NGHIEN CLfU - TRAO BOI UT THUOC LA VA ANH H U S N G CUA THUOC LA DEN CHI Tilu VA SUfC KHOE CUA NGUOl DAN QUAN NINH KIEU, THANH PHO CAN THO Truang Vdn Hdu, Thdi DUng Nam vd Nguyen Thanh Binh Vien Nghien ciiu Phdt trien dong bdng song Cdu Long, Dai hoc Cdn Tha IGlUlTHItU Hiit thudc la khong chi anh htfdng de'n chi phi trtfc tie'p cua vide mua thud'c ma cdn anh htfdng de'n cac chi phi gian tiep khac nhtf y te cho ban than va cpng ddng, giam nang sua't lao dpng Viet Nam thupc nhdm 15 ntfdc cd so' ngtfdi hiit thudc cao nha't tren the' gidi Theo dieu tra nam 2010 ve tinh hinh stf dung thud^c la d ngtfdi trtfdng tren 15 tudi Bp Y te, Tong cue Thd'ng ke va WHO phdi hdp thtfc hien, ty le ngtfdi trtfctng hiit thudc la 47,4% d nam gidi va 1,4% d ntt gidi Udc tinh, d ntfdc ta mdi nam cd khoang 40.000 ngtfdi ttf vong vi cac benh lien quan de'n hiit thudc, gap lan so' ca ttf vong vi tai nan giao thdng dtfdng bp, vao nam 2030, so' se tang len 70.000 ca (Levy D va ctv, 2006) Nghien ctfu "Chi phi y te cho ndm benh lien quan de'n hut thudc Id tai VietNam" dtfpc tie'n hanh nam 2010-2011 bdi Dai hpc Y te' Cong cpng va to' chtfc HeathBridge Canada cho tha'y; mdi nam Viet Nam chi hdn 22.000 ty ddng cho stf dung thud'c la va 23.139 ty ddng de giai quye't nhdm benh thudc la mang lai, (ung thtf phdi, dot quy, benh tim thie'u man cue bp, benh phdi tac man tinh, ung thtf dtfdng ho ha'p va tieu hda tren), so' chie'm de'n 0,91% GDP toan qudc Qua cho tha'y ganh nang ve kinh te', stfc khde va chi phi phai tra de giai quye't hau qua viec hut thudc la gay nen la qua to ldn Nghien ctfu dtfdc thtfc hien nham fim hieu hien trang hiit thudc la cung nhtf danh gia anh htfdng cua hiit thudc la de'n chi tieu va stfc khde cua ngtfdi dan tren dia ban phd Can Thd (TP.Can Thd); ttf de xua't nhttng giai phap nham han che' finh trang hiit thud'c la va tac dpng viec hut thud'c la gay nen cho nln kinh te' TP.Can Thd ndi rieng, vilng ddng bang sdng Ctfu Long (DBSCL) va ca ntfdc ndi chung PHU0NG PHUP NGHIEN CHU Nghien ctfu dtfdc thtfc hien tai quan Ninh Kieu, TPCT vao thang 8/2014 bang each phdng va'n trtfc tiep 60 ngtfdi dang htit thud'c va 30 ngtfdi khdng hiit thudc de tim hieu hien trang hiit thud'c la va so sinh cac va'n dl lien quan de'n stfc khde, chi tieu gitfa nhdm dang hiit thud'c (DHT) va khdng hut thud'c (KHT) Phtfdng phap thd'ng ke mo ta va so sanh hai mSu dpc lap (t-test) dtfdc stf dung de phan tich sd Udu thu thap dtfdc 3.KETQUAvATH/iOLUAN 3.1 Thdng tin chung vl dap vidn va hd Thdng tin ve gidi, dan tpc, trinh dp hpc va'n va nghe nghiep cua 90 dap vidn dtfdc trinh bay Bang Qua cho tha'y dd'i vdi nhdm KHT, dap vien la nam gidi chie'm 80% va ntt gidi 20%; dd'i vdi nhdm DHT dii 100% dap vien la nam gidi; tinh trung hinh chung cho ta't ca 90 quan sat nghien ctfu thi 93,3% dap vien la nam gidi va 6,7% la ntt gidi Ve dan tpc 97,8% la ngtfdi Kinh va 2,2% la ngtfdi Khd-me Bdng 1: Thong tin ve gidi, ddn toc, trinh hoc vdn vd nghe nghiep cua ddp vien Gidi tinh Dan tdc 24 Nam Ntt long Kinh Khd-me Tdng Nhdm khdng hut o Ty le (%) 24 80,0 20,0 30 100,0 29 96,7 3,3 30 100,0 Nhdm dang hiit n Ty Ie {%) 60 100,0 0,0 60 100,0 98,3 59 1.7 100,0 60 Tong chung Ty Id (%) n 93,3 '?4 6,7 100,0 90 97,8 88 2,2 100,0 90 TAP CHf KHOA HQC CAN THO NGHIEN CLTU-TRAO DOI Hpc va'n Khong bie't chtt Ca'pl Ca'p Ca'p mm Cao dang, dai hpc Sau dai hpc Tong Cong nhan Can bp vien chtfc Budn ban, dich vu Sinh vien Khac long 4 10 30 3,3 13,3 13,3 16,7 33,3 20,0 100,0 6,7 23,3 30,3 16,7 20,0 100,0 14 20 11 12 60 26 11 18 60 3,3 23,3 33,3 18,3 20,0 1.7 100,0 43,3 18,3 30,0 1,7 6,7 100,0 3,3 18 20,0 24 26,7 16 17,8 22 24,4 7,8 100,0 90 Nghe 28 31,1 nghiep 18 20,0 II 10 " 28 31,1 6,7 10 11.1 30 90 100,0 Ghi chii: n la sd quan sdt Trinh dp hpc va'n cua cac dap vien nhdm KHT tap trung phan ldn d bac cao dang va dai hpc (33,3%) va sau dai hpc (20,0%); do, nhdm DHT cd trinh dp hpc van tiia'p hdn, chu yen la ca'p (23,3%) va cap (33,3%) Nghe nghiep cua cac dap vien bao gdm cdng nhan 31,1%, budn ban va dich vu 31,1%, vien chtfc 20,0%, sinh vien 6,7% va cac nganh nghe khac chie'm 11,1% (Bang 1) Tud'i dap vien, tdng vien hp va tiiu nhap binh quan dau ngtfdi tren tiiang cua hp dtfdc the Men d Bang Tudi ciia dap vien dao dpng ttf 19 de'n 69 tud'i, trung binh la 42,7 tud'i va khong cd stf khac biet ve tudi dap vien gitfa nhdm KHT va nhdm DHT qua phep thtf t-test d mtfc y nghla 5% So' tiianh vien trung binh mdi hp d nhdm KHT va DHT lan Itfdt la 4,13 va 3,63 ngtfdi/hp, chi tieu cung khdng khac biet gitta hai nhdm hp khao sat (P>0,05) Ttfdng ttf, tiiu nhap binh quan dau ngtfdi gitfa nhdm hp cung khdng khac biet qua thd'ng ke, ddi vdi nhdm KHT thu nhap binh quan dau ngtfdi la 3,81 trieu ddng/ngtfdi/thang va nhdm DHT la 3,23 trieu ddng/ngtfdi/thang Bdng 2: Tudi ddp vien, tdng thdnh vien ho vd thu nhap binh qudn ddu ngUdi tren thdng cua ho duac phong vd'n So sanh giffa hai nhdm P-value Nhdm Nhdm khdng hut dang hut 43,7 0,373 40,9 4,13 3,63 0.113 3,81 3,23 0,177 Tdng chung Trung Nhd Ldn nha't binh nhat Tudi dap vidn (tudi) 42,7 19 69 Tong vien (ngtfdi/hp) 3,42 0,9 10,0 TNBQ (trieu/ngtfdi/thang) Ghi chii: TNBQ = thu nhgp binh qudn Nhin chung, cac chi tidu cd ban ve thdng tin dap vien va hp khdng khac biet gitta nhdm dang khao sat Day la da'u hieu td't ve tinh khach quan cua vide lay man nghien ctfu, lam tang dp tin cay so sanh anh htfdng cua hiit thud'c la de'n cac thdng so' ve chi tieu va stfc khde ke't qua nghien ctfu 3.2 Hidn trang hut thud'c la 3.2.1 Tudi bdt ddu hut thudc Id Kd't qua nghien ctfu cho tha'y tmng binh tudi bat dau hiit thud'c la ciia ngtfdi dan quan Ninh Kieu la 19,9 tud'i; dtfdi 18 tudi chid'm 11,7%, ttf 18 de'n 24 tud'i chie'm 75,0% va tren 28 tud'i chie'm 13,3% (Bang 2) Nhieu nghien ctfu chi rang tudi bat dau hiit thud'c cang tre thi nguy cd nghien thud'c cang cao; qua dp tudi nhtf da trinh bay thi tud'i bat dau hut thud'c la d thie'u nien quan Ninh Kieu chie'm ty 16 kha cao, day se la mpt hid'm hpa ldn cho gia dinh va xa hdi ndn can dtfdc quan tam nhieu hdn, nha't la stf khuyen nhii cua gia dinh, tuyen truyen nha trtfdng, doan nidn-hdi sinh vidn va tren cac phtfdng tidn thdng tin dai chung nham giiip tudi tre nang cao nhan thtfc ve tac hai cua thud'c va thtfc hidn khau hieu "Hay ndi khdng vdi thud'c la!" Bdng 2: Tudi bat ddu hut thudc Id eda ngUdi ddn d qudn Ninh Kieu Tuoi bdt dau hiit Dtfdi 18 tudi Ttf 18 de'n 24 tuoi Trdn 24 tudi I Ting TAP CHf KHOA HQC CAN THO Soltfcfng Tile(%) 11,7 75,0 13,3 100,0 25 NGHIEN cufu-TRAO DOI 3.2.2 Sddie'u thudc Id hut moi ngdy 60 E 40 is c Q 20 - * Dir6M0di4u Ti>11 dln20ai^u Tr«n20(3i^u s6 thu6c hCit (ai^u/ngi/*i/ngSy) //m/z 1: Ty le ngUdi hiit thudc Id theo sd luang thudc hut moi ngdy d qudn Ninh Kieu Tac hai cua vide hiit thud'c la ttfdng quan vdi sd die'u thud'c la hiit mdi Hinh cho bie't cd 33,3% ngtfdi hiit thud'c la hiit dtfdi 10 die'u/ngay, ttf 11 de'n 20 die'u chie'm 58,3% va tren 20 die'u chie'm 8,3% Ke't qua dieu tra cdn cho tha'y binh quan mdi ngtfdi htit thud'c la d quan Ninh Kieu stf dung 16,7 die'u thudc/ Nghien ctfu tren toan qud'c nam 2010 thi sd la 13,5 die'u/ngtfdi/ngay (GATS, 2010) Nhtf vay Itfdng thud'c la tieu thu binh quan mdi ngtfdi mpt ciia ngtfdi dan d quan Ninh Kieu cao hdn so vdi binh quan ca ntfdc 3.2.3 Nhan hieu thudc hut Hinh 2: Ty le cdc nhdn hieu thudc Id duac ngUdi tieu dUng sd dung d qudn Ninh Kieu Cac nhan hieu thud'c la ngtfdi dan d quan Ninh Kieu stf dung nhieu nha't la Hero (47%) va Jet (40%), ke' de'n la Caraven (con meo) chie'm 10% va cac nhan hieu khac nhtf 555, Basto chie'm 3% (Hinh 2) Hero va Jet la hai mat hang thud'c la lau chie'm de'n 90% thi trtfdng thudc la lau d Viet Nam (CAST, 2010) Viec stf dting cac mat hang thud'c la lau gay that thu ldn cho nha ntfdc Tuy nhien, cac bien phap phong chd'ng thud'c la lau Hero va Jet ttf Campuchia qua Viet Nam v i n chtfa that stf hieu qua Cd the mpt nhttng bien phap "gd'c r e " de khdng cdn finh trang thud'c la lau hien la tuyen truyen de ngtfdi hiit thud'c la chpn cac san pham san xua't ntfdc hay nhap khau hdp phap thay vi thdi quen stf dung Hero va Jet nhap lau nhtf ke't qua khao sat d quan Ninh Kieu nghien ctfu 3.2.4 Nai hut thudc Id Ke't qua fim hie'u ve ndi hiit thudc la cua ngtfdi dan quan Ninh Kieu dtfdc trinh bay d Bang Qua cho tiia'y ndi hiit thud'c la phd bie'n nha't la d nha (76,7%), ke tie'p la ndi lam viec (70,0%), d cac quan ca phe, quan (61,7%) va ndi cdng cpng (56,7%) Ngtfdi hiit thud'c la cung cho bie't hp hiit liic nghi ngdi (65,0%), liic giao tie'p vdi ban be, khach hang (38,3%), liic lam vide (33,3%) hay luc bi cang thang (23,3%) Bdng 3: Nai hiit thudc Id cua ngUdi ddn qudn Ninh Kieu Ndi hiit Hut liic Dac diem Nha Ndi lam viec Ndi cdng cdng Ndi khac (quan ca phd, quan nhSu, v.v) Liic nghi ngdi Liie giao tie'p vdi ban be, khach hang Liic lam vide Liie hi cang thang (stress) i^ Tild(%) 76,7 70,0 56,7 61,7 65,0 38,3 33,3 c khie sinh sin B#nh ring mifng dtfdng, giam kha nang sinh san v.v khdi thudc la cd chtfa hdn 7.000 chat hoa hpe, dd ed Hinh 4: Nhdn thde eda ddp vien ve benh thude Id nicotine la chat gay nghidn va khoang 70 chat la tqi qudn Ninh Kieu tae nhan gay ung thtf Ngtfdi nghidn thude la cd 1 J1 TAP CHf KHOA HQC CAN THO 27 NGHIEN cufu-TRAO DPI nguy cd ttf vong cao gap 2,5 de'n 10 lan so vdi ngtfdi khdng hiit thud'c la (GATS, 2010) Tuy nhien, nghien ctfu chi ed 27% ngtfdi hut thude la cho rang hut thud'c la cd anh htfdng nhieu de'n stfc khde ban than Nhtf vay, mac dii ngtfdi dan cd hie'u bie't ve tac hai cua thud'c la gay nen mpt sd bdnh nhtflig stf hie'u bie't vSn cdn han che' Do do, viec nang cao nhan thtfc eua edng ddng ve tae hai cua thud'c la can phai dtfde quan tam hdn ntfa 3.4.2 Nhilm benh lien quan den thudc id Benh tim Ddi vdi nhtfng ngtfdi DHT, cd 37% cho bie't Anh hirang v l mach \ - rang mieng khdng bi cac benh Uen quan de'n thud'c la, 54% bi benh 2% \ 7% Uen quan de'n hd ha'p, 7% Uen quan de'n rang ntfeng va 2% Uen quan de'n tim mach (Hinh 5) Chi phi kham ehtfa cac benh Uen quan de'n thudc la ciing ttfdng dd'i cao, binh quan 243 ngan ddng/ngtfdi/thang Mae dii d day cac dap vien khdng de cap de'n benh ung thtf phdi nhtfng dieu chtfa h i n la hp khdng bi, ed the hp hi cac benh Uen quan de'n hd ha'p nhtfng chtfa phat hien vi phan ldn ngtfdi dan chi di xet nghiem ung thtf cd trieu chtfng nang Hien tai, Benh vien Lao va Phdi tai Can Thd dang theo doi va dieu tri 714 benh nhan Hinh 5: Ty le mac benh lien quan den thudc Id ciia hi benh phdi tac man tinh, theo cae ehuyen gia nhom dang hut thude d qudn Ninh Kieu y te' tai day thi "Khoang 90% benh nhan mac benh phdi tae man tinh la thude la, hiit thud'c la gay hau qua am tham lau dai, khdng bpe lp trtfdc mat nen gidi tre, ngtfdi mdi hut thud'c khdng tha'y dtfdc de' bd thud'c hay tranh hut thude" (Le Anh, 2014) 4.Klftluanvakllfnngli| Nghien ctfu ve hien trang hiit thud'c la va anh htfdng eua hiit thude la de'n chi tieu va stfc khde eua ngtfdi dan d quan Ninh Kieu, phd Can Thd riit dtfde mpt so' ke't luan nhtf sau: Tudi bat dau hiit thud'c la la 19,9 tudi - So' die'u thud'c hiit binh quan mdi la 16,7 die'u Hero va Jet la hai nhan hieu dtfdc ngtfdi tieu dung stf dung vdi ty le rat eao, nhtfng day lai la hai loai thude nhap lau; Ngtfdi hiit thude la ed the hiit d mpi ndi, mpi liic, nhtfng phd bie'n nha't la cae ndi edng cpng nen anh htfdng khdng chi cho ban than hp ma cdn cho nhtfng ngtfdi xung quanh; - Chi tieu cho thud'c la ttfdng dd'i ldn, chie'm 6,5% tdng ehi tidu gia dinh eua nhdm DHT, so' tien ttfdng dtfdng vdi chi cho gas-dien-ntfdc hay ehi cho giao due cua em hp; Nhan thtfc cua ngtfdi dan ve tac hai cua thud'c la cdn han che, phan ldn cho rang hiit thudc la ehi lien quan de'n benh ung thtf phdi va benh hd ha'p; Dd'i vdi nhdm dang hiit thud'c, 63% dap vien bi nhidm cae bdnh lien quan dd'n thudc la (hd ha'p, rang mieng, tim mach) va phi dieu tri cac benh binh quan d mtfc 243 ngan ddng/ngtfdi/thang De han che' tac hai thud'c la gay ndn, de tai cd mdt so' kie'n nghi nhtf sau: Tuyen truyen, nang cao nhan thtfc cho ngtfdi dan, nha't la thid'u nidn ve tae hai eua thud'c la de'n ban than ngtfdi hiit eiing nhtf de'n gia dinh va epng ddng Viee tuyen truyen nen ke't hdp bang nhieu hinh thtfc thdng qua phtfdng tien thdng tin dai ehiing, nha trtfdng, doan nien, v.v.; Tuyen truyen cho ngtfdi hiit thud'c khdng stf dting thud'c la nhap lau nhtf Hero va Jet ma nen diing eac san pham san xua't ntfdc hoae san pham dtfde nhap khau theo luat phap Viet Nam de tranh that thoat nguon thu ngan sach; O cae ndi edng cpng, cdng sd phai bd tri phdng hiit thud'c danh rieng eho ngtfdi mud'n hut thud'c de khdng anh htfdng de'n ngtfdi khae; - Chinh quyen dia phtfdng phai trien khai va giam sat chac che viec thtfc hien Luat Phdng chd'ng tac hai thud'c la tren dia ban TAI UEU THAM KHAO Dai hoc y te cong cong va to chu'c Heath Bridge Canada (2010-2011), "Chi phi y te cho benh lien quan den thudc la tai VietNam" GATS (2010) Dieu tra toan cau ve hiit thudc la d ngtfdi trtfdng tai Viet Nam Ha Noi, 2010 Levy D, Bales, S, Nguyen TL (2006) The role of public policies in reducing smoking anh deaths caused by smoking in Vietnam: Results from the Vietnam tobacco policy simulation model Social Science & Medicine 62 (2006) 18191830 Le Anh (2014) Hut thudc cang sdm hau qua cang nang ne http://www.baocantho.com.vn Tong cue Thdng ke (2013) Ke't qua khao sat mu'c sdng dan ctf nam 2012 Nha xuat ban thdng ke Ha Noi 28 TAP CHf KHOA HQC CAN THO ... dd''n chi tidu chi cho thtfc pham chiem 50,6%, chi giao due 14,5%, cae khoan gas-dien-ntfdc 7,8%, stfc khde 4,4%, tiidng tin Uen lac 3,9%, thud''c la 1,5% va cae chi phi khac 17,4% Trong dd, tdng chi. .. la ciia ngtfdi dan quan Ninh Kieu la 19,9 tud''i; dtfdi 18 tudi chid''m 11,7%, ttf 18 de''n 24 tud''i chie''m 75,0% va tren 28 tud''i chie''m 13,3% (Bang 2) Nhieu nghien ctfu chi rang tudi bat dau hiit... ngtfdi dan DBSCL chie''m khoan 52,9% tdng chi tieu (Td''ng cue Thdng ke, 2013) Nhtf v | y , ke''t qua dieu tra d quan Ninh Kieu nghien ctfu cung ttfdng dtfdng vdi bao eao tren (chi tiitfc pha''m