Factors associated with smoking in immigrants from non-western to western countries – what role does acculturation play? A systematic review

Abstract

IntroductionWe 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.MethodsWe 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.ResultsWe 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.ConclusionImmigrants’ 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.

Perceptions of smoking cessation among Glasgow's Chinese community

“…The participants' higher prevalence of cessation attempts on migration to Glasgow is supported by the literature, which suggests that acculturation is a considerable determinant of smoking cessation behaviour among immigrants 18,42 . Twothirds of the participants reported that Chinese immigrant smokers had adopted the UK smoking pattern, and smoking among the individual's social circle is a well-established reason for initiation or relapse in smoking 13,43,44 .…”

“…In the UK, attention to individual health, setting an example for children, and smoking expenditure, are amongst the top three motives for smoking cessation 16,17 . It is widely accepted that certain socio-demographic and socio-economic factors can affect smoking behaviour 18 . The health behaviour of immigrants may be expected to eventually reflect those of the host country's population through acculturation, and hence smoking cessation might follow this pattern 19 .…”

An American Thoracic Society/National Heart, Lung, and Blood Institute Workshop Report: Addressing Respiratory Health Equality in the United States

“…For example, a study of 1,000 women of Mexican descent showed that birth in the United States, years lived in the United States, and acculturation were each significantly associated with higher prevalence of cigarette smoking (32). A link between acculturation and smoking has been reported in other studies of female, but not male, Hispanic and Asian immigrants (22,33). Similar to findings for smoking, birth in the United States has been associated with asthma among Mexican Americans (34,35).…”

Nicotine and addiction beliefs and perceptions among the US-born and foreign-born populations

“…A similar pattern is also found in tobacco use studies as foreign-born individuals generally display lower smoking prevalence compared to their US-counterparts (Baluja et al, 2003; Lariscy et al, 2013; Wade et al, 2013). However, the relationship between foreign-born status and smoking behavior is complicated and can vary based on factors such as gender, country of origin, race/ethnicity, acculturation, and the intersections of these factors (Bethel and Schenker, 2005; Kim et al, 2007; National Cancer Institute, 2017; Reiss et al, 2015).…”