Unfair and Unjust Practices and Conditions Harm Asian, Native Hawaiian, and Pacific Islander People and Drive Health Disparities

At a glance

  • The tobacco industry targets A/NH/PI communities with marketing and advertising.
  • Tobacco companies promote flavored products—especially menthol—in neighborhoods where A/NH/PI people live.
  • Stress can increase commercial tobacco use and can make health problems worse.
A young man in a suit in front of a brick wall


Some U.S. historical policies and practices have led to mental and physical health risks and challenges, and related long-term health outcomes, for Asian, Native Hawaiian, and Pacific Islander (A/NH/PI) people. For example:

  • Discrimination and distress related to immigration policies.12
  • Colonization of Hawaii, leading to people losing their homes, land, and cultural practices that kept people healthy and well.3456
  • Refugee resettlement in the U.S. and lasting effects on mental health, health behaviors, and effects on people's health and quality of life.7
  • More and different kinds of commercial tobacco products coming into the Pacific region after large numbers of people moved in and used commercial tobacco as payment for food products, work, or other goods. 89

There are also current reasons—like the ones explored below—that help explain why the health of A/NH/PI people is affected by commercial tobacco.

Child hugging parent.
Asian Americans have historically faced discrimination related to immigration.

The tobacco industry targets A/NH/PI communities with marketing and advertising

Marketing plays a big role in whether people try or use commercial tobacco products. Commercial tobacco ads make smoking seem more appealing and increase the chance that someone will try smoking for the first time or start using commercial tobacco products regularly.101112

Tobacco companies spend billons of dollars each year to aggressively market their products.13 They also target specific populations, including A/NH/PI populations, with commercial advertising.14

  • Tobacco companies consider Asian people a key group for marketing commercial tobacco products, since cigarette smoking is more prevalent in some Asian countries than in the U.S.1115
  • Commercial tobacco ads on billboards and in stores are more common in city neighborhoods with mostly Asian residents than in other city neighborhoods.7
  • Tobacco companies promote to Asian American business owners by supporting their business groups and giving them special materials to help drive product sales.7
  • Commercial tobacco brands try to appeal to Asian people by making sure their brands are seen, giving money to community organizations, and targeting ads to this group. For example, the tobacco industry has sponsored Lunar New Year festivals and other activities related to Asian Pacific American Heritage Month.11
  • The industry has also supported groups serving Asians and others, such as women’s groups, political groups, arts and culture groups, and senior citizens’ groups, with the goal of drawing in Asians and promoting their brands.16

To help protect A/NH/PI people from tobacco marketing and discourage tobacco product use, states and communities can consider increasing prices and prohibiting price discounts. They can also prohibit the sale of flavored tobacco products, and either allow fewer stores in a neighborhood to sell commercial tobacco products or prohibit tobacco product sales altogether.17

Dragon dance celebration.
Tobacco companies target cultural events such as this Dragon Dance celebration for Lunar New Year.

Tobacco companies promote flavored products—especially menthol—in neighborhoods where A/NH/PI people live

Menthol has a minty flavor that masks the harsh taste of tobacco. Menthol makes cigarette smoke feel easier to inhale and makes it harder to quit smoking.181920 Tobacco companies have aggressively marketed menthol cigarettes to A/NH/PI people for decades and continue to do so today.

  • The tobacco industry targets neighborhoods with more Asian residents, other communities of color, low-income neighborhoods, and youth with menthol advertising.21
  • In 2019, 77% of NH/PI and 41% of Asian adults who smoked reported using a menthol brand, compared to 30% of White people who smoked.22
  • In 2011, over half of Asian youth aged 12-17 who smoked reported using a menthol brand—second only to that of Black youth (72%).23
  • Filipino and Native Hawaiian/Pacific Islander adults who smoke are more likely to use menthol cigarettes than other groups of Asian adults.24

What can states and communities do? ‎

There are actions states and communities could take to reduce the availability of flavored commercial tobacco products.1025 For example, prohibiting the sale of all flavors in tobacco products, including cigarettes, e-cigarettes, cigars, and cigarillos, could help to reduce the number of youth who use these products.26

Stress can increase commercial tobacco use, and can make health problems worse

Stress, such as that caused by financial problems, discrimination, or unsafe neighborhoods, can make someone more likely to smoke.272829 Some A/NH/PI people face many types of stress:

  • Asian people who reported many instances of discrimination were more likely to smoke than Asian people who reported fewer instances of discrimination.30
  • Compared to other racial/ethnic groups, Native Hawaiians are more likely to have low-paying jobs and to have below average living conditions. Many report high levels of racism and discrimination, and that it affects their jobs, housing, and income.31
  • Southeast Asian ethnic groups have lower incomes than the average U.S. household income, according to the Southeast Asia Resource Action Center.32 Continuing financial problems are a major source of stress.

When people experience severe or long-lasting forms of stress, their bodies respond by raising stress hormones and keeping them raised. When this goes on for a long time, they may develop health problems like high blood pressure and diabetes.3334 Smoking cigarettes also leads to disease and disability and harms nearly every organ of the body.10

Woman looking off to the side with text, "62% of Asian Americans report experiencing discrimination based on ethnicity."
Stress can make people more likely to smoke.
  1. Martell BN, Garrett BE, Caraballo RS. Disparities in Adult Cigarette Smoking—United States, 2002-2005 and 2010-2013. MMWR Morb Mortal Wkly Rep. 2016;65(30):753–758.
  2. Yoo HC, Gee GC, Takeuchi D. Discrimination and health among Asian American immigrants: disentangling racial from language discrimination. Soc Sci Med. 2009;68(4):726–732.
  3. Merry SE. Colonizing Hawai’i: The Cultural Power of Law. Princeton University Press, 2000.
  4. U.S. Dept of Housing and Urban Development. Housing Needs of Native Hawaiians: A Report From the Assessment of American Indian, Alaska Native, and Native Hawaiian Housing. Office of Policy Development and Research; 2017. Accessed February 16, 2021. https://www.huduser.gov/portal/sites/default/files/pdf/HNNH.pdf
  5. Dept of Hawaiian Homelands. Hawaiian Homes Commission Act, 1920. Accessed February 16, 2021.
  6. Herman RDK. Out of sight, out of mind, out of power: Leprosy, race, and colonization in Hawai'i. Multidisciplinary Research on Hawaiian Well-Being 2010;6:265–291.
  7. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–1314.
  8. Marshall M. Drinking Smoke: The Tobacco Syndemic in Oceania. University of Hawai’i Press; 2013.
  9. Linhart C, Naseri T, Lin S, et al. Tobacco smoking trends in Samoa over four decades: can continued globalization rectify that which it has wrought? Global Health. 2017;13:31.
  10. U.S. Dept of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. U.S. Dept of Health and Human Services; 2014. Accessed May 25, 2022. https://www.ncbi.nlm.nih.gov/books/NBK179276/
  11. Carson NJ, Rodriguez D, Audrain-McGovern J. Investigation of mechanisms linking media exposure to smoking in high school students. Prev Med. 2005;41(2):511–520.
  12. Charlesworth A, Glantz SA. Smoking in the movies increases adolescent smoking: a review. Pediatrics. 2005;116(6):1516–1528.
  13. Federal Trade Commission. Federal Trade Commission Cigarette Report for 2019. Federal Trade Commission; 2021. Accessed March 2, 2022. https://www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2019-smokeless-tobacco-report-2019/cigarette_report_for_2019.pdf
  14. Cruz TB, Rose SW, Lienemann BA, et al. Pro-tobacco marketing and anti-tobacco campaigns aimed at vulnerable populations: a review of the literature. Tob Induc Dis. 2019;17:68.
  15. U.S. Dept of Health and Human Services. Tobacco Use Among U.S. Racial/Ethnic Minority Groups—African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, Hispanics: A Report of the Surgeon General. U.S. Dept of Health and Human Services, 1998. Accessed January 4, 2021. https://stacks.cdc.gov/view/cdc/13237
  16. Muggli ME, Pollay RW, Lew R, Joseph AM. Targeting of Asian Americans and Pacific Islanders by the tobacco industry: results from the Minnesota Tobacco Document Depository. Tob Control. 2002;11:201–209.
  17. Robertson L, McGee R, Marsh L, Hoek J. A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine Tob Res. 2015;17(1):2–17.
  18. Ton HT, Smart AE, Aguilar BL, et al. Menthol enhances the desensitization of human alpha3beta4 nicotinic acetylcholine receptors. Mol Pharmacol. 2015;88(2):256–264.
  19. Oliver AJ, Jensen JA, Vogel RI, Anderson AJ, Hatsukami DK. Flavored and nonflavored smokeless tobacco products: rate, pattern of use, and effects. Nicotine Tob Res. 2013;15(1):88–92.
  20. Food and Drug Administration. Preliminary scientific evaluation of the possible health effects of menthol versus nonmenthol cigarettes. U.S. Dept of Health and Human Services; 2011. Accessed December 8, 2020. https://www.fda.gov/media/86497/download
  21. Widome R, Brock B, Noble P, Forster JL. The relationship of neighborhood demographic characteristics to point-of-sale tobacco advertising and marketing. Ethn Health. 2013;18(2):136–151.
  22. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health. Substance Abuse & Mental Health Data Archive, 2019. Accessed May 25, 2022.
  23. Caraballo RS, Asman K. Epidemiology of menthol cigarette use in the United States. Tobac Induc Dis. 2011;9(Suppl 1):S1.
  24. Mukherjea A, Wackowski OA, Lee YO, Delnevo CD. Asian American, Native Hawaiian and Pacific Islander tobacco use patterns. Am J Health Behav. 2014;38(3):362–369.
  25. Office of the U.S. Surgeon General. Surgeon General's Advisory on E-Cigarette Use Among Youth. Centers for Disease Control and Prevention, 2018. Accessed February 16, 2021. https://e-cigarettes.surgeongeneral.gov/documents/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf
  26. Harrell MB, Loukas A, Jackson CD, Marti CN, Perry CL. Flavored tobacco product use among youth and young adults: what if flavors didn't exist? Tobac Regul Sci. 2017;3(2):168–173.
  27. Slopen N, Dutra LM, Williams DR, et al. Psychosocial stressors and cigarette smoking among African American adults in midlife. Nicotine Tob Res. 2012;14(10):1161–1169.
  28. Slopen N, Kontos EZ, Ryff CD, Ayanian JZ, Albert MA, Williams DR. Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9–10 years: A prospective study of middle-aged adults in the United States. Cancer Causes Control. 2013;24(10):1849–1863.
  29. Purnell JQ, Peppone LJ, Alcaraz K, et al. Perceived discrimination, psychological distress, and current smoking status: results from the Behavioral Risk Factor Surveillance System Reactions to Race module, 2004–2008. Am J Public Health. 2012;102(5):844–851.
  30. Chae DH, Takeuchi DT, Barbeau EM, Bennett GJ, Lindsey J, Krieger N. Unfair treatment, racial/ethnic discrimination, ethnic identification, and smoking among Asian Americans in the National Latino and Asian American Study. Am J Public Health. 2008;98(3):485–492.
  31. Kaholokula JK, Grandinetti A, Keller S, Nacapoy AH, Kingi TK, Mau MK. Association between perceived racism and physiological stress indices in Native Hawaiians. J Behav Med. 2012;35(1):27–37.
  32. Southeast Asia Resource Action Center, Asian Americans Advancing Justice. Southeast Asian American Journeys: A National Snapshot of Our Communities. Southeast Asia Resource Action Center; 2020. Accessed December 8, 2020. https://www.searac.org/wp-content/uploads/2020/02/SEARAC_NationalSnapshot_PrinterFriendly.pdf
  33. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev. 2010;35(1):2–16.
  34. Guyll M, Matthews KA, Bromberger JT. Discrimination and unfair treatment: relationship to cardiovascular reactivity among African American and European American women. Health Psychol. 2001;20(5):315–325.
  • "Commercial tobacco" means harmful products that are made and sold by tobacco companies. It does not include "traditional tobacco" used by Indigenous groups for religious groups or ceremonial purposes.