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Chang E, Dove M, Saw A, Tsoh JY, Fung LC, Tong EK. Home Smoking Bans and Urinary NNAL Levels to Measure Tobacco Smoke Exposure in Chinese American Household Pairs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147682. [PMID: 34300133 PMCID: PMC8305615 DOI: 10.3390/ijerph18147682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 11/23/2022]
Abstract
Home smoking bans can reduce tobacco smoke exposure, but little is known about the impact for Chinese American household pairs. In this study of 202 household pairs with low acculturation, 53.9% reported a home smoking ban, 31.7% had inconsistent reports, and 14.4% reported no ban. With decreasing home smoking ban enforcement, more nonsmokers had tobacco smoke exposure (66.1%–86.2%) as measured by the tobacco-specific nitrosamine biomarker urine NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol). Despite reported bans, about one-quarter of nonsmokers still reported tobacco smoke exposure at home (23.6%–30%) within the past 2 months and three-quarters reported outdoor exposure. In adjusted regression analyses of geometric mean NNAL ratios, nonsmokers in households with no ban had over two times higher levels than nonsmokers in households with a ban: adjusted log NNAL ratio = 2.70 (95% CI 1.21, 6.03). Higher smoker NNAL level and nonsmoker English fluency were also significantly associated with nonsmoker NNAL levels. Nonsmoker levels in households with an inconsistent ban were not significantly different compared to those with a ban. Although home smoking bans were generally associated with lower NNAL levels, tobacco smoke exposure in this immigrant population with low English proficiency was higher than that of the general population. From a health equity standpoint, there is a need for broader implementation and enforcement of comprehensive smoke-free policies.
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Affiliation(s)
- Emiley Chang
- Department of Medicine, Harbor-UCLA Medical Center, 1000 W. Carson St, Torrance, CA 90502, USA;
- David Geffen School of Medicine, University of California—Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
- The Lundquist Institute, 1124 W Carson St, Torrance, CA 90502, USA
| | - Melanie Dove
- Department of Public Health Sciences, University of California—Davis, One Shields Ave, Medical Sciences 1-C, Davis, CA 95616, USA;
| | - Anne Saw
- Department of Psychology, DePaul College of Science and Health, 2219 North Kenmore Ave, Chicago, IL 60614, USA;
| | - Janice Y. Tsoh
- Department of Psychiatry, University of California—San Francisco, 401 Parnassus Ave, San Francisco, CA 94143, USA;
| | - Lei-Chun Fung
- Chinatown Public Health Center, San Francisco Department of Public Health, 1490 Mason St, San Francisco, CA 94133, USA;
| | - Elisa K. Tong
- Department of Medicine, UC Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA 95817, USA
- Correspondence:
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Zavala VA, Bracci PM, Carethers JM, Carvajal-Carmona L, Coggins NB, Cruz-Correa MR, Davis M, de Smith AJ, Dutil J, Figueiredo JC, Fox R, Graves KD, Gomez SL, Llera A, Neuhausen SL, Newman L, Nguyen T, Palmer JR, Palmer NR, Pérez-Stable EJ, Piawah S, Rodriquez EJ, Sanabria-Salas MC, Schmit SL, Serrano-Gomez SJ, Stern MC, Weitzel J, Yang JJ, Zabaleta J, Ziv E, Fejerman L. Cancer health disparities in racial/ethnic minorities in the United States. Br J Cancer 2021; 124:315-332. [PMID: 32901135 PMCID: PMC7852513 DOI: 10.1038/s41416-020-01038-6] [Citation(s) in RCA: 438] [Impact Index Per Article: 146.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 07/16/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023] Open
Abstract
There are well-established disparities in cancer incidence and outcomes by race/ethnicity that result from the interplay between structural, socioeconomic, socio-environmental, behavioural and biological factors. However, large research studies designed to investigate factors contributing to cancer aetiology and progression have mainly focused on populations of European origin. The limitations in clinicopathological and genetic data, as well as the reduced availability of biospecimens from diverse populations, contribute to the knowledge gap and have the potential to widen cancer health disparities. In this review, we summarise reported disparities and associated factors in the United States of America (USA) for the most common cancers (breast, prostate, lung and colon), and for a subset of other cancers that highlight the complexity of disparities (gastric, liver, pancreas and leukaemia). We focus on populations commonly identified and referred to as racial/ethnic minorities in the USA-African Americans/Blacks, American Indians and Alaska Natives, Asians, Native Hawaiians/other Pacific Islanders and Hispanics/Latinos. We conclude that even though substantial progress has been made in understanding the factors underlying cancer health disparities, marked inequities persist. Additional efforts are needed to include participants from diverse populations in the research of cancer aetiology, biology and treatment. Furthermore, to eliminate cancer health disparities, it will be necessary to facilitate access to, and utilisation of, health services to all individuals, and to address structural inequities, including racism, that disproportionally affect racial/ethnic minorities in the USA.
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Affiliation(s)
- Valentina A Zavala
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Paige M Bracci
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - John M Carethers
- Departments of Internal Medicine and Human Genetics, and Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Luis Carvajal-Carmona
- University of California Davis Comprehensive Cancer Center and Department of Biochemistry and Molecular Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
- Genome Center, University of California Davis, Davis, CA, USA
| | | | - Marcia R Cruz-Correa
- Department of Cancer Biology, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | - Melissa Davis
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Adam J de Smith
- Center for Genetic Epidemiology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Julie Dutil
- Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico
| | - Jane C Figueiredo
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rena Fox
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kristi D Graves
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA
| | - Andrea Llera
- Laboratorio de Terapia Molecular y Celular, IIBBA, Fundación Instituto Leloir, CONICET, Buenos Aires, Argentina
| | - Susan L Neuhausen
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
| | - Lisa Newman
- Division of Breast Surgery, Department of Surgery, NewYork-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
- Interdisciplinary Breast Program, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA
| | - Tung Nguyen
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Nynikka R Palmer
- Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
- Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Sorbarikor Piawah
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Stephanie L Schmit
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Silvia J Serrano-Gomez
- Grupo de investigación en biología del cáncer, Instituto Nacional de Cancerología, Bogotá, Colombia
| | - Mariana C Stern
- Departments of Preventive Medicine and Urology, Keck School of Medicine of USC, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey Weitzel
- Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jun J Yang
- Department of Pharmaceutical Sciences, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jovanny Zabaleta
- Department of Pediatrics and Stanley S. Scott Cancer Center LSUHSC, New Orleans, LA, USA
| | - Elad Ziv
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Fejerman
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
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Tong EK, Saw A, Fung LC, Li CS, Liu Y, Tsoh JY. Impact of a smoke-free-living educational intervention for smokers and household nonsmokers: A randomized trial of Chinese American pairs. Cancer 2019; 124 Suppl 7:1590-1598. [PMID: 29578595 DOI: 10.1002/cncr.31115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chinese American men smoke at a high rate, which puts household nonsmokers at risk. The objective of this study was to evaluate the effectiveness of a brief-intensity versus moderate-intensity smoke-free-living educational intervention for household pairs. METHODS The authors conducted a randomized controlled trial of Cantonese-speaking Chinese American smoker and household nonsmoker pairs in San Francisco, California. Pairs were randomized to moderate-intensity or brief-intensity group sessions with their household partner. The moderate-intensity group received 2 group sessions, a laboratory report of their baseline smoke exposure, as measured by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and 3 follow-up calls over 6 months. The brief-intensity group received 1 group session on tobacco-cessation resources. Primary outcomes were biochemically validated, past-month smoking abstinence and elimination of nonsmoker household exposure at 12 months. RESULTS Participant pairs (n = 203) were male smokers, one-half of whom did not intend to quit within 6 months, with mostly female spouses as household nonsmokers. Approximately three-quarters of nonsmokers in both groups already had smoke-free home rules. At 12 months, smokers in both groups had similar biochemically validated 30-day abstinence rates (moderate-intensity group, 0%-20.7%; brief-intensity group, 0%-20.0%; P = .002 over time). More smokers in the moderate-intensity group used subsequent cessation group classes (moderate-intensity group, 50%; brief-intensity group, 24%; P = .004). Household nonsmokers in both groups had similar biochemically validated rates of no home exposure (moderate-intensity group, 24.5%-42.2%; brief-intensity group, 24.8%-33.3%; P = .0001 over time). CONCLUSIONS A moderate-intensity smoke-free-living educational intervention for Chinese-speaking household pairs was not more effective than a brief-intensity intervention for smoking abstinence and elimination of household nonsmoker exposure. Abstinence rates were similar to those achieved with standard group counseling. Cancer 2018;124:1590-8. © 2018 American Cancer Society.
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Affiliation(s)
- Elisa K Tong
- Department of Internal Medicine, University of California-Davis, Sacramento, California
| | - Anne Saw
- Department of Psychology, DePaul University, Chicago, Illinois
| | - Lei-Chun Fung
- Chinatown Public Health Center, San Francisco, California
| | - Chin-Shang Li
- Department of Public Health Sciences, University of California-Davis, Sacramento, California
| | - Yu Liu
- Department of Statistics, University of California-Davis, Sacramento, California
| | - Janice Y Tsoh
- Department of Psychiatry, University of California-San Francisco, San Francisco, California
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Saw A, Paterniti DA, Fung LC, Tsoh JY, Tong EK. Perspectives of Chinese American smoker and nonsmoker household pairs about the creating smokefree living together program. Cancer 2019; 124 Suppl 7:1599-1606. [PMID: 29578597 DOI: 10.1002/cncr.31220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/27/2017] [Accepted: 12/14/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chinese men smoke at high rates, and this puts household members at risk for tobacco-related diseases. Culturally responsive interventions that provide education and support are needed to promote smokefree living and reduce smoke exposure, particularly for US immigrants who experience changes in smokefree social norms. This qualitative study examines perspectives of Chinese American smoker and nonsmoker household pairs in the Creating Smokefree Living Together program. METHODS Four focus groups were conducted with 30 Chinese American participants (15 smokers and 15 nonsmokers) who, in household pairs, completed smokefree education interventions of either brief or moderate intensity. Nearly three-quarters of the smokers continued to smoke after the intervention at the time of focus group participation. All smokers were male, and most household nonsmokers were female spouses. All participants had limited English proficiency. Focus group meetings were recorded, and the recordings were translated and transcribed. Transcripts and field notes were thematically analyzed. RESULTS The following themes, shared by smokers and nonsmokers across interventions, were identified: 1) there was a preference for dyadic and group interventions because of the support offered, 2) increased knowledge of the health harms of smoke exposure within a pair improved the nonsmoker's support for smokefree living, 3) learning communication strategies improved household relationships and assertiveness for smokefree environments, 4) biochemical feedback was useful but had short-term effects, and 5) project magnets provided cues to action. CONCLUSIONS Involving household partners is critical to smokefree interventions. Simple reminders at home appear to be more powerful than personal biochemical feedback of smoke exposure for sustaining motivation and engagement in ongoing behavioral changes within the household. Cancer 2018;124:1599-606. © 2018 American Cancer Society.
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Affiliation(s)
- Anne Saw
- Department of Psychology, DePaul University, Chicago, Illinois
| | - Debora A Paterniti
- Center for Healthcare Policy and Research, Davis Medical Center, University of California, Sacramento, California.,Department of Sociology, Sonoma State University, Rohnert Park, California
| | - Lei-Chun Fung
- Chinatown Public Health Center, San Francisco Department of Public Health, San Francisco, California
| | - Janice Y Tsoh
- Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Elisa K Tong
- Department of Internal Medicine, Davis Medical Center, University of California, Sacramento, California
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Vu M, Escoffery C, Srivanjarean Y, Do E, Berg CJ. Acculturation and Exposure to Secondhand Smoke in the Home Among Vietnamese Immigrants in Metropolitan Atlanta. J Immigr Minor Health 2019; 22:580-587. [PMID: 31154544 DOI: 10.1007/s10903-019-00906-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study represents the first effort to examine associations between various measures of acculturation and past 30-day secondhand smoke (SHS) exposure among Vietnamese-Americans in metro-Atlanta, one of the areas with the highest number of Vietnamese-Americans in the U.S. Survey data of 96 Vietnamese-American nonsmoking adults attending health fairs/programs hosted by community-based organizations (2017-2018) were analyzed. Acculturation-related predictors included Vancouver Acculturation Index, language fluency, years in the U.S., and area-level proportion of Asian residents. The sample was an average 37.49 years old and 65.3% female; the average number of years in the U.S. was 18.17 years. Past 30-day SHS exposure was reported by 21.9%. In multiple logistic regressions, the only variable associated with SHS exposure was the number of years living in the U.S. [OR = 0.91, CI = (0.85-0.99), p = 0.02]. Newly-immigrated Vietnamese-Americans have increased SHS exposure risk. Education about smoke-free policies and harmful effects of SHS may benefit this population.
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Affiliation(s)
- Milkie Vu
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, GCR 521, Atlanta, GA, 30322, USA.
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, GCR 521, Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | | | - Elizabeth Do
- Center for Pan Asian Community Services, Atlanta, GA, USA
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, GCR 521, Atlanta, GA, 30322, USA
- Winship Cancer Institute, Emory University, Atlanta, GA, USA
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Research Needs on Respiratory Health in Migrant and Refugee Populations. An Official American Thoracic Society and European Respiratory Society Workshop Report. Ann Am Thorac Soc 2018; 15:1247-1255. [DOI: 10.1513/annalsats.201807-478st] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mukherjea A, Modayil MV, Tong EK. Moving toward a true depiction of tobacco behavior among Asian Indians in California: Prevalence and factors associated with cultural smokeless tobacco product use. Cancer 2018; 124 Suppl 7:1607-1613. [PMID: 29578599 PMCID: PMC5876718 DOI: 10.1002/cncr.31102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 10/10/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Asian Indians (AIs) in the United States exhibit disproportionate burdens of oral cancer and cardiovascular disease, which are potentially linked to smokeless tobacco. However, little is known about the use of cultural smokeless tobacco (CST) products in this population. METHODS California Asian Indian Tobacco Use Survey data from 2004 (n = 1618) were used to investigate CST prevalence among California's AIs. CST products included paan, paan masala, and gutka. A multivariable logistic regression was conducted to examine factors (socioeconomic status, acculturation measures, and religious affiliation) associated with current CST use versus never use. RESULTS The current CST prevalence was 13.0% (14.0% for men and 11.8% for women). In contrast, the prevalence of current cigarette use was 5.5% (8.7% for men and 1.9% for women), and the prevalence was lower for cultural smoked tobacco (0.1% for bidis and 0.5% for hookahs). Factors associated with CST use included the following: being male, being 50 years old or older, being an immigrant, speaking an AI language at home, having a higher level of education (adjusted odds ratio [AOR] for high school/some college, 2.6; 95% confidence interval [CI], 1.1-6.5; AOR for college degree or higher, 4.0; 95% CI, 1.7-9.5), having a higher income (AOR for $75,000-$100,000, 2.5; 95% CI, 1.3-4.7; AOR for ≥$100,000, 2.6; 95% CI, 1.4-5.0), identifying as non-Sikh (AOR for Hinduism, 10.0; 95% CI, 6.0-16.5; AOR for other faiths, 10.2; 95% CI, 5.9-17.7), and disagreeing that spiritual beliefs are the foundation of life (AOR, 2.1; 95% CI, 1.2-3.5). CONCLUSIONS The current CST prevalence is relatively high among California's AIs in comparison with the prevalence of smoking, with narrower differences between sexes. The association with a higher socioeconomic status is contrary to typical cigarette smoking patterns. Acculturation and religious affiliation are important factors associated with current use. Health care providers and policymakers should consider such determinants for targeted interventions. Cancer 2018;124:1607-13. © 2018 American Cancer Society.
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Affiliation(s)
- Arnab Mukherjea
- Health Sciences Program; College of Science; California State University, East Bay (Hayward, CA, USA)
| | - Mary V. Modayil
- Primary Health Care; Alberta Health Services (Edmonton, Alberta, Canada)
| | - Elisa K. Tong
- Division of General Internal Medicine; University of California, Davis (Sacramento, CA, USA)
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Echeverria SE, Mustafa M, Pentakota SR, Kim S, Hastings KG, Amadi C, Palaniappan L. Social and clinically-relevant cardiovascular risk factors in Asian Americans adults: NHANES 2011-2014. Prev Med 2017; 99:222-227. [PMID: 28219784 DOI: 10.1016/j.ypmed.2017.02.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 12/24/2016] [Accepted: 02/17/2017] [Indexed: 12/17/2022]
Abstract
Little evidence exists examining cardiovascular risk factors among Asian Americans and how social determinants such as nativity status and education pattern risk in the United States (U.S.) context. We used the National Health and Nutrition Examination Survey, which purposely oversampled Asian Americans from 2011 to 2014, and examined prevalence of Type II diabetes, smoking and obesity for Asian Americans (n=1363) and non-Latino Whites (n=4121). We classified Asian Americans as U.S. or foreign-born and by years in the U.S. Obesity status was based on standard body mass index (BMI) cut points of ≥30kg/m2 and Asian-specific cut points (BMI≥25kg/m2) that may be more clinically relevant for this population. We fit separate logistic regression models for each outcome using complex survey design methods and tested for the joint effect of race, nativity and education on each outcome. Diabetes and obesity prevalence (applying Asian-specific BMI cut points) were higher among Asian Americans when compared to non-Latino Whites but smoking prevalence was lower. These patterns remained in fully adjusted models and showed small increases with longer duration in the U.S. Joint effects models showed higher odds of prevalent Type II diabetes and obesity (Asian-specific) for foreign-born Asians, regardless of years in the U.S. and slightly higher risk for low education, when compared to non-Latino Whites with high education. Smoking models showed significant interaction effects between race and education for non-Latino Whites only. Our study supports the premise that social as well as clinical factors should be considered when developing health initiatives for Asian Americans.
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Affiliation(s)
- Sandra E Echeverria
- CUNY Graduate School of Public Health and Health Policy, New York, NY, United States.
| | - Mehnaz Mustafa
- New Jersey Department of Health and Human Services, United States
| | - Sri Ram Pentakota
- Department of Surgery, Rutgers New Jersey Medical School, Newark, NY, United States.
| | - Soyeon Kim
- Department of Biostatistics, Rutgers School of Public Health, New Brunswick, NY, United States.
| | - Katherine G Hastings
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States.
| | - Chioma Amadi
- CUNY Graduate School of Public Health and Health Policy, New York, NY, United States.
| | - Latha Palaniappan
- Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States.
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Li J, Collins D. Smoking environments in transition: the experiences of recent Chinese migrants to Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:65-74. [PMID: 26087896 DOI: 10.1111/hsc.12252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2015] [Indexed: 06/04/2023]
Abstract
International migrants experience first-hand differences between countries in terms of the social meanings, spatial regulation and prevalence of smoking. This research centred on the smoking-related perceptions, experiences and behaviours of recent migrants from China to Canada. Eight focus groups were held in Edmonton, Alberta, in July-October 2013 to explore migrants' understandings of the practices and meanings of smoking in both countries. There were 58 participants (37 non-smokers and 21 smokers), most of whom were international students. Qualitative content analysis of focus group transcripts was undertaken to identify key themes. Participants observed that smoking remains almost ubiquitous in China due to ineffective spatial restrictions and the social importance of smoking among men. By contrast, smoking bans in Canada were perceived as effective due to widespread compliance and expectations of enforcement. They were conscious that male smoking was both less prevalent and less socially valued in Canada; conversely, female smoking was perceived as more accepted in Canada than in China. There was broad agreement that smoking was tolerated in Canada, provided it occurred in appropriate places. Complying with widespread spatial restrictions brought about changes in smokers' behaviours: they smoked less often, and consumed fewer cigarettes. Because smoking was more difficult to perform, participants thought the Canadian context supported quitting. Non-smokers were enthusiastic about smoke-free environments in Canada, and had become acculturated to air that did not smell of smoke. These findings affirm the importance of comprehensive smoking bans, backed by enforcement, in contributing to the denormalisation of smoking and the protection of non-smokers.
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Affiliation(s)
- Jia Li
- Human Geography Program (EAS), University of Alberta, Edmonton, Alberta, Canada
| | - Damian Collins
- Human Geography Program (EAS), University of Alberta, Edmonton, Alberta, Canada
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Petersen AB, Tsoh JY, Nguyen TT, McPhee SJ, Burke NJ. Suffering in Silence: Impact of Tobacco Use on Communication Dynamics Within Vietnamese and Chinese Immigrant Families. JOURNAL OF FAMILY NURSING 2016; 22:108-132. [PMID: 26717960 PMCID: PMC5714689 DOI: 10.1177/1074840715618194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The goal of this project was to explore family communication dynamics and their implications for smoking cessation. We conducted 39 in-depth dyadic and individual qualitative interviews with 13 immigrant smoker-family member pairs of Vietnamese ( n = 9 dyads, 18 individuals) and Chinese ( n = 4 dyads, 8 individuals) descent, including seven current and six former smokers and 13 family members. All 13 dyadic and 26 individual interviews were analyzed using a collaborative crystallization process as well as grounded theory methods. We identified three interrelated pathways by which tobacco use in immigrant Vietnamese and Chinese families impacts family processes and communication dynamics. Using a two-dimensional model, we illustrate how the shared consequences of these pathways can contribute to a dynamic of avoidance and noncommunication, resulting in individual family members "suffering in silence" and ultimately smoking being reinforced. We discuss the implications of these findings for development of smoking cessation interventions.
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Affiliation(s)
- Anne Berit Petersen
- 1 University of California, San Francisco, CA, USA
- 2 Loma Linda University, CA, USA
| | | | | | | | - Nancy J Burke
- 1 University of California, San Francisco, CA, USA
- 3 University of California, Merced, CA, USA
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Yang L, Tong EK, Mao Z, Hu TW, Lee AH. A Clustered Randomized Controlled Trial to Reduce Secondhand Smoke Exposure Among Nonsmoking Pregnant Women in Sichuan Province, China. Nicotine Tob Res 2015; 18:1163-70. [PMID: 26296651 DOI: 10.1093/ntr/ntv171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 07/30/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Nonsmoking pregnant women in China have significant exposure to secondhand smoke (SHS). Few interventions have focused on pregnant women reducing their SHS exposure. METHODS This clustered randomized controlled trial, conducted at eight hospitals in Sichuan, China, compared a prenatal health education intervention with usual clinical care as a control. The primary outcome was self-reported "no SHS exposure" before and 3 months after birth. The intervention consisted of three large group educational sessions, standardized clinician advice, brief monthly follow-up calls, and educational materials and resources. A random sample of participants was biochemically validated before birth with hair nicotine, a long-term biomarker of smoke exposure. RESULTS Overall, 1181 participants were randomized to intervention (n = 526) and control (n = 655) groups. More participants in the intervention group than the control group reported no SHS exposure 3 months after birth (Total: 77.9% vs. 52.6%, P < .001; Home: 81.2% vs. 53.3%, P < .001). The intervention group also had greater changes in improved smoke-free homes and SHS knowledge and attitudes. Controlling for covariates, the intervention group was less likely to report SHS exposure than the control group (Total: OR = 0.47, 95% CI = 0.31 to 0.71; Home: OR = 0.33, 95% CI = 0.21 to 0.53), and this effect was sustained 3 months after birth. The adjusted log concentration of hair nicotine for the intervention group decreased by 0.28 log µg/g more than the control group. CONCLUSIONS Our smoke-free health education intervention for nonsmoking pregnant women significantly reduced SHS exposure before and after birth. This intervention model can become part of a standard protocol for the care of pregnant women in hospital settings.
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Affiliation(s)
- Lian Yang
- Department of Health Economics, School of Administration, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Elisa K Tong
- Department of Internal Medicine, University of California, Davis, Sacramento, CA;
| | - Zhengzhong Mao
- Department of Health Economics, Huaxi School of Public Health, University of Sichuan, Chengdu, China
| | - Teh-Wei Hu
- School of Public Health, University of California, Berkeley, Berkeley, CA; Center for International Tobacco Control, Public Health Institute, Berkeley, CA
| | - Anita H Lee
- Center for International Tobacco Control, Public Health Institute, Berkeley, CA
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Tong EK, Fagan P, Cooper L, Canto M, Carroll W, Foster-Bey J, Hébert JR, Lopez-Class M, Ma GX, Nez Henderson P, Pérez-Stable EJ, Santos L, Smith JH, Tan Y, Tsoh J, Chu K. Working to Eliminate Cancer Health Disparities from Tobacco: A Review of the National Cancer Institute's Community Networks Program. Nicotine Tob Res 2015; 17:908-23. [PMID: 26180215 PMCID: PMC4542844 DOI: 10.1093/ntr/ntv069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 03/13/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION In 2005, the National Cancer Institute funded the Community Networks Program (CNP), which aimed to reduce cancer health disparities in minority racial/ethnic and underserved groups through community-based participatory research, education, and training. The purpose of this study was to describe the CNP model and their tobacco-related work in community-based research, education, and training using a tobacco disparities research framework. METHODS We conducted a comprehensive review of the CNP tobacco-related activities including publications, published abstracts, research activities, trainee pilot studies, policy-related activities, educational outreach, and reports produced from 2005-2009. Two authors categorized the tobacco-related activities and publications within the framework. RESULTS Although there was no mandate to address tobacco, the CNPs produced 103 tobacco-related peer-reviewed publications, which reflects the largest proportion (12%) of all CNP cancer-related publications. Selected publications and research activities were most numerous under the framework areas "Psychosocial Research," "Surveillance," "Epidemiology," and "Treatment of Nicotine Addiction." Thirteen CNPs participated in tobacco control policymaking in mainstream efforts that affected their local community and populations, and 24 CNPs conducted 1147 tobacco-related educational outreach activities. CNP activities that aimed to build research and infrastructure capacity included nine tobacco-related pilot projects representing 16% of all CNP cancer-related pilot projects, and 17 publications acknowledging leveraged partnerships with other organizations, a strategy encouraged by the CNP. CONCLUSIONS The CNP is a promising academic-community model for working to eliminate tobacco-related health disparities. Future efforts may address scientific gaps, consider collaboration across groups, assess the extent of operationalizing community-based participatory research, and improve common tracking measures.
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Affiliation(s)
- Elisa K Tong
- Department of Internal Medicine, University of California, Davis, Sacramento, CA;
| | - Pebbles Fagan
- Cancer Prevention and Control Program, University of Hawaii Cancer Center, Honolulu, HI
| | | | - Maria Canto
- Center for Research Capacity Building, National Institute of General Medical Sciences, Bethesda, MD
| | - William Carroll
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | - James R Hébert
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | | | - Grace X Ma
- Department of Public Health, Temple University, Philadelphia, PA
| | | | - Eliseo J Pérez-Stable
- Department of Internal Medicine, University of California, San Francisco, San Francisco, CA
| | | | | | - Yin Tan
- Department of Public Health, Temple University, Philadelphia, PA
| | - Janice Tsoh
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Kenneth Chu
- Formerly National Cancer Institute's Center to Reduce Cancer Health Disparities (retired), Bethesda, MD
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Kim SS, Kim SH, Fang H, Kwon S, Shelley D, Ziedonis D. A Culturally Adapted Smoking Cessation Intervention for Korean Americans: A Mediating Effect of Perceived Family Norm Toward Quitting. J Immigr Minor Health 2015; 17:1120-9. [PMID: 24878686 PMCID: PMC4250475 DOI: 10.1007/s10903-014-0045-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Korean men and women have the highest current smoking rates across all Asian ethnic subgroups in the United States. This is a 2-arm randomized controlled study of a culturally adapted smoking cessation intervention. The experimental condition received eight weekly 40-min individualized counseling sessions that incorporated Korean-specific cultural elements, whereas the control condition received eight weekly 10-min individualized counseling sessions that were not culturally adapted. All participants also received nicotine patches for 8 weeks. One-hundred nine Korean immigrants (91 men and 18 women) participated in the study. The rate of biochemically verified 12-month prolonged abstinence was significantly higher for the experimental condition than the control condition (38.2 vs. 11.1 %, χ (2) = 10.7, p < 0.01). Perceived family norm significantly mediated the effect of cessation intervention on abstinence. Smoking cessation intervention for Korean Americans should be culturally adapted and involve family members to produce a long-term treatment effect.
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Affiliation(s)
- Sun S Kim
- University of Massachusetts Medical School, Department of Psychiatry, Worcester MA, USA
| | - Seong-Ho Kim
- Korean Bible University, Department of Social Welfare, Seoul, South Korea
| | - Hua Fang
- University of Massachusetts Medical School, Department of Quantitative Health Sciences, Worcester MA, USA
| | - Simona Kwon
- New York University, School of Medicine, New York, NY, USA
| | - Donna Shelley
- New York University, School of Medicine, New York, NY, USA
| | - Douglas Ziedonis
- University of Massachusetts Medical School, Department of Psychiatry, Worcester MA, USA
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Mukherjea A, Wackowski OA, Lee YO, Delnevo CD. Asian American, Native Hawaiian and Pacific Islander tobacco use patterns. Am J Health Behav 2014; 38:362-9. [PMID: 24636032 PMCID: PMC5173306 DOI: 10.5993/ajhb.38.3.5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To provide a national depiction of Asian American (AA) and Native Hawaiian/Pacific Islander (NHPI) tobacco use and highlight considerations for targeted interventions. METHODS We analyzed data from the 2009-2010 National Adult Tobacco Survey for subgroup differences in prevalence and consumption of various tobacco products. RESULTS Use varies considerably by ethnic subgroups for cigarette smoking (including menthol) and other forms of tobacco. Despite being lighter, less frequent, and seemingly less dependent smokers, AANHPIs had similar quit ratios as non-AANHPIs. CONCLUSIONS AA and NHPI disparities in tobacco use may be due to underutilization of cessation resources, including those for non-cigarette tobacco products, and lack of availability of culturally-appropriate resources. Community-based and regulatory approaches should be employed to reduce use of all tobacco products, especially among high prevalence subgroups.
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Affiliation(s)
- Arnab Mukherjea
- Center for Tobacco Control Research & Education / Division of General Internal Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA.
| | - Olivia A Wackowski
- Department of Health Education and Behavioral Science, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Youn Ok Lee
- RTI International, Research Triangle Park, NC, USA
| | - Cristine D Delnevo
- Department of Health Education and Behavioral Science, Rutgers School of Public Health, New Brunswick, NJ, USA
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Tong EK, Lew R. Moving communities toward policy change: APPEAL's 4-prong policy change model. Health Promot Pract 2013; 14:29S-35S. [PMID: 23707962 DOI: 10.1177/1524839913484763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Policy change is recognized for underlying much of the success of tobacco control. However, there is little evidence and attention on how Asian American and Native Hawaiian and Pacific Islander (AA and NHPI) communities may engage in policy change. Challenges for AA and NHPI communities include the racial/ethnic and geographic diversity, and tobacco data accurately representing the communities. Over the past decade, the Asian Pacific Partners for Empowerment, Advocacy and Leadership (APPEAL) has worked to develop and implement policy change for AA and NHPI communities. This article describes APPEAL's 4-prong policy change model, in the context of its overall strategic framework for policy change with communities that accounts for varying levels of readiness and leadership capacity, and targets four different levels of policy change (community, mainstream institution, legislative, and corporate). The health promotion implication of this framework for tobacco control policy engagement is for improving understanding of effective pathways to policy change, promoting innovative methods for policy analysis, and translating them into effective implementation and sustainability of policy initiatives. The APPEAL strategic framework can transcend into other communities and health topics that ultimately may contribute to the elimination of health disparities.
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Affiliation(s)
- Elisa K Tong
- University of California, Davis, Sacramento, CA, USA
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16
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Li S, Delva J. Social capital and smoking among Asian American men: an exploratory study. Am J Public Health 2012; 102 Suppl 2:S212-21. [PMID: 22401511 DOI: 10.2105/ajph.2011.300442] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined how different dimensions of social capital (i.e., family and friend connections, neighborhood and family cohesion, family conflict) were associated with smoking behavior among a nationally representative sample of Asian American men and whether the associations varied by ethnic group. METHODS The sample consisted of 998 adult Asian American men who participated in the National Latino and Asian American Survey from 2002 to 2003. We conducted weighted multivariate logistic regressions on data for the sample and for each of 4 ethnic subgroups (Chinese, Vietnamese, Filipino, and Other). RESULTS Vietnamese American men had the highest prevalence of current smoking; Chinese American men, the lowest. After controlling for sociodemographics, socioeconomic status, acculturation, and perceived discrimination, neighborhood cohesion was inversely associated with smoking among Asian American men, and family and friend connections and family cohesion were not. An exception was family cohesion, which was associated with increased odds of smoking among Filipino American men. CONCLUSIONS The relationship between social capital and smoking among Asian American men varied according to specific dimensions of social capital and was ethnicity specific. These findings highlight the need for smoking prevention and cessation interventions to take into consideration the heterogeneity that exists among Asian Americans.
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Affiliation(s)
- Shijian Li
- Center for Study of Asian American Health, School of Medicine, New York University, New York, NY 10016, USA.
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18
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Trinidad DR, Pérez-Stable EJ, White MM, Emery SL, Messer K. A nationwide analysis of US racial/ethnic disparities in smoking behaviors, smoking cessation, and cessation-related factors. Am J Public Health 2011; 101:699-706. [PMID: 21330593 DOI: 10.2105/ajph.2010.191668] [Citation(s) in RCA: 318] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We used nationally representative data to examine racial/ethnic disparities in smoking behaviors, smoking cessation, and factors associated with cessation among US adults. METHODS We analyzed data on adults aged 20 to 64 years from the 2003 Tobacco Use Supplement to the Current Population Survey, and we examined associations by fitting adjusted logistic regression models to the data. RESULTS Compared with non-Hispanic Whites, smaller proportions of African Americans, Asian Americans/Pacific Islanders, and Hispanics/Latinos had ever smoked. Significantly fewer African Americans reported long-term quitting. Racial/ethnic minorities were more likely to be light and intermittent smokers and less likely to smoke within 30 minutes of waking. Adjusted models revealed that racial/ethnic minorities were not less likely to receive advice from health professionals to quit smoking, but they were less likely to use nicotine replacement therapy. CONCLUSIONS Specific needs and ideal program focuses for cessation may vary across racial/ethnic groups, such that approaches tailored by race/ethnicity might be optimal. Traditional conceptualizations of cigarette addiction and the quitting process may need to be revised for racial/ethnic minority smokers.
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Affiliation(s)
- Dennis R Trinidad
- School of Community and Global Health, Claremont Graduate University, Claremont, San Dimas, CA, USA.
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19
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Yang L, Tong EK, Mao Z, Hu TW. Exposure to secondhand smoke and associated factors among non-smoking pregnant women with smoking husbands in Sichuan province, China. Acta Obstet Gynecol Scand 2010; 89:549-557. [PMID: 20367430 DOI: 10.3109/00016341003713851] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure harms pregnant women and the fetus. China has the world's largest number of smokers and a high male smoking prevalence rate. OBJECTIVE To compare exposure to SHS among rural and urban Chinese non-smoking pregnant women with smoking husbands, and analyze factors associated with the level of SHS exposure and hair nicotine concentration. SETTING Sichuan province, China. POPULATION In all 1,181 non-smoking pregnant women with smoking husbands recruited from eight district/county Women and Children's hospitals. METHODS The women completed a questionnaire in April and May 2008. Based on systematic sampling, 186 pregnant women were selected for sampling the nicotine concentration in their hair. Ordinal logistic regression analysis was conducted to examine correlates with self-reported SHS exposure (total and at home); linear regression was conducted for the sub-sample of hair nicotine concentrations. MAIN OUTCOME MEASURES Secondhand smoking exposure rates, hair nicotine levels. RESULTS About 75.1% of the non-smoking pregnant women with smoking husbands reported regular SHS exposure. The major source of exposure was through their husband. In the multivariate analysis, the risk of greater SHS exposure (total and at home) and hair nicotine concentration was increased for women who were rural, had a husband with greater cigarette consumption, less knowledge about SHS, less negative attitudes about SHS, and no smoke-free home rules. CONCLUSIONS The high prevalence rate of SHS exposure suggests that it is important for non-smoking pregnant women, especially rural women, to establish smoke-free home rules and increase knowledge and negative attitudes towards SHS.
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Affiliation(s)
- Lian Yang
- Department of Health Economics, Huaxi School of Public Health, University of Sichuan, Chengdu, China.,Department of Health Economics, School of Public Health and Administration, Chengdu University of Traditional Chinese Medicine, China
| | - Elisa K Tong
- Department of Internal Medicine, University of California, Davis, USA
| | - Zhengzhong Mao
- Department of Health Economics, Huaxi School of Public Health, University of Sichuan, Chengdu, China
| | - Teh-Wei Hu
- School of Public Health, University of California, Berkeley, USA
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Zhu SH, Wong S, Stevens C, Nakashima D, Gamst A. Use of a smokers' quitline by Asian language speakers: results from 15 years of operation in California. Am J Public Health 2010; 100:846-52. [PMID: 20299658 DOI: 10.2105/ajph.2009.168385] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined state quitline utilization by smokers who called Chinese-, Vietnamese-, or Korean-language lines, and compared their usage rates to those of Asians and Whites calling the English-language line. METHODS Using data from 15 years (1993-2008) of operation of the California quitline (which included data on 22 061 callers to Chinese, Korean, and Vietnamese lines) and from multiple California Health Interview Surveys, we computed the call rates for Whites, English-speaking Asians, and the 3 Asian-language groups. We also examined callers' demographics and where they heard about the quitline. RESULTS Asian smokers who spoke English were significantly less likely than English-speaking White smokers to call the quitline (odds ratios range from 0.36 to 0.62). Smokers speaking 1 of the 3 Asian languages were no less likely than White smokers to call (odds ratios range from 0.82 to 3.25). More than 80% of those calling the Asian-language lines reported hearing about the quitline through mass media. CONCLUSIONS Contrary to general expectation, smokers speaking Asian languages were just as likely to call the quitline as English-speaking White smokers. State quitlines should consider adding Asian-language lines to help address disparities in access to cessation services.
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Affiliation(s)
- Shu-Hong Zhu
- Cancer Center 0905, University of California, San Diego, La Jolla, CA 92093-0905, USA.
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21
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Cook DM, Lee WL, Yang W. Factors associated with total restrictions on smoking at work and at home: a study among populations in multiple US states and the US Virgin Islands. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2009; 15:392-401. [PMID: 19886350 DOI: 10.1179/oeh.2009.15.4.392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study investigated factors associated with smoking restrictions in the workplace and at home in order to better understand the effects of workplace smoking restrictions. Data from the 2006 Behavior Risk Factor Surveillance System were analyzed. Multiple logistic regression was used to determine independent risk factors for potential smoking exposure at work and at home. The population potentially exposed at work were more likely to be young, male, low-income, Latino adults without college degrees or health insurance; they were also more likely to be a current or former smoker and be at risk for heavy drinking. Our study also investigated self-reported restrictions at home and found significant disparities between populations. We conclude that men, Latinos, and young adults are more likely to live in a home with a smoking ban, but are disproportionately exposed to risks at work, presumably against their preferences. Workplace smoking restrictions in 2006 offered unequal protection.
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Affiliation(s)
- Daniel M Cook
- University of Nevada-Reno, School of Community Health Sciences, Lombardi Building 203A, Reno, NV 89557-0274, USA.
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Tong EK, Tang H, Tsoh J, Wong C, Chen MS. Smoke-free policies among Asian-American women: comparisons by education status. Am J Prev Med 2009; 37:S144-50. [PMID: 19591754 PMCID: PMC3992924 DOI: 10.1016/j.amepre.2009.05.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/03/2009] [Accepted: 05/05/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND California has significantly decreased racial/ethnic and educational disparities in smoke-free home and indoor work policies. California's ethnic-specific surveys present an opportunity to disaggregate data and examine the impact of California's smoke-free social norm campaign for Asian-American women. METHODS The California Tobacco Use Surveys for Chinese Americans and Korean Americans were conducted in 2003 and analyzed in 2008 to compare women with lower ( RESULTS Lower-educated and higher-educated women had similar proportions of smoke-free policies at home (58%) or indoor work (90%). However, lower-educated women were more likely than higher-educated women to report anyone ever smoking at home (OR=1.62, 95% CI=1.06, 2.48, p=0.03) and exposure during the past 2 weeks at an indoor workplace (OR=2.43, 95% CI= 1.30, 4.55, p=0.005), even after controlling for ethnicity, smoke-free policy, knowledge about the health consequences of secondhand smoke exposure, and acculturation. There was no interaction between education and knowledge about secondhand smoke health harms. CONCLUSIONS The intended consequences of California's tobacco-control efforts have resulted in similar rates of smoke-free policies at home and in indoor work environments among Asian-American women across educational levels. However, an unintended consequence of this success is a disparity in enforcement by educational status, with lower-educated Asian-American women reporting greater smoke exposure despite similar rates of knowledge about the health consequences of secondhand smoke exposure. Besides establishing policies, lower-educated Asian-American women may need to be empowered to assert and enforce their right to smoke-free environments.
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Affiliation(s)
- Elisa K Tong
- Department of Internal Medicine, University of California, Davis, California, USA.
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Mills AL, Messer K, Gilpin EA, Pierce JP. The effect of smoke-free homes on adult smoking behavior: a review. Nicotine Tob Res 2009; 11:1131-41. [PMID: 19633273 DOI: 10.1093/ntr/ntp122] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Smoke-free homes are known to reduce exposure to harmful secondhand smoke. Recent studies suggest that they may also positively affect smoking behavior among smokers themselves. METHODS We review the literature on the effect of smoke-free homes on adult smoking behavior. The literature search included database (PubMed) and manual searches of related articles and reference lists for English-language studies published from 1 January 1990 to 16 November 2008. RESULTS We identified 16 cross-sectional and 7 longitudinal studies of the population-level association of smoke-free homes with adult smoking behavior. Additional studies provided population estimates of trends in and correlates of smoke-free homes. Prevalence of smoke-free homes varies but has been increasing over time in the countries studied and was greater among smokers who were younger, of higher income or educational attainment, smoked fewer cigarettes per day, or lived with a nonsmoking adult or child. Both longitudinal and cross-sectional studies showed that smokers who had or who newly implemented a smoke-free home were significantly more likely to make a quit attempt and to be abstinent, after controlling for confounding factors. In longitudinal studies, those who continued to smoke had a modest, but significant, decrease in cigarette consumption at follow-up. DISCUSSION There is strong and consistent population-level evidence that a smoke-free home is associated with increased smoking cessation and decreased cigarette consumption in adult smokers. As they not only reduce exposure to secondhand smoke but also increase cessation rates, promotion of smoke-free homes should be a key element in tobacco control programs.
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Affiliation(s)
- Alice L Mills
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, CA 92093-0901, USA
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