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Uong SP, Torres JM, Alexeeff SE, Morey BN, Caan BJ, Kushi LH, Kroenke CH. Differences in Smoking Behavior by Nativity, Race/Ethnicity, and Education among Women Diagnosed with Breast Cancer. Cancer Epidemiol Biomarkers Prev 2024; 33:694-702. [PMID: 38345508 PMCID: PMC11062809 DOI: 10.1158/1055-9965.epi-23-0386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/22/2023] [Accepted: 02/08/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND We evaluated smoking differences across nativity and race/ethnicity among women diagnosed with breast cancer. METHODS In our Northern Californian pooled population of 5,653 [670 Asian, 690 Hispanic, and 4,300 non-Hispanic White (White)] women diagnosed with breast cancer, we evaluated smoking differences across nativity, race/ethnicity, and acculturation and effect modification of nativity by race/ethnicity and education. RESULTS Foreign-born women currently smoked less than US-born women [odds ratio (OR) = 0.46, 95% confidence limit (CL): 0.29-0.72]. Hispanic (OR = 0.50; 95% CL: 0.32-0.78) women currently smoked less than White women. Among those who ever smoked (n = 2,557), foreign-born women smoked 5.23 fewer pack-years (PY) than US-born women (95% CL: -2.75 to -7.70). Furthermore, Asian (-4.60, 95% CL: -0.81 to -8.39) and Hispanic (-6.79, 95% CL: -4.14 to -9.43) women smoked fewer PY than White women. Associations were generally suggestive of greater smoking with greater acculturation (immigration age, US years, survey language). Finally, associations for nativity differed by education but not race/ethnicity, with a higher likelihood of smoking in US-born women only among those with less than a bachelor's degree (OR = 2.84, 95% CL: 2.15-3.77; current smoking: P = 0.01, PY: P = 0.05). CONCLUSIONS Asian and Hispanic (vs. White) and foreign-born (vs. US-born) breast cancer survivors reported fewer smoking behaviors. Smoking differences across nativity and education were driven by higher rates of smoking in US-born women with lower educational attainment. IMPACT Smoking behavioral patterns were similar among breast cancer survivors and the general population, informing potential smoking interventions.
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Affiliation(s)
- Stephen P. Uong
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | | | - Stacey E. Alexeeff
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | | | - Bette J. Caan
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Lawrence H. Kushi
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
| | - Candyce H. Kroenke
- Kaiser Permanente Northern California, Division of Research, Oakland, CA
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JuÁrez SP, Honkaniemi H, Gustafsson NK, Berg L. Is duration of residence a proxy for acculturation? The case of health risk behaviors among international immigrants. Scand J Public Health 2023:14034948231199534. [PMID: 37723980 DOI: 10.1177/14034948231199534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
AIMS Among international immigrants, health changes by duration of residence are commonly interpreted as an expression of acculturation to the receiving country context. This study compares changes in immigrants' health risk behaviors by duration of residence to changes by acculturation levels, in order to assess whether duration of residence can be regarded as a proxy for acculturation. METHODS Using data from a previous systematic review, we identified 17 quantitative studies examining changes in alcohol, tobacco and drug use, physical inactivity, and diet by both duration of residence and acculturation level in the same population. We compared the directionality and consistency of these associations through tabulation and vote counting. RESULTS The majority of studies reported no or inconsistent changes in health risk behaviors by duration of residence versus by acculturation, including with opposite directionality. Four studies reported significant estimates with consistent directionality, while five reported consistent, non-significant estimates. CONCLUSIONS Our findings suggest that duration of residence should not be used as a proxy for acculturation when studying health risk behaviors among immigrants. Researchers should consider additional time-dependent factors to explain behavioral changes by duration of residence.
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Affiliation(s)
- Sol P JuÁrez
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | - Helena Honkaniemi
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | - Nina-Katri Gustafsson
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Sweden
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Sweden
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3
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Bayly JE, Panigrahi A, Rodriquez EJ, Gallo LC, Perreira KM, Talavera GA, Estrella ML, Daviglus ML, Castaneda SF, Bainter SA, Chambers EC, Savin KL, Loop M, Pérez-Stable EJ. Perceived neighborhood factors, health behaviors, and related outcomes in the Hispanic Community Health Study/Study of Latinos. Prev Med 2022; 164:107267. [PMID: 36150447 PMCID: PMC9691577 DOI: 10.1016/j.ypmed.2022.107267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/31/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022]
Abstract
Hispanic/Latino populations may experience significant neighborhood disadvantage, but limited research has explored whether these factors affect their health behaviors. Associations between perceived neighborhood factors at Visit 1 and health behaviors and related outcomes at Visit 2 in the Hispanic Community Health Study/Study of Latinos were evaluated. Multivariable logistic regression assessed cross-sectional and longitudinal relationships between perceived neighborhood social cohesion (NSC, 5 items), and neighborhood problems (NP, 7 items), with cancer screening, current smoking, excessive/binge drinking, hypertension, obesity, physical activity, and poor diet by gender and birthplace. NSC and NP scores were converted into quartiles. Mean age of participants was 42.5 years and 62.1% were women. Perceived NP, but not perceived NSC, differed by gender (p < 0.001). In unstratified models, no significant associations were observed between perceived NSC and any health behavior, whereas greater perceived NP was associated with less adherence to colon cancer screening (moderate level: aOR = 0.68, 95% CI = 0.51, 090) and more physical activity (very high level: aOR = 1.34, 95% CI = 1.06, 1.69) compared to low perceived NP. Women with moderate perceived NP, versus low NP, had a lower odds of colon cancer screening at Visit 1 (aOR = 0.62, 95% CI = 0.43, 0.91) and higher odds of mammogram adherence at Visit 2 (aOR = 2.86, 95% CI = 1.44, 5.68). Men with high perceived NP had a higher odds of excessive or binge drinking at Visit 2 (aOR = 1.99, 95% CI = 1.19, 3.31). We conclude that perceived NP were significantly related to health behaviors among HCHS/SOL individuals. Perceptions of neighborhood environment may be considered modifiable factors of structural neighborhood environment interventions.
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Affiliation(s)
- Jennifer E Bayly
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States of America.
| | - Asmi Panigrahi
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
| | - Linda C Gallo
- Department of Psychology, San Diego State University, CA, United States of America.
| | - Krista M Perreira
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, CA, United States of America.
| | - Mayra L Estrella
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, University of Texas Health Science Center at Houston, TX, United States of America.
| | - Martha L Daviglus
- Institute for Minority Health Research, University of Illinois at Chicago, IL, United States of America.
| | - Sheila F Castaneda
- Department of Psychology, San Diego State University, CA, United States of America.
| | - Sierra A Bainter
- Department of Psychology, University of Miami, FL, United States of America.
| | - Earle C Chambers
- Department of Family and Social Medicine, Albert Einstein College of Medicine, NY, United States of America.
| | - Kimberly L Savin
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America.
| | - Matthew Loop
- Department of Biostatistics, University of North Carolina School of Public Health, Chapel Hill, NC, United States of America.
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America; Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, United States of America.
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Juárez SP, Honkaniemi H, Gustafsson NK, Rostila M, Berg L. Health Risk Behaviours by Immigrants’ Duration of Residence: A Systematic Review and Meta-Analysis. Int J Public Health 2022; 67:1604437. [PMID: 35990194 PMCID: PMC9388735 DOI: 10.3389/ijph.2022.1604437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 06/28/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: The aim was to systematically review and synthesise international evidence on changes in health risk behaviours by immigrants’ duration of residence. Methods: We searched literature databases for peer-reviewed quantitative studies published from 2000 to 2019, examining alcohol, drug and tobacco use; physical inactivity; and dietary habits by duration of residence. Results: Narrative synthesis indicated that immigrants tend to adopt health risk behaviours with longer residence in North America, with larger variation in effect sizes and directionality in other contexts. Random-effects meta-analyses examining the pooled effect across all receiving countries and immigrant groups showed lower odds of smoking (OR 0.54, 0.46–0.63, I2 = 68.7%) and alcohol use (OR 0.61, 0.47–0.75, I2 = 93.5%) and higher odds of physical inactivity (OR 1.71, 1.40–2.02, I2 = 99.1%) among immigrants than natives, but did not provide support for a universal trend by duration of residence. Conclusion: Findings suggest that duration of residence could serve as an effective instrument to monitor immigrants’ health changes. However, differences in receiving country contexts and immigrant populations’ composition seem to be important to predict the level and direction of behavioural change. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, PROSPERO CRD42018108881.
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Affiliation(s)
- Sol P. Juárez
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
- *Correspondence: Sol P. Juárez,
| | - Helena Honkaniemi
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Nina-Katri Gustafsson
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Mikael Rostila
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Lisa Berg
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, Stockholm, Sweden
- Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
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Cartwright K. Delivered from the Temptation of Smoking: An Examination of Religion and Health Behaviors of New US Immigrants. JOURNAL OF RELIGION AND HEALTH 2021; 60:1739-1759. [PMID: 31154592 DOI: 10.1007/s10943-019-00843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study aims to contribute to the literature on smoking, religion, and health, by analyzing the associations between smoking and health of a sample of US immigrants, who represent many religions, ethnicities, and cultural backgrounds. Immigrants to the USA have better health outcomes than their native-born peers. This paper asserts that the pattern of smoking, influenced by immigrants' religion and religiosity, is key to understanding this phenomenon. This study investigates the relationship between religion and health of new legal immigrants to the USA by analyzing the New Immigrant Survey. The findings suggest that there is a protective relationship between immigrant religion and smoking patterns, both in likelihood of having ever smoked and in quitting smoking.
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Affiliation(s)
- Kate Cartwright
- School of Public Administration, 1 University of New Mexico, MSC05 3100, Albuquerque, NM, 87131, USA.
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Khlat M, Legleye S, Bricard D. Migration-related changes in smoking among non-Western immigrants in France. Eur J Public Health 2020; 29:453-457. [PMID: 30398617 PMCID: PMC6532831 DOI: 10.1093/eurpub/cky230] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Migrants make up a growing share of European populations, and very little is known about the impact of migration on their smoking patterns. We develop a longitudinal analysis of smoking prevalence among native-born and immigrants in France based on retrospective data collected in the 2010 national Baromètre santé health survey. Methods Analyses concerned 19 578 individuals aged 18–70 years and born in metropolitan France, in the Maghreb or in sub-Saharan Africa. Person-years with and without smoking were reconstructed using migration and smoking histories and analyzed with discrete-time regression models. Results Prior to migration, immigrants from both the Maghreb and sub-Saharan Africa had lower smoking prevalence than the native-born of similar birth cohort, age and education. After migration, the prevalence increased over time among Maghrebin men up to levels beyond those of the native-born (odds ratio: 1.54 [1.09–2.17] for 10 years of residence or more), while it remained much lower throughout among men from sub-Saharan Africa (odds ratio: 0.36 [0.19–0.68] for 10 years of residence or more). Starting at extremely low levels, the prevalence in both groups of women rose considerably after migration. Women from sub-Saharan Africa nearly caught up to the native-born (odds ratio: 0.70 [0.37–1.32] for 10 years of residence or more), but this was not the case for those from the Maghreb (odds ratio: 0.52 [0.33–0.81] for 10 years of residence or more). Conclusion The findings uncover the low pre-migration prevalence and the diversity of post-migration trajectories. Tobacco control programs targeting recently arrived migrants would contribute to prevent unhealthy assimilation.
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Affiliation(s)
- M Khlat
- Mortality, Health, Epidemiology Unit, Institut National d'Études Démographiques (INED), Paris, France
| | - S Legleye
- Institut National de la Statistique et des Etudes Economiques (Insee), Montrouge, France.,CESP, Faculté de Médecine, Université Paris Sud; Faculté de Médecine UVSQ; Inserm; Université Paris Saclay, Villejuif, France
| | - D Bricard
- Mortality, Health, Epidemiology Unit, Institut National d'Études Démographiques (INED), Paris, France.,Institut de Recherche et Documentation en Economie de la Santé (Irdes), Paris, France
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Pampel F, Khlat M, Bricard D, Legleye S. Smoking Among Immigrant Groups in the United States: Prevalence, Education Gradients, and Male-to-Female Ratios. Nicotine Tob Res 2019; 22:532-538. [DOI: 10.1093/ntr/ntz022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/09/2019] [Indexed: 01/12/2023]
Abstract
Abstract
Introduction
Immigrants in the United States are less likely to smoke than those born in the United States, but studies have not fully described the diversity of their smoking patterns. We investigate smoking by world region of birth and duration of residence in the United States, with a comprehensive approach covering current prevalence levels, education gradients, and male-to-female ratios.
Methods
The data originate from the National Health Interview Surveys, 2000–2015, and the sample of 365 404 includes both US-born and foreign-born respondents aged 25–70 years. World region of birth and duration of residence in the United States measure immigrant characteristics. Current cigarette smoking was analyzed using logistic regression.
Results
Immigrant groups were protected from smoking and had weaker education gradients in smoking and larger male-to-female smoking ratios than the US-born population. However, large differences emerged among the immigrant groups for region of birth but less so for duration of residence in the United States. For example, immigrants from sub-Saharan Africa and the Indian subcontinent have low prevalence, weak education gradients, and high male-to-female ratios. Immigrants from Europe have the opposite pattern, and immigrants from Latin America fall between those two extremes.
Conclusion
The stage of the cigarette epidemic in the region of birth helps explain the diverse group profiles. Duration of residence in the United States does less to account for the differences in smoking than region of birth. The findings illustrate the heterogeneity of immigrant populations originating from diverse regions across the world and limited convergence with the host population after immigration.
Implications
The study identifies immigrant groups that, because of high smoking prevalence related to levels in the host country, should be targeted for cessation efforts. It also identifies immigrant groups with low prevalence for which anti-smoking programs should encourage maintenance of healthy habits. Many immigrant groups show strong education disparities in smoking, further suggesting that smokers with lower levels of education be targeted by public health programs.
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Affiliation(s)
- Fred Pampel
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO
| | - Myriam Khlat
- Institut National d’Etudes Démographiques, Paris, France
| | - Damien Bricard
- Institut National d’Etudes Démographiques, Paris, France
- Institut de Recherche et Documentation en Economie de la Santé, Paris, France
| | - Stéphane Legleye
- Institut National de la Statistique et des Etudes Economiques (Insee), Montrouge, France
- CESP, Faculté de Médecine, Université Paris Sud, Faculté de Médecine UVSQ, Inserm, Université Paris Saclay, Villejuif, France
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Parrinello CM, Isasi CR, Xue X, Bandiera FC, Cai J, Lee DJ, Navas-Nacher EL, Perreira KM, Salgado H, Kaplan RC. Risk of Cigarette Smoking Initiation During Adolescence Among US-Born and Non-US-Born Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos. Am J Public Health 2015; 105:1230-6. [PMID: 25322293 PMCID: PMC4431078 DOI: 10.2105/ajph.2014.302155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed risk of cigarette smoking initiation among Hispanics/Latinos during adolescence by migration status and gender. METHODS The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) surveyed persons aged 18 to 74 years in 2008 to 2011. Our cohort analysis (n = 2801 US-born, 13 200 non-US-born) reconstructed participants' adolescence from 10 to 18 years of age. We assessed the association between migration status and length of US residence and risk of cigarette smoking initiation during adolescence, along with effects of gender and Hispanic/Latino background. RESULTS Among individuals who migrated by 18 years of age, median age and year of arrival were 13 years and 1980, respectively. Among women, but not men, risk of smoking initiation during adolescence was higher among the US-born (hazard ratio [HR] = 2.10; 95% confidence interval [CI] = 1.73, 2.57; P < .001), and those who had resided in the United States for 2 or more years (HR = 1.47; 95% CI = 1.11, 1.96; P = .01) than among persons who lived outside the United States. CONCLUSIONS Research examining why some adolescents begin smoking after moving to the United States could inform targeted interventions.
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Affiliation(s)
- Christina M Parrinello
- Christina M. Parrinello, Carmen R. Isasi, Xiaonan Xue, and Robert C. Kaplan are with the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY. Frank C. Bandiera and David J. Lee are with the Department of Epidemiology and Public Health, University of Miami, Miami, FL. Jianwen Cai is with the Department of Biostatistics, Gillings School of Global Public Health, and Krista M. Perreira is with the Department of Public Policy, University of North Carolina, Chapel Hill. Elena L. Navas-Nacher is with the Department of Preventive Medicine, Northwestern University, Chicago, IL. Hugo Salgado is a doctoral student at the Institute for Behavioral and Community Health, San Diego State University and the University of California, San Diego
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Factors associated with smoking in immigrants from non-western to western countries - what role does acculturation play? A systematic review. Tob Induc Dis 2015; 13:11. [PMID: 25908932 PMCID: PMC4407357 DOI: 10.1186/s12971-015-0036-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 03/28/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION We aimed to identify factors associated with smoking among immigrants. In particular, we investigated the relationship between acculturation and smoking, taking into consideration the stage of the 'smoking epidemic' in the countries of origin and host countries of the immigrants. METHODS We searched PubMed for peer-reviewed quantitative studies. Studies were included if they focused on smoking among adult immigrants (foreign-born) from non-western countries now residing in the USA, Canada, Ireland, Germany, the Netherlands, Norway, the UK, and Australia. Studies were excluded if, among others, a distinction between immigrants and their (native-born) offspring was not made. RESULTS We retrieved 27 studies published between 1998 and 2013. 21 of the 27 studies focused on acculturation (using bidimensional multi-item scales particularly designed for the immigrant group under study and/or proxy measures such as language proficiency or length of stay in host country) and 16 of those found clear differences between men and women: whereas more acculturated women were more likely to smoke than less acculturated women, the contrary was observed among men. CONCLUSION Immigrants' countries of origin and host countries have reached different stages of the 'smoking epidemic' where, in addition, smoking among women lags behind that in men. Immigrants might 'move' between the stages as (I) the (non-western) countries of origin tend to be in the early phase, (II) the (western) host countries more in the advanced phase of the epidemic and (III) the arrival in the host countries initiates the acculturation process. This could explain the 'imported' high (men)/low (women) prevalence among less acculturated immigrants. The low (men)/high (women) prevalence among more acculturated immigrants indicates an adaptation towards the social norms of the host countries with ongoing acculturation.
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Burgess DJ, Mock J, Schillo BA, Saul JE, Phan T, Chhith Y, Alesci N, Foldes SS. Culture, acculturation and smoking use in Hmong, Khmer, Laotians, and Vietnamese communities in Minnesota. BMC Public Health 2014; 14:791. [PMID: 25087937 PMCID: PMC4148553 DOI: 10.1186/1471-2458-14-791] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 07/21/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Southeast Asian communities in the United States have suffered from high rates of tobacco use and high rates of chronic diseases associated with firsthand and secondhand smoking. Research is needed on how best to reduce and prevent tobacco use and exposure to secondhand smoke in these communities. The objective of this study was to examine how tobacco use patterns in Minnesota's Southeast Asian communities have been shaped by culture, immigration, and adjustment to life in America in order to inform future tobacco control strategies. METHODS The study consisted of semi-structured interviews with 60 formal and informal leaders from Minnesota's Hmong, Khmer (Cambodian), Lao, and Vietnamese communities and incorporated principles of community-based participatory research. RESULTS Among Khmer, Lao and Vietnamese, tobacco in the homeland was a valued part of material culture and was used to signify social status, convey respect, and support social rituals among adult men (the only group for whom smoking was acceptable). Among the Hmong, regular consumption of tobacco was unacceptable and rarely seen until the civil war in Laos when a number of Hmong soldiers became smokers. In Minnesota, social norms have begun to shift, with smoking becoming less acceptable. Although older male smokers felt social pressure to quit, smoking functioned to reduce the stress of social isolation, economic hardship, prior trauma, and the loss of power and status. Youth and younger women no longer felt as constrained by culturally-rooted social prohibitions to smoke. CONCLUSIONS Leaders from Minnesota's Southeast Asian communities perceived key changes in tobacco-related attitudes, beliefs, and behaviors which were embedded in the context of shifting power, status, and gender roles within their communities. This has practical implications for developing policy and interventions. Older Southeast Asians are likely to benefit from culturally-tailored programs (e.g., that value politeness and the importance of acting in ways that benefit the family, community, and clan) and programs that work with existing social structures, as well as initiatives that address smokers' psychological distress and social isolation. Leaders remained uncertain about how to address smoking uptake among youth, pointing to a need for additional research.
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Affiliation(s)
- Diana J Burgess
- />Minneapolis Veterans Affairs Healthcare System, Center for Chronic Disease Outcomes Research (CCDOR), One Veterans Drive, 152/2E, Minneapolis, MN 55417 USA
- />Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Jeremiah Mock
- />Center for the Study of Communication-Design, Osaka University, Suita, Japan
| | | | - Jessie E Saul
- />North American Research & Analysis, Inc, Faribault, MN USA
| | - Tam Phan
- />Asian American Health Forum, San Francisco, CA USA
| | - Yanat Chhith
- />Southeast Asian Refugee Community Home, Minneapolis, MN USA
| | - Nina Alesci
- />Blue Cross and Blue Shield of Minnesota, Eagan, MN USA
| | - Steven S Foldes
- />Foldes Consulting LLC, and Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN USA
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