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Li J, Daida YG, Bacong AM, Rosales AG, Frankland TB, Varga A, Chung S, Fortmann SP, Waitzfelder B, Palaniappan L. Trends in cigarette smoking and the risk of incident cardiovascular disease among Asian American, Pacific Islander, and multiracial populations. Am J Prev Cardiol 2024; 19:100688. [PMID: 39070025 PMCID: PMC11278113 DOI: 10.1016/j.ajpc.2024.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/15/2024] [Accepted: 06/12/2024] [Indexed: 07/30/2024] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death in the United States, and rates of CVD incidence vary widely by race and ethnicity. Cigarette smoking is associated with increased risk of CVD. The purpose of the study was: 1) to examine smoking prevalence over time across Asian and Pacific Islander (API) and multi-race API subgroups; 2) to determine whether the CVD risk associated with smoking differed among these subgroups. Methods We identified patients belonging to 7 single race/ethnicity groups, 4 multi-race/ethnicity groups, and a non-Hispanic White (NHW) comparison group at two large health systems in Hawaii and California. We estimated annual smoking prevalence from 2011 through 2018 by group and gender. We examined incidence of CVD events by smoking status and race/ethnicity, and computed hazard ratios for CVD events by age, gender, race/ethnicity, census block median household income, census block college degree, and study site using Cox regression. Results Of the 12 groups studied, the Asian Indian and Chinese American groups had the lowest smoking prevalence, and the Asian + Pacific Islander multiracial group had the highest smoking prevalence. The prevalence of smoking decreased from 2011 to 2018 for all groups. Multi-race/ethnicity groups had higher risk of CVD than the NHW group. There was no significant interaction between race/ethnicity and smoking in models predicting CVD, but the association between race/ethnicity and CVD incidence was attenuated after adjusting for smoking status. Conclusions There is considerable heterogeneity in smoking prevalence and the risk of CVD among API subgroups.
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Affiliation(s)
- Jiang Li
- Sutter Health Center for Health Systems Research/Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, USA
| | | | | | | | - Alexandra Varga
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Sukyung Chung
- Sutter Health Center for Health Systems Research/Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | | | - Beth Waitzfelder
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, USA
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Zeng Q, Zhang C, Su F, Wan Y, Tu WJ, Hu H. Prevalence, cessation, and geographical variation of smoking among middle-aged and elderly adults in China: A population-based study. Tob Induc Dis 2024; 22:TID-22-133. [PMID: 39034965 PMCID: PMC11259031 DOI: 10.18332/tid/190247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/12/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Smoking significantly burdens human health, contributing to an increasing incidence of mortality and morbidity. This study aims to explore the prevalence of smoking, cessation, and the association between various risk factors and smoking intensity measured in pack-years among Chinese adults. METHODS During 2020-2021, the China Stroke High-risk Population Screening and Intervention Program (CSHPSIP) invited participants aged ≥40 years from 31 provinces in mainland China. This cross-sectional study presents the standardized prevalence of smoking and cessation across various demographics, including age, sex, residence, income, education level, BMI, and geographical region of residence. Multivariable logistic regression was used to examine the associations between smoking pack-years and related factors. RESULTS Among 524741 participants (mean age: 61.9 ± 10.9 years; 41.1% male; 58.9% female), standardized smoking prevalence was 19.3% (95% CI: 19.2-19.4), with men (37.2%; 95% CI: 37.0-37.4) displaying significantly higher rates than women (1.3%; 95% CI: 1.2-1.3). Smoking cessation rate stood at 11.2% (95% CI: 11.0-11.4), with 11.3% (95% CI: 11.1-11.5) for men and 8.4% (95% CI: 7.5-9.2) for women. Urban residents and those with advanced education had lower smoking rates and higher cessation rates. Additionally, the dose-response relationship indicated a more pronounced association between higher smoking pack-years and elevated health risks, including hypertension (AOR=1.30; 95% CI: 1.24-1.36), diabetes (AOR=1.26; 95% CI: 1.20-1.33), hyperlipidemia (AOR=1.22; 95% CI: 1.16-1.28), heart disease (AOR=1.40; 95% CI: 1.26-1.54), and stroke (AOR=1.23; 95% CI: 1.10-1.36). CONCLUSIONS This comprehensive study emphasizes the profound impact of smoking on health in Chinese adults, indicating the critical need for tailored cessation programs, particularly for middle-aged individuals, men, rural residents, and those with lower level of education.
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Affiliation(s)
- Qingjia Zeng
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chongyang Zhang
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feiyu Su
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanli Wan
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-jun Tu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongpu Hu
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Twum F, Tome J, Ledel E, Roy V, Mallhi AK, Aguirre D, Wei Y, Zhang J. The Diverging Trend in Exposure to Environmental Tobacco Smoke Among US Children. J Racial Ethn Health Disparities 2024; 11:1718-1729. [PMID: 37326795 DOI: 10.1007/s40615-023-01645-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Environmental tobacco smoke exposure (ETSE) was race/ethnicity-specific, but how the race/ethnicity-specific ETSE has changed over time, diverging or converging, remains unclear. We examined ETSE trends by race/ethnicity in US children aged 3-11 years. METHODS We analyzed the data of 9678 children who participated in the biennial National Health and Nutrition Examination Surveys, 1999-2018. ETSE was defined as serum cotinine ≥ 0.05 ng/ml, with ≥ 1 ng/ml as heavy exposure. For trend description, adjusted biennial prevalence ratios (abiPR: the ratio associated with a 2-year increase in time) were estimated by race/ethnicity. The prevalence ratios between races/ethnicities were used to quantify ethnoracial differences in different survey periods. Analyses were performed in 2021. RESULTS The overall ETSE prevalence was cut by almost half, from 61.59% (95% confidence interval = 56.55%, 66.62%) in the 1999-2004 survey to 37.61% (33.90%, 41.31%) in 2013-2018, exceeding the national 2020 health target (47.0%). However, the decrease occurred unequally between races/ethnicities. Heavy ETSE declined significantly in white [abiPR = 0.80 (0.74, 0.86)] and Hispanic children [0.83 (0.74, 0.93)], but insignificantly in black children [0.97 (0.92, 1.03)]. Consequently, the adjusted prevalence ratio between black children and white children increased from 0.82 (0.47, 1.44) in 1999-2004 to 2.73 (1.51, 4.92) in 2013-2018 for heavy ETSE. Hispanic children remained at the lowest risk throughout the study period. CONCLUSION Overall ETSE prevalence was cut by half between 1999 and 2018. However, due to uneven declines, the gaps between black children and others have expanded in heavy ETSE. Special vigilance is needed in preventive medicine practice with black children.
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Affiliation(s)
- Felix Twum
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, 30460, USA.
- The Dr. Lynn Cook Hartwig Public Health Program, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, 39406, USA.
| | - Joana Tome
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, 30460, USA
| | - Erica Ledel
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, 30460, USA
| | - Victoria Roy
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, 30460, USA
| | - Arshpreet Kaur Mallhi
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, 30460, USA
| | - Diana Aguirre
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, 30460, USA
| | - Yudan Wei
- Department of Community Medicine, Mercer University School of Medicine, Macon, GA, 31207, USA
| | - Jian Zhang
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, 30460, USA
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Lim A, Elias S, Benjasirisan C, Byiringiro S, Chen Y, Turkson‐Ocran R, Dennison Himmelfarb CR, Commodore‐Mensah Y, Koirala B. Heterogeneity in the Prevalence of Cardiovascular Risk Factors by Ethnicity and Birthplace Among Asian Subgroups: Evidence From the 2010 to 2018 National Health Interview Survey. J Am Heart Assoc 2024; 13:e031886. [PMID: 38420759 PMCID: PMC10944060 DOI: 10.1161/jaha.123.031886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Asian people in the United States have different sociodemographic and health-related characteristics that might affect cardiovascular disease (CVD) risk by ethnicity and birthplace. However, they are often studied as a monolithic group in health care research. This study aimed to examine heterogeneity in CVD risk factors on the basis of birthplace among the 3 largest Asian subgroups (Chinese, Asian Indian, and Filipino) compared with US-born non-Hispanic White (NHW) adults. METHODS AND RESULTS A cross-sectional analysis was conducted using the 2010 to 2018 National Health Interview Survey data from 125 008 US-born and foreign-born Chinese, Asian Indian, Filipino, and US-born NHW adults. Generalized linear models with Poisson distribution were used to examine the prevalence and prevalence ratios of self-reported hypertension, diabetes, high cholesterol, physical inactivity, smoking, and overweight/obesity among Asian subgroups compared with US-born NHW adults. The study included 118 979 US-born NHW and 6029 Asian adults who self-identified as Chinese (29%), Asian Indian (33%), and Filipino (38%). Participants' mean (±SD) age was 49±0.1 years, and 53% were females. In an adjusted analysis, foreign-born Asian Indians had significantly higher prevalence of diabetes, physical inactivity, and overweight/obesity; foreign-born Chinese had higher prevalence of physical inactivity, and foreign-born Filipinos had higher prevalence of all 5 CVD risk factors except smoking compared with NHW adults. CONCLUSIONS This study revealed significant heterogeneity in the prevalence of CVD risk factors among Asian subgroups by ethnicity and birthplace, stressing the necessity of disaggregating Asian subgroup data. Providers should consider this heterogeneity in CVD risk factors and establish tailored CVD prevention plans for Asian subgroups.
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Affiliation(s)
- Arum Lim
- Johns Hopkins School of NursingBaltimoreMDUSA
| | | | | | | | - Yuling Chen
- Johns Hopkins School of NursingBaltimoreMDUSA
| | - Ruth‐Alma Turkson‐Ocran
- Beth Israel Deaconess Medical Center, Division of General MedicineHarvard Medical SchoolBostonMAUSA
| | - Cheryl R. Dennison Himmelfarb
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
- Johns Hopkins School of MedicineBaltimoreMDUSA
| | - Yvonne Commodore‐Mensah
- Johns Hopkins School of NursingBaltimoreMDUSA
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
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Lozano P, Peters A, Southworth A, Mo Y, Lam H, Randal FT, Kim KE. Smoking behavior among Asian Americans during the initial phase of the COVID-19 pandemic: The influence of pandemic stressors and depression. Tob Induc Dis 2024; 22:TID-22-28. [PMID: 38274001 PMCID: PMC10809060 DOI: 10.18332/tid/176923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/13/2023] [Accepted: 12/16/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Heightened levels of distress among Asian Americans during the initial phases of the pandemic may be associated with current smoking behavior. In this study, we examine differences in current smoking among Asian Americans from two different ethnic backgrounds before and during the COVID-19 pandemic. METHODS We analyzed cross-sectional survey data (n=202) from Chinese and South Asian adults in Chicago, collected between February and May 2020. We conducted logistic regression models to estimate the relationship between exposure to the COVID-19 pandemic and current smoking. We tested whether the association varied by Asian American ethnic group, unemployment, racial discrimination, and depression symptoms. RESULTS We found that current smoking increased from 28% to 48% among Asian Americans (i.e. Chinese and South Asians) during the pandemic. We found a statistically significant interaction between the COVID-19 period indicator variable and current smoking by Asian American ethnic groups (p=0.014), such that current smoking was lower for Chinese compared to South Asians before COVID-19, but was comparable for both groups during the pandemic. We also found a statistically significant interaction between the period indicator variable and current smoking by racial discrimination (p=0.047) and depression symptoms (p=0.02). Results from these interactions suggest that Asian Americans who experienced racial discrimination and depression during the pandemic may be more likely to be current smokers compared to their pre-pandemic counterparts. CONCLUSIONS The findings of the study highlight the need for culturally tailored smoking cessation interventions for Asian American communities that address pandemic-related stressors such as discrimination that may trigger cigarette use.
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Affiliation(s)
- Paula Lozano
- Department of Biomedical Sciences, Center for Asian Health Equity - University of Chicago Medicine, Chicago, United States
| | - Aven Peters
- Department of Biomedical Sciences, Center for Asian Health Equity - University of Chicago Medicine, Chicago, United States
| | | | - Yicklun Mo
- Asian Health Coalition, Chicago, United States
| | - Helen Lam
- Department of Biomedical Sciences, Center for Asian Health Equity - University of Chicago Medicine, Chicago, United States
| | | | - Karen E. Kim
- Department of Biomedical Sciences, Center for Asian Health Equity - University of Chicago Medicine, Chicago, United States
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Do EK, Aarvig K, Muller-Tabanera H, Mills S, Sumibcay JR, Koh HK, Vallone DM, Hair EC. E-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander youth in the contiguous United States: Insights from the Monitoring the Future Study (2018-2019). Prev Med Rep 2023; 35:102376. [PMID: 37662868 PMCID: PMC10472302 DOI: 10.1016/j.pmedr.2023.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/02/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023] Open
Abstract
This study examines e-cigarette use behaviors of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) youth, in relation to other racial/ethnic groups in the United States. Data were obtained from the 2018 and 2019 Monitoring the Future surveys, which include a random, probability-based sample of youth in 8th, 10th, and 12th grades surveyed annually across the contiguous United States. Respondents provided information on race/ethnicity and e-cigarette use (n = 42,980). Measures of e-cigarette use included current (1 + of past 30 days) and regular use (10 + of past 30 days). Chi-square tests were used to determine differences in e-cigarette use by race/ethnicity. Associations between race/ethnicity, other sociodemographic factors, and e-cigarette use were explored using logistic regression analyses. Approximately 5.1% (n = 2,410) of the sample identified as AANHPI. A greater proportion of Native Hawaiian and Pacific Islanders reported current e-cigarette use (NHPI, 28.0%), relative to Asian American (AA, 10.3%), Black (9.5%), Hispanic or Latino (15.0%), American Indian or Alaskan Native (AIAN, 16.5%), multiracial (22.3%), and non-Hispanic White (25.2%) youth. Regular e-cigarette use was highest among non-Hispanic White (12.3%), followed by multiracial (10.7%), AIAN (7.8%), Hispanic or Latino (5.0%), AA (4.3%), and Black (3.0%) youth. Associations between race/ethnicity and e-cigarette use remained significant, after controlling for other sociodemographic factors. Continued monitoring of e-cigarette use is needed among AANHPI, a historically underrepresented population in tobacco research. Special attention should be paid to NHPI, who reported the highest rates of e-cigarette use.
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Affiliation(s)
- Elizabeth K. Do
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | | | - Sarah Mills
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Howard K. Koh
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Donna M. Vallone
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth C. Hair
- Schroeder Institute, Truth Initiative, Washington, DC, USA
- Department of Health, Behavior and Society, Bloomberg School of Public Health, John Hopkins University, Baltimore, MD, USA
- School of Global Public Health, New York University, New York, NY, USA
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