Journal of Community Health

, Volume 37, Issue 6, pp 1226–1233 | Cite as

Ethnic Differences in Smoking Rate, Nicotine Dependence, and Cessation-Related Variables Among Adult Smokers in Hawaii

Original Paper


This study tests hypotheses concerning ethnic disparities in daily cigarette smoking rates, nicotine dependence, cessation motivation, and knowledge and past use of cessation methods (e.g., counseling) and products (e.g., nicotine patch) in a multiethnic sample of smokers in Hawaii. Previous research has revealed significant differences in smoking prevalence among Native Hawaiians, Filipinos, Japanese, and Caucasians in Hawaii. However, no study has examined differences in dependence and cessation-related knowledge and practices among smokers representing these ethnic groups. Participants were recruited through newspaper advertisement as part of a larger smoking cessation intervention study. Participants (N = 919; M age = 45.6, SD = 12.7; 48 % women) eligible to participate provided self-report data through mail and telephone. Participants included 271 self-identified Native Hawaiians, 63 Filipinos, 316 Caucasians, 145 “East Asians” (e.g., Japanese, Chinese), and 124 “other” (e.g., Hispanic, African-American). Pair-wise comparisons of means, controlling for age, gender, income, education, and marital status, indicated that Native Hawaiian smokers reported significantly higher daily smoking rates and higher levels of nicotine dependence compared to East Asians. Native Hawaiian smokers reported significantly lower motivation to quit smoking than Caucasians. Further, Filipino and Native Hawaiian smokers reported lesser knowledge of cessation methods and products, and less frequent use of these methods and products than Caucasians. The results suggest that Native Hawaiian and Filipino smokers could be underserved with regard to receiving cessation-related advice, and may lack adequate access to smoking cessation products and services. In addition, cessation interventions tailored for Native Hawaiian smokers could benefit from a motivational enhancement component.


Cigarette smoking Nicotine dependence Cessation Asian/Pacific Islander 


  1. 1.
    Abrams, D. B., Herzog, T. A., Emmons, K. M., & Lannan, L. (2000). Stages of change versus addiction: A replication and extension. Nicotine and Tobacco Research, 2, 223–229.PubMedCrossRefGoogle Scholar
  2. 2.
    Center for Disease Control and Prevention (CDC). (2004). Cigarette smoking among adults—United States, 2002. Mortality and Morbidity Weekly Report, 53, 427–431.Google Scholar
  3. 3.
    Crimmins, E. M., Hayward, M. D., & Seeman, T. E. (2004). Race/ethnicity, socioeconomic status, and health. In N. B. Anderson, R. A. Bulatao, & B. Cohen (Eds.), Critical perspectives on racial and ethnic differences in health in late life (pp. 450–491). Washington, DC: The National Academies Press.Google Scholar
  4. 4.
    Derby, K., Cuthrell, K., Caberto, C., Carmella, S. G., Franke, A., Hecht, S. S., et al. (2008). Nicotine metabolism in three ethnic/racial groups with different risks of lung cancer. Cancer Epidemiology, Biomarkers and Prevention, 17, 3526–3535.PubMedCrossRefGoogle Scholar
  5. 5.
    Fagan, P., Moolchan, E. T., Lawrence, D., Fernander, A., & Ponder, P. K. (2007). Identifying health disparities across tobacco continuum. Addiction, 102, 5–29.PubMedCrossRefGoogle Scholar
  6. 6.
    Gee, G. C., Delva, J., & Takeuchi, D. T. (2007). Relationships between self-reported unfair treatment and prescription medication use, illicit drug use, and alcohol dependence among Filipino Americans. American Journal of Public Health, 97, 933–940.PubMedCrossRefGoogle Scholar
  7. 7.
    Glanz, K., Maskarinec, G., & Carlin, L. (2005). Ethnicity, sense of coherence, and tobacco use among adolescents. Annals of Behavioral Medicine, 29, 192–199.PubMedCrossRefGoogle Scholar
  8. 8.
    Goodwin, R. D., Keyes, K. M., & Hasin, D. S. (2009). Changes in cigarette use and nicotine dependence in the United States: Evidence from the 2001–2002 wave of the national epidemiologic survey of alcoholism and related conditions. American Journal of Public Health, 99, 1471–1477.PubMedCrossRefGoogle Scholar
  9. 9.
    Haiman, C. A., Stram, D. O., Wilkens, L. R., Pike, M. C., Kolonel, L. N., Henderson, B. E., et al. (2006). Ethnic and racial differences in the smoking-related risk of lung cancer. The New England Journal of Medicine, 354, 333–342.PubMedCrossRefGoogle Scholar
  10. 10.
    Heatherton, T., Kozlowski, L., Frecker, R., & Fagerström, K. (1991). The Fagerstro¨m test for nicotine dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction, 86, 1119–1127.PubMedCrossRefGoogle Scholar
  11. 11.
    Herzog, T. A., & Blagg, C. O. (2007). Are most precontemplators contemplating smoking cessation? Assessing the validity of the stages of change. Health Psychology, 26(222), 231.Google Scholar
  12. 12.
    Hawaii: Cancer Facts and Figures, (2010). A sourcebook for planning and implementing programs for cancer prevention and control. Hawaii State Department of Health, American Cancer Society, and Cancer Research Center of Hawaii.Google Scholar
  13. 13.
    Hong, B. M. (2002). Asian American and Pacific Islander adolescent cigarette smoking: A review. In D. M. Burns, R. H. Amacher & W. Ruppert (Eds.), Smoking and tobacco control monograph no. 14. Changing adolescent smoking prevalence: Where it is and why? Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Institutes.Google Scholar
  14. 14.
    Hu, M.-C., Davies, M., & Kandel, D. (2006). Epidemiology and correlates of daily smoking and nicotine dependence among young adults. American Journal of Public Health, 96, 299–308.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaholokula, J. K., Haynes, S. H., Grandinetti, A., & Chang, H. K. (2006). Ethnic differences in the relationship between depressive symptoms and health-related quality of life in people with type 2 diabetes. Ethnicity and Health, 11, 59–80.PubMedCrossRefGoogle Scholar
  16. 16.
    Kaholokula, J. K., Grandinetti, A., Keller, S., Nacapoy, A. H., Kingi, T. K., & Mau, M. K. (2011). Association between perceived racism and physiological stress indices in Native Hawaiians. Journal of Behavioral Medicine, Online first publication,. doi: 10.1007/s10865-011-9330-z.Google Scholar
  17. 17.
    Kassel, J. D., Paronis, C. A., & Stroud, L. R. (2003). Smoking, stress, and negative affect: Correlation, causation, and context across stages of smoking. Psychological Bulletin, 129, 270–304.PubMedCrossRefGoogle Scholar
  18. 18.
    Kim, S. S., Ziedonis, D., & Chen, K. W. (2007). Tobacco use and dependence in Asian Americans: A review of the literature. Nicotine and Tobacco Research, 9, 169–184.PubMedCrossRefGoogle Scholar
  19. 19.
    Kolonel, L. N., Henderson, B. E., Hankin, J. H., Nomura, A. M. Y., Wilkens, L. R., Pike, M. C., et al. (2000). A multiethnic cohort in Hawaii and Los Angeles: Baseline characteristics. American Journal of Epidemiology, 151, 346–357.PubMedCrossRefGoogle Scholar
  20. 20.
    Kuramoto, F., & Nakashima, J. (2000). Developing and ATOD prevention campaign for Asian and Pacific Islanders: Some considerations. Journal of Public Health Management Practice, 6, 57–64.Google Scholar
  21. 21.
    Le Marchand, L., Wilkens, L. R., & Kolonel, L. N. (1992). Ethnic differences in the lung cancer risk associated with smoking. Cancer Epidemiology, Biomarkers and Prevention, 1(103), 107.Google Scholar
  22. 22.
    Maskarinec, G., Dhakal, S., Pagano, I., Carlin, L., Goodman, M. T., Le Marchand, L., et al. (2005). Ethnic differences in trends and determinants of cigarette smoking in Hawaii. Ethnicity and Disease, 15, 316–323.PubMedGoogle Scholar
  23. 23.
    McCubbin, L. D., Ishikawa, M. E., & McCubbin, H. L. (2008). The Kanaka Maoli: Native Hawaiians and their testimony of trauma and resilience. In A. J. Marsella, J. L. Johnson, P. Watson, & J. Gryczynski (Eds.), Ethnocultural perspectives on disaster and trauma (pp. 271–298). New York: Springer.CrossRefGoogle Scholar
  24. 24.
    Teodoro, L. V., Jr. (1981). Out of his struggle: The Filipinos in Hawaii. Honolulu, HI: The University Press of Hawaii.Google Scholar
  25. 25.
    U.S. Census Bureau, (2000). Projections of the resident population by race, Hispanic origin, and nativity: Middle series, 2050–2070 (NP-T5-G) (Vol. 2009). Washington, DC: Population Projec-tions Program, Population Division, U.S. Census Bureau.Google Scholar
  26. 26.
    United States Department of Health and Human Services. (2004). The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.Google Scholar
  27. 27.
    West, R. (2004). ABC of smoking cessation: Assessment of dependence and motivation to stop smoking. British Medical Journal, 328, 338–339.PubMedCrossRefGoogle Scholar
  28. 28.
    Winkleby, M. A., & Cubbin, C. (2004). Racial/ethnic disparities in health behaviors: A challenge to current assumptions. In N. B. Anderson, R. A. Bulatao, & B. Cohen (Eds.), Critical perspectives on racial and ethnic differences in health in late life (pp. 450–491). Washington, D.C.: The National Academies Press.Google Scholar
  29. 29.
    Wills, T. A., & Shiffman, S. (1985). Coping and substance use: A conceptual framework. In S. Shiffman & T. A. Wills (Eds.), Coping and substance use (pp. 3–24). New York: Academic Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Cancer Prevention and Control ProgramUniversity of Hawaii Cancer CenterHonoluluUSA

Personalised recommendations