Southeast Asian tobacco use study published


A Minnesota report on Southeast Asian cultural perceptions regarding tobacco use was released in February, producing data to better understand the prevalence of smoking in the Southeast Asian communities of Minnesota. Read the reports in their entirety at”Tobacco use in Minnesota: A Quantitative Survey of Cambodian, Hmong, Lao and Vietnamese Community Members” was completed in November 2009 and released in February as the product of Diverse Racial Ethnic Groups and Nations, a research project to measurably reduce tobacco use in the state’s four primary Southeast Asian communities.

DREGAN is a community-based participatory study of tobacco use among Southeast Asians in Minnesota. It is a collaboration between the Asian Pacific Tobacco-Free Coalition of Minnesota; Southeast Asian Refugee Community Home; Blue Cross and Blue Shield of Minnesota Center for Tobacco Reduction and Health Improvement; and Clearway Minnesota.

“This is a very historic study,” said Zha Blong Xiong, Ph.D. an Associate Professor with the Department of Family Social Science at the University of Minnesota-Twin Cities. “We haven’t had any study like this in Minnesota with over a thousand people participating, using a very vigorous study design which is random sample based on a community based participatory research.”

Dr. Xiong credited BCBS and Clearway for the collaboration that enabled a study with a focus on a community goal to produce common knowledge acceptance of tobacco use and with it the dangers of exposure to direct and second hand smoke with all the related health consequences.

Dr. Marc Manley, Chief Prevention Officer, Blue Cross and Blue Shield of Minnesota, said his organization is pleased that the report is out and said BCBS would use it in its commitment to ensure that smoking rates continue to drop in the state.

“We’ve been working on that for a long time and we want to make sure that we are reaching as many different people and as many communities as we can and this report was one big part of that process,” said Manley.

The study is the final portion of a nearly 10 year project that produced a quantitative and qualitative report from surveys conducted with the Cambodian, Hmong, Lao and Vietnamese communities of Minnesota. The researchers said it took a lot of work to ensure it resulted in a culturally appropriate report.

“There were a lot of detailed methods and decisions along the way and everything was made in collaboration with the community, which was really important to us in this process,” said Nina Alesci, a Senior Healthcare Analyst with Blue Cross and Blue Shield of Minnesota. “This report closes chapter in research portion, started four years ago released qualitative portion of the study and so this adds the quantitative component to it get the complete picture.”

Karen M. Lyons, Public and Health Affairs, Blue Cross Blue Shield of Minnesota, said the report provides the details to understand why health inequities exist and points out unique cultural aspects of each community as opposed to larger non specific groupings.

“In many ways this focused on culture,” said Lyons. “There really hasn’t been this kind of unique, tailored study for a community like this before, so it is really focused on unique needs.”

DREGAN had two key components of researching and developing culturally appropriate interventions to reduce the harm that tobacco causes the Asian Pacific community.

The first qualitative research stage had 16 community liaisons undergoing training on the techniques of interviewing for effective listening with awareness for bias-free recording of social research interviews and focus group meetings.

The liaisons included Phalla Keo, Channary Pen, Pengsan Ou, Lon Meak, Lah Visayvong, Kaphet Koracan, Phouratsamay Littana, Onsa Thamavong, Malichansouk Kouanchao, Valerie Tran, Dung Pham, Anthony Dang, Hiep V. Huynh, Loc Nguyen, Pang Tang Yang, Chong Moua, Jesse Kao Lee, and Xwm Dean Yaj.

The team used a questionnaire developed by anthropologist researchers and health professionals, which they helped to simplify with clear translation with an Asian Community Advisory Group.

These members included (Cambodian) Pengsan Ou, Sacha Lempiainen and Sinuon Leiendecker; (Hmong) Ayer Xong, Tou Pao Khang and Choua Thao (Laotian) Sunny Chanthanouvong, Phouninh Vixayvong and Kaphet Koracan; (Vietnamese) Phuong Dao, Nghi Huynh, Dzuy Ho, Hoa Young and Dung Pham.

The interview team completed 1,600 surveys: 550 for the Hmong and 350 each for the Cambodian, Lao and Vietnamese communities between 2003 and 2005. The survey reached 11 Minnesota counties, including the 7 county metropolitan area.

The surveys looked at differences by gender and age within the Hmong as a separate group and within the Cambodian, Lao and Vietnamese communities combined.

This first study involved 15 community leaders to uncover beliefs and attitudes surrounding tobacco use and described the experience of tobacco use among Southeast Asian cultures. The report, titled Tobacco Use in Minnesota: Perspectives from Cambodian, Hmong, Lao and Vietnamese Communities was released in 2006 and is online at

The quantitative report is a continuation of the 2006 qualitative surveys, said DREGAN Project Coordinator for both phases was Yanat Chhith, a retired executive with the Federal Bank in Minneapolis.

“The work brought more awareness about the problem of tobacco and how it relates to our cultures,” he said.

Although the study is intended to be used to develop culturally appropriate strategies and tailored programs and limited interventions.

Chhith said that one small project now stems from the strategies developed from the reports. He said that since so many people worked to produce a report to shows how tobacco perceptions and use differs by community and to better understand the risks of tobacco use and from second hand smoke – that it should result in more awareness and programs.

“This is something that should be useful for the community,” he said. “I hope that it will continue into implementation of what we have learned in the report to help the community benefit from its findings.”

Dr. Xiong said the report would help with continued efforts to change Southeast Asian behavioral norms with tobacco use in individuals and the community. The report details how attitudes and behaviors were formed from the French colonial period, the Wartime or post-war genocidal experience, or in the case of the Hmong, the wedding exchange.

He said the report led to recommendations for the 18 Council to affect change in the community with suggestions on alternative exchange gifts during ceremonies. It also helped to address the acculturation process and smoking in men, which has increased awareness of the dangers of secondhand smoke – and changed daily and cultural use to avoid smoking around others, according to the report.

At the same time it said acculturation increased tobacco use among women, youth, Hmong, and new immigrants.

The report states that the consequences of becoming ‘Americanized’ is that smoking “symbolically represents values of freedom and gender equality.” These American ‘values’ touted in advertising, by their peers, and the early empowerment youth have with the “role reversals” where some children have difficulty telling parents and grandparents to quit – and other youth are starting to smoke with a sense of empowerment.

“Acculturalization plays a significant role,” said Dr. Xiong, noting that the Hmong sample has a younger sampling than the three other population groups.

“Given just the number of the type of people that we have for the survey and an analysis alone with the Hmong population we know that acculturalization does impact smoking behaviors for this population,” he added. “Younger and younger Hmong children are exposed to smoking and so therefore are actually getting engaged in smoking behaviors. This is reflected in the survey.”

The report notes that Southeast Asians tend not to associate doctors with preventive health or see smoking as a medical problem but a self-discipline issue, making the nonprofit, civic and spiritual leaders more significant in the awareness process.

Xiong is also a founding member of the Statewide Tobacco Education & Engagement Project. STEEP is a collaborative project to build capacity with Southeast Asian community organizations with a goal to increase awareness and improve family and community health through tobacco education and community engagement.

“We need to work with the community leaders that have the trust in the community so that they could also help us send those messages to their community,” said Xiong. “We also try to expose people to the harmful effects of tobacco and approaching this at multiple levels to make significant changes.”

Efforts like this will address the areas that prevent the mainstream prevention efforts from being effective within the context of the larger mainstream efforts, he added.

Dr. Manley said BCBS goals were to both accurately measure the rate of smoking in the Southeast Asian community, and to better understand the previously undocumented cultural information. It was important that it was conducted with the communities and with people in the communities that understood the culture as well as the goals and objectives of the report to succeed as culturally sensitive and competent.

“Which is one reason that it takes a long time, it really is new work in many ways,” he added.