Asian, Native Hawaiian, and Pacific Islander People Experience a Health Burden From Commercial Tobacco
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).
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
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
|Population Group||Smoking Prevalence|
- 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].
- 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].
- 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].
- 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].
- 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].
- 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].
- Heron M. Deaths: Leading causes for 2018. Natl Vital Stat Rep 2021;70(4):1–115 [accessed 2022 May 25].
- 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].
- 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].
- 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].
- Merry SE. Colonizing Hawai’i: The Cultural Power of Law. Princeton: Princeton University Press, 2000 [accessed 2020 Dec 08].
- 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].
- Department of Hawaiian Homelands. Text of the Hawaiian Homes Commission Act, 1920 [PDF – 567 KB] [accessed 2021 Feb 16].
- 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].
- 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].
- Marshall M. Drinking Smoke: The Tobacco Syndemic in Oceania. University of Hawai’i Press, 2013 [accessed 2020 Dec 09].
- 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].
- 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].
- 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].
- Federal Trade Commission. Federal Trade Commission Cigarette Report for 2019 [PDF – 1 MB]. Federal Trade Commission, 2021 [accessed 2022 March 2].
- 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].
- 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].
- 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].
- 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].
- 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].
- 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].
- 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].
- Widome, R., Brock, B., Noble, P., & Forster, J. L. (2013). The relationship of neighborhood demographic characteristics to point-of-sale tobacco advertising and marketing. Ethnicity & health, 18(2), 136-151 [accessed 2021 Jan 06].
- 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].
- Caraballo RS, Asman K. Epidemiology of menthol cigarette use in the United States. Tobac Induc Dis 2011;9(S1):S1 [accessed 2022 May 25].
- 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].
- 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].
- 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].
- 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].
- 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].
- 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]
- 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].
- 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].
- Asian Americans Advancing Justice. Southeast Asian American Journeys: A National Snapshot of Our Communities. 2020 [accessed 2020 Dec 08].
- 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].
- 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].
- 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].
- 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].
- 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].
- 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].
- 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].
- 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].