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'It's Rude to Say No': Vietnamese Attitudes Toward Smoking

1998-10-30

[Photo: Vietnamese woman pushing a rack of clothes in Hanoi.]

Public attitudes toward smoking is one of the main obstacles to tobacco control efforts in Viet Nam, suggests a recent study by Canadian and Vietnamese researchers.

"The former prevailing attitude in North America — that it is rude to tell someone not to smoke — is still the prevailing feeling here in Viet Nam," says Debra Efroymson, a PATH Canada advisor and co-author of It's Rude to Say No: Vietnamese Opinions About Tobacco Control, funded by Research for International Tobacco Control (RITC). (Formerly named the International Tobacco Initiative, RITC is based at the International Development Research Centre in Ottawa.)

Reasons for smoking

Efroymson and her partners, Dr Vu Pham Nguyen Thanh of the Institute of Sociology in Hanoi and Dao Tran Phuong of the Hanoi Research and Training Center for Community Development, based their report on interviews with classrooms of students and with individuals — including health care workers, teachers, and tobacco vendors. They found that Vietnamese people smoke "to prevent cold and boredom, to reach out to their friends by offering and accepting cigarettes, because someone encouraged them, to lose weight, to show they're not stingy, because their job requires it," and for other purposes.

"One of the most common reasons men give for smoking is to be masculine," states the report. "In one group discussion, six out of ten young women agreed that if a man smokes, it makes him look more manly." By contrast, female smokers are generally considered unladylike.

Skeptical attitudes

Most of the people who were interviewed had heard that cigarettes are harmful, "but they often question that information, or qualify it to the point of erasing all concern." They were also skeptical about the addictiveness of cigarettes, or unsure what addiction means. In addition, the subjects generally viewed tobacco as economically beneficial to Viet Nam. Only a minority believed that the health costs associated with tobacco-related illness could cause long-term economic harm. Many Vietnamese misunderstand the intent of government measures to restrict tobacco use and, in fact, are openly hostile.

"Clearly there is a great need among the population at large — and we suspect among policy makers as well — for better information about tobacco, so people can make informed choices both about whether to smoke and about policies on tobacco control," says Efroymson.

Political mapping

It's Rude to Say No grew out of a larger study, which used political analysis software to map the political environment surrounding Vietnamese tobacco policy. The research team used this software to identify key players, their positions and interests, and how tobacco policy affects them. Their results pinpointed opportunities and obstacles for potential anti-smoking policies, illustrating which ones are most likely to succeed.

Viet Nam was the focus of the RITC study because multinational tobacco firms had only recently entered the country and begun to promote their products. "The contrast between the situation before and after Viet Nam's economy opened up was dramatic," says Efroymson. "It was also clear that smoking rates in Viet Nam were quite high, that smoking is a big part of the culture, and that tobacco control efforts were weak."

Recommendations

It's Rude to Say No calls for more extensive public awareness campaigns on the dangers of tobacco, including the effects of secondhand smoke. In addition, "people need to understand more clearly the likely economic impact of tobacco consumption on Viet Nam," as current generations of smokers gradually overburden its health care system.

"Until people better understand the true extent of the harm caused by cigarettes to health and economy, and the motivation behind government measures to control tobacco, any government measures are likely to meet with strong opposition and current educational attempts are likely to fail," the report concludes.

Future plans

The research team is using these findings to plan further activities including a series of reports on tobacco, health, and economies, which are intended to help influence the opinions of Vietnamese decision makers and, ultimately, of the general population. But Efroymson says there is much more to do. "We hope in future to work more closely with policy makers, giving them information and advice on reducing the impact of tobacco on health and the economy," she stresses.

Keane J. Shore is an Ottawa-based writer and editor. (Photo: R. Ramlochand, IDRC)

Contacts:

Research for International Tobacco Control (formerly the International Tobacco Initiative), 250 Albert Street, PO Box 8500, Ottawa, Ontario, Canada K1G 3H9;
Tel: (613) 236-6163, ext. 2154; Fax: (613) 236-4026; E-mail: ritc@idrc.ca

Debra Efroymson, PATH Canada Regional Advisor, 273/1 Jafrabad, Shangkor, Dhaka-1207, Bangladesh;
Tel: (880-2) 913-1965; Fax: (880-2) 912-2831; E-mail: pathCan@citechco.net

It's Rude to Say No: Vietnamese Opinions About Tobacco Control

Lessons from Canada's Tobacco War, by Lauren Walker

Smoke & Mirrors: The Canadian Tobacco War, by Rob Cunningham

The Global Tobacco War, by Michael Smith

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