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Accident Analysis and Prevention 41 (2009) 789–797

Contents lists available at ScienceDirect

Accident Analysis and Prevention

journa l homepage: www.e lsev ier .com/ locate /aap

andatory helmet legislation and the print media in Viet Nam

eter S. Hill a,∗, Anh D. Ngo a, Tuan A. Khuong a, Huong L. Dao c, Hanh T.M. Hoang b,ang T. Trinh b, Lien T.N. Nguyen b, Phong H. Nguyen b

School of Population Health, The University of Queensland, Herston Road, Herston 4006, AustraliaHealth Strategy and Policy Institute, 138 Giang Vo Street, Hanoi, Viet NamWorld Bank, Viet Nam Office, 63 Ly Thai To Street, Hanoi, Viet Nam

r t i c l e i n f o

rticle history:eceived 25 November 2008eceived in revised form 18 March 2009ccepted 14 April 2009

eywords:iet Namotorcycles

a b s t r a c t

With motorcycle ownership high and rising in Viet Nam, and motorcycle riders vulnerable to both fataland non-fatal injury, the re-introduction of mandatory helmet legislation in 2007 has been a priority forthe Vietnamese government. The paper uses a qualitative analysis of web-based versions of the eightmost popular newspapers in Viet Nam to track reporting over four phases of the implementation of thelegislation, identifying codes and constructing the dominant themes of the media coverage. The studydocuments the justification and promotion of the legislation, and the mechanisms for preparing for itsimplementation at a national and local level, developing solutions and encouraging the replication of

elmetsrint mediaolicyrevention

successful strategies. It records opposition and obstacles to helmet use, and concerns raised around thequality of helmets purchased. In return, the press notes the response of the market in innovative solutionsto these problems. With the successful implementation of the legislation, the functions of the print mediain promulgating and promoting the legislation, together with the reporting of ongoing resistance to theprocess, serve to enable a dialogue between the State and population around expressed concerns. Inhighlighting quality control of helmets as a key issue, the media have identified a potential ongoing role

initia

in monitoring the state’s

. Introduction

.1. Road trauma in Viet Nam and motorcycle helmet legislation

Road traffic trauma is the leading cause of fatal and non-fatalnjuries in Viet Nam, with the country’s first National Viet Nam

ulti-centre Injury Survey (VMIS) in 2001 providing an estimatedeath rate of 26.7 per 100,000 population (DHYTCC, 2003). In 2006,1.2 deaths per 100,000 population were reported as due to trafficnjury (Huyen, 2008). Estimates suggest that 95% of road vehiclesn Viet Nam are motorcycles, with ownership of motorcycles risingapidly from 104.6/1,000 population in 2001 to 224/1,000 popula-ion in 2007 (Peden et al., 2004). Motorcycle users in Viet Nam are

he most vulnerable to road traffic injuries, with the VMIS show-ng that motorcycle users suffered 51.3% of all non-fatal road trafficnjuries, a rate of 733.5 per 100,000 population (DHYTCC, 2003).

∗ Corresponding author. Tel.: +61 7 33655432; fax: +61 7 33655599.E-mail addresses: peter.hill@sph.uq.edu.au (P.S. Hill), n.anh@sph.uq.edu.au (A.D.

go), khuonganhtuan@hspi.org.vn (T.A. Khuong), hdao1@worldbank.org (H.L. Dao),oangmyhanh@hspi.org.vn (H.T.M. Hoang), namedmoon@yahoo.com (H.T. Trinh),amlien71@yahoo.com (L.T.N. Nguyen), phong the great@yahoo.com (P.H. Nguyen).

001-4575/$ – see front matter © 2009 Elsevier Ltd. All rights reserved.oi:10.1016/j.aap.2009.04.001

tive in reducing the road toll from traumatic brain injury in motorcyclists.© 2009 Elsevier Ltd. All rights reserved.

Traumatic brain injury from motorcycle collisions has thepotential to impact on whole families, precipitating catastrophicexpenditure and consequent household poverty (Hanh et al., 2008).Internationally, mandatory motorcycle helmet use is regarded asthe single most effective approach for the prevention of head injuryand traumatic brain injury among motorcycle users (Liu et al.,2008). Helmet use reduces the incidence, severity and mortalityrates of traumatic brain injury in motorcycle collisions, with 20–45%reductions reported for fatal and serious head injury (Servadei etal., 2003).

Helmet legislation was first introduced in a Ministry of TransportCircular in 2000 (Ministry of Transport, 2000), making motorcyclehelmet use compulsory on specified road sections, mainly thosedesignated as national roads. In 2001, the government of Viet Namintroduced the National Policy on Accidents and Injury Prevention,which included the target of reducing road traffic deaths from 14 to9 per 100,000 vehicles by 2010 (Hung et al., 2006), and upgraded thehelmet legislation to apply to all roads (Ministry of Transport, 2001).As indicated in Table 3, which summarizes the factors relating to

the failure of implementation of this legislation, enforcement ofthese circulars was irregular, and compliance poor, and media sup-port for the implementation of the policy equivocal. In 2003, a newcircular reduced the requirement for helmets to only those roadssignposted for compulsory helmet wearing (Ministry of Transport,

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003). Fines imposed for breaching these regulations were insignif-cant, set at 10,000–20,000 VND (US$0.62–1.241), and there was none for wearing helmets that did not meet regulation standards

Hung et al., 2006).In 2007, the Government introduced Resolution number

2/2007/NQ-CP (Government of Viet Nam, 2007), a consolidation ofhe previous laws on road traffic safety, requiring the introductionf mandatory motorcycle helmet use on all roads, phased in overthree-month period from 15 September to 15 December 2007.

mplementation was overseen by the National Traffic Safety Com-ittee (NTSC). With a seven year history of resistance to helmets,

ismissed colloquially as “rice cookers” (Hung et al., 2008; Globaload Safety Partnership, 2008), and indifference to existing leg-

slation (Adam Fforde and Associates, 2008), the almost completeompliance astonished even the Minister of Transport and Chair-an of the National Traffic Safety Committee, Mr Ho Nghia Dung

Saigon Giai Phong, 2007a).The success of the implementation was dependent on a complex

f political will, leadership and coordination, the availability of suit-ble helmets and the support of international donors for advocacynd mass media promotion and the production of helmets (Globaload Safety Partnership, 2008; Craft et al., 2008; McDonnell et al.,008). Concerned not to repeat its earlier failures, government usef the media was deliberate and strategic. The policy, legislativeramework and the schedule of penalties were announced over thehree-month period of implementation, and quality control issuesere addressed as these emerged. Local implementation activitiesere modeled, and the population counseled on helmet purchase

nd use. But motorcycle ownership in Viet Nam is a symbol of lib-ralization, financial and personal independence (Truitt, 2008) andespite government ownership, the complex factors that influencehe print media in Viet Nam resulted in coverage was quite mixed,nd included surprising levels of resistance to the legislation.

.2. The media and the state in Viet Nam

Buse et al. (2005) argue that the media – print and electronic –ake a significant contribution to policy agenda setting, function-

ng as sources of information, propaganda and socialization—givingegitimacy to government functions, and promoting acceptance ofominant political and economic frameworks. The actual mech-nisms for achieving change are less clearly understood (Otten,992), with the media acting to both shape policy agendas, and theiroverage in turn shaped by them. Much has been made of the impor-ance of media advocacy in identifying health issues, framing themnd maintaining focus (Wallack, 1994). However, the predictabilityf outcomes is not always clear (Paalman, 1997), and the impor-ance of health issues may not be reflected in their media coverageChapman, 1998). In turn, column inches of reporting do not nec-ssarily correspond with the impact of coverage (Harrabin et al.,003).

The media in Viet Nam however, have an unusual positioningn relation to the implementation of public policy that arises fromheir financial dependence on advertising and popular demand, athe same time as being fully owned by State agencies (Marr, 1998).he organizational structure of the media in Viet Nam ensures thatll lines of control can be traced to the Communist Party, through

overnment ministries, provincial and municipal governments andass organizations. With legislation reliant on a hierarchy of imple-entation through these same Party and government structures,

eporting in the news media reinforces its use as a vehicle of the

1 Currency conversion rates are set at US$1.00 = 16,208.5 VND, as at 15ecember 2007 (OANDA.com The Currency Site. Accessed 9 Jan 2009 at:ttp://www.oanda.com/convert/classic).

Prevention 41 (2009) 789–797

state to “inform and educate citizens but also to inundate themwith official positions. . .and to mobilize people to do what gov-ernment, party, and mass organization leaders require” (Kerkvliet,2001). Consequently, in Viet Nam, analysis of the media providesa reliable means of tracking policy pronouncements, with printmedia linked directly to government sources of legislation andregulation (see Table 1). Paradoxically, this complex “network ofcriss-crossing horizontal and vertical lines of control” between theparty and the various government agencies and mass organiza-tions responsible for the media, allows considerable diversity ofpositions and perspectives (Heng, 2001; Kerkvliet, 2001). Rapidsocio-economic change has contributed further to this. The 1986

economic liberalization policy of Ð�oi Moi (‘renovation’) with itsdismantling of collective agriculture, introduction of banking andcurrency reforms, growth of the private sector and engagementwith international financial markets and the international media,has substantially increased social awareness (Witter, 1996). Despite

state control, the implications of �oi Moi, and the vigorous inter-nal political dynamics, the decentralization of authority, social andcultural diversity ensure that a spectrum of political positions findexpression, including overt opposition (Heng, 2001).

This paper uses content analysis of the print media coverageof the 2007 re-introduction of mandatory motorcycle helmet leg-islation to undertake three tasks. Firstly, to identify and examinethe key themes of the news coverage identified through the con-tent analysis; secondly to present these in a structure that reflectsthe reported ‘narrative’ of implementation; and finally, to exam-ine the functions of the print media in the broader context of thissuccessful campaign, by triangulating news coverage with our ownobservation and available policy analyses.

2. Methodology

Researchers selected the eight highest circulation daily newspa-pers in Viet Nam for analysis. The newspapers are published by theViet Nam Communist Party and various government authorities,including the Ministries of Police, Information and Communica-tion, and Science and Technology, and represent both national andprovincial interests, as well as addressing differing demograph-ics, including youth through the Communist Youth Union and theYouth Association of Ho Chi Minh (Table 1). All newspapers pro-vide electronic editions, with Vietnamnet and VNexpress exclusivelyweb-based.

As the introduction of the policy was phased incrementally from15 September (when mandatory helmet use was applied to stateemployees, and national roads) to 15 December 2007 (when hel-mets were required for all riders, on all roads), four one-monthperiods were selected to examine trends in reporting during theprocess of implementation: pre-implementation (15 August–14September, 2007); early implementation (15 September–14 Octo-ber, 2007); late implementation (15 November–14 December,2007); post-implementation (15 December, 2007–14 January,2008). The patterns of reporting frequency are included in Table 1.

Newspaper web-site search engines were used to identify allarticles using the term mu ba�o hi�em (helmet) in all editions overthese periods. These include editorials, news reports, opinion andinformation, together with government news releases, but do notinclude advertisements or letters to the editor. A total of 721 newsreports was identified for analysis, using a content analysis pro-cess informed by Chapman (1998) and Paalman (1997). Following

an initial overview of the articles, the research team met to discussbroad themes, and to discuss trends in reporting over the four one-month periods (Table 1). Two researchers (LNN and PHN) enteredeach article into the Atlas.ti Qualitative Analysis Software program(AQDAS, 2008), independently coding content for primary codes,

P.S. Hill et al. / Accident Analysis and Prevention 41 (2009) 789–797 791

Table 1Print media articles pre-, during and post-implementation of mandatory helmet legislation, Viet Nam.

Newspaper Source Distribution Pre-implementation Early implementation Late implementation Post-implementation

Cong An Nhan Dan Ministry of Police National Not available Not available 11 20Lao Dong Viet Nam Labor Federation National 45 27 32 32Nhan Dan Communist Party National 23 26 11 8Saigon Giai Phong People’s Committee of HCMC Ho Chi Minh

City48 25 29 25

Thanh Nien Communist Youth Union National 10 16 13 15Tuoi Tre Youth Association of Ho Chi Minh National 38 32 26 25Vietnamnet Ministry of Information and Internet 37 30 17 12

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ith multiple codes possible per articles, depending on content. Anpen approach to coding was adopted. Their preliminary findingsere presented to the research team and following discussion, the

odes were clustered into themes, adding themes that had emergeduring coding. A consensus was reached by the research team onhe themes, and coding standardized. Earlier codes were re-codedhere necessary to reflect the agreed themes. Following further

nalysis and discussion, a final thematic analysis was developed.ey themes have been combined where appropriate for the pur-oses of this paper, and the linkages between headings, themesnd codes shown in Table 2. Quotations that illustrate the key the-atic issues and the titles of referenced newspaper reports were

ranslated into English for the convenience and understanding ofnglish speaking readers.

News coverage does not present independent, objective data

Chapman, 1998) though it does provide important insights intoow events are represented publicly. In order to locate the medianalysis in the broader context of this recent and previous failedegislation, the content analysis of the print media has been tri-ngulated with a policy analysis of evaluations by independent

able 2ection headings and qualitative analysis themes and codes, with frequency of codes by p

ection headings Themes Codes

ection 3.1.1 Political directives Central policy pronounLocal application of po

Promotion and persuasion Helmet promotionCommunication/educaPractical guidance on c

ection 3.1.2 Implementation Barriers to implementaPunishment for infringIncorrect wearing of heSolutions proposed/rep

ection 3.1.3 Resistance to legislation Non-compliant behavioQuestioning of evidenc

Attitudes to legislation Supportive of legislatioNeutralResistant to legislation

ection 3.1.4 Helmet quality CounterfeitSmuggling/illegal impoApproved helmet brandUnmet quality standardHelmets for children

Quality control measures Descriptions of currentProposals for quality coQuality control difficul

ection 3.1.5 Market response to legislation Supply/demand of helmCost/affordability of heServices: Lockers, safe-

ection.1.6

Benefits of the legislation Reported outcomes ofEstimated benefits of le

Other Assorted codes

18 19 33

174 158 170

(McDonnell et al., 2008) and other stakeholder sources (Asia InjuryPrevention Foundation, 2008; Craft et al., 2008; Global Road SafetyPartnership, 2008), together with the authors’ observation andanalysis. The findings have been integrated into the discussion andare summarized in Table 3.

3. Findings

The following section represents the findings of the con-tent analysis of all relevant print media articles published inthe eight selected newspapers, during the three-month incre-mental implementation of the mandatory helmet legislation inViet Nam. The frequency and pattern of reporting between thepapers varied over the period of implementation, as shown in

Table 1. The pre-implementation period showed the greatest fre-quency of publication as newspapers met their obligations toannounce the legislation and its implementation details, and asconcerns were immediately raised regarding issues of helmetquality and the opportunistic promotion of helmets that did not

hase of implementation.

Implementation phase

Pre- Early Late Post-

cements 48 17 20 12licy 46 17 29 19

33 38 18 214tion 10 3 25hoosing, wearing 13 16 2 0

tion 4 1 18 18ements 10 12 10 23lmets 0 0 0 20orted for implementation 42 15 2 2

rs/resistance 16 22 0 27e for implementation 1 2 2 5n 14 8 28 22

0 0 2 019 29 17 33

49 10 6 1rt 7 0 0 5s 42 6 1 1s 58 12 7 9

0 0 4 8quality control 74 36 35 5ntrol 10 4 5 3

ties 10 5 0 0

ets 69 13 14 8lmets 32 4 19 5keeping, decoration 43 15 9 13

legislation 1 2 3 21gislation 6 8 9 25

13 0 0 0

792 P.S. Hill et al. / Accident Analysis and Prevention 41 (2009) 789–797

Table 3Factors influencing implementation of mandatory helmet legislation in Viet Nam, 2001 and 2007 (Sources: Hung et al., 2006; Adam Fforde and Associates, 2008; Craft et al.,2008; Global Road Safety Partnership, 2008; McDonnell et al., 2008).

Factors influencing implementation 2001 2007

Political support Limited political support Prime Minister and Party strongly supportiveLack of clear policy leadership Minister of Transport policy championNTSC recently formed Strong, active NTSCFragmented support from government, provinces and massorganizations

Unified government and mass agency support

Uncoordinated, early international support Critical mass of international agency support

Legislative program Lack of comprehensive evidence for legislation Strong evidence justifying legislationIncremental, uncoordinated regulation Comprehensive, coordinated legislation and regulationUnclear, contradictory messages Single consistent messageQuality standards limited Quality control infrastructure developed

Quality standards revised and extended to “tropical”designs

Enforcement issues Enforcement dependent on local authorities Universal commitment to enforcementFines insignificant Fines higher than helmet pricesLimited police coverage Mobilization of police and civil inspectors for enforcementInsufficient instruction to comply Clear instruction to complyWhole legislation package introduced once withoutsufficient preparation (e.g. helmet supply, publiceducation, human resources)

Enforcement increased incrementally through severalsequential steps

Proper preparation for implementation (e.g. helmet supply,public education, human resources)

Poorly coordinated and weak media education campaign Intense media education campaign, using public rolemodels and celebrities

Anticipated barriers not identified for effective solutions Anticipated barriers identified, followed by effectivesolutions

Helmet promotion and facilitation ofhelmet use

Limited or no promotional activities for helmets Intense promotional activities for helmets: e.g. freehelmets for the needy, children, helmet advertisements byhelmet manufacturers.

No subsidy for helmets Subsidized helmets for government employeesStorage issues not available Market, employers mobilized to solve storage issuesAesthetic issues not considered Rates reduced

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eet standards. Most key issues were covered over all peri-ds, including justifications for helmet use and promotion of the

egislation, resistance to the legislation, problems during imple-entation, the response of the market and negotiating solutions.

he post-implementation period saw an understandable surgen coverage of the success of the intervention and its predictedenefits.

.1. Key themes in the media coverage

Over the course of implementation of the legislation several keyhemes emerged and were developed in the print media coverage.he themes are presented in a sequence that broadly follows the

mplementation ‘narrative’, though specific themes may have beeneferred to during different phases of implementation. They reflecthe early promotion of the law and its implementation, but withecord resistance to the legislation reported throughout the foureriods. Early concerns around the theme of helmet quality were

ollowed by state quality control responses. The market joined gov-rnment agencies in ensuring the availability of helmets, but alsoersonalizing them. The final theme reflects the completed imple-entation, with the benefits of the legislation reported or projected

Table 2). Coding for thirteen articles did not fit with any identifiedheme.

All the content presented in these findings is sourced from the

rint media reports, and needs to be read as reports of evidencend events, subject to the biases of the media, rather than inde-endently verified data. As the media are state owned, however,ata presented coincides closely with state authorized sources oftatistics and other information.

le Designs introduced suitable for tropical climate andaesthetic preferencePersonalization encouraged

3.1.1. Justification and promotion for the legislationThe pre-implementation month saw the highest volume of arti-

cles justifying the proposed legislation, as the various ministriesand state agencies met their obligations to inform the population ofthe policy. Press reports from government and international author-ities, copied often verbatim in differing newspapers, were bluntaround the exponential growth in motorcycle ownership and theescalating cost of motorcycle related trauma to Viet Nam: “In VietNam, traffic accidents kill an average of 35 people and injure 60others every day” (Nhan Dan, 2007a); “Every year traffic accidentskill more than 12,000 people” (Tuoi Tre, 2007a). International com-parisons and statistics (Vietnamnet, 2007a) were invoked by theNTSC to challenge current perceptions: “Wearing helmets is a nor-mal practice in a developed society, where people value their lives”(VNexpress, 2007a). Political leaders – the Prime Minister, DeputyPrime Minister and Minister of Transport (also chair of the NTSC) –were prominent in reports progressively updating the legislation,as were representatives of mass organizations such as the YouthUnion. The Asian Injuries Prevention Foundation (AIPF) president,Mr. Greig Craft, impressed journalists by wearing a helmet to hispress conference (Saigon Giai Phong, 2007b).

While the heaviest coverage came from papers associated withthe Viet Nam Communist Party and the Ministry of Informationand Communication, all papers communicated the clear politi-cal commitment to change. With both government and the Party

now endorsing the legislation, the policy arguments were framedconsistently in three ways: firstly, as personal protection: “Whenan accident happens, only the helmet will be broken, instead ofyour head” (Tuoi Tre, 2007b,c); secondly, as social action: “Wear-ing a helmet helps reduce social loss and burden, protect happiness

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or thousands of families, save thousands of lives, and contributeo economic growth” (Saigon Giai Phong, 2007c); and thirdly, asocial obligation, with fines now raised to 100,000–200,000VNDUS$6.17–12.34), equivalent in cost to an approved helmet, andchools, government departments and offices instructed to enforceecessary change:

“Besides, schools have also coordinated with parents not to givechildren motorbike driving licenses, and worked closely withthe districts to check and strictly punish those who violatethe regulations. In addition, the schools also have to educatepupils about the traffic law. . . The Hanoi Culture and Informa-tion Department has been assigned to increase communicationcampaigns on the street about safety helmet wearing and installpanels with information about punishment. This must be com-pleted before October 21” (VNexpress, 2007b).

This prescriptive approach was tempered by more persuasiveoverage, with articles assisting motorcyclists to understand spe-ific requirements of the legislation, for example, helmets forhildren or pillion passengers. Particularly in the initial phases ofhe campaign, articles provided information on appropriate choicef helmets and preferred brands, showing how to identify the offi-ial hologram and certification number, how to select helmetshat fit their head size and correctly wear their helmet (Tuoi Tre,007b,c; Nhan Dan, 2007b).

Reporters used “human interest” narratives to underline the pro-ection to families offered by helmets, as in the case of a Dong Anhgg vendor who transports her eggs over 20 kilometers of highwayo downtown Hanoi. Her concern was for her dependent school agehildren and farmer husband: “I wear a safety helmet to ensureafety so that I can do my business not only for myself, but also fory husband and children” (Nhan Dan, 2007c). The cost of ignoring

elmet advice was echoed in the anguish of one grieving mother:This morning before he left, I told him to wear his safety helmet bute refused. He said that traffic police will only check that tomorrow,on’t worry. . .” (Vietnamnet, 2007b).

.1.2. Preparation for implementationFor legislation in Viet Nam to be effectively implemented,

t requires support for regulation, promotion and enforcementrom the Party structure, government ministries, provincial and

unicipal authorities and the ‘mass organizations’. Preparationor implementation across all levels of the political system waseported, with newspapers highlighting the activities of their spon-ors. The Communist Party Nhan Dan announced that politicalommitment to the legislation was strong, with the Prime Ministerublically charging the two responsible ministers (Police, Trans-ortation), the general directors of media agencies, and Chairmenf the Provincial People’s Committees to intensify communicationnd educational activities, promising strict enforcement of the hel-et legislation from December 15 (Nhan Dan, 2007d). Reporting

ecognized the collaborative NTSC as the primary vice for govern-ent action, generating solidarity of commitment between keyinistries, and coordinating the resources of the ministries and

upportive international agencies. With the legislative process iniet Nam requiring tiers of regulation implemented at each level

n order to operationalize government legislation, the reporting ofnitiatives by popular papers such as the Viet Nam Labor Federa-ion’s Lao Dong or the Youth Association’s Tuoi Tre was intendedoth to profile the extent and diversity of helmet promotion activi-ies, and to provide examples for other agencies to copy (Lao Dong,

007a):

“In HCM City, Danang and Hanoi cities, helmet wearing festi-vals were organized with some games where the players wouldwin gifts if they performed well. The games included painting,

Prevention 41 (2009) 789–797 793

sketching, assembling transport safety models, song contests,etc. The key objective of the games was to raise awarenessof wearing helmets for parents and their children” (Tuoi Tre,2007d).

People’s Committees launched initiatives, and at festivals inmajor urban centre, free helmets were distributed to “disadvan-taged students who have excelled in their studies” (Tuoi Tre, 2007d;Lao Dong, 2007b). University students were mobilized to make hel-mets more attractive:

“For just about 40,000 - 50,000 VND more, you’ll have a nicelooking helmet. Decorating helmets with colorful pattern hasbecome a trend for many young people. Seizing this opportunity,many students at the Hanoi Architecture University and ArtsUniversity have offered services to decorate helmets” (Tuoi Tre,2007e).

The reporting of more regulatory approaches provided a coun-terbalance: papers reported government cadres instructed to wearhelmets (Nhan Dan, 2007e), and security guards in some officesrecording the names of those not wearing safety helmets and refus-ing them entry (Tuoi Tre, 2007f). In major cities such as Hanoi, DaNang, and Ho Chi Minh City, the press confirmed that monitor-ing cameras were installed at some check-points, underlining thepolice commitment to enforcement. Just prior to final implemen-tation, the government slogan “From December 15, not wearing ahelmet: immediate fine, no more reminders” appeared on majornewspapers (Cong An Nhan Dan, 2007a).

The issues of enforcement were prominent in the print media,with traffic police mobilized to “remind” riders to wear helmets(Lao Dong, 2007c), and themselves put under pressure to set a con-stant example (Tuoi Tre, 2007g). Reports editorialized, or expressedthe concerns of unnamed “citizens” at the incapacity of the policeto enforce the legislation. Significant non-compliance was expectedduring implementation, even with all police forces mobilized (NhanDan, 2007f,g) and civil inspectors authorized to fine offenders(Thanh Nien, 2007a). The VNexpress speculated: “maybe the policewill be deployed at T-junctions or intersections, but each one hasto manage thousands of motorbikes. How could they handle all theoffenders?” (VNexpress, 2007c). Compounding this were reportsquestioning the complex procedure required for the payment offines, requiring offenders to present at the State Treasury duringlimited office hours—with predictions that the lengthy queues wait-ing to pay fines would overwhelm processing capacity (Thanh Nien,2007b).

3.1.3. Resistance to the legislationDespite the concerted government campaign, and the print

media’s instrumental role in presenting the legislation, reportingthe initiatives and mobilizing community responses, dissatisfac-tion and resistance were reported throughout the implementationperiod. Reports presented as personal commentary were common:nine percent of all articles quoted “local citizens” – frequentlynamed – as either supporting or opposing the legislation. Earlyreports re-voiced the common aesthetic objections to helmets:“Wearing a helmet is unfashionable. With young females, nobodycan see the beauty of their made-up face and stylish hair”(VNexpress, 2007c; Vietnamnet, 2007c). Helmets “looked stupid”(VNexpress, 2007c). They were hot and heavy, restricted vision andhearing, were inconvenient, difficult to store and likely to be stolen(Tuoi Tre, 2007h). Cost was described as an issue, but overlaid on

the cost was uncertainty around quality. Motorcyclists reportedtheir preferences for uncertified helmets at 40,000–80,000 VND(US$2.47–4.94), aware that good quality helmets would be morethan 150,000 VND (US$9.25) (Tuoi Tre, 2007i). Even an expen-sive motorcycle did not justify an expensive helmet, suggested one

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wner, unconvinced that quality could be guaranteed, regardless ofrice (Thanh Nien, 2007c).

The very high compliance rate following the final implemen-ation date 15 December 2007 was reported as driven by a desireo avoid fines, rather than for the protection helmets offered: “Iear a helmet only to avoid police stopping and fining me” (Thanhien, 2007c). Incorrect helmet wearing was conspicuous – a fouray study in Hanoi estimated 90% of helmets were not correctlyorn (Tuoi Tre, 2007j). Reporting of inappropriate helmet use was

requently ambiguous, with a sense of being “cool” implicit in thenfringement. Riders were observed carrying their helmets untilhey encountered a police check point, failing to buckle the chin-trap, or leaving the strap too loose, wearing caps under theirelmets or wearing their helmets the wrong way round (Saigon Giaihong, 2007d). In response, the press reported fines for incorrectearing of helmets raised to match fines for not having a helmet at

ll (Thanh Nien, 2008).

.1.4. The question of helmet qualityThe initial announcement of the proposed legislation was imme-

iately countered by reports of concerns regarding quality, with 156rticles on quality equaling the 150 promoting the legislation inhe pre-implementation month (Table 2). Coverage focused on thevailability of counterfeit helmets, often smuggled from China, withuestions around which brands met standards, and concerns onuality control. While motorcycle riders were represented as largelyomplying with the requirement to purchase helmets, equivoca-ion around the quality of helmets undermined the value of helmetearing: “One of my friends was killed in an accident riding aotorbike. Though he wore a helmet, it failed to protect his head,

s the helmet broke and one fragment pierced his forehead. Maybehe helmet was of low quality” (Tuoi Tre, 2007k). Early reportingrom Hanoi’s premier trauma hospital, VietDuc, raised concernsround the ineffectiveness of poor quality helmets, despite overalleductions in head injuries (Vietnamnet, 2007b):

“on average 20 head injury patients were admitted daily. Thisnumber is not lower than in the mid year when fewer peoplewore a helmet. Importantly, many people who wore a helmetstill got head injuries” (VNexpress, 2007e).

From pre-implementation, legitimate question lines continuedo develop around quality: imports of sub-standard helmets, coun-erfeits of popular brand-names, the use of inappropriate materialsTuoi Tre, 2007l; Nhan Dan, 2007h). Reports in the Saigon pressonfirmed inspections by the Department of Science and Tech-ology in Ho Chi Minh City that found 78% of checked samplesid not meet Vietnamese standards (Saigon Giai Phong, 2007f).vailability of helmets for children was limited, and reported com-ents from clinicians surprisingly questioned the value of helmets

n children under 14 (currently exempt from the legislation), theeadlines declaring they were “dangerous in children under 3 yearsld” (VNexpress, 2007f). Response from the government was swiftnd widely communicated in the media: an Inter-sectoral Steeringommittee for Helmet Quality Control was established under theuspices of the Ministry of Science and Technology; certificationetails were disseminated (Tuoi Tre, 2007b,c); lists of manufactur-rs meeting or not meeting standards were published (Tuoi Tre,007m; Saigon Giai Phong, 2007f); escalating prices controlled and

nspection and legal interventions increased (Thanh Nien, 2007d).eputable brands offered complimentary injury insurance up to00 million VND (US$61.70) per case with their helmets (Tuoi Tre,

007n).

.1.5. The market responds to facilitate helmet useWhile the early phase of implementation focused on political

ress releases and advice through government agencies, newspa-

Prevention 41 (2009) 789–797

pers also highlighted the broader need for services to facilitatehelmet use. The lack of public storage facilities left motorcycliststhe unenviable choice of high charges or risking theft, leading toconflict in motorcycle parking areas: “There is no space for the hel-met in schools, markets, shopping centers, or offices. Many are veryangry when motorcycle keeping services refuse to keep helmets orcharge a very high price” (Cong An Nhan Dan, 2008). In the finalstages of implementation an accommodation was reached, withmotorcycle parking attendants reported to be directing clients howbest to secure their helmets to their bikes, and reducing holding feesfrom 2,000 VND (US$0.12) to 500 VND (US$0.03) or, in some cases,

no charge. In the spirit of Ð�oi Moi, helmet locks and boxes werequickly made available at reasonable costs to prevent theft. Sev-eral news outlets reported helmet containers imported from Chinaor Taiwan, but noted that the high cost, 300,000–600,000 VND(US$18.51–37.02) – up to four times the price of a certified helmet –was a deterrent (VNexpress, 2007d; Lao Dong, 2007d). The marketwas reported as responding to complaints around the unattractive-ness of helmets by diversifying its choice of helmets, and offeringto decorate them: “high quality, fashionable and personalized”(Saigon Giai Phong, 2007e). While winter hat sales dropped, facemasks and cloth caps for wearing under helmets responded toincreased demand (Saigon Giai Phong, 2007c).

3.1.6. Celebrating the benefits of the legislationDespite the significant persisting cloud around the quality of

available helmets, the reports of almost complete compliance withthe legislation, in urban and rural communities, suggested anovernight transformation. “The percentage of people wearing hel-mets was nearly 100%,” one Hanoi traffic policeman was quoted asexclaiming, “I would not have thought the people would implementthe law so well. The first day was so perfect!” (Thanh Nien, 2007e).

The Minister of Transport was “jubilant” when interviewed(Saigon Giai Phong, 2007a). Motorcycle fatalities and injuries werereported by the Ministry of Health to have fallen (Thanh Nien,2008), and the Wonderpark tourism and recreational centre wascelebrating with a 20 m Christmas tree – decorated with motorcy-cle helmets – with “Christmas God Father” himself also wearinga helmet! (Thanh Nien, 2007f; Cong An Nhan Dan, 2007b). Themedia reflected on the unprecedented outcomes of the campaign,highlighting the commitment of all levels in the political hierar-chy, and their own role: “This success would be largely due tointense and comprehensive education and communication activ-ities involving all levels of the political system. The contributionof media would also be significant” (Thanh Nien, 2007g). An edi-torial in Tuoi Tre (2007o) noted the importance of a central policymessage that was simple, direct, and comprehensible: “Wearinghelmets is mandatory when riding motorcycles”. It argued that theintense communication campaign, with the print media an activecontributor, had shown the importance of the intervention and thegovernment’s determination. Strong leadership and positive rolemodeling in the media had shown political commitment to helmetsat the highest level—and determination to enforce the legislation(Tuoi Tre, 2007o).

4. Discussion

This paper has presented an account of the 2007 mandatoryhelmet legislation in Viet Nam, as published in the print media,analyzing the key themes reported over the implementation period.

Over one year later, it is clear that the campaign has been success-ful in terms of helmet compliance. To what extent that success isdependent on the contribution of the print media is less clear, and isa task arguably beyond the ambit of this paper, though the analysisdoes provide insight into the functions of the media in this process.

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or neighboring developing countries considering the implementa-ion of mandatory helmet legislation, it is useful to locate this print

edia coverage in the broader context of the successful campaign,hile acknowledging the limitations of available sources.

.1. Lessons from the 2007 implementation process

The success of the 2007 mandatory helmet legislation, as pre-ented by the print media, can triangulated from a number oforroborating sources. The NTSC itself has confirmed estimatesf 99% compliance for helmet wearing and a reduction in trafficatalities of 14.27% in the first quarter of 2008 (which includeshe Tet Vietnamese New Year festivities) compared with the pre-ious year (Thai, 2008). Academics from Viet Duc Hospital, theey trauma hospital for the northern region of Viet Nam, haveeported a decrease in both traffic trauma and deaths from trau-

atic brain injury (Chinh et al., 2008). Independent analyses haveeen commissioned (McDonnell et al., 2008) and the key interna-ional stakeholder organizations have published commentary (Asianjury Prevention Foundation, 2008; Craft et al., 2008; Global Roadafety Partnership, 2008). Combining these sources with our ownbservations, and discussions with involved colleagues, we haveummarized the key reasons identified for the overall success ofhis campaign, compared to the failed 2001 legislation (Table 3).

National legislation in Viet Nam requires extensive collaborativeegulation through relevant ministries, provincial governments and

unicipalities for effective implementation (Conway, 2004). In thease of the 2001 mandatory helmet law, this was largely ignoredCraft et al., 2008; Adam Fforde and Associates, 2008), with sub-equent legislation focusing on national highways and specifiedoutes undermined by irregular signage, inadequate fines, incon-istent enforcement and easy circumvention of the requirementsHung et al., 2006; McDonnell et al., 2008) (Table 3).

Key international advocates for road safety argue that a com-ination of high level government and Party endorsement, policy

eadership and coordination from the NTSC were critical to theegislation’s success. International stakeholders supported withdvocacy, mass media promotion and the production and distri-ution of helmets (Global Road Safety Partnership, 2008; Craft etl., 2008). The fragmentation of the 2001 legislation was avoidedy the simultaneous completion of the necessary legislative pack-ge – including quality standards – implementation regulation andrganizational directives, realistic fines and an adequate enforce-ent capacity. The consistent, unqualified requirement for all riders

o have helmets on all roads was effectively communicated in theedia, and supported by celebrity role models. The simultaneous,

niversal change to helmet-wearing dispelled much of the anxietyround being “different” (Asia Injury Prevention Foundation, 2008).ublic-private partnerships to produce attractive tropical helmetesigns contributed, as did the mobilization of the market to solve

ocal problems of storage, and “value-add” with decoration (Craftt al., 2008). Free distribution of helmets to the needy, and subsi-ization in the workplace eased the economic burden of purchasingelmets, and increased fines provided a necessary counterbalanceKhanh et al., 2008).

.2. The media and policy change

Media advocacy for public health has an established position,articularly in tobacco control, but also in gun control, traffic injury,lcohol and substance abuse and more recently, childhood obesity

Chapman and Lupton, 1994; Shelov, 1995; Wilson, 2007). In traf-c injury prevention, mass media campaigns have been evaluated

or theory-based approaches to speeding reduction (Stead et al.,005); tested for drinking and driving message recognition in targetudiences (National Highway Traffic Safety Administration, 2004);

Prevention 41 (2009) 789–797 795

and systematically reviewed for their effectiveness in reducingalcohol-related crashes (Elder et al., 2004). Media coverage has beenanalyzed for the ways in which arguments for and against restric-tions for young drivers are framed (Blows et al., 2005), and the roleof the media in supporting voluntary local council recommenda-tions for bicycle helmet use in Sweden has been documented (Nolénand Lindqvist, 2002). However, no previous academic publica-tions tracing the implementation of mandatory helmet legislationthrough the print media have been identified.

4.3. The print media and mandatory helmet legislation in VietNam

The focus of this paper has been the print media coverage of theimplementation of the 2007 mandatory helmet legislation in VietNam. While the content analysis is able to examine the key issuesreported by the press to the population of Viet Nam, it does notprovide a basis from which the contribution of the print media canbe objectively evaluated. However, the data provided in this studydoes enable us to identify the key functions provided by the pressmedia as part of the implementation process, and to examine these.

The first of these functions is characteristic of government-owned media in a socialist state: the promulgation of governmentpolicy, commencing with the announcement of the legislation andits implementation schedule. With legislation in Viet Nam requiringa coordinated cascade of circulars, regulations and organizationaldirectives (Conway, 2004), this political function of the press isassumed—but as shown by previous experience, not sufficient toguarantee successful implementation. What was conspicuous inthis study was the evidence of the iterative communication of polit-ical resolve, and a united commitment at all levels of Party andgovernment to implementation.

The second function has been the promotion and interpretationof the legislation, offering advice and guidance, and reporting localresponses to the legislation, showcasing innovations and success-ful applications of directives that in turn stimulate imitation andcompetition. With the endorsement of the Party and mass organiza-tions, the media has played a key role in reporting local solutions toshared problems—subsidizing costs, identifying quality standards,selecting appropriate designs, decorating and personalizing, resolv-ing storage issues.

The third function, the reporting of resistance to the legisla-tion, reflects the emergent liberalization of the media in Viet Nam,a product of decentralization and diversity within state owner-ship (Heng, 2001). Despite the 2001 experience of an unsupportivemedia, the reporting opposition to the legislation was well estab-lished in the pre-implementation phase and has been allowed topersist throughout. The relief expressed by Ho Nghia Dung, Minis-ter of Transport and Chair of the NTSC reflected genuine uncertaintythat the government’s concerted efforts would succeed:

“The result was a nice surprise to many people. Before Decem-ber 15, Ho Nghia Dung, Minister of Transport and Chairman ofthe National Traffic Safety Committee was very worried aboutthe implementation level of the Government’s Decision 32 onmandatory helmet wearing. He said ‘The awareness of a cer-tain group of the population about the benefits, importance andstrictness of the Decree 32 was low. Among them, some evendisagreed with the government’s decision and refused to imple-ment it.’ But after the first day, the high percentage of peoplewearing the helmet made the minister happy. ‘A new cultureis being formed!’ said Minister Ho Nghia Dung.” (Saigon Giai

Phong, 2007a)

The sustained reporting of resistance may have contributed tothe government’s awareness that it could not assume compliance,consolidating support and motivating constant reinforcement of

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trategies. But it also appears to have opened up spaces throughhe media where the state could dialogue with the population,nd where the concerns of the citizen could be acknowledged.rguably, a “new culture” has been formed. Questions over quality

esulted in the publishing of approved brands and quality controleviews; skepticism over the capacity of police to enforce fines wasnswered by the recruitment of civil officers to assist; ill-informedrofessional commentary on helmets for children was rebuffed;omplaints around the aesthetics of helmets or the cost of storagerompted reports of solutions.

As a result, the media now has a claim to a continuing role inhe policy dialogue, monitoring government responses to the mostritical issue of this campaign: the high proportion of substandardelmets purchased and currently worn. This is an issue that requiresngoing surveillance and vigilance, and the newsprint is now welllaced to provide a public surveillance function, publicly collatingnd recording reported deaths from motorcycle related trauma, andlacing pressure on the government to maintain enforcement ofhe legislation, and address the ongoing issues of quality control,orrect helmet use, and the provision of appropriate helmets forhildren.

cknowledgements

The authors wish to acknowledge The Atlantic Philanthropiesho funded the research as part of the Evidence for Health Policy

roject (VINE), Viet Nam.

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