Tobacco Use 

Health Threat to Asian and Pacific Islander Communities 

By Jody Vilschick


Closing the Gap, Men’s Health • September/October 2001


Tonganese Americans can take heart that their former king, 

King Taufa‘ahau Tupou IV, is working to help improve their 

health by collaborating in the making of an anti-tobacco video 

for youth in Tongan and English. “He still has great influence among 

Tongans in the U.S.” says Percival Leha‘uli, the director of the Tobacco 

Control Program at the Tongan Community Center in Los Angeles. 

Still, according to Tobacco or Health: A Global Status Report, by 

the World Health Organization, 1997, the smoking rate among Tongan-American men is an astounding 65%, compared with an average 

of 24% among other Americans. But the staLew. He notes that many American and international tobacco companies market their products extensively in Asian countries—where many 

mmigrants to America originate—then, these companies reach these 

ame people again—once they assimilate into American culture. 

China, for example, produces more tobacco than any other counry in the world, and is also its greatest consumer of tobacco, according 

o the World Health Organization. And, as a true testament to adverising and marketing ingenuity, a store in Seattle’s Little Saigon neighorhood cleverly integrates the Marlboro logo with Asian cultural 

icons like Buddha. Marlboro signs also hang 

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tistics for other Asian American/ Pacific Is- “If the services are adjacent to rice bags, cash registers and other 

lander (AA/PI) groups—72% of Laotian

American men and 71% of Cambodian

American men smoke—underline the need 

for tobacco cessation and prevention programs 

that can appropriately communicate with the 

AA/PI communities. 

Complicating the lack of culturally competent and translated materials and resources 

high-traffic areas, Lew added. “It’s a shame 

hat until a few years ago, the tobacco comanies knew more about getting their mesage out to the AA/PI community than the 

ublic health tobacco cessation programs,” 

e said. 

culturally competent and language 

appropriate, then that will build a 

higher trust— 

nd ultimately have a greater effect.” 

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for the AA/PI community is the diversity among the AA/PI commuities. “There are more than 50 distinct ethnic and language groups 

ithin the umbrella of the AA/PI community,” says Rod Lew, founder 

nd current executive director of the Asian Pacific Partners for Emowerment and Leadership (APPEAL). “There are very limited cessaion resources even for the very large groups.” Founded seven years 

go, APPEAL is a national network of individuals and organizations 

hat work to prevent tobacco use among the AA/PI community. 

Yet creating such resources is critically important. “If the services 

re culturally competent and language appropriate, then that will 

uild a higher trust—and ultimately have a greater effect,” says Elaine 

ishiwara, who runs the Washington Asian Pacific Islander Families 

gainst Substance Abuse (WAPIFASA). WAPIFASA, located in Settle, provides a variety of substance abuse outreach activities that 

ncorporate anti-tobacco messages. 

obacco Advertising—A Cause for Concern 

The tobacco industry spends almost $7 billion every year on 

dvertising—contributing, in part, to the high incidence of smoking 

ithin the AA/PI community. “Many within the AA/PI community 

eceive the tobacco industry’s targeted messages again and again,” says 

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Addressing Cultural Barriers 

Alison Shigaki is a physician with International Community 

ealth Services, a community health clinic that primarily serves memers of Seattle’s AA/PI community. Shigaki has come face-to-face with 

ome of the cultural barriers to the anti-tobacco message her clinic 

romotes. “Smoking is a big part of some Asian cultures,” she says, 

ointing out that men in many Asian countries use smoking to sociale and transact business. “If someone offers you a cigarette, you need 

o be polite and accept it. You also need your own cigarettes to offer 

thers,” she says. “Then they come to the U.S. and it takes them a long 

hile to realize cigarettes aren’t so important.” 

Shigaki’s clinic, which is funded by grants from Seattle King 

ounty Health Department, has recently started a pilot six-weekng smoking cessation program in Vietnamese targeting Vietnamese 

en. “Men in the class at the beginning can bring someone else as 

upport—even up to week five,” she says. “We hadn’t expected it to 

e this way, but it’s now a rolling admission. Men who started the class 

ter are now attending the second round of classes to catch up on 

hat they missed in the first few meetings.” 

She notes however, that most of these men are already highly 

otivated—of the 20 that finished the first set of classes, two had 

lready quit smoking and 12 others were starting the nicotine patch. 

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Office of Minorit

continue to page 2>>>> 

y Health Resource Center 1 U.S. Department of Health and Human Services 
AAPI Tobacco Use

Tobacco Use 

Health Threat to Asian and Pacific Islander Communities 

By Jody Vilschick


Closing the Gap, Men’s Health • September/October 2001


APPEAL offers a tool-kit, “Making Tobacco Relevant for Asian 

merican and Pacific Islander Communities,” that recommends that 

mmunity organizations follow these steps: 

	 Identify the people in the community already active in cessation 

efforts to approach about tobacco and smoking cessation efforts. 

	 Cultivate relationships with that group, or establish contacts to 

collaborate with them. 

	 Know the community at first hand: learn about what concerns 

motivate them to act. 

	 Find ways to relate tobacco to those concerns. 

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5.	 Provide information about tobacco control in a way that interests 

the community. 

6.	 Provide opportunities for the organization to be involved in tobacco control. 

AA/PI men are much more likely than AA/PI women to smoke, 

says Lew, although he notes that as AA/PI men become more acculturated, their rate of smoking tends to drop, while AA/PI women’s rate of 

smoking increases with acculturation. 

The good news of acculturation—according to Shigaki—is that, 

“now that they’re in the United States, the wives are more vocal—they 

don’t want the men to smoke in the house and they encourage the 

men to pay more attention to their health,” she says. 

For more information, contact APPEAL at http:// 

www.APPEALforcommunities.org

Smoking Behavior of Asian Americans and Pacific Islanders 

Cigarette Smoking Behavior 

Research shows an association between 

cigarette smoking and acculturation among 

Asian American and Pacific Islander adults 

from Southeast Asia. Those who had a higher 

English-language proficiency and those living in the United States longer were less likely 

to be smokers. 

Among Chinese men, the average number of cigarettes smoked per day increased 

with the percentage of their lifetime spent in 

the United States. 

Among Vietnamese, the prevalence of 

smoking was higher among men who immigrated to the United States in 1981 or later 

and who were not fluent in English. 

Health Effects 

Smoking is responsible for 87% of the 

lung cancer deaths in the United States. In 

1993, lung cancer was the leading cause of 

cancer death (22.3%) among Asian Americans and Pacific Islanders. 

The death rate for lung 

cancer was 27.9 per 100,000 

for Asian American and Pacific Islander men 

and 11.4 per 100,000 for women. 

Among subgroups, both Hawaiian men 

(88.9 per 100,000) and women (44.1 per 

100,000) had the highest rate of lung cancer 

deaths, and Filipino men (29.8 per 100,000) 

and women (10.0 per 100,000) had the 

lowest. 

Prevalence 

The 1997 National Health Interview 

Survey data show that overall adult smoking 

prevalence was lower among Asian Americans and Pacific Islanders (16.9%) than 

among Hispanics (20.4%), whites (25.3%), 

African Americans (26.7%), and American 

Indians and Alaska Natives (34.1%).4 

Smoking rates are much higher among 

Asian American and Pacific Islander men than 

among Asian American and Pacific Islander 

women, regardless of country of origin. 

Quitting 

Among current smokers, Asian Americans and Pacific Islanders were slightly more 

likely than white smokers to have quit for at 

least one day during the previous year 

(32.0%, compared with 26.0%). 

Asian Americans and Pacific Islanders 

(2.5%), however, are less likely than whites 

(3.4%) to remain abstinent for up to 90 days. 

A community intervention trial for Vietnamese men conducted in San Francisco significantly increased the likelihood of quitting smoking. This program included a longrunning anti-tobacco media campaign and 

school- and family-based components. 

Tobacco Industry 

Among racial/ethnic minority communities in San Diego, the highest average number of tobacco displays was found in Asian 

American stores (6.4), compared with Hispanic (4.6) and African American (3.7) stores. 

Source: U. S. Surgeon General’s Report, Tobacco Use Among U.S. Racial/Ethnic Minority 

Groups—African Americans, American Indians and 

Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics, 2000.

Office of Minority Health Resource Center	 2 U.S. Department of Health and Human Services