Factors Associated With Intention to Quit Among Male Smokers in Vietnam: Results From the Vietnam Population-Based Provincial Global Adult Tobacco Survey in 2022-2023

Abstract

Objective: This study seeks to extensively examine the intentions of Vietnamese male smokers to quit, delving into key factors associated with their inclination toward smoking cessation to gain insights to inform and enhance tobacco control initiatives in the country. Methods: The data in this cross-sectional study was informed by the Vietnam Provincial Global Adult Tobacco Survey (PGATS) 2022-2023. A total of 35 974 male smokers aged 15 years and older from 30 provinces and cities in Vietnam were surveyed regarding their intentions to quit. Data on the participants’ demographic characteristics, smoking habits, and smoking cessation attempts were collected and analyzed for their associations with quit intention using chi-square test and logistic regression. Results: Overall, 48.4% of current smokers expressed an intention to quit. Those residing in rural areas were less likely to report this intention (OR = 0.929, 95% CI = 0.862-1.000), while occasional smokers (OR = 1.672, 95% CI = 1.580-1.769) and individuals who delayed their first cigarette by more than 60 minutes after waking (OR = 1.710, 95% CI = 1.583-1.845) were more likely to express a desire to quit. Factors such as exposure to information on smoking hazards, health warnings on cigarette packages, and receiving advice from healthcare professionals also significantly increased quit intentions. In contrast, those who had not attempted to quit in the past 12 months were much less likely to express a desire to quit (OR = 0.125, 95% CI = 0.116-0.134). Conclusion: This study underscored the complex interplay of demographic, behavioral, and informational factors associated with the intention of Vietnamese male smokers to quit. These findings contribute to Vietnam’s tobacco control efforts by guiding policymakers and public health authorities in refining smoking cessation programs, enhancing effectiveness of smoking interventions, ultimately reducing smoking prevalence and improving public health outcomes in Vietnam.

Keywords

smoking cessation intention to quit tobacco control male smokers Vietnam

Introduction

Tobacco consumption poses a significant threat to health and is one of the most significant factors leading to premature death. In 2019, 200 million disability-adjusted life years (DALYs) were attributed to tobacco and more than 8 million individuals died from illnesses associated with tobacco use globally.¹ Tobacco use is linked to a 30-fold rise in cancer rates, especially, cancers in the pharynx, esophagus, bladder, larynx, and pancreas and a 9-fold surge in heart attack risk, as well as the increased likelihood of chronic obstructive pulmonary disease (COPD).² In Vietnam, tobacco-related diseases, such as stroke and coronary artery diseases, cause around 40 000 deaths each year. Significantly, cigarette smoking accounts for 30% of all deaths due to heart disease.³ The overall economic burden of smoking in Vietnam was estimated to be approximately US$1.173 billion.⁴

However, the prevalence of smoking remains considerably high despite the detrimental health effects. In 2020, around 22.3% of the worldwide population were actively engaged in tobacco consumption, mainly in the form of cigarettes.⁵ Vietnam ranked among the top nations with the highest prevalence of smokers, with over half of Vietnamese households (56.46%) reported consumption of tobacco products.⁶ Notably, there is a significant gender disparity in smoking rates, with 42.3% of Vietnamese men using tobacco compared to 1.4% of women in 2010.^7,8 The higher prevalence of smoking among males is influenced by a combination of social, cultural, and historical factors. Traditionally, smoking has been more socially acceptable among men, reinforced by targeted advertising and cultural norms associating smoking with masculinity. Biological differences and varying patterns of tobacco initiation also contribute to the gender disparity in smoking prevalence.^9,10 Therefore, quitting tobacco, especially among male smokers, is crucial in preventing the substantial mortality and morbidity associated with its use.

Countries worldwide have actively promoted and supported smoking cessation efforts and other tobacco control measures at the population level. In the case of Vietnam, tobacco policies, smoking cessation programs and strategies have been implemented to encourage smoking cessation and tackle the prevalent issue of smoking.¹¹ The World Health Organization (WHO)’s Framework Convention on Tobacco Control (FCTC) has been in effect in Vietnam since March 2005, emphasizing the creation of smoke-free environments as an effective measure to reduce exposure to tobacco smoke.¹² Additionally, the 2012 Law on Prevention and Control of Tobacco Harms in Vietnam enforces comprehensive smoking bans at workplaces and public places, underscoring the significance of tobacco cessation as a pivotal measure to curtail smoking prevalence in the country.¹³ Although there are official regulations, compliance and implementation of tobacco control regulations is still a big challenge for Vietnam, where smoking behavior is widely accepted in the community. The level of compliance and support for tobacco control policies is limited, and there is still a lack of specific and strong sanctions.

Yet, Vietnamese smokers showed high quit intentions. In a 2015 population-based survey conducted in Vietnam, over 50% of the smoking participants expressed intention to quit.¹⁴ Additionally, according to a study by Huang et al. (2021) among patients seeking healthcare in 46 health facilities in Vietnam, 34.8% of current smokers reported quit attempts.¹⁵ Research findings suggest a significant correlation between success of smoking cessation programs and the participants’ intention and motivation to quit smoking.¹⁶ Therefore, this study seeks to thoroughly examine the intentions and motivations of Vietnamese male smokers to quit, exploring the factors that influence their inclination towards smoking cessation. The study will provide valuable insights and guidance for refining and enhancing strategies, interventions, and approaches in smoking cessation programs, thereby contributing to Vietnam’s tobacco control efforts and promoting the overall health and well-being of the Vietnamese population.

Method

Study Design and Data Collection

The cross-sectional study draws upon data extracted from the dataset of Vietnam Provincial Global Adult Tobacco Survey (PGATS) 2022-2023, which was a study conducted to depict the current status of tobacco use among adults and the associated factors in Vietnam and to provide a comprehensive overview of adult tobacco consumption and the enforcement landscape of tobacco control laws in the country.

The questionnaire employed in the PGATS 2022-2023 was adapted from previous GATS surveys administered in 2010, 2015 and PGATS 2020. To streamline the data collection process, the PGATS interview questions were integrated into smartphones. All interviews were conducted face-to-face in Vietnamese by trained and qualified investigators. Prior to full implementation, the questionnaire underwent rigorous pre-testing to ensure clarity, comprehensiveness, and cultural appropriateness for the Vietnamese context. This pre-testing phase involved a pilot study with a small sample of participants to refine wording, sequence, and response options. Additionally, the questionnaire was validated among a representative sample of the population to assess its reliability and validity in accurately capturing smoking behaviors and intentions among Vietnamese adults.

The data was systematically gathered across 30 provinces and cities in Vietnam through the collaborative efforts of 30 provincial Centers for Diseases Control, Departments of Health, the Vietnam Tobacco Control Fund (VNTCF), and Hanoi University of Public Health (HUPH). Data collection in the last quarter of 2022 and early 2023. Adjusted for a non-response rate of 10% and the design effect resulting from cluster sampling, the total sample size was 72 000 people, with 2400 people (1200 males and 1200 females) in each province/city. The formula used to calculate sample size is as follows:

In which:

n is the minimum sample size,

P is the smoking prevalence

z = 1.96 (Significance level = 95% and two-tailed test),

e is the acceptable relative error = 8%.

There were 71 981 participants completed interviews, representing a 99.97% response rate.

In each province, areas were chosen based on economic status: one urban area, one district of average economic status, and one district with lower economic status. In urban areas, two communes were randomly selected from a provided list, and 600 households were chosen randomly from these communes (300 households per commune). In districts of average and lower economic status, one town was randomly selected. From each town, three neighborhoods were randomly chosen, and within each selected neighborhood, 50 households with male members and 50 households with female members were randomly selected, totaling 300 households per town. Additionally, in each district of average and lower economic status, two communes were randomly selected. In each commune, five villages were randomly selected, and within each village, 60 households (30 with male members and 30 with female members) were randomly selected, totaling 300 households per commune.

Each household must have one individual aged 15 or above selected to participate in the study. Even though adults are often defined as individuals aged 18 or above, the inclusion of individuals aged 15 aligned with various studies in other countries and global health organizations, including the WHO.¹⁷ Additionally, including individuals aged 15 and older helps capture early tobacco use patterns and initiation behaviors among young adults, as well as provide a comprehensive overview of tobacco consumption across different adult age groups, which is crucial for developing targeted prevention and cessation strategies that can effectively reduce tobacco use over the long term. For households with two or more members aged 15 or above, the KISH method selected one participant by listing all eligible members, assigning them sequential numbers, and using a selection grid with a random number to identify the respondent.¹⁸ Individuals with mental health issues or compromised health that prevent them from participating in the interview were not included in the study.

Our analysis exclusively focused on male respondents, resulting in a total participant count of 35 974 individuals. By focusing exclusively on males, we aimed to provide a focused and detailed examination of smoking behaviors, cessation intentions, and associated factors specifically among this demographic group. Understanding these differences is critical for tailoring effective smoking cessation interventions that are gender-specific and address the unique challenges faced by male smokers, as men historically have higher rates of smoking initiation and prevalence compared to women.

Variables

The dependent variable in this study was the smokers’ intention to quit smoking. To extract this intention, respondents were asked, “Do you plan to quit smoking?” Those who indicated intentions such as “I plan to quit next month,” “I am considering quitting in the next 12 months,” or “I will quit someday, but not in the next 12 months” were classified as having the intention to quit. In contrast, respondents who selected “I do not intend to quit” or “Unknown” were categorized as lacking the intention to quit. Those who refused to respond were excluded from the analysis.

The independent variables in this study were identified by previous PGAST and GATS study.¹⁹ These included:

1. Demographic information: age, education, occupation, ethnicity, religion, and place of residence.

2. Tobacco use habits: Smoking status, access to relevant tobacco-related information, and perceived impact of tobacco use, advice/counseling received from healthcare professionals or tobacco control workers at healthcare facilities.

3. Smoking cessation habits: History of quit attempts, duration of smoking cessation, methods employed for smoking cessation, motivation for quitting.

Data Analysis

Data have been cleaned and analyzed using Stata 14 (StataCorp, College Station, TX, USA). Descriptive statistics were used to describe the data as frequencies and percentages. Bivariable analyses was performed to study the association between smokers’ characteristics and their intention to quit smoking, The Chi-square test served as the tool to evaluate associations. Statistical significance was established at a threshold of P < 0.05. Further analysis was conducted using a logistic regression model, to provide the odds ratios (ORs) and 95% confidence intervals (CIs) to specify the impact of various studied factors on the intention to quit. Only independent variables with P-values <0.05 (statically significant) were incorporated into the logistic regression model.

Ethics

The study obtained ethics approval from the ethical committee of Hanoi University of Public Health, Decision No. 242/2022/YTCC-HD3, dated June 15^th, 2022. A written informed consent was taken from all the participants before conducting the interviews.

Results

Smoking Prevalence

Among the participants, 17 622 individuals, constituting 49.0% of the total participants, reported that they have never smoked. Meanwhile, 13 515 individuals, accounting for 37.6%, indicated that they were currently smoking. Additionally, 4752 participants, equivalent to 13.2%, reported that they have ceased smoking. A small percentage of respondents, 0.2%, declined to provide information on their smoking status (Figure 1).

Figure 1.

Smoking Prevalence

Quit Intention Among Current Smokers

A total of 6517 participants, representing 48.4% of the current smokers, expressed the intention to quit smoking. Among them, 6.5% plan to quit smoking next month, 15.5% will quit within the next 12 months, and 26.5% will quit someday. 39.9% of the current smokers had no intention to quit, while 9.3% was not sure if they wanted to quit smoking. 2.4% participants refused to answer (Figure 2).

Figure 2.

Quit Intention Among Current Smokers

Characteristics and Factors Affecting Intention to Quit Among Current Smokers

The mean age was 46.8 ± 13.7 years, with most of the participants fell in the 45-64 years old category Age did not show significant differences in quit intentions across the various age groups, though there was a slight trend toward higher quit intentions among older age groups (P = 0.143). Similarly, most of the participants are married and marital status did not show a statistically significant difference in quit intentions (P = 0.058). On the other hand, education played a significant role, with 59.2% of participants who had completed university or technical college reporting an intention to quit, compared to 31.1% of those who had never attended school. Similarly, occupation influenced quit intentions, with state employees (60.9%) and retirees (58.5%) showing the highest intention to quit, while self-employed individuals (46.9%) and unemployed participants (43.9%) were less likely to intend to quit. There were also notable differences by ethnicity; 58.6% of Thai participants, 50.0% of Muong participants, and 49.2% of Kinh participants expressed an intention to quit (Table 1).

Table 1.

Demographic Characteristics and Quit Intentions of Current Smokers

Characteristics	Intention to quit among participants		P-value
Characteristics	Yes n (%)	No n (%)	P-value
Age
15-24 years old	265 (44.8%)	327 (55.2%)	0.143
25-44 years old	2505 (47.0%)	2822 (53.0%)
45-64 years old	2775 (48.4%)	2958 (51.6%)
65 years and older	705 (49.2%)	728 (50.8%)
Mean age: 46.82 ± 13.72 years
Education level
Never attended school	130 (31.1%)	288 (68.9%)	P < 0.001
Did not complete primary school	514 (38.4%)	824 (61.6%)
Completed primary school	1112 (42.2%)	1525 (57.8%)
Completed secondary school	2315 (51.0%)	2220 (49.0%)
Completed high school	1606 (51.9%)	1487 (48.1%)
Completed undergraduate studies	797 (59.2%)	550 (40.8%)
Completed postgraduate studies	36 (60.0%)	24 (40.0%)
Occupation
Employed by a state organization/agency	488 (60.9%)	314 (39.1%)	P < 0.001
Employed by a non-governmental organization/company	374 (52.5%)	338 (47.5%)
Self-employed	4739 (46.9%)	5355 (53.1%)
Student	47 (52.2%)	43 (47.8%)
Homemaker	28 (37.3%)	47 (62.7%)
Retired	449 (58.5%)	318 (41.5%)
Unemployed and capable of working	208 (43.9%)	266 (56.1%)
Unemployed and incapable of working	176 (42.2%)	241 (57.8%)
Religion
No affiliation with any religion	5291 (49.2%)	5417 (50.6%)	P < 0.001
Buddhism	781 (42.3%)	1063 (57.7%)
Catholicism	257 (43.1%)	339 (56.9%)
Protestantism	25 (64.1%)	14 (35.9%)
Cao dai	142 (61.7%)	88 (38.3%)
Others	15 (48.4%)	16 (51.6%)
Ethnicity
Kinh	5229 (49.2%)	5400 (50.8%)	P < 0.001
Tay	442 (47.9%)	480 (52.1%)
Thai	214 (58.6%)	151 (41.4%)
Muong	137 (50.0%)	137 (50.0%)
Mnong	142 (45.5%)	170 (54.5%)
Others	353 (37.0%)	602 (63.0%)
Marital status
Single	567 (45.4%)	681 (5.0)	0.058
Married	5826 (48.9%)	6096 (51.1%)
Separated	15 (46.9%)	17 (53.1%)
Divorced	53 (41.1%)	76 (58.9%)
Widowed	55 (44.4%)	69 (55.6%)
Region
Urban	3164 (49.4%)	3245 (50.6%)	0.035
Rural	3353 (47.6%)	3698 (52.4%)	0.035
Smoking frequency
Daily	5739 (54.3%)	4824 (45.7%)	P < 0.001
Occasionally	1204 (41.6%)	1693 (58.4%)	P < 0.001
Mean cigarettes smoke per day: 13.4 ± 8.4 cigarettes
Time to first cigarette after waking up
Less than 5 minutes	625 (38.5%)	998 (61.5%)	P < 0.001
6-30 minutes	1943 (44.8%)	2396 (55.2%)
31-60 minutes	1029 (46.8%)	1169 (53.2%)
More than 60 minutes	1023 (47.9%)	1111 (52.1%)
Saw information on smoking hazards or quitting promotion in the last 30 days	5230 (52.4%)	4743 (47.6%)	P < 0.001
Saw health warnings on cigarette packages in the last 30 days	5121 (50.7%)	4985 (49.3%)	P < 0.001
Did not see any cigarette packages	170 (38.9%)	267 (61.1%)	P < 0.001
Advice to quit smoking from healthcare providers in the last 12 months	983 (66.7%)	490 (33.3%)	P < 0.001
Previous quit attempt in the last 12 months	3430 (80.4%)	839 (19.6%)	P < 0.001
Duration of most recent quit attempt (n = 4275)
≥30 days	1937 (83.5%)	382 (16.5%)	P < 0.001
≥7 days	626 (82.2%)	136 (17.8%)
1-7 days	476 (79.4%)	124 (20.6%)
<1 day	175 (77.1%)	52 (22.9%)
Mean duration of most recent quit attempt: 88.5 ± 113.5 days
Smoking restrictions at home
Smoking allowed	1066 (45.2%)	1294 (54.8%)	P < 0.001
Smoking not allowed, but with exceptions	1700 (55.8%)	1346 (44.2%)
Smoking not allowed	1583 (58.6%)	1118 (41.4%)
No restrictions	1951 (42.7%)	2620 (57.3%)
Smoking restrictions at work (n = 4491)
Smoking allowed	220 (41.1%)	315 (58.9%)	P < 0.001
Smoking not allowed, but with exceptions	727 (52.5%)	632 (46.5%)
Smoking not allowed	702 (54.8%)	580 (45.2%)
No restrictions	439 (41.3%)	623 (58.7%)
Awareness of the law on prevention and control of tobacco harms	4189 (54.7%)	3472 (45.3%)	P < 0.001

Most of the smokers smoked daily, and smoked their first cigarette 6 to 30 min after waking up, with an average consumption of 13.4 ± 8.4 cigarettes per day. Only 4269 smokers tried to quit smoking in the last 12 months, though more than half of them succeeded in quitting for more than 1 month. The mean duration of their most recent quit attempt was 88.5 ± 113.5 days (Table 1). Notably, a substantial portion of those attempting to quit did so without seeking any external support (Supplement Table S1). Smoking restrictions at home and work were also associated with a greater likelihood of intending to quit. Among participants who were not allowed to smoke at home, 58.6% expressed an intention to quit, compared to 45.2% of those who were allowed to smoke (P < 0.001). A similar trend was seen at work, with 54.8% of participants with smoking restrictions at work intending to quit, compared to 41.1% of those who were allowed to smoke at work (P < 0.001).

Exposure to anti-smoking campaigns and warnings was a critical factor in shaping quit intentions. Most smokers have heard of the Law on Prevention and Control of Tobacco Harms, and 54.7% of those who had heard of the law reporting an intention to quit. Additionally, among those who had seen information on the hazards of smoking or quitting promotions in the last 30 days, 52.4% intended to quit. Similarly, 50.7% of participants who had noticed health warnings on cigarette packages intended to quit. Receiving advice to quit smoking during healthcare visits also had a significant impact, with 66.7% of those who received such advice intending to quit (Table 1).

In more details, college graduates were over three times more likely to express intentions to quit smoking compared to those who never attended school (OR = 3.21, 95% CI: 2.54-4.06), while high school graduates were more than twice as likely (OR = 2.39, 95% CI: 1.92-2.98). Regarding occupations, individuals employed by non-governmental organizations/companies, self-employed individuals, homemakers, and both categories of unemployed individuals (capable and incapable of working) were significantly less likely to intend to quit smoking than those employed by state organizations or agencies. Religious affiliation also played a role, with Cao Dai adherents (OR = 2.12, 95% CI: 1.56-2.88) and Protestants (OR = 2.17, 95% CI: 1.03-4.59) exhibiting significantly higher odds of intending to quit compared to individuals with no religious affiliation. Smokers of Tay, Thai, or Muong had increased odds of intending to quit compared to the Kinh group, while other ethnicities showed lower odds. Smokers in urban areas are approximately 1.08 times more likely to quit smoking compared to those in rural areas (Table 2).

Table 2.

Bivariate Logistic Regression Model for Factors Affecting Intention to Quit Among Current Smokers^a

Characteristics	OR (95% CI)	P-value
Age
15-24 years old	N/A	N/A
25-44 years old
45-64 years old
65 years and older
Education level
Never attended school	Ref.
Did not complete primary school	1.38 (1.09, 1.75)	0.001
Completed primary school	1.62 (1.30, 2.02)	P < 0.001
Completed secondary school	2.31 (1.86, 2.86)	P < 0.001
Completed high school	2.39 (1.92, 2.98)	P < 0.001
Completed undergraduate studies	3.21 (2.54, 4.06)	P < 0.001
Completed postgraduate studies	3.32 (1.90, 5.80)	P < 0.001
Occupation
Employed by a state organization/agency	Ref.
Employed by a non-governmental organization/company	0.71 (0.58, 0.87)	0.001
Self-employed	0.57 (0.49, 0.66)	P < 0.001
Student	0.70 (0.45, 1.09)	0.115
Homemaker	0.38 (0.24, 0.63)	P < 0.001
Retired	0.91 (0.74, 1.11)	0.351
Unemployed and capable of working	0.50 (0.40, 0.63)	P < 0.001
Unemployed and incapable of working	0.47 (0.37, 0.60)	P < 0.001
Religion
No affiliation with any religion	Ref.
Buddhism	0.86 (0.78, 0.95)	0.002
Catholicism	0.76 (0.67, 0.93)	0.004
Protestantism	2.17 (1.03, 4.59)	0.042
Cao dai	2.12 (1.56, 2.88)	P < 0.001
Others	0.90 (0.44, 1.84)	0.776
Ethnicity
Kinh	Ref.
Tay	0.95 (0.83, 1.09)	0.464
Thai	1.46 (1.18, 1.81)	P < 0.001
Muong	1.03 (0.81, 1.31)	0.793
Mnong	1.03 (0.81, 1.31)	0.001
Others	0.68 (0.60, 0.77)	P < 0.001
Marital status
Single	N/A	N/A
Married
Separated
Divorced
Widowed
Region
Urban	Ref.
Rural	0.93 (0.87, 0.99)	0.035
Smoking frequency
Daily	Ref.
Occasionally	1.67 (1.54, 1.82)	P < 0.001
Time to first cigarette after waking up
Less than 5 minutes	Ref.
6-30 minutes	1.28 (1.14, 1.44)	P < 0.001
31-60 minutes	1.39 (1.22, 1.58)	P < 0.001
More than 60 minutes	1.71 (1.50, 1.95)	P < 0.001
Saw information on smoking hazards and quitting promotion in the last 30 days
No	Ref.
Yes	1.88 (1.74, 2.04)	P < 0.001
Saw health warnings on cigarette packages in the last 30 days
Yes	Ref.
No	0.73 (0.67, 0.80)	P < 0.001
Did not see any cigarette packages	0.62 (0.51, 0.75)	P < 0.001
Advice received to quit smoking during healthcare visits
Yes	Ref.
No	0.44 (0.31, 0.61)	P < 0.001
Previous quit attempt in the last few months
Yes	Ref.
No	0.12 (0.11, 0.14)	P < 0.001
Duration of most recent quit attempt
≥30 days	Ref.
≥7 days	0.62 (0.52, 0.74)	P < 0.001
1-7 days	0.76 (0.60, 0.94)	0.016
<1 day	0.66 (0.48, 0.92)	0.014
Smoking restrictions at home
Smoking allowed	Ref.
Smoking not allowed, but with exceptions	1.53 (1.38-1.71)	P < 0.001
Smoking not allowed	1.72 (1.54-1.92)	P < 0.001
No restrictions	0.90 (0.82-1.00)	0.048
Smoking restrictions at work (n = 4491)
Smoking allowed	Ref.
Smoking not allowed, but with exceptions	1.65 (1.35-2.02)	P < 0.001
Smoking not allowed	1.73 (1.41-2.12)	P < 0.001
No restrictions	1.01 (0.82-1.25)	0.934
Awareness of the law on prevention and control of tobacco harms
Yes	Ref.
No	0.58 (0.54-0.62)	P < 0.001

^aThose variables labelled as “N/A” were not statistically significant in the Chi-square.

Furthermore, occasional smokers were 1.67 times more likely to express intentions to quit than daily smokers (OR = 1.67, 95% CI = 1.58-1.82). The time to the first cigarette after waking up also played a crucial role, with progressively higher odds of intending to quit associated with longer durations. Compared to those whose most recent quit attempt lasted 30 days or more, individuals who attempted to quit for 1-7 days showed a decrease in the odds of expressing an intention to quit smoking (OR = 0.12, 95% CI = 0.11-0.14). Shorter durations of quit attempts are associated with lower intentions to quit smoking compared to longer attempts. Notably, stricter smoking restrictions at home and work were associated with higher intentions to quit, with those living or working in smoke-free environments being 1.72 and 1.73 times more likely, respectively, to consider quitting (Table 2).

Exposure to information on smoking hazards and quitting promotion in the last 30 days significantly increased the likelihood of intending to quit by 1.88 times (OR = 1.88, 95% CI = 1.74-2.04), similarly to those who saw health warnings on cigarette packages in the last 30 days, those who received advice to quit smoking during healthcare visits, and those who were aware of the Law on Prevention and Control of Tobacco Harms (Table 2). In fact, 9.099 participants agreed that information on the health impacts of smoking and advices to quit prompted them to consider giving up smoking (Supplement Table S2).

Discussion

This study examines the quit intentions of Vietnamese male smokers, and the factors that impact their motivations for smoking cessation. The male smoking prevalence in our study was 37.6%, which was slightly higher than the global prevalence,²⁰ but lower than the overall prevalence among Vietnamese male smokers.²¹

Our findings unveiled that out of 13 515 current male smokers across 30 provinces in Vietnam, 48.4% expressed their intentions to quit. Notably, this figure reflects a decline compared to the previous GAST study conducted in 2016-2017 in India, where 56.3% of current smokers were reported to have the intention to quit smoking.²² In comparison to a prior study involving Vietnamese male smokers in 2019, where 75.9% of participants expressed intentions to quit smoking, the prevalence of intention to quit in our study was notably lower; nevertheless, our study featured a significantly larger sample size.²³ Our results align with results from other Southeast Asian nations, including Thailand and Malaysia, where 40.5% and 53.9% of smokers, respectively, indicated their intentions to quit.²⁴ However, in Western countries like Switzerland, a significant 71.0% of adult smokers expressed their desire to quit smoking, indicating a notably higher level of commitment to smoking cessation compared to the observed intentions in our study.²⁵ This underscores the need for targeted interventions and tailored approaches to increase smoking cessation in the Vietnamese context.

In our study, it was evident that residents in rural settings exhibited a lower propensity to express an intention to cease smoking compared to their urban counterparts. This is consistent with research in Poland, the United States, and India.^23,26,27 Therefore, efforts should be directed towards developing targeted smoking cessation interventions, particularly in rural areas, to address the observed disparity in quit intention and enhance overall public health outcomes. However, a previous study in Vietnam did not find a statically significant association between residence and intention to quit.²⁸ Other demographics factors such as education level, occupation, religion, ethnicity showed a statistically significant association with quit intention. These demographic factors could influence quit intentions through mechanisms such as greater awareness of health risks, better access to resources, or stronger social networks supporting smoking cessation.

Occasional smokers exhibited a greater inclination to express an intention to quit in comparison to daily smokers. Particularly, smokers who smoked their first cigarette over 60 min after they woke up showed the highest quit intention. Studies in Canada and Turkey supported this.^29,30 However, Chaiton et al. (2016) indicated occasional smokers faced a 2.9-fold increased likelihood of experiencing a relapse (95% = 2.0-4.3).²⁹ Information regarding smoking hazards and quitting promotion, including health warnings on cigarette packages and advice from healthcare professional, had a statistically significant effect on the smokers’ intentions to quit. The majority of smokers acknowledge that such information instills concerns regarding their health, as well as the well-being of their families and friends. Furthermore, it serves as a motivational factor, prompting them to contemplate reducing their smoking habits or actively seeking ways to quit. This is in accordance with findings from prior Vietnam GATS 2015, demonstrating a statistically significant increase in the odds of quit attempts among male smokers who were exposed to anti-smoking messages from three or more channels compared to those without any exposure to anti-smoking messages across various channels.³¹ This emphasizes the effectiveness of employing diverse channels for smoking cessation promotion to influence smokers’ intentions to quit. Continuous efforts should be directed towards expanding and optimizing these channels to reach a broader audience and enhance the impact on smoking cessation initiatives.

Within the past 12 months, 3,430, or 31.6% of male smokers made attempts to quit smoking. This was lower than the proportion from the GATS 2015 study or from a study among Vietnamese Americans.^31,32 This figure was also below the percentage of over 50% of adult smokers attempting to quit each year in the United States.³³ Our results showed that quit attempt was a strong indication of quit intention among smokers. This corresponds with research conducted among smokers in China.³⁴ The primary driving force behind these cessation attempts was the awareness of the negative health impacts associated with smoking. Counseling emerging as the most prevalent method employed for cessation. However, over half of those who embarked on this cessation journey opted to do so without seeking external support. Though, medications and behavioral counseling have demonstrated greater efficacy in smoking cessation compared to relying solely on external support for quitting. In light of these findings, it becomes imperative for smoking cessation programs and public health initiatives to emphasize the benefits of comprehensive support, including medications and behavioral counseling, and efforts should be directed toward increasing awareness, accessibility, and utilization of such resources, to enhance the success rates of individuals attempting to quit smoking.³⁵

While this study provided valuable insights into the intention to quit smoking among male respondents in Vietnam, it is important to acknowledge certain limitations. Firstly, the exclusive focus on male participants in 30 out of 63 provinces of Vietnam may limit the generalizability of the findings to the broader population. While this approach could optimize the customization of smoking cessation interventions to suit the specific gender and geographical contexts, it may limit the applicability of the findings to the entire Vietnamese population, as the study potentially overlooks important variations in smoking behaviors, attitudes, and cessation intentions that could exist across different demographic groups and regions within Vietnam smoking patterns. Therefore, caution should be exercised in extrapolating the study results beyond the specific demographic and geographic scope of the sampled population. Future research should aim for more comprehensive sampling strategies that encompass diverse demographic groups and geographical regions to provide a more nuanced understanding of smoking behaviors and cessation efforts across Vietnam. Additionally, the study relied on self-reported data, which introduced the potential for recall bias and social desirability bias. Participants may provide responses that align with societal expectations rather than reflecting their true behaviors and intentions. Moreover, the cross-sectional design of the study captured a snapshot in time, preventing the establishment of causal relationships between variables. Longitudinal studies would be beneficial to explore the dynamic nature of smoking intentions and behaviors over time. Despite these limitations, this study contributed valuable insights into the factors influencing smoking cessation intentions in the Vietnamese context.

Conclusion

This study highlights the motivations and factors influencing Vietnamese male smokers’ intentions to quit, with nearly half expressing a desire to stop smoking. Key factors include urban residency, higher education, non-state employment, lower smoking frequency, strict smoking regulations, exposure to health warnings, advice from healthcare professionals, and prior quit attempts. To strengthen tobacco control efforts in Vietnam, targeted smoking cessation programs in rural areas and diverse promotional channels are essential. Emphasizing counseling, medication, and improved access to cessation resources can enhance quit success rates. Addressing these factors can improve public health and advance smoking cessation initiatives nationwide.

Supplemental Material

Supplemental Material - Factors Associated With Intention to Quit Among Male Smokers in Vietnam: Results From the Vietnam Population-Based Provincial Global Adult Tobacco Survey in 2022-2023

Supplemental Material for Factors Associated With Intention to Quit Among Male Smokers in Vietnam: Results From the Vietnam Population-Based Provincial Global Adult Tobacco Survey in 2022-2023 by Ngoc Bich Nguyen, Hoang Van Minh, Tran Thi Tuyet Hanh, Anh Kim Thi Le, Luong Ngoc Khue, Phan Thi Hai, Linh Thuy Nguyen, Duong Tu Anh, Thanh Quoc Pham, Thuy Thu Thi Tran, Linh Phuong Nguyen and Phan Van Can in Tobacco Use Insights

Supplemental Material

Supplemental Material - Factors Associated With Intention to Quit Among Male Smokers in Vietnam: Results From the Vietnam Population-Based Provincial Global Adult Tobacco Survey in 2022-2023

Footnotes

Acknowledgments

This survey of tobacco use among adults in Vietnam in late 2022 and early 2023 in 30 provinces/cities (Provincial Global Adult Tobacco Survey – PGATS 2022-2023) could not have been successfully implemented without the valuable contribution from many organizations. These include the World Health Organization office in Vietnam, the Vietnam Tobacco Control Fund, the HUPH, and CDCs in 30 provinces and cities nationwide. We also valued the collaboration and support of governmental, non-governmental organizations and experts in tobacco harm prevention in Vietnam.

ORCID iD

Linh Phuong Nguyen

Author Contributions

NNB, TTTH, PVC, HVM, LNK, PTH, NTL, DTA, and PQT conceived and designed the study, agreed with the results and conclusions and came up with arguments for the manuscript. TTTH, PVC, PQT, LNK, PTH, NTL, DTA, LTKA, TTTT, NPL and HVM coordinated data collection and/or analyzed the data. NNB, NPL, and TTTH wrote the first draft of the manuscript. All the authors made critical revisions and agreed on the final versions of the manuscript, which was submitted by LPN.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Vietnam Tobacco Control Fund under Grant number 29/2022/HĐ-QPCTHTL-ĐHYTCC dated 28/4/2022.

Declaration of Conflicting Interests

The authors of this study declared no conflicts of interest to the research, authorship and publication of this manuscript.

Data Availability Statement

Raw data were generated at Hanoi University of Public Health, Vietnam. Derived data supporting the findings of this study are available from the corresponding author on request.*

Supplemental Material

Supplemental material for this article is available online.

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