Asian, Native Hawaiian, and Pacific Islander People Experience a Health Burden From Commercial Tobacco

In 2020, an estimated 8% of Asian adults smoked cigarettes.

Asian, Native Hawaiian, and Pacific Islander (A/NH/PI) communities are diverse—made up of people from more than 50 different ethnic and language groups. In general, A/NH/PI adults smoke cigarettes at a lower prevalence than other racial groups; however, this varies based on the country of heritage.1

Reporting A/NH/PI population groups as one combined group is only one way to estimate the behaviors of A/NH/PI populations as it relates to commercial tobacco* use. When possible, by studying tobacco product use separately among each of these populations, we can better identify tobacco product use patterns in each group. For example:

  • In 2019, an estimated 18.7% of Native Hawaiian/Pacific Islander adults smoked cigarettes in the past year, compared to 11.5% of Asian adults.2
  • In 2014-2017, 45% of Native Hawaiian/Pacific Islander middle and high school students reported ever using any tobacco product, compared to 16.3% of Asian middle and high school students.3
  • Differences in cigarette smoking are seen among diverse Asian population groups.4 For instance, during 2010–2013, 7.6% of Chinese American adults smoked cigarettes, compared to 20% of Korean American adults.5

Commercial tobacco creates challenges in achieving health equity for all people, including for A/NH/PI. A/NH/PI people experience negative health effects related to the use of commercial tobacco products (e.g., cigarettes, smokeless tobacco, cigars, e-cigarettes).

head heart ribbin

The two leading causes of death among A/NH/PI adults are cancer and heart disease.7 Cigarette smoking increases the risk of developing these two conditions.8

90% of lung cancer is from smoking

Lung cancer is the leading cause of cancer deaths among A/NH/PI adults.9 Smoking can cause cancer almost anywhere in the body and, along with secondhand smoke exposure, can cause nearly 90% of all lung cancer deaths.8

Prevalence of Cigarette Smoking Among Asian People in America (2010-2013)6
Population Group Smoking Prevalence
Prevalence of Cigarette Smoking Among Asians in America (2010-2013) <sup>6</sup
Chinese 7.6%
Asian Indian 7.6%
Japanese 10.2%
Filipino 12.6%
Vietnamese 16.3%
Korean 20.0%
*“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 or ceremonial purposes.
  1. Creamer MR, Wang TW, Babb S, et al. Tobacco Product Use and Cessation Indicators Among Adults – United States, 2018 [PDF – 218 KB]. Morbidity and Mortality Weekly Report 2019, 68(45);1013-1019 [accessed 2021 Jan 04].
  2. Substance Abuse and Mental Health Services Administration. Results from the 2018 National Survey on Drug Use and Health: Detailed Tables. Table 2.12B-Cigarette use in Past Year among Persons Aged 12 or Older, by Age Group and Demographic Characteristics Percentages, 2018 and 2019: Rockville, MD: Substance Abuse and Mental Health Services (SAMHSA), 2019 [accessed 2021 Jan 04].
  3. Odani S, Armour BS, Agaku IT. Racial/Ethnic Disparities in Tobacco Product Use Among Middle and High School Students — United States, 2014–2017. MMWR Morb Mortal Wkly Rep 2018; 67:952–957 [accessed 2021 Jan 06].
  4. Mattingly DT, Hirschtick JL, and Fleischer NL. Unpacking the Non-Hispanic Other Category: Differences in Patterns of Tobacco Product Use Among Youth and Adults in the United States, 2009–2018. J Immigrant and Minority Health 2020; 22:1368-72 [accessed 2021 Jan 04].
  5. 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: 753–758 [accessed 2021 Jan 04].
  6. Centers for Disease Control and Prevention. Disparities in Adult Cigarette Smoking—United States, 2002-2005 and 2010-2013. Morbidity and Mortality Weekly Report 2016;65(30) [accessed 2021 Feb 03].
  7. Heron M. Deaths: Leading causes for 2018. Natl Vital Stat Rep 2021;70(4):1–115 [accessed 2022 May 25].
  8. U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2022 May 25].
  9. Islami F, Ward EM, Sung H, et al. Annual report to the Nation on the status of cancer, part 1: National Cancer Statistics [published online ahead of print, 2021 Jul 8]. J Natl Cancer Inst 2021;113(12):1648–1669 [accessed 2022 May 25].
  10. Yoo HC, Gee GC, Takeuchi D. Discrimination and health among Asian American immigrants: disentangling racial from language discrimination [PDF – 140 KB]. Soc Sci Med 2009;68(4): 726-32 [accessed 2021 Jan 04].
  11. Merry SE. Colonizing Hawai’i: The Cultural Power of Law. Princeton: Princeton University Press, 2000 [accessed 2020 Dec 08].
  12. U.S. Department of Housing and Urban Development. Office of Policy Development and Research. Housing Needs of Native Hawaiians: A Report From the Assessment of American Indian, Alaska Native, and Native Hawaiian Housing [PDF – 6.2 MB]. 2017 [accessed 2021 Feb 16].
  13. Department of Hawaiian Homelands. Text of the Hawaiian Homes Commission Act, 1920 [PDF – 567 KB] [accessed 2021 Feb 16].
  14. Herman RDK. Out of State, Out of Mind, Out of Power: Leprosy, Race, and Colonization in Hawai’i. Multidisciplinary Research on Hawaiian Well-Being 2010;6: 265-291 [accessed 2021 Feb 16].
  15. Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in Western countries: a systematic review. [PDF – 92 KB] Lancet. 2005;365(9467):1309–14 [accessed 2021 Jan 04].
  16.  Marshall M. Drinking Smoke: The Tobacco Syndemic in Oceania. University of Hawai’i Press, 2013 [accessed 2020 Dec 09].
  17.  Linhart C, Naseri T, Lin S, Taylor R, Morrell, et al. Tobacco smoking trends in Samoa over four decades: can continued globalization rectify that which it has wrought? Global Health, 2017;13: 31 [accessed 2021 Feb 16].
  18. Carson NJ, Rodriguez D, Audrain-McGovern J. Investigation of mechanisms linking media exposure to smoking in high school students [PDF – 92 KB]. Prev Med 2005;41(2): 511-20 [accessed 2021 Jan 04].
  19. Charlesworth A & Glantz SA. Smoking in the movies increases adolescent smoking: A review [PDF – 270 KB]. Pediatrics 2005;116(6): 1516-28 [accessed 2020 Dec 08].
  20. Federal Trade Commission. Federal Trade Commission Cigarette Report for 2019 [PDF – 1 MB]. Federal Trade Commission, 2021 [accessed 2022 March 2].
  21. 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 [accessed 25 May 2022].
  22. U.S. Department 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 [PDF – 64 MB]. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1998 [accessed 2021 Jan 04].
  23. Muggli ME, Pollay RW, Lew R, et al. Targeting of Asian Americans and Pacific Islanders by the tobacco industry: results from the Minnesota Tobacco Document Depository [PDF – 156 KB]. Tob Control 2002;11: 201-209 [accessed 2021 Jan 04].
  24. Robertson L, McGee R, Marsh L, & Hoek J. A systematic review on the impact of point-of-sale tobacco promotion on smoking [PDF – 602 KB]. Nicotine Tob Res 2015;17(1): 2-17 [accessed 2021 Jan 04].
  25. Ton HT, Smart AE, Aguilar BL, et al. Menthol enhances the desensitization of human alpha3beta4 nicotinic acetylcholine receptors. Mol Pharmacol 2015 [602 KB];88(2):256-64 [accessed 2020 Jan 06].
  26. 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 [ accessed 2020 Dec 08].
  27. Tobacco Products Scientific Advisory Committee. Menthol Cigarettes and Public Health: Review of the Scientific Evidence and Recommendations. Rockville, MD: US Department of Health and Human Services, Food and Drug Administration, 2011 [accessed 2020 Dec 08].
  28. Widome, R., Brock, B., Noble, P., & Forster, J. L. (2013). The relationship of neighborhood demographic characteristics to point-of-sale tobacco advertising and marketingEthnicity & health18(2), 136-151 [accessed 2021 Jan 06].
  29. Substance Abuse and Mental Health Services Administration. National Survey on Drug Use and Health. Center for Behavioral Health Statistics and Quality, Substance Abuse & Mental Health Data Archive, 2019 [accessed 2022 May 25].
  30. Caraballo RS, Asman K. Epidemiology of menthol cigarette use in the United States. Tobac Induc Dis 2011;9(S1):S1 [accessed 2022 May 25].
  31. Mukherjea A, Wackowski OA, Lee YO, & Delnevo CD. Asian American, Native Hawaiian and Pacific Islander tobacco use patterns [PDF – 347 KB]. Am J Health Behavior 2014;38(3): 362–369 [accessed 2021 Jan 04].
  32. Office of the U.S. Surgeon General. Surgeon General’s Advisory on E-Cigarette Use Among Youth [PDF – 582 KB]. Atlanta, GA: Centers for Disease Control and Prevention, 2018 [accessed 2021 Feb 16].
  33. 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?  [PDF – 76 KB]Tobac Regulatory Sci 2017;3(2): 168-173 [accessed 2020 Dec 08].
  34. Slopen N, Dutra LM, Williams DR, et al. Psychosocial stressors and cigarette smoking among African American adults in midlife. [PDF – 233 KB] Nicotine Tob Res. 2012;14(10):1161-1169 [accessed 2020 Dec 08].
  35. 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 [accessed 25 May 2022].
  36. 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 [accessed 25 May 2022]
  37. 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 [accessed 2020 Dec 08].
  38. Kaholokula JK, Grandinetti A, Keller S, Nacapoy AH, Kingi TK, & Mau MK. Association between perceived racism and physiological stress indices in Native Hawaiians. J Behavioral Med 2012;35(1): 27–37 [accessed 2020 Dec 08].
  39. Asian Americans Advancing Justice. Southeast Asian American Journeys: A National Snapshot of Our Communities. 2020 [accessed 2020 Dec 08].
  40. Juster RP, McEwen BS, & Lupien SJ.  Allostatic load biomarkers of chronic stress and impact on health and cognition [PDF – 589 KB]. Neuroscience & Biobehavioral Reviews 2010;35(1): 2-16 [accessed 2020 Dec 08].
  41. Guyll M, Matthews KA, & Bromberger JT. Discrimination and unfair treatment: relationship to cardiovascular reactivity among African American and European American women. Health Psychology 2001;20(5): 315 [accessed 2020 Dec 08].
  42. Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults — United States, 2000–2015. MMWR, 2017;65(52):1457-64 [accessed 2021 Jan 4].
  43. U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General [PDF – 10 MB]. Centers for Disease Control and Prevention, 2020 [accessed 2021 Jan 04].
  44. Cox, L. S., Okuyemi, K., Choi, W. S., Ahluwalia, J. S. (2011). A review of tobacco use treatments in U.S. ethnic minority populations. American Journal of Health Promotion, 25(5), S30-S30 [accessed 2021 Jan 28].
  45. Hooper MW, Payne M, and Parkinson KA. Tobacco cessation pharmacotherapy use among racial/ethnic minorities in the United States: Considerations for primary care. Family Medicine and Community Health, 2018(5): 193-203 [accessed 2021 Jan 28].
  46. Kuiper N, Zhang L, Lee J, Babb SD, Anderson CM, Shannon C, et al. A National Asian-Language Smokers’ Quitline–United States, 2012-2014. Prev Chronic Dis 2015;12:E99 [accessed 2020 Dec 08].
  47. DiGiulio A, Jump Z, Babb S, et al. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018. MMWR Morb Mortal Wkly Rep 2020;69:155–160 [accessed 2022 May 25].