This study explored Korean American women’s experiences with smoking and tested the theory of planned behavior to identify factors associated with their intentions to quit smoking. It employed a mixed-methods research design, using qualitative and quantitative data. Participants were recruited via a combination of random (N = 49) and convenience (N = 45) sampling techniques. Women in this study initiated smoking at age of 23 on average, and nearly half smoked at indoor houses. They initiated smoking out of curiosity about the effect and belief that smoking would relieve their stress. Reasons for continued smoking were (a) to avoid nicotine withdrawal symptoms, (b) to cope with life stressors, including acculturative stress, and (c) to fulfill one’s destiny as a lifetime smoker. Many attempted to quit due to health issues and pregnancy. Fear of disclosure and limited English proficiency were found to be major barriers to seeking help for quitting. Past-year quit attempt(s), attitudes toward quitting, and perceived family norm favoring quitting explained 25% of the variance in intentions to quit smoking ( , ). Findings suggest that gender- and culture-specific intervention strategies are needed to assist Korean American women in smoking cessation. 1. Introduction Tobacco use is widely recognized as the most preventable cause of illness and death in the United States (US). In 2010, an estimated 17.3% of US women were current smokers as compared to 21.5% of US men, supporting the historical difference seen in prevalence rates [1]. Of the US population, Asian Americans present the most striking gender difference in smoking rates [2–5]. While Asian men of some ethnic subgroups smoke at higher rates than the general US population, their female counterparts reportedly smoke at the lowest rate (4.3%) of all racial and ethnic groups [1]. Similar to what has been found among Asian men, however, smoking rates among Asian women vary across ethnic subgroups [2–5] and by acculturation level [5–7]. In addition, among certain segments of this population smoking rates have been on the rise. For example, the rates of smoking among Korean American women in California have been steadily increasing from 8% to 21% in the past decade [8–10]. Six tobacco research articles [5–7, 11–13] have been published to date that have any information on Korean American women, but findings are limited to reports on correlates of smoking and number of quit attempts. Korean American women who were not married were found to have more than 3 times the odds of being smokers as compared to married
References
[1]
Centers for Disease Control and Prevention, “Cigarette smoking among adults-United States, 2007,” Morbidity and Mortality Weekly Report, vol. 57, pp. 1221–1226, 2011.
[2]
K. F. Baluja, J. Park, and D. Myers, “Inclusion of immigrant status in smoking prevalence statistics,” American Journal of Public Health, vol. 93, no. 4, pp. 642–646, 2003.
[3]
S. S. Kim, D. Ziedonis, and K. W. Chen, “Tobacco use and dependence in Asian Americans: a review of the literature,” Nicotine and Tobacco Research, vol. 9, no. 2, pp. 169–184, 2007.
[4]
R. S. Caraballo, S. L. Yee, J. Gfroerer, and S. A. Mirza, “Adult tobacco use among racial and ethnic groups living in the United States, 2002–2005,” Public Health Research, Practice and Policy, vol. 5, no. 3, pp. 1–9, 2008.
[5]
S. Li, S. C. Kwon, I. Weerasinghe, M. J. Rey, and C. Trinh-Shervin, “Smoking among Asian Americans: acculturation and gender in the context of tobacco control policies in New York city,” Health Promotion Practice, 2013.
[6]
N. An, S. D. Cochran, V. M. Mays, and W. J. McCarthy, “Influence of American acculturation on cigarette smoking behaviors among Asian American subpopulations in California,” Nicotine and Tobacco Research, vol. 10, no. 4, pp. 579–587, 2008.
[7]
Y. J. Song, C. R. Hofstetter, M. F. Hovell, et al., “Acculturation and health risk behaviors among Californians of Korean descent,” Preventive Medicine, vol. 39, no. 1, pp. 147–156, 2004.
[8]
California Health Interview Survey, California Health Interview Survey: Adult Survey, 2003, University of California Los Angeles Center for Health Policy Research, 2005.
[9]
California Health Interview Survey, California Health Interview Survey: Adult Survey, 2009, University of California Los Angeles Center for Health Policy Research, 2011.
[10]
A. E. Maxwell, C. M. Crespi, R. E. Alano, M. Sudan, and R. Bastani, “Health risk behaviors among five Asian American subgroups in California: identifying intervention priorities,” Journal of Immigrant and Minority Health, vol. 14, no. 5, pp. 890–894, 2012.
[11]
R. Lew, J. M. Moskowitz, B. A. Wismer, et al., “Correlates of cigarette smoking among Korean American adults in Alameda county, California,” Asian American and Pacific Islander Journal of Health, vol. 19, no. 1, pp. 50–60, 2001.
[12]
M. Ji, C. R. Hofstetter, M. Hovell, et al., “Smoking cessation patterns and predictors among adult Californians of Korean descent,” Nicotine and Tobacco Research, vol. 7, no. 1, pp. 59–69, 2005.
[13]
E. K. Tong, H. Tang, J. Tsoh, C. Wong, and M. S. Chen Jr., “Smoke-free policies among Asian-American women: comparisons by education status,” American Journal of Preventive Medicine, vol. 37, no. 2, supplement, pp. S144–S150, 2009.
[14]
J. P. Allem, J. W. Ayers, V. L. Irvin, C. R. Hofstetter, and M. F. Hovell, “South Korean military service promotes smoking: a quasi-experimental design,” Yonsei Medical Journal, vol. 53, no. 2, pp. 433–438, 2012.
[15]
S. S. Kim, H. Son, and K. A. Nam, “The sociocultural context of Korean American men's smoking behavior,” Western Journal of Nursing Research, vol. 27, no. 5, pp. 604–623, 2005.
[16]
K. H. Jung-Choi, Y. H. Khang, and H. J. Cho, “Hidden female smokers in Asia: a comparison of self-reported with cotinine-verified smoking prevalence rates in representative national data from an Asian population,” Tobacco Control, vol. 21, no. 6, pp. 536–542, 2012.
[17]
I. Ajzen, Attitudes, Personality and Behavior, Dorsey Press, Chicago, Ill, USA, 1988.
[18]
I. Ajzen, “The theory of planned behavior,” Organizational Behavior and Human Decision Processes, vol. 50, no. 2, pp. 179–211, 1991.
[19]
H. Juon, M. Kim, H. Han, J. P. Ryu, and W. Han, “Acculturation and cigarette smoking among Korean American men,” Yonsei Medical Journal, vol. 44, no. 5, pp. 875–882, 2003.
[20]
K. K. Kim, E. S. H. Yu, E. H. Chen, J. Kim, R. Brintnall, and S. Vance, “Smoking behavior, knowledge, and beliefs among Korean Americans,” Cancer Practice, vol. 8, no. 5, pp. 223–230, 2000.
[21]
S. S. Kim, H. Lee, P. Kiang, D. Kalman, and D. Ziedonis, “Factors associated with alcohol problems among Asian American college students: gender, ethnicity, smoking, and depressed mood,” Journal of Substance Use, 2013.
[22]
A. Bandura, “Self-efficacy: toward a unifying theory of behavioral change,” Psychological Review, vol. 84, no. 2, pp. 191–215, 1977.
[23]
S. S. Kim, “Predictors of short-term smoking cessation among Korean American men,” Public Health Nursing, vol. 25, no. 6, pp. 516–525, 2008.
[24]
D. Broadhead-Fearn and K. M. White, “The role of self-efficacy in predicting rule-following behaviors in shelters for homeless youth: a test of the theory of planned behavior,” Journal of Social Psychology, vol. 146, no. 3, pp. 307–325, 2006.
[25]
E. L. Tolma, B. M. Reininger, A. Evans, and J. Ureda, “Examining the theory of planned behavior and the construct of self-efficacy to predict mammography intention,” Health Education and Behavior, vol. 33, no. 2, pp. 233–251, 2006.
[26]
A. Niven, A. Nevill, F. Sayers, and M. Cullen, “Predictors of rehabilitation intention and behavior following anterior circulate ligament surgery: an application of the theory of planned behavior,” Scandinavian Journal of Medicine & Science in Sports, vol. 22, pp. 316–322, 2012.
[27]
C. J. Armitage and M. Conner, “Efficacy of the theory of planned behaviour: a meta-analytic review,” British Journal of Social Psychology, vol. 40, no. 4, pp. 471–499, 2001.
[28]
S. S. Kim, S. H. Kim, C. McKay, and D. Ziedonis, “Comparison of characteristics among Korean American male smokers between survey and cessation studies,” Open Journal of Prevention Medicine, vol. 3, no. 3, pp. 293–300, 2013.
[29]
Korean American Coalition-Census Information Center, Top 100 Cities/Places in the United States for the Korean Population, California State University, Los Angeles, Calif, USA, 2000.
[30]
C. R. Hofstetter, M. F. Hovell, J. Lee, et al., “Tobacco use and acculturation among Californians of Korean descent: a behavioral epidemiological analysis,” Nicotine and Tobacco Research, vol. 6, no. 3, pp. 481–489, 2004.
[31]
D. D. Heckathorn, “Respondent-driven sampling: a new approach to the study of hidden populations,” Social Problems, vol. 44, no. 2, pp. 174–199, 1997.
[32]
D. D. Heckathorn, “Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations,” Social Problems, vol. 49, no. 1, pp. 11–34, 2002.
[33]
S. S. Kim, H. Fang, J. DiFranza, D. Ziedonis, and G. Ma, “Gender differences in the fagerstr？m test for nicotine dependence in Korean Americans,” Journal of Smoking Cessation, vol. 7, pp. 31–36, 2012.
[34]
S. S. Kim, E. E. Gulick, K. A. Nam, and S. H. Kim, “Psychometric properties of the alcohol use disorders identification test: a Korean version,” Archives of Psychiatric Nursing, vol. 22, no. 4, pp. 190–199, 2008.
[35]
S. S. Kim, S. H. Kim, and E. E. Gulick, “Cross-cultural validation of a smoking abstinence self-efficacy scale in Korean American men,” Issues in Mental Health Nursing, vol. 30, no. 2, pp. 122–130, 2009.
[36]
S. A. McKee, S. S. O'Malley, P. Salovey, S. Krishnan-Sarin, and C. M. Mazure, “Perceived risks and benefits of smoking cessation: gender-specific predictors of motivation and treatment outcome,” Addictive Behaviors, vol. 30, no. 3, pp. 423–435, 2005.
[37]
R. M. Suinn, K. Rickard-Figueroa, S. Lew, and P. Vigil, “The suinn-lew Asian self-identity acculturation scale: an initial report,” Educational and Psychological Measurement, vol. 47, no. 2, pp. 401–407, 1987.
[38]
F. T. Leong and E. L. Chou, “Developing brief versions of the Suinn-Lew Asian Self-Identity Acculturation (SL-ASIA) scale for counseling research,” Asian American & Pacific Islander Journal of Health, vol. 6, pp. 13–24, 1988.
[39]
T. F. Babor, J. C. Higgins-Biddle, J. B. Saunders, and M. G. Monteiro, The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care, World Health Organization, 2nd edition, 2001.
[40]
T. F. Heatherton, L. T. Kozlowski, R. C. Frecker, and K. O. Fagerstr？m, “The Fagerstrom test for nicotine dependence: a revision of the fagerstrom tolerance questionnaire,” British Journal of Addiction, vol. 86, no. 9, pp. 1119–1127, 1991.
[41]
J. O. Prochaska and C. C. DiClemente, “Stages and processes of self-change of smoking: toward an integrative model of change,” Journal of Consulting and Clinical Psychology, vol. 51, no. 3, pp. 390–395, 1983.
[42]
Y. O. Jee, “Instrument development for the application of the theory of planned behavior,” Korean Journal of Nursing Query, vol. 2, pp. 102–117, 1993.
[43]
W. F. Velicer, C. C. Diclemente, J. S. Rossi, and J. O. Prochaska, “Relapse situations and self-efficacy: an integrative model,” Addictive Behaviors, vol. 15, no. 3, pp. 271–283, 1990.
[44]
M. Miles and A. M. Huberman, An Expanded Sourcebook: Qualitative Data Analysis, Sage, Thousand Oaks, Calif, USA, 1994.
[45]
Y. S. Lincoln and E. G. Guba, Naturalistic Inquiry, Sage, Newbury Park, Calif, USA, 1985.
[46]
A. Kaida, J. Edwards, N. Fraser-Lee, et al., Smoking in the Capital Health Region—Report, Population Health Survey 2002, Capital Health, Edmonton, Canada, 2004.
[47]
J. F. Etter and S. Sutton, “Assessing “stage of change” in current and former smokers,” Addiction, vol. 97, no. 9, pp. 1171–1182, 2002.
[48]
A. H. Weinberger, S. Krishnan-Sarin, C. M. Mazure, and S. A. McKee, “Relationship of perceived risks of smoking cessation to symptoms of withdrawal, craving, and depression during short-term smoking abstinence,” Addictive Behaviors, vol. 33, no. 7, pp. 960–963, 2008.
[49]
J. Y. Tsoh, E. K. Tong, G. Gildengorin, et al., “Individual and family factors associated with intention to quit among male vietnamese American smokers: implications for intervention development,” Addictive Behaviors, vol. 36, no. 4, pp. 294–301, 2011.
[50]
S. Shiffman, M. H. Balabanis, J. A. Paty, et al., “Dynamic effects of self-efficacy on smoking lapse and relapse,” Health Psychology, vol. 19, no. 4, pp. 315–323, 2000.
[51]
S. S. Kim, H. Son, and K. A. Nam, “Personal factors influencing Korean American men's smoking behavior: addiction, health, and age,” Archives of Psychiatric Nursing, vol. 19, no. 1, pp. 35–41, 2005.
[52]
A. S. Marks, K. Steyn, and E. Ratheb, Policy Brief: Tobacco Use by Black Women in Cape Town, Research for International Tobacco Control, 2001.
[53]
D. Burgess, S. S. Fu, A. M. Joseph, D. K. Hatsukami, J. Solomon, and M. Van Ryn, “Understanding smoking and cessation among hmong smokers,” Journal of Health Care for the Poor and Underserved, vol. 19, no. 2, pp. 442–451, 2008.
[54]
C. Y. Fang, G. X. Ma, S. M. Miller, Y. Tan, X. Su, and S. Shive, “A brief smoking cessation intervention for Chinese and Korean American smokers,” Preventive Medicine, vol. 43, no. 4, pp. 321–324, 2006.
[55]
S. S. Kim, M. S. Kwon, Y. C. Klessig, and D. Ziedonis, “Adapting tobacco dependence group therapy treatment for Korean Americans: a case report of pilot treatment program,” Journal of Groups in Addiction and Recovery, vol. 3, no. 1-2, pp. 93–108, 2008.
[56]
D. Wu, G. X. Ma, K. Zhou, D. Zhou, A. Liu, and A. N. Poon, “The effect of a culturally tailored smoking cessation for Chinese American smokers,” Nicotine and Tobacco Research, vol. 11, no. 12, pp. 1448–1457, 2009.
[57]
S.-H. Zhu, S. Wong, C. Stevens, D. Nakashima, and A. Gamst, “Use of a smokers' quitline by asian language speakers: results from 15 years of operation in California,” American Journal of Public Health, vol. 100, no. 5, pp. 846–852, 2010.
[58]
S. J. Blumberg and J. V. Luke, Wireless Substitution: Early Release of Estimates from the National Health Interview Survey from July-December 2009, National Center for Health Statistics, 2010.
