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|T6'NGQDAN&NGHIEMCliU| Ltfa chon bo canh bao stfc khoe bang hinh anh va bang chff trdn vo bao bi thuoc la tai Viet Nam Lg Thi Thanh Htftftig*, Tran Khanh Long\ Fhan Thuy Linh* Li/tfng Ngpc Khtie% Phan Thi Hai', Doan Thi Thu Huydn* Tai Viet Nam Ludi Phong chd'ng idc hai cua thudc Id co hiiu luc td ngdy 1/5/2013 Dieu 15 cUa Ludt quy dinh viec in CBSK bang hinh dnh phdi chii'm diin tich it nhdt Id 50% tren mat chinh trudc vd sau cUa bao thudc Nghien cdu "Lua chgn bd cdnh bdo sdc khoe bang hinh dnh vd bang chU tren vo bao bl thud'c Id tai Viet Nam " duac ti^n hdnh niidm muc dich lua chgn duac mQt bo gom sdu hlnh dnh CBSK duac coi la phii hap nhd't vdi hodn cdnh Viet Nam de di trinh len BQ Y li' vd Bo Cdng thuang viec xdy dung vd thdng qua Thdng tu lien tich "Hudng ddn viic ghi nhdn, in cdnh bdo sdc khde tren bao bi thuoc Id" Nghien cii'u duac ti^n hdnh id thdng 11/2012 den gida thdng 1/2013 lai Hd Ndi vd Ho Chi Minh tren 560 ngudi td 15 tuoi trd len Ket qud nghien cdu cho thdy sdu mdu CBSK dut^c lua chgn vdi diem so trung binh cao nhdt Idn lU0 Id mdu (Hiit thudc gdy ung thuphSi) vdi 4.0 diim; mdu (Hiit thudc gdy ung thuhong, qudn) vdi 3.90 diem; mdu (Hiit thuoc ddn den cdi chet td td vd dau ddn) vdi 3,85 diem; mSu (Hut thudc gdy chdy mdu ndo) vdi 3,84 diim; mdu (Hiit thudc gdy hdi mieng vd hdng rang) vdi 3.82 diem vd mdu (Khoi thudc Id rdt CO hqi cho thai nhi vd tre nho) vdi 3.77 diim Sdu mdu cd ti le lUa chon cao nhd't cung dong nhd't vdi mdu co diim so trung binh cao nhdt Td khoa: cdnh bdo sdc khoe, cdnh bdo sdc khoe bdng hinh dnh thudc Id, Viet Nam Selection of Pictorial health warning on cigarette packs in Vietnam Le Thi Thanh Huong", Tran Khanh Long', Phan Thuy Linh' Luong Ngoc Khue', Phan Thi Hai', Doan Thi Thu Huyen' In Viet Nam ihe Law on Tobacco Control came into effect on May 1, 2013 Il is stated in Article 15 ofthe Law thai pictorial health warning must occupy at least 50% of both front and back spaces of the cigarette packs The aim ofthe study entitled "Selection of Pictorial health warning on cigarette packs in Viet Nam" was to select six most appropriate samples of pictorial health warning in the context of Viet Nam to submit them lo the Ministry of Health and Ministry of Industry and Trade for development and issuance of a joint-circular on the "Guidelines for labeling and printing of health 52 Tap chi Ytd Cdng cdng, 1.2014, Sd'30 (30) , Ngiy nt**" b^i: 2.10 2013 • NgSy phin bi$n-17.12.2013 • Ngiy chinh siia: 26.12.2013 • Ngiy diTdc chap ob«n dang: 30.12.2013 |T6'NGQUAK&N6HIENCUU| warning on cigarette packages " This study was conducted from November 2012 to mid-January 2013 in Ha Noi and Ho Chi Minh City with a sample size of 560 people aged 15 years and above, both smokers and non-smokers The study results showed that selected samples can be ranked, based on the highest mean scores, respectively as follows: sample (Smoking causes lung cancer) with 4.00 points; sample (Smoking causes throat and larynx cancer) with 3.90 points; sample (Smoking leads to a gradual and painful death) with 3.85 points; sample (Smoking causes cerebral hemorrhage) with 3.84 points; sample (Smoldng causes cacostomia and tooth decay ) with 3.82 points; and sample (Tobacco smoke is very harmful to the fetus and young children) with 3.77 points Those six samples with the highest selection rale were consistent with the highest recorded mean scores Key words: health warning, pictorial health warning, cigarette, Viet Nam C&c tac gia: TnrflngD^i hpc Yte cong cpng Cijc Quan 1^ Khim chila b^nh, B6 Y tS' Lign hg' lth@hsph.edu.vn D a t vSn dd Vide in canh bdo stfc khde (CBSK) bSng hinh anh dd du'dc Td chdc Y te the gidi (WHO) khuyen edo tai Dieu 11 Cdng Udc Khung ve Kiem sodt tdc hai thud'c Id (FCTC) CBSK bang hlnh anh k6't hdp vdi b^ng chff da difdc chd'ng minh Id hi6u qua hdn rat nhieu so vdi vi?c chi in CBSK b^ng chff viec gidp ngffdi nghien thudc la hffdng ldi y dinh bd thud'c [ 12], [5], tin tffdng hdn vao kha nang bo thud'c cua minh [5], giam nhu c l u tieu thu thud'c Id sd' nhffng ngffdi hdt thud'c [7] cung nhff Iam cho nhffng ngffdi chffa hiit thuoc cd khuynh hffdng khdng mud'n hut thu" san p h a m [16] Chinh vi vay To chffc Y te' the^ gidi (2009) cho rang viec in CBSK ke't hdp ca chff va hinh anh tren vo bao bl thud'c la Id mdt nhffng bi?n phap chi phi - hieu qua nhd't gidp tdng n h | n thffc cua cgng d6ng vi cdc nguy cd stfc khoe nghiem vi^c sff dung thuS^c Id gay vd giup giam tieu thu thuoc Id [ 16] Tinh de'n he't ndm 2012, da cd 63 nffdc trdn the gidi in CBSK bang hinh anh Trong khu vffc Ddng Nam A, cdc nffdc co dp dung in CBSK b^ng hinh anh gom Thai Lan Malaysia, Brunei vd Singapore [4] Tai Viet Nam, Luat Phdng chdng Tdc hai cua thuoc Id (PCTHTL) da dffdc Qud'c hpi thdng qua ngdy 18/6/2012 va cd hieu Iffc tff 1/5/2013 Dieu 15 L u a t P C T H T L ve CBSK quy dinh "Ndi dung cdnh bdo sdc khoe trin bao bi thud'c Id phdi mo td cu thi tdc hgi cua viec sd dung thudc Id dd'i vdi sdc khoe vd thdng diep thich hap khdc, phdi duac thay ddi theo dinh ky 02 ndm mot ldn " vd "Cdnh bdo sdc khde quy dfnh tqi diim a khodn Dieu ndy phdi chiim it nhdt 50% di0n lich cUa moi mgt chinh trudc vd mdt chinh sau trin bao, tiit, hdp thudc Id" [2], Nbdm ddp ffng yeu c l u cua Bd Y t^ vd B Cdng thffdng, nghien ctfu "Lffa chon canh bdo sffc khde bang hinh anh vd bang chff Iren vd bao bi thud'c Id tai Vi6t N a m " dffdc tien hanh vdi muc tieu Iffa chon mau CBSK bang hinb anh vd bang chff phu hdp vdi hoan canh thffc te vd vdn hda ci3a Vi^t N a m d l phuc vu cho viec xay dffng Thdng tff lien tich "Hudng ddn viic ghi nhdn, in cdnh bdo sdc khde trin bao bi thud'c Id" hffdng dan thffc hi?n Dieu 15 cda Lu^t PCTHTL Phiftfng p h a p n g h i e n c d ^ 2.1 Dia diem va thdi gian nghien c^u: Nghien cffu dffdc tien hdnh tff thdng 11/2012 den thang 1/2013, tai Ha Ndi (quan Thanh Xudn vd huygn Ba Vl) vd Thdnh phCT H Chi Minh (qudn 10 vd huyen Hdc M d n ) 2.2 Bdi ti&ifng nghien cdu: Ngffdi hiil thudc va khdng hut Ihudc cd dp tuoi tff 15 trd len Tap chi Y te' Cdng cdng, 1.2014, Sd 30 (30) 53 ITfi'NGQD&Ns 2.3 Thie't kevd cdmdu nghiin cHu nghien cdu - Nghien ciJU dffdc thiet ke theo dang nghien cffu md ta cat ngang ket hdp thao tuan nhdm vdi cdc d^i tffdng vi thdnh nien (hdt thud'c vd khdng hiii thud'c), phu nff, nien va ngffdi trffdng (hut ihudc va khdng hut ihud'c) tai Hd Ndi va phd Ho Chi Minh (TP HCM) - Cd mau dffdc tinh theo cdng thffc dp dung cho mau ddn mpt ly I^ N= Z"xp(l-p)^p d- - P udc lu^g Id 0.6 (ti 14 ngudi dupe Mi hai long vdi b$ sm phdm CBSK b&ng Kinh dnh vd bing chit 3uffc lhi HgM^itt dua trin ket qud diiu tra thit nghidm cia nhdm aghiin citu) • Df lin c^ = 0.05 z = 1.96 - Sai sScho phep d = 0.05 - Hi$ul\lcni3uD = }.5 Cd mdu llnh dupc N = 553 ngudi 2.4 Chgn mdu Phffdng phdp chpn mdu cd xdc sud't ti 16 vdi dd ldn cua cum (probability proportionate to size PPS) dffdc dp dung [9] Nghifin cffu mong mu6^n tim hi^u nhffng pban dnh tff cdng dong (ca nhdm ngffdi hdt thud'c, khdng hut thud'c, nam gidi vd nff gidi d cac quan npi thdnh vd ngoai thdnh tai cdc thdnh Idn) vl cdc mlu CBSK bang hlnh anh - Qudn 10 va huyen Hdc Mdn (TP HCM) vd quan Thanh Xuan va huyen Ba Vi (Ha Ndi) dffdc chpn vao nghien cffu, mdi quan/huyen chon hai xa/ phffdng Cdc qu^n/huyen, xa/phtfdng dffdc chpn dam bao tieu chi \k dan sd', dieu kien kinh te'xa hdi vd tl le hut thud'c cpng ddng Tai mdi quSn/huyen, hai xa/phtfdng se dffdc Iffa chpn Nhffng xa/phffdng cung can dam bao cdc tieu chl ve dan so', dieu kien kinh te'xa hdi va ti 1$ htit thud'c cpng ddng Dffa trfin ky thuat chpn mau PPS, 32 td dan phd'/ thdn tff 16 xa/phffdng d qudn huyen dffdc chpn - Dffa vao danh sach ngtfdi trfin 15 lud'i phan nhdm theo gidi tinh va tinh trang hdt thud'c dffdc thu thSp bdi cdc cpng tdc vien dia phtfdng dffdi sff hffdng dan cua nghifin cffu vien va cdn bp tram y te^ xa/phffdng, cdc dd'i tffdng nghifin cffu dffdc chpn theo phffdng phdp ngdu nhien ddn can cff theo ty If hut thud'c/ khdng hdt thud'c nam gidi/nff gidi theo 54 Tap chi Y te Cdng cdng, 1.2014, S6' 30 (30) nghifin crfu GATS 2010 [8] 2.5 BQ cong cif 12 mdu CBSK bang hinh anh dffdc thifi't kfi' vd in mdu ddng kich thffdc 50% trfin vo bao thudc Id vd vd tdt ihud'c la dffdc su" dung qud trlnh thu th^p sd lifiu (Bang 1) Trong 12 mlu ndy cd mdu Vifit Nam xdy dtfng (mau 5, mau 6, mau 8, mau 11 vd mlu 12), mlu dang dtfdc IiAi hdnh sff dung t^i Thdi Lan (mlu 1, mdu 2, mdu vd mlu 7) vd mau dtfdc sff dung tai Uc (mlu 4, mlu vd mlu 10) Cdc mau CBSK deu nhan dffdc sff cbo phep ci!a cdc td chffc sd hffu iffdng li^g Bdng Cdc mdu cdnh bdo sdc khoe bdng hinh dnh vd bdng chn dUftc sd difng qud trinh thu thqp sdlifu 1^ ^p^iiB a if gH Bd cdng cu thu thdp sd'lieu dffdc xay dffng dtfdi dang Iff dien, cac dieu tra vien dffdc tap hua'n hffdng dan ddi tffdng nghien cffu dien phieu Bd'n nhdm tifiu chi dffdc xem \€i ddnh gid dffa tren thang diem Iff (hoan loan khdng ddng ^) d^n (hoan loan ddng y) the hifin mffc dd ddng tinh vdi tittig muc nhd dd'i vdi tffng mlu CBSK Cac nhdm tifiu chi dffdc xay dffng dffa trfin nghien cffu tdng quan tai lifiu cdc nghien cffu lien quan dfi'n ddnh gid CBSK bang hinh anh nffdc Trung tdm Nghifin ctfu va Trd giup Phat irien cpng ddng (CDS) [3] va ngoai nffdc Lifin minh Phdng chdng tac hai thudc la Ddng Nam A (SEATCA) thffc hien [11], [13] Eg chi tifiu danh gia da dffdc sff dung vd hifiu chinh phu hdp vdi Viet Nam [3] Tieu chi 1: Hinh dnh cdnh bdo - Hinh anh canh bdo gdy a'n tffdng manh - Hinh anh canh bdo phu hdp vdi van hda cua ngffdi Vifit Nam - Kich cd hinh anh canh bao phA hdp, dfi nhin - Vi tri cua hlnh anh canh bdo de nhin - Mau sac hinh anh canh bdo phii hdp ITaNBQUftN&HGHrEHCBUI - Hinh anh canh bdo dang tin c^y, drfdc chup tff ngoai ddi th$t Tieu chi 2: Thong di$p cdnh bdo - Thdng diep canh bdo phu hdp vdi hinh anh canh bdo - Cd chff phff hdp - Vi tri chff de nhin, ro rang - Kidu chff phQ hdp, dfi dpc - Mau chff phff hdp, de nhin Tieu cki 3: Tdc dgng cua cdnh bdo - Thl'y ghfi rdn - Thay sd - Khdng mudn nhin bao thudc cd canh bdo - Khdng mudn md bao thudc cd canh bdo - Khdng mudn mua bao ihudc cd canh bdo ndy - Khdng mudn tang bao thud'c cd canh bdo ndy cho ngffdi khdc Tieu chid: Tdc dgng cua cdnh bdo den ngiidi hdt thudc Nhom tieu chi chl ddnh cho nhiing ngiidi dang hut thudc - Quyet lam se bd thudc - Cd thfim dpng Iffc thff bd Ihudc - Dff dinh se bd thudc - Khdng mudn hdt thud'c nffa Bd cdu hdi tff dien dffdc tifi'n hanh thtf nghiem trfin 5% cd mlu vd dffdc chinh sffa trffdc tifi'n hdnh thu th§p sdlifiu Tff 12 mlu CBSK dffdc dieu tra, mdu dtfdc ffu tien lffa chpn cao nhS^t cdn ctf trfin thtf tff lffa chpn ci3a ddi tffdng nghifin cffu ke't hdp vdi diem sd'trung binh se dffdc chpn d l dfi trinh Ifin Bd Y tfi'va Bp Cdng thffdng Kg't qua nghidn c ^ 3.1 Thong tin chung veddi tU0tg nghien citu Tudi trung binh ciia cdc ddi tffdng nghien cffu la 29,2 tudi, chu yeu nam dp tudi 19-45 tudi (69,6%) Nam gidi chifi'm 78,8% long sd mlu nghifin cffli 47,9% ddi ttfdng la ngtfdi hdt thudc Ti Ifi dd'i ttfdng Iii vifin chffc chie'm 17,5%, budn bdn dich vu chid'm 15,7%, lao ddng tff Id 18,9%, ndng ddn chifi'm la 4,5% Cdc dd'i ttfdng Id hpc sinh/sinh vien chiem ty Ie nhieu nhat (31,6%) Trong 268 ddi tffdng dang hdt thudc, phin ldn cd thdm nifin hdt thudc tren ndm (66,1%) Ty Ifi ddi ttfdng cd thdi gian hut thuoc tff - nam la 13,8% Ty Ifi dd'i tffdng mdi bat dau hdt thudc (it hdn thdng) chifi'm 3,7% vd tff thdng de'n nam chifi'm 16,4% 4,1% ngffdi htft ihud'c hdt it (
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