginalworkisproperlycited. Citation:GlobHealthAction2013,6:18707-http://dx.doi.org/10.3402/gha.v6i0.18707
(pagenumbernotforcitationpurpose)
DaoThiMinhAnetal.
Policy Recommendations
. IEC activities in Vietnam should be designed specifically to focus on specific target populations, given their
smoking status and demographic characteristics.
. Information conveyed to smokers should be comprehensive, including not only general messages of smoking-
healthharmsbutalsospecifichealthrisksofactive,secondhandsmoking,anddiseaseburdensofsmokingbased
on the real data of specific diseases related to smoking which Vietnamese people suffered from.
. To improve accessibility to information of health consequences of smoking, messages that smoking is harmful
should be conveyed appropriately, frequently, and efficiently to different targeted populations by different
channels/modesofcommunicationwhicharemostlypreferredormostlyaccessiblebyeachtargetedpopulationin
the Vietnamese setting.
youth reported being exposed to secondhand smoke at Development Establishment (IDE). These activities con-
home (2). The prevalence of cigarette smoking among sisted of celebrity television interviews; tobacco control
students was 3.3% overall, while that among male communication activities in combination with a trans (cid:2)
students was 5.9% (3). The 2010 Global Adult Tobacco Viet bicycle riding tour from Hanoi to Ho Chi Minh
Survey (GATS) in Vietnam showed that smoking pre- City; hosting training IEC workshops on designing a
valence among adult males was 47.4%, and in a survey smokers’ behavior influencing project, called ‘Keep
conducted in hospitals and public places evidence re- tobacco smoke away from your wife and kids’ in Hai
vealed that smoking was common (4, 5). Phong City; and improving public awareness on the
KnowledgeisdefinedbytheOxfordEnglishDictionary negative effects of tobacco on human health and the
as expertise and skills acquired by a person through economy.VINACOSHhasbeencooperatingwithIDEin
experienceoreducation;whileperceptionistheprocessby developing tobacco and secondhand smoke control IEC
which humans interpret and organize sensation to pro- materials,applyingsocialmarketingapproachesindesign-
duce a meaningful experience of the world (6). It is now ingIECmaterials,and selectingrelevant communication
well established that if people’s perceptions of the com- channels (10). Although many efforts have been made
monalityandacceptabilityofabehaviorcanbeadjusted, under the IEC programs in Vietnam, there is still a need
their inclination to engage in that behavior may be in- for additional research to understand the relationship of
fluenced.Forexample,themorecommonandacceptable knowledgeofsmoking-healthrisksandsmokingbehavior
young people think smoking is among their immediate inVietnam.Thepurposeofthisstudywastoidentifythe
peers, their family group and society as a whole, the level of knowledge of health consequences of tobacco
morelikely theyareto take upthe habit (7). Conversely, smoking and its associated factors to inform IEC pro-
smoking uptake can potentially be reduced if pro- gramsonreducingtobaccosmoking.
smoking norms are challenged and anti-smoking norms
are strengthened. Gerards Hastings in his book titled Methods
‘SocialMarketing(cid:2)Whyshouldthedevilhaveallthebest’
wrote that ‘Normative education or de-normalization Selectionanddescriptionofparticipants
programs, therefore, can correct erroneous perceptions Data used in this article were obtained from the 2010
of the prevalence and acceptability of drug and alcohol GATS Vietnam, which was part of the multi-countries
use and establish conservative group norms that are household survey of the ongoing Global Tobacco Sur-
postulated to operate through lowering expectations veillanceSystem(GTSS)(11).TheGATSinVietnamwas
aboutprevalenceandacceptabilityofuseandthereduced designedasanationallyrepresentativesurveyofallnon-
availabilityofsubstancesinpeer-orientedsocialsettings’. institutionalizedmenandwomenaged15andolder,with
Therefore, Article 4 of FCTC of the World Health their primary residence in Vietnam.
Organization (WHO) stated that every person should be Atotalof11,142householdswereselectedusingatwo-
informed of the health consequences, addictive nature, phase sampling design analogous to a three-stage strati-
and mortal threat posed by tobacco consumption and fiedclustersampling.In2009,theGeneralStatisticsOffice
exposuretotobaccosmoke.Asaresult,severalcountries (GSO) in Vietnam conducted a population and housing
have attempted to educate their populations about the census.Meanwhile,GSOprepareda15%mastersampleto
healthconsequencesofsmoking(8,9).TheVietnamSteer- serveasafuturenationalsurvey-samplingframe.The15%
ing Committee on Smoking and Health (VINACOSH) master sample contains a subset of enumeration areas
hasmadesignificanteffortstoconveymessagesoftobacco (EAs) that consist of 15% of the population in Vietnam
controltoVietnamesepopulationduringthepast10years stratifiedintothreegroups.Thefirstgroupconsistsof132
by several Information, Education, and Communication districts, towns, or cities of provinces. The second group
(IEC) activities in cooperation with the International consistsof294plainandcoastaldistricts.Thethirdgroup
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Knowledgeofsmoking(cid:2)healthrisksamongVietnameseadults
consists of 256 mountainous and island districts. The (2) Knowledge of health consequences of secondhand
GATS sample was drawn from the 15% master sample smoke defined by one answered ‘yes’ to question
afterfurtherstratificationofthethreegroupsintourban ‘breathingotherpeople’ssmokecauseseriousillness
andruralareas(sixstrataintotal). in non-smokers’.
At the first stage of sampling, the primary sampling
unit (PSU) was EAs. The sampling frame was a list of Independent variables
the EAs, from the 15% master sample, with the number
of households as well as identifiable information, admi- (1) Smoking status: current smokers and current non-
nistered by the GSO Vietnam in 2009 from the census. smokers
Foreachofthesixstrata,thedesignatednumberofEAs (2) Demographicvariables:age;sex;education,quintile
wasselected. Aselectionprobability proportionaltosize of household income which is based on the current
(PPS)samplingmethodwasused,wherethesizewasthe study; area (urban/rural); region (ecological area),
selection probabilityof an EAusing PPS sampling from ethnic group
the entire target population divided by the selection (3) Accesstopositiveinformationchannelinthelast30
probabilityof an EA for the master sample. days(Answer‘yes’tooneofthefollowing:informa-
At the second stage of sampling, 18 households from tionabouthealthconsequencesofsmoking,encour-
the selected urban EAs and 16 households from the agement to quit, or health warnings on cigarette
selected rural EAs were chosen using simple systematic packages)
random sampling. One eligible household member from (4) Accesstonegativeinformationchannelinthelast30
eachselectedhouseholdwasthenrandomlychosenforan days(Answer‘yes’tooneofthefollowing:cigarette
interview. advertisement through media, cigarette advertise-
Note that the current design and the design where ment events, or cigarette promotion).
EAs were sampled directly universally were analogous.
The selection probability of an eligible individual was Statistics
calculated as a product of selection probability for each Descriptive and statistical analyses with percentages
stage.Thesamplingbaseweightforaneligibleindividual and 95% confidence interval (CI) were calculated using
wastheinverseofthe selectionprobabilityshownabove. Stata 10 software (Stata Corporation). The relationship
between demographic variables (sex, areas, education,
Datacollection age group, quintiles of income, regions), smoking status,
Handheldcomputers(iPAQ)wereusedforcollectingdata. and levels of access to information and knowledge of
Interviewers and supervisorsfrom GSO conductedfield- health consequences were conducted. Multivariate logis-
work, under the co-supervision of the WHO in Vietnam tic regression modeling was performed to identify what
andHanoiMedicalUniversity.Thefieldworklastedfrom variables associated with knowledge of health conse-
March 22, 2010, to May 13, 2010, in all 63 provinces of quencesofactivesmokingandpassivesmokinginwhich
Vietnam. The interviewers and supervisors were experi- variablesofdemographiccharacteristics,smokingstatus,
enced, trained in using computers and handheld (iPAQ) rule of ‘no smoking at home’ and levels of access to
devices, and had previous experience working with local information were screened for bivariate association
authorities,whichiskeytominimizingnon-responserates. and then all entered into the model as the independent
Acasefilecontainingaddressesandnamesofthehouse- factors. Backward elimination was used to remove ones
holds assigned to the interviewer was preloaded in the thatwerenotstatisticallysignificant(p(cid:2)0.05).Theodds
iPAQ prior to the fieldwork. The data collectorswent to ratio(OR)with95%CIwasused.Samplingweightswere
theresidencesoftherespondentsandmettheheadofthe used in all of the computations.
household to acquire general information about the
number of eligible individuals in the household. This Results
numberwasenteredintothehandheldcomputerandone The household response rate was 96.9% and was a
individual was automatically selected to be interviewed. little higher in rural areas than that in urban areas
AllresponseswereenteredintheiPAQ. (97.5 and 96.5%, respectively). The individual response
ratewas95.7%andwasalsoalittlehigherinruralareas
Variablesanddefinitionusedinthisarticle than that in urban areas (96.3 and 95.0%, respectively).
Dependent variables Overall,0.6%ofthehouseholdsand0.6%oftheselected
individuals refused to respond to the survey. The total
(1) Knowledge of specific diseases of active smoking responseratewas92.7%(93.9%inruralareasand91.7%
defined by one who answered ‘yes’ to all four inurban sites).
situations (smoking causes serious illness, stroke, Among 9,925 completed interviews of adults aged 15
heart attack, and lung cancer) and above, two-thirds were living in rural areas. People
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aged25(cid:2)44 madeupthelargestproportion(41.9%). The Table2. Knowledge of healthconsequences oftobacco
educational level that predominated was secondary smokingbydemographic characteristics
school (52.5%), followed by primaryor less (26%), while
college degree or above was only 7.2% of the total. The Activesmoking Secondhand
main occupation of the study population was farmers causesserious smokingcauses
(49.6%), followed by service/sales (19.2%) and produc- illness seriousillness
tion/driving (12.9%). By ethnicity, 84.5% were Kinh
Demographic Percentage Percentage
people, and the remaining 15.5% belonged to other
characteristics (95%CI*) (95%CI*)
ethnic groups. By marital status, 67.7% of the total was
married,26.2%weresingle,andtheremaining6.2%were
Overall 93.4(91.0(cid:2)95.2) 83.8(81.3(cid:2)86.1)
separated/divorced/widowed (Table 1).
Sex
Generally, the percentage of adults who agreed that
Male 93.7(91.9(cid:2)95.1) 84.3(81.8(cid:2)86.4)
activesmokingandexposuretosecondhandsmokecauses
Female 93.2(89.9(cid:2)95.4) 83.4(80.3(cid:2)86.1)
serious illness were at high levels (93.4 and 83.8%, res-
Residence
pectively) but differed by demographic characteristics.
Urban 97.1(96.4(cid:2)97.6) 90.8(89.7(cid:2)91.8)
Regarding knowledge of harmful health effects of active
Rural 92.1(88.8(cid:2)94.5) 81.3(78.0(cid:2)84.2)
and passive smoking, adults living in urban areas were
Ethnicgroup
moreknowledgeablethanthoselivinginruralareas(97.1
Kinh 96.8(96.1(cid:2)97.3) 88.2(87.0(cid:2)89.2)
vs92.1%and90.8vs81.3%,respectively);Kinhethnichad
Other 84.3(76.6(cid:2)89.8) 72.0(64.7(cid:2)78.2)
greater knowledge than non-Kinh ethnic (96.8 vs 84.3%
and 88.2 vs 72.0%, respectively). The respondents who Ecologicalregions
hadhigherincomeandeducationweremorelikelytohave RedRiverDelta 97.4(96.6(cid:2)98.0) 91.5(90.2(cid:2)92.7)
betterknowledgethanthosewhohadnot.Therewereno Northernmidland 96.1(94.6(cid:2)97.2) 86.2(82.9(cid:2)88.9)
differences for knowledge of health damage by sex, age andmountain
group,andecologicalregion(Table2). NorthCentralarea 97.1(95.0(cid:2)98.3) 92.6(90.0(cid:2)94.5)
andCentralcoastal
Table1. Distributionof adults ]15years byselected Centralhighlands 98.0(94.5(cid:2)99.3) 93.0(84.6(cid:2)97.0)
demographiccharacteristics (cid:2)VietNam GATS, 2010 SouthEast 95.1(93.8(cid:2)96.2) 82.5(80.0(cid:2)84.8)
MekongRiverDelta 88.6(82.1(cid:2)92.9) 78.9(72.5(cid:2)84.1)
Weighted Agegroups
15(cid:2)24 93.9(90.6(cid:2)96.0) 89.7(86.1(cid:2)92.4)
Number Unweighted
25(cid:2)34 93.7(89.0(cid:2)96.5) 85.0(79.6(cid:2)89.1)
Demographic Percentage ofadults numberof
35(cid:2)44 94.0(89.3(cid:2)96.7) 84.6(81.0(cid:2)87.6)
characteristics (95%CI*) (inthousands) adults
45(cid:2)54 95.6(94.1(cid:2)96.7) 87.0(84.8(cid:2)88.9)
55(cid:2)64 93.5(90.1(cid:2)95.8) 79.1(75.1(cid:2)82.6)
Overall 100 64,321 9,925
(cid:2)64 87.1(83.7(cid:2)89.9) 70.0(66.1(cid:2)73.6)
Gender
Male 48.6(47.3(cid:2)49.9) 31,259 4,356 Incomes
Female 51.4(50.1(cid:2)52.7) 33,063 5,569 Quintile1 85.3(78.8(cid:2)90.1) 69.6(64.1(cid:2)74.6)
Quintile2 96.0(94.5(cid:2)97.1) 86.7(84.1(cid:2)89.0)
Age(years)
Quintile3 96.9(95.6(cid:2)97.8) 88.9(86.5(cid:2)90.8)
15(cid:2)24 25.9(24.6(cid:2)27.2) 16,637 1,656
Quintile4 97.9(97.0(cid:2)98.6) 92.1(90.6(cid:2)93.4)
25(cid:2)44 41.9(40.6(cid:2)43.2) 26,944 4,251
Quintile5 97.7(96.8(cid:2)98.3) 94.8(93.5(cid:2)95.8)
45(cid:2)64 23.4(22.4(cid:2)24.5) 15,065 2,886
65(cid:4) 8.8(8.2(cid:2)9.5) 5,675 1,132 Education
Primaryorless 84.5(79.0(cid:2)88.7) 64.6(60.3(cid:2)68.7)
Residence
Lowersecondary 96.8(95.4(cid:2)97.8) 88.7(86.6(cid:2)90.5)
Urban 30.7(30.0(cid:2)31.4) 19,725 4,958
Uppersecondary 98.2(96.9(cid:2)99.0) 95.0(93.1(cid:2)96.3)
Rural 69.3(68.6(cid:2)70.0) 44,596 4,967
Collegeand/or 99.1(98.4(cid:2)99.5) 97.1(95.8(cid:2)97.9)
Educationlevel
above
Primaryorless 26.0(24.2(cid:2)27.8) 12,377 2,034
Lowersecondary 52.5(50.8(cid:2)54.3) 25,031 3,981 *95%confidenceinterval.
Uppersecondary 14.3(13.1(cid:2)15.5) 6,794 1,023 N(cid:3)9,919individualsfrom656PSUsof6strata.
Collegeorabove 7.2(6.6(cid:2)7.9) 3,447 1,227
However,only51.5%ofintervieweesansweredcorrectly
*95%confidenceinterval. to all three specific health consequences (stroke, heart
N(cid:3)9,925individualsfrom656PSUsof6strata. attack, and lung cancer). The most common health
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Knowledgeofsmoking(cid:2)healthrisksamongVietnameseadults
consequence was lung cancer (95.8%), while strokes and health consequences of active smoking are education,
heart attacks were found to be much lower (67.6 and ethnicity, access to information, and smoking status.
60.9%, respectively). Of interest, current smokers dis- Adults at lower secondary, upper secondary, and college
played significantly lower knowledge of health risks of or above were more likely to have significantly better
active smoking than current non-smokers, for example, knowledge of health consequences of active smoking
smoking causes serious illness (83.3 vs 95.1%), stroke than those at primary school (OR: 1.6, 1.7, and 1.9,
(59.4vs70.3%),heartattack(54.2vs.63.1%),lungcancer respectively).Itwasalsothecaseofknowledgeonhealth
(93.0 vs 96.7%), all three main consequences (43.1 vs consequences of secondhand smoke (OR: 2.4, 3.9, and
54.3%),andsecondhandsmoke(77.3vs86.0%)(Table3). 5.7, respectively). Adults belonging to non-Kinh ethnic
There were significant differences in the knowledge of had significantly lower knowledge of active and passive
healthconsequencesforthosewhohaveaccesstopositive smoking-healthrisksthanKinhethnic(OR:0.7and0.4,
information and those who did not, with those having respectively). This model also indicated that accessing
access to information having more knowledge of health positive information had significant association with
consequences of active smoking than those who did knowledge of both active and passive smoking-health
not, for example, knowledge of: serious illness 96.2 vs risks (OR: 2.3 and 1.9, respectively). Noticeably, current
76.3%, stroke 71.8 vs 41.1%, heart attack 64.5 vs 37.9%, non-smokers have significantly better knowledge of
lung cancer 97.7 vs 83.4%, and all three main health active and passive smoking-health risks than current
consequences 55.5 vs 27.0%. This relationship held for smokers (OR: 1.6 and 1.7, respectively). Increasing age
individuals having access to information about second- was positively related to knowledge of the health
hand smoke exposure; 87.9% of individuals with access consequences of secondhand smoke (Table 5).
knew that breathing other people’s smoke can cause
serious illness in non-smokers, while among adultswith- Discussion
out access only 59.0% knew about the consequences. This study found that although there was a high pro-
However, as demonstrated in Table 4, there were not portion among adults answering that active and second-
manyother differences between the groups. hand smoking can cause serious illness (Table 1), only
Education level was reported onlyamong respondents 51.5% of them understood that smoking can cause all
aged 25 yearswith the assumption that at age of 25 and three specific diseases (stroke, heart attack, and lung
above, people have completed their education and have cancer) which were scientifically documented to have
acquired knowledge and attitudes about tobacco use. close relationships with smoking (Table 2) (12, 13). The
Twomodelswereconstructed:(1)Modela:forallofthe finding that the riskof lung cancer was most frequently
study subjects (all aged 15 years and above) education reported is consistent with other findings about the
was excluded and (2) Model b: for those aged 25 years causes of disease reported by adults, even though heart
andaboveandeducationwasincludedasanindependent disease is the numberone killerof smokers (14).
variable. Model a had similar results as model b. In this The difference in knowledge between current smokers
article, model b was presented in Table 5 of the results and current non-smokers was also studied elsewhere.
section while model a was presented in Table 6 in the Yang et al. found in the 2010 GATS China that current
appendixsection.Multivariatelogisticregressionanalysis smokers were aware of fewer health effects of smoking
indicatedthatafteradjustingfordemographiccharacter- than current non-smokers, respectively. For individual
istics,accessibilitytoinformation,ruleof‘nosmokingat health effects, only 68% of current smokers agreed that
home’, and smoking status, predictors of knowledge of smoking causes lung cancer in smokers while among
Table3. Knowledge of healthconsequences oftobacco smoking by smoking status
Knowledgeofhealthconsequencesoftobaccosmoking Currentsmokers Currentnon-smokers Total
Smokingcauses Percentage(95%CI*) Percentage(95%CI*) Percentage(95%CI*)
Seriousillness 88.3(82.8(cid:2)92.2) 95.1(93.6(cid:2)96.3) 93.4(91.0(cid:2)95.2)
Stroke 59.4(54.0(cid:2)64.6) 70.3(67.8(cid:2)72.7) 67.6(64.9(cid:2)70.3)
Heartattack 54.2(49.9(cid:2)58.5) 63.1(60.8(cid:2)65.4) 60.9(58.5(cid:2)63.4)
Lungcancer 93.0(89.9(cid:2)95.2) 96.7(95.8(cid:2)97.3) 95.8(94.6(cid:2)96.7)
Stroke,heartattack,andlungcancer 43.1(38.0(cid:2)48.4) 54.3(52.0(cid:2)56.6) 51.5(48.8(cid:2)54.2)
Breathingotherpeople’ssmokecauseseriousillness 77.3(71.3(cid:2)82.4) 86.0(84.2(cid:2)87.7) 83.8(81.3(cid:2)86.1)
innon-smokers
*95%confidenceinterval.
N(cid:3)9,919individualsfrom656PSUsof6strata.
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Table4. Knowledge of healthconsequences oftobacco smoking bydifferent channels of accessingto information
Accesstopositiveinformation** Accesstonegativeinformation***
Knowledgeofhealthconsequencesoftobaccosmoking Percentage(95%CI*) Percentage(95%CI*)
Smokingcauses No Yes No Yes
Seriousillness 76.3(67.5(cid:2)83.3) 96.2(94.9(cid:2)97.2) 93.2(90.9(cid:2)94.9) 94.7(90.1(cid:2)97.2)
Stroke 41.1(34.5(cid:2)48.0) 71.8(69.7(cid:2)73.7) 66.5(63.5(cid:2)69.3) 75.1(70.0(cid:2)79.7)
Heartattack 37.9(32.0(cid:2)44.3) 64.5(62.5(cid:2)66.4) 59.6(56.9(cid:2)62.2) 69.6(64.7(cid:2)74.0)
Lungcancer 83.4(77.7(cid:2)87.9) 97.7(97.1(cid:2)98.1) 95.4(94.1(cid:2)96.5) 97.8(96.6(cid:2)98.6)
Stroke,heartattack,andlungcancer 27.0(21.9(cid:2)32.7) 55.5(53.4(cid:2)57.6) 50.1(47.3(cid:2)52.9) 60.0(55.1(cid:2)64.7)
Breathingotherpeople’ssmokecauseseriousillness 59.0(52.0(cid:2)65.6) 87.9(86.0(cid:2)89.6) 83.4(80.9(cid:2)85.6) 86.6(82.2(cid:2)90.0)
innon-smokers
*95%confidenceinterval.
**Accesstopositiveinformationchannelinthelast30days(informationabouthealthconsequencesofsmokingorencouragementtoquit;
healthwarningsoncigarettepackages).
***Accesstonegativeinformationchannelinthelast30days(cigaretteadvertisementthroughmedia,cigaretteadvertisementevents,
cigarettepromotion).
N(cid:3)9,919individualsfrom656PSUsof6strata.
current non-smokers, the percentage is more than 90%. secondhandsmokingwere2.3and1.9times,respectively,
In addition, only 36% of current smokers agreed that more likely to have more knowledge than those who
smoking causes coronary heart diseases while among did not. Returning to the first major model for com-
currentnon-smokersthepercentageisover50%(15).The munication in 1949 by Claude Elwood Shannon and
difference in knowledge of health risk between smokers Warren Weaver, the process of communication was
andnon-smokersissimilartopatternsobservedinChina broken down into eight discrete components, that is,
and Western countries, where smokers systematically informationsource,message,transmitter,signal,channel,
underestimated their personal risks from smoking, pre- noise, receiver, and destination. The current study has
sumably in an attempt to minimize cognitive dissonance identified three out of eight components of this model
fromsmokingandshieldthemselvesfromworry(16(cid:2)18). that should be carefully considered when developing
RegardingdifferencesinknowledgebetweenKinhethnic and carrying out an IEC program for tobacco control
and non-Kinh ethnic, the 2002 Vietnamese national conducted in Vietnam.
health survey indicated that non-Kinh ethnic groups are First, by indicating that an understanding about
peoplelivinginruralareaswithlowerlevelsofeducation specific health risks related to tobacco smoking among
than those living inurban areas (19), and a World Bank Vietnameseadults,especiallyamongcurrentsmokersand
survey indicated that 90%of the poor inVietnam live in non-Kinhethnic,maystillnotbespecific,thisstudycan
the rural areas (20). ‘This has resulted in significant help inform IEC programs designed to prevent tobacco
educational challenges’, as said by the Vice General smoking;messagesshouldbedesignedtobescientifically
Director of the Department of Sports, Entertainment credible, comprehensive, andconsistent for thenation as
and Economic Information at Viet Nam Television awhole. Second, by indicating that current smokers and
(VTV). In addition, in a very recent household survey non-Kinh ethnic groups have lower levels of knowledge
inVietnamconductedin2011,itindicatedthatpeopleat thanothergroups,itmaybenecessarytotargetmessages
loweducationlevelsweremorelikelytosmoke(21).This to individual population subgroups. Third, byindicating
iswheretheIECcanplayanimportantroleinpreventing that access to positive information is predictive of
smoking.CheeRueyHsiehinhisstudyonknowledgeof knowledge, this current study highlights the importance
health risks in anti-smoking campaigns found that anti- of coverage of an IEC program. This issue is specially
smoking campaignshad a significantlypositive effect on concernedinVietnamesecontextbecausetheGATS2010
the public health-related knowledge (22). The Centers indicated that, percentage of population accessing to
for Disease Control (CDC)’s best practice guidelines massmediawasstillverylow(32.8%)andthataccessing
suggested that public education is an integral part in to health warnings on cigarette packets among current
the efforts to both prevent initiation of tobacco use and smokers was only 14% and among general population
to encourage tobacco cessation (23). This current study was only 12.7% (24).
supportstheimportanceoftheabilitytoaccessinforma- Therefore,intermsofpolicyimplication,itisnecessary
tion in both descriptiveand multivariate analyses. Those todevelopanationalIECprogramforpreventingsmok-
accessing information of the health harms of active and ing tobaccowhichwould be designedfordifferent target
6
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Knowledgeofsmoking(cid:2)healthrisksamongVietnameseadults
Table5. Logisticregressionanalysis forfactors associatedwithknowledge of healthconsequences of smoking(model b)
Dependentvariables
Knowledgeonhealthrisks Knowledgeofhealthrisksof
ofactivesmoking secondhandsmoking
Independentvariables Sub-categories OR** 95%CI* OR** 95%CI*
Gender Male 1
Female 0.9 0.8(cid:2)1.1 1 0.7(cid:2)1.4
Agegroup 25(cid:2)34 1
35(cid:2)44 0.9 0.7(cid:2)1.2 2 1.5(cid:2)2.7
45(cid:2)54 1 0.9(cid:2)1.3 1.9 1.5(cid:2)2.4
55(cid:2)64 1.2 1(cid:2)1.5 2.2 1.6(cid:2)2.9
65andabove 1.3 1(cid:2)1.6 1.3 1(cid:2)1.7
Education Primary 1
Lowersecondary 1.6 1.3(cid:2)1.9 2.4 1.9(cid:2)3
Uppersecondary 1.7 1.3(cid:2)2.2 3.9 2.6(cid:2)5.8
Collegeorabove 1.9 1.4(cid:2)2.5 5.7 3.7(cid:2)8.6
Income Quintile5 1
Quintile1 0.9 0.7(cid:2)1.1 0.5 0.3(cid:2)0.6
Quintile2 0.9 0.7(cid:2)1.1 0.8 0.6(cid:2)1.1
Quintile3 0.8 0.7(cid:2)1 0.7 0.5(cid:2)1
Quintile4 0.9 0.8(cid:2)1.1 0.9 0.6(cid:2)1.2
Ethnic Kinh 1
Non-Kinhethnic 0.7 0.5(cid:2)0.8 0.4 0.3(cid:2)0.6
Accesstopositiveinformation No 1
Yes 2.3 2(cid:2)2.6 1.9 1.6(cid:2)2.3
Accesstonegativeinformation No 1
Yes 0.7 0.4(cid:2)1.1 0.7 0.2(cid:2)1.9
Area Urban 1
Rural 1.1 1(cid:2)1.3 1.1 0.9(cid:2)1.3
Region RedRiverDelta 1
Northernmidlandandmountain 1.2 0.9(cid:2)1.5 1.9 1.2(cid:2)3
NorthCentralareaandCentralcoastal 1.2 1(cid:2)1.4 1.1 0.8(cid:2)1.5
Centralhighlands 1.2 0.8(cid:2)1.7 1.2 0.7(cid:2)2.1
SouthEast 1.1 0.9(cid:2)1.4 0.8 0.6(cid:2)1.1
MekongRiverDelta 0.9 0.7(cid:2)1.1 0.5 0.4(cid:2)0.7
Smokingstatus Currentsmokers 1
Currentnon-smoker 1.6 1.3(cid:2)1.9 1.7 1.1(cid:2)2.5
*95%confidenceinterval,**oddsratio.
N(cid:3)8,265individualsfrom656PSUsof6strata.
groups of adults, including a general one, smokers, and smoking can cause all three diseases of stroke, heart
non-Kinh ethnic groups in which clear and comprehen- attack, and lung cancer. Regarding knowledge of health
sive messages/images about the health harm of tobacco harms of active and passive smoking, current non-
smoking is conveyed appropriately and efficiently by smokers were 1.6(cid:2)1.7 times likely to have better knowl-
differentchannels/modestolocal-specificcultures. edgethancurrentsmokers,respectively;non-Kinhethnic
groups were less likely to have knowledge (OR(cid:3)0.7 and
Conclusion 0.4, respectively) than Kinh ethnic group smokers.
The 2010 GATS in Vietnam showed that adults’ knowl- Accessing positive information had a close association
edge of specific diseases related to tobacco smoking was with knowledge of smoking-health risks (OR(cid:3)2.3 and
stillvagueasreflectedinonly51.5%adultsknowingthat 1.9, respectively, with pB0.001). The more education
7
Citation:GlobHealthAction2013,6:18707-http://dx.doi.org/10.3402/gha.v6i0.18707
(pagenumbernotforcitationpurpose)
DaoThiMinhAnetal.
adults had, thebetterknowledge of health consequences Kingdom, and Australia: findings from the ITC four country
of tobacco smoking they got. Increasing age was posi- survey. APACT 2010. Handbook and Conference Program.
FCTC in the Asia Pacific: Change, Challenge and Progress.
tivelyrelatedtoknowledgeofthehealthconsequencesof
APACT2010-Sydney,Australia,2010,p.141.
secondhand smoke.
9. Otani J. Awareness of college students on health impact of
smokingandimpactofhealtheducation,measuredbytheKano
Test for Social Nicotine Dependence (KTSND): comparative
Acknowledgements
survey of Japan and Central Asian countries. APACT 2010.
HandbookandConferenceProgram.FCTCintheAsiaPacific:
Sincethebeginningofthe2-yearsurvey,wehavereceivedveryclose
Change, 2010. Challenge and Progress. APACT 2010-Sydney,
andvaluabletechnicalassistancefromCDCinthedevelopmentof
Australia,p.163.
questionnaires,sampledesign,dataanalysis,aswellasstandardized
10. Vinacosh, International Cooperation. Vietnam Steering
GATS methodology and protocols in a series of manuals and
Committee on Smoking and Health; 2012. Available from:
guidelines. Our appreciation goes out to CDC for these valuable
http://www.vinacosh.gov.vn[cited15January2012].
contributions.
11. WarrenCW,LeeJ,LeaV,GodingA,O’HaraB,CarlbergM,
We also acknowledge and highly appreciate the strong commit-
etal.Evolutionoftheglobaltobaccosurveillancesystem(GTSS)
ment,leadership,andsupportfromMinistryofHealthandMinistry
1998(cid:2)2008. Glob Health Promot 2009; 16(2 Suppl): 4(cid:2)37.
of Planning and Investment for completing this survey. Excellent
12. CDC. State-specific smoking-attributable mortality and years
cooperationfromtheVietnamSteeringCommitteeonSmokingand
ofpotentiallifelost(cid:2)UnitedState,2000(cid:2)2004.MMWRMorb
Health,theGSO,andHanoiMedicalUniversityhascontributedto
MortalWklyRep2009;58:91.
thesuccessofthisproject.
13. U.S. Departmentof Health and Human Services (2010). How
Collaboration and support from related governmental and non-
tobaccosmokecausesdisease.ReportoftheSurgeonGeneral(cid:2)
governmental organizations and tobacco control experts are also
Executive Summary. Atlanta: U.S. Department of Health and
highlyappreciated.
Our sincere thanks go to the World Health Organization, from HumanServices,CentersforDiseaseControlandPrevention.
14. U.S. Department of Health and Human Services (2004). The
HeadquarterstoRegionalOfficestoCountrylevels,forfacilitating
GATSimplementation,providingtechnicalandmanagementassis- healthconsequencesofsmokingareportofthesurgeongeneral.
tance, financial support, and coordinating national and interna- Atlanta: U.S. Department of Health and Human Services,
tionalpartners. Centers for Disease Control and Prevention, National Center
Themostgratefulacknowledgmentgoestothehardworkoffield for Chronic Disease Prevention and Health Promotion, Office
supervisors, field interviewers, and all respondents. Without their onSmokingandHealth.
contributions,ourworkwouldneverhavebeenpossible. 15. Yang J, Hammond D, Driezen P, Fong GT, Jiang Y. Health
knowledgeandperceptionofrisksamongChinesesmokersand
Conflict of interest and funding non-smokers:findingsfromtheWave1ITCChinaSurvey.Tob
Control2010;19(Suppl2):18(cid:2)23.
The authors have not received any funding or benefits
16. Weinstein N. Public understanding of the illnesses caused by
from industryor elsewhere to conduct this study. smoking.NicotineTobRes2004;6:349(cid:2)55.
17. SlovicP.Smoking:risk,perceptionandpolicy.ThousandOaks,
CA:Sage;2001.
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Knowledgeofsmoking(cid:2)healthrisksamongVietnameseadults
Appendix
Table6. Logisticregression: factors associatedwithknowledge ofhealthconsequences of smoking (model a)
Dependentvariables
Knowledgeonhealth Knowledgeofhealthrisksof
risksofactivesmoking secondhandsmoking
Independentvariables Sub-categories OR** 95%CI* OR** 95%CI*
Gender Male 1
Female 0.8 0.7(cid:2)1 0.8 0.5(cid:2)1.1
Agegroup 25(cid:2)34 1
35(cid:2)44 0.8 0.6(cid:2)1 3 2.2(cid:2)4.1
45(cid:2)54 0.8 0.7(cid:2)1.1 2.6 2(cid:2)3.4
55(cid:2)64 1 0.8(cid:2)1.2 3.1 2.3(cid:2)4.1
65andabove 0.7 0.5(cid:2)0.9 1.7 1.2(cid:2)2.2
Education Primary 1
Lowersecondary 1.6 1.3(cid:2)1.9 2.4 1.9(cid:2)3
Uppersecondary 1.7 1.3(cid:2)2.2 3.9 2.6(cid:2)5.8
Collegeorabove 1.9 1.4(cid:2)2.5 5.7 3.7(cid:2)8.6
Income Quintile5 1
Quintile1 0.7 0.6(cid:2)0.9 0.3 0.2(cid:2)0.4
Quintile2 0.8 0.6(cid:2)1 0.5 0.4(cid:2)0.7
Quintile3 0.8 0.6(cid:2)0.9 0.5 0.4(cid:2)0.7
Quintile4 0.9 0.7(cid:2)1 0.7 0.5(cid:2)1
Ethnic Kinh 1
Non-Kinhethnic 0.6 0.5(cid:2)0.7 0.3 0.3(cid:2)0.5
Accesstopositiveinformation No 1
Yes 2.4 2.1(cid:2)2.8 2.2 1.8(cid:2)2.6
Accesstonegativeinformation No 1
Yes 0.6 0.4(cid:2)1.1 0.6 0.2(cid:2)1.8
Area Urban 1
Rural 1.1 0.9(cid:2)1.2 1 0.8(cid:2)1.2
Region RedRiverDelta 1
Northernmidlandandmountain 1.2 0.9(cid:2)1.5 1.8 1.1(cid:2)2.9
NorthCentralareaandCentralcoastal 1.2 1(cid:2)1.4 1.1 0.8(cid:2)1.5
Centralhighlands 1.1 0.7(cid:2)1.6 1 0.6(cid:2)1.8
SouthEast 1 0.8(cid:2)1.3 0.6 0.5(cid:2)0.9
MekongRiverDelta 0.8 0.6(cid:2)1 0.4 0.3(cid:2)0.6
Regulationof‘nosmokingathome’ No 1
Yes 1 0.8(cid:2)1.3 0.8 0.6(cid:2)1.2
Smokingstatus Currentsmokers 1
Currentnon-smokers 1.6 1.3(cid:2)2 1.8 1.2(cid:2)2.7
*95%confidenceinterval,**oddsratio.
N(cid:3)9,919individualsfrom656PSUsof6strata.
9
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