Canadian Journal of Public Health

, Volume 106, Issue 5, pp e333–e340 | Cite as

Acculturation and smoking in North Americans of Chinese ancestry: A systematic review

  • Carolyn C. GotayEmail author
  • Michelle S. Reid
  • Marliese Y. Dawson
  • Shouzheng Wang
Systematic Review



Many North American immigrants come from China. Given the critical impact of tobacco use on health, it is important to understand rates and correlates of smoking in this population. This systematic review addressed the question: based on current research, what is the association between acculturation and smoking behaviours in Chinese immigrants to North America?


The search was conducted in PubMed, Medline, Web of Science, and Academic Search Complete for papers published from 2005 to 2014. Data were extracted from Canadian and American studies for population characteristics, study design, measures of smoking and acculturation, and findings regarding smoking rates and associations between smoking and acculturation.


The literature search identified 147 articles, and 14 met inclusion criteria. Three studies were based on Canadian samples and the remaining 11 were from the United States. Of the 14 papers, 3 reported findings for youth and 11 for adults. Among adults, daily smoking rates were consistently much higher in men than women; for men, rates varied from 9% to 30%. Language use and time in North America were the most common indicators of acculturation. Almost all studies found a relationship between acculturation and smoking, such that more acculturated men smoke less and more acculturated women smoke more.


The findings suggest that the association between acculturation and smoking is gender-specific. This correlation is found in youth and adults and in both Canada and the US. Increased acculturation has a protective effect on smoking for Chinese North American men, but a harmful effect for women. Tobacco control interventions need to develop targeted strategies appropriate to these different populations.

Key Words

Smoking acculturation Asian continental ancestry group 



De nombreux immigrants nord-américains viennent de la Chine. Vu l’impact crucial du tabagisme sur la santé, il est important de connaître les taux de tabagisme et leurs corrélats dans cette population. Notre revue systématique tente de répondre à la question suivante: D’après les études actuelles, quelle est l’association entre l’acculturation et l’usage du tabac chez les immigrants chinois en Amérique du Nord?


Nous avons interrogé les articles publiés entre 2005 et 2014 dans PubMed, Medline, Web of Science et Academic Search Complete. Nous en avons extrait les données d’études canadiennes et américaines sur les caractéristiques de la population, les protocoles d’étude, les indicateurs du tabagisme et de l’acculturation, et les constatations portant sur les taux de tabagisme et les associations entre le tabagisme et l’acculturation.


La recherche bibliographique a identifié 147 articles, dont 14 répondaient à nos critères d’inclusion. Trois études se fondaient sur des échantillons canadiens, et les 11 études restantes provenaient des États-Unis. Sur ces 14 articles, 3 présentaient des constatations axées sur les jeunes et 11, des constatations axées sur les adultes. Chez les adultes, les taux de tabagisme quotidiens étaient systématiquement plus élevés chez les hommes que chez les femmes; chez les hommes, les taux variaient entre 9 % et 30 %. La langue utilisée et le temps passé en Amérique du Nord étaient les indicateurs les plus courants de l’acculturation. Presque toutes les études ont observé une relation entre l’acculturation et le tabagisme: les hommes plus acculturés fument moins, et les femmes plus acculturées fument davantage.


L’association entre l’acculturation et le tabagisme est sexospécifique. Cette corrélation est observée chez les jeunes et les adultes, tant au Canada qu’aux États-Unis. L’acculturation accrue a un effet protecteur sur le tabagisme chez les hommes nord-américains d’origine chinoise, mais elle a un effet nocif chez les femmes. Les mesures de lutte antitabac doivent élaborer des stratégies ciblées en fonction de ces différentes populations.

Mots Clés

tabagisme acculturation population d’origine asiatique continentale 


  1. 1.
    World Health Organization. Why Tobacco Is a Public Health Priority. Tobacco Free Initiative (TFI), 2014. Available at: priority/en/ (Accessed July 3, 2014).Google Scholar
  2. 2.
    Oliveira A, Valente J, Leite I. Aspects of tobacco attributable mortality: Systematic review. Revista de Saúde Pública 2008;42(2):335–45.CrossRefGoogle Scholar
  3. 3.
    Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ 2004;328(7455):1519. doi: 10.1038/sj.bjc.6602359.CrossRefGoogle Scholar
  4. 4.
    World Health Organization. Prevalence of Tobacco Use among Adults and Adolescents, 2012. Available at: charts/tobacco/use/atlas.html (Accessed July 30, 2014).Google Scholar
  5. 5.
    Citizenship and Immigration Canada. Citizenship and Immigration Canada, Facts and Figures, 2013. Available at: publications/annual-report-2013/section2.asp (Accessed July 30, 2014).Google Scholar
  6. 6.
    Migration Policy Institute. Largest U.S. Immigrant Groups over Time, 1960-Present. 2012. Available at: (Accessed July 30, 2014).Google Scholar
  7. 7.
    Shelley D, Fahs M, Scheinmann R, Swain S, Qu J, Burton D. Acculturation and tobacco use among Chinese Americans. Am J Public Health 2004;94(2):8. PMID: 14759946.CrossRefGoogle Scholar
  8. 8.
    Melville MB. Acculturation–Theory, models and some new findings–Padilla, AM. Am Anthropol 1982;84(2):466–67. doi: 10.1525/ae.1981.8.4. 02a00200.CrossRefGoogle Scholar
  9. 9.
    Ayala GX. Baquero B, Klinger S. A systematic review of the relationship between acculturation and diet among Latinos in the United States: Implications for future research. J Am Diet Assoc 2008;108(8):1330–44. doi: 10.1016/j.jada.2008.05.009.CrossRefGoogle Scholar
  10. 10.
    Lee SK. Sobal J, Frongillo EA. Jr. Acculturation and health in Korean Americans. Soc Sci Med 2000;51(2):159–73. PMID: 10832565. doi: 10.1016/ S0277-9536(99)00446-3.CrossRefGoogle Scholar
  11. 11.
    Leung LA. Healthy and unhealthy assimilation: Country of origin and smoking behavior among immigrants. Health Econ 2014;23(12):1411–29. PMID: 24019149. doi: 10.1002/hec.2992.CrossRefGoogle Scholar
  12. 12.
    Nierkens V, De Vries H, Stronks K. Smoking in immigrants: Do socioeconomic gradients follow the pattern expected from the tobacco epidemic? Tob Control 2006;15(5):385–91. PMID: 16998173. doi: 10.1136/tc.2006.014902.CrossRefGoogle Scholar
  13. 13.
    Newbold KB. Neligan D. Disaggregating Canadian immigrant smoking behaviour by country of birth. Soc Sci Med 2012;75(6):997–1005. PMID: 22709444. doi: 10.1016/j.socscimed.2012.05.008.CrossRefGoogle Scholar
  14. 14.
    Choi S, Rankin S, Stewart A, Oka R. Effects of acculturation on smoking behavior in Asian Americans: A meta-analysis. J Cardiovasc Nurs 2008; 23(1):67–73. PMID: 18158512. doi: 10.1097/01.JCN.0000305057.96247.f2.CrossRefGoogle Scholar
  15. 15.
    Kim SS. Ziedonis D, Chen KW. Tobacco use and dependence in Asian Americans: A review of the literature. Nicotine Tob Res 2007;9(2):169–84. PMID: 17365748. doi: 10.1080/14622200601080323.CrossRefGoogle Scholar
  16. 16.
    Zhang J, Wang Z. Factors associated with smoking in Asian American adults: A systematic review. Nicotine Tob Res 2008;10(5):791–801. PMID: 18569752. doi: 10.1080/14622200802027230.CrossRefGoogle Scholar
  17. 17.
    Health Canada. Canadian Tobacco Use Monitoring Survey (CTUMS) 2012. Ottawa, ON, 2013.Google Scholar
  18. 18.
    Centers for Disease Control and Prevention. Current cigarette smoking among adults–United States, 2005–2013. Morbidity and Mortality Weekly Report (MMWR). Atlanta, GA, 2014.Google Scholar
  19. 19.
    An N, Cochran SD. Mays VM. McCarthy WJ. Influence of American acculturation on cigarette smoking behaviors among Asian American subpopulations in California. Nicotine Tob Res 2008;10(4):579–87. PMID: 18418780. doi: 10.1080/14622200801979126.CrossRefGoogle Scholar
  20. 20.
    Asbridge M, Tanner J, Wortley S. Ethno-specific patterns of adolescent tobacco use and the mediating role of acculturation, peer smoking, and sibling smoking. Addiction 2005;100(9):1340–51. PMID: 16128723. doi: 10.1111/ j.1360-0443.2005.01165.x.CrossRefGoogle Scholar
  21. 21.
    Cantrell J, Hung D, Fahs MC. Shelley D. Purchasing patterns and smoking behaviors after a large tobacco tax increase: A study of Chinese Americans living in New York City. Public Health Rep 2008;123(2):135–46. PMID: 18457066.CrossRefGoogle Scholar
  22. 22.
    Chiu M, Austin PC. Manuel DG. Tu JV. Cardiovascular risk factor profiles of recent immigrants vs long-term residents of Ontario: A multi-ethnic study. Can J Cardiol 2012;28(1):20–26. PMID: 21827964. doi: 10.1016/j.cjca.2011.06.002.CrossRefGoogle Scholar
  23. 23.
    Hislop TG. Teh C, Low A, Yasui Y, Tu SP. Li L, et al. Knowledge and behaviour regarding heart disease prevention in Chinese Canadian immigrants. Can J Public Health 2008;99(3):232–35. PMID: 18615948.PubMedGoogle Scholar
  24. 24.
    Hu S, Pallonen UE. Meshack AF. The impact of immigration status on tobacco use among Chinese-American adults in Texas. J Immigr Minor Health 2010;12(2):206–14. PMID: 18030623. doi: 10.1007/s10903-007-9097-z.CrossRefGoogle Scholar
  25. 25.
    Kaplan CP. Nguyen TT. Weinberg V. Longitudinal study of smoking progression in Chinese and Vietnamese American adolescents. Asian Pac J Cancer Prev 2008;9(2):335–41. PMID: 18712987.PubMedGoogle Scholar
  26. 26.
    Li S, Delva J. Social capital and smoking among Asian American men: An exploratory study. Am J Public Health 2012;102(2 Suppl, 1254074, 3xw): S212–21. PMID: 22401511. doi: 10.2105/AJPH.2011.300442.CrossRefGoogle Scholar
  27. 27.
    Li S, Kwon SC. Weerasinghe I, Rey M, Trinh-Shevrin C. Smoking among Asian Americans: Acculturation and gender in the context of tobacco control policies in New York City. Health Promot Pract 2013;14(Suppl 5): 18S–28S. PMID: 23667057. doi: 10.1177/1524839913485757.CrossRefGoogle Scholar
  28. 28.
    Parikh NS. Fahs MC. Shelley D, Yerneni R. Health behaviors of older Chinese adults living in New York City. J Community Health 2009;34(1):6–15. PMID: 18830807. doi: 10.1007/s10900-008-9125-5.CrossRefGoogle Scholar
  29. 29.
    Sussman NM. Truong N. “Please extinguish all cigarettes”: The effects of acculturation and gender on smoking attitudes and smoking prevalence of Chinese and Russian immigrants. Int J Intercult Relat 2011;35(2):163–78. doi: 10.1016/j.ijintrel.2010.11.009.CrossRefGoogle Scholar
  30. 30.
    Taylor VM. Yasui Y, Tu SP. Neuhouser ML. Li L, Woodall E, et al. Heart disease prevention among Chinese immigrants. J Community Health 2007;32(5): 299–310. PMID: 17922202.CrossRefGoogle Scholar
  31. 31.
    Weiss JW. Garbanati JA. Effects of acculturation and social norms on adolescent smoking among Asian-American subgroups. J Ethn Subst Abuse 2006;5(2):75–90. PMID: 16635975.CrossRefGoogle Scholar
  32. 32.
    Wong CC. Tong EK. Tsoh JY. Chen MJ. Hom FB. Patterns of tobacco-use behavior among Chinese smokers with medical conditions. J Community Health 2009;34(6):472–79. PMID: 19707860. doi: 10.1007/s10900-009-9182-4.CrossRefGoogle Scholar
  33. 33.
    von Elm E, Altman DG. Egger M, Pocock SJ. Gøtzsche PC. Vandenbroucke JP. et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. BMJ 2007;335(7624):806–8. PMID: 17947786. doi: 10.1136/bmj.39335.541782.AD.CrossRefGoogle Scholar
  34. 34.
    Gorber SC. Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: A systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res 2009;11(1):12–24. PMID: 19246437. doi: 10.1093/ntr/ntn010.CrossRefGoogle Scholar
  35. 35.
    Hiscock R, Bauld L, Amos A, Fidler JA. Munafò M. Socioeconomic status and smoking: A review. Ann N Y Acad Sci 2012;1248:107–23. PMID: 22092035. doi: 10.1111/j.1749-6632.2011.06202.xCrossRefGoogle Scholar
  36. 36.
    Thun M, Peto R, Boreham J, Lopez AD. Stages of the cigarette epidemic on entering its second century. Tob Control 2012;21:96–101. PMID: 22345230. doi: 10.1136/tobaccocontrol-2011-050294CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2015

Authors and Affiliations

  • Carolyn C. Gotay
    • 1
    Email author
  • Michelle S. Reid
    • 1
  • Marliese Y. Dawson
    • 1
  • Shouzheng Wang
    • 2
  1. 1.Centre of Excellence in Cancer Prevention, School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  2. 2.Fuwai Hospital, National Center for Cardiovascular DiseaseChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople’s Republic of China

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