1 Smoking among Smoking among Vietnamese American Vietnamese American men in relation to men in relation to traditional health traditional health beliefs beliefs Presenter: Nadine L. Chan, MPH Presenter: Nadine L. Chan, MPH Email: [email protected]Email: [email protected]University of Washington & University of Washington & Fred Hutchinson Cancer Research Center Fred Hutchinson Cancer Research Center National Conference on Tobacco or Health National Conference on Tobacco or Health December 11, 2003 December 11, 2003
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Smoking among Smoking among Vietnamese American Vietnamese American men in relation to men in relation to traditional health traditional health beliefsbeliefs
Presenter: Nadine L. Chan, MPHPresenter: Nadine L. Chan, MPHEmail: [email protected]: [email protected] of Washington & University of Washington & Fred Hutchinson Cancer Research CenterFred Hutchinson Cancer Research CenterNational Conference on Tobacco or Health National Conference on Tobacco or Health December 11, 2003December 11, 2003
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AcknowledgementsAcknowledgements
Vietnamese Community Coalition and Vietnamese Community Coalition and InterviewersInterviewers
Vicky Taylor MD, MPHVicky Taylor MD, MPH Yutaka Yasui PhDYutaka Yasui PhD Carey Jackson MD MPHCarey Jackson MD MPH Beti Thompson PhDBeti Thompson PhD NCI Grant #CA823226-01NCI Grant #CA823226-01 Biobehavioral Cancer Prevention and Biobehavioral Cancer Prevention and
Control Training Program: NCI Grant Control Training Program: NCI Grant #R25 CA92408 #R25 CA92408
33
AgendaAgenda
Background on Background on – smoking among Southeast Asianssmoking among Southeast Asians– traditional health practices traditional health practices
Vietnamese Health Study in Vietnamese Health Study in Seattle, WASeattle, WA
Background: Tobacco Background: Tobacco UseUse Tobacco use is single most preventable Tobacco use is single most preventable
cause of death and illness in US cause of death and illness in US CDC, 1998CDC, 1998
– One in five deaths One in five deaths – 87% of lung cancer deaths87% of lung cancer deaths
Lung cancer is the leading cause of Lung cancer is the leading cause of cancer death among all Americanscancer death among all Americans
Lung cancer rates in Southeast Asians Lung cancer rates in Southeast Asians are 18% higher than general population are 18% higher than general population Chen and Hawks, 1995Chen and Hawks, 1995
55
Smoking PrevalenceSmoking Prevalence
PrevalencePrevalence– 34% to 43% among Southeast Asian men 34% to 43% among Southeast Asian men
vs.vs.– 27% in white men 27% in white men Centers for Disease Control Centers for Disease Control
and Prevention, 2000and Prevention, 2000
Tobacco use different by sexTobacco use different by sex– Much higher in API men than in womenMuch higher in API men than in women– More than 70% of newer male immigrants More than 70% of newer male immigrants
from Laos or Cambodia smoke from Laos or Cambodia smoke
66
Prevalence in King Prevalence in King County, WACounty, WA
% Current Smokers 1995-1996King County
12%17%
21%
38%
1%0%5%
10%15%20%25%30%35%40%
Hea
lthy
Peop
le20
10O
bjec
tives
Kin
gC
ount
y
Vie
tnam
ese
Vie
tnam
ese
men
Vie
tnam
ese
wom
en
%C
urr
en
t S
mo
kers
King County Ethnicity and Health Survey, 1998
77
Why?Why?
88
Challenges for Tobacco Challenges for Tobacco ControlControl More than 50% of tobacco companies More than 50% of tobacco companies
exports are sent to Asian countriesexports are sent to Asian countries Higher density of billboards and store Higher density of billboards and store
displays in Asian neighborhoods (e.g. displays in Asian neighborhoods (e.g. San Diego)San Diego) Elder et al, 1993Elder et al, 1993
– 6.4/Asian store6.4/Asian store– 4.6/Latino store4.6/Latino store– 3.7/African American store3.7/African American store– lowest in white neighborhoodslowest in white neighborhoods
99
Challenges for Tobacco Challenges for Tobacco ControlControl Lack of knowledge of health Lack of knowledge of health
effects of tobacco useeffects of tobacco use NAWHO, 1998NAWHO, 1998
– 1 in 5 Vietnamese did not know 1 in 5 Vietnamese did not know smoking causes heart disease, smoking causes heart disease, bronchitis, emphysema, COPD, and bronchitis, emphysema, COPD, and mouth cancermouth cancer
– 27% (1 in 4) Vietnamese adults did 27% (1 in 4) Vietnamese adults did not know smoking can cause cancernot know smoking can cause cancer
1010
Challenges for Tobacco Challenges for Tobacco ControlControl
““Little is known about levels of Little is known about levels of tobacco control awareness or tobacco control awareness or
attitudes and beliefs about attitudes and beliefs about tobacco in Asian American tobacco in Asian American
populations.”populations.”
National Asian Women’s Health Organization, National Asian Women’s Health Organization, 19981998
1111
Hold that thought…Hold that thought…
1212
Traditional Health Traditional Health BeliefsBeliefs
Vietnamese Americans commonly Vietnamese Americans commonly turn to traditional health beliefs in turn to traditional health beliefs in managing personal health, even if managing personal health, even if they use Western medicine they use Western medicine
1313
Vietnamese Health Vietnamese Health Project 2002Project 2002 PurposePurpose
– Identify cancer preventive behaviors Identify cancer preventive behaviors specific to Vietnamese American specific to Vietnamese American communitiescommunities
TeamTeam– Harborview Medical Center Harborview Medical Center – Refugee Immigrant Health ClinicRefugee Immigrant Health Clinic– Vietnamese Community CoalitionVietnamese Community Coalition– Fred Hutchinson Cancer Research CenterFred Hutchinson Cancer Research Center
used for potential determinants of used for potential determinants of smokingsmoking– Predisposing factors (traditional Predisposing factors (traditional
beliefs, knowledge, attitudes)beliefs, knowledge, attitudes)– Enabling (availability and access to Enabling (availability and access to
health services) health services) – Reinforcing (family, peer, medical Reinforcing (family, peer, medical
support)support)Green et al 91Green et al 91
1515
Methods: SamplingMethods: Sampling
Cross-sectional survey designCross-sectional survey design Addresses from 7 South Seattle zip codesAddresses from 7 South Seattle zip codes List of Vietnamese last names to identify List of Vietnamese last names to identify
Vietnamese households from phone bookVietnamese households from phone book Identified 1,639 householdsIdentified 1,639 households Randomly sampled n=900 householdsRandomly sampled n=900 households
– Interviewed one man and one woman (18-64 Interviewed one man and one woman (18-64 yrs) in each householdyrs) in each household
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Methods: RecruitmentMethods: Recruitment
Publicized surveys through posters in Publicized surveys through posters in communitycommunity
Mailed introductory letters to each Mailed introductory letters to each householdhousehold
Conducted interviews in respondents’ Conducted interviews in respondents’ homes using bilingual, bicultural homes using bilingual, bicultural interviewersinterviewers
Tokens of appreciation Tokens of appreciation – Original artwork depicting scenes from Original artwork depicting scenes from
VietnamVietnam– Summary of social and health resourcesSummary of social and health resources
1717
Methods: Instrument Methods: Instrument and Analysisand Analysis InstrumentInstrument
Asked if smoked in last routine Asked if smoked in last routine check-upcheck-up
7272
Have friends who smokeHave friends who smoke 9494
2222
Results: KnowledgeResults: Knowledge
VariableVariable% Correct % Correct
(N = 509)(N = 509)
Smoking can cause lung cancerSmoking can cause lung cancer 9797
Second-hand smoke can cause lower Second-hand smoke can cause lower respiratory tract infections in childrenrespiratory tract infections in children
9696
Is addictiveIs addictive 9595
Second-hand smoke can cause lung Second-hand smoke can cause lung cancer in non-smokerscancer in non-smokers
8787
Causes heart diseaseCauses heart disease 8383
Second-hand smoke can cause heart Second-hand smoke can cause heart disease in non-smokersdisease in non-smokers
7676
Causes strokeCauses stroke 7070
2323
Results: AttitudesResults: Attitudes
VariableVariable % Agree % Agree
(N = 509)(N = 509)
Smoking not allowed anywhere Smoking not allowed anywhere inside homeinside home
9393
Smoking is widely accepted Smoking is widely accepted among men in Vietnamese among men in Vietnamese communitycommunity
8282
Appropriate for Appropriate for menmen to smoke to smoke with friendswith friends
3030
Appropriate for Appropriate for womenwomen to to smoke with friendssmoke with friends
22
2424
Results: AttitudesResults: Attitudes
VariableVariable % Agree % Agree
(N = 509)(N = 509)
Gifts of tobacco acceptable in Gifts of tobacco acceptable in Vietnamese communityVietnamese community
1616
Impolite to refuse cigarette by Impolite to refuse cigarette by hosthost
1313
Smoking makes Smoking makes menmen appear appear more sophisticated and more sophisticated and confidentconfident
1212
Smoking makes Smoking makes womenwomen appear appear more sophisticated and more sophisticated and confidentconfident
44
2525
Results: Traditional Results: Traditional Health Beliefs and Health Beliefs and Correlations with Current Correlations with Current SmokersSmokersVariableVariable % Agree % Agree
(N = 509)(N = 509)SmkSmk
CorrCorr
Illness Illness
-can be prevented by taking -can be prevented by taking herbsherbs
-can be prevented by -can be prevented by maintaining a positive attitudemaintaining a positive attitude
6565
8989++
--
-is a matter of karma or fate-is a matter of karma or fate
-is caused by imbalance of -is caused by imbalance of cold/heatcold/heat
18 18
7070++
++
Course of illness changed by faithCourse of illness changed by faith 6161 --
Some diseases caused by wind Some diseases caused by wind illnessesillnesses 5252
++
2626
Results: Traditional Results: Traditional Health Beliefs and Health Beliefs and Correlations with Current Correlations with Current SmokersSmokersVariableVariable % Agree % Agree
(N = 509)(N = 509)SmkSmk
CorrCorr
Some American medicines too Some American medicines too strongstrong
2626 --
Western medicine is as good or Western medicine is as good or more effective to treat more effective to treat
A.A. root causeroot cause of illness of illness
B.B. symptomssymptoms
5555
6363++
++
Should visit a Dr regularly even Should visit a Dr regularly even without problemswithout problems
9393 --
Coining is best treatment for Coining is best treatment for some illnessessome illnesses
5050 ++
2727
Traditional Health Beliefs Traditional Health Beliefs Independently Independently Associated with Current Associated with Current Smoking Smoking
OR 95%(CI)OR 95%(CI)
Some diseases are caused by Some diseases are caused by wind illnesseswind illnesses
1.6 1.6
(1.10, 2.33)(1.10, 2.33)
Illness is caused by imbalance Illness is caused by imbalance cold/heatcold/heat
1.7 1.7
(1.09, 2.69)(1.09, 2.69)
2828
Traditional Health Belief Traditional Health Belief Summary Msrs vs Summary Msrs vs Current Smoking StatusCurrent Smoking StatusIndependent variableIndependent variable OROR 95% CI95% CI
Strong/weak Strong/weak traditional health traditional health beliefsbeliefs
1.271.27 .88, 1.82.88, 1.82
Traditional health Traditional health belief scorebelief score
1.121.12 1.01, 1.231.01, 1.23
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SummarySummary
High prevalence of smoking among High prevalence of smoking among Vietnamese American menVietnamese American men
Strong traditional beliefs held Strong traditional beliefs held about healthabout health
Current smokers independently Current smokers independently associated with belief that associated with belief that – illness caused by wind illness caused by wind – illness caused by imbalance of illness caused by imbalance of
heat/coldheat/cold
3030
ImplicationsImplications
Little change in prevalence of smoking in Little change in prevalence of smoking in this community since 1995this community since 1995
Smokers may attribute poor health Smokers may attribute poor health especially to wind or cold/heat imbalance especially to wind or cold/heat imbalance insteadinstead
Smokers may believe that illness is fated, Smokers may believe that illness is fated, but that Western medicine will curebut that Western medicine will cure
Possibly identify risk in community using a Possibly identify risk in community using a summary score for traditional health summary score for traditional health beliefsbeliefs
3131
LimitationsLimitations
Generalizeability to other regions Generalizeability to other regions or to neighborhoods with smaller or to neighborhoods with smaller proportions of Vietnamese proportions of Vietnamese residentsresidents
Acquiescence bias Acquiescence bias Direction of causality Direction of causality
undetermined because of cross-undetermined because of cross-sectional nature of analysissectional nature of analysis
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Strengths of StudyStrengths of Study
Community-based sampling methodCommunity-based sampling method Use of theoretical model to guide Use of theoretical model to guide
projectproject First known study to look in depth at First known study to look in depth at
the associations between traditional the associations between traditional health beliefs and smoking status in health beliefs and smoking status in a high risk populationa high risk population
3333
Questions?Questions?
3434
Summary Scale for Summary Scale for Traditional Health Traditional Health BeliefsBeliefs