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CORK Bibliography: Asian Americans

55 citations. January 2006 to present

Prepared: September 2009

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.

Barry DT; Steinberg MA; Wu R; Potenza MN. Differences in characteristics of Asian American and white problem gamblers calling a gambling helpline. CNS Spectrums 14(2): 83-91, 2009. (39 refs.)

Introduction: The characteristics of Asian American and white problem gamblers using a gambling helpline were examined to identify race-related differences. Methods: Logistic regression analyses were conducted on data obtained from callers to a gambling helpline serving southern New England in 2000-2003, inclusive. Results: Of the 144 phone calls used in the analyses, 72 were from Asian American callers and 72 were from white callers who were matched on gender, education, income, marital/cohabitation status, and age. Race-related differences were observed in forms of gambling problems, psychiatric problems secondary to gambling, substance use problems, and family history. Asian American gamblers were more likely to report suicide attempts related to gambling and problems with non-strategic gambling. White gamblers were more likely to report both casino and non-casino gambling problems and personal and familial alcohol use problems. High proportions of both groups reported problems with strategic gambling, gambling-related anxiety, family and financial problems secondary to gambling, financial debt, daily tobacco use, and a family history of problem gambling. Conclusion: Race-related differences should be considered in optimizing prevention and treatment strategies related to problem gambling.

Booker CL; Unger JB; Azen SP; Baezconde-Garbanati L; Lickel B; Johnson CA. A longitudinal analysis of stressful life events, smoking behaviors, and gender differences in a multicultural sample of adolescents. Substance Use & Misuse 43(11): 1509-1531, 2008. (91 refs.)

Many studies have addressed the associations between stressful life events and adolescent smoking. Few studies, however, have examined gender differences, specifically with multicultural samples. This longitudinal study examines the relationship between 6 stress subscales and smoking behaviors 716 multicultural U.S. adolescents living in the greater Los Angeles area in 2000-2001. At baseline the ethnic break-down of the sample was 63% Latino and 26% Asian/PI and 70% were 11 years of age. Negative personal events were associated with lifetime smoking and negative school events were associated with intentions to smoke. Stratification of the sample by gender indicated that gender confounded the relationship between negative personal stress and lifetime smoking and negative school stress, positive personal stress and intentions to smoke. Two significant interactions were found. Findings indicate there are differential effects of stressful events between genders which may lead to smoking experimentation or intentions to smoke. Implications and limitations are discussed.

Cantrell J; Hung D; Fahs MC; Shelley D. Purchasing patterns and smoking behaviors after a large tobacco tax increase: A study of Chinese Americans living in New York City. Public Health Reports 123(2): 135-146, 2008. (53 refs.)

Objectives. Tobacco taxes are one of the most effective policy interventions to reduce tobacco use. Tax avoidance, however, lessens the public health benefits of higher-priced cigarettes. Few studies examine responses to cigarette tax policies, particularly among high-risk minority populations. This study examined the prevalence and correlates of tax avoidance and changes in smoking behaviors among Chinese American smokers in New York City after a large tax increase. Methods. We conducted a cross-sectional study with data for 614 male smokers from in-person and telephone interviews using a comprehensive household-based survey of 2,537 adults aged 18-74 years. Interviews were conducted in multiple Chinese dialects. Results. A total of 54.7% of respondents reported engaging in at least one low- or no-tax strategy after the New York City and New York State tax increases. The more common strategies for tax avoidance were purchasing cigarettes from a private supplier/importer and purchasing duty free/overseas. Higher consumption, younger age, and number of years in the U.S. were consistently associated with engaging in tax avoidance. Younger and heavier continuing smokers were less likely to make a change in smoking behavior in response to the tax increase. Despite high levels of tax avoidance and varying prices, nearly half of continuing smokers made a positive change in smoking behavior after the tax increase. Conclusions. Expanded legislation and enforcement must be directed toward minimizing the availability of legal and illegal low- or no-tax cigarette outlets. Public education and cessation assistance customized for the Chinese American community is key to maximizing the effectiveness of tobacco tax policies in this population.

Chae DH; Takeuchi DT; Barbeau EM; Bennett GG; Lindsey J; Krieger N. Unfair treatment, racial/ethnic discrimination, ethnic identification, and smoking among Asian Americans in the National Latino and Asian American study. American Journal of Public Health 983(3): 485-492, 2008. (64 refs.)

Objectives. We examined the relations of self-report of general unfair treatment and self-report of race/ethnicity-specific discrimination with current smoking among Asian Americans. We investigated whether ethnic identification moderated either association. Methods. Weighted logistic regressions were performed among 1977 Asian Americans recruited to the National Latino and Asian American Study (2002-2003). Results. In weighted multivariate logistic regression models including both general unfair treatment and racial/ethnic discrimination, odds of current smoking were higher among Asian Americans who reported high levels of unfair treatment (odds ratio [OR] = 2.80; 95% confidence interval [01 = 1.13, 6.95) and high levels of racial/ethnic discrimination (OR=2.40; 95% CI=0.94, 6.12) compared with those who reported no unfair treatment and discrimination, respectively. High levels of ethnic identification moderated racial/ethnic discrimination (F-3 = 3.25; P= .03). High levels of ethnic identification were associated with lower probability of current smoking among participants reporting high levels of racial/ethnic discrimination. Conclusions. Our findings suggest that experiences of unfair treatment and racial/ethnic discrimination are risk factors for smoking among Asian Americans. Efforts to promote ethnic identification may be effective in mitigating the influence of racial/ethnic discrimination on smoking in this population.

Chae DH; Takeuchi DT; Barbeau EM; Bennett GG; Lindsey JC; Stoddard AM et al. Alcohol disorders among Asian Americans: Associations with unfair treatment, racial/ethnic discrimination, and ethnic identification (the National Latino and Asian Americans Study, 2002-2003). Journal of Epidemiology and Community Health 62(11): 973-979, 2008. (50 refs.)

Study objective: To examine history of alcohol abuse/dependence disorder in relation to unfair treatment, racial/ethnic discrimination, and ethnic identification among Asian Americans. Design: Weighted multivariate analyses of cross-sectional national survey data predicting lifetime history of alcohol abuse/dependence disorders. Setting: USA, Asian Americans. Participants: 2007 Asian American adults recruited to the National Latino and Asian American Study (NLAAS; 2002-2003). Results: Controlling for sociodemographic characteristics, Asian Americans who reported experiencing unfair treatment had higher odds of history of alcohol abuse/dependence disorder (OR 5.26, 95% CI 1.90 to 14.56). Participants who reported high levels of ethnic identification had lower odds of history of alcohol abuse/dependence disorders (OR 0.46, 95% CI 0.23 to 0.90). Ethnic identification moderated the influence of racial/ethnic discrimination (p = 0.097). Among participants with low levels of ethnic identification, racial/ethnic discrimination was associated with greater odds of having a history of alcohol disorder compared with those with high levels of ethnic identification. Conclusions: Social hazards such as unfair treatment and racial/ethnic discrimination should be considered in the development of programmes addressing alcohol disorders among Asian Americans. Interventions that promote ethnic identification in this population may be particularly relevant in mitigating the negative influence of racial/ethnic discrimination on alcohol disorders.

Chatterji P; Alegria M; Lu MS; Takeuchi D. Psychiatric disorders and labor market outcomes: Evidence from the National Latino and Asian American Study. Health Economics 16(10): 1069-1090, 2007. (58 refs.)

This paper investigates to what extent psychiatric disorders and mental distress affect labor market outcomes in two rapidly growing populations that have not been studied to date-ethnic minorities of Latino and Asian descent, most of whom are immigrants. Using data from the National Latino and Asian American Study (NLAAS), we examine the labor market effects of meeting diagnostic criteria for any psychiatric disorder in the past 12 months as well as the effects of psychiatric distress in the past year. The labor market outcomes analyzed are current employment status, the number of weeks worked in the past year among those who are employed, and having at least one work absence in the past month among those who are employed. Among Latinos, psychiatric disorders and mental distress are associated with detrimental effects on employment and absenteeism, similar to effects found in previous analyses of mostly white, American born populations. Among Asians, we find more mixed evidence that psychiatric disorders and mental distress detract from labor market outcomes. Our findings suggest that reducing disparities and expanding access to effective treatment may have significant labor market benefits-not just for majority populations, as has been demonstrated, but also for Asians and Latinos.

Choi S; Rankin S; Stewart A; Oka R. Effects of acculturation on smoking behavior in Asian americans: A meta-analysis. Journal of Cardiovascular Nursing 23(1): 67-73, 2008. (29 refs.)

Background: Cigarette smoking is the most preventable risk factor for many negative health consequences, such as cancer, heart disease, and lung disease. in the United States, the prevalence rate in Asian immigrants is high (26%-70%), with Southeast Asian men having the highest rate. Acculturation has been associated with smoking behavior in this ethnic group. Objective: The purposes of this meta-analysis are to describe the extent to which acculturation affects smoking behavior in Asian immigrants and to compare the direction and magnitude of the effect between subgroups by gender and age. Methods: Databases within PubMed, CINAHL, The Cochrane Library, and PsycINFO were searched. Twenty-one studies published in English or Korean from 1994 through 2005 met criteria, and 9 of these studies contained sufficient data. Among the 9 studies, 3 presented gender-specific data; thus, these studies were entered separately for men and women, making a total of 12 entries for final analysis. The odds ratio was used as an effect size statistic. The values of odds ratios were calculated from the data in the studies. Results: The average effect size for men was 0.53 (95% confidence interval, 0.28-0.99), indicating that acculturated men are 53% less likely to smoke than nonacculturated or "traditional" men. The average effect size for women was 5.26 (2.75-10.05), suggesting that acculturated women are 5 times more likely to smoke than traditional women. In adolescents, the average effect size was 1.92 (1.22-3.01), indicating that acculturated adolescents are almost 2 times more likely to smoke than traditional adolescents. Conclusions: Acculturation may have a protective effect on smoking behavior in Asian men and a harmful effect in Asian women and adolescents. The magnitude of effect is larger in women and adolescents than in men. Smoking cessation programs should target acculturated women, adolescents, and traditional men.

Choi Y; He M; Harachi TW. Intergenerational cultural dissonance, parent-child conflict and bonding, and youth problem behaviors among Vietnamese and Cambodian immigrant families. Journal of Youth and Adolescence 37(1): 85-96, 2008. (62 refs.)

Intergenerational cultural dissonance (ICD)-a clash between parents and children over cultural values-is a frequent issue for Asian American youth. Using longitudinal data from the Cross Cultural Families Project, this study examines the mechanisms by which ICD contributes to problem behaviors, including whether ICD predicts parent-child conflict, whether parent-child conflict then has a direct effect on youth problem behavior, and whether positive bonding with parents mediates the effects of such conflict on youth problem behaviors among Vietnamese (n = 164) and Cambodian (n = 163) families with adolescents [average age = 15.2 years (SD = 1.05)]. The results from the path analyses show that, in both groups, ICD indirectly predicts problem behaviors by increasing parent-child conflict, which in turn weakens positive parent-child bonding. Interventions that target youths' perception of intergenerational cultural gaps, help them manage conflict, and help strengthen bonds with parents may prevent problem behaviors among Cambodian and Vietnamese families. This study contributes to inform how to effectively prevent problems and difficulties among these families.

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 and Drugs 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.

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.

Doran N; Myers MG; Luczak SE; Carr LG; Wall TL. Stability of heavy episodic drinking in Chinese- and Korean-American college students: Effects of ALDH2 gene status and behavioral undercontrol. Journal of Studies on Alcohol and Drugs 68(6): 789-797, 2007. (65 refs.)

Objective: A previous cross-sectional study showed that, among individuals of Chinese and Korean descent, possession of ALDH2*2 alleles was associated with protection against alcohol dependence, whereas conduct disorder was associated with increased vulnerability to dependence. The purpose of this longitudinal study was to examine the roles of ALDH2 and behavioral undercontrol (a temperamental trait that is associated with conduct disorder) in stability of heavy episodic drinking. Method: Chinese- and Korean-American college students (N= 336; 51% female), who had initiated alcohol use before study enrollment, provided information on drinking habits during their freshman and sophomore years. Participants were classified as (1) stable nonheavy drinkers, (2) regressors, (3) progressors, or (4) stable heavy drinkers. Results: Participants with ALDH2 *2 alleles were more likely to be classified as stable nonheavy drinkers than as progressors (z = -2.49, p =.0 13). Higher levels of behavioral undercontrol were associated with a greater probability of being classified as a stable heavy drinker relative to a stable nonheavy drinker (z = 2.26, p =.024). Stable heavy drinkers reported the most alcohol-related problems, whereas progressors reported more problems than either regressors or stable nonheavy drinkers, particularly at Year 2. Conclusions: Elevated behavioral undercontrol appears to predispose Asian-American college students to increased frequency of heavy drinking, whereas ALDH2*2 may act as a protective factor. The degree of alcohol consumption observed among participants with ALDH2*2 alleles is consistent with previous findings showing that, although their presence may be protective, it does not preclude heavy drinking episodes.

Duranceaux NCE; Schuckit MA; Luczak SE; Eng MY; Carr LG; Wall TL. Ethnic differences in level of response to alcohol between Chinese Americans and Korean Americans. Journal of Studies on Alcohol and Drugs 69(2): 227-234, 2008. (47 refs.)

Objective: Koreans have higher rates of alcohol-use disorders and family history of alcoholism, compared with Chinese. These differences likely reflect both environmental and genetic influences. One genetically influenced characteristic that may contribute to these ethnic differences is level of response to alcohol. Variant alleles of aldehyde dehydrogenase (ALDH2) and alcohol dehydrogenase (ADH1B) genes are prevalent in individuals of Asian heritage and have been associated with an increased level of response to alcohol and a decreased risk for alcohol dependence. Additionally, a low level of response to alcohol is more common in individuals with a first-degree family history of alcoholism and is predictive of increased risk for this disorder. It also is possible that sociocultural factors have an impact on an individual's response to alcohol. The current study examined self-report level of response to alcohol, ALDH2 and ADH1B, country of origin, and family history of alcoholism in 154 Chinese- and 181 Korean-American college students. Method: Participants were evaluated via in-person interviews and genotyped at the ALDH2 and ADH1B loci. Results: Ethnicity was significantly related to level of response to alcohol, with Koreans having a lower self-reported level of response than Chinese. This relationship remained significant after considering the effects of gender, height, weight, quantity and frequency of alcohol consumption (over the previous 90 days), ALDH2 genotype, ADH1B genotype, country of origin, and first-degree family history of alcohol dependence. Conclusions: The results suggest that a low level of response to alcohol may contribute to the increased risk for alcohol abuse and dependence found in Koreans, relative to Chinese. More research is needed to determine additional factors that may be contributing to the low alcohol response and high rates of alcoholism in Koreans.

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.

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.

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.

Hahm HC; Wong FY; Huang ZJ; Ozonoff A; Lee J. Substance use among Asian Americans and Pacific Islanders sexual minority adolescents: Findings from the National Longitudinal Study of Adolescent Health. Journal of Adolescent Health 42(3): 275-283, 2008. (39 refs.)

Purpose: We assessed the prevalence, incidence, and correlates of substance use among Asian American individuals transitioning from adolescence to young adulthood. Methods: Data were obtained from the National Longitudinal Study of Adolescent Health, Wave 11 (1996) and Wave 111 (2001). Information on substance use was abstracted from a nationally representative sample of 1108 Asian Americans and Pacific Islanders (AAPIs) from both Waves. Weighted prevalence, incidence, and patterns of smoking, binge drinking, marijuana use, and other drug use were analyzed by sexual orientation and gender. Multiple logistic regression analyses were conducted to investigate the unique contribution of being a sexual minority in relation to four types of substance use by gender. Results: A link between sexual orientation and substance use behaviors among AAPIs did not emerge until young adulthood. Significant increases in the incidence and prevalence of all four types of substance use (tobacco, binge drinking, marijuana, and other drugs) were found among sexual minority AAPIs. Specifically being an AAPI sexual minority young woman, compared with being a heterosexual young woman, a heterosexual young man, or a sexual minority young man, was significantly associated with substance use after controlling for demographic characteristics, problem behaviors, and substance use during adolescence. Also the highest prevalence of substance use was found among AAPI sexual minority women. Conclusions: These findings add greater urgency to addressing the role of sexual orientation in designing substance abuse programs.

Hendershot CS; Dliworth TM; Neighbors C; George WH. Differential effects of acculturation on drinking behavior in Chinese- and Korean-American college students. Journal of Studies on Alcohol and Drugs 69(1): 121-128, 2008. (51 refs.)

Objective: Recent evidence suggests increasing rates of alcohol use and related disorders among Asian-American young adults. Relatively little research has focused on this group, and few studies have examined heterogeneity in drinking prevalence and correlates across Asian subgroups. This study examined interactive effects of ethnicity, acculturation, and gender on drinking behavior among Asian-American undergraduates. Method: Participants were 112 Chinese Americans and 108 Korean Americans (mean age = 19.2 years, 61% female) who completed measures of alcohol use, acculturation, and demographic factors. Multivariate analyses examined drinking behavior (defined as quantity, frequency, and duration) as a function of ethnicity, gender, and acculturation. Results: Overall, Korean ethnicity predicted increased drinking, and acculturation predicted decreased drinking. However, acculturation interacted with ethnicity such that its influence was protective for Korean Americans and negligible for Chinese Americans. Conclusions: Previous research implicates acculturation as a risk factor for drinking among Asian Americans, but the current findings suggest that protective effects may also exist. Results also indicate that Korean ethnicity is a risk factor particularly in the context of low acculturation. These findings illustrate the need to consider ethnic subgroup differences in drinking rates and in risk and protective factors for alcohol use among Asian Americans.

Hofstetter CR; Hovell MF; Jung KR; Raman R; Irvin V; Ni R. The first puff: Forces in smoking initiation among Californians of Korean descent. Nicotine & Tobacco Research 9(12): 1277-1286, 2007. (28 refs.)

This study presents the correlates of initial exposure to cigarettes, variables associated with smoking prevalence and with continued smoking (or not) among adult Californians of Korean descent who have any initial exposure to cigarettes. Among those who have taken a puff, social contingencies contrast those who become current smokers from those who do not. Data were drawn from telephone interviews with adults (N=2,830) developed from a random sampling of listed persons in California with Korean surnames during 2000-2001. Of the attempted interviews, 86% were completed; and 85% of the interviews were conducted in Korean. Nearly half of all respondents (49.0%) had been exposed to cigarettes, and 41.9% of these reported current smoking, according to Centers for Disease Control and Prevention criteria (currently smoke and have smoked 100 cigarettes during lifetime). Multivariate analysis suggests that social contingencies may influence both initial exposure to tobacco and continued smoking among Californians of Korean descent. Influences of acculturation on taking the first puff and on current smoking status diverged by gender. Social support increased the likelihood of the first puff among both genders, but the association was stronger among females than among males. Social reinforcers that lead to taking the first puff also discriminated between those who became current smokers and those who did not. Interventions should be directed at these variables among young Korean nonsmokers and new smokers.

Hsia FN; Spruijt-Metz D. Acculturation and meanings of smoking among Asian-American college students. Addictive Behaviors 32(10): 2292-2296, 2007. (6 refs.)

We investigated meanings of smoking in white and Asian-American college students with different acculturation patterns. The associations between meanings of smoking and smoking behaviors were also examined. A survey was administered to two post secondary institutions in Southern California. A total of 460 Asian and 115 White students completed the survey. Results of this study demonstrate that the determinants of smoking may vary across cultural groups. A culturally appropriate smoking education curriculum tailored to different acculturation patterns and ethnicities is necessary.

Hughes SC; Corcos IA; Hofstetter CR; Hovell MF; Irvin VL. Environmental tobacco smoke exposure among Korean American nonsmokers in California. Nicotine & Tobacco Research 10(4): 663-670, 2008. (31 refs.)

Information about the extent and patterns of environmental tobacco smoke (ETS) exposure among Korean Americans is sparse, despite the population's having one of the highest male smoking rates. This paper estimates the prevalence of ETS exposure among Korean American nonsmokers in California, and identifies demographic and other characteristics associated with exposure. Data were collected during 2001-2002 from telephone interviews (in English or Korean) with 2,328 nonsmoking Korean American adults. ETS was encountered by 31% of respondents during a typical day. Exposure was most common in "other locations," where 24% of respondents were exposed, compared with 6% at home and 9% at work. Among those exposed, the greatest dose of exposure occurred at work (6 cigarettes/day) and at home (5 cigarettes/day). Women were four times more likely than men to be exposed to ETS at home (8% vs. 2%, respectively). For both men and women, the odds of exposure were greater among those who were younger, who were unmarried, and whose friends smoked. Additionally, traditional men and bicultural women had greater odds of ETS exposure than those who were more acculturated. Women who were married to smokers, had no children at home, consumed more alcohol, and had no home smoking ban also had greater likelihood of exposure. The results indicate the need for a complete ban of smoking in workplaces and in private homes to prevent exposure, particularly for women whose husbands smoke.

Kandula NR; Wen M; Jacobs EA; Lauderdale DS. Association between neighborhood context and smoking prevalence among Asian Americans. American Journal of Public Health 99(5): 885-892, 2009. (62 refs.)

Objectives. To study neighborhood-level determinants of smoking among Asian Americans, we examined 3 neighborhood factors (ethnic enclave, socioeconomics, and perceived social cohesion) and smoking prevalence in a population-based sample. Methods. We linked data from the 2003 California Health Interview Survey to tract-level data from the 2000 Census. We used multivariate logistic regression models to estimate the associations between smoking and neighborhood-level factors, independent of individual factors. Results. Twenty-two percent of 1693 Asian men and 6% of 2174 Asian women reported current smoking. Women living in an Asian enclave were less likely to smoke (adjusted odds ratio [AOR]=0.27; 95% confidence interval [CI]=0.08, 0.88). Among men, higher levels of perceived neighborhood social cohesion were associated with lower odds of smoking (AOR=0.74; 95% CI=0.61, 0.91). Conclusions. The association between contextual factors and smoking differed for men and women. For women, living in an Asian enclave may represent cultural behavioral norms. For men, neighborhood trust and cohesiveness may buffer stress. Smoking prevention and cessation interventions among Asian Americans may be more effective if they address contextual factors.

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. Predictors of short-term smoking cessation among Korean American men. Public Health Nursing 25(6): 516-525, 2008. (38 refs.)

Objectives: The purpose of this study was to examine which demographic, smoking behavior, and theoretical variables of theory of planned behavior would predict smoking cessation attempts among Korean American men. Design: This is a longitudinal study and data collection was conducted at baseline and 1-month follow-up. Sample: At baseline, 118 Korean adult male smokers were recruited into the study and of these, 93 participated at follow-up. Measures: Study questionnaires consisted of demographic data, smoking behavior, and theoretical variables. Analysis: A multiple regression analysis was performed to identify correlates of behavioral intentions to quit smoking at baseline and binary logistic regression analysis for predictors of actual quitting behavior at follow-up. Results: Among smoking behavior variables, past-year quit attempts and average number of cigarettes smoked per day explained 15% of the variance in behavioral intentions to quit smoking (p <.0001). Two theoretical variables attitudes and perceived family social norms increased the explanatory power by 22% (p <.0001) with an overall of 37%. Religion and perceived family social norms had about 32% predictive power over actual quitting behavior (p <.0001). Conclusions: Any smoking cessation programs planned for Korean American men consider encouraging family members to affirm antismoking messages to this ethnic subgroup.

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.

Kim SS; Ziedonis DM; Chen K. Tobacco use and dependence in Asian Americans/Pacific Islander adolescents: A review of the literature. Journal of Ethnicity in Substance Abuse 6(3/4): 113-142, 2007

Purpose: This article identifies gaps in extant tobacco literature and areas for further research on Asian American adolescents. Methods: Research articles published until December 2005 were retrieved from computer-database and manual searches. Results: A total of 62 data based research articles were identified and most (N = 38, 61.3%) had been published within the past 5 years. Chinese, Filipino, and Japanese American adolescents were studied most frequently. In general, Asian-American adolescents initiated smoking later and had a lower prevalence rate than non-Asian American adolescents. However, the estimates of current smoking for Native Hawaiian, Pacific Islander, and Filipino American adolescents in Hawaii were higher than those for adolescents in any other racial and ethnic groups. Most risk factors for smoking initiation were found to be similar to other ethnic minority groups, including the positive association of smoking with acculturation. For this age group the three treatment studies evaluated culturally focused interventions, but did not find improved outcomes. Conclusion: Further research is needed to identify factors associated with the growing use of cigarettes and other tobacco products in late adolescence and young adulthood within the population, including treatment outcome studies. Research recommendations are suggested.

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.

Ling PM; Neilands TB; Nguyen TT; Kaplan CP. Psychographic segments based on attitudes about smoking and lifestyle among Vietnamese-American adolescents. Journal of Adolescent Health 41(1): 51-60, 2007. (40 refs.)

Purpose: Tobacco marketing campaigns target distinct psychographic segments of the population. We describe psychographic segments among Vietnamese-American youth and their relationship to smoking behavior. Methods: This was a cross-sectional survey of 411 Vietnamese-American young people (aged 14-24 years). Cluster analysis was performed to describe different population segments. Results: We identified four segments, categorized as follows: risk seekers, stressed pessimists, optimistic achievers, and sedentary well-behaved individuals. The risk seekers and stressed pessimists reported that they had tried smoking at some time (60% and 53%, respectively) in greater proportions than the other two segments (25% and 24%); and 20% of risk seekers and 22% of stressed pessimists were current smokers compared with 2% of the other clusters. In comparison to the other groups, the risk seekers more frequently went to bars and clubs, and their friends engaged in risky behavior. They agreed that secondhand smoke was dangerous, but accepted ventilation as an alternative to smoke-free policies more frequently than the other groups. The stressed pessimists had negative views of the future, did not value physical fitness, and doubted the dangers of secondhand smoke. Optimistic achievers were active in sports and student activities, were optimistic about future achievements, prioritized good nutrition, and supported smoke-free policies. The sedentary well-behaved group had well-behaved friends, did not value physical fitness, strongly opposed smoking, and supported smoke-free policies. Conclusion: Different segments of the Vietnamese-American population have different attitudes and smoking risk, which may facilitate targeted tobacco control message development. Future research should address whether similar psychographic segments exist in other ethnic populations.

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.

Lum C; Corliss HL; Mays VM; Cochran SD; Lui CK. Differences in the drinking behaviors of Chinese, Filipino, Korean, and Vietnamese college students. Journal of Studies on Alcohol and Drugs 70(4): 568-574, 2009. (41 refs.)

Objective: This study examined alcohol drinking behaviors across ethnic subgroups of Asian college students by gender, foreign-born status, and college-related living arrangements. Method: Univariate and ordinal logistic regression analyses were employed to explore male and female Asian subgroup differences in alcohol drinking behaviors. The sample included 753 male and female undergraduates between the ages of 18 and 27 years who self-identified as Chinese, Filipino, Korean, or Vietnamese and who varied in their foreign-born status. Participants completed a self-administered questionnaire on their alcohol drinking practices. Results: Ordinal regression analysis assessed risks for increased consumption and found that Korean and Filipino students reported higher levels of alcohol consumption compared with other Asian subgroups. Students living in on-campus dormitories and in off-campus apartments reported higher alcohol consumption than did those living at home. Being born in the United States was a significant predictor of higher levels of alcohol consumption for women but not for men. Conclusions: Results of this study indicate the need for campus alcohol education and prevention programs capable of responding to specific Asian subgroup needs.

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.

Myers MG; Doran NM; Trinidad DR; Klonoff EA; Wall TL. A prospective study of cigarette smoking initiation during college: Chinese and Korean American students. Health Psychology 28(4): 448-456, 2009. (59 refs.)

Objective: The present study was a prospective investigation of baseline influences on initial smoking and transition to established smoking among college students who had not smoked prior to college. Design: Included were 267 participants in a longitudinal study of tobacco use. Students of Chinese (52%) or Korean (48%) descent were enrolled during their freshman year in college. Data for the present study were collected during four annual in-person interviews. Main outcome measures: (1) Initial use of a cigarette reflected having first smoked a cigarette (more than a puff) during college. (2) Established smoking was defined as having smoked at least 100 cigarettes. Results: Over the course of the study, 25% of baseline never-smokers tried their first cigarette, and 9% became established smokers. Overall, men were significantly more likely to experiment and progress to established smoking. Baseline alcohol and drug use, behavioral undercontrol, and parental smoking predicted smoking experimentation but not established smoking. Students of Korean ethnicity were more likely to become established smokers. However, acculturation was not a significant predictor of experimentation or established smoking after accounting for the effects of other predictors. Conclusion: These findings suggest a need for efforts to prevent smoking uptake among Asian American college students.

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.

Nguyen TT; Gildengorin G; Gregorich SE; McPhee SJ; Kaplan CP. Smoking susceptibility and attitudes toward smoking among Chinese and Vietnamese American adolescents. Journal of Ethnicity in Substance Abuse 6(3/4): 16-181, 2007

In California, 641 Chinese and 629 Vietnamese age 12-17 participated in a longitudinal telephone study from 1999 to 2001. Four attitude scales were constructed: acceptance of smokers, addictive nature of smoking, psychosocial reasons to smoke, and gender roles and smoking. Vietnamese American adolescents had more pro-smoking attitudes than Chinese American adolescents. Male gender, having friends who smoked, and baseline smoking were associated with smoking susceptibility at follow-up. Those factors, U.S. birthplace, and the acceptance and psychosocial scales were associated with smoking. Smoking prevention efforts targeting Chinese and Vietnamese American adolescents should focus on gender, birthplace, peer smoking, and attitudes. doi:10.1300/J233v06n03_08

Niv N; Wong EC; Hser YI. Asian Americans in community-based substance abuse treatment: Service needs, utilization, and outcomes. Journal of Substance Abuse Treatment 33(3): 313-319, 2007. (19 refs.)

The objectives of this study were to examine differences in substance abuse treatment needs, treatment utilization, and outcomes between Asian Americans/Pacific Islanders (AAPI) and others. Data were collected from 452 AAPI and a matched sample of 403 non-AAPI who were admitted to 43 drug treatment programs across California. A subset of these participants was assessed at 3 months (n = 112) and 9 months (n = 140) after treatment admission. Differences in pretreatment characteristics, treatment retention and completion, services received, and treatment outcomes were examined. AAPI presented to treatment with lower alcohol and drug severity lower than the comparison group and similar problem severity in other domains. There were no group differences in treatment retention, but AAPI received a greater number of legal services and fewer medical and psychiatric services than the comparison group. AAPI also received fewer total services within their treatment program. Treatment outcomes were similar between the two groups, with one exception: AAPI demonstrated better alcohol outcomes than those in the comparison group.

Oei TPS; Jardim CL. Alcohol expectancies, drinking refusal self-efficacy and drinking behaviour in Asian and Australian students. Drug and Alcohol Dependence 87(2/3): 281-287, 2007. (43 refs.)

The effects of alcohol expectancies (AE) and drinking refusal self-efficacy (DRSE) in predicting alcohol consumption in Caucasians has been well studied. However, the role of AE and DRSE in Asian students is still not well understood. This study reported on this using Caucasian (n = 98) and Asian (n = 92) student samples. Participants completed the Alcohol Use Disorder Identification Test (AUDIT) to measure their hazardous alcohol consumption, and the drinking expectancy profile (DEP) to assess their alcohol related expectancies and ability to resist drinking in certain situations. Results showed that Caucasians reported significantly higher confidence, higher sexual interest, and higher tension reduction expectancies than Asians. Conversely, Asians significantly expected cognitive enhancement and negative consequences more than Caucasians. Relative to Caucasians, the Asian sample also reported that they would be more able to refuse alcohol when under social pressure. Results from regression analyses showed that for the Caucasian sample, AE, DRSE and their interactions were significant predictors of alcohol consumption. For the Asian group, the only significant effect to emerge was that DRSE was negatively related to alcohol consumption. The clinical implications of the differential pattern of results between the samples are discussed in terms of self-efficacy and negative consequences of alcohol consumption, especially when dealing with university aged individuals.

Office of Applied Studies, Substance Abuse and Mental Health Administration. 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/

Otsuki M; Tinsley BJ; Chao RK; Unger JB. An ecological perspective on smoking among Asian American college students: The roles of social smoking and smoking motives. Psychology of Addictive Behaviors 22(4): 514-523, 2008. (52 refs.)

Using electronic diaries, the present study examined the roles of social smoking and smoking motives in relation to cigarette use patterns among Asian American college smokers. Multilevel modeling results showed that participants smoked more cigarettes when smoking with peers than when smoking alone. Participants' coping (but not social) motives moderated the within-person associations between smoking with peers and the cigarettes smoked during a smoking episode. The findings support the utility of an ecological perspective in examining the dynamic interaction between smoking motives and the social settings of cigarette use, and call for further research on the social smoking behaviors in diverse populations.

Pinhey TK; Wells NR. Asian-Pacific Islander adolescent methamphetamine use: Does "ice" increase aggression and sexual risks? Substance Use & Misuse 42(11): 1801-1809, 2007. (29 refs.)

Using a probability sample from a 2001 Youth Risk Behavior Survey of Asian- Pacific Islander youths in Guam, this brief study examined the outcomes for methamphetamine use on aggression and risky sexual activities. The results of the study indicated that both male and female adolescents who used methamphetamine were significantly more likely to participate in aggressive behaviors and sexual risks (i.e., numerous sex partners). The inclusion of grade point averages in a logistic regression equation revealed that White adolescents were more likely than other ethnicities to indicate that they had used methamphetamine and the inclusion of student grade point averages reduced male gender to nonsignificance. We also discuss the limitations of the study.

Ramirez AG; Velez LF; Chalela P; Grussendorf J; McAlister AL. Tobacco control policy advocacy attitudes and self-efficacy among ethnically diverse high school students. Health Education & Behavior 33(4): 502-514, 2006. (41 refs.)

This study applied self-efficacy theory to assess empowerment to advocate on behalf of tobacco control policies. The Youth Tobacco Survey with added policy advocacy self-efficacy, attitudes, and outcome expectations scales was given to 9,177 high school students in Texas. Asians showed the lowest prevalence of experimentation and current smoking, followed by African Americans. Anglo-Europeans had higher rates of current smoking. Latino male students had the highest experimentation and current smoking rates. Policy advocacy self-efficacy was higher among African Americans. Latinos scored lowest. Asians had the highest level of approval for tobacco control policies. African Americans had the highest scores in policy advocacy outcome expectations, followed by Asians and Latinos. Anglo-Europeans scored lowest. Students who had never tried smoking had the highest scores in all three scales, with a decreasing trend as the frequency of smoking increased. Associations with smoking status remained significant when controlling by gender and ethnicity.

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.

Romero RA; Messer K; West JH; White MM; Trinidad DR. Smoking trends among Filipino adults in California, 1990-2002. Preventive Medicine 46(4): 336-339, 2008. (15 refs.)

Objectives. Filipinos comprise about 18% of the Asian/Pacific Islander American (APIA) population and are increasing. Few studies have examined Filipino current smoking prevalence rates (CSPR) and none have described trends over time. Methods. Trends in CSPR were estimated for Filipinos and non-Hispanic whites (NHW) from 1990-2002 from the California Tobacco Surveys (N > 42,000/year). Results. CSPR for Filipino males declined: 23.7% (95% CI: 18.7, 28.7) in 1990 to 18.7% (15.3, 22.1) in 2002 (p < 0.05). The decline in CSPR for Filipino women was non-significant (p = 0.24),9.8% (5.5, 14.1) in 1990 and 7.7% (5.3, 10.1) in 2002. During the same period, CSPR among NHW males declined: 24.4% (23.8, 25.0) in 1990 to 18.8% (18.1, 19.4) in 2002 (p < 0.01). For female NEW, CSPR were 21.3% (20.5, 22.0) in 1990 and 15.0% (14.4, 15.6) in 2002 (p < 0.01). Adjusted logistic regression for Filipinos suggest that English language use is associated with current smoking among females (p < 0.01) and that, overall, 18-29 year-olds were more likely to be current smokers than those 45+ years old (p < 0.01). Conclusion. Trends for male Filipino current smokers declined similarly to male NEW from 1990-2002; female rates were lower but did not decline. Future smoking prevention and cessation programs would benefit by taking into account important differences in smoking rates between genders and age groups.

Shelley D; Fahs M; Yerneni R; Das D; Nguyen N; Hung D et al. Effectiveness of tobacco control among Chinese Americans: A comparative analysis of policy approaches versus community-based programs. Preventive Medicine 47(5): 530-536, 2008. (43 refs.)

Objective. To estimate the effectiveness of a tailored multicomponent community-based smoking cessation intervention among Chinese immigrants living in New York City, implemented within the context of state and city-wide tobacco control policy initiatives for the general population. Methods. A pre-post-test quasi-experimental design with representative samples from Chinese populations living in two communities in New York City: Flushing, Queens, the intervention community and Sunset Park, Brooklyn, the comparison community. From November 2002 to August 2003 baseline interviews were conducted with 2537 adults aged 18-74. In early 2006, 1384 participants from the original cohort completed the follow-up interview. During the intervention period (October 2003 to September 2005), both communities were exposed to tobacco control public policy changes. However, only Flushing received additional linguistically and culturally-specific community-level tobacco control interventions. Results. From 2002 to 2006 overall smoking prevalence among Chinese immigrants declined from 17.7% to 13.6%, a relative 23% decrease. After controlling for socio-demographic characteristics, there was an absolute 3.3% decrease in smoking prevalence attributed to policy changes with an additional absolute decline in prevalence of 2.8% in the intervention community relative to the control community. Conclusion. City-wide tobacco control policies are effective among high-risk urban communities, such as Chinese immigrants. In addition, community-based tailored tobacco control interventions may increase the reduction in smoking prevalence rates beyond that achieved from public policies.

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.

Smith SM; Stinson FS; Dawson DA; Goldstein R; Huang B; Grant BF. Race/ethnic differences in the prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Medicine 36(7): 987-998, 2006. (42 refs.)

Background. Very few large national epidemiologic surveys have examined the prevalence of psychiatric disorders among Asians and Native Americans due to small sample sizes. Very little is also known about the co-occurrences between substance use disorders and mood and anxiety disorders among these two minority groups and how their rates compare to Whites. Blacks, and Hispanics. Method. Analyses were based on a large (n = 41093) nationally representative survey of the adult (18+ years), U.S. population Supplemented by a group quarters sampling frame. Prevalences and associations of major DSM-IV mood, anxiety an substance use disorders were examined among all major race/ethnic subgroups of the population. Results. Twelve-month rates of most mood, anxiety and substance use disorders were generally greatest among Native Americans and lowest among Asians. For most race/ethnic subgroups, alcohol and drug dependence, but not abuse, were significantly associated with mood disorders. With few exceptions, there were no significant associations between alcohol and drug abuse and anxiety disorders. In contrast. alcohol dependence was associated with most anxiety disorders among Whites, Blacks and Asians. but not among Native Americans. Conclusions. The 12-month prevalence of substance use, mood, and anxiety disorders varied greatly across the five major race/ethnic subgroups of the population. Twelve-month co-occurrence of substance use disorders and mood and anxiety disorders was pervasive among all race/ethnic subgroups. Future research is also needed to understand race/ethnic differentials in prevalence and co-occurrence of these disorders with a particular focus on factors that may give rise to them.

Spigner C; Yip MP; Huang B; Shigaki A; Tu SP. Chinese and Vietnamese adult male smokers' perspectives regarding facilitators of tobacco cessation behavior. Asian Pacific Journal of Cancer Prevention 8(3): 429-435, 2007. (39 refs.)

Introduction: National surveys show a low prevalence of tobacco cigarette smoking within the Asian American/Pacific Islander population. However, smoking rates loom higher when data is disaggregated by ethnicity and gender. Nevertheless, few data are available on how smokers in this population quit smoking. The aim of this study was to collect first-hand perspectives from adult male Chinese and Vietnamese current and former smokers who were patients at a community clinic in Seattle, Washington, in order to understand the facilitators toward smoking cessation and the methods that they might use to quit smoking. Methods: A telephone survey was administered to age-eligible male Chinese and Vietnamese clinic patients who were current or former smokers. A total of 196 Chinese and 198 Vietnamese (N=394) adult male current and former smokers were contacted from a pool culled from the clinic database. Results: Descriptive analysis using SPSS software revealed ethnicity-specific differences between current and former smokers regarding influences on smoking cessation behavior as well as uptake and endorsement of cessation methods. Family encouragement and physician recommendations were significant facilitators on the cessation process. Will power and self-determination were frequently mentioned by both Vietnamese and Chinese smokers as helpful methods to quit smoking. Vietnamese smokers were more resourceful than Chinese smokers in their use of smoking cessation methods. Conclusion: Even with access to cessation classes at a health clinic, half of current smokers indicated that they had no intention to quit. Such attitudes underscore the need for promotion of effective smoking cessation programs as well as successful strategies for reaching smokers. These conclusions are particularly important for Chinese smokers, who were comparatively less resourceful in their use of smoking cessation methods. Future studies should explore integrating the concept of will power with current mainstream state-of-the-art smoking cessation programs.

Tong EK; Nguyen T; Vittinghoff E; Perez-Stable EJ. Light and intermittent smoking among California's Asian Americans. Nicotine & Tobacco Research 11(2): 197-202, 2009. (16 refs.)

Asian Americans, along with other ethnic minorities, have been described to be more likely than Whites to be light and intermittent smokers. Characterizing Asian American smoking behavior accurately on a population level requires oversampling groups of different national origin and including non-English-speaking participants. We analyzed the California Health Interview Survey to compare moderate/heavy (>= 10 cigarettes/day), light (0-9 cigarettes/day), and intermittent (not daily) smoking patterns in Asian Americans with those of Whites. We also examined whether social and demographic factors that had been associated with Asian American smoking prevalence also were associated with light and intermittent smoking patterns in each of the national origin groups. Most Asian American smokers were more likely to be light and intermittent smokers (range = 36.6%-61.5% for men and 29.9%-81.5% for women) compared with Whites, with lower mean cigarette consumption. Asian American light and intermittent smokers were more likely than moderate/heavy smokers to be women (odds ratio [OR] = 2.12, 95% CI = 1.14-3.94), highly educated (OR = 3.16, 95% CI = 1.21-8.28), not Korean (compared with Chinese; OR = 0.32, 95% CI = 0.13-0.79), and bilingual speakers with high English language proficiency compared with English-only speakers (OR = 2.83, 95% CI = 1.21-6.84). Asian American intermittent smokers were more likely than daily smokers to be women (OR = 2.25, 95% CI = 1.08-4.72) and to have lower household income. The predominance of Asian American light and intermittent smoking patterns has important implications for developing effective tobacco control outreach. Further studies are needed to elaborate the relationship between biological, psychosocial, and cultural factors influencing Asian American smoking intensity.

Tong EK; Nguyen TT; Vittinghoff E; Perez-Stable EJ. Smoking behaviors among immigrant Asian americans: Rules for smoke-free homes. American Journal of Preventive Medicine 35(1): 64-67, 2008. (20 refs.)

Background: Higher acculturation is associated with Asian-American smoking prevalence decreasing in men and increasing in women. Asian immigrants in California are significantly more likely than their counterparts in Asia to have quit smoking. Smoke-free environments may mediate this acculturation effect because such environments are not widespread in Asia. Methods: In 2006, Asian-American current and former smokers were analyzed using the 2003 California Health Inter-view Survey. A multivariate logistic regression analysis examined how the interaction between having a smoke-free-home rule and immigrating to the U.S. is associated with status as a former smoker and lighter smoking. Results: For recent Asian immigrants (< 10 years in the U.S.) and longer-term residents (born/>= 10 years in the U.S.), having a smoke-free-home rule was associated with status as a former smoker (OR 14.19, 95% CI = 4.46, 45.12; OR 3.25, 95% CI = 1.79, 5.90, respectively). This association was stronger for recent immigrants (p=0.02). Having a smoke-free-home rule was associated with lighter smoking only for longer-term residents (OR 5.37, 95% CI = 2.79, 10.31). Conclusions: For Asian Americans, smoke-free-home rules are associated with status as a former smoker, particularly among recent immigrants, and lighter smoking in long-term residents. Interventions encouraging Asian Americans to adopt smoke-free-home rules should be evaluated.

Tong EK; Tang H; Tsoh J; Wong C; Chen MS. Smoke-free policies among Asian-American women: Comparisons by education status. American Journal of Preventive Medicine 37(2, Supplement S): s144-s150, 2009. (23 refs.)

Background: California has significantly decreased racial/ethnic and educational disparities in smoke-free home and indoor work policies. California's ethnic-specific surveys present an opportunity to disaggregate data and examine the impact of California's smoke-free social norm campaign for Asian-American women. Methods: The California Tobacco Use Surveys for Chinese Americans and Korean Americans were conducted in 2003 and analyzed in 2008 to compare women with lower (<= high school graduate) or higher education status for smoke-free policy adoption and enforcement. Results: Lower-educated and high er-educated women had similar proportions of smoke-free policies at home (58%) or indoor work (90%). However, lower-educated women were more likely than higher-educated women to report anyone ever smoking at home (OR=1.62, 95% CI=1.06, 2.48, p=0.03) and exposure during the past 2 weeks at an indoor workplace (OR=2.43, 95% CI=1.30, 4.55, p=0.005), even after controlling for ethnicity, smoke-free policy, knowledge about the health consequences of secondhand smoke exposure, and acculturation. There was no interaction between education and knowledge about secondhand smoke health harms. Conclusions: The intended consequences of California's tobacco-control efforts have resulted in similar rates of smoke-free policies at home and in indoor work environments among Asian-American women across educational levels. However, an unintended consequence of this success is a disparity in enforcement by educational status, with lower-educated Asian-American women reporting greater smoke exposure despite similar rates of knowledge about the health consequences of secondhand smoke exposure. Besides establishing policies, lower-educated Asian-American women may need to be empowered to assert and enforce their right to smoke-free environments.

Weiss JW, Garbanati JA. Effects of acculturation and social norms on adolescent smoking among Asian-American subgroups. Journal of Ethnicity in Substance Abuse 5(2): 75-90, 2006

This study provides new information about how acculturation and perceived social norms affect adolescents smoking among four Asian-American subgroups. Results showed differences in smoking prevalence rates across subgroups, with Koreans having the highest rates of smoking, while Chinese have the lowest rates. In contrast to the large gender disparity in the ancestral countries, smoking rates were equal for Asian-American boys and girls. Acculturation was significantly associated with an increased risk for lifetime smoking for Asian-American girls, but not for boys. Perceived social norms regarding peer smoking were significantly associated with smoking behaviors for both genders and for all subgroups.

Wong CC; Tsoh JY; Tong EK; Hom FB; Cooper B; Chow EA. The Chinese Community Smoking Cessation Project: A Community Sensitive Intervention Trial. Journal of Community Health 33(6): 363-373, 2008. (17 refs.)

This paper describes (1) the design, methods and baseline data of the first smoking cessation clinical trial for Chinese Americans with medical conditions - Chinese Community Smoking Cessation Project (CCSCP); (2) the collaborative process between researchers and the Chinese community; and (3) the barriers and facilitators of implementing the study. CCSCP was a culturally tailored, randomized, smoking cessation trial testing the efficacy of an intensive (physician advice, in-person counseling with nicotine replacement therapy, 5 telephone calls) compared to a minimal (physician advice and self-help manual) intervention. The study applied a community-sensitive research method involving community members in all phases of the research process in San Francisco Bay Area during 2001-2007. CCSCP recruited 464 smokers from health care facilities (79%) located in Chinese neighborhoods and through Chinese language media (21%). Baseline assessments and interventions were conducted in-person using translated and tested questionnaire and intervention materials. The majority of the participants were men (91%) with a mean age of 58.3 years, foreign born (98%), with less than high school education (58%), spoke no English (42%) and in non-skilled or semi-skilled occupations (60%) with <$20,000 household income (51%). Participants smoked regularly on an average 38.6 +/- 17 years, smoked 9.1 +/- 8 cigarettes per day and 85% smoked daily. Cultural tailoring of recruitment methods and intervention design led to successful enrollment and retention of participants, overcoming barriers faced by the participants. Community sensitive collaborative process facilitated implementation of study protocol in community health care settings.

Wong FY; Huang ZJ; Thompson EE; De Leon JM; Shah MS; Park RJ et al. Substance use among a sample of foreign- and U.S.-born southeast Asians in an urban setting. Journal of Ethnicity in Substance Abuse 6(1): 45-66, 2007

Asian Americans (AA) are thought to have the lowest rates of substance use. This study examined substance use prevalence among 494 urban-dwelling Southeast Asians using snowball techniques. Prevalence estimates were age-adjusted proportionate to the U.S. Asian population. Findings show beer and alcohol consumption approximated the national percentage among 25-44 year olds. U.S.-born were about three times likelier to have past month substance use. Foreign-born Vietnamese were likelier than U.S.-born to use all substances except for beer. U.S.and foreign-born beer consumption rates were similar. Future research is needed to delineate substance use determinants and patterns in foreign and U.S.-born AA sub-groups.

Zhang J; Wang ZM. Factors associated with smoking in Asian American adults: A systematic review. (review). Nicotine & Tobacco Research 10(5): 791-801, 2008. (53 refs.)

This review systematically examined the factors associated with smoking in Asian American adults (aged >= 17 years). A total of 21 quantitative studies published in peer-reviewed journals from 1997 to 2006 were reviewed and abstracted using the matrix method. Statistically significant factors reported by the studies were summarized. Methodological quality of the studies also was assessed (maximum possible score=10). Acculturation and education were the most frequently reported factors (n=10, 47.6%). Acculturation was negatively associated with men's smoking but was positively associated with women's smoking. Education was uniformly found to be negatively related to smoking. Age was reported to have either a positive or a negative relationship with smoking (n=9, 42.9%). Men were more likely to smoke than women (n=7, 33.3%). The mean methodological score of the reviewed studies was 4.14 (on a scale of 1-10 points; SD = 1.62; range = 2-8). Health promotion professionals need to consider the summarized factors associated with Asian American adults' smoking behavior when planning smoking prevention programs and when recruiting participants for smoking cessation programs. When addressing acculturation, program planners should design different health education materials and use different strategies for men and women. To identify, understand, and incorporate essential factors into effective interventions, future studies should aim at higher methodological quality by using longitudinal design and increasing the use of theory, the test of data validity and reliability, and the report of effect sizes.