all common precursors of suicidal ideation, In Hong Kong, Lai and McBride-Chang (25) found that parental over-control was associated with high risk of suicidal ideation in both male and female adolescents.There are some notable points of difference with prior research. The Vietnamese adolescents’ self-reports of parental drug problems, alcohol problems, and divorce had very weak associations with risk behaviors. Also in Vietnam, the SAVY I & II surveys found that there was no association between having a family member with a history of drug or alcohol problem and youth drinking behaviors. This pattern is very different from trends in Western research, where parental drug abuse is often found to have a strong negative influence on their children's behaviors. The difference might be attributed to cultural differences that lead to a lower prevalence of these risk factors, especially very low prevalence of alcohol abuse by mothers, and the relatively low rate of divorce compared to economically developed countries (15).Inner city school location had a strong influence on behaviors of the school children, especially for girls. There may be a number of contributing factors. Although no associations were found between self-reported (single item) ‘academic achievement’ and any of the three risk behaviors, media reports and other research in Vietnam (26, 27) have highlighted educational stress to be a significant problem in Vietnam. Pressure to succeed academically has negative effects on the well-being and behavior of young people, especially children living in urban areas (18, 19, 21, 26). In inner urban areas, the pressure from parents, teachers, and society may be higher than that in less developed suburban and rural areas. In many families, educational success, especially admission to university, is perceived as essential for their children's future and family pride. Further investigation of the prevalence, indicators, and effects of this problem is needed.Health risk behaviors need to be recognized and identified early. Therefore, emphasis should be put on increasing capacity for mental health services and on human resource development in this field, including individualized and group support for students, parents, and teachers. For underage driving of motorbikes, there should be involvement not only from the school and family but also enforcement from the government and different sectors such as the police and transportation authorities. The enforcement should be continuous and strong.Strengths and limitations of the studyThis is one of the few school-based studies on health risk behavior among secondary school children in Vietnam to examine a range of family and school determinants. The interviews were based on standardized measures of behavior and social correlates that have been validated and widely used in similar studies in other countries. The main limitation is that just two schools in Hanoi city participated; they were not randomly selected and therefore the results may not be representative of other cities and rural areas. As with many other studies of this type, all data were gathered by retrospective self-report, so there may have been recall bias that reduced the accuracy of the findings.
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