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CORK Bibliography: Asian Americans

105 citations. January 1999 to present

Prepared: September 2007

Arliss RM. Cigarette smoking, binge drinking, physical activity, and diet in 138 Asian American and Pacific Islander community college students in Brooklyn, New York. Journal of Community Health 32(1): 71-84, 2007. (34 refs.)

Assessment of cigarette smoking, alcohol consumption, physical activity, and diet in the Asian American and Pacific Islander (AAPI) community has been neglected. A questionnaire was used to investigate these health risk behaviors in 466 students at an urban community college and results for the 138 AAPI study participants were compared to the 328 non-Asians. Results for AAPI study participants showed that twenty percent (20.3%) were current cigarette smokers and 7.7% smoked eleven or more cigarettes per day. Ten percent (10.7%) reported binge drinking on one to two days per month and 17.3% reported binge drinking on three or more days per month. With regard to physical activity, 28.8% participated in stretching, 23.6% in strength and toning, 29.4% in moderate exercise, and 25.4% in vigorous exercise. Results indicated that on the day preceding the survey, only 11.9% consumed five or more servings of fruits and vegetables, 88.4% ate no more than two servings of high-fat foods, and 37.6% consumed tofu, soymilk, or other soy food. AAPI study participants were more likely to frequently binge drink (p < .05), less likely to participate in strength and toning exercises (p < .05), and more likely to consume soy foods daily (p < .01) than non-Asian study participants. Recommendations are presented for health promotion program planning.

D'Amico EJ; Schell TL; Marshall GN; Hambarsoomians K. Problem drinking among Cambodian refugees in the United States: How big of a problem is it? Journal of Studies on Alcohol 68(1): 11-17, 2007. (37 refs.)

Objective: The present study assesses current drinking behavior in a representative sample of Cambodian refugees. Earlier estimates of alcohol use in this population suggest that Cambodian refugees are at elevated risk for alcohol-use problems, but these studies have relied on convenience samples and may not reflect current consumption patterns. Method: A cross-sectional, face-to-face interview was conducted in Khmer on a household probability sample of Cambodian refugees residing in the largest such community in the United States. The overall response rate was 87% and yielded 490 respondents in the current analyses. Results: Rates of consumption and alcohol-use problems were low in this population. Few participants (26%) reported any alcohol consumption in the 30 days preceding the interview, and only 2% reported any heavy drinking in the last 30 days. Multivariate analyses indicated that younger participants and men were more likely to report any recent drinking, and men were more likely to report any heavy drinking. Notably, recent consumption was not related to degree of trauma exposure or extent of psychiatric distress when controlling for age and gender. Conclusions: These data contrast dramatically with the widespread belief that Cambodian refugees are at elevated risk for problem drinking. Findings highlight the pitfalls of drawing population-based conclusions from data based on nonrepresentative samples or from nonstandard measures of alcohol consumption.

Fang CY; Ma GX; Miller SM; Tan Y; Su XF; Shive S. A brief smoking cessation intervention for Chinese and Korean American smokers. Preventive Medicine 43(4): 321-324, 2006. (11 refs.)

Objective. This study evaluated changes in smoking-related beliefs and behavior following a brief, culturally adapted smoking cessation intervention for Chinese and Korean smokers. Method. From May 2002 to March 2003, 66 smokers residing in or around southeastern Pennsylvania were randomly assigned to a theory-based smoking cessation intervention or general health counseling. Participants completed assessments of perceived risks of smoking, pros and cons of quitting, quitting self-efficacy, and distress at baseline and follow-up time points. Sessions were conducted in the participant's native language (Korean, Cantonese, or Mandarin). Both groups received nicotine replacement therapy. Results. Overall, 38% of participants reported quitting smoking at 3-month follow-up. Quit rates were higher (52.6% among Chinese, 60.0% among Korean) in the intervention condition compared to the control condition (23.5% among Chinese, 40.0% among Korean) at 1-month, but not 3-month, follow-up. There was a main effect of treatment condition for self-efficacy with intervention participants reporting significantly higher levels of self-efficacy compared to control participants. Further, a treatment x time interaction was observed for cons of quitting, reflecting fewer cons in the intervention group than the control group at 1-month and 3-month follow-up. Conclusion. A culturally adapted intervention for Chinese and Korean Americans can be effective in changing specific smoking-related cognitions and behavior. This study represents a promising first step toward advancing our understanding of the associations between smoking-related cognitions and behavior among Asian American smokers.

Ferketich AK; Kwong K; Shek A; Lee M. Design and evaluation of a tobacco-prevention program targeting Chinese American youth in New York City. Nicotine & Tobacco Research 9(2): 249-256, 2007. (14 refs.)

In 1994 the Centers for Disease Control and Prevention recognized the importance of incorporating tobacco prevention programs into school curricula with the publication of guidelines for such programs. Included in these guidelines are recommendations to provide instruction about the consequences of tobacco use and to provide tobacco prevention programs to all students, with a particularly intensive curriculum in junior high school. Many school-based programs have been developed and tested; however, most have been delivered in English. This paper presents a culturally appropriate tobacco prevention curriculum developed for Chinese American 7th and 8th graders. The curriculum was delivered by a community organizer, in conjunction with lay health advocates, in one junior high school with a large proportion of Chinese immigrant students in New York City. This curriculum, delivered in English and Mandarin, began with 7th graders in four classrooms and consisted of seven sessions during the first year with a booster session the second year. Various presentation methods were used, including lectures, videos, demonstration, and group discussion. Valuable information about components that worked well and parts that need to be improved was gathered from school administrators, teachers, lay health advocates, and the community organizer who delivered the curriculum. This information should be incorporated into future tobacco prevention programs targeting the Chinese American community.

Grov C; Bimbi DS; Nanin JE; Parsons JT. Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York City and Los Angeles. Journal of Drug Education 36(2): 105-123, 2006. (57 refs.)

Reported rates of recreational drug use among gay and bisexual men are currently rising. Although there has been much empirical research documenting current trends in drug use among gay and bisexual men, little research has empirically contrasted differential rates across urban epicenters, while even less has addressed racial or ethnic variation (between and within cities). This knowledge is essential both for the development of effective culturally-sensitive health education prevention/services and for understanding drug use prevalence among urban epicenters. Using the men's data gathered from large-scale gay, lesbian, and bisexual (GLB) community events in New York and Los Angeles in the fall of 2003 and spring of 2004 (N = 2,335), this study explored racial and ethnic variance in the use of methamphetamine, cocaine, MDMA/ecstasy (methylenedioxymethamphetamine), ketamine, GHB (gamma-hydroxy-butyrate), marijuana, and nitrate inhalants (poppers) among gay and bisexual men both between and within cities (NYC and LA). Levels of recent drug use were fairly consistent between New York City and Los Angeles; however there was some between and within city racial and ethnic variance. In particular, Asian/Pacific Islander men were among those least likely to report use of some drugs. Findings suggest substance use in the gay community permeates geographic boundaries in addition to some racial and ethnic boundaries such that interventions targeting drug-using gay and bisexual men should appropriately attend to racial and ethnic diversity within communities.

Kim SS; Ziedonis D; Chen KW. Tobacco use and dependence in Asian Americans: A review of the literature. (review). Nicotine & Tobacco Research 9(2): 169-184, 2007. (116 refs.)

This article reports on an integrative review of literature on Asian American tobacco use and dependence, identifies gaps in the literature, and proposes studies needed in the future. Articles were retrieved from electronic health-related databases indexed for permutations of the keywords Asian Americans, smoking, tobacco use, tobacco dependence, and nicotine dependence. A manual search also was done to identify additional literature. A total of 216 articles were identified; the review includes 39 articles reporting gender- and ethnic-specific information on subgroups of Asian Americans in the following areas: Smoking prevalence, correlates of smoking, and tobacco dependence treatment. In addition, 13 articles on tobacco and nicotine metabolism were reviewed. Empirical studies have concentrated on Chinese, Korean, and Vietnamese American men. Smoking prevalence is higher among Asian American men with low acculturation than among their counterparts, but the reverse pattern is observed among Asian American women. Asian Americans tend to smoke fewer cigarettes per day than White Americans, and this difference may be explained by differences between the two groups in nicotine metabolism. More research is needed on this diverse population, especially Asian American women of all ethnic subgroups and Asian Indian, Filipino, Pakistani, and Thai American men. A need also exists for the development of specialized tobacco dependence treatments to address the cultural issues of specific Asian American ethnic subgroups, to enhance access to treatment, and to determine how treatment recommendations should reflect differences in acculturation level and tobacco and nicotine metabolism.

Luczak SE; Shea SH; Hsueh AC; Chang J; Carr LG; Wall TL. ALDH22 is associated with a decreased likelihood of alcohol-induced blackouts in Asian American college students. Journal of Studies on Alcohol* 67(3): 349-353, 2006. (35 refs.)

A recent report found the heritability estimate for alcohol-induced blackouts was 53%. The present Study was designed to determine whether possession of two specific genetic variations, an aldehyde dehydrogenase ALDH2*2 allele and an alcohol dehydrogenase ADH1B*2 allele, were associated with lower rates of lifetime blackouts. Method: Asian American college students (N = 403) of Chinese and Korean descent were genotyped at the ALDH2 and ADH1B loci and assessed for lifetime alcohol-induced blackouts and the maximum number of drinks ever consumed in a 24-hour period. Results: Participants who had an ALDH2*2 allele had approximately one third the risk of having a lifetime blackout of participants without this allele. Rates of experiencing a lifetime blackout did not significantly differ by ADH1B*2 status. Possessing an ALDH2*2 allele was associated with decreased risk of lifetime blackouts even after controlling for maximum number of drinks ever consumed in a 24-hour period and ethnicity. Conclusions: These findings suggest the protective effects of possessing an ALDH2*2 allele include a lowered risk of experiencing alcohol-induced blackouts.

Ma GX; Fang CY; Knauer CA; Tan Y; Shive SE. Tobacco dependence, risk perceptions and self-efficacy among Korean American smokers. Addictive Behaviors 31(10): 1776-1784, 2006. (21 refs.)

Psychosocial variables related to smoking cessation may differ among ethnic groups. This research focuses on Korean Americans, a group that receives little attention in smoking cessation research, yet has an elevated smoking rate when compared with that of the general US population. This article reports our findings on tobacco dependence, risk perceptions and self-efficacy and examines potential associations between these psychosocial variables and key demographic variables. One hundred Korean American adult smokers enrolled in the study and completed the psychosocial measurement. The majority of the participants (61%) were heavy smokers. The findings indicated that demographic factors were associated with key psychosocial variables that have been demonstrated to play a role in smoking cessation behaviors. In particular, younger age and higher educational level were associated with greater self-efficacy in quitting smoking. No differences in risk perception were observed by any of the demographic indicators assessed. The findings suggest that enhancing self-efficacy among older and less educated smokers may improve the efficacy of smoking cessation efforts that target Korean smokers.

Nguyen TD; Yoshioka M. Alcoholism level differences between Vietnamese batterers and non-batterers. Journal of Family Violence 21(6): 401-406, 2006. (51 refs.)

Frequency of alcohol consumption and alcoholism levels were compared between Vietnamese batterers and non-batterers. A sample of 200 Vietnamese men was administered a self-reported questionnaire which combined the Conflict Tactics Scale 2 and the Michigan Alcohol Screening Test. Results of the study revealed statistical significant differences between the two groups regarding frequency of alcohol consumption and alcoholism levels. However, through logistic regression analysis, it was found that participants' frequency of alcohol consumption and alcoholism levels were not statistically significant in predicting battering among Vietnamese men.

Office of Applied Studies. The NSDUH Report: Past Month Cigarette Use among Racial and Ethnic Groups. Issue 30. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (5 refs.)

This report, an issue in an occasional series of reports based upon data collected by the National Survey on Drug Use and Health, focuses upon cigarette use among racial and ethnic minorities. While smoking declined in the US between 2002 and 2004, there remains variations in rates among racial and ethnic groups. In the 2002-2004 period, the rates of cigarette smoking in the past month among those age 12 and older, were highest among American Indians and Alaska Natives (34.8%), those who identify themselves as of two or more races (34.6) and lowest among Asian-Ameriancs (13.4%). Among Asians, Koreans reported the higest rate of smoking, at 24/9% and Chinese the lowest at 7.5%. Among Hispanics, Cubans and Puerto Ricans are more likely to be daily smokers than Central or South Americans and Mexicans. Informatioon is also provided on the average number of cigarettes smoker per day for various ethnic groups and rates of daily smoking/

Rastogi M; Wadhwa S. Substance abuse among Asian Indians in the United States: A consideration of cultural factors in etiology and treatment. Substance Use & Misuse 41(9): 1239-1249, 2006. (41 refs.)

We explore cultural factors that contribute to substance use in the Asian Indian population in the United State and propose culturally sensitive treatment, with an emphasis on family issues. The 2000 U.S. Census figures show that Asian Indians residing in this country have grown to about 1.7 million from the 1990 U.S. Census figure of 815,000. On average, Asian Indians have a higher level of education and proficiency in English compared with many other new immigrant groups. The median family income for Asian Indians in the United State in 1999 was $70,708, compared with $53,356 for Whites. Based on these statistics, Asian Indians are erroneously labeled a "model minority. However, a closer look shows that Asian Indians are paid lower than their White counterparts with comparable education. Also, many Asian Indians live in areas where the cost of living is higher, and high family income does not automatically translate into a higher standard of living. There is large within-group disparities in income, and Asian Indian families might fall at either end of the Socio-economic status (SES) pole.

Shelley D; Fahs MC; Yerneni R; Qu JJ; Burton D. Correlates of household smoking bans among Chinese Americans. Nicotine & Tobacco Research 8(1): 103-112, 2006. (28 refs.)

No population-based data are available on the degree to which Chinese Americans have adopted smoke-free household policies and whether these policies are effective in reducing environmental tobacco smoke (ETS) exposure. The present study examines the prevalence of smoke-free home rules among Chinese Americans living in New York City, describes predictors of adopting full smoking bans in the home, and explores the association between household smoking restrictions and ETS exposure at home. In-person interviews using a comprehensive household-based survey were conducted with 2,537 adults aged 18-74 years. Interviews were conducted in Mandarin, Cantonese, and other Chinese dialects. A total of 66% of respondents reported that smoking was not allowed inside the home, 22% reported a partial ban on smoking in the home, and 12% reported no smoking ban. Among current smokers, 38% reported a full household smoking ban. Current smoking status was the strongest predictor of less restrictive household smoking policies. Knowledge of the dangers of ETS, support of smoke-free air legislation, years in the United States, gender, income, and marital status also were associated with household smoking bans. Those living with a total household smoking ban were significantly less likely to report 30-day exposure to ETS than were those living in homes with a partial ban or no ban (7% vs. 68% and 73%, respectively). In homes of smokers and nonsmokers alike, exposure to ETS remains high. Smoke-free home rules and interventions among smokers and nonsmokers to raise awareness of the dangers of ETS have the potential to significantly reduce exposure to household ETS among this immigrant population.

Shelley D; Yerneni R; Hung D; Das D; Fahs M. The relative effect of household and workplace smoking restriction on health status among Chinese Americans living in New York City. Journal of Urban Health 84(3): 360-371, 2007. (38 refs.)

Households and workplaces are the predominant location for exposure to secondhand smoke. The purpose of this study is to examine the association between health status and smoking restrictions at home and work and to compare the relative effect of household and workplace smoking restrictions on health status. This study uses data from a cross sectional representative probability sample of 2,537 Chinese American adults aged 18-74 living in New York City. The analysis was limited to 1,472 respondents who work indoors for wages. Forty-three percent of respondents reported a total smoking ban at home and the workplace, 20% at work only, 22% home only, and 15% reported no smoking restriction at home or work. Smokers who live under a total household smoking ban only or both a total household and total workplace ban were respectively 1.90 and 2.61 times more likely to report better health status compared with those who reported no smoking ban at work or home. Before the NYC Clean Indoor Air Act second-hand smoke (SHS) exposure among this immigrant Chinese population at home and work was high. This study finds that household smoking restrictions are more strongly associated with better health status than workplace smoking restrictions. However, better health status was most strongly associated with both a ban at work and home. Public health efforts should include a focus on promoting total household smoking bans to reduce the well-documented health risks of SHS exposure.

Ahluwalia KP. Assessing the oral cancer risk of South-Asian immigrants in New York City. Cancer 104(12, Supplement S): 2959-2961, 2005. (19 refs.)

Increasing immigration from South Asia, where oral cancer is one of the most common cancers in adults, suggests that this disease will probably pose a serious public health problem in the United States. According to the 2000 Census, there are approximately 1.9 million South Asians in the U.S., and their access to dental care is limited. The morbidity and mortality associated with oral cancer can be reduced by primary prevention and early detection. South Asians are not a homogenous group, and areca, and important risk factor for oral cancer, has religious and cultural significance in some South Asian communities. In order to develop culturally relevant preventive and educational interventions, it is important to assess risk behaviors according to ethnic and religious subgroup identity. In this report, the author provides an overview of oral cancer risk factors among South-Asian immigrants in the U.S., and describes a recently funded pilot study designed to assess oral cancer risk behaviors in South Asian seniors. The data collected will be used to develop risk profiles of South Asian religious and ethnic sub-groups. It is hoped that medical and dental providers will be able to use the risk profiles to target early-detection and risk-reduction services in this population.

Au JG; Donaldson SI. Social influences as explanations for substance use differences among Asian-American and European-American adolescents. Journal of Psychoactive Drugs 32(1): 15-23, 2000. (42 refs.)

The present study examines the social influences in the Asian- American and European-American adolescent environment to provide a greater understanding of effect of ethnic differences on the prevalence of substance abuse. Participants were 957 Asian-American and 3705 European-American seventh grade adolescents. It was found that Asian-American students were less Likely to use alcohol and cigarettes, and had a more abstinence-promoting environment than European-American adolescents. This difference in Asian-American adolescents appeared to be the result of less adult and peer influence to use alcohol or cigarettes, less offers of alcohol, and an increased likelihood of having an intact family when compared to European-American adolescents. Additionally, Asian-American adolescents reported having fewer friends and spending less time with their friends than European-American adolescents. It was concluded that social influences play an important role in explaining why Asian- American adolescents have lower rates of substance use.

Bhattacharya G. Drug abuse risks for acculturating immigrant adolescents: Case study of Asian Indians in the United States. Health & Social Work 27(3): 175-183, 2002. (30 refs.)

Immigrant parents and their U.S.-born children may experience stressful family conflicts over the disparate sociocultural norms of the United States and their country, of origin. Such stresses may heighten adolescents' vulnerability to drug abuse. This article documents the extent of drug use in a sample of 200 US.-born Asian Indian adolescents. According to the study participants' self-reports on lifetime use, 28 percent had used alcohol on at least one occasion, 165 percent had used cigarettes, and 2.5 percent had used marijuana. Adolescents who placed importance on their parents' drug abuse prevention messages tended not to use drugs. The implications of the study's findings for drug abuse assessment, treatment, and prevention are discussed.

Bradizza CM; Stasiewicz PR. Introduction to the special issue "Addictions in special populations". Addictive Behaviors 24(6): 737-740, 1999. (6 refs.)

Castro FG; Proescholdbell RJ; Abeita L; Rodriguez D. Ethnic and cultural minority groups. IN: McCrady BS; Epstein EE, eds. Addictions: A Comprehensive Guidebook. New York: Oxford University Press, 1999. pp. 499-526. (88 refs.)

This chapter examines some of the issues that impact on substance use/abuse among ethnic and cultural minority groups. The experience of ethnicity is unique and somewhat different for each of the more than 70 million persons of color who currently constitute over 25 percent of the U.S. population. This considerable diversity has been typically described according to ethnic/racial identity by referencing one of the four major ethnic/racial groups: African-Americans, Hispanics/Latinos, Asian-Americans and Pacific Islanders, and Native American Indians. Within these four groups are subgroups and subcultures that differ in their collective experiences of ethnicity based on variations in nationality, in the tribe or geographic region where raised, by urban-rural status, and/or by the cultural orientation of the members of a subgroup. Today, more refined analyses are needed to move beyond "ethnic gloss" in order to better describe and understand how various experiences of ethnicity may relate to the use and abuse of various illicit drugs. In understanding this diversity, along with the cultural commonalities that bind a people and create a sense of belonging, drug abuse service providers should work diligently to develop and expand their levels of cultural competence. A commitment to cultural competence is expected to promote the delivery of more culturally relevant and effective drug abuse prevention interventions and/or drug treatment services. Attending to the cultural aspects of the client- provider relationship, of client assessment, of drug treatment and relapse prevention, and of agency organization, policies, and procedures will contribute to improving the quality of care and treatment.

Chen MS. Cancer health disparities among Asian Americans: What we know and what we need to do? Cancer 104(12, Supplement S): 2895-2902, 2005. (76 refs.)

Asian Americans are the nation's fastest growing racial group in terms of percentages, and they constitute a very heterogeneous population. The author reviewed the literature and proposed an agenda to reduce cancer health disparities based on this review and the accomplishments and aspirations of the National Cancer Institute-funded Asian American Network for Cancer Awareness, Research, and Training. The Asian American cancer burden is unique, unusual, and, to a certain extent, unnecessary. The Asian American cancer burden is unique, because Asians are the only racial/ethnic population to experience cancer as the leading cause of death. The unusual aspects of the cancer burden among Asian Americans include experiencing proportionally more cancers of infectious origin, such as human papillomavirus-induced cervical cancer, hepatitis B virus-induced liver cancer, and stomach cancer, than any other racial/ethnic population and, at the same time, experiencing an increasing numbers of cancers associated with "Westernization." To a certain extent, the cancer burden for Asian Americans is unnecessary if barriers to cancer screening, overcoming resistance to physician visits, and culturally competent interventions to reduce smoking, unhealthy diet, and increasing proper exercise can be instituted. Reducing cancer health disparities among Asian Americans will involve research into their unique, unusual, and unnecessary cancer burden.

Chen WW. Drug abuse prevention research for Asian and Pacific Islander Americans. IN: Sloboda Z; Bukoski WJ, eds. Handbook of Drug Abuse Prevention: Theory, Science, and Practice. New York: Kluwer Academic/Plenum Publishers, 2003. pp. 411-426. (83 refs.)

This is one of several chapters that considers substance abuse prevention from the perspective of special populations. This chapter considers issues related to preventing substance use among Asian and Pacific Islanders. The chapter begins with a review of the epidemiology of substance use and factors which affect drug use and abuse. It concludes with discussion of prevention research targeted as Asian and Pacific-Islanders.

Chen X; Unger JB; Palmer P; Weiner MD; Johnson CA; Wong MM et al. Prior cigarette smoking initiation predicting current alcohol use: Evidence for a gateway drug effect among California adolescents from eleven ethnic groups. Addictive Behaviors 27(5): 799-817, 2002. (70 refs.)

Studies have reported a gateway effect of cigarette smoking on alcohol use among adolescents. However, there is a lack of knowledge regarding ethnic differences in this effect. Using data from a cross-sectional survey in California, 11,239 subjects (46.3 percent male) from 31 high schools entered the analysis. Among them, 6016 were ninth graders (mean age=14.3) and 5,223 were twelfth graders (mean age=17.3). After controlling for seven variables, the risk ratio of last 30-day alcohol use among prior smoking initiators versus noninitiators was 5.82 for non-Hispanic Whites, 4.25 for Blacks, 8.37 for Asian Indians, 3.99 for Chinese, 3.45 for Filipinos, 3.48 for Japanese, 5.41 for Koreans, 7.57 for Vietnamese, 4.02 for Mexicans, 2.64 for South/Central Americans, and 5.95 for adolescents with multiethnic background. Comparison of the 11 ethnic groups indicated that adolescents from different ethnic groups but with similar cultural background had a similar risk level; such pattern existed after controlling for acculturation, parents' monitoring, and school performance. The risk ratio did not differ by gender and grade. There is an association between prior cigarette smoking initiation and current alcohol use among adolescents from different ethnic backgrounds, including those of multiethnicity, which supports the generalizability of gateway drug effect of cigarette smoking on alcohol use. Studies should be conducted to investigate factors attributable to the ethnic variations of this association.

Chen XG; Unger JB. Hazards of smoking initiation among Asian American and non-Asian adolescents in California: A survival model analysis. Preventive Medicine 28(6): 589-599, 1999

Background. Information about the risk of smoking initiation among whites, African Americans, and Latino Americans has provided an important information base for smoking prevention programs among adolescents from these ethnic backgrounds. Unfortunately, there is a lack of such information for Asian Americans, a fast-growing ethnic minority group with much internal diversity. Method. This study used cross-sectional data from 20,482 subjects 12- 17 years of age, randomly sampled in California, to describe and compare the risk of smoking initiation for adolescents by age among Asian American and other non-Asian ethnic groups, using survival analysis. Computer-aided telephone interview techniques were used in data collection. Result. The risk of early smoking initiation among Asian American adolescents is about a third of that of Caucasians. However, the risk among Asian Americans continues to increase throughout adolescence, while the same risk among Caucasians and African Americans plateaus around 14-15 years of age. Significant differences in the levels and patterns of smoking initiation among Asian American subgroups were observed, with Chinese Americans showing the lowest risk of smoking initiation and Filipino Americans the highest, Japanese and Korean Americans being in-between. Conclusion. Asian American adolescents may be especially at risk of smoking initiation later in adolescence, even though they are at lower risk early in adolescence. Smoking prevention programs for Asian Americans should continue throughout adolescence and early adulthood.

Chen XG; Unger JB; Johnson CA. Is acculturation a risk factor for early smoking initiation among Chinese American miners? A comparative perspective. Tobacco Control 8(4): 402-410, 1999. (56 refs.)

Objective-To determine the extent to which Chinese American and white minors differ in age of smoking initiation, and to determine the effect of acculturation on smoking initiation. Design-Cross-sectional telephone surveys. Setting-Stratified random samples of the state of California, United States. Subjects-347 Chinese American and 10 129 white adolescents aged 12 through 17 years, from the California Tobacco Survey (1990-93) and the California Youth Tobacco Survey (1994-96). Outcome measures-Hazards (risk) of smoking initiation by age, smoking initiation rate, cumulative smoking rate, mean age of smoking initiation, and acculturation status. Statistical methods-Life table methods, proportional hazards models, and chi(2) tests Results-The risk of smoking initiation by age among Chinese American miners was about a third of that among white miners. The risk for Chinese Americans continued to rise even in later adolescence, in contrast to that for whites, which slowed after 15 years of age. Acculturation was associated significantly with smoking onset among Chinese Americans. Acculturation, smoking among social network members, attitudes toward smoking, and perceived benefits of smoking were associated with the difference in hazards of smoking onset between Chinese American miners and their white counterparts. Conclusions-Chinese American adolescents had a lower level and a different pattern of smoking onset than white adolescents. Levels of acculturation and other known risk factors were associated with the hazards of smoking initiation among Chinese American miners and with the difference in smoking initiation between the Chinese and white adolescents. Tobacco prevention policies, strategies, and programmes for ethnically diverse populations should take acculturation factors into account.

Chen XG; Unger JB; Palmer P; Weiner MD; Johnson CA; Wong MM; Austin G. Prior cigarette smoking initiation predicting current alcohol use: Evidence for a gateway drug effect among California adolescents from eleven ethnic groups. Addictive Behaviors 27(5): 799-817, 2002. (70 refs.)

Gateway drug theory provides a useful framework for understanding drug use among adolescent populations. Studies have reported a gateway effect of cigarette smoking on alcohol use among adolescents; but there is a lack of knowledge regarding ethnic differences in this effect. Using data from a cross-sectional survey in California, 11,239 subjects (46.3% male) from 31 high schools with at least 25% of total enrollment of Asian and at least 200 students with Asian ancestry entered the analysis. Among them, 6016 were ninth graders (mean age=14.3, S.D.=0.49) and 5223 were twelfth graders (mean age=17.3, S.D.=0.54). After controlling for seven variables, the risk ratio of last 30-day alcohol use among prior smoking initiators vs. noninitiators was 5.82 for non-Hispanic Whites, 4.25 for Blacks, 8.37 for Asian Indians, 3.99 for Chinese, 3.45 for Filipinos, 3.48 for Japanese, 5.41 for Koreans, 7.57 for Vietnamese, 4.02 for Mexicans, 2.64 for South/Central Americans, and 5.95 for adolescents with multiethnic background. Comparison of the 11 ethnic groups indicated that adolescents from different ethnic groups but with similar cultural background had a similar risk level; such pattern existed after controlling for acculturation, parents' monitoring, and school performance. The risk ratio did not differ by gender and grade. There is an association between prior cigarette smoking initiation and current alcohol use among adolescents from different ethnic backgrounds, including those of multiethnicity, which supports the generalizability of gateway drug effect of cigarette smoking on alcohol use. Studies should be conducted to investigate factors attributable to the ethnic variations of this association.

Choi KH; Operario D; Gregorich SE; McFarland W; MacKellar D; Valleroy L. Substance use, substance choice, and unprotected anal intercourse among young Asian American and Pacific Islander men who have sex with men. AIDS Education and Prevention 17(5): 418-429, 2005. (32 refs.)

Substance use has been shown to be an important factor associated with having unprotected anal intercourse (UAI) among Asian and Pacific Islander (API) men who have sex with men (MSM). However, little is known about which substances are used in conjunction with sexual activity and whether having UAI varies by substance choice in this population. From January 2000 to September 2001, we sampled API MSM aged 18-29 years from 30 gay-identified venues in San Francisco, California, and interviewed 496 API men face-to-face using a standardized questionnaire. Overall, 47% of the sample reported UAI in the past 6 months. During the same time period, 32% and 34% reported being "high" or "buzzed" on alcohol and drugs during sex, respectively. The most common drugs used in conjunction with sex were methylenedioxymethamphetamine ("ecstasy"; 19%), followed by marijuana (14%), inhalant nitrites ("poppers"; 11 %), and crystal methamphetamine ("crystal"; 10%). In a multivariate model, we observed associations between UAI and being high or buzzed on ecstasy (odds ratio [OR] = 2.62; 95% confidence interval [CI] = 1.37,5.02) and poppers during sex (OR = 3.29; 95% CI = 1.50, 7.25). However, being high or buzzed on alcohol, marijuana, gamma-hydroxybutyrate (GHB), and crystal methamphetamine during sex had no association with UAI. One third of sampled young API MSM used drugs or alcohol during sex. The co-occurrence of ecstasy and popper use and unprotected sex underscores the need to develop HIV prevention programs focusing on particular drugs.

Chow J. Asian American and Pacific Islander mental health and substance abuse agencies: Organizational characteristics and service gaps. Administration and Policy in Mental Health 30(1): 79-86, 2002. (20 refs.)

Asian Americans are often termed "the model minority" and have lower prevalences of both substance use disorders and psychiatric problems. However, when treated, their problems are identified as more severe. This raises questions about under-utilization and whether barriers exist that restrict access. To explore this, a survey was conducted of agencies that serve a significant Asian-American population. Agencies were from 12 states, and were all member of a professional association of service providers for Asian Americans. Among the significant findings were that most of these agencies were did not exclusively provide mental health and substance abuse services. Of services provided those that were most common were out-patient care. None of the agencies provided detoxification or day treatment programs. In respect to boards, all had board member of their community Asian-American generally in proportion of the size of the local Asian population. However, it was noted that Southeast Asian communities and Filipino communities were under-represented. In terms of funding, public funding was almost the exclusive source of funding for substance abuse programs although that was not the case for mental health services. In addition, while mental health service funding had been largely stable, this was not the case for substance use services, with ups and largely downs. In terms of unmet needs among the programs mentioned were aftercare, family and individual counseling, and after school programs. In respect to outreach and community education, these agencies rarely used English language newspapers nor used local radio stations, the most common methods was via other community groups, and neighborhood-directed publications.

Collins RL; McNair LD. Minority women and alcohol use. Alcohol Research & Health 26(4): 251-256, 2002. (47 refs.)

Women's drinking patterns are influenced by the cultural norms and practices of the ethnic groups to which they belong, in addition to other environmental and biological factors. This article examines the drinking behavior of women from the four largest non-European ethnic groups in the United States, addressing a specific variable in relation to each group: religious activity among African American women; the facial flushing response in Asian American women; the level of acculturation to U.S. society among Latinas; and historical, social, and policy variables unique to American Indian women. Although little research to date has focused on minority women and alcohol, the current state of knowledge in this area provides a starting point from which to view commonalities among groups as well as the many sources of heterogeneity within and between them.

Public Domain

Cook TAR; Luczak SE; Shea SH; Ehlers CL; Carr LG; Wall TL. Associations of ALDH2 and ADH1B genotypes with response to alcohol in Asian Americans. Journal of Studies on Alcohol 66(2): 196-204, 2005. (65 refs.)

Objective: Individuals with alcohol dependence are less likely to possess variant alleles of the alcohol-metabolizing genes, aldehyde dehydrogenase (ALDH2*2) and alcohol dehydrogenase (ADHIB*2), than non-alcohol-dependent controls. It is hypothesized that the mechanism through which these alleles protect against alcohol dependence is by causing elevations in acetaldehyde, which in turn cause an increased response to alcohol. Previous research has shown that individuals with ALDH2*2 demonstrate enhanced reactions to alcohol compared with those without this genetic variant, but evidence that ADHIB*2 is associated with a greater alcohol response is mixed. This study was designed to determine whether the ADHIB genotype is associated with more intense reactions to alcohol after controlling for the ALDH2 genotype. Method: Participants (N = 101) were Asian American college students. Each was evaluated using objective and subjective measures before and after ingestion of alcohol and placebo beverages. Results: Participants with the ALDH2*1/*2 and ALDH2*2/*2 genotypes were more likely to experience vomiting following ingestion of the alcohol beverage than those with the ALDH2*1/*1 genotype. Participants with the ALDH2*1/*2 genotype also had greater pulse-rate increases, observed flushing ratings, and subjective feelings of intoxication 30 minutes after ingestion of alcohol than participants with the ALDH2*1/*1 genotype, despite equivalent blood alcohol concentration (BAC) measurements. Among participants with the ALDH2*1/*1 genotype, there were no additional effects of the ADHIB genotype on any measures of response to alcohol. Among participants with the ALDH2*1/*2 genotype, those with the ADHIB*2/*2 genotype were more likely to experience alcohol-induced vomiting and to report feeling less "great overall" 30 minutes after ingestion of alcohol than those with the ADHIB*1/*2 genotype. Conclusions: These findings are consistent with the hypothesis that there is an additional effect of ADHIB*2 on level of response to alcohol, but only among individuals with the ALDH2*1/*2 genotype.

Dawson DA. Beyond black, white and Hispanic: Race, ethnic origin and drinking patterns in the United States. IN: National Institute on Alcohol Abuse and Alcoholism; Dufour MC, eds. Alcohol Consumption and Problems in the General Population: Findings from the 1992 National Longitudinal Alcohol Epidemiologic Survey. Rockville MD: National Institute on Alcohol Abuse and Alcoholism, 2002. pp. 13-24. (39 refs.)

This study used data on 42,862 U.S. adults, including 18,352 past- year drinkers, to describe differentials by race and national origin in U.S. drinking patterns. Age-sex standardized estimates were presented within 21 categories of ethnic origin for whites and within five categories each for individuals of black and other races. Of the three racial groups, whites were the most likely to drink but blacks had the highest volume of intake and frequency of heavy drinking. Differences by ethnic origin within racial categories were as marked as differentials between races. Compared to whites of European origin, those of Hispanic and native American origin were less likely to drink but consumed more alcohol on days when they drank. Whites of Southern and Eastern European origin drank proportionately more wine and demonstrated more moderate drinking patterns (lower intake per drinking day and/or less frequent heavy drinking) than those of Northern or Central European origin. Hispanics of Caribbean origin were less prone to heavy drinking than other white Hispanics; similarly, blacks from the English-speaking Caribbean showed more moderate drinking patterns than other blacks. Individuals of Asian origin, in particular those of non-Japanese origin, had the most moderate drinking patterns within the category of other race. Although the black/white differentials in volume of intake and frequency of heavy drinking disappeared after adjusting for marital status, education and income, most of the differences by ethnic origin retained their statistical significance if not their original magnitudes. These findings indicate that cultural forces exert a strong effect on drinking behavior. Differences among European whites with respect to prevalence of drinking, beverage preference and frequency of heavy drinking suggest that the association between ethnic origin and drinking behavior may persist even after many generations of presumed acculturation.

Doolan DM; Froelicher ES. Efficacy of smoking cessation intervention among special populations: Review of the literature From 2000 to 2005. Nursing Research 55(4, Supplement S): S29-S37, 2006. (68 refs.)

The United States Public Health Service acknowledges in the 2000 Clinical Practice Guideline for Treating Tobacco Use and Dependence that certain special populations have unique needs and considerations in regard to smoking cessation interventions. In a review of the current smoking cessation literature, the following special populations were identified: women; older adults; gay, lesbian, bisexual, and transgender smokers; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; American Indians and Alaska Natives; African Americans; Hispanic; and Asian Americans. Existing smoking cessation research pertaining to these special populations was assessed, and an agenda for future research is proposed in this presentation. The available smoking cessation randomized clinical trials for efficacy and other research relevant to these groups is insufficient. Recent progress has been made in research in the areas of smoking cessation and women; smokers with psychiatric diagnoses; smokers addicted to illicit drugs, alcohol, or both; and African Americans. There is, however, a paucity of research evaluating smoking cessation interventions and older adults; gay, lesbian, bisexual, and transgender smokers; American Indians and Alaska Natives; Hispanic; and Asian Americans. Further research relevant to the smoking cessation needs of these special populations can enable nurses and other healthcare providers to administer culturally adequate and efficacious smoking cessation interventions to these groups.

Ebberhart NC; Luczak SE; Avanecy N; Wall TL. Family history of alcohol dependence in Asian Americans. Journal of Psychoactive Drugs 35(3): 375-377, 2003. (10 refs.)

A positive family history of alcoholism is one of the most consistent and powerful predictors of developing this disorder. Compared to other ethnic groups, Asian Americans, as a whole, report the lowest prevalence of family history of alcoholism, but differences in rates for Asian American subgroups have not been reported previously. This study assessed first- and second-degree family history of alcohol dependence in two Asian-American subgroups: individuals of Chinese (n = 142) and Korean (n = 152) heritage. As hypothesized, Korean Americans reported higher rates of first-degree family history of alcohol dependence than Chinese Americans. These findings highlight the heterogeneity in vulnerability to alcohol-related problems between Asian subgroups.

Ebberhart NC; Luczak SE; Carr LG; Wall TL. Factors associated with high scores on the self rating effects of alcohol form among Chinese- and Korean-American college students. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 160A-160A, 2004. (0 refs.)

Ellickson PL; Perlman M; Klein DJ. Explaining racial/ethnic differences in smoking during the transition to adulthood. Addictive Behaviors 28(5): 915-931, 2003. (37 refs.)

Using data from a longitudinal panel of nearly 3000 adolescents to predict current smoking among young adults, we test whether adding variables that tap prior social bonds and influences to the model eliminates race/ethnicity as a significant predictor of current smoking. At age 23, African Americans and Asians exhibited substantially lower rates of current smoking than Whites and Hispanics. Controlling for social influences during high school, particularly exposure to siblings and friends who smoked plus parental disapproval of smoking, accounted for these differences. Social bonding variables, in contrast, had a limited mediating effect. Interventions aimed at decreasing adolescent vulnerability to prosmoking influences, reducing overall levels of peer cigarette use, and helping parents better convey their disapproval of smoking should help curb young adult smoking and diminish racial/ethnic differences in tobacco use.

Friis RH; Forouzesh M; Chhim HS; Monga S; Sze D. Sociocultural determinants of tobacco use among Cambodian Americans. Health Education Research 21(3): 355-365, 2006. (22 refs.)

The objectives of this study included the following: obtaining qualitative information on tobacco use among Cambodian Americans, identifying cultural factors that influence tobacco use and acquiring information for the development of effective smoking prevention and cessation strategies. Data were collected by using demographic and behavioral questionnaires and focus group interviews. A total of 14 focus group interviews that covered cultural practices associated with smoking were administered. Statistical analyses included univariate frequency distributions and cross-tabulations. The subjects (n = 119) were Cambodian American volunteers who participated in social services programs offered by a community service organization. All subjects were 18 years of age or older and resided in the city of Long Beach. The principal outcomes measured were cigarette smoking and tobacco use. Other variables included reasons for smoking, traditional uses of tobacco, stress factors related to smoking and the perceived health effects of smoking. Predisposing, reinforcing and enabling factors associated with tobacco-use behaviors included peer group influences, smoking adopted as a coping method, tobacco used for medicinal purposes and smoking practiced within cultural traditions. The frequency of smoking was four times higher among males than among females. Smokers (n = 29) in comparison with non-smokers (n = 90) tended to be men (79% versus 33%), not married (68% versus 49%) and unemployed (79% versus 54%), and had attained somewhat lower levels of education. The role of cultural factors needs to be considered when designing appropriate smoking cessation strategies for Cambodian Americans.

Fu SS; Ma GX; Tu XM; Siu PT; Metlay JP. Cigarette smoking among Chinese Americans and the influence of linguistic acculturation. Nicotine and Tobacco Research 5(6): 803-811, 2003. (38 refs.)

Less acculturated Chinese Americans experience cultural and language barriers. The present study assessed the relationship between linguistic aspects of acculturation and cigarette smoking among Chinese Americans. A cross-sectional, self-administered survey was administered to a consecutive sample of 541 Chinese American adults (aged 18 years or older) attending four pediatric, medical, or dental practices located in Philadelphia's Chinatown from November 2000 to February 2001. Linguistic acculturation was measured by adapting a reliable and valid acculturation scale developed for Southeast Asians. English and Chinese language proficiency subscales were utilized to analyze the association between language proficiency and current smoking. Whereas 25% of Chinese American men reported current smoking, only 3% of Chinese American women reported current smoking. Chinese American men with lower English proficiency reported significantly higher rates of current smoking compared with Chinese American men with a higher level of English proficiency (33% vs. 18%, p<.01). Less English-proficient Chinese American male smokers were less likely to have received advice from a physician to quit smoking (50% vs. 85%, p=.01). In multivariate analysis, increased English proficiency was associated with decreased odds of current smoking (OR=0.38, 95% CI=0.16-0.89) among Chinese American men after controlling for confounding variables. In conclusion, higher English proficiency was associated with decreased current smoking among Chinese American men. Chinese American men with limited English proficiency should especially be targeted for tobacco control interventions. Further research is needed to assess whether acculturation is associated with smoking among Chinese American women and with use of smoking cessation treatments and services by Chinese American smokers.

Gomberg ESL. Treatment for alcohol-related problems: Special populations. Research opportunities. IN: Galanter M, ed. Recent Developments in Alcoholism. Volume 16: Research on Alcoholism Treatment. Methodology/Psychosocial Treatment/Selected Treatment Topics/Research Priorities. New York: Kluwer Academic, 2003. pp. 313-333. (70 refs.)

Treatment for alcohol-related problems is discussed, with a focus on women, elderly, and minority (Native American [Indian], Black Americans, Asian-American, and Hispanic-American populations. Questions relevant to all three groups include heterogeneity of the special populations; efficacy of professional and indigenous therapy modalities; and group-specific and/or group-sensitive therapies. When male and female alcoholics are compared, females report more positive family history, a later onset of drinking, more marital disruption, and more comorbidity, although there were few gender differences in treatment outcomes. Medications are more often used by the elderly and the elderly are more likely to experience adverse drug reactions. There are more than 200 Native American tribes in the U.S., each with its own culture. Some tribes are abstinent while some tribes have problems with alcohol and other drugs. Orthodox treatment methods have not been very effective. Black Americans include people from the Caribbean, Central and South America as well as African Americans. There appears to be a history of ambivalence toward alcohol. Asian-Americans, including Chinese, Japanese, Filipinos, and Koreans, differ in drinking beliefs and behaviors. Japanese-Americans report the largest number of heavy drinkers, although problematic alcohol use is considered a private matter. As a total group, Hispanic-Americans drink more and present more alcohol-related problems than other immigrant groups. Specific recommendations are included.

Gong F; Takeuchi T; Agbayani-Siewert P; Tacata L. Acculturation, psychological distress, and alcohol use: Investigating the effects of ethnic identity and religiosity. IN: Chun KM; Organita PB; Marin G, eds. Acculturation: Advances in Theory, Measurement, and Applied Research. Washington DC: American Psycological Association, 2002. pp. 189-206. (24 refs.)

This chapter addresses how acculturation (including age at immigration, length of residence in the US, and language abilities), ethnic identity, and religiosity are linked, as well as their influence on psychological distress (PD) and alcohol dependence (AD) among Filipino American immigrants. Data were collected from the Filipino American Epidemiological Study. Analyses were based on interview data from 1,796 respondents (aged 18-65 yrs). Results show that the developmental context of immigration and the time spent in the US have strong implications for lowering indicators of ethnic identity. Strong English proficiency enhances the sense of ethnic identity. Only English language proficiency was a significant predictor of religious behavior. AD was inversely affected by age during immigration. When controlling for other demographic and acculturation variables, analyses show that ethnic identity was an especially significant variable in predicting PD. Findings indicate that ethnic identity and religiosity partially mediate the effect of age during immigration on AD. Results suggest that age during immigration has direct and indirect effects on AD. It is concluded that ethnic identity and religiosity are significant factors in reducing the risk of AD.

Grunbaum JA; Lowry R; Kann L; Pateman B. Prevalence of health risk behaviors among Asian American/Pacific Islander high school students. Journal of Adolescent Health 27(5): 322-330, 2000. (31 refs.)

Purpose: To compare the prevalence of selected risk behaviors among Asian American/Pacific Islander (AAPI) students and white, black, and Hispanic high school students in the United States. Methods: The national Youth Risk Behavior Survey conducted in 1991, 1993, 1995, and 1997 by the Centers for Disease Control and Prevention produced nationally representative samples of students in grades 9 through 12 in all 50 states and the District of Columbia. To generate a sufficient sample of AAPI students, data from these four surveys were combined into one dataset yielding a total sample size of 55,734 students. Results: In the month preceding the survey, AAPI students were significantly less likely than black, Hispanic, or white students to have drunk alcohol or used marijuana. AAPI students also were significantly less likely than white, black, or Hispanic students to have had sexual intercourse; however, once sexually active, AAPI students were as likely as other racial or ethnic groups to have used alcohol or drugs at last intercourse or to have used a condom at last intercourse. AAPI students were significantly less likely than white, black, or Hispanic students to have carried a weapon or fought but were as likely as any of the other groups to have attempted suicide. Conclusions: A substantial percentage of AAPI students engage in risk behaviors that can affect their current and future health. Prevention programs should address the risks faced by AAPI students using culturally sensitive strategies and materials. More studies are needed to understand the comparative prevalence of various risk behaviors among AAPI subgroups.

Hahm HC; Lahiff M; Guterman NB. Acculturation and parental attachment in Asian-American adolescents' alcohol use. Journal of Adolescent Health 33(2): 119-129, 2003. (46 refs.)

Purpose: To test whether the degree of acculturation predicts subsequent alcohol use among Asian-American adolescents, and to test the moderating effect of parental attachment. Methods: This was a prospective study using a sub-sample of the National Longitudinal Adolescent Health data set. A nationally representative sample of 714 Asian-American boys (n = 332) and girls (n = 382) in grades 7-12 was analyzed. In-home self-report data were collected on two types of acculturation status, alcohol use, demographics, and parental attachment. After controlling for acculturation status and background variables at Wave 1, logistic regression analysis was used to estimate the odds ratios to assess the association between acculturation and alcohol use at Wave II for adolescents. Results: Asian-American adolescents with the highest level of acculturation (English use at home, born in the United States) were identified as the highest risk group. For adolescents with low parental attachment, the odds of alcohol use were 11 times greater in the highly acculturated group than in the least acculturated group. However, the odds of alcohol use for adolescents with moderate or high levels of parental attachment did not vary across acculturation groups. Conclusions: Overall, a greater level of acculturation was associated with greater alcohol use. However, when parental attachment was taken into account, highly acculturated adolescents with moderate or high parental attachment had no greater risk than adolescents with same levels of parental attachment who were less acculturated. Thus, it appears that acculturation per se was not a risk factor unless it was accompanied by a low level of parental attachment.

Hahn R; Vesely S; Chang MH. Health risk aversion, health risk affinity, and socio-economic position in the USA: The demographics of multiple risk. Health, Risk & Society 2(3): 295-314, 2000. (89 refs.)

Understanding the distribution of behavioural risk factors in the population can improve health promotion. This article reports on a research project which analysed the distribution of numbers of behavioural risk factors among US adults, by race/Hispanic origin, sex, and age. Income, education, and region were examined as potential confounders in observed patterns. The Behavioral Risk Factor Surveillance System (BRFSS) data for 1993 were used to assess the distribution of numbers of risk factors, i.e. smoking, heavy drinking, overweight, inadequate seatbelt use, Papanicolaou (pap) smear screening, mammography, colorectal screening, and influenza and pneumonia vaccination. Two hypotheses were examined: (1) given the distribution of each risk factor in the US population by age and sex, prevalences both of low and of high numbers of risk behaviours (but not of moderate numbers of risk behaviours) are greater than expected within each race/Hispanic origin-sex-age group; and (2) differences in socio-economic position among these groups account for the differences between observed and expected prevalences of numbers of risk factors. The second hypothesis was assessed both graphically by adjustment for income and education, and by multiple linear regression. The research found higher than expected prevalences of both low and high numbers of risk factors among whites and, possibly, among Hispanics. Among Asians prevalences were less than expected with greater numbers of risk factors. Among blacks and American Indians prevalences were lower than expected for low numbers of risk factors and were greater than expected with greater numbers of risk factors. Adjustment for income or education reduced differences between observed and expected prevalences. It appears that risk aversion and risk affinity vary substantially by race/Hispanic origin and are only partially explained by socio-economic position. Exploration of the causes of high and low risk behaviour may improve risk behaviour interventions.

Hendershot CS; MacPherson L; Myers MG; Carr LG; Wall TL. Psychosocial, cultural and genetic influences on alcohol use in Asian American youth. Journal of Studies on Alcohol 66(2): 185-195, 2005. (59 refs.)

Objective: Environmental and cultural factors, as well as a genetic variant of the aldehyde dehydrogenase gene (the ALDH2*2 allele) have been identified as correlates of alcohol use among Asian Americans. However, concurrent examination of these variables has been rare. The present study assessed parental alcohol use, acculturation and ALDH2 gene status in relation to lifetime, current and heavy episodic drinking among Chinese and Korean American undergraduates. Method: Participants (N = 428, 51% women; 52% Chinese American, age 18-19 years) were first-year college students in a longitudinal study of substance use initiation and progression. Data were collected via structured interview and self-report, and participants provided a blood sample for genotyping at the ALDH2 locus. Results: Gender, parental alcohol use and acculturation significantly predicted drinking behavior. However, none of the hypothesized moderating relationships were significant. In contrast with previous studies, ALDH2 gene status was not associated with alcohol use. Conclusions: Results indicate that although the variables examined influence alcohol use, moderating effects were not observed in the present sample of Asian American college students. Findings further suggest that the established association of ALDH2 status and drinking behavior in Asians may not be evident in late adolescence. It is possible that ALDH2 status is associated with alcohol consumption only following initiation and increased drinking experience.

Hicks M; Clarke M; Tough SC. A comparison of urban and rural health care providers' knowledge, attitudes, and clinical practice related to fetal alcohol spectrum. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 126A-126A, 2004. (0 refs.)

Hong B; Yu J-H. Asian and Pacific Islander Tobacco Education Network: A statewide partnership for the wellness of Asian and Pacific Islander communites. IN: Forst ML, ed. Planning and Implementing Effective Tobacco Education and Prevention Programs. Springfield IL: Charles C Thomas, 1999. pp. 51-68. (32 refs.)

The fastest growing ethnic/racial group in the US are Asian Americans and Pacific Islanders. Contrary to the popular stereotype, this is not a homogeneous group, nor a "model" minority, but a very diverse population. Information is provided on the epidemiology of tobacco use among Asian Americans and pacific Islanders. The majority of the chapter describes the efforts of the Asian and Pacific Islander Tobacco Education Network (APITEN) established in California with monies provided from proceeds of Proposition 99, passed to increase cigarette taxes to fund education and prevention efforts.

Hsia FN; Spruijt-Metz D. The meanings of smoking among Chinese American and Taiwanese American college students. Nicotine and Tobacco Research 5(6): 837-849, 2003. (34 refs.)

Smoking on college campuses in the United States has increased at an alarming rate since the early 1980s. Smoking rates differ according to students' culture/ethnicity and are linked to levels of acculturation. Little is known concerning the determinants of smoking in college populations. To develop effective smoking interventions targeting college smoking, an understanding of why these populations are taking up tobacco is vital. The meanings with which adolescents imbue smoking have been related to smoking behaviors in adolescent populations. Meanings of particular behaviors are strongly influenced by cultural background and acculturation. Meanings of smoking have not yet been investigated in culturally diverse college-aged populations. This in-depth qualitative investigation examined the meanings of smoking among Chinese and Taiwanese students, who are among the fastest growing populations on U.S. college campuses. These groups were selected to attempt to trace why Asian American students are at higher risk for increased smoking prevalence than any other ethnic group. Personal, functional, and socially relevant meanings emerged as powerful factors that direct smoking behaviors. Because smoking is not accepted as readily in the United States as it is in China and Taiwan, subjects reported experiencing a profound shift in social norms after immigration, which led to a change in meanings of smoking. These changes in meanings precipitated changes in smoking behavior. Smokers reported reducing tobacco use or quitting altogether. Implications of these findings as they relate to patterns of smoking in Chinese American and Taiwanese American populations are discussed.

Hunt G; Evans K; Wu E; Reyes A. Asian American youth, the dance scene, and club drugs. Journal of Drug Issues 35(4): 695-731, 2005. (51 refs.)

The available research data on young Asian American drug use is relatively limited compared to the availability of research on other major ethnic groups. Today more published data have highlighted the extent to which drug use is significant and rising in Asian American communities. From our ongoing research on the social context of ecstasy and other club drug use in the San Francisco Bay Area, we analyze data from a total of 56 face-to-face interviews with young Asian American club and rave attendees. We explore the development of a distinctive Asian American experience, in order to understand the attraction of club drugs and the dance scene. We examine the specific social groupings in which they operate, the types of social events they attend, and the nature of their club drug use. We highlight some of the ways in which they construct and express their identities around these social groupings, in terms of ethnic and socio-cultural distinctions as well as other cultural commodities.

Ji M; Hofstetter CR; Hovell M; Irvin V; Song YJ; Lee J; Park H; Paik HY. Smoking cessation patterns and predictors among adult Californians of Korean descent. Nicotine & Tobacco Research 7(1): 59-69, 2005. (46 refs.)

This paper describes smoking cessation among adult Californian residents of Korean descent, based on a telephone survey (N=2,830). The overall quit rate (number of former smokers divided by number of ever-smokers) was 55.0% (55.8% among males and 49.6% among females). Acculturation was negatively associated with 90-day abstinence after controlling for demographic, social support, health belief, environmental, lifestyle, and respiratory illness history variables (OR=0.59, 950% CI=0.38-0.91). Those with lower acculturation, higher body mass index, a social network discouraging smoking, home smoking restriction, correct beliefs about smoking harm, and significant concern about one's health were most likely to quit smoking for 90 days or longer. Results suggest that social and situational conditions should be included in the design of smoking cessation interventions among Koreans.

Kaplan CP; Zabkiewicz D; McPhee SJ; Nguyen T; Gregorich SE; Disogra C et al. Health-compromising behaviors among Vietnamese adolescents: The role of education and extracurricular activities. Journal of Adolescent Health 32(5): 374-383, 2003. (36 refs.)

Purpose: To examine the prevalence of unhealthy behaviors among a cohort of Vietnamese adolescents in California; to examine the relationship between these behaviors and school-related variables (school performance, educational risk behaviors, higher-education aspirations, and participation in extracurricular activities); and to assess the differences that may exist between males and females with regard to these factors. Methods: We conducted telephone interviews with 783 Vietnamese adolescents, aged 12-17 years, recruited through telephone listings from four California counties where large Vietnamese populations reside: San Francisco, Santa Clara, Los Angeles, and Orange. Of the 783 completed interviews, 60.8% were conducted in English and 39.2% in Vietnamese. The main outcome measure is a health risk behavior scale that includes adolescents' reports of ever smoking a cigarette, sedentary vs. active lifestyle, consumption of fruits and vegetables, consumption of foods high in fat, ever drinking alcohol, and ever engaging in sexual behavior. Multiple regression analyses were employed to estimate the association among the demographic variables, acculturation, school performance, aspirations, extracurricular activities, and the overall health risk. Results: Females were significantly more sedentary than males. Over one-quarter (29%) of the females reported not having participated in vigorous physical activity on 3 or more days per week, compared with just 18% of the males. Most adolescents reported they had never tried cigarettes (84%), never used alcohol (77%), and never had sex (97%). Males were more likely than females to report a higher frequency of experimentation with smoking and drinking. Overall, school performance and participation in extracurricular activities were significantly related to the health risk behavior scale. Adolescents who demonstrated at least one educational risk (ever skipped school or ever sent out of the classroom) were more likely to engage in other risky behaviors. Also, older and more acculturated adolescents were at increased risk of engaging in health-compromising behaviors. Analysis by gender revealed that the variables age, educational risk, and chance of attending college were all related to health risk behavior for both males and females. Among the boys, those who reported achieving an average grade of B or better had a decreased risk of engaging in health-compromising behaviors; however, neither extracurricular activities nor acculturation was related to health-compromising behaviors in boys. Among the girls, the reverse was true: lack of participation in extracurricular activities was related to health-compromising behaviors, whereas grades were not a significant risk factor. Conclusion: Among sampled Vietnamese adolescents in California, health risk behaviors are common and inversely related to some school performance indicators. Using these indicators to identify high-risk groups could allow targeted educational programs or interventions for the mitigation of health-compromising behaviors.

Kim IJ; Zane NWS; Hong S. Protective factor against substance use among Asian American youth: A test of the peer cluster theory. Journal of Community Psychology 30(5): 565-584, 2002. (85 refs.)

Few viable theoretical models of risk and protective factors for adolescent substance use have been empirically tested on diverse populations. The purpose of this study was twofold. First, the cross- cultural validity 4, Oetting and Beauvais' (1987) peer cluster theory was tested on a sample of Asian American youth. Second , the effect of youths' immigration experience on the relationship among the protective factors was examined. Results showed partial support for the validity of the peer cluster model for this sample. As hypothesized, the peer domain variable Was significantly related to substance use, while the family domain variable served as a protective factor against substance use. However, the school domain variable did not have any direct or indirect effects on substance use. There were no significant differences in the path model when the sample was split according to youth immigrant status. Implications for substance use prevention are discussed.

Kim J; McCarthy WJ. School-level contextual influences on smoking and drinking among Asian and Pacific Islander adolescents. Drug and Alcohol Dependence 84(1): 56-68, 2006. (45 refs.)

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.

Kim SS; Son H; Nam KA. Personal factors influencing Korean American men's smoking behavior: Addiction, health, and age. Archives of Psychiatric Nursing 19(1): 35-41, 2005. (40 refs.)

The purpose of this qualitative study was to identify factors influencing Korean American men's smoking behavior. Focus-group research method was used, and participants were 22 Korean male smokers in New York City. They talked about their experiences of smoking and smoking cessation. Addiction, health, and age emerged as major personal factors affecting Korean men's smoking behavior. Their experiences in relation to addiction were similar to those reported in other racial/ethnic groups, whereas the dramatic change in the perception of smoking-related health risks coming with their forties, some cessation strategies used by former smokers, and preference for group meetings over individual counseling appeared to be specific to Korean men.

Kitano KJ; Louie LJ. Asian and Pacific Islander women and addiction. IN: Straussner SLA; Brown S, eds. Handbook of Addiction Treatment for Women. San Francisco: Jossey-Bass, Inc., 2001. pp. 348-373

In this chapter, the authors identify patterns of addiction among Asian American and Pacific Islander women, identify cultural and familial factors that protect women from and contribute to risk of substance abuse, discuss limitations of assessment tools and treatment modalities, and provide recommendations as to the best treatment approaches for this population. This chapter also creates a historical and cultural context though which to explore the complexity of addiction with regard to Asian and Pacific Islander women.

Kolonel LN; Henderson BE; Hankin JH; Nomura AMY; Wilkens LR; Pike MC et al. A multiethnic cohort in Hawaii and Los Angeles: Baseline characteristics. American Journal of Epidemiology 151(4): 346-357, 2000. (67 refs.)

The authors describe the design and implementation of a large multiethnic cohort established to study diet and cancer in the United States. They detail the source of the subjects, sample size, questionnaire development, pilot work. and approaches to future analyses. The cohort consists of 215,251 adult men and women (age 45- 75 years at baseline) living in Hawaii and in California (primarily Los Angeles County) with the following ethnic distribution: African- American (16.3%), Latino (22.0%), Japanese-American (26.4%), Native Hawaiian (6.5%), White (22.9%), and other ancestry (5.8%). From 1993 to 1996, participants entered the cohort by completing a 26-page, self-administered mail questionnaire that elicited a quantitative food frequency history, along with demographic and other information. Response rates ranged from 20% in Latinos to 49% in Japanese- Americans. As expected, both within and among ethnic groups, the questionnaire data show substantial variations in dietary intakes (nutrients as well as foods) and in the distributions of non-dietary risk factors (including smoking, alcohol consumption, obesity, and physical activity). When compared with corresponding ethnic-specific cancer incidence rates, the findings provide tentative support for several current dietary hypotheses. As sufficient numbers of cancer cases are identified through surveillance of the cohort, dietary and other hypotheses will be tested in prospective analyses.

Lafferty CK; Heaney CA; Chen MS Jr. Assessing decisional balance for smoking cessation among Southeast Asian males in the US. Health Education Research 14(1): 139-146, 1999. (22 refs.)

This study examines the relationship of positive and negative perceptions of smoking to self-reported readiness to quit smoking among Southeast (SE) Asian males of Cambodian, Laotian or Vietnamese descent. In order to investigate this relationship, measures of decisional balance constructs (i.e, the pros and cons of smoking) appropriate for these ethnic groups were developed. Decisional balance was calculated by subtracting the cons from the pros. Following the criteria established by Prochaska and DiClemente, subjects were categorized into four levels of readiness to quit smoking (precontemplation, contemplation, preparation/action and maintenance). The expected pattern of relationship between decisional balance and stages of change included: (1) the cons of smoking being of less importance than the pros of smoking for those smokers in the precontemplation stage, (2) the pros and cons intersecting at the contemplation stage, and (3) the cons being of greater importance than the pros in the later stages of change. The SE Asian men in this study did not exhibit these decisional balance patterns, although mean decisional balance scores for precontemplators and contemplators were significantly more positive than mean scores for those in the preparation/action and maintenance stages. Decisional balance patterns differed across the three ethnic groups included in the sample.

Lai KQ; McPhee SJ; Jenkins CNH; Wong C. Applying the Quit & Win contest model in the Vietnamese community in Santa Clara County. Tobacco Control 9(Supplement): 56-59, 2000. (22 refs.)

Objective-To evaluate the effectiveness of modifying and applying a Quit & Win contest model to Vietnamese Americans. Design-Uncontrolled trial, multicomponent program, including two Quit & Win incentive contests, smoking cessation classes, videotape broadcasts, and newspaper articles. Subjects and setting-Vietnamese smokers living in Santa Clara County, California. Main outcome measures-Contest participation rates and quit rates at six month follow up; saliva cotinine validation of quitting. Results-There were 57 eligible contest entrants to the 1995 contest, approximately 0.9% of the potential pool of smokers, and 32 entrants to the 1996 contest, approximately 0.5% of the potential pool. Overall, 48 of 49 (98%) individuals who said that they had quit smoking had validation of that fact by saliva cotinine testing. At six months, telephone follow up of 76 individuals revealed a self reported continued abstinence rate of 84.2%. Conclusion-Modification and application of the Quit & Win contest model for Vietnamese resulted not only in reasonable participation by Vietnamese male smokers, but also good success in initial quitting and an unexpectedly high abstinence rate at six month follow up.

Lew R; Tanjasiri SP. Slowing the epidemic of tobacco use among Asian Americans and Pacific Islanders. American Journal of Public Health 93(5): 764-768, 2003. (40 refs.)

Data on tobacco use among the Asian American/Pacific Islander (AAPI) population remain limited, although existing studies indicate that tobacco use prevalence among males from specific AAPI groups is significantly higher than in the general US male population. This high prevalence of tobacco use and the disparities in use result from social norms, targeted marketing by the tobacco industry, lack of culturally and linguistically tailored prevention and control programs, and limited impact of mainstream tobacco control programs for AAPIs. We review the available literature on tobacco use among AAPI men and women, highlight a national agenda that promotes tobacco prevention and control for AAPI communities, and acknowledge recent trends including the increase of tobacco use among AAPI women and girls.

Lim S; Kasprow WJ; Rosenheck RA. Psychiatric illness and substance abuse among homeless Asian-American veterans. Psychiatric Services 57(5): 704-707, 2006. (11 refs.)

Objectives: This study examined the proportion of Asian Americans among homeless veterans and among veterans in the general population to calculate the relative risk of homelessness among Asian-American veterans. It also examined differences in rates of psychiatric and substance use disorders between homeless racial and ethnic subgroups. Methods: Data were gathered between 1997 and 2001 from the Health Care for Homeless Veterans program and included data from administrative intake, patients' self-reports, and clinicians' diagnostic assessments of substance use disorders and psychiatric illness. Results: Data were examined for 67,441 veterans. Asian-American veterans had a significantly lower risk of homelessness than veterans of other ethnic groups. Alcohol abuse was significantly and consistently less prevalent among Asian Americans compared with blacks and Hispanics. However, drug abuse was less prevalent among Asian Americans than among blacks and Hispanics, but rates were similar to those of whites. Conclusions: Lower rates of alcohol abuse may protect Asian-American veterans from becoming homeless.

Linton A; Peterson MR. Effect of preexisting chronic disease on primary cesarean delivery rates by race for births in US military hospitals, 1999-2002. Birth Issues in Perinatal Care 31(3): 165-175, 2004. (58 refs.)

Background: A previous study of the United States Department of Defense healthcare beneficiaries reported elevated cesarean delivery rates for black and Asian women relative to white women that were independent of maternal socioeconomic status. This finding suggests that other maternal factors may explain the elevated rates. The purpose of this study was to examine the prevalence of specific chronic diseases identified as risk factors for complications during pregnancy, labor, and delivery, and to explore the strength of each disease to predict a cesarean outcome. Methods: United States military hospital discharge records from 1999 to 2002 for singleton births to women without a previous cesarean were used to calculate primary cesarean and chronic disease rates for diabetes, hypertension, cardiovascular disease, renal disease, anemia, asthma, sexually transmitted diseases, and substance abuse. Stepwise logistic regression was used to calculate adjusted odds ratios for dichotomized race and chronic disease indicators for five maternal age groups using the chi(2)difference(p < 0.05) to identify significant variables for inclusion in the model. Primary cesarean delivery rates were then adjusted for the presence of chronic diseases that were significantly associated with a cesarean outcome. Results: Diabetes, genital herpes, and hypertension were significant predictors of cesarean use among all maternal age groups. Cardiovascular disease, renal disease, asthma, and anemia were predictors in some age groups. The remaining disease conditions were not significant predictors for cesarean delivery. Adjustment of cesarean rates for these chronic diseases did not significantly alter the differences in primary cesarean rates for black and Asian mothers relative to white mothers. Conclusions: The presence of certain chronic conditions before pregnancy may increase the likelihood that a woman will deliver by cesarean section. Adjustment of cesarean rates for the presence of these chronic diseases, however, does not account for the difference in cesarean rates observed for white and minority mothers in the study population. The potential for underreporting of chronic diseases complicates a true assessment of the impact of chronic disease on cesarean delivery rate variations between white and minority women.

Lo CC; Globetti G. Chinese in the United States: An extension of moderation in drinking. International Journal of Comparative Sociology 42(3): 261-274, 2001. (31 refs.)

Our initial study compared drinking patterns among high-school students from three cultural groups (Chinese adolescents in Hong Kong, adolescents of Chinese origin living in Chicago, American adolescents in the United States). While the present study focuses on one group, Chinese-Americans, it devotes some effort to comparing this group's drinking patterns to those of Chinese adolescents in Hong Kong, and those of adolescents generally in the United States. We hypothesize that the acculturation status of Chinese-American students (indicated by an index developed in the study and by other acculturation factors defined later) is related to their drinking status. We also hypothesize that, in addition to its role in whether or not these adolescents drink, acculturation helps determine how much they drink. Specifically, the study sought to evaluate whether data support one of three acculturation hypotheses (simple acculturation, damaging culture, and acculturation stress hypotheses). An acculturation index was constructed based on the variables residence, place of birth, language used at home, language used with friends, friends' nationality, and movie preferences. Other relevant acculturation factors included the number of years that respondents lived in the United States, the number of years that their friends lived in the United States, and the number of movies rented in a month in Chinatown. The results did not support any one of the three acculturation hypotheses. Adolescents of Chinese origin living in the United States were less likely to be drinkers than adolescents from the other two cultures (Chinese adolescents in Hong Kong and American adolescents in the United States), and they tended to conform to drinking practices found in Hong Kong. Mixed results were found between acculturation factors and drinking levels. Modification of existing acculturation ideas were needed to explain drinking patterns among Chinese-American adolescents.

Luczak SE; Corbett K; Oh C; Carr LG; Wall TL. Religious influences on heavy episodic drinking in Chinese-American and Korean-American college students. Journal of Studies on Alcohol 64(4): 467-471, 2003. (34 refs.)

Objective: The purpose of the current study was to examine religious influences that relate to heavy episodic drinking in Chinese-American and Korean-American college students, after controlling for the effects of ALDH2 gene status. Method: Participants (159 Chinese-American and 188 Korean-American college students) were assessed for the presence or absence of a heavy drinking episode in the past 2 weeks, using a gender-specific measure. All participants also reported their religious affiliation and the number of religious services attended in the past year, and were genotyped at the A LDH2 locus. Results: Chinese were less likely than Koreans to be affiliated with any religion (55% vs 84%), but were more likely to be affiliated with Eastern religions (12% vs 1%). When controlling for the effects of ALDH2 status, service attendance significantly related to lower rates of heavy episodic drinking in Koreans, but did not reach significance in Chinese. The relationship was significant, however, in Chinese affiliated with Western religions. In addition, religious service attendance only related to heavy drinking in individuals with ALDH2*1/*1 genotype. Conclusions: These results suggest religious service attendance is inversely related to heavy episodic drinking in Korean Americans and in Chinese Americans with Western religious affiliation. Moreover, service attendance appears to more strongly influence heavy drinking in individuals who are not already protected by an ALDH2*2 allele.

Luczak SE; Elvine-Kreis B; Shea SH; Carr LA; Wall TL. Genetic risk for alcoholism relates to level of response to alcohol in Asian-American men and women. Journal of Studies on Alcohol 63(1): 74-82, 2002. (56 refs.)

Objective: Previous studies have shown that Asians who possess a variant aldehyde dehydrogenase allele (ALDH2*2) have lower rates of alcohol consumption and dependence. Research in Asian men has shown that those with ALDH2*2 have greater responses to alcohol than do those without this genetic variant. The present study was designed to determine whether similar levels of response to alcohol, using objective and subjective measurements, are seen in men and women with different ALDH2 genotypes. Method: Participants (N = 30) were 16 men and 14 women, of whom five each were heterozygous for ALDH2*2. They were evaluated in response to alcohol and placebo beverage challenges, dosed according to estimated body water. Objective and subjective responses were measured every 30 minutes from baseline to 150 minutes after ingestion. Results: Men and women with ALDH2*1/*2 had greater pulse-rate increases, greater observed flushing responses and greater subjective feelings of being dizzy, drunk and high compared with ALDH2*1/*1 participants, despite having equivalent breath alcohol concentrations. ALDH2*1/*2 participants also reported being less likely to drive, following this level of intoxication, compared with ALDH2*1/*1 participants. Some gender differences were found in subjective, but not objective, responses to alcohol, with women reporting lower levels of being high, nauseated and uncomfortable and having a lower total subjective rating scale score. Conclusions: This study suggests that low risk for alcoholism based on possession of an ALDH2*2 allele relates to greater response to alcohol in both men and women.

Luczak SE; Wall TL; Shea SH; Byun SM; Carr LG. Binge drinking in Chinese, Korean, and white college students: Genetic and ethnic group differences. Psychology of Addictive Behaviors 15(4): 306-309, 2001. (19 refs.)

Studies of Asian college students have found that rates of binge drinking are associated with variation in the aldehyde dehydrogenase (ALDH2) gene. Chinese and Koreans have different prevalence rates of the ALDH2*2 allele, alcohol use, and alcoholism. The association of ALDH2 status and ethnic group with binge drinking was examined in 328 Chinese, Korean, and White college students. Ethnic group differences were found, with Whites having the highest rate of binge drinking, followed by Koreans and then Chinese. Among Asian participants, ALDH2 status and ethnicity related to binge drinking in an additive manner. Possessing an ALDH2*2 allele and being Chinese were protective factors, and being White and being Korean without an ALDH2*2 allele were risk factors for binge drinking. These results suggest that ALDH2 status, as well as other factors that differ in Koreans and Chinese, but do not interact with ALDH2, are associated with binge drinking among Asians.

Ma GX; Fang CY; Tan Y; Feeley RM. Perceptions of risks of smoking among Asian Americans. Preventive Medicine 37(4): 349-355, 2003. (34 refs.)

Background. Tobacco use is the single most preventable cause of illness and death in the United States. Few studies focus on Asian Americans, one of the fastest growing but underserved populations in the United States. Methods. A cross-sectional survey method was used for this study. The study sample was identified by using a stratified-cluster proportional sampling technique. A questionnaire was developed in English, translated into the four Asian languages (Chinese, Koreans, Vietnamese, and Cambodians), and back-translated. The sample consisted of 1174 individuals, distributed as follows: Chinese, 34.9%; Korean, 37.1%, Vietnamese, 16.7%; Cambodian, 8.4%; and others, 2.7%.Results. Findings indicated that attitudes toward tobacco-related dangers were associated with smoking status: former and never smokers held more negative perceptions regarding smoking compared to current smokers. Further, results indicated that the Asian American subgroups differed in their respective attitudes. The study is the first to compare attitudes toward tobacco-related dangers among racial/ethnic and language subgroups of Asian Americans. Conclusion. The growing body of empirical data on smoking among Asian Americans indicates that smoking cessation programs should take into account variations in smoking-related perceptions and attitudes across the ethnic subgroups.

Ma GX; Fleisher L. Awareness of cancer information among Asian Americans. Journal of Community Health 28(2): 115-130, 2003. (31 refs.)

The present study aimed to find the awareness level of cancer information among Asian Americans in the Delaware Valley region (Pennsylvania and South Jersey). A cross-sectional self-report survey was conducted with a sample of 1374 Asian Americans including Chinese, Korean, Vietnamese and Cambodians. The sample was collected by using a stratified-cluster proportional sampling technique. This paper assessed self-reported smoking behaviors, knowledge of smoking cessation methods, availability of health professional's advice in quitting smoking in the past 12 months, awareness of the National Cancer Institute's Cancer Information Service, knowledge of, and interest in participation in cancer clinical trials for identified Asian smokers. Overall, the level of awareness of cancer information services among the four subgroups was low. Among current and former smokers, only 31% had been advised by a health care professional to quit smoking. Forty-three percent used at least one smoking cessation method to quit in the past. The results also reveal an increased awareness level among those who had health insurance, higher education and were less likely to speak their native language. Significant differences on cancer awareness existed among the four ethnic groups as well. This study suggests urgent needs to educate Asian Americans about important cancer control issues and services and highlights the differences in baseline knowledge and attitudes among the various ethnic groups.

Ma GX; Henderson G, eds. Ethnicity and Substance Abuse: Prevention and Intervention. Springfield IL: Charles C Thomas Publisher, Ltd., 2002. (Chapter refs.)

The goal of this volume is to attend to highlight factors that affect substance abuse, treatmen,t and recovery in racial and ethnic groups, to review multidisciplinary research to ascertain helpful and unhelpful health care practices, and to provide practical suggestions for improving substance prevention and intervention programs. The book addresses three questions: What kind of treatment and services do most ethnic minority substance abusers receive in the nation's hospitals, clinics, and other community rehabilitation services? How effective are those programs? What can be done, when necessary, to improve the quality of treatment and services. The book, with six chapters is is organized in six sections: the first summarizing the importance of ethnicity; then individual sections dealing with African Americans, Asian Americans, Hispanic Americans, Native Americans; and the concluding section that deals with clinical approaches that attend to cultural heritage and traditions as well as current issues pertinent to ethnicity in providing care for those with substance use problems as well as planning preventive efforts.

Ma GX; Shive S; Tan Y; Toubbeh J. Prevalence and predictors of tobacco use among Asian Americans in the Delaware Valley region. American Journal of Public Health 92(6): 1013-1020, 2002. (44 refs.)

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.

Ma GX; Shive SE; Tan Y; Toubbeh JI; Fang CY; Edwards RL. Tobacco use, secondhand smoke exposure and their related knowledge, attitudes and behaviors among Asian Americans. Addictive Behaviors 30(4): 725-740, 2005. (44 refs.)

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.

Ma GX; Tan Y; Toubbeh J; Su X. Differences in stages of change of smoking behavior among current smokers of four Asian American subgroups. Addictive Behaviors 28(8): 1431-1439, 2003. (20 refs.)

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 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.

Melbye K; Khamboonruang C; Kunawararak P; Celentano DD; Prapamontol T; Nelson KE; Natpratan C; Beyrer C. Lifetime correlates associated with amphetamine use among northern Thai men attending STD and HIV anonymous test sites. Drug and Alcohol Dependence 68(3): 245-253, 2002

Aims: To investigate the demographic, sexual, and other substance use risk correlates of amphetamine use among men in northern Thailand prior to the current epidemic of amphetamine use in the Kingdom. Design: Cross-sectional quantitative behavioral questionnaires. Setting: Thai Ministry of Health STD and HIV Anonymous Test Sites in the upper northern provinces of Chiang Mai and Lamphun. Participants: Adult Thai men recruited at clinics for enrollment in an HIV seroincidence cohort study (The Thai HIVNET). All men were HIV negative at enrollment, and had at least one self-reported sexual risk for HIV infection (a recent STD, use of sex workers, multiple sexual partners, low or absent condom use, sex with men). Measurements: Participants answered a structured questionnaire. Findings: Lifetime history of amphetamine use was reported by 133/914 men, 14.5%. Older age was protective for use (odds ratio (OR) 0.5) and use was associated with use of other substances; heroin (OR 7.1), thinner (OR 6.2), opium (OR 5.9), and marijuana (OR 5.7). Several STDs were associated with amphetamine use: gonorrhea (OR 2.3) and genital warts (OR 2.4), and any STD (OR 1.9). In multivariate analysis, use of heroin (OR 3.1), soft drugs (OR 4.9), and a history of gonorrhea (OR 2.0) were independently associated with amphetamine use in northern Thai men. Conclusions: Associations between young age, gonorrhea, other substance use and amphetamines indicate that prevention measures could occur at STD clinics and be incorporated into school programs when individuals are entering adolescence.

Mishra SI; Osann K; Luce PH. Prevalence and predictors of smoking behavior among Samoans in three geographical regions. Ethnicity & Disease 15(2): 305-315, 2005. (47 refs.)

Objectives: Provide comprehensive data on smoking behavior among Samoans. Design: Cross-sectional, using systematic random sampling procedures, and in-person interviews. Setting: US Territory of American Samoa, Hawaii, and Los Angeles, California. Participants: 1834 adult, non-institutionalized Samoans. Intervention: None Main Outcome Measures: Prevalence and independent predictors of smoking. Results: Approximately one fourth (26.6%) of Samoans were current smokers, with 31.4% of men and 22.5% of women currently smoking. More current smokers were found in American Samoa (28.9%), followed by Hawaii (26.9%) and Los Angeles (24.1 %, P <.001). At each site, Samoan men compared with the women were significantly more likely to smoke (P <.001), initiate smoking earlier (P <.05), and smoke more cigarettes (P <.05). Cessation rates for the sample were very low. Predictors of smoking included being younger, male, married, less educated, with lower income, and more acculturated. Conclusion: The high smoking and low cessation rates indicate that smoking-related diseases will be significant causes of morbidity and mortality for Samoans for many years. The findings further underscore the importance of documenting smoking patterns and their determinants for subgroups rather than aggregates such as Asian American and Pacific Islanders. If Samoans are to meet the Healthy People 2010 tobacco goals, there is a need to: 1) develop tailored tobacco awareness and cessation programs based on the recommendations made by the Taskforce on Community Preventive Services; 2) understand the complex interactions between social, cultural, and psychological determinants of smoking and cessation behaviors; and 3) develop policies to limit availability of tobacco, environmental exposure from tobacco, and increase cessation efforts.

Naegle MA; Ng A; Barron C; Lai TFM. Alcohol and substance abuse. (review). Western Journal of Medicine 176(4): 259-263, 2002. (22 refs.)

Mr W, a 53-year-old Chinese man, was seen at the internal medicine clinic for recurrent lower leg pain, for which he requested analgesia. A physical examination revealed hypertension and signs of chronic liver disease. When the primary care practitioner asked him about his use of alcohol and drugs, Mr Wu said that he consumed five to six drinks of whiskey at least 4 days per week. Born in rural China, Mr W began drinking in his late teens and gradually increased his intake. By his mid-30s, he was drinking as much as half a liter of whiskey a day. He claims that there were no negative effects related to his alcohol consumption on his health or his work performance during that period. After arriving in New York City about 10 years previously, however, he had difficulty keeping a job. He complained that his jobs were exhausting and that he felt overwhelmed. At the next consultation, Mr W reports that his actual intake of whiskey exceeds 750 ml (25 fl oz) daily. He says that he is drinking more because his boss is giving him a "hard time." Also, he states that he is unable to fall asleep without drinking alcohol. Mr W claims to be unaware that he physically and verbally abuses his wife and children while intoxicated, although he says he feels that he has lost status at home because he is not providing sufficient income.

Nagasawa R; Qian ZC; Wong P. Theory of segmented assimilation and the adoption of marijuana use and delinquent behavior by Asian Pacific youth. Sociological Quarterly 42(3): 351-372, 2001. (24 refs.)

This article examines the adoption of behaviors of the teen drug and delinquent subcultures among Asian Pacific youth within the framework of the theory of segmented assimilation. Alejandro Portes and Min Zhou's theory offers a new perspective to the question: Under what conditions are youth susceptible to marijuana use and delinquent behavior? In contrast to Milton Gordon's classic one-path theory, segmented assimilation theory looks to the immigrant culture and social capital (e.g., social solidarity) as critical factors in the assimilation process. The theory suggests several different types of adaptation by immigrant youth and Asian youth born in the United States. The data from the Asian Student Drug Survey were used to analyze the patterns of marijuana use and delinquent behavior among Japanese, Chinese, Filipino, Korean, Southeast Asian, Asian Indian, and Pacific Islander youth, controlling for human capital and social capital, as well as other relevant factors. Logistic regression analysis was used to determine the factors that affect the odds of marijuana use and delinquent behavior for the seven ethnic groups in this study. The likelihood of marijuana use differed significantly among the ethnic groups. For example, Pacific Islander and Filipino youth were much more likely than Japanese youth to use marijuana. Korean, Southeast Asian, and Asian Indian youth did not differ significantly from the Japanese youth in marijuana use. Like the model that predicted marijuana use, the Chinese youth were least likely to engage in delinquent behavior, while Filipino and Pacific Islander youth were most likely. Segmented assimilation theory points to the importance of the human and social capital that serve to insulate youth from the influence of the teen drug and delinquent cultures.

Nakashima J; Wong MM. Characteristics of alcohol consumption, correlates of alcohol misuse among Korean American adolescents. Journal of Drug Education 30(3): 343-359, 2000. (24 refs.)

There is scant research on alcohol and other drug use among Asians and Pacific Islanders living in the United States. In particular, there are no studies on alcohol consumption patterns among Korean American adolescents. This study provides new information on alcohol use for a population that has not been extensively studied. Descriptive analyses reveal that alcohol misuse does occur among Korean American adolescents. Results from logistic regression indicate that alcohol misuse among Korean American adolescents is influenced by the social variables found to affect use among other ethnic groups. For Whites, psychological variables (depression, self- esteem), perceived prejudice, and feeling safe where one lives explained variance beyond social influences. These findings support the contention that there are similarities in the social milieu of alcohol use among all adolescents in the United States. However, our data indicate that psychological forces provide additional influences on White alcohol misuse. Implications of our findings are discussed.

Nemoto T; Aoki B; Huang K; Morris A; Le MN; Nguyen H et al. HIV risk behaviors among Asian drug users in San Francisco. AIDS Education and Prevention 12(2): 126-140, 2000. (57 refs.)

This study identified patterns of drug use and HIV risk behaviors in relation to cultural factors among Asian drug users in San Francisco. A sample of 92 Asian drug users (35 Chinese, 31 Filipino, 26 Vietnamese) who were not currently enrolled in drug treatment programs were recruited through targeted sampling methods and interviewed using a questionnaire with open-ended questions. The study evaluated responses of the participants based on content analyses. Compared with Chinese and Vietnamese, Filipino drug users had engaged in riskier behaviors in terms of injection drug use, having sex while on drugs, and having sex with injection drug users (IDUs). Cultural factors such as stigma of injection drug use and fear of needles were cited as reasons for not injecting drugs. Among IDUs, half cited trust as a reason for having shared needles. AIDS prevention programs targeting Asian drug users should consider specific cultural factors among high-risk groups (i.e., Filipinos, immigrants, women, and IDUs).

Nemoto T; Aoki B; Huang K; Morris A; Nguyen H; Wong W. Drug use behaviors among Asian drug users in San Francisco. Addictive Behaviors 24(6): 823-838, 1999. (26 refs.)

Due to a pervasive bias toward Asian Americans, such as tendency to view Asian Americans as model minorities, drug use behaviors among them are often ignored by health professionals, researchers, and community members, including Asian community members. This study identified patterns of drug use behaviors in relation to cultural factors among Asian drug users in San Francisco, CA. A sample of 92 Asian drug users (35 Chinese, 31 Filipino, 26 Vietnamese) who were not currently enrolled in drug treatment programs were recruited through targeted sampling methods and interviewed using a questionnaire with open-ended questions. The study evaluated responses of the participants and used content analyses. This study clearly revealed that the patterns of drug use among Asian drug users are unique to their ethnicity, gender, immigrant status, and age groups. Also, Asian drug users share cultural constructs related to drug use such as fear of addiction and injecting drugs, and stigma attached to drug users in the community. Therefore, drug abuse prevention programs should address both common factors among Asian drug users, as well as unique factors in specific target groups (e.g., ethnic groups, Asian immigrants, Asian women, refugees, and adolescents).

Nemoto T; Operario D; Soma T. Risk behaviors of Filipino methamphetamine users in San Francisco: Implications for prevention and treatment of drug use and HIV. Public Health Reports 117(3 Supplement): S30-S38, 2002. (45 refs.)

Objective: This study describes the demographics, HIV risk and drug use behaviors, and psychosocial status of Filipino American methamphetamine users in the San Francisco Bay area. Methods: Individual interviews were conducted with 83 Filipino American methamphetamine users, recruited through snowball sampling methods. A structured survey questionnaire included measures of drug use behaviors, HIV-related sexual behaviors, psychosocial factors, and demographics. Results: Filipino methamphetamine users tended to be male, to have low levels of perceived personal control in their lives, and to report low levels of shame about their drug use. Methamphetamine use was strongly associated with HIV-related risk behaviors. Frequent methamphetamine users tended to engage in drug use before or during sex and to use condoms infrequently. Commercial sex activity was associated with frequency of methamphetamine use. About one-third of the study participants had never been tested for HIV. Conclusion: HIV/STD and drug abuse prevention programs that target Filipino Americans are needed. These programs should be tailored to meet clients' needs on the basis of gender, employment status, acculturation, and psychosocial variables that affect drug use and sexual behaviors.

Public Domain

Nishimura ST; Goebert D; Caetano R; Onoye J; Chang J. Alcohol abuse, alcohol dependence, and drug abuse among native Hawaiian, Asian American, and Caucasian groups in Hawaii. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 161A-161A, 2004. (0 refs.)

O'Hare T; Van Tran T. Substance abuse among Southeast Asians in the U.S.: Implications for practice and research. IN: Ma GX; Henderson G, eds. Ethnicity and Substance Abuse: Prevention and Intervention. Springfield IL: Charles C Thomas Publisher, Ltd, 2002. pp. 145-155. (57 refs.)

This chapter examines research findings on Southeast Asian mental health and substance abuse problems and provides a framework for preliminary practice guidelines and future research. The vast majority of immigrants from Vietnam, Cambodia, and Laos arrived as political refugees and all have shown disproportionate signs of psychological stress. Preliminary evidence suggests that they and their children are at increased risk for abuse of alcohol and other drugs. In a study of Vietnamese immigrants, over 40 percent reported using alcohol as a means of "coping with sorrows," nearly 12 percent reported using other drugs for the same purpose, and nearly 14 percent reported having trouble with other drugs "some of the time." In structured interviews with a snowball sample of 120 Cambodian women on the East and West Coasts, almost 7 percent said they had a family with a drinking problem, about 15 percent of the East Coast group reported that a family member, usually adolescent, was using street drugs, and 17 percent reported using prescription drugs themselves, partly for street-drug effects. Diagnosis of substance abuse in these groups should recognize a continuum of abuse along which the causes, course, and consequences are often intertwined with co-occurring health, mental health, and other psychosocial problems. Research is needed to measure more completely the incidence and prevalence of substance abuse in Southeast Asian immigrants, and to examine the causes and extent of associated psychosocial dysfunction.

Operario D; Nemoto T. Sexual risk behavior and substance use among a sample of Asian Pacific Islander transgendered women. AIDS Education and Prevention 17(5): 430-443, 2005. (35 refs.)

We examined the prevalence and correlates of HIV-related sexual risk and substance use behaviors among Asian Pacific Islander (API) male-to-female (MTF) transgendered individuals, referred to here as API transgendered women. As part of a larger study on HIV risk among transgendered women of color (Nemoto, Operario, Keatley, Han, & Soma, 2004), a sample of 110 API transgendered women in San Francisco completed individual interviews, of which 13% reported being HIV-positive. In the past 30 days, one fifth of the sample engaged in unprotected receptive anal intercourse (URAI) with any male partner, nearly one half had sex while under the influence of substances, and over half used illicit drugs. In multivariate models, URAI was associated with commercial sex work (odds ratio [OR] = 4.23, 95% confidence interval [CI] = 1.10, 16.25) and previous attempted suicide (OR = 5.83, 95% CI = 1.02, 33.44). Sex under the influence of substances was associated with commercial sex work (OR = 3.35, 95% CI = 1.11, 10.13) and having a college degree (OR = 5.32, 95% CI = 1.34, 21.18). Illicit drug use was associated with commercial sex work (OR = 7.15, 95% = 2.26, 22.63). Findings suggest that API MTF transgenders are on the front line of HIV risk for the API community, and provide insight into factors within this group that might contribute to unsafe sex and substance use.

Pilgrim C; Luo Q; Urberg KA; Fang XY. Influence of peers, parents, and individual characteristics on adolescent drug use in two cultures. Merrill-Palmer Quarterly 45(1): 85-107, 1999. (40 refs.)

The longitudinal influence of close friends, parents, and individual characteristics on adolescent drug use was assessed for seventh, ninth, and eleventh graders. The proposed structural equation model fit well for three cultures: European American, African American, and Chinese adolescents. The data provide support for similarity across cultures in the association of high adolescent sensation seeking and low authoritative parenting with higher rates of adolescent drug use. Also, as hypothesized, even after controlling for initial friend drug use (selection effects), adolescent sensation seeking, and parental authoritativeness, the close friend had a moderate influence effect on adolescent substance use. However, this finding applied only to Chinese and European American adolescents. Implications for prevention programming and research are discussed.

Price RK; Risk NK; Wong MM; Klingle RS. Substance use and abuse by Asian Americans and Pacific Islanders: Preliminary results from four national epidemiologic studies. Public Health Reports 117(3 Supplement): S39-S50, 2002. (48 refs.)

Objective: The authors analyzed four recent large national surveys to assess the degree of use and abuse of a wide range of psychoactive substances across subgroups of Asian Americans and Pacific Islanders (AAPIs) and in comparison with whites. Method: The surveys analyzed were the 1999 National Household Survey on Drug Abuse, the 1992 National Longitudinal Alcohol Epidemiologic Survey, and the 1995 National Longitudinal Study of Adolescent Health In-School and In-Hom

CORK Bibliography: Asian Americans

105 citations. January 1999 to present

Prepared: September 2007

Arliss RM. Cigarette smoking, binge drinking, physical activity, and diet in 138 Asian American and Pacific Islander community college students in Brooklyn, New York. Journal of Community Health 32(1): 71-84, 2007. (34 refs.)

D'Amico EJ; Schell TL; Marshall GN; Hambarsoomians K. Problem drinking among Cambodian refugees in the United States: How big of a problem is it? Journal of Studies on Alcohol 68(1): 11-17, 2007. (37 refs.)

Fang CY; Ma GX; Miller SM; Tan Y; Su XF; Shive S. A brief smoking cessation intervention for Chinese and Korean American smokers. Preventive Medicine 43(4): 321-324, 2006. (11 refs.)

Ferketich AK; Kwong K; Shek A; Lee M. Design and evaluation of a tobacco-prevention program targeting Chinese American youth in New York City. Nicotine & Tobacco Research 9(2): 249-256, 2007. (14 refs.)

Grov C; Bimbi DS; Nanin JE; Parsons JT. Exploring racial and ethnic differences in recreational drug use among gay and bisexual men in New York City and Los Angeles. Journal of Drug Education 36(2): 105-123, 2006. (57 refs.)

Kim SS; Ziedonis D; Chen KW. Tobacco use and dependence in Asian Americans: A review of the literature. (review). Nicotine & Tobacco Research 9(2): 169-184, 2007. (116 refs.)

Luczak SE; Shea SH; Hsueh AC; Chang J; Carr LG; Wall TL. ALDH2*2 is associated with a decreased likelihood of alcohol-induced blackouts in Asian American college students. Journal of Studies on Alcohol 67(3): 349-353, 2006. (35 refs.)

Ma GX; Fang CY; Knauer CA; Tan Y; Shive SE. Tobacco dependence, risk perceptions and self-efficacy among Korean American smokers. Addictive Behaviors 31(10): 1776-1784, 2006. (21 refs.)

Nguyen TD; Yoshioka M. Alcoholism level differences between Vietnamese batterers and non-batterers. Journal of Family Violence 21(6): 401-406, 2006. (51 refs.)

Office of Applied Studies. The NSDUH Report: Past Month Cigarette Use among Racial and Ethnic Groups. Issue 30. Rockville MD: Substance Abuse and Mental Health Services Administration, 2006. (5 refs.)

Rastogi M; Wadhwa S. Substance abuse among Asian Indians in the United States: A consideration of cultural factors in etiology and treatment. Substance Use & Misuse 41(9): 1239-1249, 2006. (41 refs.)

Shelley D; Fahs MC; Yerneni R; Qu JJ; Burton D. Correlates of household smoking bans among Chinese Americans. Nicotine & Tobacco Research 8(1): 103-112, 2006. (28 refs.)

Shelley D; Yerneni R; Hung D; Das D; Fahs M. The relative effect of household and workplace smoking restriction on health status among Chinese Americans living in New York City. Journal of Urban Health 84(3): 360-371, 2007. (38 refs.)

Ahluwalia KP. Assessing the oral cancer risk of South-Asian immigrants in New York City. Cancer 104(12, Supplement S): 2959-2961, 2005. (19 refs.)

Au JG; Donaldson SI. Social influences as explanations for substance use differences among Asian-American and European-American adolescents. Journal of Psychoactive Drugs 32(1): 15-23, 2000. (42 refs.)

Bhattacharya G. Drug abuse risks for acculturating immigrant adolescents: Case study of Asian Indians in the United States. Health & Social Work 27(3): 175-183, 2002. (30 refs.)

Bradizza CM; Stasiewicz PR. Introduction to the special issue "Addictions in special populations". Addictive Behaviors 24(6): 737-740, 1999. (6 refs.)

Castro FG; Proescholdbell RJ; Abeita L; Rodriguez D. Ethnic and cultural minority groups. IN: McCrady BS; Epstein EE, eds. Addictions: A Comprehensive Guidebook. New York: Oxford University Press, 1999. pp. 499-526. (88 refs.)

Chen MS. Cancer health disparities among Asian Americans: What we know and what we need to do? Cancer 104(12, Supplement S): 2895-2902, 2005. (76 refs.)

Chen WW. Drug abuse prevention research for Asian and Pacific Islander Americans. IN: Sloboda Z; Bukoski WJ, eds. Handbook of Drug Abuse Prevention: Theory, Science, and Practice. New York: Kluwer Academic/Plenum Publishers, 2003. pp. 411-426. (83 refs.)

Chen X; Unger JB; Palmer P; Weiner MD; Johnson CA; Wong MM et al. Prior cigarette smoking initiation predicting current alcohol use: Evidence for a gateway drug effect among California adolescents from eleven ethnic groups. Addictive Behaviors 27(5): 799-817, 2002. (70 refs.)

Chen XG; Unger JB. Hazards of smoking initiation among Asian American and non-Asian adolescents in California: A survival model analysis. Preventive Medicine 28(6): 589-599, 1999

Chen XG; Unger JB; Johnson CA. Is acculturation a risk factor for early smoking initiation among Chinese American miners? A comparative perspective. Tobacco Control 8(4): 402-410, 1999. (56 refs.)

Chen XG; Unger JB; Palmer P; Weiner MD; Johnson CA; Wong MM; Austin G. Prior cigarette smoking initiation predicting current alcohol use: Evidence for a gateway drug effect among California adolescents from eleven ethnic groups. Addictive Behaviors 27(5): 799-817, 2002. (70 refs.)

Choi KH; Operario D; Gregorich SE; McFarland W; MacKellar D; Valleroy L. Substance use, substance choice, and unprotected anal intercourse among young Asian American and Pacific Islander men who have sex with men. AIDS Education and Prevention 17(5): 418-429, 2005. (32 refs.)

Chow J. Asian American and Pacific Islander mental health and substance abuse agencies: Organizational characteristics and service gaps. Administration and Policy in Mental Health 30(1): 79-86, 2002. (20 refs.)

Collins RL; McNair LD. Minority women and alcohol use. Alcohol Research & Health 26(4): 251-256, 2002. (47 refs.)

Cook TAR; Luczak SE; Shea SH; Ehlers CL; Carr LG; Wall TL. Associations of ALDH2 and ADH1B genotypes with response to alcohol in Asian Americans. Journal of Studies on Alcohol 66(2): 196-204, 2005. (65 refs.)

Doolan DM; Froelicher ES. Efficacy of smoking cessation intervention among special populations: Review of the literature From 2000 to 2005. Nursing Research 55(4, Supplement S): S29-S37, 2006. (68 refs.)

Ebberhart NC; Luczak SE; Avanecy N; Wall TL. Family history of alcohol dependence in Asian Americans. Journal of Psychoactive Drugs 35(3): 375-377, 2003. (10 refs.)

Ebberhart NC; Luczak SE; Carr LG; Wall TL. Factors associated with high scores on the self rating effects of alcohol form among Chinese- and Korean-American college students. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 160A-160A, 2004. (0 refs.)

Ellickson PL; Perlman M; Klein DJ. Explaining racial/ethnic differences in smoking during the transition to adulthood. Addictive Behaviors 28(5): 915-931, 2003. (37 refs.)

Friis RH; Forouzesh M; Chhim HS; Monga S; Sze D. Sociocultural determinants of tobacco use among Cambodian Americans. Health Education Research 21(3): 355-365, 2006. (22 refs.)

Fu SS; Ma GX; Tu XM; Siu PT; Metlay JP. Cigarette smoking among Chinese Americans and the influence of linguistic acculturation. Nicotine and Tobacco Research 5(6): 803-811, 2003. (38 refs.)

Grunbaum JA; Lowry R; Kann L; Pateman B. Prevalence of health risk behaviors among Asian American/Pacific Islander high school students. Journal of Adolescent Health 27(5): 322-330, 2000. (31 refs.)

Hahm HC; Lahiff M; Guterman NB. Acculturation and parental attachment in Asian-American adolescents' alcohol use. Journal of Adolescent Health 33(2): 119-129, 2003. (46 refs.)

Hahn R; Vesely S; Chang MH. Health risk aversion, health risk affinity, and socio-economic position in the USA: The demographics of multiple risk. Health, Risk & Society 2(3): 295-314, 2000. (89 refs.)

Hendershot CS; MacPherson L; Myers MG; Carr LG; Wall TL. Psychosocial, cultural and genetic influences on alcohol use in Asian American youth. Journal of Studies on Alcohol 66(2): 185-195, 2005. (59 refs.)

Hicks M; Clarke M; Tough SC. A comparison of urban and rural health care providers' knowledge, attitudes, and clinical practice related to fetal alcohol spectrum. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 126A-126A, 2004. (0 refs.)

Hsia FN; Spruijt-Metz D. The meanings of smoking among Chinese American and Taiwanese American college students. Nicotine and Tobacco Research 5(6): 837-849, 2003. (34 refs.)

Hunt G; Evans K; Wu E; Reyes A. Asian American youth, the dance scene, and club drugs. Journal of Drug Issues 35(4): 695-731, 2005. (51 refs.)

Ji M; Hofstetter CR; Hovell M; Irvin V; Song YJ; Lee J; Park H; Paik HY. Smoking cessation patterns and predictors among adult Californians of Korean descent. Nicotine & Tobacco Research 7(1): 59-69, 2005. (46 refs.)

Kaplan CP; Zabkiewicz D; McPhee SJ; Nguyen T; Gregorich SE; Disogra C et al. Health-compromising behaviors among Vietnamese adolescents: The role of education and extracurricular activities. Journal of Adolescent Health 32(5): 374-383, 2003. (36 refs.)

Kim IJ; Zane NWS; Hong S. Protective factor against substance use among Asian American youth: A test of the peer cluster theory. Journal of Community Psychology 30(5): 565-584, 2002. (85 refs.)

Kim J; McCarthy WJ. School-level contextual influences on smoking and drinking among Asian and Pacific Islander adolescents. Drug and Alcohol Dependence 84(1): 56-68, 2006. (45 refs.)

Kim SS; Son H; Nam KA. Personal factors influencing Korean American men's smoking behavior: Addiction, health, and age. Archives of Psychiatric Nursing 19(1): 35-41, 2005. (40 refs.)

Kitano KJ; Louie LJ. Asian and Pacific Islander women and addiction. IN: Straussner SLA; Brown S, eds. Handbook of Addiction Treatment for Women. San Francisco: Jossey-Bass, Inc., 2001. pp. 348-373

Kolonel LN; Henderson BE; Hankin JH; Nomura AMY; Wilkens LR; Pike MC et al. A multiethnic cohort in Hawaii and Los Angeles: Baseline characteristics. American Journal of Epidemiology 151(4): 346-357, 2000. (67 refs.)

Lafferty CK; Heaney CA; Chen MS Jr. Assessing decisional balance for smoking cessation among Southeast Asian males in the US. Health Education Research 14(1): 139-146, 1999. (22 refs.)

Lai KQ; McPhee SJ; Jenkins CNH; Wong C. Applying the Quit & Win contest model in the Vietnamese community in Santa Clara County. Tobacco Control 9(Supplement): 56-59, 2000. (22 refs.)

Lew R; Tanjasiri SP. Slowing the epidemic of tobacco use among Asian Americans and Pacific Islanders. American Journal of Public Health 93(5): 764-768, 2003. (40 refs.)

Lim S; Kasprow WJ; Rosenheck RA. Psychiatric illness and substance abuse among homeless Asian-American veterans. Psychiatric Services 57(5): 704-707, 2006. (11 refs.)

Linton A; Peterson MR. Effect of preexisting chronic disease on primary cesarean delivery rates by race for births in US military hospitals, 1999-2002. Birth Issues in Perinatal Care 31(3): 165-175, 2004. (58 refs.)

Lo CC; Globetti G. Chinese in the United States: An extension of moderation in drinking. International Journal of Comparative Sociology 42(3): 261-274, 2001. (31 refs.)

Luczak SE; Corbett K; Oh C; Carr LG; Wall TL. Religious influences on heavy episodic drinking in Chinese-American and Korean-American college students. Journal of Studies on Alcohol 64(4): 467-471, 2003. (34 refs.)

Luczak SE; Elvine-Kreis B; Shea SH; Carr LA; Wall TL. Genetic risk for alcoholism relates to level of response to alcohol in Asian-American men and women. Journal of Studies on Alcohol 63(1): 74-82, 2002. (56 refs.)

Luczak SE; Wall TL; Shea SH; Byun SM; Carr LG. Binge drinking in Chinese, Korean, and white college students: Genetic and ethnic group differences. Psychology of Addictive Behaviors 15(4): 306-309, 2001. (19 refs.)

Ma GX; Fang CY; Tan Y; Feeley RM. Perceptions of risks of smoking among Asian Americans. Preventive Medicine 37(4): 349-355, 2003. (34 refs.)

Ma GX; Fleisher L. Awareness of cancer information among Asian Americans. Journal of Community Health 28(2): 115-130, 2003. (31 refs.)

Ma GX; Henderson G, eds. Ethnicity and Substance Abuse: Prevention and Intervention. Springfield IL: Charles C Thomas Publisher, Ltd., 2002. (Chapter refs.)

Ma GX; Shive S; Tan Y; Toubbeh J. Prevalence and predictors of tobacco use among Asian Americans in the Delaware Valley region. American Journal of Public Health 92(6): 1013-1020, 2002. (44 refs.)

Ma GX; Shive SE; Tan Y; Toubbeh JI; Fang CY; Edwards RL. Tobacco use, secondhand smoke exposure and their related knowledge, attitudes and behaviors among Asian Americans. Addictive Behaviors 30(4): 725-740, 2005. (44 refs.)

Ma GX; Tan Y; Toubbeh J; Su X. Differences in stages of change of smoking behavior among current smokers of four Asian American subgroups. Addictive Behaviors 28(8): 1431-1439, 2003. (20 refs.)

Melbye K; Khamboonruang C; Kunawararak P; Celentano DD; Prapamontol T; Nelson KE; Natpratan C; Beyrer C. Lifetime correlates associated with amphetamine use among northern Thai men attending STD and HIV anonymous test sites. Drug and Alcohol Dependence 68(3): 245-253, 2002

Mishra SI; Osann K; Luce PH. Prevalence and predictors of smoking behavior among Samoans in three geographical regions. Ethnicity & Disease 15(2): 305-315, 2005. (47 refs.)

Naegle MA; Ng A; Barron C; Lai TFM. Alcohol and substance abuse. (review). Western Journal of Medicine 176(4): 259-263, 2002. (22 refs.)

Nagasawa R; Qian ZC; Wong P. Theory of segmented assimilation and the adoption of marijuana use and delinquent behavior by Asian Pacific youth. Sociological Quarterly 42(3): 351-372, 2001. (24 refs.)

Nakashima J; Wong MM. Characteristics of alcohol consumption, correlates of alcohol misuse among Korean American adolescents. Journal of Drug Education 30(3): 343-359, 2000. (24 refs.)

Nemoto T; Aoki B; Huang K; Morris A; Le MN; Nguyen H et al. HIV risk behaviors among Asian drug users in San Francisco. AIDS Education and Prevention 12(2): 126-140, 2000. (57 refs.)

Nemoto T; Aoki B; Huang K; Morris A; Nguyen H; Wong W. Drug use behaviors among Asian drug users in San Francisco. Addictive Behaviors 24(6): 823-838, 1999. (26 refs.)

Nemoto T; Operario D; Soma T. Risk behaviors of Filipino methamphetamine users in San Francisco: Implications for prevention and treatment of drug use and HIV. Public Health Reports 117(3 Supplement): S30-S38, 2002. (45 refs.)

Nishimura ST; Goebert D; Caetano R; Onoye J; Chang J. Alcohol abuse, alcohol dependence, and drug abuse among native Hawaiian, Asian American, and Caucasian groups in Hawaii. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 161A-161A, 2004. (0 refs.)

O'Hare T; Van Tran T. Substance abuse among Southeast Asians in the U.S.: Implications for practice and research. IN: Ma GX; Henderson G, eds. Ethnicity and Substance Abuse: Prevention and Intervention. Springfield IL: Charles C Thomas Publisher, Ltd, 2002. pp. 145-155. (57 refs.)

Operario D; Nemoto T. Sexual risk behavior and substance use among a sample of Asian Pacific Islander transgendered women. AIDS Education and Prevention 17(5): 430-443, 2005. (35 refs.)

Pilgrim C; Luo Q; Urberg KA; Fang XY. Influence of peers, parents, and individual characteristics on adolescent drug use in two cultures. Merrill-Palmer Quarterly 45(1): 85-107, 1999. (40 refs.)

Price RK; Risk NK; Wong MM; Klingle RS. Substance use and abuse by Asian Americans and Pacific Islanders: Preliminary results from four national epidemiologic studies. Public Health Reports 117(3 Supplement): S39-S50, 2002. (48 refs.)

Luczak SE; Shea SH; Hsueh AC; Chang J; Carr LG; Wall TL. ALDH22 is associated with a decreased likelihood of alcohol-induced blackouts in Asian American college students. Journal of Studies on Alcohol* 67(3): 349-353, 2006. (35 refs.)