Factors associated with smoking in immigrants from non-western to western countries – what role does acculturation play? A systematic review
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Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, Bielefeld, Germany
Publish date: 2015-04-16
Tobacco Induced Diseases 2015;13(April):11
We aimed to identify factors associated with smoking among immigrants. In particular, we investigated the relationship between acculturation and smoking, taking into consideration the stage of the ‘smoking epidemic’ in the countries of origin and host countries of the immigrants.

We searched PubMed for peer-reviewed quantitative studies. Studies were included if they focused on smoking among adult immigrants (foreign-born) from non-western countries now residing in the USA, Canada, Ireland, Germany, the Netherlands, Norway, the UK, and Australia. Studies were excluded if, among others, a distinction between immigrants and their (native-born) offspring was not made.

We retrieved 27 studies published between 1998 and 2013. 21 of the 27 studies focused on acculturation (using bidimensional multi-item scales particularly designed for the immigrant group under study and/or proxy measures such as language proficiency or length of stay in host country) and 16 of those found clear differences between men and women: whereas more acculturated women were more likely to smoke than less acculturated women, the contrary was observed among men.

Immigrants’ countries of origin and host countries have reached different stages of the ‘smoking epidemic’ where, in addition, smoking among women lags behind that in men. Immigrants might ‘move’ between the stages as (I) the (non-western) countries of origin tend to be in the early phase, (II) the (western) host countries more in the advanced phase of the epidemic and (III) the arrival in the host countries initiates the acculturation process. This could explain the ‘imported’ high (men)/low (women) prevalence among less acculturated immigrants. The low (men)/high (women) prevalence among more acculturated immigrants indicates an adaptation towards the social norms of the host countries with ongoing acculturation.

Katharina Reiss   
Department of Epidemiology & International Public Health, Bielefeld School of Public Health (BiSPH), Bielefeld University, P.O. Box 10 01 31, 33501 Bielefeld, Germany
1. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328(7455):1519–28.
2. Vineis P, Alavanja M, Buffler P, Fontham E, Franceschi S, Gao YT, et al. Tobacco and cancer: recent epidemiological evidence. J Natl Cancer Inst. 2004;96(2):99–106.
3. Burns DM. Epidemiology of smoking-induced cardiovascular disease. Prog Cardiovasc Dis. 2003;46(1):11–29.
4. Shinton R, Beevers G. Meta-analysis of relation between cigarette smoking and stroke. BMJ. 1989;298(6676):789–94.
5. Mackenbach JP, Karanikolos M, McKee M. The unequal health of Europeans: successes and failures of policies. Lancet. 2013;381(9872):1125–34.
6. Branstetter SA, Blosnich J, Dino G, Nolan J, Horn K. Gender differences in cigarette smoking, social correlates and cessation among adolescents. Addict Behav. 2012;37(6):739–42.
7. Karasek D, Ahern J, Galea S. Social norms, collective efficacy, and smoking cessation in urban neighborhoods. Am J Public Health. 2012;102(2):343–51.
8. Wilson LM, Avila Tang E, Chander G, Hutton HE, Odelola OA, Elf JL, et al. Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review. J Environ Public Health. 2012;2012:961724.
9. Hiscock R, Bauld L, Amos A, Fidler JA, Munafò M. Socioeconomic status and smoking: a review. Ann N Y Acad Sci. 2012;1248:107–23.
10. McKee SA, Sinha R, Weinberger AH, Sofuoglu M, Harrison EL, Lavery M, et al. Stress decreases the ability to resist smoking and potentiates smoking intensity and reward. J Psychopharmacol. 2011;25(4):490–502.
11. Christakis NA, Fowler JH. The collective dynamics of smoking in a large social network. N Engl J Med. 2008;358(21):2249–58.
12. Huisman M, Kunst AE, Mackenbach JP. Educational inequalities in smoking among men and women aged 16 years and older in 11 European countries. Tob Control. 2005;14(2):106–13.
13. Kassel JD, Stroud LR, Paronis CA. Smoking, stress, and negative affect: correlation, causation, and context across stages of smoking. Psychol Bull. 2003;129(2):270–304.
14. Barbeau EM, Leavy-Sperounis A, Balbach ED. Smoking, social class, and gender: what can public health learn from the tobacco industry about disparities in smoking? Tob Control. 2004;13(2):115–20.
15. Waldron I. Patterns and causes of gender differences in smoking. Soc Sci Med. 1991;32(9):989–1005.
16. Lopez AD, Collishaw NE, Piha T. A descriptive model of the cigarette epidemic in developed countries. Tob Control. 1994;3(3):242–47.
17. Thun M, Peto R, Boreham J, Lopez AD. Stages of the cigarette epidemic on entering its second century. Tob Control. 2012;21(2):96–101.
18. Narain JP, Sinha DN. Tobacco epidemic in South-East Asia region: challenges and progress in its control. Indian J Public Health. 2011;55(3):151–4.
19. Singh PN, Yel D, Sin S, Khieng S, Lopez J, Job J, et al. Tobacco use among adults in Cambodia: evidence for a tobacco epidemic among women. Bull World Health Organ. 2009;87(12):905–12.
20. Ward KD, Eissenberg T, Rastam S, Asfar T, Mzayek F, Fouad MF, et al. The tobacco epidemic in Syria. Tob Control. 2006;15 Suppl 1:i24–9.
21. Pampel FC. Patterns of tobacco use in the early epidemic stages: Malawi and Zambia, 2000-2002. Am J Public Health. 2005;95(6):1009–15.
22. Chen ZM, Xu Z, Collins R, Li WX, Peto R. Early health effects of the emerging tobacco epidemic in China. A 16-year prospective study. JAMA. 1997;278(18):1500–4.
23. Razum O, Twardella D. Time travel with Oliver Twist – towards an explanation for a paradoxically low mortality among recent immigrants. Trop Med Int Health. 2002;7(1):4–10.
24. Rudmin FW. Catalogue of Acculturation Constructs: Descriptions of 126 Taxonomies, 1918-2003. In: Lonner WJ, Dinnel DL, Hayes SA, Sattler DN, editors. Online Readings in Psychology and Culture (Unit 8, Chapter 8). Bellingham, Washington DC: Center for Cross-Cultural Research, Western Washington University; 2003.
25. Berry JW. Immigration, acculturation, and adaptation. Appl Psychol - Int Rev. 1997;46(1):5–34.
26. Schwartz SJ, Unger JB, Zamboanga BL, Szapocznik J. Rethinking the concept of acculturation: implications for theory and research. Am Psychol. 2010;65(4):237–51.
27. Cabassa LJ. Measuring acculturation: where we are and where we need to go. Hispanic J Behav Sci. 2003;25(2):127–46.
28. Chakraborty BM, Chakraborty R. Concept, measurement and use of acculturation in health and disease risk studies. Coll Antropol. 2010;34(4):1179–91.
29. Abraído-Lanza AF, Armbrister AN, Flórez KR, Aguirre AN. Toward a theory-driven model of acculturation in public health research. Am J Public Health. 2006;96(8):1342–6.
30. Chun KM, Organista PB, Marin G. Acculturation: Advances in Theory, Measurement, and Applied Research. Washington DC: American Psychological Association; 2002.
31. Schaefer SE, Salazar M, Bruhn C, Saviano D, Boushey C, van Loan MD. Influence of race, acculturation, and socioeconomic status on tendency toward overweight in Asian-American and Mexican-American early adolescent females. J Immigr Minor Health. 2009;11(3):188–97.
32. Lara M, Gamboa C, Kahramanian MI, Morales LS, Bautista DE. Acculturation and Latino health in the United States: a review of the literature and its sociopolitical context. Annu Rev Public Health. 2005;26:367–97.
33. Kandula NR, Kersey M, Lurie N. Assuring the health of immigrants: what the leading health indicators tell us. Annu Rev Public Health. 2004;25:357–76.
34. Salant T, Lauderdale DS. Measuring culture: a critical review of acculturation and health in Asian immigrant populations. Soc Sc Med. 2003;57(1):71–90.
35. Lee S, Chen L, He X, Miller MJ, Juon HS. A cluster analytic examination of acculturation and health status among Asian Americans in the Washington DC metropolitan area, United States. Soc Sci Med. 2013;96:17–23.
36. Lim JW, Yi J, Zebrack B. Acculturation, social support, and quality of life for Korean immigrant breast and gynecological cancer survivors. Ethn Health. 2008;13(3):243–60.
37. Abraído-Lanza AF, Chao MT, Flórez KR. Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox. Soc Sci Med. 2005;61(6):1243–55.
38. Van Wieren AJ, Roberts MB, Arellano N, Feller ER, Diaz JA. Acculturation and cardiovascular behaviors among Latinos in California by country/region of origin. J Immigr Minor Health. 2011;13(6):975–81.
39. Pérez-Stable EJ, Ramirez A, Villareal R, Talavera GA, Trapido E, Suarez L, et al. Cigarette smoking behavior among US Latino men and women from different countries of origin. Am J Public Health. 2001;91(9):1424–30.
40. Tang H, Shimizu R, Chen Jr MS. English language proficiency and smoking prevalence among California’s Asian Americans. Cancer. 2005;104(12 Suppl):2982–8.
41. Kim SS, Ziedonis D, Chen KW. Tobacco use and dependence in Asian Americans: a review of the literature. Nicotine Tob Res. 2007;9(2):169–84.
42. Zhang J, Wang Z. Factors associated with smoking in Asian American adults: a systematic review. Nicotine Tob Res. 2008;10(5):791–801.
43. Bethel JW, Schenker MB. Acculturation and smoking patterns among Hispanics: a review. Am J Prev Med. 2005;29(2):143–8.
44. Choi S, Rankin S, Stewart A, Oka R. Effects of acculturation on smoking behavior in Asian Americans: a meta-analysis. J Cardiovasc Nurs. 2008;23(1):67–73.
45. Marin G, Perez-Stable EJ, Marin BV. Cigarette smoking among San Francisco Hispanics: the role of acculturation and gender. Am J Public Health. 1989;79(2):196–8.
46. Bhopal R, Vettini A, Hunt S, Wiebe S, Hanna L, Amos A. Review of prevalence data in, and evaluation of methods for cross cultural adaptation of, UK surveys on tobacco and alcohol in ethnic minority groups. BMJ. 2004;328(7431):76.
47. Brzoska P. Psychometrically Relevant Differences between Source and Migrant Populations. Frankfurt am Main: Peter Lang; 2014.
48. Peto R, Lopez AD. Future Worldwide Health Effects of Current Smoking Patterns. In: Koop CE, Pearson CE, Schwarz MR, editors. Critical Issues in Global Health. San Francisco: Jossey-Bass; 2001. p. 154–61.
49. Landrine H, Klonoff EA. Culture change and ethnic-minority health behavior: an operant theory of acculturation. J Behav Med. 2004;27(6):527–55.
50. Corral I, Landrine H. Acculturation and ethnic-minority health behavior: a test of the operant model. Health Psychol. 2008;27(6):737–45.
51. Acevedo-Garcia D, Pan J, Jun HJ, Osypuk TL, Emmons KM. The effect of immigrant generation on smoking. Soc Sci Med. 2005;61(6):1223–42.
52. Constantine ML, Adejoro OO, D’Silva J, Rockwood TH, Schillo BA. Evaluation of use of stage of tobacco epidemic to predict post-immigration smoking behaviors. Nicotine Tob Res. 2013;15(11):1910–7.
53. Spallek J, Zeeb H, Razum O. What do we have to know from migrants’ past exposures to understand their health status? A life course approach. Emerg Themes Epidemiol. 2011;8(1):6.
54. Schooling M, Kuh D. A Life Course Perspective on Women’s Health Behaviours. In: Kuh D, Hardy R, editors. A Life Course Approach to Women’s Health. Oxford: Oxford University Press; 2002. p. 279–303.
55. Poonia J. Smoking Cessation and Ethnic Minority Communities. Findings of Qualitative Research Project with Turkish, Polish, and Somalian Communities in London. London, England: NHS Commissioning Support for London; 2009.
56. Constantine ML, Rockwood TH, Schillo BA, Alesci N, Foldes SS, Phan T, et al. Exploring the relationship between acculturation and smoking behavior within four Southeast Asian communities of Minnesota. Nicotine Tob Res. 2010;12(7):715–23.
57. Hu SS, Pallonen UE, Meshack AF. The impact of immigration status on tobacco use among Chinese-American adults in Texas. J Immigr Minor Health. 2010;12(2):206–14.
58. Al-Omari H, Scheibmeir M. Arab Americans’ acculturation and tobacco smoking. J Transcult Nurs. 2009;20(2):227–33.
59. Stoddard P. Risk of smoking initiation among Mexican immigrants before and after immigration to the United States. Soc Sci Med. 2009;69(1):94–100.
60. Maxwell AE, Garcia GM, Berman BA. Understanding tobacco use among Filipino American men. Nicotine Tob Res. 2007;9(7):769–76.
61. An N, Cochran SD, Mays VM, McCarthy WJ. Influence of American acculturation on cigarette smoking behaviors among Asian American subpopulations in California. Nicotine Tob Res. 2008;10(4):579–87.
62. Maxwell AE, Bernaards CA, McCarthy WJ. Smoking prevalence and correlates among Chinese- and Filipino-american adults: findings from the 2001 California health interview survey. Prev Med. 2005;41(2):693–9.
63. Rahman MM, Luong NT, Divan HA, Jesser C, Golz SD, Thirumalai K, et al. Prevalence and predictors of smoking behavior among Vietnamese men living in California. Nicotine Tob Res. 2005;7(1):103–9.
64. Wilkinson AV, Spitz MR, Strom SS, Prokhorov AV, Barcenas CH, Cao Y, et al. Effects of nativity, age at migration, and acculturation on smoking among adult Houston residents of Mexican descent. Am J Public Health. 2005;95(6)):1043–9.
65. Hofstetter CR, Hovell MF, Lee J, Zakarian J, Park H, Paik HY, et al. Tobacco use and acculturation among Californians of Korean descent: a behavioral epidemiological analysis. Nicotine Tob Res. 2004;6(3):481–9.
66. Shelley D, Fahs M, Scheinmann R, Swain S, Qu J, Burton D. Acculturation and tobacco use among Chinese Americans. Am J Public Health. 2004;94(2):300–7.
67. Fu SS, Ma GX, Tu XM, Siu PT, Metlay JP. Cigarette smoking among Chinese Americans and the influence of linguistic acculturation. Nicotine Tob Res. 2003;5(6):803–11.
68. Juon HS, Kim M, Han H, Ryu JP, Han W. Acculturation and cigarette smoking among Korean American men. Yonsei Med J. 2003;44(5):875–82.
69. Ma GX, Shive S, Tan Y, Toubbeh J. Prevalence and predictors of tobacco use among Asian Americans in the Delaware Valley region. Am J Public Health. 2002;92(6):1013–20.
70. Yu ES, Chen EH, Kim KK, Abdulrahim S. Smoking among Chinese Americans: behavior, knowledge, and beliefs. Am J Public Health. 2002;92(6):1007–12.
71. Kim KK, Yu ES, Chen EH, Kim J, Brintnall R, Vance S. Smoking behavior, knowledge, and beliefs among Korean Americans. Cancer Pract. 2000;8(5):223–30.
72. Shankar S, Gutierrez-Mohamed ML, Alberg AJ. Cigarette smoking among immigrant Salvadoreans in Washington, DC: behaviors, attitudes, and beliefs. Addict Behav. 2000;25(2):275–81.
73. King G, Polednak AP, Bendel R, Hovey D. Cigarette smoking among native and foreign-born African Americans. Ann Epidemiol. 1999;9(4):236–44.
74. Wiecha JM, Lee V, Hodgkins J. Patterns of smoking, risk factors for smoking, and smoking cessation among Vietnamese men in Massachusetts (United States). Tob Control. 1998;7(1):27–34.
75. Hyman I, Fenta H, Noh S. Gender and the smoking behaviour of Ethiopian immigrants in Toronto. Chronic Dis Can. 2008;28(4):121–7.
76. Kabir Z, Clarke V, Keogan S, Currie LM, Zatonski W, Clancy L. Smoking characteristics of Polish immigrants in Dublin. BMC Public Health. 2008;8:428.
77. Reiss K, Spallek J, Razum O. ‘Imported risk’ or ‘health transition’? smoking prevalence among ethnic german immigrants from the former soviet union by duration of stay in germany - analysis of microcensus data. Int J Equity Health. 2010;9:15.
78. Reeske A, Spallek J, Razum O. Changes in smoking prevalence among first- and second-generation Turkish migrants in Germany - an analysis of the 2005 Microcensus. Int J Equity Health. 2009;8:26.
79. Nierkens V, de Vries H, Stronks K. Smoking in immigrants: do socioeconomic gradients follow the pattern expected from the tobacco epidemic? Tob Control. 2006;15(5):385–91.
80. Vedøy TF. The role of education for current, former and never-smoking among non-western immigrants in Norway. Does the pattern fit the model of the cigarette epidemic? Ethn Health. 2013;18(2):190–210.
81. White M, Harland JO, Bhopal RS, Unwin N, Alberti KG. Smoking and alcohol consumption in a UK Chinese population. Public Health. 2001;115(1):62–9.
82. Girgis S, Adily A, Velasco MJ, Garden FL, Zwar NA, Jalaludin BB, et al. Smoking patterns and readiness to quit-a study of the Australian Arabic community. Aust Fam Physician. 2009;38(3):154–61.
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