Asian Americans, Native Hawaiians and Pacific Islanders, a heterogenous group of more than 50 diverse ethnic and language subgroups, represent one of the fastest growing racial groups in the United States, numbering 11.9 million (when considered in combination with one or more other races) and constituting 4% of the population in 2000.1 Pacific Islanders alone number 874,000 or .3%, of the population.2 Unfortunately, these groups also suffer disproportionately in terms of disparate poverty rates, educational levels, and other socioeconomic characteristics.3
Recognizing these challenges, APPEAL has engaged its policy subcommittee and key stakeholders to identify policy priorities for APPEAL’s advocacy. Through committee calls and discussions, the following federal policy issues have been identified as those that impact our communities’ ability to address tobacco use among AAs and NHPIs.
Communities of color and AA and NHPI communities in particularly experience high rates of menthol cigarette use. In fact, 23.3% of current AA and NHPI smokers smoke menthol cigarettes. Additionally, the use of menthol cigarettes among Asian Americans (62%) is second only to African Americans (76%) in high school. Recently passed legislation that gives the Food and Drug Administration authority to regulate tobacco products gives menthol a protected status. Considering that menthol affects communities of color disproportionately, APPEAL is concerned this law would effectively devalue the health of communities of color.
Recommendation: Extend FDA regulation of tobacco products to include menthol cigarettes and other menthol products.
Because of industry targeting, priority populations, and AAs and NHPIs in particular, receive misinformation on the health effects of tobacco. Studies has shown that Asian stores were significantly more likely to have tobacco advertising outside stores, and ads inside and outside stores were significantly less likely to have health warnings.
Recommendation: Increase efforts to provide visual warning labels on all tobacco products, and make these warnings available in multiple languages.
AA and NHPI community-based organizations report low capacity to respond to tobacco use issues, particularly in terms of resources, infrastructure development, and focused leadership on tobacco control. Part of this challenge may stem from the many priorities that must be address by these communities, including other health issues, economic development, discrimination, civil rights, and sovereignty issues. Limitations in regard to community resources and leadership also affect the involvement of AAs and NHPIs and other populations in the tobacco control movement.
Recommendation: Increase funding, (e.g. through the federal stimulus program) for AA and NHPIs and other priority populations to build capacity by expanding leadership training opportunities for emerging and established advocates in most states.
CDC National Networks are key resources to increase capacity in priority populations to address tobacco control. Because the National Networks have strong relationships with community organizations and stakeholders, they play a key role in promoting tobacco control efforts among priority populations. As a National Network, APPEAL sees a huge demand for community competent technical assistance, training, and materials from the state departments of health. Our work with state departments of health provides an opportunity to expand the community-based “complementary” cessation outreach and training that the community organizations provide to better coordinate efforts with the quitlines and strengthen the community health infrastructure so that priority populations can better integrate tobacco into other chronic disease management.
Recommendation: Increase funding for the National Networks, so that they can provide mini-grants to local and regional programs to address tobacco issues comprehensively in each priority population.
The challenge of promoting tobacco control among AAs and NHPIs in the United States is also compounded by the more global problem of tobacco use in Asia and the Pacific Islands. Because 67% of the AA and NHPI population is foreign born, tobacco use overseas may have a major impact on the use among AA and NHPI groups in the United States. One tool to address the global nature of tobacco use is ratification of the Framework Convention on Tobacco Control. The Framework Convention on Tobacco Control (FCTC) is the world’s first global public health treaty, and provides an internationally coordinated response to combating the tobacco epidemic. The treaty addresses tobacco industry marketing campaigns executed simultaneously throughout different countries, and cigarette smuggling that is often coordinated by the tobacco industry in many countries.
Recommendation: Adopt the Framework Convention for Tobacco Control.
Many low-income AAs and NHPIs live in federally funded affordable housing, either in public housing units or Section 8 approved apartments, whose clean indoor air policies are determined by local ordinances or building policy. Surveys show that the general public strongly supports laws requiring nonsmoking sections in apartments. Indeed, statewide scientific polls commissioned by the Center for Tobacco Policy & Organizing reveal that 69% of California renters (and 46% of renters who smoke) support a law requiring landlords to create nonsmoking units. In addition, 66% of apartment owners and managers in California would support a law requiring the creation of nonsmoking units. The polls also show that 82% of renters would prefer to live in an apartment complex where smoking is not allowed anywhere or where there are separate smoking and nonsmoking sections. More recent data from the California Department of Public Health shows that 77% of California residents agree that apartment complexes should require half their rental units to be smoke-free.
Recommendation: Require all federally subsidized and public housing to adopt clean indoor air policies.
In the United States, documentation of national smoking prevalence rates has been hampered by the lack of adequate sample sizes, both in surveys collected via the Behavioral Risk Factor Surveillance System and the National Health Interview Survey. Furthermore, the continual aggregation of diverse ethnic groups within collected data, as well as use of English in surveys used to collect data from these populations, highly acculturates and influences the information received and documented. Lack of sound data has been a significant barrier to documenting and addressing tobacco use among AAs and NHPIs.
Recommendations: Disaggregate ethnic subgroups depending on known subpopulations in specific states; oversample American Indian, Asian, Native Hawaiian, Pacific Islanders, immigrant groups, African, Caribbean, as well as Puerto Rican, Mexican American, Central American and South American, as well as Brazilians; add LGBT data collection in all survey instruments used to monitor Healthy People 2010/2020 impact; support local data collection as valid evidence for community needs on tobacco control and the range of prevalence collected from other similar local communities; provide funds for data collection in Community Health Care settings where those primarily served include priority populations; provide linkages with NIH (NCI) to engage in participatory action research efforts with priority populations; provide linkages with Diabetes, Heart Disease, Asthma and HIV/AIDS sections of CDC to incorporate tobacco related questions in research carried out by chronic disease; provide funding on participatory action research on tobacco cessation to community-based organizations (CBOs) and local programs.
1 Max Niedzwiecki and TC Duong, Southeast Asian American Statistical Profile (Washington, DC: Southeast Asia Resource Action Center (SEARAC), 2004), 5.
3 Ibid., 22.