Cigarette Smoking Among Southeast Asian Immigrants --
Washington State, 1989
Since 1975, approximately one million Southeast Asians have
immigrated to the United States (1). In general, the efforts of
local public health agencies to meet the needs of these immigrants
have focused on identifying and treating acute and chronic diseases
rather than identifying and modifying health-risk behaviors (e.g.,
smoking) among these immigrants (2-4). However, efforts to
determine the prevalence of smoking suggest that smoking rates are
high, especially among men of Southeast Asian origin (5-7). During
1989, to characterize cigarette smoking among Southeast Asian
immigrants, the Seattle-King County (Washington) Health Department
surveyed newly arriving Southeast Asian immigrants who intended to
reside in the county regarding their health problems and
health-risk behaviors. This report summarizes survey findings
regarding their smoking habits.
Washington has the third largest population of Southeast Asian
immigrants (an estimated 50,000) in the United States;
approximately 32,000 reside in Seattle-King County (B. Duong,
Division of Refugee Assistance, Washington State Department of
Social and Health Services, personal communication, 1992). Each
year since 1982, approximately 1000 persons immigrating to the
United States from Vietnam, Cambodia, and Laos have received
medical screening interviews and examinations at Seattle-King
County Department of Public Health clinics. During 1989, Southeast
Asian immigrants were interviewed in their native language by
trained interpreters at the Seattle-King County Central Clinic (one
of two county public health clinics). Persons aged greater than or
equal to 18 years were asked if they were current smokers (i.e.,
"Do you smoke now?"), and smokers were asked how many cigarettes
they smoked per day. A convenience sample of medical interview
records were analyzed for 274 Vietnamese, 147 Laotian, and 112
Cambodian immigrants. Of the 533 records analyzed, 280 (52.5%) were
for women.
The overall prevalence of smoking (23.1%) differed
substantially by sex and age (Table 1). Men (42.5%) were more
likely than women (5.7%) to smoke, and prevalence of smoking was
higher for men aged greater than or equal to 30 years (54.6%) than
for men aged 18-29 years (29.5%). Among men, prevalence of smoking
was highest for Laotians (51.2%), followed by Vietnamese (41.7%)
and Cambodians (32.8%) (Table 2).
Reported by: FJ Frost, PhD, K Tollestrup, PhD, Lovelace Medical
Foundation, Albuquerque. D Vu, Fred Hutchinson Cancer Research
Center, Minority High School Apprentice Program; ER Alexander, MD,
J Riess, Seattle-King County Dept of Public Health, Seattle;
Washington State Center for Health Statistics, JM Kobayashi, MD,
State Epidemiologist, Washington Dept of Health. Epidemiology Br,
Office on Smoking and Health, National Center for Chronic Disease
Prevention and Health Promotion, CDC.
Editorial Note
Editorial Note: In Washington during 1988, the overall prevalence
of smoking for men was 25.5%; therefore, the findings in this
report suggest that, in 1989, Southeast Asian male immigrants were
1.6 times more likely to smoke than were men statewide. In
comparison, the prevalence of smoking among Southeast Asian female
immigrants during 1989 was one fourth that among all women in
Washington (8). Previous reports also have documented a high
prevalence of smoking among Southeast Asian male immigrants,
especially Vietnamese (6-7), and low rates of smoking among
Southeast Asian female immigrants (7).
For at least two reasons, the findings in this report may
underestimate actual smoking prevalence among Southeast Asian
immigrants arriving in Seattle. First, during the immigration
health screening interviews, respondents and their family members
often discussed how to answer questions, including those about
smoking. Several respondents were advised by family members to deny
that they smoked because of concern about criticism or penalties
(D. Vu, Fred Hutchinson Cancer Research Center, personal
observation, 1989). Second, the results regarding the number of
cigarettes these immigrants smoked per day were unreliably recorded
and interviewers did not repeat questions regarding smoking habits.
In addition, although these results were stratified by country of
origin, the findings reported represent a small convenience sample
of newly arriving immigrants screened at one health clinic and,
therefore, may not be generalizable to newly arriving Vietnamese,
Laotian, and Cambodian immigrants elsewhere or to the existing
Southeast Asian immigrant population in the United States.
Educational efforts to reduce smoking in the overall U.S.
population may not be as effective for recently-arrived immigrants
because of differences in language and culture; in particular, many
immigrants may neither understand nor believe health risks are
associated with smoking (7). To develop culturally appropriate
smoking-prevention and smoking-cessation programs in Washington and
other locations, the knowledges, attitudes, and behaviors of
Southeast Asian immigrants concerning smoking require further
characterization (9). In addition, educational materials must be
tailored to the cultural background of these immigrants, available
in their native languages, and evaluated for effectiveness.
Finally, prevalence of smoking in these and other immigrant
populations should be monitored through public health surveillance
efforts to determine whether smoking rates change in relation to
years of residence in the United States.
References
Lin-Fu JS. Population characteristics and health care needs of
Asian Pacific Americans. Public Health Rep 1988;103:18-27.
Nolan CM, Elarth AM. Tuberculosis in a cohort of Southeast Asian
refugees: a five-year surveillance study. Am Rev Respir Dis
1988;137:805-9.
Poss JE. Hepatitis B virus infection in Southeast Asian
children. Journal of Pediatric Health Care 1989;3:311-5.
Swerdlow AJ. Mortality and cancer incidence in Vietnamese
refugees in England and Wales: a follow-up study. Int J Epidemiol
1991;20:13-9.
Bates SR, Hill L, Barrett-Connor E. Cardiovascular disease risk
factors in an Indochinese population. Am J Prev Med 1989;5:15-20.
Jenkins CNH, McPhee SJ, Bird JA, Bonilla NTH. Cancer risks and
prevention behaviors among Vietnamese refugees. West J Med
1990;153:34-9.
CDC. Cigarette smoking among Chinese, Vietnamese, and Hispanics
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California, 1989-1991. MMWR 1992;41:362-7.
8. Anda RF, Waller MN, Wooten KG, et al. Behavioral risk factor
surveillance, 1988. MMWR 1990;39(no. SS-2):1-21.
9. CDC. Reducing the health consequences of smoking: 25 years of
progress -- a report of the Surgeon General. Rockville, Maryland:
US
Department of Health and Human Services, Public Health Service,
1989; DHHS publication no. (CDC)89-8411.
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