NEW BRUNSWICK – Efforts to adapt tobacco cessation efforts to the unique needs of South Asians living in the United States may receive a boost from what is believed to be a first-of-its-kind study. The research, conducted by investigators at The Cancer Institute of New Jersey (CINJ) and UMDNJ-School of Public Health, closely examined tobacco- and smokeless tobacco-use patterns by South Asians in New Jersey and the Northeast. The findings appear in the special Cigarette Smoke and Cancer edition of the Journal of Oncology (http://www.hindawi.com/journals/jo/2011/252675/). CINJ is a Center of Excellence of UMDNJ-Robert Wood Johnson Medical School.
The study, Epidemiology of Cigarette and Smokeless Tobacco Use among South Asian Immigrants in the Northeastern United States, utilized population behavioral surveillance data from the 2003 and 2006-2007 National Cancer Institute Tobacco Use Supplement to the Current Population Survey. At focus were data from 7,354 adults in New Jersey (176 of whom were South Asian) and 71,152 adults in the Northeast (583 of whom were South Asian). South Asians were defined as those who indicated they or one of their parents was a native of India, Pakistan or Bangladesh. While other South Asian countries were not represented, U.S. Census data show that the three countries named are the native lands of 98 percent of South Asian immigrants living in the U.S.
Questions from the Tobacco Use Supplement to the Current Population Survey determined whether participants were cigarette smokers and/or smokeless tobacco users. Overall, cigarette smoking rates among South Asians were similar to or lower than those of the general population. However, while previous data show the use of smokeless tobacco is a predominant behavior among Caucasian males in the U.S., this current study found that South Asian males in New Jersey (2.7 percent) have the highest rate of current use among males in the state. In the Northeast, the rate for South Asian males is lower, with 1.4 percent currently using smokeless tobacco products with Caucasian male use at 2.3 percent in this region. Smokeless tobacco use was found to be extremely low among all racial/ethnic female groups both in New Jersey and the Northeast. However, the rate of South Asian females in New Jersey who said they had ever used smokeless tobacco (1.7 percent), was significantly higher than the 0.2 percent of females overall in the state.
The study also found that tobacco use behavior among South Asian subgroups was not the same. For instance, among South Asians, Pakistani males were found to be overrepresented among current cigarette smokers in the Northeast while more Indian males in this region were found to use smokeless tobacco.
CINJ Member Cristine Delnevo, PhD, MPH, director of the Center for Tobacco Surveillance and Evaluation Research Program and interim chair, Department of Health Education and Behavioral Science at UMDNJ-School of Public Health, is the lead author of the study. She says the research is methodologically unique, because it utilized country of origin to identify South Asians.
“South Asians are almost always aggregated into a broad ‘Asian’ category, thus potentially masking subgroup differences and preventing identification of potential health disparities between subgroups. Moreover, research suggests that South Asians choose a wide variety of racial descriptors on surveys, which is partially dependent on the question options,” she stated.
Dr. Delnevo and colleagues note there were some limitations to the study. The authors caution that health surveillance measures of tobacco use are designed to capture usage of traditional “western” tobacco products, such as manufactured cigarettes. Yet, tobacco use in India is characterized by a large proportion of indigenous tobacco products, such as bidis, which are hand-rolled cigarettes, and gutkha and paan masala, types of chew tobacco. Commercial cigarettes make up a smaller proportion of the market. Delnevo believes that “these traditional survey measures may yield biased estimates of tobacco use among South Asian immigrants,” who may continue to use various indigenous tobacco products, but not may not consider and report its use when asked about “western” tobacco products. This, she adds, may not paint the whole picture, and she plans for future methodological research to provide for an in-depth collection mechanism so that specific cessation interventions can be identified and tailored toward the use of these particular products.
Along with Delnevo, the author team consists of Michael B. Steinberg, MD, MPH, FACP, CINJ and UMDNJ-Robert Wood Johnson Medical School; Shawna V. Hudson, PhD, CINJ and UMDNJ-Robert Wood Johnson Medical School; Rajiv Ulpe, MPH, CINJ and UMDNJ-School of Public Health; and Robert S. DiPaola, MD, CINJ and UMDNJ-Robert Wood Johnson Medical School.
The research was supported through grants from the National Cancer Institute (P30 CA072720-13S8 and K01 CA131500). CINJ’s Survey Research and Qualitative Methods Shared Resource also supported the study.
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