Tobacco control policies in Vietnam: Smoking behaviors and stakeholders' perceptions

Abstract

Tobacco remains a significant public health concern in Vietnam, particularly among men, with over 15 million users. It has been 12 years since the tobacco control law was enacted; however, the smoking prevalence has decreased marginally. Therefore, this thesis aims to investigate tobacco control policies in Vietnam through a quantitative assessment of purchase and cessation behaviors and qualitative exploration to explore both smokers’ experience with tobacco control policy and stakeholder perceptions of its implementation. A mixed-methods approach was employed, using both quantitative and qualitative studies. Quantitative data were derived from two sources: (1) a cross-sectional survey conducted in 2015 with a nationally representative sample of Vietnamese adults (n=3983), and (2) a longitudinal study in 2018 with 1525 participants. Qualitative data was collected in nine focus group discussions (FGDs) with current and former smokers and in twelve in-depth interviews with key stakeholders. The cross-sectional survey indicated that 44.4% of smokers are price-insensitive and smoked international brands; the remaining smokers fall into price-sensitive classes, particularly those from poorer economic backgrounds. The longitudinal study showed that 14.8% of smokers successfully quit after one year, and 56.5% of persistent smokers expressed the intention to quit. The qualitative study among smokers identified that health warnings were somewhat effective in shifting attitudes but have limited impact on their behaviors. Stakeholders identified challenges in policy implementation, including ineffective enforcement and insufficient sanctions, resource constraints, and tobacco industry interference. In contrast, stakeholders recognized some facilitating factors, such as government commitment and support from various organizations to facilitate tobacco control efforts, especially the Vietnam Tobacco Control Fund. This thesis highlights the complex dynamics of individual, social, and policy-related factors in shaping smoking behaviors among Vietnamese men. Future actions should consider the complexity of smoking behavior, enhancing policy enforcement and implementation, countering tobacco industry interference, and working to denormalize tobacco behavior in society, especially among men.