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Cigarette Smoking Among Southeast Asian Immigrants -- Washington State, 1989

Since 1975, approximately one million Southeast Asians have immigrated to the United States (1). In general, the efforts of local public health agencies to meet the needs of these immigrants have focused on identifying and treating acute and chronic diseases rather than identifying and modifying health-risk behaviors (e.g., smoking) among these immigrants (2-4). However, efforts to determine the prevalence of smoking suggest that smoking rates are high, especially among men of Southeast Asian origin (5-7). During 1989, to characterize cigarette smoking among Southeast Asian immigrants, the Seattle-King County (Washington) Health Department surveyed newly arriving Southeast Asian immigrants who intended to reside in the county regarding their health problems and health-risk behaviors. This report summarizes survey findings regarding their smoking habits.

Washington has the third largest population of Southeast Asian immigrants (an estimated 50,000) in the United States; approximately 32,000 reside in Seattle-King County (B. Duong, Division of Refugee Assistance, Washington State Department of Social and Health Services, personal communication, 1992). Each year since 1982, approximately 1000 persons immigrating to the United States from Vietnam, Cambodia, and Laos have received medical screening interviews and examinations at Seattle-King County Department of Public Health clinics. During 1989, Southeast Asian immigrants were interviewed in their native language by trained interpreters at the Seattle-King County Central Clinic (one of two county public health clinics). Persons aged greater than or equal to 18 years were asked if they were current smokers (i.e., "Do you smoke now?"), and smokers were asked how many cigarettes they smoked per day. A convenience sample of medical interview records were analyzed for 274 Vietnamese, 147 Laotian, and 112 Cambodian immigrants. Of the 533 records analyzed, 280 (52.5%) were for women.

The overall prevalence of smoking (23.1%) differed substantially by sex and age (Table 1). Men (42.5%) were more likely than women (5.7%) to smoke, and prevalence of smoking was higher for men aged greater than or equal to 30 years (54.6%) than for men aged 18-29 years (29.5%). Among men, prevalence of smoking was highest for Laotians (51.2%), followed by Vietnamese (41.7%) and Cambodians (32.8%) (Table 2).

Reported by: FJ Frost, PhD, K Tollestrup, PhD, Lovelace Medical Foundation, Albuquerque. D Vu, Fred Hutchinson Cancer Research Center, Minority High School Apprentice Program; ER Alexander, MD, J Riess, Seattle-King County Dept of Public Health, Seattle; Washington State Center for Health Statistics, JM Kobayashi, MD, State Epidemiologist, Washington Dept of Health. Epidemiology Br, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: In Washington during 1988, the overall prevalence of smoking for men was 25.5%; therefore, the findings in this report suggest that, in 1989, Southeast Asian male immigrants were 1.6 times more likely to smoke than were men statewide. In comparison, the prevalence of smoking among Southeast Asian female immigrants during 1989 was one fourth that among all women in Washington (8). Previous reports also have documented a high prevalence of smoking among Southeast Asian male immigrants, especially Vietnamese (6-7), and low rates of smoking among Southeast Asian female immigrants (7).

For at least two reasons, the findings in this report may underestimate actual smoking prevalence among Southeast Asian immigrants arriving in Seattle. First, during the immigration health screening interviews, respondents and their family members often discussed how to answer questions, including those about smoking. Several respondents were advised by family members to deny that they smoked because of concern about criticism or penalties (D. Vu, Fred Hutchinson Cancer Research Center, personal observation, 1989). Second, the results regarding the number of cigarettes these immigrants smoked per day were unreliably recorded and interviewers did not repeat questions regarding smoking habits. In addition, although these results were stratified by country of origin, the findings reported represent a small convenience sample of newly arriving immigrants screened at one health clinic and, therefore, may not be generalizable to newly arriving Vietnamese, Laotian, and Cambodian immigrants elsewhere or to the existing Southeast Asian immigrant population in the United States.

Educational efforts to reduce smoking in the overall U.S. population may not be as effective for recently-arrived immigrants because of differences in language and culture; in particular, many immigrants may neither understand nor believe health risks are associated with smoking (7). To develop culturally appropriate smoking-prevention and smoking-cessation programs in Washington and other locations, the knowledges, attitudes, and behaviors of Southeast Asian immigrants concerning smoking require further characterization (9). In addition, educational materials must be tailored to the cultural background of these immigrants, available in their native languages, and evaluated for effectiveness. Finally, prevalence of smoking in these and other immigrant populations should be monitored through public health surveillance efforts to determine whether smoking rates change in relation to years of residence in the United States.


  1. Lin-Fu JS. Population characteristics and health care needs of Asian Pacific Americans. Public Health Rep 1988;103:18-27.

  2. Nolan CM, Elarth AM. Tuberculosis in a cohort of Southeast Asian refugees: a five-year surveillance study. Am Rev Respir Dis 1988;137:805-9.

  3. Poss JE. Hepatitis B virus infection in Southeast Asian children. Journal of Pediatric Health Care 1989;3:311-5.

  4. Swerdlow AJ. Mortality and cancer incidence in Vietnamese refugees in England and Wales: a follow-up study. Int J Epidemiol 1991;20:13-9.

  5. Bates SR, Hill L, Barrett-Connor E. Cardiovascular disease risk factors in an Indochinese population. Am J Prev Med 1989;5:15-20.

  6. Jenkins CNH, McPhee SJ, Bird JA, Bonilla NTH. Cancer risks and prevention behaviors among Vietnamese refugees. West J Med 1990;153:34-9.

  7. CDC. Cigarette smoking among Chinese, Vietnamese, and Hispanics -

    1. California, 1989-1991. MMWR 1992;41:362-7. 8. Anda RF, Waller MN, Wooten KG, et al. Behavioral risk factor surveillance, 1988. MMWR 1990;39(no. SS-2):1-21. 9. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

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