Decreased Smoking Disparities Among Vietnamese and Cambodian Communities — Racial and Ethnic Approaches to Community Health (REACH) Project, 2002–2006

Supplements

April 18, 2014 / 63(01);37-45

Hong Zhou, MS, MPH1

Janice Y. Tsoh, PhD2

Dorcas Grigg-Saito, MS3

Pattie Tucker, DrPH1

Youlian Liao, MD1

1National Center for Chronic Disease Prevention and Control, CDC

2University of California, San Francisco, CA

3Lowell Community Health Center, Lowell, MA

Corresponding author: Youlian Liao, MD, Division of Community Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Telephone: 770-488-5299; E-mail: ycl1@cdc.gov.

Summary

Since 1964, smoking prevalence in the United States has declined because of nationwide intervention efforts. However, smoking interventions have not been implemented uniformly throughout all communities. Some of the highest smoking rates in the United States have been reported among Southeast Asian men, and socioeconomic status has been strongly associated with smoking. To compare the effect in reducing racial and ethnic disparities between men in Southeast Asian (Vietnamese and Cambodian) communities and men residing in the same states, CDC analyzed 2002–2006 data from The Racial and Ethnic Approaches to Community Health (REACH) project. The prevalence of current smoking significantly decreased and the quit ratio (percentage of ever smokers who have quit) significantly increased in REACH Vietnamese and Cambodian communities, but changes were minimal among all men in California or all men in Massachusetts (where these communities were located). The smoking rate also declined significantly, and the quit ratio showed an upward trend in U.S. men overall; however, the changes were significantly greater in REACH communities than in the nation. Stratified analyses showed decreasing trends of smoking and increasing trends of quit ratio in persons of both high and low education levels in Vietnamese REACH communities. The relative disparities in the prevalence of smoking and in the quit ratio decreased or were eliminated between less educated Vietnamese and less educated California men and between Cambodian and Massachusetts men regardless of education level.

Eliminating health disparities related to tobacco use is a major public health challenge facing Asian communities. The decline in smoking prevalence at the population level in the three REACH Vietnamese and Cambodian communities as described in this report might serve as a model for promising interventions in these populations. The results highlight the potential effectiveness of community-level interventions, such as forming community coalitions, use of local media, and enhancing communities' capacity for systems change. The Office of Minority Health and Health Equity selected this intervention analysis and discussion to provide an example of a program that might be effective for reducing tobacco use-related health disparities in the United States.

Introduction and Background

Despite an overall decline in smoking prevalence in the United States since 1964, prevalence remains high in some groups (1), particularly among Asian American men, including Vietnamese, Cambodian, Laotian, Korean, and Filipino Americans (2). The National Latino and Asian American Study in 2002–2003 found smoking prevalences of 23.6% in Chinese men, 24.4% in Filipino men, and 29.5% in Vietnamese men (3). Smoking is a social and cultural norm for men in Asian countries (4), and review of tobacco industry documents indicated that the tobacco industry has targeted and developed specific strategies to promote tobacco-use among immigrants and Asian American communities (5). Since 1985, a limited number of tobacco-control interventions were targeted to Asian American communities (6–10).

A 2010 study documented overall decreasing trends in the prevalence of smoking among men in Asian communities served by the Racial and Ethnic Approaches to Community Health (REACH) project (11). REACH is a CDC effort to eliminate racial/ethnic disparities in health by supporting community coalitions to design, implement, and evaluate community-driven strategies (12). Because some of the highest smoking rates in the United States have been reported among Southeast Asian men (2,3), 5-year trends in smoking prevalence during 2002–2006 were examined among men in three REACH Southeast Asian communities: two Vietnamese communities in California (one each in Los Angeles/Orange counties and Santa Clara County) and one Cambodian community in Lowell, Massachusetts. Trends were compared with those in the total population of men living in the respective states and in the total U.S. male population. Because smoking is strongly associated with socioeconomic status (2,3,13), rates stratified by education levels were compared.

CDC's Office of Minority Health and Health Equity selected the intervention analysis and discussion that follows to provide an example of a program that might be effective in reducing smoking-related disparities in the United States. Criteria for selecting this program are described in the Background and Rationale for this supplement (14).