"It's Not a Life or Death Thing": A Grounded Theory Study of Smoking Decisions among Chinese Americans

By Lu, Yu | The Qualitative Report, March 2017 | Go to article overview

"It's Not a Life or Death Thing": A Grounded Theory Study of Smoking Decisions among Chinese Americans


Lu, Yu, The Qualitative Report


Cigarette smoking is a significant global health issue that has been considered a priority for the world health community (WHO, 2008). Cigarette smoking is the leading cause of preventable death resulting in over 5 million deaths each year worldwide (WHO, 2008) including 480,000 deaths in the U.S. alone (U.S. Department of Health and Human Services, 2014). Tobacco increases mortality from cancer, cardiovascular and heart diseases (Gandini et al., 2008; He et al., 2008), however, Chinese Americans continue to smoke despite reductions in smoking among American populations (U.S. Department of Health and Human Services, 2014; Gomez et al., 2013; McCracken et al., 2007). This study explores the smoking decisionmaking processes of Chinese Americans who continue to risk severe health problems for themselves and others around them to maintain their smoking behaviors. Understanding smoking decisions could help us better understand these choices as well as develop effective prevention and treatment strategies (Chang, Song, & Lee, 2008).

Previous research identified a variety of factors that influence Chinese Americans' smoking behavior including low education level (Yu, Chen, Kim, & Abdulrahim, 2002), low language proficiency (Fu, Ma, Tu, Siu, & Metlay, 2003), lack of adequate knowledge about smoking consequences (Hu et al., 2006) and early warning signs and symptoms of cancer (Yu et al., 2002), positive social smoking norms (Tu, Walsh, Tseng, & Thompson, 2000), perceived benefits of smoking (FitzGerald, Poureslami, & Shum, 2015), acculturation (Sussman & Truong, 2010), and depression (Tsoh, Lam, Delucchi, & Hall, 2003). These factors provide a context in which Chinese Americans make smoking decisions. However, to date, little is known about the decision process, itself. We know, for example, that lack of knowledge about smoking harm is one of the main reasons that Chinese Americans smoke (Hu et al., 2006). However, we do not know if Chinese Americans use inaccurate information or just lack basic information in making smoking decisions. In other words, how these identified factors (e.g., lack of knowledge) play out in Chinese Americans' smoking decisions remain unknown. The aim of the study is to describe Chinese Americans' smoking decision processes and identify factors that influence these decisions.

Literature Review

Smoking Disparities and Chinese Americans

The past 50 years have witnessed aggressive tobacco control programs in the U.S. that resulted in great changes of the social acceptability of smoking (U.S. Department of Health and Human Services, 2014) and, ultimately, in decreased smoking prevalence (CDC, 2011). However, this success has not been uniformly shared by all segments of the population. Smoking remains a problem particularly among Asian Americans (Maxwell, Crespi, Alano, Sudan, & Bastani, 2012; Ma, Tan, Fang, Toubbeh, & Shive, 2005), with its prevalence exceeding 50% in some Asian communities (Averbach, Lam, Lam, Sharfstein, Cohen, & Koh, 2002). Like all racial groups, considerable within-group variation in smoking prevalence exists among Asian Americans. The observed high level of heterogeneity of smoking prevalence rates (Maxwell et al., 2012; Weiss, Garbanati, Tanjasiri, Xie, & Palmer, 2006) leads to the recommendation to target smoking interventions by country of origin (Baluja, Park, & Myers, 2003). This study focuses on smoking among Chinese Americans, the largest Asian group in the U.S., constituting 23% of the Asian American population (U.S. Census Bureau, 2010). The term "Chinese American" refers to anyone who is of Chinese origin. In most demographic research, this includes both immigrants and their descendants from Mainland China, Hong Kong, Macau, Taiwan, as well as overseas Chinese who have immigrated from Southeast Asia and South America. Since the initial wave of Chinese immigrants arrived in the 19th century in response to the need for labor to build railroads and in response to the gold rush, their numbers have continued to grow, reaching 4 million in 2010 (U. …

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