THE 2003 GYTS IN VIETNAM: A PRELIMINARY REPORT ON
YOUTH TOBACCO USE
With current smoking patterns, about 500 million people alive today will eventually killed by
tobacco use. More than half of these are now children and teenagers. By 2030, tobacco is
expected to be the single biggest cause of death worldwide, accounting for about 10 million
deaths a year. Whereas until recently this epidemic of chronic disease and premature death
mainly affected the rich countries, it is now rapidly shifting to the developing world. By 2020,
seven of every 10 people killed by smoking will be in low and middle income countries (1).
It is estimated that in 1995, there were about 1.1 billion smokers in the world (30% of the
global population aged 15 years and above). There are wide variations between regions and, in
particular, in the prevalence of smoking among different groups. For example, in Eastern
Europe and Central Asia, 59% of men and 26% of women smoked in 1995, more than in any
other region (2). In East Asia and the Pacific region, the prevalence of male smoking was
equally high, at 59%, just 4% of women were smoked.
The overwhelming majority of smoker start before age 25, often in childhood or adolescence.
In the high-income countries, eight out of 10 begin in their teens while most smokers start by
early twenties, but the trend is toward younger ages in the middle-income and low-income
countries. In China between 1984 and 1996, there was a significant increase in the number of
young men aged between 15 and 19 years who took up smoking. A similar decline in the age of
starting has been observed in the high-income countries (3).
In response to the worrying trend in youth smoking the World Health Organization (WHO) and
Centers for Disease Control and Prevention's (CDC) has developed the Global Youth Tobacco
Survey (GYTS) surveillance system. This global survey will track tobacco use among young
people across countries using a common methodology and core questionnaire. The GYTS
surveillance system is intended to enhance the capacity of countries to design, implement, and
evaluate tobacco control and prevention programs. Funding for the GYTS has been provided by
the Centers for Disease Control and Prevention, Canadian Public Health Association, National
Cancer Institute, UNICEF, and the World Health Organization-Tobacco Free Initiative.
In Vietnam reliable adult smoking rates has been available from results of some large-scale
household-based national surveys. The Vietnam Living Standard Survey 1997 found that about
50% of adult men and 3.5% adult women smoke regularly (4). National Health survey 2002
found some 56% of adult men and 1.8% adult women smoking (5). These surveys, however,
found extremely few cases of children under 15 year of age smoking. This is probably due to
the fact that these surveys are households-based and children often try not to let their parents
know that they are smoking.
To bridge this data gap in Vietnam a first round of GYTS survey was carried out in five
provinces in the country in 2003. This document reports the result of the survey and
recommends possible measures to effectively prevent youth smoking in Vietnam based on the
results of the survey.
Subject: Subjects of this study were secondary school students aged 13-15 (grades of 8-10).
Study design: The Vietnam’s GYTS was a school based cross-sectional survey. A two-stage
cluster sample design was employed to produce a representative sample of students aged 13-15
in five regions in Vietnam. Five cities/province were representatively selected for 5 different
socio-economic regions. In the first stage, a list of all schools in theses cities/provinces was
prepared and schools were selected with probability proportional to school enrollment size. The
number of schools selected was 125 in 5 provinces. The second sampling stage consisted of
systematic equal probability sampling (with a random start) of classes from each school that
participated in the survey. All students in selected classes were eligible to participate in the
survey (18,000 students).
Findings of this survey are represented for 5 regions but not for the whole Vietnamese students
aged 13-15 in Vietnam. This should be considered when compared to other studies in Vietnam
and other countries.
The questionnaire was based on the core questionnaire, which was standardized by CDC for
every country. The 2001 questionnaire consists of 56 questions and includes questions on the
following topics: prevalence of tobacco use, age of initiation, exposure to tobacco advertising,
perception and attitudes on behavioral norms with regard to tobacco use among young people,
media and advertisement, legislation, economics, school curriculum and environmental tobacco
smoke (ETS). In Vietnam, a additional questions are added on the questionnaire, bringing the
total of questions to 65.
Data was collected by field staffs from 5 provinces. The data collectors were trained for two
days on how to do the sampling (choose classes), and administer the questionnaires in a
standardized way. Materials used for conducting the survey were readily prepared and sent to
Data analysis: Data was processed and analyzed by the use of Epi Info software (Version
2002). The prevalence of events related to smoking, cessation, knowledge, attitude, access,
ETS, media, advertisement and their confidential intervals of were calculated. The χ2 test was
used to compare differences in proportions.
Ethical consideration: The study was presented and discussed among those who are in charge
of health research at Ministry of Health and provincial authorities to get approval. Approval
was also received from teachers, representatives of parents and students before carrying out
Table 1 shows the prevalence of ever smoked, current smoke and never smoke in five different
regions in Vietnam, in total and by gender of students. The prevalence of ever smoking, even
one or two puffs, among students aged 13-15 varied between provinces ranging from 10.4% in
Hanoi to 22.9% in Tuyen Quang. Students in Tuyen Quang province (mountainous area) were
more likely to smoke than students in other surveyed cities Ho Chi Minh, Ha Noi, Hai Phong
and Da Nang. Similar to ever smoking, the prevalence of current smoking is the highest in
Tuyen Quang (8.8%) and the lowest in Ha Noi (3.0%).
Table 1. Prevalence of tobacco use among students, Viet Nam GYTS, 2003
Ever Smoked Current Use Never
Cigarettes, Any Cigarettes Other Smokers -
Even One or Tobacco CSMOKE Tobacco Susceptible to
Provinces Two Puffs Product R Products Initiating
ESMOKE CTOB OTOB Smoking
(%) (%) (%)
Total 22.9 (±3.5) 8.8 (±2.7) 8.5 (±2.6) 3.0 (±1.1) 8.8 (±2.3)
Tuyen Quang: M 41.5 (±6.5) 17.6 (±5.3) 16.9 (±5.0) 5.9 (±2.4) 13.0 (±5.3)
F 6.7 (±3.3) 1.2 (±0.8) 1.2 (±0.8) 0.7 (±0.6) 5.4 (±1.8)
Total 18.1 (±3.7) 6.2 (±1.9) 5.3 (±1.8) 2.6 (±1.0) 6.8 (±1.8)
Hai Phong: M 29.8 (±5.4) 11.4 (±3.0) 10.0 (±3.0) 5.0 (±1.8) 12.8 (±3.6)
F 8.9(±3.6) 1.7 (±1.2) 1.6 (±1.2) 0.5 (±0.5) 3.0 (±1.2)
Total 17.4 (±3.3) 5.7 (±2.3) 4.3 (±2.0) 2.1 (±0.8) 8.1 (±2.1)
Ho Chi Minh: M 22.1 (±4.8) 8.5 (±3.6) 7.0 (±3.0) 2.6 (±1.5) 9.6 (±4.1)
F 13.5 (±3.8) 3.3 (±1.7 2.1 (±1.2) 1.5 (±1.0) 6.8 (±1.7)
Total 14.1 (±3.0) 5.1 (±2.0) 4.7 (±1.9) 0.9 (±0.7) 7.1 (±1.3)
Da Nang: M 22.2 (±4.7) 8.9 (±3.3) 8.5 (±3.2) 1.4 (±1.0) 11.9 (±3.1)
F 7.3 (±1.9) 1.8 (±1.0) 1.6 (±0.9) 0.5 (±0.6) 3.9 (±1.0)
Total 10.4 (±2.2) 3.0 (±1.4) 1.9 (±0.9) 1.6 (±1.0) 7.3 (±3.1)
Hanoi: M 16.7 (±4.0) 4.8 (±2.8) 2.9 (±1.7) 2.8 (±2.0) 11.4 (±5.6)
F 5.9 (±1.8) 1.3 (±0.9) 1.0 (±0.7) 0.5 (±0.5) 4.8 (±2.4)
Total 16.6 5.8 4.9 2.0 7.6
Average: M 26.46 10.24 9.06 3.54 11.74
F 8.46 1.86 1.5 0.74 4.78
Notes: M: males F: females
Boys smoke more than girls, As indicated in figure 1, in all five provinces. Especially, in Tuyen
Quang province the prevalence of current smoking among boys was six times higher than girls
(P<0.001). In four other cities Ha Noi, Ho Chi Minh, Da Nang and Hai Phong, boys smoke 1,5-
3 times higher than girls. The difference was significant with P<0.05.
Figure 1. Prevalence of current smoking by sex, Viet Nam GYTS, 2003
Hanoi Haiphong TuyenQuang Danang HoChiMinh
Never smokers who indicated that they are likely to initiate smoking ranged from 6.8% in Hai
Phong to 8.8% in Tuyen Quang (Table 1). The rate is substantially higher (P<0.05) for boys
than girls. Among girls, the rate os susceptible to initiation are often more than two times
higher than the rate of current smoking.
Figure 2. Prevalence of never smoking - Susceptible to Initiating Smoking by sex, Viet Nam
Ha Noi Hai Phong Tuyen Quang Da Nang HCM City
More than 6 in 10 students said that they had been taught dangers of smoking in class during
the past year (from 61.0% in Hanoi to 72.7% in Tuyen Quang). Between 27 percent (in HCMC)
and 47 percent (in Tuyen Quang) said they had discussed why people of their age smoke, and
there was no significant difference by gender.
Table 2: Percentage of students being taught, and discussed about dangers of smoking,
Viet Nam GYTS, 2003
Percentage being taught dangers Percentage discussed reasons why
of smoking people their age smoke
Ha Noi 61.0 (±4.9) 35.6 (±5.6)
Hai Phong 61.0 (±4.9) 35.6 (±5.6)
Tuyen Quang 72.7 (±4.7) 47.1 (±4.7)
Da Nang 63.3 (±3.2) 32.9 (±6.2)
Ho Chi Minh 61.2 (±5.9) 27.1 (±3.3)
Among those students who are current smokers, more than three quarters said they want to quit
smoking (Table 3). The rate was highest in Tuyen Quang (89.7%) and lowest in Ha Noi
(75.5%). A similar percentage said they had tried to stop smoking during the past year. There
were no significant differences by gender.
Table 3: Cessation among current student-smokers, Viet Nam GYTS, 2003
Provinces Percentage desire to stop Percentage tried to stop this year
Ha Noi 75.5 (±14.5) 62.0 (±18.5)
Hai Phong 77.3 (±13.0) 81.6 (±11.3)
Tuyen Quang 89.7 (±6.3) 97.0 (±2.1)
Da Nang 79.2 (±8.5) 74.5 (±10.2)
Ho Chi Minh 82.0 (±15.9) 69.2 (±17.1)
Environmental Tobacco Smoke
Exposure to secondhand smoke at home is very high for students in all provinces (table 4).
More than half of never smokers students, and more than three quarters of current smokers
reported being exposed to second-hand smoke at home. This rate is the highest in Da Nang
province for both groups, 65.8% for never smokers and 89.7% for current smokers. Students
who had never smoked cigarettes were significantly less likely than current smokers to be
exposed to second-hand smoke.
More than 8 in 10 students who had never smoked think smoking should be banned in public
places. The rates are lower among current smokers than among those who never smoke, in all
provinces. A very high percentage (ranging from 63% to 91%) of students think that second-
hand smoke is harmful to them. The rate is higher among never smokers (ranging from 78% to
91%) than among current smokers (ranging from 63% to 85%).
Table 4: Environmental Tobacco Smoke, Viet Nam GYTS, 2003
Percentage exposed to Percentage think smoking Percentage definitely
smoke from others in their should be banned from think smoke from others
home public places is harmful to them
Never Current Never Current Never Current
Smokers Smokers Smokers Smokers Smokers Smokers
Ha Noi 53.2 (±8.3) 82.1 (±8.4) 90.2 ±2.3 50.8±15.7 87.8 ±3.9 69.9±10.4
Hai Phong 55.8 (±5.3) 73.3 (±11.6) 87.5 ±1.8 70.0±11.3 78.3 ±2.2 63.2±12.0
Tuyen Quang 52.4 (±5.0) 84.6 (±6.5) 86.7 ±3.1 82.0±6.4 89.7±2.6 85.5 ±9.4
Da Nang 65.8 (±2.9) 89.7 (±4.7) 88.2 ±2.2 64.5±12.5 91.1 ±2.1 69.5 ±7.3
Ho Chi Minh 64.3 (±6.1) 78.0 (±12.9) 89.8 ±2.6 41.1±13.0 89.4 ±3.8 67.0 13.7
Knowledge and Attitude
About 2 in 10 of never-smokers and 3 in 10 of current smokers think boys who smoked have
more friends and look more attractive than non-smokers. A smaller percentage of never
smokers and current smokers, respectively, think girls who smoked have more friends and look
more attractive than non-smokers. In general those student who are smokers are more likely to
have positive ideas about smoking, i.e. having more friends or looking more attractive, than
Table 5: Knowledge and Attitudes, Viet Nam GYTS, 2003
Percentage think boys Percentage think girls Percentage think Percentage think
who smoke have more who smoke have smoking makes boys smoking makes girls
friends more friends look more attractive look more attractive
Never Current Never Current Never Current Never Current
Smokers Smokers Smokers Smokers Smokers Smokers Smokers Smokers
Ha Noi 15.0 25.4 8.6 19.2 10.2 32.8 6.4 20.1
(±2.7) (±10.1) (±2.0) (±11.1) (±3.0) (±11.6) (±2.7) (±16.5)
Hai Phong 18.6 30.2 5.9 18.5 9.7 27.2 5.4 11.8
(±3.6) (±15.0) (±1.2) (±18.4) (±1.9) (±9.0) (±1.6) (±7.8)
Tuyen 24.0 31.2 5.3 7.0 13.1 27.3 5.0 6.4
Quang (±3.1) (±7.1) (±1.8) (±4.8) (±2.8) (±8.4) (±1.9) (±4.6)
Da Nang 17.5 36.5 5.3 8.2 9.5 26.1 3.8 17.7
(±2.8) (±12.5) (±1.3) (±6.7) (±2.4) (±16.9) (±1.2) (±5.8)
Ho Chi 17.1 29.3 6.3 9.6 10.8 25.0 6.8 21.6
Minh (±2.7) (±9.4) (±3.0) (±8.2) (±2.2) (±8.8) (±1.9) (±3.8)
Media and advertising
About 9 in 10 students in each province saw anti-smoking media messages in the past 30 days
(Table 6). Approximately 5 in 10 of both never smokers and current smokers saw pro-tobacco
messages in newspapers and magazines during the past 30 days. About 2 in 10 never smokers
and 3 in 10 current smokers had an object with a cigarette brand logo on it in most provinces.
More current smokers than never-smokers were offered a free cigarette by a tobacco company
representative in most provinces (Figure 3). Boys who are current smokers were significantly
more likely than girls to have been offered free cigarettes.
Table 6: Media and Advertising, Viet Nam GYTS, 2003
Percentage Percentage saw pro-tobacco Percentage who had object Percentage offered a free
saw anti- messages in newspapers and with a cigarette brand logo on cigarettes by a tobacco
smoking magazines It company representative
messages Never Current Never Current Never Current
Smokers Smokers Smokers Smokers Smokers Smokers
Ha Noi 94.9 (±1.5) 55.8 (±6.8) 64.6 (±15.7) 15.7 (±4.7) 19.2 (±16.4) 9.7 (±3.6) 22.4 (±16.8)
Hai Phong 87.5 (±2.0) 44.8 (±5.0) 61.7 (±9.0) 14.4 (±3.9) 27.2 (±11.2) 6.0 (±1.4) 16.4 (±9.6)
Tuyen Quang 89.7 (±2.5) 34.4 (±3.7) 35.2 (±6.2) 8.3 (±1.7) 13.4 (±6.3) 6.7 (±1.8) 5.7 (±3.4)
Da Nang 90.6 (±2.2) 41.8 (±3.3) 62.1 (±14.3) 13.8 (±2.5) 25.3 (±8.9) 6.7 (±1.9) 17.1 (±9.3)
Ho Chi Minh 91.4 (±1.4) 47.2 (±4.1) 43.3 (±11.6) 17.9 (±3.8) 27.2 (±8.8) 9.1 (±3.6 20.5 (±10.4)
Figure 3. Percent Offered A Free Cigarettes by a Tobacco Company Representative, Viet Nam
15 Never smoker
10 Current smoker
Ha Noi Hai Phong Tuyen Da Nang HCM City
Access and Availability
About 15% of respondents who are current smokers usually smoke at home and more than 50%
of them purchase their cigarettes in a store (table 7). There was little difference in the rates
between provinces (Table 7).
Majority of current smokers who bought their cigarettes in a store were not refused purchase
because of their age (not refused ranging from 65.6% in Tuyen Quang and 95.9% in Ha Noi).
There was no statistical difference by gender.
Table 7: Access and Availability, Viet Nam GYTS, 2003
Percentage of current Percentage of current Percentage of smokers not
Smokers who usually smokers purchasing refused purchasing because
smoke at Home cigarettes in a Store of age
Ha Noi 12.0 (±5.8) 50.8 (±16.5) 95.9 (±8.5)
Hai Phong 18.3 (±11.9) 51.3 (±19.0) 80.2 (±15.6)
Tuyen Quang 15.5 (±4.8) 59.5 10.1) 65.6 (±9.1)
Da Nang 13.7 (±9.8) 58.2 (±6.1) 84.5 (±7.0)
Ho Chi Minh 17.3 (±8.8) 59.5 (±11.1 79.1 (±14.8)
4. Discussions/ Conclusions
As stated in the methodological part, due to the sampling procedures, findings of this survey are
not represented for all students aged 13-15 in the whole country. It should be considered when
comparing our findings with other studies both in Vietnam and other countries.
Prevalence of tobacco use:
Our findings presented above has helped to re-enforce our prediction that the household- based
surveys is not an appropriate way to investigate smoking prevalence among those below 15
year of age.
Overall, the smoking prevalence in Vietnam as from the five provinces are relatively low
compared to other countries in Western Pacific Region that have conducted GYTS (6).
The smoking rate among the boys of this age group are fairly high in some provinces, i.e.
17.6% in Tuyen Quang, 11.4% in Hai Phong, and 8.5% in HCMC, while smoking rate among
girls is, fortunately, still very low. This could be explained by a fact that in Vietnamese society,
smoking among female is still considered to be unladylike, and it is largely considered as
unacceptable for very young female students. The gender difference in smoking rate among
students was to some extent similar to many other Asian countries.
Nevertheless, the results showed a fairly high percentage of female students who never smoke
but likely to initiate smoking in next few years. These rates among girls in most provinces are
three times higher than that of current smokers. This is a concern. In developing countries,
young woman are targeted by the tobacco industry (3), so the tobacco control program have to
focus on young woman in the coming years. At present smoking prevalence among boys is
higher than girl, however if we neglect to prevent smoking among girls, this situation may
change in the future.
More than 6 in 10 students had been taught in school about the dangers of smoking in most
province. However only 3 in 10 students had discussions in class about reasons why people
their age smoke. Therefore, the content of tobacco control curriculums in school should
mention both the danger of smoking and the reasons why people their age smoke.
About 7 in 10 students who currently smoke wanted to quit smoking during the past years. This
is positive news. However we need to develop the cessation programs to help these students
quit smoking. This is also a challenge in Vietnam, where there have virtually no budget for
developing cessation program.
Environmental tobacco smoke:
The high rate of students exposed to second-hand smoking found in this survey re-enforces the
results from an earlier small survey by Medical University in Ha Noi that found more than 50%
of non-smokers exposed to environmental tobacco smoke for 30 minutes a day on average, and
90% smokers usually smoke at home (7).
The fact that an extremely high percentage of students think that second-hand smoke is harmful
to them and support a smoking ban in public places is a strong justification for issuing stricter
regulations on public smoking ban, with heavy fines for violation. In addition, there need to be
more programs promoting smoke-free homes and smokers not to smoke near women and
Knowledge and attitude:
The fact that about one fifth of students believing boys who smoke have more friends, is
certainly part of the impact of the advertising of tobacco companies that portrait smoking as
manly and glamorous. This way of thinking certainly lead some students into smoking or
reluctant to stop smoking. So in communication for tobacco control we have to change this
attitude among the students.
Media and advertising:
The high proportion, about 90%, of students report seeing anti-smoking media messages in the
past 30 days certainly reflect efforts of the Vietnamese Government and the Tobacco Control
Program in the past few years in promoting tobacco control messages in the mass media.
However, this somehow too high percentage may have been biased because the survey was
carried out at the same period of the National No Tobacco Week in Vietnam (May, 25-30),
when a lot of tobacco control meetings and performances were carried out and reported in the
A considerable percentage of students possessing an object with a cigarette brand logo, or
having been offered free cigarettes by a tobacco company representative seems to indicate two
things: tobacco companies in Vietnam have violated the advertising bans; and the enforcement
of the ban needs to be improved. Tobacco Control Program in Vietnam should pay more
attention to monitoring tobacco industry's advertising techniques, to propose necessary new
regulations and to improve the enforcement of current regulations.
Access and Availability:
Although Vietnam has regulation banning selling cigarettes for people under 18, the results of
this survey which showed that most students were not refused purchasing of cigarettes because
of their age is not surprising. One of the main reason for non-compliance with regulation is that
cigarettes are sold almost every where in the countries through street venders and small shops
where enforcement of the regulation is not very practical. The youth can also have access to
cigarettes through other sources such as the free cigarettes in the weddings and funerals,
especially in rural areas. These sources are important for initiation of smoking among children.
In addition, the very low cigarette price in Vietnam, estimated at 3,000 VND (equal to UD$
0.15) on average per pack of 20 cigarettes (5), is also a favorable factor for youth initiation.
In the coming years, in order to effectively prevent smoking among the youth tobacco control
in Vietnam should address the following issues:
In Vietnam there have been a strict tobacco advertising and promotion ban. However, there are
remaining issues with enforcement, and there exist loopholes utilized by tobacco companies.
So in the coming years, VINACOSH should work with ministry of Trade to develop stricter
regulations on banning all forms of advertising promotion tobacco products to submit to the
government. Also the enforcement of the ban also needs to be improved.
VINACOSH should work with Ministry of Training and Education on the curriculum for
tobacco control in school. Students should be taught not only about dangers of smoking but
also the skills to say “no” when offered cigarettes. Students should also be encouraged to
discuss the youth smoking issues with their friends under the guidance of the teachers, and the
curriculum need to be repeated every year.
Prevention of passive smoking should be a focus to protect the health of non-smoking young
children and women. The government should enact legislation to impose heavy fines on
smokers who violate public smoking bans. Also, programs to promote smoke-free homes (8)
should be expended to national scale.
Tobacco tax and price increase has been proved to be one of the most effective measures to
prevent youth smoking. Given the currently extremely low price, low tax level in Vietnam
tobacco tax increase should be a priority for tobacco control in Vietnam not only to prevent
youth smoking but also to reduce tobacco use among adults. As tobacco tax increase will at the
same time improve government tax revenue (1), the earmarking of a certain percentage of the
tobacco tax for a health promotion foundation which also cover tobacco control activities
should be advocated for in coming years.
Tobacco Control Program should consider developing a cessation program for young people
because students have an urgent need to quit smoking. This cessation program should ideally be
funded by the tobacco tax earmarking.
GYTS is a good way to monitor the trend of tobacco among young people and evaluate the
Tobacco Control Program, so this survey should be repeated every 3 years.
1 World Bank. Curbing the epidemic: Governments and the economics of tobacco control.
The World Bank Publication. WB, Washington DC 1999.
2 World Health Organization. Tobacco or Health: a global status report, WHO. Geneva
3. World Health Organization. Women and the tobacco epidemic: challenges for the 21 St
Century. WHO. Geneva 1997.
4 Bales, Sarah with Hoang Van Kinh. An Empirical Analysis of Smoking Using the
Vietnam Living Standard Surveys, Report submitted to the World Bank, 2000.
5 Ministry of Health. Vietnam National Health Survey: a preliminary report. Ha Noi,
6 Country factsheets from GYTS website at: http://www.cdc.gov/tobacco/global/GYTS.htm.
7 Ngo Van Toan, Tran Thu Thuy, Dao Ngoc Phong. Passive smoking and health status of the
people in two urban districts in Ha Noi. Ha Noi Medical University. Research paper. Ha
8 Vinacosh. Preliminary results of the pilot smoke free communities in 5 provinces and cities
in Vietnam. Document of the workshop on pilot smoke free communities. Ministry of
Health. Ha Noi 2001.