Presence of tobacco in supposedly tobacco-free Vietnamese hospitals

A study observing the real situation of hospitals in Vietnam puts the implementation of anti-smoking regulations into perspective and recommends its better application.

In Vietnam, the 2012 Law on Prevention and Control of Tobacco-related Harm mandated that all health care facilities be tobacco-free, as explicitly provided for in Article 14 of the WHO Framework Convention on Tobacco Control (CCLAT).

To verify the effectiveness of this measure, a team of Vietnamese and Australian researchers conducted a series of systematic observations over a week in 40 Vietnamese hospitals of different sizes, spread across four provinces.[1].

Numerous violations of anti-smoking regulations found in Vietnam

The results of the study show that 23 of the healthcare facilities visited (57.5 %) comply with national regulations in terms of banning the sale of tobacco, advertising and the presence of signage. The absence of tobacco advertising was the most widely followed anti-smoking measure (70 %). In the event of non-compliance with the ban on advertising, it was sometimes visible on several sites in the hospital. The display of non-smoking signage was the other most widespread measure (64.4 %), but was only deployed on all hospital sites in six facilities (15 %).

Smokers were observed within the premises of 26 of these hospitals (65 %), while 35 of them (88 %) showed indirect evidence of smoking, via collections of cigarette butts on the floor and surveys of ashtrays. These observations were more frequent in the two establishments that still permitted smoking without real restrictions, as well as in the five that still had rooms dedicated to smokers. Smoking behaviour was more observed in the seven hospitals where the sale of tobacco was still tolerated. These smoking behaviours among patients and visitors, as well as the indices of tobacco consumption, were more observed in the departments where the staff included a smoker. On the other hand, the presence of non-smoking signage reduced direct or indirect observations of consumption.

Bridging the gap between tobacco control policies and their implementation

The researchers conclude from these observations that anti-smoking regulations are still far from being properly followed in Vietnamese hospitals. However, Vietnam is not alone in this, as other studies conducted in the United Kingdom and Indonesia have highlighted numerous failures by hospitals to comply with their countries' anti-smoking regulations.

The authors of the study point out that, to be effective, an anti-smoking policy must be clearly announced, have visible signage, monitor its proper application and impose sanctions in the event of violations. They therefore advocate that other anti-smoking interventions be conducted in healthcare establishments, particularly with doctors and caregivers, with a view to making them genuinely smoke-free spaces and not tarnishing their reputation. Experience has also shown that the explicit involvement of the director of the establishment in enforcing the regulations, and the inclusion of anti-smoking provisions in the internal regulations are essential for their proper observance. Finally, the authors recommend conducting regular external studies to ensure proper observance of the measures adopted.

The challenge of the effectiveness of measures to reduce tobacco consumption in this country is major: with a smoking prevalence of 45.3% among men, it is estimated that each year, 50,000 people die prematurely because of tobacco.

Keywords: Vietnam, smoke-free hospital, observations, anti-smoking policy.

MF

[1] Merritt JD, Yen PN, Thu-Anh N, et al. Smoking behavior, tobacco sales and tobacco advertising at 40 'Smoke Free Hospitals' in Vietnam. Tobacco Control, Published Online First: 05 September 2023. doi: 10.1136/tc-2023-058003