Review and special article
Acculturation and Smoking Patterns Among Hispanics: A Review

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Objective

To conduct a systematic review of published studies investigating the association of acculturation and smoking patterns among Hispanic men and women in the United States.

Methods

Online bibliographic databases were searched from 1985 to 2003 using three key search terms. The methodology and findings of all retrieved articles were critically evaluated. Data were extracted from each article regarding study population, study methods, exposure assessment, outcomes measured, acculturation measures used, and results.

Results

The literature search identified 78 articles from MEDLINE, PubMed, and PsychINFO databases; of these, 11 studies met the inclusion criteria. Seven regional studies based in the western United States and four nationwide studies were included in the review. Seven studies used formal acculturation scales, three used language spoken, and one used language spoken and country of birth to indicate acculturation status. Nine studies showed a positive association between acculturation and smoking among women, and one study involving men showed a negative association.

Conclusions

The findings suggest that the association of acculturation and smoking is gender-specific. In this instance, increased smoking prevalence with increased acculturation is consistently observed among Hispanic women but not among men. As Hispanic women acculturate, their cigarette smoking may increase because their behavior becomes more strongly influenced by the norms and practices of the dominant group than among men. Immigrant- and gender-specific public health interventions need to be designed to combat the increase in smoking rates among Hispanics in the United States.

Introduction

Cigarette smoking is the leading cause of preventable death in the United States and produces substantial health-related economic costs to society.1 From 1995 to 1999, >440,000 people in the United States died from smoking-related causes each year. Among adults, most smoking deaths were from lung cancer (124,813), ischemic heart disease (81,976), and chronic airway obstruction (64,735).1 Estimates show that smoking caused over $150 billion in annual health-related economic losses from 1995 to 1999, including $81.9 billion in mortality-related productivity and $75.5 billion in excess medical expenditures in 1998.1

National and regional surveys have shown that Hispanics have lower smoking rates than non-Hispanic whites. Data from the 2001 National Health Interview Survey (NHIS) show that the overall prevalence of cigarette smoking was significantly lower for Hispanics (16.7%, standard deviation [SD]=1.2) than for non-Hispanic whites (24.0%, SD=0.6).2 The percentage of Hispanic men who currently smoked (21.6%, SD=1.9) was lower than the percentage among non-Hispanic white men (25.4%, SD=1.0). However, a wider gap was seen when comparing Hispanic and non-Hispanic white women. The percentage of Hispanic women who currently smoked (11.9%, SD=1.3) was nearly half of the percentage among non-Hispanic white women (22.8%, SD=0.9).2

Acculturation to mainstream U.S. society is a complex, multidimensional phenomenon that has a crucial but poorly understood role in many health behaviors, including smoking.3 The term “acculturation” refers to changes in values, attitudes, and behaviors experienced by individuals of an ethnic group as a result of continuous interaction with people of a different ethnic group.4, 5, 6 This acculturation model predicts that smoking patterns of Hispanics would reflect the extent to which they have adopted the smoking norms and practices of the larger society. This suggests that Hispanic smoking rates will eventually equal those of non-Hispanic whites with increasing levels of acculturation. With >35 million Hispanics living in the United States (40% are foreign-born), the effect of acculturation on smoking is clearly a public health concern.7 Again, the concept of acculturation is a complex phenomenon that is not fully understood. However, formal scales have been developed and proxy measures used in an attempt to better understand its association with health outcomes and health behaviors.

The objectives of this paper are to (1) review published studies investigating the association of acculturation on smoking patterns among Hispanic men and women in the United States, and (2) examine the acculturation measures used in these studies.

Section snippets

Methods

This literature review consisted of studies that examined acculturation and health behaviors of Hispanics in the United States. Studies under review were initially identified using MEDLINE, PubMed, and PsychINFO database search engines. The three key search terms were “smoking”; “acculturation” or “immigration”; and “Hispanic” or “Mexican-American” or “Latino/a.” The searches were limited from 1985 to 2003, but included all journals in the databases. This lower limit was chosen to include

Results

A total of 26,611 men and women were included in the 11 selected studies with sample sizes ranging from 76 to 8882. Three studies analyzed women only, and the remaining eight studies analyzed men and women (Table 1). The respondents were predominantly of Mexican origin, with a small proportion coming from Puerto Rico, Cuba, Central America, and South America. Approximately 70% of the respondents were drawn from the general U.S. population, and the remainder were from western U.S. states

Discussion

This review found a consistent positive association between acculturation and smoking among Hispanic women but not men, indicating a differential association of acculturation and current smoking status by gender. Specifically, 9 of the 11 studies involving women reported a significant positive association between acculturation and current smoking status. In these studies, more acculturated women were more likely to be current smokers. In contrast, only one of the eight studies involving men

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