A tobacco and alcohol use profile of San Francisco's Chinese community

Estimating alcohol-related premature mortality in San Francisco: use of population-attributable fractions from the global burden of disease study

BACKGROUND

In recent years, national and global mortality data have been characterized in terms of well-established risk factors. In this regard, alcohol consumption has been called the third leading "actual cause of death" (modifiable behavioral risk factor) in the United States, after tobacco use and the combination of poor diet and physical inactivity. Globally and in various regions of the world, alcohol use has been established as a leading contributor to the overall burden of disease and as a major determinant of health disparities, but, to our knowledge, no one has characterized alcohol-related harm in such broad terms at the local level. We asked how alcohol-related premature mortality in San Francisco, measured in years of life lost (YLLs), compares with other well-known causes of premature mortality, such as ischemic heart disease or HIV/AIDS.

METHODS

We applied sex- and cause-specific population-attributable fractions (PAFs) of years of life lost (YLLs) from the Global Burden of Disease Study to 17 comparable outcomes among San Francisco males and females during 2004-2007. We did this in three ways: Method 1 assumed that all San Franciscans drink like populations in developed economies. These estimates were limited to alcohol-related harm. Method 2 modified these estimates by including several beneficial effects. Method 3 assumed that Latino and Asian San Franciscans drink alcohol like populations in the global regions related to their ethnicity.

RESULTS

By any of these three methods, alcohol-related premature mortality accounts for roughly a tenth of all YLLs among males. Alcohol-related YLLs among males are comparable to YLLs for leading causes such as ischemic heart disease and HIV/AIDS, in some instances exceeding them. Latino and black males bear a disproportionate burden of harm. Among females, for whom estimates differed more by method and were smaller than those for males, alcohol-related YLLs are comparable to leading causes which rank somewhere between fifth and fourteenth.

CONCLUSIONS

Alcohol consumption is a major contributor to premature mortality in San Francisco, especially among males. Interventions to avert alcohol-related harm in San Francisco should be taken at the population level and deserve the same attention that is given to other major risk factors, such as smoking or obesity.

Purchasing patterns and smoking behaviors after a large tobacco tax increase: a study of Chinese Americans living in New York City

OBJECTIVES

Tobacco taxes are one of the most effective policy interventions to reduce tobacco use. Tax avoidance, however, lessens the public health benefits of higher-priced cigarettes. Few studies examine responses to cigarette tax policies, particularly among high-risk minority populations. This study examined the prevalence and correlates of tax avoidance and changes in smoking behaviors among Chinese American smokers in New York City after a large tax increase.

METHODS

We conducted a cross-sectional study with data for 614 male smokers from in-person and telephone interviews using a comprehensive household-based survey of 2,537 adults aged 18-74 years. Interviews were conducted in multiple Chinese dialects.

RESULTS

A total of 54.7% of respondents reported engaging in at least one low- or no-tax strategy after the New York City and New York State tax increases. The more common strategies for tax avoidance were purchasing cigarettes from a private supplier/importer and purchasing duty free/overseas. Higher consumption, younger age, and number of years in the U.S. were consistently associated with engaging in tax avoidance. Younger and heavier continuing smokers were less likely to make a change in smoking behavior in response to the tax increase. Despite high levels of tax avoidance and varying prices, nearly half of continuing smokers made a positive change in smoking behavior after the tax increase.

CONCLUSIONS

Expanded legislation and enforcement must be directed toward minimizing the availability of legal and illegal low- or no-tax cigarette outlets. Public education and cessation assistance customized for the Chinese American community is key to maximizing the effectiveness of tobacco tax policies in this population.

Smoking prevalence among asian americans: findings from the National Latino and Asian American Study (NLAAS)

OBJECTIVE

National studies suggest that the prevalence of current smoking among Asian Americans is lower than that for other racial/ethnic groups. However, these studies may have yielded inaccurate estimates because of the underrepresentation of non-English-speaking groups. Using data from the National Latino and Asian American Study (NLAAS), the authors estimated the prevalence of current and lifetime smoking among Asian Americans.

METHODS

Current and lifetime smoking status was assessed through a population-based survey administered to Asian American adults aged 18 and older.

RESULTS

An overall current smoking prevalence of 14.9% was found, with notable differences by gender, nativity, and other sociodemographic factors. The prevalence of current smoking was higher among foreign-born vs. U.S.-born men (24.9% vs. 15.6%), while U.S.-born women had a higher prevalence than foreign-born women (6.3% vs. 11.7%). Overall, 28.3% of Asian Americans were ever smokers (including current and former smokers), suggesting that approximately half of ever smokers cease smoking. Results indicated that some Asian American groups are more likely to initiate smoking and/or be more likely to continue smoking.

CONCLUSION

Results revealed that the prevalence of current smoking exceeds that of the general U.S. population for some Asian American groups and suggest that excluding non-English-speaking Asian Americans may underestimate the prevalence of smoking among men. Findings indicate that some Asian American groups are at greater risk for initiating smoking and/or continuing smoking, and highlight the need for tailored interventions that address differential smoking patterns by gender, nativity, and other social characteristics.

Sexual activity and other risk-taking behaviors among Asian-American adolescents

STUDY OBJECTIVE

The purpose of this paper is to review the existing literature of sexual activity and risk-taking behaviors among Asian-American youth.

DESIGN

Literature review of sexual activity, alcohol, tobacco, and illicit drug use among Asian-American adolescents.

RESULTS

Asian-Americans are the fastest growing racial group in the United States. Asian-American adolescents report lower involvement with sexual activity than all other racial/ethnic peer groups. Once initiated, however, Asian-American adolescents have sexual behavior patterns comparable to other adolescent groups. In general, Asian-Americans have low rates of alcohol and tobacco usage and the males have higher use rates than the females. Degree of acculturation in the United States appears to be associated with risk-taking behavior. Asian-American adolescents also initiate smoking later than other groups. Although drug use among Asian-American adolescents is historically low, there appears to be variability on the level of illicit drug use among certain Asian-American adolescent subgroups.

CONCLUSION

Clinicians should focus prevention efforts and education on the Asian-American groups associated with higher risk-taking behaviors, particularly males and those who are more acculturated. Furthermore, to benefit Asian-American youth, anti-smoking education should continue through high school and early adulthood.

School-level contextual influences on smoking and drinking among Asian and Pacific Islander adolescents

In this study, we seek to identify school contextual predictors of tobacco and alcohol use patterns (smoking only, drinking only, and both) among Asian and Pacific Islander (API) adolescents in California public schools and ethnic variation in determinants of substance use. The data included a sample of 26,692 Asian and 3518 Pacific Islander (PI) adolescents from the 2000-2001 California Healthy Kids Survey. School-level information (n=836 schools) was from the California Basic Educational Data System and the 2000 census. Multilevel multinomial logistic regression was used to assess the association of school contexts with substance use patterns, controlling for individual-level factors. Pacific Islanders showed much higher prevalence of smoking and drinking than Asians, and the prevalence varied by school. School contexts were independently associated with API adolescents' substance use beyond the individual-level characteristics. The associations between school factors and outcomes also varied by ethnic group. Latino majority schools and schools with a high Asian immigrant concentration in the surrounding neighborhood had a lower risk of substance use among Asians but only to a modest degree among PIs. This study confirmed the importance of distinguishing Asians and PIs and the need for more attention to school contextual factors in adolescent substance use research.

Smoking prevalence and correlates among Chinese- and Filipino-American adults: findings from the 2001 California Health Interview Survey

OBJECTIVES

We report prevalence rates and correlates of cigarette smoking among a population-based sample of Chinese- and Filipino-American adults together with rates found in other racial/ethnic groups in California.

METHODS

All analyses are based on the 2001 California Health Interview Survey.

RESULTS

The proportion of current smokers among males was lowest among Chinese Americans (14%), followed by Non-Hispanic Whites (19%), Hispanics (20%), African Americans (22%), Filipino Americans (24%), American Indians/Alaska Natives (29%), and Pacific Islanders (32%). The proportion of current smokers among females was lowest among Chinese Americans (6%), followed by Hispanics (8%), Filipino Americans (11%), Non-Hispanic Whites (17%), African Americans (20%), Pacific Islander (21%), and American Indians/Alaska Natives (32%). Smoking rates were higher among foreign-born versus U.S.-born Asian males. CHIS data show an opposite effect among Asian women: acculturation to the U.S. is associated with increased smoking prevalence rates. Multivariate analyses with Chinese and Filipino respondents showed that the likelihood of smoking varied among foreign-born versus U.S.-born men (OR 2.59 for Chinese, 1.42 for Filipino, 2.01 for all Asian men combined) and for foreign-born versus U.S.-born women (OR 0.41 for Chinese, 0.38 for Filipino, and 0.59 for all Asian women combined).

CONCLUSION

Public health intervention efforts should take into account Asian ethnic subgroup, gender, and acculturation status in targeting high-risk smoking groups.

Tobacco use, secondhand smoke exposure and their related knowledge, attitudes and behaviors among Asian Americans

The present study examined tobacco use, secondhand smoke exposure and related knowledge, attitudes and behaviors among Asian Americans in the Delaware Valley of Pennsylvania and New Jersey, and the relationship between acculturation and smoking, social influence patterns on smoking, and stages of change of smoking among Asian subgroups. Study sample was 1174 Chinese, Koreans, Vietnamese, Cambodians, and other Asians. Findings revealed mean age of initiation to be 18.3, 40% ever and 30% current users. Significant differences were reflected in smoking by gender, ethnicity, educational level, marital and employment status. While knowledge and attitudes about smoking and secondhand smoke were associated with these variables, ethnic pride and smoking status played significant roles. Fathers and brothers had greater social influence on young male smoking behavior; smoking friends had influence on both genders. Stages of change of smoking and acculturation impact on smoking varied with gender, age, and time living in the U.S. Findings provide comprehensive insights into tobacco use and related KAB among Asian Americans that reflect the need for developing culturally appropriate programs for this underserved population.

Acculturation and tobacco use among Chinese Americans

OBJECTIVES

We examined the relationship between acculturation and tobacco use behaviors among Chinese Americans.

METHODS

Using a Chinese-language instrument based on validated questions from several national surveys, we conducted in-person, household-based interviews with 712 representative adults aged 18-74 years.

RESULTS

Observed smoking prevalence was 29% for men and 4% for women. Predictors of smoking cessation included being 35 years and older and having a high level of tobacco-related knowledge. Acculturation was positively associated with a history of never smoking, as was being younger than 35 years and having a high level of tobacco-related knowledge.

CONCLUSIONS

Acculturation was positively associated with never smoking among men but not with smoking cessation. However, knowledge of tobacco-related health risks was associated with both. Results indicate a need for language-specific educational interventions.

Smoking, drinking and colorectal cancer in Hong Kong Chinese: A case-control study

Expert opinions differ on the causal role of cigarettes and alcohol in colorectal cancer. This study investigates such associations in Hong Kong Chinese. A hospital-based case-control study was conducted from April 1998 to March 2000. Newly diagnosed colorectal adenocarcinoma and sex- and age-matched inpatient controls without gastrointestinal and malignant conditions were included. Structured interviews were conducted using a validated questionnaire to study any association of smoking, drinking and the lifelong extent of such exposures with colorectal cancer risk. We successfully interviewed 822 cases and 926 controls. Current regular cigarette smokers had an increased rectal cancer risk (adjusted OR = 1.44; 95% CI = 1.001-2.06). Increasing tertiles of smoking duration in ever smokers was also associated with increased rectal cancer risk (p trend = 0.038). An increased risk of colorectal cancer was found in current drinkers (adjusted OR = 1.42; 95% CI = 1.09-1.85) and in those who drank > or = 4 days (current and ex-drinkers) or > 4 units (ever and ex-drinkers) weekly. Moreover, colorectal cancer risk was found to decrease with increasing duration of drinking abstention (p trend = 0.006). This is the first report of a positive association between cigarette smoking and rectal cancer risk in a Chinese population. Current drinkers and those who drank regularly and heavily had increased colorectal cancer risk. Moreover, this study is the first to show that drinking cessation could be effective in reversing such increased risk in a duration-dependent manner. These new findings are important for cancer prevention and healthcare promotion.

Differences in stages of change of smoking behavior among current smokers of four Asian American subgroups

This study assessed the impact of demographics and acculturation on stages of change in smoking behavior among Asian current smokers (Koreans, Chinese, Vietnamese, and Cambodians) who live in the Delaware Valley region. Three stages (precontemplation, contemplation, and preparation) that applied to current smokers in Prochaska's Transtheoretical Model were measured, with a small modification. A cross-sectional self-report survey was conducted by utilizing a stratified cluster proportional sampling technique. Recruited were 1374 Asian Americans from 26 randomly selected community organization clusters and 1174 completed the survey (83%). Data were analyzed using the Pearson chi(2) test of significance. Education was negatively associated with stages of smoking behavior change. Time living in the United States showed a statistically significant positive correlation. Individuals older than 21 years appeared more seriously inclined to quit (be in the preparation stage) than those below age 21. Among the four subgroups, Cambodians (91%) were more likely to fall in either contemplation or preparation, while Chinese had the highest rate in precontemplation stage. Men were more likely than women to be in the preparation stage. Immigration status was not a significant predictor of stages.

Prevalence and predictors of tobacco use among Asian Americans in the Delaware Valley region

OBJECTIVES

This study examined tobacco use rates and potential predictors of use among Asian Americans residing in the Delaware Valley region.

METHODS

A cross-sectional survey design was used. The sample consisted of 1174 Chinese, Koreans, Vietnamese, and Cambodians.

RESULTS

Findings indicated that the mean age at initiation of tobacco use was 18.3 years. Among the respondents, 40.2% had a history of tobacco use, and 29.6% were current users. Men were more likely than women to smoke. There were significant differences between never smokers, current smokers, and ex-smokers in sex, ethnicity, educational attainment, and marital and employment status.

CONCLUSIONS

The findings suggest that tobacco use is still a serious public health problem among Asian Americans, especially men.

Sociodemographic diversity and behavioral medicine

The broad array of economic and cultural diversity in the U.S. population correlates with and impacts on the study of behavioral aspects of health. The purpose of this article was to provide a selective overview of behavioral medicine research on sociodemographically diverse populations, with a focus on ethnicity, gender, and socioeconomic status. Suggestions are provided with regard to methodological refinement of research and insights into possible future directions in behavioral medicine research on ethnically and economically diverse populations.

Smoking among Chinese Americans: behavior, knowledge, and beliefs

Objectives. This report describes and examines factors significantly associated with smoking among Chinese Americans, using multiple logistic regression methods. Methods. We conducted a population-based survey (n = 644, age = 40-69 years) in Chicago's Chinatown using a Chinese questionnaire based on the National Health Interview Survey (NHIS). Results. Smoking prevalence was 34% for males and 2% for females. Some 93% of current smokers had smoked regularly for 10 or more years. Low education (odds ratio [OR] = 2.41; 95% confidence interval [CI] = 1.31, 4.46), use of a non-Western physician or clinic for health care (OR = 2.64; 95% CI = 1.46, 4.80), and no knowledge of early cancer warning signs and symptoms (OR = 2.52; 95% CI = 1.35, 4.70) were significantly associated with smoking among men. Conclusions. The male prevalence of smoking is higher than those reported in California, the NHIS, and the Behavioral Risk Factor Surveillance System (BRFSS); exceeds the rate for African Americans aged 18 years and older; is comparable with the rate for African American males aged 45 to 64 years; and is far above the Healthy People 2010 target goal of less than 12%. Multisite surveys and smoking cessation campaigns in Chinese are needed.

Development of targeted message concepts for recent Asian immigrants about secondhand smoke

Residents of Boston's Chinatown and the Vietnamese community in Boston's Dorchester section are recent immigrants from China and Vietnam, countries whose smoking prevalence rates for men are among the highest in the world and whose rates for women are very low. We conducted exploratory focus groups in these communities to examine issues related to secondhand smoke and to generate message concepts for health education materials that would convince recent Asian immigrants to respond to the public health threat that secondhand smoke poses. The message concepts, which were tailored specifically for Chinese and Vietnamese immigrants, used themes that were consistent with the cultural values of each group as expressed in the focus groups, yet also reflected the fact that, in many ways, these immigrants are seeking to adapt to American norms. We suggest that it is possible to construct culturally appropriate health education materials for recent immigrant populations rather than rely on simple translations of English-language materials. An intervention study using these message concepts is needed.