Reducing the Social Acceptability of Smoking in Vietnam

Introduction

This project complements the efforts of HealthBridge and the Vietnam Public Health Association (VPHA) to foster the implementation of smoke-free policy in Vietnam and to support the long-term national plans to decrease the social acceptability of smoking in the country. It is hoped that these efforts will lead to declines in smoking rates and in passive smoking. In addition to the anticipated long-term effects on smoking, this project also seeks to increase the capacity of the Vietnam Public Health Association to work in tobacco control.

Objectives

The specific objectives of the project were to:

• Improve current levels of public awareness of health consequences of active smoking and secondhand smoke exposure (SHS);
• Increase public support of smoking bans in the public places;
• Improve the behavior of smokers (not to smoke in the vicinity of others) and non-smokers (confident to request smokers not to smoke in their vicinity);
• Build capacity of the Viet Nam Public Health Association to work effectively in tobacco control.

Results

Related to Objective 1

Improved awareness among the target population of the health consequence of smoking and passive smoking. There is evidence that the project has contributed to improving knowledge about the harmful effects of smoking and passive smoking among the two target groups. However, aside from respiratory diseases and cancer, understanding of other diseases related to tobacco remained limited. Greater increases in awareness were noted among the male participants than among the female participants.

Related to Objective 2

(i) Increased public support for smoke-free policy implementation. There is evidence that both smokers and non-smokers agree that non-smokers should be protected from exposure to tobacco smoke, and that public support for smoke-free places increased during the project’s implementation. This should be considered as a foundation upon which the Government can strictly enforce the smoke-free policy in public places.

(ii) Increased public and media attention to TC. The project team intensively engaged the media (at the central level) and the public (in the intervention province) in a large-scale media campaign. However, the long term interest of the media on the issues still needs to be encouraged and followed up.

(iii) Effective, evidence-based, culturally-specific media products developed for use in tobacco control in Viet Nam. The project produced some evidence-based, culturally-specific media products for use in tobacco control in Viet Nam. The results of the evaluation survey showed that there was evidence of the effectiveness of these media products in changing the behaviors of the target population (related to reducing secondhand smoke exposure).

Related to Objective 3

(i) Facts ascertained on the impact of different approaches in changing public awareness and behaviors. There was evidence from the surveys that additional community- based activities bring further benefits in improving the knowledge and behaviors of the target populations.

(ii) Increased positive behaviors among smokers and non-smokers. The project contributed to the development of positive behaviors among both target groups.

(iii) Reduced public exposure (particularly among women and children) to secondhand smoke in the intervention area. There was evidence that the project contributed to reducing the level of exposure to secondhand smoke among women and children. The proportion of women who reported exposure to secondhand smoke and their average time of exposure decreased significantly. The proportion of children exposed to secondhand smoke also declined remarkably. However, the reported exposure levels were based on information provided by the respondents themselves, and could not be verified by more scientific measurements of tobacco smoke pollution levels in the environments where the respondents lived and worked.

Related to Objective 4

(i) Improved VPHA capacity and capability in tobacco control. Through direct and intensive involvement in all project activities, the Viet Nam Public Health Association was able to strengthen its capacity, both institutionally and individually, not only in tobacco control but also in designing and implementing a media campaign, working inter-disciplinarily, and coordinating local tobacco control activities.

(ii) Relationship developed between VPHA and media.

(iii) Experiences in tobacco control learned by different local organizations. Through their active involvement in the project’s implementation, the knowledge and skill levels of local partners were reported to have increased. However, the accuracy of this conclusion needs to be confirmed through a specific objective designed evaluation.

The final report and evaluation are found here.

Lessons learned

• The instruments used in research are crucial, and should be carefully developed taking into consideration local cultural context/languages.
• Selecting the field site should be based on the representativeness of the proposed study site, not just on its convenience to the researchers.
• Careful recruitment of interviewers and training is important; however, strict supervision is crucial to detect and manage any problems in a timely manner
• Keeping field intervention bias-free is always a challenge. Working carefully with local partners from an early stage to identify all possible risks and to develop measures to limit the impact of these risks is important.
• Keeping the commitment of VTV (Vietnam TV) to a low cost, appropriate airing campaign was a challenge. Meeting with people in positions of authority to increase their understanding of the importance of the messages being aired and developing a network of supporters is important.
• Support from national committees such as the National Committee for Science and Education and the National Committee for Culture and Sports is very helpful to gain permission from the national television network to air TV spots at reasonable peak times with adequate frequency and at no cost. Advocacy using different channels is a key skill at this interventional stage of the project
• Working closely with local partners could identify opportunities to integrate project activities with low cost and good participation.

Recommendations

• The knowledge and positive behavior changes of the target group should be strengthened and maintained. The funding is needed to develop and conduct the media campaign targeting different groups on regular basis
• The development of messages and media products of Tobacco Control media campaigns should be evidence based. The media campaigns should use effectively every possible communication channels to approach whole target groups. As women have limited time available to expose to mass media, it is important to investigate more suitable approaches for this target group.
• The Government should support Tobacco control communication programs by reducing advertising costs of these programs in state-owned media channels.
• The media products produced by this project should be further improved and used. The experience of developing this media campaign should be shared with the other anti-smoking communication projects in the future.
• The government should take immediate and strict measures to ban smoking in public places to protect and meet the expectations of public
• The Viet Nam Public Health Association should be given more favorable conditions to further participate in Tobacco Control activities in order to strengthen their knowledge and experience gained from the project.