Socialist Republic of Viet Nam: HIV/AIDS Prevention Among Youth Project (Financed by Asian Development Fund IX Grants Program)

Transcription

1 Grant Consultant s Report Project Number: June 2006 Socialist Republic of Viet Nam: HIV/AIDS Prevention Among Youth Project (Financed by Asian Development Fund IX Grants Program) Thematic Report on Using Alcohol, Beer and Cigarette Among Vietnamese Youth Ha Noi 2010 Prepared by Savy 2 Consultants For Asian Development Bank This consultant s report does not necessarily reflect the views of ADB or the Government concerned, and ADB and the Government cannot be held liable for its contents. (For project preparatory technical assistance: All the views expressed herein may not be incorporated into the proposed project s design.

2 Survey Assessment of Vietnamese Youth 2 (SAVY2) THEMATIC REPORT USing Alcohol, Beer And cigarette Among VietnAmeSe YoUth The Analysis Result of Survey Assessment of Vietnamese Youth 2003 and 2009 (SAVY) nguyen Thanh liem Vu cong nguyen nguyen hanh nguyen hanoi, 2010

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4 Introduction The development of adolescents and youth is always a matter of primary concern in Vietnam as well as many countries around the world. This is the generation to decide the future and destiny of the country. In Vietnam, adolescents and young adults aged are the largest population group, accounting for nearly a quarter of the national population (over 20 million people - the General Statistics Office, Census and Housing 2009). The catch is these fundamental characteristics related to social life, attitudes, aspirations and challenges in the development of this population group is very important In the framework of the HIV/AIDS prevention among youth, the General office of Population and Family Planning and the General Statistics Office conducted the 2nd round of the Survey Assessment of Vietnamese Youth (SAVY). SAVY (round 1 and 2) is the large and most comprehensive survey about youth in Vietnam. The 2nd round of the survey was a collaboration between many national and international agencies and organizations in the country, from central to local levels, with the participation of 10,044 young people between years old in 63 provinces/cities, from urban to rural and remote mountainous areas. SAVY 2 data provided a comprehensive picture of the young Vietnam today as well as their changes compared with there same cohorts 5 years ago. SAVY 2 helps us see the aspects related to the development of youth such as education, employment, health (including reproductive health, HIV/AIDS, drug use, Injuries and violence. Besides the positive signs, SAVY2 also shows young people were facing the challenge to adapt to extensively transformed social and economic environment. Vulnerable youth groups of ethnic minorities, remote areas... also face the difficulties of material conditions, education and employment. The survey helps us understand more profoundly the thoughts, attitudes, desires and ambitions of Vietnam youth today and towards the future. SAVY2 overall results was launched in June 2010 On the basis of survey data, the financial assistance of Asian Development Bank and technical support of the United Nations Population Fund (UNFPA), the General office of Population and Family planning in collaboration with national researchers compiled 9 thematic reports and policy briefs. Topics include 3

5 1. Education 2. Employment 3. Puberty Sexual and Reproductive health 4. Mental Health 5. Access and use of means of mass media 6. Attitudes of Vietnam towards some social issues 7. Injuries and violence 8. Substances use 9. Knowledge and attitude of Vietnam youth about HIV/AIDS and people living with HIV/AIDS. We hope that the findings of social life, attitudes and aspirations of Vietnam youth and the policy implications from 9 policies will contribute efficiently and practically to the policy making and the implementation of existing policies and programs for health improvement and overall development of the young people. The General Office of Population and family planning would like to thank the Asian Development Bank; the United Nations Population Fund (UNFPA); Dr. Robert Blum and all the national experts for the valuable financial and technical support for the implementation of the survey, data analysis and development of the survey reports and policy briefs. We appreciate the dedication and passion of all the reports authors: Prof&PhD. Vu Manh Loi (Institute of Sociology), Prof&PhD. Nguyen Huu Minh, MSc.Tran Thi Hong (Institute for Family and Gender); PhD. Nguyen Thanh Huong, Prof&PhD. Le Cu Linh (Hanoi School of Public Health); PhD. Bui Phuong Nga (Independent Expert); MSc. Nguyen Thi Mai Huong (Center for Community Research and Development), MSc. Nguyen Dinh Anh (IEC Department, GoPFP), MSc. Ngo Quynh An (National Economics University), PhD. Nguyen Thanh Liem, Ms. Nguyen Hanh Nguyen, MSc. Vu Cong Nguyen (Institute of Sociology), Dr. Dao Xuan Dung (independent expert). 4

6 Despite enormous efforts have been made, however the thematic reports may inevitably contain shortcomings. General Office of Population and Family Planning would like to receive valuable inputs from national and international individuals, organizations interested in the development of Vietnam youth in an order to finalize these reports. We are pleased to present a set of thematic reports and policy briefs to all managers, scientists, local and international organizations working in and contributing to the comprehensive growth of young people in Vietnam Phd. duong Quoc trong general director General Office of Population and Family Planning 5

7 list of Steering committee of 2nd national SUrVeY ASSeSSment of VietnAmeSe YoUth Steering committee Phd. nguyen Ba thuy, Vice Minister of Health, chair md, Phd. duong Quoc trong, Director of General Office for Population and Family Planning, Vice-chair dr. ngo Khang cuong, Former Director of Department of Communication and Education, General Office for Population and Family Planning ms. tran thi thanh mai, Vice Director of Department of Communication and Education, General Office for Population and Family Planning mr. nguyen duy Khe, Director of Material Child Heath Department, the Ministry of Health ms. nguyen thi hoa Binh, Steering Board Member, Director of Center for Support of HIV/AIDS Prevention and Reproductive Healthcare for Women Vietnam Women s Union mr. Phung Khanh tai, Standing Member of Central Ho Chi Minh Communist Youth Union mr. nguyen Van Kinh, Former Vice Director of Vietnam Administration of HIV/AIDS Control, Director of National Institute for Tropical Diseases ms. le thi ha, Vice Director of Department of Social Evils Prevention, Ministry of Labor, Invalids and Social Affairs mr. nguyen dinh chung, Vice Director of Society and Environment Statistics Department, General Statistics Office, Ministry of Planning and Investment mr. la Quy don, Vice Director of Department of Pupil and Student Affairs, Ministry of Education and Training 6

8 thematic report AUthor group msc. ngo Quynh An, National Economics University msc. nguyen dinh Anh, Vice Director of Department for Communication and Education, General Office of Population and Family Planning dr.dao Xuan dung, Freelance expert msc. nguyen mai huong, Director of Center for Community Health Research and Development Phd. nguyen thanh huong, Hanoi School of Public Health Prof&Phd. nguyen huu minh, Director of Institute of Gender and Family Prof&Phd. le cu linh, Dean of Post Graduation Department, Hanoi School of Public Health Prof & Phd. Vu manh loi, Director of Family and Society Studies, Institute of Sociology Phd. nguyen thanh liem, Institute of Population, Health and Development Phd. Vu Quy nhan, Freelance expert Phd. Bui Phuong nga, Freelance expert ms. nguyen hanh nguyen, Institute of Population, Health and Development msc. Vu cong nguyen, Institute of Population, Health and Development international expert Prof & Phd.robert Blum, Jon Hopkins University of United States 7

9 table of contents i. introduction...11 ii. data, method ABd ScoPe of research...12 iii. USing Alcohol And Beer Among the YoUth Using and abusing alcohol and beer...13 a. Use rate...13 b. Drunkenness...14 c. Age at first use of alcohol and beer regional variation Variation by ethnicity Variation by education Variation by living standard of the household Family and friends influences on alcohol and beer use...23 a. Alcohol addiction of other members in the household...23 b. Pressure from friends determinants of alcohol and beer use drinking and driving motor vehicles...28 iv. SmoKing cigarette Among the YoUth Smoking behavior...32 a. Smoking rate...32 b. Age at first smoking reasons for smoking and giving up smoking...34 a. Reasons for smoking...34 b. Giving up smoking regional variation

10 4. Variation by ethnicity Variation by education Variation by living standard of the household influence from family and friends...41 a. Influence from family...41 b. Pressure from friends to smoke determinants of smoking among male youth...42 V. discussion And recommendation The use of alcohol and beer among youth Smoking among youth...48 references

11 ABBreViAtion MOH WHO SAVY UNICEF VINACOSH Ministry Word Health Organization Survey Assessment of Vietnam Youth The United Nations Children s Fund Vietnam Tobacco Control Program 10

12 I. Introduction Like many other Asian countries, Vietnam has a young population and the youth play an important role in the development of the country (UN, 2007). Results of the 2009 Census showed that more than 16 million people were the young aged accounting for 19.4% of the whole population in the country (CSC, 2010) 1. The development of young generation was partly held back due to the use of addictive substances including cigarette and alcohol. International researches proved that using cigarette and alcohol among young people created a big burden on health and socio-economy (WHO, 2001; WHO, 2004). Using and cigarette and alcohol also dragged down independence and responsibility of the youth when they grew up and discouraged them to take part in social activities (UN, 2007: 29). In Vietnam, the government promulgated regulations and laws to reduce the use of alcohol. For example, the law to levy luxury tax on alcohol/beer was applied in , the regulations to prohibit alcohol use when driving car/motorbike was applied in 2007, new terms in the Land Traffic Law (effected on 01-Jul-09) stipulated that using alcohol during motor-vehicle operation was strictly prohibited, 3 etc. Another forbidden activities were selling cigarette for clients aged under 18, 4 advertising and importing tobacco or cigarette, 5 selling cigarette at public places such as school, hospital, cinema, 6 smoking at public locations, 7 apart from those, a warning message on the evil influences of cigarette was forced to be printed in each and every packet of the product, 8 etc. Government of Vietnam has also approved a National Policy against the harmfulness of cigarette for the period 9. Since , The National Prevention Program on cigarette harmfulness has been implementing officially. Regardless of those efforts, the National Health Survey in 2002 indicated the use of alcohol, beer and cigarette was popularized in Vietnam especially among men (Dam Viet Cuong and Vu Thi Minh Hanh, 2006). 1 These figures are based on available data on the website of the General Statistics Office ( from Population and Housing Census in The Law No. 05/1998/QH 10 and adjustment document No. 916/TCT-CS of the General Deparment of Taxation dated March 17, Directive No CT / TU. 4 According to Decree No. 293/CP dated July 4, According to the Directive No. 278/CT of the Council of Ministers dated August 3, According to Decree No. 76/2001/ND-CP and Decree No. 119/2007/ND-CP dated July 18, 2007; the policy takes effect starting from According to Decree No. 45/2005/ND-CP dated April 6, 2005, Decision No.129/2007/QD-TTg dated August 2, 2007, and most recently, Decision No. 1315/QD-TTg dated August 21, Decree No. 76/2001/ND-CP, Decree No. 119/2007/ND-CP, Decree No. 06/2009/ND - CP 9 Resolution No. 12 of the Cabinet Council. 10 According to the Decision No.467/QD-TTg dated April 17,

13 The data of the Survey Assessment of Vietnam Youth (SAVY) was used to find out the status, variation tendency and factors influencing the use of alcohol, beer and cigarette among Vietnamese youth. Besides, policy recommendations in support of intervention programs for reducing the use of alcohol and beer among young people are also brought out based on the data analysis findings of this survey. II. Data, method and scope of research The Survey Assessment of Vietnam Youth was first carried out in 2003 with the coordination among the Ministry of Health, General Statistics Office, World Health Organization and United Nations Children's Fund. For the first time, the survey has presented an overall picture of actual conditions of Vietnam youth in areas such as education, employment, physical health, sexual and reproductive health, marriage and family relationships, friendship and love; as well as health problems with which youth are facing including HIV/AIDS, use of addictive substances, accidents, injuries and violence. SAVY I collected data from 7,584 youth aged in 42 provinces and cities nationwide. After 5 years, SAVY II was undertaken in 2008 with the similar content to its predecessor to explore change over the previous 5 years as well as to document the current situation facing youth in the country 11. Both surveys included questions on the use of alcohol, tobacco and other substances as well as the health consequences of that use. Overall, the questions remain unchanged between the two surveys but SAVY II has added some questions on the number of cigarettes smoked monthly. The report will focus on use of alcohol, beer and cigarette in Vietnam youth rather than other addictive substances. The reason for this is that use of substances other than these three is reported to be very low with only 0.4% (or 37 people) reporting having used any other drug. This research mainly uses bi-variate tables to analyze and clarify the relation between substance and demographic and socio-economic factors. We will compare SAVY II with SAVY1 exploring change over time. Multivariate regression models are used to analyze the independent impacts of factors associating with substance use behavior. III. Using alcohol and beer among the youth 1. Using and abusing alcohol and beer a. Use rate The rate of alcohol and beer use among Vietnamese youth is high and tends to increase. The 11 See detail information of those two surveys at MOH, GSO, UNICEF and WHO (2005) and MOH and ADB (2010). 12

14 analysis of SAVY II data shows that 60% youth reported ever having finished a glass of beer or liquor. Compared with 5 years ago, the rate of alcohol and beer use among youth has increased significantly from 51%. Similarly, 75% youth ever drunk in 2008 compared with 64% in The gender difference in drinking behavior is dramatic. Specifically, in SAVY II, 80% of males and less than half that number (37%) of females report having finished a glass of beer or liquor. The rate of alcohol and beer use by the youth of 5 years ago was less but the gender differences were the same as in Specifically, in SAVY I 69% male youth reported ever finished a glass of beer or liquor which was two and a half times higher than females at 28%. When we look at change in drinking behavior over time we see that while girls still drink significantly less than their male counterparts, the increase since SAVY I is proportionally greater for girls. Specifically, between the two surveys the increase in male drinking was 13% while for girls it was 40%. chart 3.1: The rate of youth drank a glass of beer or liquor by gender 100% 90% 80% 22% 12% 8% 40% Never have had a drink 70% 9% 56% 60% Never have finished a glass 50% 23% 40% 30% 69% 15% 80% Ever have finished a glass 20% 10% 28% 37% 0% Male Female Male Female SAVY I SAVY II 13

15 b. Drunkenness Consistent with overall drinking behavior, there is nearly a three to one ratio of males who report ever having been drunk (60%) when compared with females (22%). When asked if they had been drunk in the previous month, there was a 7 fold difference with 21% of males compared with 3% of females responding affirmatively. Interestingly, for both males and females there is a significant decline since SAVY I in reporting having been drunk in the previous month (Chart 2.2) regardless of the increasing trend of the use of alcohol and beer since SAVY I chart 3.2: The rate of youth that had ever been drunk by gender 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 58% 60% 30% 32% 22% 21% 12% 3% SAVY I SAVY II SAVY I SAVY II Male Female Ever drunk Drunk last month 14

16 Turning to drunkedness by age and gender, we see that for every age group males are two to three times more likely to report ever having been drunk. Quite significantly, two out of five males under the age of 17 report having been drunk; and by the age of 21 that has risen to 72% - fully 11 percentage points higher than in SAVY I. chart 3.3: The rate of youth report having been drunk by age group and gender 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 82% 72% 72% 61% 44% 39% 29% 30% 32% 23% 27% 18% Male Female SAVY I SAVY II c. Age at first use of alcohol and beer While selling alcohol to those below 18 is illegal (Decree No ) child use of alcohol remains quite common. Table 3.1 shows that more than half of those surveyed reported using beer and alcohol before age 18. The average age of the male youth at which they start to use alcohol and beer is 16.5 years old while female youth it is 17.5 years old. As can be seen below, there is little change from 2003 table 3.1: Age at first use of alcohol and beer by gender SAVY i SAVY ii male Female total male Female total Mean Median Standard deviation N

17 2. Regional variation Among the 8 socio-economic regions of the country, the North West and the North East hold the highest rate of using alcohol and beer among youth in both years of survey. The rate of upto 90% of young men have ever drunk up a glass of beer or a cupful of alcohol was found in those two regions in The rate was lower in other regions but still kept at a very high level of more than 75%. By gender, the North West and the North East not only own the highest rate of using alcohol and beer among youth but also have a smallest gap between male and female in drinking rate. That means the rate of using alcohol and beer among young women in these areas, especially in the North West is considerably higher than other regions. Compared with SAVY I the rate of using alcohol and beer among the youth has increased in all regions, particularly in the Central Highlands. ChARt 3.4: trate of using alcohol and beer among the youth (have ever drunk up a glass of beer or a cupful of alcohol) by gender and regional variation SAVY I SAVY II Mekong River Delta South East Central Highlands Central Coastal North Central North West North East Red River Delta Mekong River Delta South East Central Highlands Central Coastal North Central North West North East Red River Delta 20% 25% 24% 18% 23% 35% 40% 39% 41% 49% 31% 36% 31% 47% 43% 76% Female 76% 80% 85% Male 77% 63% 90% 89% 80% 69% 71% 57% 71% 60% 74% 78% 72% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% The North East is one out of two regions having the highest rate of using alcohol and beer among youth and keeps the largest proportion of young men ever in drunkenness. This proportion among young girls is not much different to that in other regions. In the North West, the rate of drunkenness among young men is ratherly lower than in other regions but the rate among young girl is much higher. The ratio of using alcohol and beer in the North Central and Red River Delta is lowest throughout the country. 16

18 ChARt 3.5: Rate of drunkenness among youth by gender and socio-economy region SAVY I SAVY II Mekong River Delta South East Central Highlands Central Coastal North Central North West North East Red River Delta Mekong River Delta South East Central Highlands Central Coastal North Central North West North East Red River Delta 10% 13% 27% 27% 25% 21% 37% 27% 32% 27% 30% 28% 24% 27% 33% 47% 46% 48% 64% 64% 67% 64% 61% 69% 54% 67% 60% 61% 59% 57% 65% 51% Female Male 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Perhaps, the results from analysis on the difference of age at first use of alcohol based on socioeconomy regional variation can partly clarify the differences between rates of using. The North West is the region having the highest use of alcohol and young people there, both male and female start their first use of alcohol when they were very young. More than a half of them used alcohol for the first time when they were 15 years old or younger. As a matter of fact, the starting age of using alcohol is greater among young men in the Central Coastal but the rate of using alcohol among them is not the lowest. The findings show that apart from age at first use of alcohol, there remain many other factors which have stronger effects on the rate of using alcohol among the youth. 17

19 ChARt 3.2: Age of first use of alcohol by socio-economic region and gender SAVY 1 SAVY 2 mean male median Sd mean number of people Female median Sd number of people Red River Delta 16,0 16 2, ,2 18 3, North East 16,1 16 2, ,9 17 2, North West 14,9 15 2, ,5 15 2, North Central 15,9 16 2, ,6 17 2, Central Coastal 16,9 17 2, ,8 19 2, Central Highlands 17,1 17 2, ,3 17 3, North East 16,7 17 2, ,6 18 2, Mekong River Delta 17,5 18 2, ,9 18 2, Red River Delta 16,0 16 2, ,2 17 3, North East 16,1 16 2, ,9 17 2, North West 15,5 15 2, ,4 16 2, North Central 16,6 17 2, ,4 17 3, Central Coastal 16,4 16 2, ,7 18 2, Central Highlands 16,4 16 2, ,8 18 2, North East 16,9 17 2, ,9 18 2, Mekong River Delta 3. Variation by ethnicity 17,5 18 2, ,1 18 2, When compare to ethnic minorities, Kinh/Hoa youth had a lower rate of using beer and alcohol in SAVY I but it was higher in SAVY II. It was found that the proportion of youth reported having finished a glass of beer or liquor increased over the period between the two SAVY surveys for both ethnic groups, it increased faster among the ethnic minorities, especially among female ethnic minorities. The proportion of male Kinh/Hoa reported having finished a glass of beer or liquor increased to 79% from 70% while it increased to 85% from 66% for the male ethnic minorities; similarly, it increased to 34% from 27% for female Kinh/Hoa and increased to 50% from 34% for the female ethnic minorities. 18

20 ChARt 3.6: The use of beer and alcohol by ethnic groups and gender 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 21% 9% 28% 6% 70% 66% 56% 58% 17% 27% 8% 34% 13% 9% 8% 6% Kinh & Hoa Ethnic minorities Kinh & Hoa Ethnic minorities Kinh & Hoa Ethnic minorities Kinh & Hoa Ethnic minorities Male Female Male Female SAVY I SAVY II 79% 85% 42% 24% 34% 28% 21% 50% Never have had a drink Never have finished a glass Ever have finished a glass When we look at youth who reported ever having been drunk, there was almost no difference between Kinh/Hoa and the ethnic minorities in SAVY I but the difference was clearer in SAVY II with higher proportion of ethic minority youth ever having been drunk. SAVY II data showed that 69% of minority males and 59% of Kinh/Hoa males report ever having been drunk; the figures are 20% and 31% respectively for females. 19

21 ChARt 3.7: Ever having been drunk by ethnic group and gender SAVY I and % 90% 80% 70% 60% 57% 60% 59% 69% Male 50% Female 40% 30% 20% 30% 33% 20% 31% 10% 0% Kinh & Hoa Ethnic minorities Kinh & Hoa Ethnic minorities SAVY I SAVY II In terms of age at first use of alcohol, minority females appear to initiate use about a half year before their Kinh/Hoa counterparts and for males the difference is closer to a year. 4. Variation by education For both males and females there appears to be a direct relationship between drinking and education level such that as education level rises, so to do the proportion of youth who report ever having been drinking however this relationship is confounded by age. Compared with SAVY I, the rate of alcohol and beer use at university/college level slightly increase, about 4% for males and 2% for females. Nevertheless, in other educational-level groups, the rate of alcohol and beer use of the youth increases even more, especially for the females at the primary school level had double the alcohol and beer use. 20

22 ChARt 3.8: The youth rate have ever finished a glass of beer or liquor by educational level and gender. College/University 54% 26% 20% SAVY I SAVY II Male Female Male Female Senior high school Junior high school Primary education College/University Senior high school Junior high school Primary education College/University Senior high school Junior high school Primary education College/University Senior high school Junior high school 35% 28% 44% 52% 26% 25% 27% 25% 23% 12% 93% 81% 73% 81% 20% 14% 12% 89% 70% 62% 15% 40% 49% 44% 9% 9% 4% 33% 53% 62% 61% 12% 9% 29% 3% 3% 10% 18% 15% 6% 5% 18% Primary education 72% 4% 23% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ever have finished a glass Never have finished a glass Never have had a drink Respective to the high rate of alcohol and beer use, the males at primary-school and university/college level has much higher rate of being drunk than other educational-level groups in both surveys. For females, the significant changes of model as well as the rate of alcohol and beer use among groups with strong decrease (nearly 10%) for university/collegie, senior high school and junior high school groups, for primary school group, the rate of being drunk slightly increase (from 28% up to 31%). ChARt 3.9: The rate of ever having been drunk by education and gender 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 72% 66% 67% 59% 59% 49% 32% 28% 29% 31% 31% 22% Primary education Junior high school Senior high school College /University Primary education Junior high school 55% 19% Senior high school 74% 24% College /University Male Fe male SAVY I SAVY II 21

23 5. Variation by living standard of the household Basing on the household's assets, the households of youth in SAVY II are divided into 3 levels of living standard: high, medium and low. The analysis results presented in Table 3.3 suggests that alcohol use is income sensitive. Specifically, we see that as income rises so does alcohol use. That having been said, the differences are not very dramatic especially for males (15% of the lowest living standard group said that they never drank compared with 11% for the middle and higher groups). table 3.3: Alcohol use by gender and living standard gender Male Female living standard never have never have finished a glass ished a glass ever have fin- had a drink total Low 15 % 9 % 76 % 100 % Medium 11 % 8 % 81 % 100 % High 11 % 7 % 82 % 100 % Low 45 % 21 % 34 % 100 % Medium 41 % 24 % 35 % 100 % High 35 % 25 % 40 % 100 % So too, for ever having been drunk for males the lower income group is slightly less likely to report ever having been drunk while for females it is the other way around (e.g., they are slightly more likely to report having been drunk). table 3.4: Drunkeness by gender and living standard gender Male Female living standard ever been drunk never been drunk total Low 58 % 42 % 100 % Medium 62 % 38 % 100 % High 61 % 39 % 100 % Low 24 % 76 % 100 % Medium 22 % 78 % 100 % High 21 % 79 % 100 % 22

24 6. Family and friends influences on alcohol and beer use a. Alcohol addiction of other members in the household In SAVY II 17% of respondents indicated that one or more of their family members are either alcohol addicts or drink on a daily basis (this is down 3 percentage points from SAVY I). Chart 2.9 explores the relationship between the history of having a family member with a drinking problem and youth alcohol consumption. Interestingly and surprisingly, there is no association. Specifically, for both males and females fairly comparable percentages of youth report ever haven had a drink whether or not they have a family member with a drinking problem. ChARt 3.10: The use of alcohol and beer (ever used) by addiction status of household members 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 22% 22% 8% 9% 70% 69% HH with an alcohol addict HH without an alcohol addict 50% 17% 34% HH with an alcohol addict 58% 15% 27% HH without an alcohol addict 16% 7% 12% 8% 77% 81% HH with an alcohol addict HH without an alcohol addict 43% 21% 40% 24% 36% 37% HH with an alcohol addict Male Female Male Female HH without an alcohol addict SAVY I SAVY II Ever have finished a glass Never have finished a glass Never have had a drink The same is generally true for the relationship between ever having been drunk and family drinking problems. For males there is no significant difference at all in reporting having been drunk; and for females there is a somewhat greater likelihood of ever having been drunk if there is a family history (27% vs. 21% where there is no family history). 23

25 ChARt 3.11: Drunkeness (ever drunk) by addiction status of household members and gender 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 58% 58% 35% HH with an alcohol addict HH without an alcohol addict 29% 27% 61% 60% HH with an alcohol addict 21% HH without an alcohol addict Male Female SAVY I SAVY II b. Pressure from friends Pressure from friends cuts two ways. Specifically, 25% of youth indicated that they experience pressure from friends to drink while three-fourths say that the pressure they experience is not to drink. Compared to SAVY I, youth are more likely to experience pressure to drink while they experience similar pressure not to drink. There is a real gender difference when it comes to pressure from friends. Specifically, nearly half (44%) of male youth report experiencing pressure from friends to drink compared with only 5% for females. Conversely, while 83% of female youth report pressure not to drink, for males it is 67%. The similar patterns are found in SAVY I. table 3.5: The pressure from friends for alcohol and beer use SAVY i SAVY ii Friends' behaviour male Female male Female Pressure to drink 21 % 2 % 12 % 1 % No pressure /Neither 12 % 15 % 15 % 25 % Both pressures 23 % 3 % 19 % 2 % Pressure not to drink 44 % 80 % 54 % 72 % Total 100 % 100 % 100 % 100 % N

26 The use of alcohol and beer is more common among youth who have pressure to drink but it is not less common among those who have pressure not to drink (Chart 2.11). Specifically, 34% of females who have no pressure reported having finished a glass of beer or liquor which was less than a half of the proportion of females who have pressure to drink at 73%. Similarly, the rate was 69% for males who have no pressure and 95% for males who have pressure to drink. The use of alcohol and beer among males who have pressure to drink was greater than that of their female counterparts. 96% of males who have pressure to drink reported having finished a glass of beer or liquor while it was 82% for females. Similar differences between males and females can be seen in all other groups. ChARt 3.12: The proportion of youth ever finished a glass of beer or liquor by pressure from friends and gender of the respondents Pressure not to drink 34% 25% 41% SAVY I SAVY II Male Female Male Female Both No pressure /Neither Pressure to drink Pressure not to drink Both No pressure /Neither Pressure to drink Pressure not to drink Both No pressure /Neither Pressure to drink Pressure not to drink Both No pressure /Neither 34% 26% 29% 73% 21% 82% 69% 95% 66% 96% 17% 61% 13% 62% 60% 91% 57% 17% 11% 46% 7% 11% 12% 19% 3% 2% 10% 24% 2% 2% 57% 11% 28% 59% 14% 25% 12% 28% 3% 6% 10% 33% Pressure to drink 89% 4% 8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ever have finished a glass Never have finished a glass Never have had a drink Pressure from friends has similar relationships to the drunkeness. The rate of ever having been drunk among both male and female youth is significantly higher when they have pressure from friends to drink. The findings were correct for both rounds of the SAVY. 25

27 ChARt 3.13: The proportion of the youth ever been drunk by pressure from friends to drink and gender of the respondents 100% 90% Male Female 80% 73% 74% 78% 75% 70% 60% 50% 43% 48% 48% 43% 47% 45% 45% 40% 30% 20% 23% 32% 32% 21% 20% 10% 0% Pressure to drink No pressure /Neither Both Pressure not to drink Pressure to drink No pressure /Neither Both Pressure not to drink SAVY I SAVY II 7. Determinants of alcohol and beer use It was found from the previous parts that the use of alcohol and beer has clear associations with several socioeconomic factors; and it was also clear that some of those socioeconomic factors have strong correlations to each others, e.g. education and age. In this part, we use multivariate analysis to explore independent associations between each of the key socioeconomic factors and the use of alcohol and beer. After controlling for other major demographic and socioeconomic factors that may have strong association with drinking behavior, pressure to drink from friends and being male are two factors that have strongest association with drinking behavior. It should be emphasized that pressure not to drink from friends does not have significant association with drinking behavior. While not as powerful other factors that associated with higher likelihood of ever drinking include: living in the North East or North West regions, being a member of an ethnic minority group, living in a wealthier household, having lived away from home for more than a month, and being older. More education is also associated with greater use even after controlling for age and other socioeconomic factors. Significant difference starts at senior high school education and those with university or college education significantly more likely to drink. However, those who are in school are significantly less likely to drink than those who are not currently in school regardless of their working status. Interestingly, having a family member with a drinking problem, i.e. alcholhol addict, is not significantly associated with drinking behavior of an individual after controlling for the other factors. Being a member of a mass-organization does not decrease the likelihood of drinking. All are equal, rural and urban residents have very similar likelihood of drinking. 26

28 table 3.6: Results from regression model showing associations between demographic and socioeconomic factors and the use of alcohol and beer (ever drinking - SAVY II) odds ratios 95% of confidence interval lower limit Upper limit Gender Female Male 5,04 *** 4,54 5,61 Region Red River Delta North East 1,69 *** 1,40 2,04 North West 3,04 *** 2,31 4,01 North Central 0,79 ** 0,66 0,94 Central Coastal region 1,19 0,97 1,45 Central Highlands 1,13 0,90 1,41 South East 1,01 0,85 1,20 Mekong River Delta 0,88 0,75 1,03 Rural/Urban living area Large city Small city 1,01 0,76 1,34 Town 0,94 0,72 1,23 Rural areas 0,92 0,73 1,16 Age groups ,51 *** 1,30 1, ,77 *** 1,47 2,12 Ethnicity Kinh / Hoa Other ethnic minorities 1,47 *** 1,23 1,74 Education Primary school Junior High-school 0,84 0,69 1,02 Senior High-school 1,51 *** 1,23 1,86 University/College 2,00 *** 1,54 2,60 Employment and Occupation Not working Unskilled labor 0,93 0,77 1,12 Skilled labor 1,10 0,87 1,39 In-school and working 0,68 ** 0,55 0,85 In-school and not working 0,63 *** 0,51 0,78 27

29 Ever lived away for over a month 1,38 *** 1,24 1,55 living standards of the household Low Medium 1,22 * 1,08 1,04 High 1,26 ** 1,10 1,44 household has a alcohol addict 0,88 0,78 1,01 Pressure to drink from friends 6,38 *** 5,36 7,58 Member of a mass-organization 1,02 0,92 1,14 N 9999 lr Chi2(27) 3527 Psedo R2 0,26 Notes: * p<0.10; **p<0.05, ***p<0.01 So too, Table 3.7 presents the analysis of the factors associated with ever having been drunk. Again, being male and having pressure to drink from friends have strongest association to this experience. Most other demographic and socioeconomic factors have similar association with ever having been drunk as they were with ever drinking. Some exceptions include regional variation, education and living standards. When we look by region, those living in the North Central Coast and the Red River Delta are the least likely to report having been drunk in the preceding month. Significant differences among educational levels are no longer exist. Besides, association of living standards and ever having been drunk is also marginally to not significant. table 3.7: Results from the logistic regression showing associations between demographic and socio-economic variables and drunkeness (SAVY II) ever been drunk drunk in last odds ratios 95% of ci month 95% of ci odds ratios lower Upper lower Upper limit limit limit limit Gender Female Male 4,18 *** 3,70 4,73 4,80 *** 3,96 5,81 Region Red River Delta North East 1,44 *** 1,17 1,77 1,72 *** 1,29 2,30 North West 1,68 *** 1,27 2,23 2,20 *** 1,54 3,14 North Central 0,80 * 0,64 0,99 1,13 0,81 1,57 Central Coastal Region 1,12 0,89 1,41 2,36 *** 1,76 3,17 Central Highlands 1,39 ** 1,08 1,77 2,39 *** 1,75 3,26 South East 1,25 * 1,02 1,53 2,40 *** 1,83 3,15 Mekong River Delta 1,20 1,00 1,45 2,44 *** 1,90 3,14 28

30 Rural-Urban living area Large city Small city 0,78 0,57 1,06 0,67 0,45 1,02 Town 0,77 0,57 1,03 0,92 0,64 1,32 Rural areas 0,76 0,59 0,97 0,88 0,64 1,20 Age group ,81 *** 1,55 2,12 1,39 *** 1,15 1, ,09 *** 1,73 2,53 1,30 * 1,04 1,62 Ethnicity Kinh / Hoa Other ethnic minorities 1,58 *** 1,31 1,90 1,65 *** 1,33 2,05 Education Primary school Junior high-school 0,96 0,78 1,18 1,01 0,81 1,27 Senior high-school 1,16 0,93 1,46 1,06 0,82 1,36 University/College 1,11 0,84 1,46 1,02 0,75 1,41 Employment and Occupation Not working Unskilled labor 1,08 0,88 1,33 1,10 0,85 1,42 Skilled labor 1,28 * 1,01 1,63 1,36 * 1,01 1,82 In-school and working 0,76 * 0,6 0,97 0,81 0,60 1,10 In-school and not working 0,64 0,50 0,81 0,59 *** 0,43 0,80 Ever lived away for > a month 1,43 *** 1,27 1,62 1,23 ** 1,06 1,42 living standards of the household Low Medium 1,13 0,98 1,31 1,08 0,90 1,28 High 1,20 * 1,03 1,39 1,14 0,95 1,38 household has a alcohol addict 1,13 0,98 1,31 1,22 * 1,03 1,44 Pressure to drink from friends 2,87 *** 2,54 3,25 3,39 *** 2,92 3,92 Member of a mass-organization 0,92 0,82 1,04 1,07 0,93 1,24 N lr Chi 2 (27) Psedo R 2 0,22 0,22 Note: * p<0.10; **p<0.05, ***p<

31 8. Drinking and driving motor vehicles Alcohol use is strongly associated with vehicular injury and death worldwide. Article 8 of the 2001 Transportation Law indicates that it is illegal to drive a motorized vehicle on street when the alcohol volume in blood is greater than 80 miligrams per 100 mililitres of blood or 40 miligrams per 1 litter of breathing air. The revised version of this law which was effective since 1 July 2009 lower the rate to zero percent or completely forbid driving after drinking. When we asked Vietnamese youth whether they ever used a motorized vehicle after drinking a high percent said yes. Specifically, nearly half of males and one in ten females indicated that they had done so (Table 2.9). Unfortunately, we do not have figures since the effectiveness of the revised transportation law to see its impact. table 3.8: Use of motorized vehicle after drinking male Female total Ever 46 % 9 % 33 % Never 54 % 91 % 67 % Total 100 % 100 % 100 % The problem is compounded when we asked whether youth had ever ridden in a motorized vehicle with a driver who had been drinking. We see that nearly half of females (43%) and nearly twothirds of males (62%) indicate that they have. table 3.9: Ever ridden a motorized vehicle with a driver who had been drinking male Female total Ever 62 % 43 % 57 % Never 38 % 57 % 43 % Total 100 % 100 % 100 % N When we looked at characteristics of the youth most likely to ever drive after drinking, we see regional variation (lowest in the Mekong River Delta, North Central Coast and Red River Delta). Youth who came from households with high living standards and older youth were more likely to drive a vehicle after drinking. Again, more education was associated with driving under the influence of alcohol but staying in school was associated with lower likelihood of driving motorized vehicles 30

32 after drinking. It is interesting to find that ethnic minority people were more likely to ever have drinking and ever having been drunk but their likelihood of involving dangerous behavior of driving a motorized vehicle after drinking was very much similar to that of the Kinh/Hoa people. table 3.10: Results from regression model showing association between demographic and socioeconomic factors and the driving after drinking behavior (SAVY II) odds ratios 95% of ci lower limit Upper limit Region Red River Delta North East 2,36 *** 1,75 3,18 North West 1,80 ** 1,20 2,70 North Central Coast 1,24 0,91 1,67 Central Coastal region 2,19 *** 1,61 2,98 Central Highlands 2,69 *** 1,94 3,74 South East 1,66 *** 1,26 2,18 Mekong River Delta 1,15 0,90 1,49 Age group ,10 *** 2,51 3, ,43 *** 3,47 5,56 Ethnicity Kinh / Hoa Other ethnic minorities 0,99 0,76 1,29 Education Primary school Junior high school 1,51 ** 1,14 1,98 Senior high school 1,82 *** 1,36 2,45 University/college 2,91 *** 2,02 4,18 Employment and Occupation 31

33 Not working Unskilled labor 1,09 0,82 1,46 Skilled labor 1,82 *** 1,31 2,55 In-school and working 0,47 *** 0,34 0,67 In-school and not working 0,43 *** 0,30 0,61 living standards of the household Low Medium 1,22 1,00 1,49 High 1,52 *** 1,23 1,88 Member of a mass organization 0, Notes: * p<0.10; **p<0.05, ***p<0.01 IV. Smoking cigarette among the youth 1. Smoking behavior a. Smoking rate Smoking is almost entirely male phenomenon among youth in Vietnam. While nearly 40% of male youth in SAVY II reported that they had ever smoked, less than 1% of females reported the same behavior. More than a quarter of male youth (28%) reported that they were currently smoking. Those smoking rates are just marginally smaller than that in SAVY I. As smoking is entirely male phenomenon, the following parts present findings for male youth only. When we look by age at males who are smokers we see very little difference among the youngest smokers (aged 21 or younger) when we compare SAVY I and 2; however, in SAVY II there is a dramatic decline in the prevalence of those 22 years of age or older when compared with 5 years earlier (47% compared with 59%). This may suggest that interventions that were initiated in the early years of this century are having some impact; however, there is also clearly a need to target the youngest smokers where there is no measurable change in use. 32

34 ChARt 4.1: The smoking rate by gender 100% 80% Never smoked 60% Used to smoke 40% % Currently smoke 0% Male Female SAVY I Male Female SAVY II GraPh 4.2: Current male youth smokers by age group 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 59% 47% 41% 41% 10% 11% SAVY I SAVY II Among males who were currently smoke, they smoke on average about 8 cigarettes a day a level that predisposes them to significant present and future health problems. 33

35 b. Age at first smoking The average age when males start smoking is 17 years which means that half of all smokers initiate at ages less than that and as young as 14.5 years. The result implies that the current law that forbids the sale of tobacco to youth under the age of 18 2 failed to achieve the ultimate objective to stop smoking among youth. As we see with alcohol, the use of tobacco is very price sensitive. This is one area where public policy has been shown to have an impact elsewhere around the world. The government should consider to raise the age of prohibition and improve its enforcement. In addition, it should consider raising the tax on the purchase of tobacco products which most likely would have the impact of reducing adolescent smoking. 2. Reasons for smoking and giving up smoking a. Reasons for smoking We have seen a shift in the reasons why young men say that they start smoking. In SAVY I the predominant reason was because of peer pressure ( all my friends smoke ) now it is curiosity about smoking, with peer influence and stress the second and third reasons respectively. It is hard to interpret what these changes mean but they may be important clues to prevention programming. We would recommend further explortation through qualitative methods such as interview and focus groups. 2 Decision of the Government Council number 293/CP dated 4 July

36 ChARt 4.3: Reasons for starting to smoke among males, SAVY I and II 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 55% 32% All my friends smoke 3% 3% To show my adulthood 13% 15% 11% Too much stress and tension 7% People around me smoke 1% 1% Smoking is stylish 4% 38% Curiosity 12% 4% Other reasons SAVY I SAVY II b. Giving up smoking SAVY data reinforce the notion that once you start smoking it is exttrelmely difficult to quit. Specifically, in both SAVY I and 2 over 70% of current smokers said that they had tried to quit. Only 11% of those who previously smoked report that they no longer do so. 35

37 ChARt 4.4: Failed attempts to quit smoking by current smokers, SAVY I and 2 100% 80% 71% 74% 60% 40% 20% 0% SAVY I SAVY II 3. Regional variation Results from the two surveys reveal that the proportion of smoking in city is higher than that in rural areas. It is highest and keep intact as SAVY I (34%) in big cities. Althought the proportion dramatically decline but it is still at a high level (from 41% in SAVY I down to 31% in SAVY II). Current rate of smoking in town and rural areas also reduce and the difference between these areas is not noticeable (from 32% and 30% down to 27% and 28% respectively). An analysis on the average number of cigarettes smoked in one day in 2008 have the same model as the rate of smoking: The youth living in larger cities have a higher rate of cigarettes smoked per day, a young man in larger cities smokes upto 9.4 cigarettes per day, such number are 8.7, 8.4 and 8.2 in smaller cities, towns and rural area respectively. Results from the two surveys showed that the mean age for the first use of cigarette among young men living in cities was about 1 year earlier than that of young men in towns and rural areas. The differences in the age of first time smoke classified on the foundation of large cities and small cities, towns and rural area, in 2003 and 2008 are not considerable. 36

38 ChARt 4.5: Current rate of smoking among young men by rural/urban characteristic 100% 80% 71% 74% 60% 40% 20% 0% SAVY I SAVY II table 4.1: Age at first smoke by rural/urban characteristic of the plae of residence SAVY i median Sd SAVY ii median Sd mean number of people mean number of people Large cities 16,5 17 2, ,5 16 2, Small cities 16,3 17 2, ,7 17 2, Towns 17,2 17 2, ,3 17 2, Rural areas 17,1 17 2, ,4 17 2, Findings in SAVY II show that the rate of current smoking is highest in the Central Highlands (40%) nearly double compared with SAVY I (26%). Apart from the Central Highlands, the North Central also had an increasing rate of smoke during the period of 2003 and 2008 while it decreased in other socio-economic regions. The most decreasing area is the Red River Delta. The finding suggests that it is necessary to assess and compare the influences of smoking prevention activities among these different regions to find out an effective way to minimize the rate of smoking. The Central Highlands not only holds the highest and most accelerated smoking rate but also keeps a large proportion of young people engaged in smoking (include the Central Coastal, Central Highlands, South East and Mekong River Delta) with an average of 9 cigarettes per person per day and more than a half of young men in these regions smoke more than 10 cigarettes per person per day. The youth in the North do not smoke so much but not less than 5 cigarettes per day, either. Besides, it is noted that these findings may be varried considerably if taking the alternative tobacco such as pipe tobacco into account because it is used more popularly in the North. 37

39 ChARt 4.6: Smoking rate among young men by region 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 32% 31% Red River Delta 29% 26% 22% 21% 25% North East North West North Central 33% 29% Central Coastal 26% 40% Central Highlands 34% 34% 33% 28% South East Mekong River Delta SAVY I SAVY II table 4.2: Monthly used number of cigarettes for young men by region (SAVY II) mean median Sd number of people Red River Delta 207, , North East 231, , North West 164, , North Central 223, , Central Coastal 268, , Central Highlands 272, , South East 285, , Mekong River Delta 279, , Mean age at first smoking in the Central Highlands and South East (16.6 and 16.8 respectively) is more than 1 year younger compared with the Mekong River Delta and about half year older compared with other regions. Remarkably, mean age of firsrt time smoke in the North West increases by 1 year while it almost remains unchanged in the other regions. 38

40 table 4.3: Age at first smoke by socio-economic region mean number of people mean SAVY i median Sd SAVY ii median Sd number of people Red River Delta 16,8 17 2, ,1 17 2, North East 17,0 17 2, ,3 17 2, North West 16,0 16 2, ,0 17 2, North Central 16,7 17 2, ,5 17 2, Central Coastal 17,6 18 2, ,2 17 2, Central Highlands 16,9 17 2, ,6 17 2, South East 16,8 17 2, ,9 17 2, Mekong River Delta 17,7 18 2, ,9 18 2, Variation by ethnicity While the decline in smoking was found, it may not equally declined in all ethnic groups. Althought the difference is marginal, there is a decline tendency of smoking among Kinh/Hoa male youth (from 31% to 28%) but an increase tendency among ethnic minority male youth (from 29% to 31%). Smong rate among Kinh/Hoa male youth in 2003 was higher than that of the ethnic minority male youth but the reverse picture was seen in However, Kinh/Hoa male youth smoke more: on average, Kinh/Hoa male youth smoke 8.6 cigarretes per day compare with 7.4 cigarretes per day for ethnic minority male youth. No significant difference in age at first smoke was found between the two ethnic groups. It should be noted that the findings would change if other types of tobacco that are more common for use among some ethnic minority groups in mountainous areas are included. GraPh 4.7: Current male young smokers by ethnicity 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 31% 29% 28% Kinh & Hoa Others Kinh & Hoa Others 31% SAVY I SAVY II 39

41 5. Variation by education There is an interesting trend we see in the relationship between education and smoking. Specifically, up until university/college level education, as education rises smoking declines but it then increases at college/university level. In SAVY II, 43% of male youth with primary education currently smoked and the smoking rate reduced to 33% and 22% for those with junior and senior high school respectively. That trend reverses, however, with a university/college education; and now we see an increase to 30%. Similar pattern was found with SAVY I data. This could be a reflection of income (those with higher income are also those most likely to go to university), a large city phenomenon (universities tend to be in larger communities) or other dynamics influencing these trends. Similarly, relationship between number of cigarettes smoke in a day and education also follows a U-shape curve. The results indicate a need to strengthen prevention and control of tobacco smoking at primary schools and colleges/universities. GraPh 4.8: Current male smoking by education 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 47% Primary education 28% Junior secondary 23% Senior secondary 38% College /University 43% Primary education 33% Junior secondary 22% Senior secondary 30% College /University SAVY I SAVY II 6. Variation by living standard of the household When we analyze cigarette smoking by current living standards we do not see any difference between the low and middle income groups but a 4 percentage point decline among the higher income group (26% vs. 30%). Nevertheless, this difference is marginal. table 4.4: Youth smoking by living standards of the household living standard ever smoked current smoker Low 39 % 30% Medium 42 % 30% High 38% 26% 40

42 7. Influence from family and friends a. Influence from family SAVY II results indicated that in the households which have a member who smokes 41% youth reported ever smoking compared to 36% of youth who are smokers in households where others do not smoke a 5% difference. The difference is even greater for current smokers (31% vs. 24%). Interestingly, the decline between SAVY I and SAVY II of current smoking only happened among households that do not have a smoker among other members of the household. GraPh 4.9: Influence from family on male smoker rates 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 44% 43% 41% 36% 31% 31% 31% 24% HH with a smoker HH without a smoker HH with a smoker HH without a smoker SAVY I SAVY II Ever smoked Currently smoke b. Pressure from friends to smoke Pressure from friends to smoke has a strong correlation to current smoking behavior while pressure not to smoke has minor correlation to the same behavior. The current smoking rate among male youth who reported pressure from friends to smoke is 54%, but it is only 46% among those who reported both pressures (pressure to smoke and pressure not to smoke) and 22% among those who reported no pressure to smoke. While pressure not to smoke does not have strong correlation to current smoking behavior, it does have clear correlation to average number of cigarettes smoked per month of youth smokers. On average, youth smokers who have pressure not to smoke consumed 238 cigarettes per month which is lower than that of those who have no pressure at 264 cigarettes per month and those who have pressure to smoke at 269 cigarettes per month. 41

43 GraPh 4.10: Influence by friend on current male smoker rate 100% 90% 80% 70% 60% 50% 52% 53% 54% 46% 40% 30% 20% 23% 23% 22% 22% 10% 0% Pressure to smoke No pressure /Neither Both Pressure not to smoke Pressure to smoke No pressure /Neither Both Pressure not to smoke SAVY I SAVY II table 4.5: Number of cigarettes smoked in a month by pressures from friends (SAVY II) mean (Standard deviation) median n Pressure to smoke 269 (154) No pressure /Neither 264 (155) Both pressure 258 (168) Pressure not to smoke 238 (158) Determinants of smoking among male youth When a multivariable analysis was undertaken to identify those factors that are most strongly associated with smoking among male youth in Vietnam, fee factors stick out as its data is not available. Compared to other regions, those in the North West and the Mekong River Delta are significantly less likely to smoke. Compared to those who live in rural areas, those in cities, regardless of its size, are significantly more likely to smoke. This result is interesting as it contradicts to the common sense saying that rural residents smoke more and urban residents smoke less as they are af- 42

44 fected by urban civilization. The result could be affected by the use of other types of tobacco, e.g. thuoc lao or tobacco that is smoked only in Vietnam with big bamboo pipes, in rural areas. Greater economic and social pressures would also reasons for the higher likelihood of smoking in urban areas. The ethnic minorities also are not more likely to smoke cigarettes than the Kinh/Hoa. However, it should be noted that many of the ethnic minorities use other types of tobacco. Overall, those who are in school smoke less than their out of school peers. Higher educated youth tend to smoke less and working people tend to smoke less than those who are not working but those differences are not significant. Results from multivariate regression show that male youth aged 18 or higher are significantly more likely to smoke than those under 18 years old and there is no significant difference after the age 18 till 25. The median age at first smoking is 17 and it is very close to 18 which is also the age to finish senior high school and start adulthood. Those findings suggest the importance of policies targeting pre-mature male youth, i.e. male youth aged 15 to 17, especially for youth who are not in-school. Again, migrant youth or youth who have lived away from for more than one month has a much higher likelihood to smoke than those who have not done so. This could be affected by selectivily of migrant youth, i.e. migrant youth may have very different family circumstances than non-migrant youth and it could also be affected by unknown experience that happened during migration. Further exploration of this issue is needed to understand this relationship. Where family membersd smoke their youth male children are very significantly more likely to smoke. Pressure from friends to smoke also has significant association with youth smoking behavior. Similar to what was found from pressure not to drink, pressure not to smoke also has marginal impact on youth smoking behavior. 43

45 table 4.6: Results from regression model showing association between demographic and socioeconomic factors and current smoking among male youth in Vietnam odds ratios 95% of confidence interval lower limit Upper limit Region Red River Delta North East 0,90 0,68 1,20 North West 0,59 ** 0,39 0,88 North Central Coast 0,96 0,72 1,28 Central Coastal region 1,00 0,74 1,35 Central Highlands 1,35 0,98 1,86 South East 0,96 0,74 1,25 Mekong River Delta 0,62 *** 0,49 0,80 Rural-Urban Large cities Small cities 1,01 0,66 1,55 Towns 0,72 0,49 1,07 Rural areas 0,62 ** 0,44 0,87 Age group ,83 *** 2,32 3, ,81 *** 2,24 3,53 Ethnicity Kinh / Hoa Other ethnic minorities 0,94 0,73 1,19 Education Primary school Junior high school 1,13 0,88 1,44 Senior high school 0,93 0,71 1,22 University/college 0,82 0,60 1,14 Employment and Occupation Not working Unskilled labors 0,92 0,71 1,20 Skilled labors 0,89 0,66 1,19 44

46 In-school and working 0,32 *** 0,23 0,44 In-school and not working 0,19 *** 0,14 0,27 Ever lived away for more than 1 month 1,81 *** 1,55 2,11 living standard Low Medium 1,04 0,86 1,25 High 1,01 0,83 1,24 Pressure from friends Pressure to smoke No pressure / Neither 0,28 *** 0,22 0,38 Both pressures 0,72 * 0,56 0,93 Pressure not to smoke 0,31 *** 0,25 0,39 having a household member smoke 1,41 *** 1,20 1, ,71 *** 0,61 0,83 N 5045 lr Chi 2 (27) 1330 Pseudo R 2 0,22 Notes: * p<0.10; **p<0.05, ***p<0.01 V. Discussion and recommendation The results from the two rounds of SAVY indicated the visible change in alcohol and tobacco use by Vietnamese youth in different tendencies. The results also showed great variations of those behaviours by geographical regions, by household s characteristics, and by individual characteristics of youth. Those variations suggested that policies relating to alcohol and tobacco use should be made flexible with higher priority given to certain areas and target populations. This part summarizes key findings of alcohol and beer use and cigarette smoking among Vietnamese youth from SAVY data and presents some policy implications of those findings. 1. The use of alcohol and beer among youth The results from SAVY indicate the increasing of alcohol use by Vietnamese youth. The percentage of youth ever having had finished a glass of beer or liquor increased to 60% in SAVY II (2008) from 51% in SAVY I (2003). It can be seen that the increasing tendency is in both male and female youth: the percentage of youth ever having had finished a glass of beer or liquor among male youth increased to 80% in SAVY II from 69% in SAVY I and it increased to 37% in SAVY II from 28% in SAVY I among females. If the percentage of those ever used but not finished taken 45

47 into account the corresponding percentage of alcohol and beer use is much higher: 88% of male and 60% of female youth in SAVY II have ever used alcohol and beer. While alcohol and beer use increased, the percentage of drunk decreased for both male and female youth. The percentage of youth drunk in the month prior the time of survey decreased to 21% from 32% for male youth and to 3% from 12% for female youth. This is an encouraging result regardless of the unwanted trend of increasing alcohol and beer use among youth. Causes of those trends cannot be assessed in this report given data limitation. Suggested causes for exploration in further studies include: more youth drink but they drink less; youth drink more expensive liquors that have better quality and they are less likely to get drunk; youth health has been improved and their natural aptitude against drunk is getting better. Gender difference in alcohol and beer use is dramatic with substantial larger share of male youth drink or get drunk but the use rate is also on the rise among female youth. 80% of males report having finished a glass of beer or liquor while it is 37% for females. This finding implies that gender should be incorporated into liquor control programs and interventions with stronger emphasize on male youth. The variation by residential regions and ethnicity in alcohol and beer use is quite pronounced. Higher priority should be given to the Northern moutaineous regions, especially the North West region, as people living in this region have highest likelihood of drinking and getting drunk. The percentages of alcohol use and drunk in the ethnic minority youth are significantly higher than that of the Kinh/Hoa. This independent impact of ethnicity further amplifies the need to have higher priorities to the northern mountaineous regions that house a large share of ethnic minority people. As Vietnam has 54 ethnic minority groups with different languages and cultures, large variation among the ethnic minorities is expected and hence further exploration of this variation is needed. Youth start using alcohol and beer at early age and there is a high proportion of very young youth use alcohol and beer. The average age at first drinking is around 16.8 years old in both surveys. More than half of youth started using alcohol and beer before their mature age at 18 years old. The results could be affected by the facts that alcohol is widely available, it is extremely easy to buy, sellers do not ask age of the buyer and it is common to see a kid to buy alcohol for the family, and there is a large range of alcohol in the country with some very cheap local made ones. Compare the Circular No.10/2008/TT- 46

48 BCT guiding the implementation of the Governmental Decree No.40 to this Decree, it was found that the regulation prohibiting alcohol selling to those under 18 years of age as mentioned in the Decree 40 was not mentioned and detailed in the Circular No.10. This could be a gap for enforcement of this regulation since circulars are more frequently used in practice than the strategic decree. Further, the Decree No.6/2009/NĐ-CP stipulating administrative sanction relating to producing, trading of alcohol, beer, tobacco especially selling alcohol, beer, tobacco to adolescents (prohibited by Decree No.40) has not been mentioned in the documents which provide guidance on implementation and administrative sanction. Hence, amendment of the Circular No.10/2008/TT-BCT and the circular guiding the implementation of the Decree No. 6/2009/NĐ-CP is recommended; punishements to individual or organization who trades or sells alcohol, beer and tobacco to people aged 18 or younger should be made clear and enforced. The common behavior of ID check for age eligiblility as seen in many other countries should be required and strictly enforced. Alcohol and beer use increases as youth having higher education and significant difference starts at senior high school level; it is also found that youth who are in school are much less likely to drink. The results suggest that encouragement children and youth to attend school would be an effective way to reduce alcohol and beer use among youth. Higher priority should be paid to senior high school students and especially youth outside of school. Migrant youth or those who have lived away from home for more than one month are more likely to use alcohol and beer. The continuously increasing trend of migration, especially over the past decade, and the selectivity of migrants or a large share of young population aged 15 to 30 among migrant population, the result indicates that greater attention and higher priority in drinking prevention and control should be given to migrant population. Further studies that provide deeper understandings of drinking behavior and its determinants among this special and young population is recommended. tpressure from friends to drink has the most significant influence on alcohol and beer use among youth but pressure not to drink has no impact on youth drinking behavior. A quarter of youth have pressure to drink and three times higher or three-fourth of them have pressure not to drink but the significant influence only happened among youth in the first group. The finding suggests that the should not IEC messages would not work well. More effective interventions targeting removal of the pressure to drink should be applied. The alcohol abuse prevention programs should provide youth with skills to control volume of alcohol consumed and skills to refuse when having pressure from friends to drink. Driving motorized vehicles after drinking alcohol is common among male youth but female youth take no less risk from that risky behavior of male youth. Almost half of male youth reported that they have used motorized vehicles after drinking. There was less than one-tenth of females have done it but almost half of female youth have ridden in a motorized vehicle with a driver who had been drinking. The law strictly prohibiting driving after drinking was issued recently; it may takes sometimes for its impact but enforcement of this law is apparently very important to change the current situation. 47

49 2. Smoking among youth Although illicit drug use has been included in SAVY it was assessed through self reported behavior and clinical tests were not applied. Although self-administered questions were designed to improve respond rates for this sensitive issue, findings indicate an extremely low rate of using illicit drug that would be much lower than the actual rate and it is too small for any meaningful analysis of this information. Hence, analysis of illicit drug use is excluded in this study. The finding implies that further SAVY may want to eliminate those questionnaires relating to illicit drug use or having a different approach such as clinical one. Since illicit drug use is a very sensitive issue and its user population is small, its study should be done in a different approach and sampling strategy. The results indicate that smoking is a male phenomenon; it decreases over time but marginally. More than one fourth of male youth currently smoke and more than 10 percent in addition to that reported that they do not smoke now but used to smoke. Less than 0.5% of female youth currently smoke and less than 1.5% them ever smoked. Smoking among male youth is decreasing at a very slow pace and it indicates that much greater efford is needed to achieve the target of the National Target Program which aims to reduce the youth smoking rate to less than 7% by The result also suggests that invention programs should focus on men; the messages for reducing smoking should be designed mainly for men. There is a half of male youth started smoking before age 17. The result implies that the current regulation that forbids the sale of tobacco to youth under the age of 18 failed to achieve the ultimate objective to stop smoking among youth. The result indicates that this regulation should be enforced and other mechanisms to increase age at first smoking are necessary. Rural male youth are less likely to smoke than their urban peers. Among eight regions of the country, residents of the North West and Mekong River Delta regions are less likely to smoke while residents of the Central highlands have the highest likelihood to smoke. Male youth in cities regardless of their size have higher likelihoof of smoking than male youth in rural areas. The greater availability of cigarettes in cities as well as greater social pressures in urban life may have contributed to this picture. Besides, the use of alternative tobacco, e.g. thuoc lao, in rural areas would have influenced this result. Further studies on independent causes of this difference are recommended to gain specific insights and recommendations for policies and interventions. Greater understanding of the high prevalence of smoking in the Central Highlands is also recommended. This could be an interesting case study given the large proportion of some ethnic minorities and migrants living in this region and that ethnicity and migration also have strong association to smoking behavior. There is no significant difference in smoking among educational levels but youth who are in school are clearly much less likely to smoke than youth who are not in school. This result suggests that increase school participation and reduce the drop-out rate are expected to reduce smoking among youth. It also suggests that higher priority and more interventions should be given to youth outside of school. 48

50 Migrant male youth or youth who have ever lived away from home for more than one month are more likely to smoke than those who have not done so. Further studies that provide deeper understandings of smoking behavior and its determinants among migrant youth is recommended for similar reasons as presented for drinking. Similar to drinking, pressure from friends to smoke has significant impact on smoking among male youth while pressure not to smoke has very little impact. Again, the finding suggests that the should not IEC messages would not work well; more effective interventions targeting removal of the pressure to drink should be applied; and provision of skills to refuse smoking should be applied. Apart from friends, smoking behavior of household s members has strong influence on youth. The likelihood of smoking among youth increases significantly when their household has a smoker. The presence of a smoker in the household would strigger curiousness of youth and, as found in SAVY, curiousnees I the most important reason to initiate smoking. This important information should be conveyed to parents, especially the smokers, for better health of their children. last but not least, findings from analysis of SAVY indicate that quit smoking is extremely difficult; the majority of male youth have tried but did not success. Among the current male youth smokers, more than 70% of them have tried to quit smoking. The result suggests that higher priority should be given to smoking prevention rather than the ones that aim to reduce smoking rate. Besides, the result also shows a great unmet need; greater and more effective supports to youth who desire to quit smoking may help to reduce smoking among male youth. 49