Although cigarette smoking causes 434,000 premature deaths annually in the United States (1), information characterizing smoking behaviors generally lacks specificity for racial/ethnic groups and subgroups (2). To characterize smoking and other risk behaviors more fully for program planning efforts at the local level, three California communities and the California Department of Health Services developed culturally adapted versions of CDC's Behavioral Risk Factor Surveillance System (BRFSS). These surveys were administered to selected Chinese (3), Vietnamese (4), or Hispanic populations in California. This report summarizes information about smoking from these surveys during 1989-1991.

Questionnaires used for these surveys were modified for cultural appropriateness; translated into Chinese, Vietnamese, or Spanish; backtranslated; and field tested. Each questionnaire included standard BRFSS questions on smoking status and sociodemographic characteristics but differed on questions rating level of acculturation (5,6) -- the cultural and behavioral adaptation that occurs to persons in a new culture. In the Chinese survey, little or no English fluency and less than 25% of lifetime in the United States indicated less acculturation. For Vietnamese, English fluency and immigration before 1981 indicated more acculturation. Hispanics who self-reported they primarily think, read, and speak Spanish were classified as less acculturated; Hispanics who self-reported they primarily think, read, and speak English were classified as more acculturated.

The survey of Chinese included a representative sample in Oakland Chinese and was completed by face-to-face interviews during June 1989-February 1990. The survey of Vietnamese included a statewide sample and was completed by computer-assisted telephone interviews during February-March 1991. The survey of Hispanics included a representative sample of Monterey County (excluding the Monterey peninsula) and was completed by computer-assisted telephone interviews during July-December 1989. Because results for each group are not age-adjusted (except for age-specific prevalences), they cannot be compared directly.

Response rates varied substantially: of 359 eligible for the Chinese survey, 296 (82%) participated; of 1705 eligible for the Vietnamese survey, 1011 (59%) participated; and of 1067 persons eligible for the Hispanic survey, 801 (75%) participated. Because of the low number of women who reported that they were smokers, demographic characteristics (i.e., age, education level, annual income, and acculturation) are given only for men. For example, two of 454 Vietnamese women surveyed reported that they were current smokers.

Chinese. Smoking prevalence among Chinese men in Oakland was 28.1% (Table 1). Smoking prevalence was highest among those with less than a high school education; however, those who were high school graduates smoked the highest average number of cigarettes. Men who lived in households with annual incomes less than $25,000 were more likely to smoke than were men in higher income households. The average number of cigarettes smoked per day increased in relation to percentage of lifetime spent in the United States.

Vietnamese. In California, Vietnamese men aged 25-44 years were more likely to smoke than were those in other age groups (Table 2). Smoking prevalence was higher among men who immigrated in 1981 or later and who were not fluent in English; however, acculturation did not affect daily cigarette consumption.

Hispanics. For Hispanic men in Monterey County, smoking prevalence was substantially lower among those with more than a high school education (Table 3). More acculturated Hispanic men were also less likely to smoke. Among Hispanic women, the smoking prevalence was less than that among Hispanic men, but they smoked more cigarettes per day.

Reported by: CNH Jenkins, MPH, SJ McPhee, MD, DC Fordham, MPH, S Hung, MPH, KP Nguyen, NT Ha, Vietnamese Community Health Promotion Project, Div of General Internal Medicine, Dept of Medicine, G Saika, MS, Univ of California, San Francisco; A Chen, MD, R Lew, MPH, V Thai, KL Ko, MS, L Okahara, S Hirota, S Chan, MD, WF Wong, MD, Asian Health Svcs, Oakland; J Snider, MPH, D Littlefield, MPH, D Quan, MPH, Div of Health Promotion, Dept of Health, County of Monterey, Salinas; LF Folkers, MPH, B Marquez, MPH, Health Promotion Section, California Dept of Health Svcs. Div of Chronic Disease Control and Community Intervention, and Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: During the 1980s, the Asian / Pacific Islander and Hispanic populations were the fastest growing racial/ethnic groups in the United States (7). The findings in this report suggest that acculturation may influence smoking behavior among these groups, although these effects may vary. These three surveys used different measures of acculturation; only the Hispanic acculturation scale has been validated. Other models of acculturation need further investigation to develop standardized measures for comparisons between racial/ethnic groups and subgroups.

The findings in this report are subject to limitations described for previous BRFSS surveys in selected populations (3,4). These considerations reflect the limitations of self-reported information that is not independently validated, sampling frames that exclude households without telephones, and constraints on generalizability -- in particular, because these results have not been age-adjusted, even these three groups cannot be compared.

Data from each of the community surveys were presented to the respective communities and were used by community coalitions to establish priorities for program development. Data for Chinese indicated that men aged 25-44 years are most likely to smoke, which led to the development of a comprehensive community-wide tobacco-control campaign. The campaign included the development of culturally appropriate health education materials (e.g., brochures and videos) and prevention and cessation workshops. Data for Vietnamese also indicated that men aged 25-44 years are most likely to smoke; antismoking messages were directed to smokers regarding the effect of smoking on children and families. As the spouses, mothers, sisters, or daughters of smokers, women were targeted because of their increased risk from environmental tobacco smoke. In addition, because most male smokers do not speak English fluently, all intervention materials have been produced in Vietnamese. Data for Hispanics provided the basis for the coalition to develop a comprehensive plan for delivering messages about smoking and resources available through multiple channels, such as libraries, media, clinics, worksites, and housing projects.

These surveys provide models for other communities and national data collecting systems to collect specific baseline data that address the nation's year 2000 health objectives (8) for racial/ethnic groups and subgroups. In addition, the findings from these BRFSS surveys in California provide a basis for developing and evaluating culturally appropriate tobacco-control programs.

References

1. CDC. Smoking-attributable mortality and years of potential life lost -- United States, 1988. MMWR 1991;40:62-3,69-71.

2. US Department of Health and Human Services. Report of the Secretary's Task Force on Black and Minority Health. Vol I: executive summary. Washington, DC: US Department of Health and Human Services, 1987; DHHS publication no. 86-621-604.

3. CDC. Behavioral risk factor survey of Chinese -- California, 1989. MMWR 1992; 41:266-70.

4. CDC. Behavioral risk factor survey of Vietnamese -- California, 1991. MMWR 1992;41:69-72.

5. Tran T. Language acculturation among older Vietnamese refugee adults. Gerontologist 1990;30:94-9.

6. Marin G, Sabogal F, Marin B, Otero-Sabogal R, Perez-Stable E. Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences 1987;9:183-205.

7. O'Hare W. A new look at Asian Americans. American Demographics 1990;12:26-31.

8. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

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