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Prevalence, Predictors, and the Role of the Transnational Tobacco Corporations

Christopher N. H. Jenkins, MA, MPH; Pham Xuan Dai; Do Hong Ngoc, MD; Hoang Van Kinh; Truong Trong Hoang, MD; Sarah Bales, MA; Susan Stewart, PhD; Stephen J. McPhee, MD

JAMA. 1997;277(21):1726-1731.

Abstract
Objective.
—To describe tobacco use in Vietnam and the impact of transnational tobacco corporations there.

Desig.
—In cities, a multistage cluster design; in communes, a systematic sample design, using face-to-face interviews in all sites.

Setting.
—Hanoi, Ho Chi Minh City, and 2 rural communes in Vietnam.

Participants.
—Random samples totaling 2004 men and women aged 18 years or older.

Main Outcome Measures.
—Prevalence and correlates of tobacco smoking, amount and duration of smoking, age at initiation, quitting behavior, knowledge of health hazards of and attitudes toward smoking, and cigarette brand smoked, preferred, and recognized as most widely advertised.

Results.
—Smoking prevalence among men (n=970) was 72.8% and 4.3% among women (n=1031). Male smokers had smoked a mean of 15.5 years; the median age at initiation was 19.5 years. Among male smokers, 16% smoked non-Vietnamese cigarettes. More than twice as many (38%), however, said that they would prefer to smoke a non-Vietnamese brand if they could afford the cost. Among those who recalled any cigarette advertising (38%), 71% recalled a non-Vietnamese brand as the most commonly advertised. Male smokers who were significantly more likely to smoke non-Vietnamese brands lived in the south, were engaged in blue collar or business/service occupations, earned higher incomes, and lived in urban areas.

Conclusions.
—Vietnam has the highest reported male smoking prevalence rate in the world. Unless forceful steps are taken to reduce smoking among men and prevent the uptake of smoking by youth and women, Vietnam will face a tremendous health and economic burden in the near future. Implementation of a comprehensive national tobacco control campaign together with international regulation will be the keys to the eradication of the tobacco epidemic in Vietnam and throughout the developing world.

Author Affiliations
From Suc Khoe La Vang! (Health Is Gold!), Vietnamese Community Health Promotion Project, Division of General Internal Medicine, Department of Medicine, University of California, San Francisco (Mr Jenkins and Dr McPhee); National Center for Human and Social Sciences, Institute of Sociology, Hanoi, Vietnam (Mr Pham); Health Information and Education Center, Ho Chi Minh City Department of Health, Ho Chi Minh City, Vietnam (Drs Do and Truong); Hanoi Trade College (Mr Hoang); Department of Economics, University of California, Berkeley (Ms Bales); Northern California Cancer Center, Union City (Dr Stewart); and the Institute for Health Policy Studies, University of California, San Francisco (Dr McPhee).

Footnotes
Presented in part at the fifth conference of the Asian Pacific Association for the Control of Tobacco, Chiang Mai, Thailand, November 23, 1995.

Corresponding author: Christopher N. H. Jenkins, MA, MPH, Suc Khoe La Vang! (Health Is Gold!), Vietnamese Community Health Promotion Project, Division of General Internal Medicine, University of California, San Francisco, 44 Montgomery, Suite 850, San Francisco, CA 94104 (e-mail: chrisj@itsa.ucsf.edu).

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