School of Political and Social Inquiry Monash University Social Capital and Health-compromising Behaviors among Youth in Vietnam Diep Quy Vy Nguyen 22841733 Submitted in partial fulfillment of the requirement for the degree of Master of Applied Social Research Supervisor: Assoc. Dharmalingam Arunachalam November, 2011 i Declaration I hereby declare that this thesis contains no material which has been accepted for the award of any other degree or diploma at any university or equivalent institution and that, to the best of my knowledge and belief, this thesis contains no material previously published or written by another person, except where due reference is made in the text of the thesis. Sign: Date: ii Table of Contents Declaration. ii List of Acronym.
v List of Tables and Figures. viii Chapter One: Introduction. 1 Chapter Two: Literature Review and Theoretical Framework. Health-compromising Behaviors and Related Research.
Youth Health–compromising Behaviors in the Context of Vietnam. Socio-economic Characteristics and Health-compromising Behaviors among Youth. Definition of Social Capital. Forms of Social Capital.
Associations between Social Capital and Health-compromising Behaviors among Youth14 2. Family Social Capital. Peer Social Capital. School Social Capital.
Neighborhood Social Capital. 19 Chapter Three: Methodology. Data and Sample. 28 Chapter Four: Sample Characteristics.
Socio-economic Characteristics. Health-compromising Behaviors. 32 Chapter Five: Correlates of Health-compromising Behaviors. Smoking among Vietnamese Youth and Its Correlates.
Severity of Smoking. Drinking among Vietnamese Youth and Its Correlates. Severity of Drinking. Drug Use, Violence, and Unsafe sex.
45 Chapter Six: Discussion and Conclusion. 63 iv List of Acronym AHD Adolescent Health and Development FCTC Framework Convention on Tobacco Control GSO General Statistics Office GYTS Global Youth Tobacco Survey MDGs Millennium Development Goals MoH Ministry of Health SAVY1 Survey Assessment of Vietnamese Youth 1 SAVY2 Survey Assessment of Vietnamese Youth 2 UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund v List of Tables Table 4.1 Definition and classification of socio-economic variables included in the analysis, SAVY2 2009 Table 4.2 Definition and classification of social capital variables included in the analysis, SAVY2 2009 Table 4.3 Definition and classification of health-compromising behavior variables included in the analysis, SAVY2 2009 Table 5.1 Estimated odds ratios for current smoking among Vietnamese youth, SAVY2 SAVY2 2009 Table 5.2 Estimated odds ratios for current drinking among Vietnamese youth, SAVY SAVY2 2009 Table 5.3 Estimated odds ratios for involvement in drug use, violence, and unsafe sex among Vietnamese youth, SAVY2 2009 Figure Figure 1 Theoretical Link between Socio-economic Factors, Social Capital and Health- compromising Behaviors vi Abstract WHO ranks smoking, having unsafe sex, and using illicit drugs among the top risk behaviors that lead to young people’s premature deaths. This is very pertinent to Vietnam, where young people aged 14 to 25 represent about one quarter of the population (24. This research is designed to explore the associations between youth’s social capital as well as socio-economic factors and their involvement in such health-compromising behaviors.
It utilizes data from the Survey Assessment of Vietnamese Youth in 2009 and focuses on young males aged 14 to 25. Three main forms of social capital are examined including family, school, and peer social capital. Findings of the study emphasize the role of family and school as important sources of social capital to protect young males against involvement in smoking, drinking, drug use, violence, and unsafe sex. However, when young males have a weak family connection, stronger attachment to peers seems to be a risk factor.
With respect to socio-economic factors, age is likely the most consistent contributor to youth engagement in health-compromising behaviours. These findings suggest effective family communication and discussions with youth should be regularly encouraged to help increase their self-efficacy in avoiding health-risk behaviors. It also indicates the necessity of co-operating between family and school in supervising young people, and creating positive school environment for students to fully develop their potential, knowledge and skills to become healthy and productive individuals. In addition, the involvement of a proportion of young males in several types of health-risk behaviors accentuates the importance of policies and programs that tackle these behaviors as a syndrome of risk behaviors among youth rather than separate problems.
vii Acknowledgement I would like to express my deepest gratitude to my course supervisor Assoc. Dharmalingam Arunachalam for all his encouragement, support, and suggestions that substantially helped me in the completion of this thesis. Dharmalingam, it has been my great honour to apply research skills and knowledge to such an interesting project under your supervision. I also would like to thank my course coordinator Dr.
Kirsten McLean who provided me with very useful information and advice regarding the course and progression of this thesis. I am deeply indebted to AusAID for their financial support during my time in Australia. Also, my appreciation goes to the School of Political & Social Inquiry for providing me with the opportunity to pursue my study area of interest. I thank my friends Duc Hanh Nguyen and Andrew Dark who assisted me in proofreading the thesis.
The most special thanks go to my mother Bao Loan and my younger sister Thien Huong whose unconditional love gave me strength and determination to overcome all difficulties during this long process. 1 Chapter One: Introduction Adolescence is a complex life stage characterized by young people’s efforts to seek their identity and independence. This process can also be accompanied with risk taking propensity and immaturity that may expose them to various health-compromising behaviors such as substance use and unsafe sex (Kobus, 2003; Smylie, Medaglia, & Maticka-Tyndale, 2006). However, it is often thought that young people are healthy and health problems are not a concern among this particular population.
In fact, according to the World Health Organization ([WHO], 2001), up to 1.7 million young people, both males and females, in the age of 10 to 19 die each year mostly due to such incidents as accidents, suicide, violence, and pregnancy. Smoking, having unsafe sex, and using illicit drugs are ranked among the top risk behaviors that lead to young people’s premature death. In particular, unsafe sex leads to more than 6,500 cases of HIV infection among them (10 – 24 years of age) each year, which means every five minutes there is one infected individual. About 150 million smokers worldwide are adolescents, and 75 million of them are anticipated to die of smoking-related diseases in the future.
Violence, particularly homicide, is the main cause of young male deaths in some regions in the Americas. The higher level of drinking among young people, the higher risk of alcohol-related diseases to which they are exposed in later life. Illicit drug use is the root of physical and psychological damage, crime, prostitution, and HIV infection among youth. Such prevalence of illnesses has been resulted from a combination of reasons including youth’s lack of information, skills, and social support to strengthen their self-efficacy in avoiding these risk behaviors and adequate access to health services and facilities (WHO, 2001).
A common agenda has been set by WHO and its partners including the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) with a commitment to the development of young people’s health and well being. One of the most crucial targets of this agenda is to create opportunities for young people to live in a safe and supportive environment. It is because not only individual assets, for instance, high self-esteem 2 and good social skills, but also external factors such as family relationships and peer values appear to be of critical for youth to make positive decisions regarding their health. Young people who grow up in families where family members support each other and parental affection for children is high would be more likely to make responsible decisions.
Hence these factors have great magnitude in determining the developmental trajectories of young people’s lives and need to be taken into account when establishing programmes for youth health and well being (WHO, 2001). Such an agenda is particularly important for developing countries where the majority of young people aged 10 to 24 make up 30% or more of the population (Rosen, 2004). World Bank has clarified a number of reasons for implementing Adolescent Health and Development (AHD) programmes in these countries: Young people face serious health challenges, adolescent health and development affect economic prosperity, health is a key element of overall youth development, and young people have a right to good health (Rosen, 2004). It is also emphasized that better health among young people is an effective way to achieve the Millennium Development Goals (MDGs) that were established in the 1990s (Rosen, 2004).
As a developing country, Vietnam also faces many challenges in terms of youth health and development. Young people aged 14 to 25 in the country represent the largest proportion of the total population (24. Although young people all over the world share some common characteristics with respect to their development process, many aspects of them are differently shaped depending on their local culture (WHO, 2001). In Vietnam, young people have grown up during a transition time in which the society has rapidly shifted from an entire subsidized economy to a multi-sector economy.
This change along with the ‘open door policy’ of the country since 1986, on the one hand, facilitates youth’s development by improved living standards, increased national and international exchanges, and social mobility; on the other hand, put them under such pressures as intense labor market competition, unsubsidized education, social conflicts and social problems. Such a circumstance exposes young people to various challenges including 3 involvement in health-compromising behaviors (GSO, 2003; GSO, 2010). Research evidence has shown that Vietnam has one of the highest rates of male smoking in the world, and that most adult smokers initiated their habit at an early age. About 10% of school boys smoke, yet when they reach the age of 15 to 24, one in three of them is using tobacco (WHO, 2009).
HIV is mostly occurred among injection drug users and young people with 10% being between 10 – 19 years old and 55% being between 20 and 29 years (MOH, 2003; as cited in Khuat, Nguyen, & Ogden; 2004). The impact of drinking on driving has not been clear but it is likely to suggest that drinking is a major factor for road accidents (WHO, 2007). Vietnamese government has taken actions to protect young people against involvement in health- compromising behaviors such as issuing a National Tobacco Control Policy, establishing the inter-ministerial Vietnam Committee on Smoking and Health (VINACOSH) in 2001, and ratifying the WHO Framework Convention on Tobacco Control (FCTC) in 2004 to combat youth smoking (WHO, 2009); merging the National AIDS Committee with those committees on prevention and control of illicit drugs and prostitution to tackle a variety of inter-related problems affecting the rate of HIV infection among young people in Vietnam. However, as indicated by WHO (2001), such factors as family connectedness, positive peer relationships, and adequate access to health information and facilities are irreplaceable and critical factors for improving youth’s health and well being.
These factors are valuable resources, or social capital, that young people can resort to in making decisions regarding their health across their life course and at important times. Based on this theoretical premise and the actual situation of young people in Vietnam, the study ‘Social Capital and Socio-Economic Factors In Relation To Youth Health- Compromising Behaviors: Findings from the 2009 Youth Survey in Vietnam’ aims to understand the associations between three forms of social capital including family social capital, school social capital, and peer social capital as well as a number of youth socio- economic characteristics and the involvement of young people in smoking, drinking, drug use, violence, and unsafe sex. This study made use data of the 2009 Survey Assessment of Vietnamese Youth (SAVY2), the second survey after the first Survey Assessment of Vietnamese Youth in 2003 (SAVY1).