ITtiNGOUftK&NGHIEHetiUI Nghidn citu danh gia md hinh ng6i tru'dng khong khoi thuoc Le Thi Thanh Ha {*), Fham Thi Quynh Nga (**) Cdc bdng chiing khoa hgc dd cho thay viic thuc hiin mdi trudng hodn todn khong cd khdi thudc Id cdch nhdt de bdo vi ngUdi khoi phai nhiem vdi khdi thudc mdt cdch hieu qud TrUdng Dgi hgc Y te Cdng cong Id dan vi tien phong d Viit Nam viic xdy dytng md hinh ngoi trudng khong khdi thudc Dieu tra trudc vd sau thuc hien md hinh ndy dugc thUc hiin vdo ndm 2004 vd ndm 2006 de xdc dinh tl 1$ hiit thudc, kii'n ihiic vd thdi dg ddi vdi viic hut thudc cda cdn bo, gidng vien vd sinh viin nhd trudng Ke't qud nghiin cdu cho thdy: Ti li nam hut thuoc ndm 2004 khodng 17% vd ndm 2006 Id 18% Vdn quan sdt thdy hiin tugng hiit thudc trUdng, chu ye'u Id khdch bin ngodi vdo trudng Hdu nhu td't cd ddi tugng nghien ciiu cho rang hiit thuoc vd phai nhiem vdi khdi thudc rdt cd hgi cho sde khde Cd 86% ngUdi hut ihudc ndm 2004 vd 73% ngUdi hul ndm 2006 cho bie't cdm thdy nggi hiil thudc IrUdc mat ngUdi khdc Han hai phdn bangUdi tham gia nghien cdu ndm 2004 vd ba phdn tU ngUdi tham gia ndm 2006 cho bie't quan diem phdn ddi hiit thud'e nai cdng cgng Md hinh ngdi trudng khong khdi thudc dugc ung hg cua dong ddo cdn bg sinh vien nhd trudng, nhien vi$c thUc ihi quy dinh ndy cdn dugc ddy mgnh han de viec thUc hi0n md hinh cd hiiu qud tdt Tit khda: Ngdi trudng khong khdi thudc, thuc trgng hut thudc Assessment of the smoke free school model in Hanoi School of Public Health Le Thi Thanh Ha (*), Pham Thi Quynh Nga (**) There is indisputable evidence lhat implementing absolutely smoke free environment is the only effective way to protect the population from the harmful effects of exposure to second-hand smoke [11 J Hanoi School ofPublic Health is the university pioneering in building 'smokefreeschool'model in Viet Nam Two surveys were conducted in 2004 and 2006 to measure smoking prevalence, knowledge and altitudes toward smoking ofslaff, lecturers and students ofthe school Results show lhat approximately 17% of males in 2004 and 18% of males in 2006 were current smokers Smoking behaviors were still observed in the school area, mainly from visiting guests Almost all agreed that smoking and being exposed to second-hand smoke were seriously harmful to health About 86% of smokers in 2004 and 73% of smokers in 2006 fell hesitative when smoking in front of others More than two third of participants in 2004 and three quarters of participants in 2006 reported lhat they objected lo smoking in public places The majority ofparticipants supported the "Smoke free school" Tap chl Y te Cdng cong, 1.2010, Sd 14 (14) 29 {TONG QUAN & NGHIEN C i t l I model, however, the enforcement ofthe 'smoke free school' regulation should be strengthened the model could be effectively implemented Key words: No smoking school, smoking so that prevalence Tdc gia: (*) Le Thi Thanh Hi - Thae si, giang viSn Bo mon Dich tl, Trtfcfng Dai hoc Y te Cfing cfng Difn thoai: 2662337, email: lth3@hsph.edu.vn (**) Pham Thi Quynh Nga - Bic si To chile y te the gidi, email: ngap @wpro.who.int D0t vfifn de Hiit Ihud'c Id vd hau qua hiit thud'e gay dang Id mdi nhflng quan lam hdng d i u cija ngdnh y te'cdng cfing Tai Viet Nam, li Ifi hut thuo'e I d d n a m g i d i k h d e a o , I % vanff la g i n 1,8 % [6] Ti Ifi hiit thudc eiia hoc sinh nam 13-15 ludi la I0%[7] vd li Ifi hat thudc nam gidi 18-21 ludi Id 40,1 % [2], Udc Iinh vdi ly Ifi hrft thude nhff hifin nay, ddn ndm 2010, Vifii Nam se ed khoang 10% dan sd, khodng tripu ngffdi chdt vi cde can benh cd hen quan dfi'n thudc Id [9] Sff chap nhdn eua xa hfii vdi vific hdt thud'e da khie'n vific hiil thud'e xay phd bie'n d mpi ndi nhff d nha, ndi Idm vific, irffdng hpe, bfinh vipn, , Idm eho ti Ifi phdi nhiem vdi khoi ihud'c Ihu dfing cQng rat cao (Hai p h i n ba nff va mdt nffa tr^ em phdi nhiem vdi khdi ihudc tbeo nghien cffu Clia Hfii Y td Cdng cpng 2004[3]) Viee thrfc hien mdi trffdng khdng khdi thud'e la bien phdp can thidt de bao vp ngffdi khdi tdc hai cua khdi ihud'c Trffdng Dai hpe Y i d Cdng cpng (DHYTCC) la trffdng dai hoc dau Iifin d Vifit N a m thrfc hien md hinh "Ngdi trrfdng khdng khdi ihud'c" De cd drfdc cdi nhin tdng qudt ve ihrfc trang hiil thud'e cung nhrf hifi'u bifi'l va thdi dp cua can bp vd hoc vifin sinh vien nhd irrfdng U6n quan tdi viec thrfc hipn md hinh "Ngdi irrfdng khdng khdi thudc", nhdm nghien cffu ihude bp mdn Dich tfi eiia irffdng da Ue'n hdnh hai dieu tra trffde va sau thffc hien chffdng trinh "Ngdi trrfdng khdng khdi thudc" Nhdra nghien cffu hy vong r^ng, vdi nhffng phat bipn cua nghi6n crfu, nhffng difi'm manh va tdn tai ciia chffdng Irinh se la nhffng ihdng lin hiirf icb giiip 30 Tap chf Y td Cfing cfing, 1.2010, Sd 14 (14) nha trffdng U6'p tuc thffc hifin idl hdn chffdng trinh "Ngdi trrfdng khdng khdi thud'e" cung nhff cd thd la md binh difi^m nhdn rdng cde trffdng hoc khdc, Mue tieu ngbien erfrf - Xdc dinh ty Ip hiil thufi'c Id ci3a cdn bd va hpe vifin/sinh vifin ciia trffdng nam 2004 va 2006 - Md la kie'n thffc v l idc hai cua hdt thud'e Id chd dpng vd Ihu dpng cua cdn bd va hpe vifin/sinh vifin cua trrfdng nam 2004 va 2006 - Md Id thdi dp dd'i vdi hut thudc Id trrfdng va but thuoc Iai ndi edng cdng eua cdn bd va hpe vifin/sinh vifin eua trrfdng ndm 2004 vd 2006 - Md la didm manh va ban che' eua md hinh "Ngdi irrfdng khdng khdi thude" - D l xuat mpt sd khuydn ngbi nham xdy drfng rad hinh "Trrfdng Dai hpe khdng khdi thudc" ed hipu qua Phrfdng p h a p nghifin ctfu Nghifin cffu dinh Irfdng kdt hdp vdi nghien cffu dinh tinh Nghien cdu dinh luang: Nhdm nghien cffu thu ihdp Ihdng tin irfin todn bfi cdc edn bd, giang vifin nha irrfdng, sinh vifin va hpe vien eac khda hoc ddi han bao gdm hfi cff nhan, eao hpe va chuyen khoa Thdng tin dffde thu thap bang phieu trf dien Tong sd cd 424 ngrfdi tham gia nam 2004 va 639 ngrfdi tham gia nam 2006 Nghiin ciiu dinh tinh: Nhdm nghifin cffrf srf dung phrfdng phap phong vdn sau va t h i o luan nhdm I TS'NG QUAN & HGHIEN C l i i l N a m 2(X)4 cd mrfdi phdng van sau dtfdc tien hanb vdi ban gidm hifiu, can b p , giang vifin, sinb vifin dai bpe vd hoe vifin sau dai hpe Hai cupc thao luan nhdm dtfdc lien h a n h vdi nhdm sinh vien (mpt n h o m sinh vi6n but ihudc va mfit nhdm sinh vien khdng hiit thudc) N d m 2006 nhdm nghidn erfrf tidn hdnh cupc phong vdn sau vdi cdn bfi, giaog vifin, sinh vifin va hpe vien eua trrfdng Sd'lieu nghidn cffu dinh Iffdng ciia n a m 2(X)4 va 2006 d i u dtfdc nhap bang chffdng trinh Epidata 3.0 vd xff Ii bang phan m i m SPSS 11.5 S d U6u dinh tinh dffde mS hda theo bang md hod qui dinh dffa trfin nhffng nhdm thdng tin c i n thu thdp, dffde phan tich va trich d i n theo ehii de de phuc vu cho phan tich theo edc muc tifiu nghifin cffrf K d t qua va b ^ n luan 3.1 Thong nghien tin chung ve ngi^ tham gia cdu: Tong sd' cdn bd, giang vifin, hoc vifin va sinh vifin tham gia nghifin crfU n a m 2006 nhieu ga'p rffdi nghifin cffu ban dau trffdng md rdng Ioai hinh va sd Iffdng sinh vifin d a o tao Cff nhdn tai chrfc la ddi tffdng hoc vien mdi ciia nha irffdng cbidm gan 1/5 sd ngrfdi Iham gia nghien cffu nam 2006 Trinh dp vdn hda ciia pban Idn ddi tffdng ngliifin cffu la dai hoc, ti Ifi ndy d ndm 2006 cao hdn so vdi nam 2004 Hdn mpt p h i n ba ddi tffdng tudi tff 25 trd Ifin li Ifi tffdng iff d ndm 2004 so vdi nam 2(K36 Ti Ifi ngffdi Iham gia chffa Idp gia dinh va cd gia dinh cung Iffdng Iff d nam 2004 va 2006 Dae diem cua q u i n the nghifin crfu cd trinh dp hpe vdn eao, d | e thu d a o tao va cdng tdc ngdnh y t d c d n g cong, dd kidn thffc, thai dp va thffc hdnh pbdng chd'ng tdc hai thudc Id dffde ky vpng Id cao hdn q u i n the ndi chung Tinh trgng hut thudc 3.2.1 Tile hiit thudc V l tinh trang hdt thudc theo gidi, ti lfi nam gidi hut thud'e nghifin cffU nam 2004 la 17.3% va n a m 2006 cao hdn rapt chiit la 18,9% Sff tang nhe tl Ip ed thd giai thieh dd'i iffdng nghifin cffrf ed thfim nhdm cff nhdn tai chrfc - nhffng cdn bfi dang Iam d cae cd quan y tfi' Id dd'i tffdng hut thud'e n h i l u hdn so vdi sinh vifin eff nhan chinh qui Ke'l qua p h a n tich linh irang hut ihude iheo n g h i nghifip d rifing n h d m nam eho tha'y d Ifi hut Bdng Tinh trgng hiit thudc theo gi&i, nhdm nghe nghifp tudi, Nim 2004 Nim 2006 n=191 17,3 18.2 64.4 n^233 0 100,0 n=222 18.9 20,7 60.7 n=417 0,5 0.7 98,8 Unb trang hut thufc theo gidi Nam Dang hut Dd cai Chtfa hut bao gid SB Dang hut Da cai Chtfa hdt bao sid Tinh trang hut thufc ciia nam tbeo nghi nghifp Giang vidn va thtfc (f p sinh Dang hiit Da cai Chita hut bao gid Cdo bf phong ban Dang hut Da cai Chita hut bao gi& CffnhSn Dang hut Da cai Chtfa hilt bao gid Cao hgc va chuy£n khoa Dang hiit Da cai Chtfa hul bao gid Cff n h ^ tai chtfc Dang hdt Da cai Chtfa hut bao gid 11=22 18.2 22.7 59,1 n=16 31.3 37.4 31.3 n=102 8.8 4,9 86.3 n=5t 29.4 37.3 33.3 n=0 n=17 17.6 23.5 58.8 n=IS 5.6 27,8 66,7 n=121 11,6 11.6 76.9 n=26 38.5 38,5 23.0 n=40 35,0 32,5 32.5 ihudc Clia giao vien va thffc ldp sinh la 18,2% n a m 2004 va giam nhe mpt chdi 17.6% nam 2006 TI Ie cdn bd phdng ban eiia irffdng dang hfft thudc Ihd'p hdn ddng k e theo sd' lieu n a m 2006 so vdi ndm 2004 (5,6% so vdi 31,3%) Ngffdc Iai, vdi cdc ddi Iffdng hoc vifin/sinh vien li Ifi hul thude n a m 2(X)6 ed eao hdn mdt chiit so vdi n a m 2(X)4 Ti Id dang hut ciia nam sinh vifin cff nhan n a m 2004 la 8,8% vd ndm 2006 la 11,6% Ti le cua nam hpe vien sau dai hoc la 29.4^f nam 2004 vd , % n a m 2006 Ti lfi hut thudc cua giang vien, can bp nha trrfdng tbi sau hai nam hau n h u k h d n g thay ddi Tuy nhien ti Ifi hdt thudc d eff nhan va hoc vien sau dai hoc cd srf thay ddi so vdi nam 2{K)4 cd nhieu sinh vien eu da tdt nghiep trrfdng vd cd n h i l u ngtfdi mdi vdo irrfdng hoc Tap chi Y te Cdng cdng, 1.2010, Sd 14 (14) 31 |T6NGQUftN& 3.2.2 Nai hiit thudc Khi dffde hoi ve ndi hul thude, ba phan tff dd'i tffdng nghifin cffu khang dinh khdng hfft thudc trffdng Thdng tin tff phdng van sau cho iha'y hifin tffdng hut thudc trffdng da giam ban so vdi trffde lien hanh can thifip Trong Idp hoc khdng cd hifin tffdng hut thudc Nhffng ndi ed hien tffdng hrft ihudc trffde cd quy dinh "Ngdi trrfdng kbdng khdi Ihudc" nhff hdnh lang khu giang dffdng hoac cang tin thi da giam bin, dae bifil tff nha trffdng dl qui dinh xff phai Ngffdi hut Ihud'c thffdng hay ngoai cdng irffdng, quan cde canh trffdng dd hrft Tuy nhifin, khu ki tue xd la ndi tffdng ddi bipt ldp vdi khudn vifin ciia trffdng van quan sat thay mpt sd ngffdi hrft thudc Ngoai hifin Iffdng hdt thude trrfdng thinh thoang vin xay d mdt sd ddi tffdng nhff ngffdi ngoai vao trffdng, hoae hoc vien edc ldp hoc cd quan khac thue dia diem trffdng, cho sffc khde nhimg kie'n thffc hfin quan de'n cdc bfinh cu the ma hut thudc chu dpng vd hut thudc bi dpng cd the gay cdn ban chfi' Cdc bfinh thffdng drfdc dl cdp tdc bai ciia thudc Id la cdc bpnh vl drfdng hd ha'p (ung ihrfphdi, Iao phdi ) va cdc bpnh lim raach/buydl dp Kie'n Ihffc ve cde boat chd't chinh eiia thudc Id chrfa day dii, 80% ngrfdi tham gia nfiu drfde thudc Id cd nicotin edn cdc boat chdi khdc nhrf CO va cdc cha'l gay ung thff v.v, rd't it de cap ddn, Tai thdi didm nghien cffu nam 2006 van cd 1/5 cdn bp va bpe vifin/sinh vien nha irffdng cho rang hdt nhffng thudc Id nhff Mild Seven vd bac cd it tdc hai hdn eho sffc khde Dilu ndy cho thay hidu bifi't ve tdc hai cu the cua but thudc la thu dpng vd chii ddng cua can bp va hoc vien/sinh vifin nha trffdng thai sff cdn chffa day du Thdi dg dot vdi vifc hut thudc Id 4.1 Thdi dd cua ngudi hiil thudc (dd vd dang Bdng Hieu biit ve tdc hgi cua thuoc Id vdi sde khde hiit thudc) Nfl dung NSm 2004 Nam 2006 HUl OmSc ci5 h«i cho iOc Vboi Rit cii bfli & cii b«L KhSng cii hfl KhSnE biCi/khenf! tli 18i Hilt thu6'c e&y nhttng bfoh ^ Lao phdi/cic b^oll difOng hO hi'p Ung Ibif phfi Cao huygtilp/lLiii mach Anh hu'dng dBn silc khie sinh sjn Btnh rAnK mifng Hit phdi kblii IhuSc cii hai cho silc khoj Rrtciihai&ciih«i KhSng c6 hai fCbfini biStAhSaf ISi Hit phil kbdi thuOc gly nhiing bfnh ^ Lao phdi/cdc bfnh diiOng hB hi'p Ung thif phdi Cao huyfl f p/tun mach Anh hifdng dfn site khde sub lia Btnh ilDE miGDE Nhitng hof t chfl't cbfnh cti thuft: li NJccotine CO Kbic Hdt IhuHc li nh;' c6 It tic hai hdn kbdng Cd KhADg Kbdng bi^l/kbdog b i ldi n=421 WJ 0,5 0.2 0=424 63,9 75,0 30a Q=627 99,2 0.0 0,S n=639 86.4 70,0 31,1 3,3 PB n^626 99,8 0,0 0,2 n=639 80,4 50,4 19.6 4,7 2.2 n=639 87,6 2.0 10,9 n=619 19.7 63.7 16.6 n=420 99.0 0,7 0,2 •=424 S4,4 3.8 5,0 n=416 24,5 57,5 18.0 3 Hieu biet vi tdc hgi cua thud'e Id Kfi't qua Clia hai dilu ira ndm 2004 va 2006 cho tha'y cdn bfi vd hoc vifin/sinh vien nha trrfdng biet hdt thud'e chu dpng va bit phai khdi ihud'c rat cd hai 32 Tap chi Y td Cdng cfing, 1.2010, Sd 14 (14) Bdng Thdi d$ cua nhdng ngUdi da vd dang hut thudc Id vdi viic hdt huoc Trtfflc Sau (n=60) (n=80) Hiit thud'e U lam phi^n ngu'di khdc 100,0 95,0 Thay ngai hiit thuoc tnfdc m$t ngtfdi kb^c 86.7 73.8 Biet ngUdi khdc kh6 ch|u mlnh hiit thuS'c 88.3 84,8 Nhieu cdn bd vd hpe vifin/sinh vifin nha trffdng da vd dang hfft thudc cho bifi't "viec hiil thudc Id Idm phien ngffdi khde" (100% ndm 2004 vd 95% ndm 2006) vd hp cam tha'y ngai hiil thudc trffde mdl ngrfdi khde (86,7% nam 2004 va 73,8% ndm 2006) Ti lfi Iha'p hdn d nam 2006 so vdi ndm 2004 cd the Ii giai d ddy la dac thii ciia ddi iffdng nghien cffu nam 2006 cd thfim nhdra sinh vien lai ehffc - nhieu ngrfdi sd hp ed the da hdt thudc iff trrfdc vd coi viec hut thudc Id binh thrfdng 3.4.2 Thdi cua todn bd cdn bd vd hoc vien/sinh vien nhd trudng vdi viec hiil thudc Id Srf ehdp nhdn cua xa hpi ddi vdi hdnh vi hiit thude Id mpt van dl thrfdng thafy d Vifit Nam, ea tren nhffng ddi Irfdng cd hpe v^n, hieu bidt eao nhrf mfii trrfdng trrfdng dai hoc, Mdc dd ti lfi can bfi va hoc vifin/sinh vien nha trrfdng cho bidl I TfiNG QUAN & NGHIEN Cltu I Bdng Thdi dg cda mgi ngUdi ddi vdi tinh trgng hut thud'e Thil d9 cit mifi ngtfill *A tinhlrtiig blil thoO'c Tnfdc SID TWr d& cia mgi ngudi dSi vdi viicfairrfuiifr D=4IS 0=626 lUTtkbiichiu 55.7 63,0 Kh6chm 31.1 26.0 Binh ihudng/khang khd ch|u 13.1 11,0 DS bao giir lin ning phin agiftiirthugc i nai c6ng c^ng? n=4l6 Bi iCrng lea ui'iig 70,2 0=632 Hiftn kbi/Kb5ng bao giO 24,1 29.8 75,9 ed thai dp khd chiu/rd't khd chiu vdi viec hut ihudc Id cao (86,8% nam 2004 vd 89% nam 2006), nhrfng chi cd Ichoang 70% eho bie't da tffng Ien tidng phan dd'i vipc hfft ihudc d ndi eong epng Kfi't qua phong van sau cbo thd'y vifie Ien tifi'ng phan ddi hdi thudc chffa manh me vd thffdng chi difin giffa nhffng ngffdi quen bifi't hay giffa ban be vdi "nfi'u md la ban thi phan ddi cdn ngffdi khdc khdng quen thi thdi" (Sinh vifin nff khdng hdi thudc, K2) hay " ndu ndi vdi mpi ddi Iffdng thi em chrfa ddm ch^c, nhffng ngrfdi khdng than thifi't Iam hp se cho em la ke hdm hinh" (Sinh vifin nam khdng hdt thud'e K5) Vi vay va'n dl cin lffu y Irong chffdng Irinh phdng chd'ng tdc hai Ihud'c Id Id lang cffdng sff iff tin cua mpi ngrfdi Ifin tidng phdn dd'i vific hdt thudc d ndi cdng cdng 3.5 f kien ve mo hinh ngoi tnidng khong khoi thud'e 3.5.1 Md hinh cd cdn thie't khdng Bdng Thdi dg vd ly xdy dUng m hinh trUdng dgi hQC khong khoi thudc Thai vdi vi^c xSy di/ng mfi hinli Nam 2004 n=411 Nam 2006 ns:623 - Ra't can [hiel/Can Ihie't 408 (99,3) 617 (99.9) • Kh6Dg CID/ ithong J ttien (0,7) 6(0,1) Lj cin xSy di^g m6 hinh n = 639 Tyl#(%) - Trtfdng YTCC phai lam glttlng 117 18,3 - Hiit thuoc la c6 hai 112 17,5 - Bao v^ site Ithoe 283 37,2 - Mdl tnidng van minh 205 32,5 Hau hfi't ddi iffdng nghien cffu d ca hai cupe dieu tra trrfdc va sau diu eho la ra't can thifi't phai xdy dffng mdi trffdng khdng khdi thudc Nguyfin nhan de cdp tdi dd Id trffdng y tfi'cdng cdng la ndi dao tao nhffng cff nhdn y tfi' cdng cdng tffdng Iai, nhiTng ngffdi se di dau Irong cdng tdc phdng bfinh, bao vfi sffc khoe nhan ddn nfin can phai lam grfdng trrfdc Hdn nffa, vipe xay drfng md hinh la tao mdt mdi trrfdng vdn minh irrfdng dai hoc nfin deu drfdc mpi ngrfdi iing hp Bdng Nhdng bi$n phdp phong chong tdc hgi thudc Id trUdng co hiiu qud Nam 2004 NSm 2006 (n=411) (n=623) Dl luat cam phai 64,2 77,4 Khuyen khich khong hiit thuoc 43,6 41,6 Pano, ap phich 53,9 60,5 Noi chuyen chuyeii dl 50.7 45,3 To chffc CLB 46,1 46,9 Thanh 13p doi nien xung kich Khdc 48,0 4,9 7,7 Cac bifin phdp drfde cho la ed hipu qua Ihrfe hifin md hinh "Ngdi trffdng khdng khdi ihude" dd Id dl ludt cd'm hdt thudc vd chd tai xff phat, hoat ddng cua ddi ihanh nifin xung kich, cdu lac bd "Ndi khdng vdi thufi'c Id", cdc bi^n bdo "Ngdi trrfdng khdng khdi Ihudc", cdc qui dinh ca'm hfft thudc drfdc treo d Irong khudn vifin trrfdng vd khu vrfc giang drfdng Trong dd, qui dinh phai nfi'u hdt thudc Irrfdng drfdc cho la hifiu qua nhat Tff cd qui dinh ndy hifin tffdng hdt thud'e trffdng da giam ban Can lac bp "Ndi khong vdi thude Id", nfin boat dpng diu dan vdi cdc npi dung va hlnh ihffe phong phu ha'p dan hdn, cudn hdt nhieu vifin tham gia hdn va khdng nfin chi tdp trung d rapt sd'ngffdi Nfin khuyfi'n khich ca hoc vifin sau dai hoc tham gia vao cdu lac bp edng vdi edc ban sinh vifin Vai trd cua dpi nifin xung kich dffde ddnh gid cao nhien kdl qua nghien effu cho iha'y boat dfing cda dpi chrfa drfde the hien rd Tren thrfc tfi'nhffng ngffdi dffde hdi chrfa nhin thd'y dfii nifin xung kieh phat ngffdi hdt thudc Id trffdng Nhieu ngffdi bidt la ed dpi nifin xung kieh, nhffng chffa nhin tha'y boat ddng thffc sff khdng bifi'l la Ihanh vifin cua dpi 3.6 Bdn lugn Sff ldng nhe ti Ie bdt thudc la nam 2006 so Tap chi Y td Cdng cdng, 1.2010, Sd 14 (14) 33 I TiiNS QUAN & NGHIEN Cltu I vdi nam 2004 cd the giai thich nhdm ddi tffdng nghifin cffu cd thfim cff nhan tai chffc - nhffng cdn bp lam d eae ed quan y id hfft thudc nhieu hdn so vdi sinh vifin cff nhan chinh qui tai trffdng Ti Ifi nam sinh vifin chinh qui hut thudc (8,8% ndm 2004 vd 11,6% nam 2006 cung gan tffdng trf ti Ie hdt thude eua hpe sinh Iffa ludi 13-15 la 10% [5], va thdp hdn rat nhilu sovdi tile hut ciia nam gidi tuoi 18-21 [2] Ti lfi hut thudc chung cua nam gidi (17,3% nam 2004 va 18,9 ndm 2006) ihap hdn nhilu so vdi ty le hut thudc cua cdn bfi nam nganh y te nghien effu cua Ngd Quy Chdu va Nguyfin Thi Thu Huyin la 39,5%[5] thd'p hdn nhilu so vdi nghifin crfu tai Hai Phdng ndm 2005 la 72,1% nam gidi hut thude [9] Ket qua ndy Id hdp ly vi Iffa iudi nghifin cffu ciia chdng tdi thdp hdn nhilu so vdi cdc nghifin cffu neu tren, vl hdn mdl nffa nam dp tudi tre, dd tuoi chffa but thudc nhilu Ti Ip hdt thudc chung eua nff gidi (0,5%) tha'p hdn kfi'l qua dilu tra y id qudc gia 2001-2002 (1.8%) [1], Iha'p hdn kdt qua dieu tra lai tinh eua Nguyin Thi Thu vd cpng sff la 3,1%([II], So sdnh vdi cdc nganh nghe khdc ti Ifi nff hut thude nghien cffu eua chung ldi cung tha'p hdn, vi du nhff ngdnh giao Ihdng van lai (nff hdt chifi'm 6,6%), nff nghfi sT hdt thude ehiem 5,2%[8] Hien trfdng hdt thudc id van cdn quan sat iha'y d khu ky nie xd - ndi tffdng ddi bipt lap vdi khudn vifin ciia Irffdng vd d mpt sdkhdch tdi trtfdng, vi du nhff khdeh tham dff cac Idp hpe eua nhffng cd quan thufi dia diem eiia trffdng Chinb vi vdy, vific gidm sdt d khu ki tuc xd sinh vifin va nhffng ddi tffdng khdch ngodi vdo irffdng nfin chat che hdn, de hp bie't dffde cdc qui dinh cua trffdng va tudn theo d khudn vifin trffdng Sff chd'p nhan cua xa hfii vdi hanh vi hdt thude Id mdl vd'n dl ra't ddng quan ldm d Vipt Nam Vifie hdt Ihudc difin d rd't nhilu ndi nhff d nhd, tai ndi ldm vific, trffdng hoc, bfinh vifin, ndi edng cdng,,, Mac dd nha Irffdng da tifi'n hdnh thffc hifin chffdng trinh "Mo hinh ngdi trffdng khdng khdi thudc" iff giffa nam 2004, nhffng ti Ifi ngffdi eho biel "vifie hdt thudc la Iam philn ngrfdi khac" va "cam gide ngai hut thud'e trrfdc mat ngrfdi khac" d nam 2006 thd'p hdn so vdi ndm 2004 Mdl dilu cd the ly giai d ddy Id ddc IhQ ciia ngrfdi tbam gia nghien cffu nam 2006 cd them sinh vifin tai chffc mdi vao trffdng, ed the nhieu ngrfdi sdhp da hdt thudc tff irffdc va coi vipc hdt thudc la binh ihffdng 34 Tap chi Y td Cdng cdng, 1.2010, Sd 14 (14) Tuy biet hut thudc va hdt thudc thu ddng cd hat va cam thay khd chiu vdi vific hut thuoc cua ngrfdi khdc, nhffbg tdm ly ngai phan dd'i vific hdt thudc vdn Ihffdng th^y, ca vdi sinh vien/hpc vifin cua trffdng Ket qua vl hieu bidt chung ve tdc hai eda thud'e Id ciSa nghien cffu rat cao, tffdng tff vdi nghifin cffu d cic ddi tffdng trfin 15 tudi d tinh ndm 2005 (98,3%) [11] va cao hdn so vdi ket qua nghifin cffu tren can bd y te tai Bfinh vifin Bach Mai (80%) cua Ngd Quy Chdu va Nguyen Thi Thu Huyen, 2{K)4[5] Tuy nhien, thdi dfi vdi vific htit thudc ndi chung va but thudc irffdng ndi rieng cda hpe vifin/sinh vien va cdn bp trffdng van chffa that sff lich ctfc Mac dii gan 90% ngffdi dffde hdi cho bidt khd chiu cd ngffdi khdc hut thude trffde mat nhurfg cd tdi mfit phan iff chffa bao gid Ifin tieng phan ddi ca Thai dp ihifi'u Iich cffc cao hdn so vdi kdt qua nghifin cffu sff chap nhdn xa hpi vdi hanhvi hdt thudc ciia Hpi Yle edng cpng vatd chffc Heallh Bridge Canada nam 2005[3] (10% phu nff chffa bao gid Ifin tidng phan dd'i ngffdi hdt thudc irffdc mdt) Kdt qua nghifin effu eho thay vipc thffc hifin chffdng trinh "Ngoi trffdng khdng khdi ihudc" giiip mpi ngffdi Ifin tieng nh^c nhd phan ddi dfi dang bdn vd ed hifiu qua cao hdn Ddy la rapt thudn Idi cho vipc thffc hifin chffdng trinh phdng chdng thudc Id irffdng cong Mdt khdc, cung nfin tdp trung truyin thdng gido due nham gidp mpi ngffdi Iff tin Ifin tidng thuydt phuc khong hut thudc khdng chi khuon vifin irffdng ma can d ca d ndi cfing cfing ndi ehung Trong ede bifin phdp dffde cho la thffc hipn md hinh "Ngoi trrfdng khdng khdi thude" cd hifiu qua thi xff phat drfdc coi Id bifin phdp hipu qua nhd't, nhien kdl qua nghifin effrf cho ihay ra't it irrfdng hdp bi xff phat Nguyen nhdn eua vific khdng xff phat dd Id:" mpi ngrfdi deu hoc edng trffdng, bidt ed nfin ngai khong mudn hodc khdng ddm phai", Ngodi mpt sd y kien cho rSng khdng cd ngrfdi gidm sdt, kbdng cd chd tai cbo hoat ddng xff phat ngffdi hut thudc nen hoat dfing chrfa that srf ed hipu qua Vi vay, d l khuydn khich viec thrfc hipn qui dinh cd'm hdt thude trrfdng, chrfdng trinh nfin cd ngtfdi gidm sdt cdc boat dpng cua dpi nifin xung kich va cd ehd tdi eu the vdi vifie thffc hi^n Vific hdt thude trffdng giam nhimg cflng ehffa het ban, nguyfin nhdn dau lien cd the dl cap den la nhiing khaeh bfin ngodi vdo trffdng, vi ITA'NfiQUM&NGHIlNCttUI vdy can phai dffde chu trpng nhae nhd vd xff phat vi pham, Ngodi ddi nifin xung kich, b a o vfi cung nfin tham gia vao boat dpng de vipc ihrfc thi cd hifiu qua hdn, Nguyfin nhdn thff hai Id Ioai hinh hpe vifin mdi cua trffdng, cff niian y t d cong cpng tai chtfc D a y Id nhffng can bd y te hipn dang cdng tae cdc ed quan nganh y Mpt ndm hgc trung binh dd'i trfdng chi hoc tdp trung tai irffdng hoc ky vdi long thdi gian khoang - thang eho nfin viee tiep edn vdi dd'i tffdng khd khan hdn Vi vdy, c i n phai ed vifin ddi nien xung kich Ihffdng xuyen gidm sdt tai khu vffe hoc cua hoc vifin tai chffc thdi gian hp hoe tdp trung tai irffdng, 3.7 Khuyen nghi chffc vd hoc vifin sau dai hoc Kfi't hdp vdi hoat dpng ciia edc Ioai hinh khac nhff eau lae bd sffc khoe sinh san, eau lac bd tifi'ng Anh de npi dung sinh boat hdp d i n vd thu hdt dffde nhieu ngffdi tham gia V l nfii dung myen t r u y i n can nhd'n manh nhflrfg tdc hai eu the cua thud'e Id chii ddng va hi ddng, kfiu gpi sinh vifin "ndi khong vdi Ihud'c Id" va khuydn khieh thdi dp iich cffc Ifin tieng vdi hien tffdng hut thudc Id trffdng va ndi cdng cpng C a n cung c a p thdng lm can thifi't v l phrfdng phdp b o ihud'c hifiu qua cho nhifng ngrfdi dang but Md rdng boat dpng chia se kinh nghifim vdi eae trrfdng dai hpe irong ca nrfdc dd chia se kinh nghifim, nhffng khd khan va bipn phdp khac phuc va khuydn khich cdc trffdng khdc ihffe bifin md hinh khdng khdi thudc Chdng tdi de nghi e i n tang effdng thi hanh qui dinh ph^l ngffdi hdt thudc trffdng thdng qua vifie Idng effdng boat ddng cua dpi nifin xung kich vd gidra sdt boat dpng eua dpi Phai cd chfi'tai thffdng phat rd rdng cho vipe thi hdnh vd khfing thi hdnh cd ngffdi vi p h a m quy dinh hdt thud'e trffdng, Hoat dpng cua cdu lac bfi "Ndi khdng vdi thud'e Id" can d i u ddn hdn vdi npi dung, hinh ihffe phong phd hdn vd md rpng ddi iffdng thara gia can lac bp gdm ca sinh vien ehinh quy, sinh vifin tai Cudi cilng, mdc dfi chdng ta bifi't rang, vai trd cua dpi ihanh nifin xung kich la quan trpng nhifin c i n thdc day hinh ihffe Iff dffa minh vao khudn khd, ehinh ngffdi hdt thud'e can phai bifi't dffde q u y l n dtfdc hit thd b l u khdng lanh cua nbiTng ngtfdi khdng hut thud'e va nhiftig ngtfdi khdng hdt Ihud'c sfi gidp phdt hifin va nhae nhd nhffng ngffdi hut Ihudc ve q u y l n dffde hit thd b l u khdng Ianh cua minh Tai U^u tham khao http://www.viiiacosh.gov vii/nghicncuu/bai_ 12,asp Tidng Vi^t Ly Ngpc Kinh vk cOng stf (2006) Tinh hlnh sil dung thudc \k hoc sioh tudi 13-15 lai nam tinh thSnh phd Viet Nam Tap chi Y hoc thtfc hSnh sd 533 B§ Y td- Tdng cvc ihdng kfi (2003) Dilu tra Y tdQuSc gia 2001 - 2002 Nhd xuat hia Y hoc, Hil N^i 57-67 Bp Y td- Tdng CIJC Thdng kfi-UNICEF-WHO (2005) Dieu tra Qudc gia vl Vi thdnh ni£n vit Thanh Nifin Viet Nam HQI Y id Cong c^ng Viet Nam va Heallh Bridge Canada (2005) NghiSn cffu stf chap nh^n cua xa h^i ddi vdi vifc hiit thudc tai Vi#t Nam Nghlfin cffu chift xu^l bdn NgSn hicg Thd gidi (2003) Ng£n chSn nan dich hiit thudc tk - Vai trd ciia chinh phd va idiia canh kmh te cda ki^m soat thudc Id, Tdi li?u djch, Washington D.C Ngfl Quy ChSu Nguyen Thi Thu Huyin (2004) Tinh hinh hdt thudc U, hieu bidt \k thai dO ciia cdn bp y te tai B^oh vi^n Bach Mai 2004 http://www.vinacosh.gov.vn/nghiencuu/bai_14.asp 6.Ly Ngpc Kinh Pham Thi Hdi, Nguyen Trong Khoa, Nguyin Tutfn LSm, D^ng Huy Ho^ng (2003) Tinh hinh sff dijng thudc \& hpe sinh dO nidi 13-15 t^i tinh, phd VietNam DSo Ngpc Phong, liin Thu ThuJ, Ngfl VSn Toin (2003) Thtfc trang ddp xdc bi dgng vdi khfli thudc \k wk anh htfdng cda nfl ddn tinh trang site khoe cda nhan dSn tai phtfdng n$i th^nh Hi Ndi htlp://www.vinacoshgov.vn/nghiencuu/bai_01.asp Mac Ki6n Quyet (2005) Stf quan t3m ciia cgng ddng, Iflng tm vko n$i dung vd hlnh thffc ldnh hky ldi canh bdo vl stfc kho£ trin v6 bao ihudc la d quan L€ Chan Hai Phflng Khoa luan tdt nghi|p bdc sy da khoa 10 Nguyin Thi Thu vil cpng stf (2005) Nghien ciJu thtfc D^ng hilt Ihudc va kidn ibffc, thdi dp, thtfc hdnh htit thudc d Vift Nam Khoa Y tc Cflng cflng, Trtfflng Dgi hoc Y khoa m Npi Tidng Anh 11 WHO (2008) Guideline for unplemeniauon of Article http://www.who.int/fctc/cop/art%208%20guidelincs_englishpdf Tap chi Y td Cfing cdng, 1.2010, Sd 14 (14) 35