A presentation by Robert Blum as part of the Societal and Community Influences across the Life Course panel discussion at the International Symposium on Cohort and Longitudinal Studies in Developing Contexts, UNICEF Office of Research - Innocenti, Florence, Italy 13-15 October 2014

1. Johns Hopkins Bloomberg School of Public Health
POPULATION, FAMILY AND REPRODUCTIVE HEALTH
Transitions into and from tobacco
and alcohol use among
Vietnamese adolescents and
youth
Robert Blum, MD, MPH, PhD Johns Hopkins
Huan He MS Johns Hopkins
Linh Cu Le, PhD Hanoi School of Public Health
Prepared for
International Symposium on Cohort and
Longitudinal Studies
Florence, Italy
13 October, 2014

2. Chile Lab: A DHSS focused on adolescents and youth
• Located in the Chi Linh district of Dai Duong province
about half way between Hanoi and Hai Phong.
• Three modules
– Health Status Behavior module collected on approximately
10,000 14-24 year olds three times: 2006, 2009, 2013.
– Risk and Protective Factors module collected on
approximately 2500 14-24 year olds twice: 2007, 2014.
– Parent Influences and Social Factors module collected on
approximately 2500 14-24 year olds once: 2008 (a second
data collection is planned for late 2014)
13 October 2014 Longitudinal Cohorts Conference Florence, Italy

3. Adolescent and Youth Sample (14-24 year olds)
• Module 1, Time 1: 9,587
• Module 1, Time 2: 10,123
• Module 2, Time 1: 3,147
• Merged sample (all three modules): 2,796
– Females: 1479
– Males: 1317
13 October 2014 Longitudinal Cohorts Conference Florence, Italy

4. Prevalence of Ever Smoking and Having Been Drunk in Past
30 days by sex, Time 1
Behavior Engagement in
Behavior
Males Females
SMOKING NO 3500 (77.7%) 4482 (99.2)
YES 1008 (22.3%) 13 (0.3%)
MISSING 20 (0.4%) 21 (0.5%)
EVER DRUNK PAST
30 DAYS
NO 2663 (58.8) 3482 (86.8%)
YES 1258 (38.8%) 488 (12.0%)
Missing 107 (2.4%) 48 (1.2%)
13 October 2014 Longitudinal Cohorts Conference Florence, Italy

5. Prevalence (%) for ever smoking and drunk in the past 30
days by age (Time 1, full sample)
BEHAVIOR 13 y.o. 15 y.o. 17 y.o. 19 y.o. 21 y.o.
EVER SMOKE M: 1.8% 5.9% 12.1% 24.6% 38.%
F: 0 0.3% 0.2% 0 0.7%
DRUNK IN
PAST 30 DAYS
M: 11.0% 17.8% 30.7% 46.9% 62.8%
F: 2.5% 7.1% 13.2% 14.5% 17.6%
13 October 2014 Longitudinal Cohorts Conference Florence, Italy

6. Transition from Non-Smoker to
smoker
Time 1
Non-smoker
Time 2
Non-smoker
Time 2
Smoker
1081 701 (64.9%) 380
(35.15%)
Factors assoc. with transition to
smoking
• Cigarettes available in the home 2.17
(p<.05)
• Family hx of violence/abuse 1.46 (p<.01)
• Teacher violence/abuse 1.53 (p<.001)
• Ever used internet 2.47 (p<.001)
• Close friends smoke cigarettes 6.07
(p<.001)
• Drunk in past 30 da 2.68 (p<.001)
• Male dominance values 1.35 (p<.01)
• Has girlfriend 2.23 (p<.001)
• Smoking causes disease NS
Oct 13, 2014
Longitudinal Cohorts Conference Florence,
Italy
Transition to Smoking among Males
2006, 2009; Analytic Sample

7. Transition to Smoking Cessation (Quitting)
among Males 2006, 2009; Analytic Sample
Transition from Smoker to Non-smoker
Time 1
Smoker
Time 2
Smoker
Time 2
Non-Smoker
202 150 (74.3%) 52 (25.7%)
Factors assoc. with transition to
quitting smoking
• Father does not smoke cigarettes
2.10 (p<.05)
• Parents never discuss tobacco/
substances 0.20 (p<.05)
• Family member experiences
adverse event .28 (p<.05)
• Almost all friends smoke .24
(p<.001)
• Self-esteem 2.48 (p<.01)
• Drunk in the past 30 da NS
• Knows smoking causes disease NS
Oct 13, 2014 Longitudinal Cohorts Conference Florence, Italy

8. Transition to Drunk in the past 30 da.
among Males 2006, 2009; Analytic Sample
Transition from never drunk to
drunk in the past 30 days
Time 1
Never
Drunk
Time 2
Never
Drunk
Time 2
Drunk past 30
da.
959 794 (82.8%) 165 (17.2%)
Factors assoc. with transition to
drinking
• Family member experiences
adverse event 1.88 (p<.01)
• High family conflicts 1.98 (p<.001)
• Ever used internet 2.71 (p<.001)
• Almost all friends have been drunk
4.16 (p<.001)
• Too sick to go to school/work in
last year 1.50 (p<.01)
• Depression NS
• Repeated grade in School NS
Oct 13, 2014 Longitudinal Cohorts Conference Florence, Italy

9. Transition to Not Drunk in the past 30 da.
among Males 2006, 2009; Analytic Sample
Transition from drunk to ever
drunk in the past 30 days
Time 1
Drunk
in past
30 days
Time 2
Never
Drunk
Time 2
Drunk past 30
da.
142 73 (51.4%) 69 (48.6%)
Factors assoc. with transition to
non-drunk
• Pressure from peers to smoke .26
(p<.01)
• Smokes cigarettes at time one: .37
(p<.01)
• Depression 2.05 (p<.05)
• Too sick to go to school/work in
last year 2.66 (p<.01)
• Repeated grade in School NS
• School enrollment NS
Oct 13, 2014 Longitudinal Cohorts Conference Florence, Italy

10. Conclusions
• Cigarette smoking is remarkably rare among female
adolescents and youth in Viet Nam
• For males both alcohol and tobacco are social
behaviors linked with perceived peer behaviors
• Family emotional environment appears to
significantly influence substance use
• Knowledge of the effects of tobacco appear to have
little effect on behavior
• Except for violent/aggressive teachers school factors
appear to have little effect on substance use
October 13, 2014 Longitudinal Cohorts Conference Florence, Italy