HEALTH DISPARITIES
HEALTH DISPARITIES
Embedded Files
In 2022, out of the total population of 8.16 million in New York City (NYC), 3.1 million (38%) individuals are born outside of the United States. This proves to be significant in the demographics landscape. The top three most populous immigrant groups are from the Dominican Republic, China (including Hong Kong and Taiwan), and Mexico with populations of 412,925, 390,992, and 166,034 respectively.[1] The large population of immigrants is significant in the demographic landscape, involving health inequities that warrants attention.
According to the 2023 Annual Report on New York City’s Immigrant Population and Initiatives of the Office, the immigrant population in New York City have multiple key characteristics:
DETERMINANTS OF SMOKING AND ITS IMPLICATIONS
DETERMINANTS OF SMOKING AND ITS IMPLICATIONS
Over the past 20 years, the number of people smoking has decreased by 50% (22% in 2002 to 11% in 2020).[2] Although New York City has been successful with smoking cessation efforts, the progress made in each community differs as some individuals continue to smoke at higher rates or receive treatment at lower rates. The differences seen between each community are due to societal, community and neighborhood, interpersonal, and individual factors.
SOCIETAL FACTORS
SOCIETAL FACTORS
Policies
In New York State, there are policies that decrease exposure and access to smoking products.
● The New York State Tobacco Control Law (Public Health Law 13-F) prohibits:[3]
○ the sale of tobacco and vapor products to anyone under the age of 21
○ the sale of flavored nicotine-containing vapor products to anyone
There are a few limitations to this law.[4]
● New York State still permits the sale of menthol, mint, or wintergreen flavored tobacco products
● Recreational nicotine products (e.g. pouches, toothpicks, and tobacco-free dips) are not being closely regulated for the youth and can be a gateway to tobacco products
Healthcare System Access
There are currently seven treatment options: two non-nicotine pills and five types of nicotine replacement therapy.[3] However, treatment utilization varies between communities and is due to unequal access to treatment services. This hinders smoking cessation efforts across the different communities.
According to the 2016 New York City Health Survey:[3]
● Asian/Pacific Islanders (API) are less likely to utilize nicotine replacement therapy than other racial or ethnic group
● White (20%), Black (24%), and Latinx (26%) adults were two or three times more likely than API (9%) to use nicotine replacement therapy
COMMUNITY AND NEIGHBORHOOD FACTORS
COMMUNITY AND NEIGHBORHOOD FACTORS
Second-hand Smoking and Housing
Containing more than 7,000 chemicals, second-hand smoke is produced from burning tobacco products and exhaling during tobacco use. Approximately 500,000 adults and children currently experience second-hand smoke in New York City.[5]
In 2013, 77% of all New Yorkers had an in-home smoke-free policy, where smoking was prohibited anywhere inside a person’s home. It was found that White (83%), Black (84%), and Latino (85%) non-smokers were more likely to have this policy than Asian/Pacific Islander non-smokers (67%).[6]
Despite the in-home smoke-free policy, it was found that in 2016, 44% of New Yorkers reported smelling second-hand smoke at home from the outside. For the Asian/Pacific Islander population specifically, 35% reported being exposed from second-hand smoke from the outside.[6]
Studies have shown that second-hand smoke can bind to receptors in the brain and cause never- or naive-smokers to become dependent on nicotine if they start smoking.[7]
Tobacco Marketing Practices
The tobacco industry uses multiple strategies to target marginalized communities, including:[2]
● Free samples
● Event sponsorships
● Targeted marketing
● Misleading “medicinal” messaging
Individuals who encounter high numbers of tobacco retailers in their neighborhood and medium to high retail counts in recreational spaces were more likely to smoke compared to individuals exposed to fewer retailers.[8]
These marketing practices contribute to inequalities in electronic cigarettes usage rates as well. Since retail stores display an average of 21 interior tobacco advertisements, and the advertisements are placed in convenience stores where 75% of teenagers shop weekly, youth e-cigarette use increased by 160% between 2014 to 2018 in New York.[9]
Acculturation
Acculturation is the process by which an immigrant adopts the values, norms, attitudes, and behaviors of the new culture in the host country.[10] In the U.S., immigrants tend to initially have better health than U.S. born individuals. As the immigrants become more integrated with U.S. culture, they start adopting health-deteriorating behaviors, such as smoking.[11]
Evidence currently shows:
● Differences by gender
○ Acculturated men smoke less while acculturated women smoke more.[12]
○ Higher prevalence of smoking among Chinese, Filipino, Korean, South Asian and Vietnamese immigrant women is associated with higher levels of acculturation to the U.S.[13]
● Differences between immigrants and U.S. born individuals[10]
○ Chinese and Indian immigrant men have higher smoking prevalence than U.S. born Chinese and Indian men.
○ Immigrant women have lower smoking rates than native-born Americans across every ethnic group.
● Differences by education level
○ Asian immigrant men without a college degree that have lived in the U.S. for more than 10 years have the highest smoking prevalence of all Asians in the U.S.[11]
NETWORK FACTORS
NETWORK FACTORS
An individual’s social network and attachment to their community plays an important role in whether they adopt smoking behaviors. When a person feels safe, connected to pro smoking social networks, and sees the visible smoking behaviors, they are encouraged to smoke, less likely to quit, and more likely to relapse after cessation.[14]
Ethnic density of a community also influences smoking behavior. In communities with low co-ethnic density, a person will feel less attached, more neighborly distrust, more dissatisfied, and more stress. As a result, the person can pick up smoking as a coping mechanism. On the other hand, a strong social network in a high neighborhood co-ethnic density can lead to an increased acceptance of smoking behaviors.[15]
INDIVIDUAL FACTORS
INDIVIDUAL FACTORS
There are multiple personal factors that can lead to the differences in smoking behaviors.
● Education
○ In the U.S., high levels of education was associated with low smoking prevalence.[11]
○ In New York City, smoking rates were higher among adults with less than a high school education (18.1%).[2]
● Gender[16]
○ In New York State (excluding New York City), smoking rates were higher among males (12.9%) compared to females (9.7%).
○ In New York City, smoking rates were higher among males (12.3%) compared to females (9.7%).
● Health Conditions[16]
○ In New York State, smoking rates were higher among adults living with disability (15.4%) in 2022.
○ Additionally, smoking rates remained high among adults reporting frequent mental distress (18.4%) in 2022.
● Household Income
○ In New York State, smoking rates were highest among adults with an annual household income of less than $25,000 (18.4%) in 2022.[16]
○ Smoking rates were higher among New York adults enrolled in Medicaid (17.5%) or who are unemployed (16.7%) in 2022.[16]
○ In 2020, New York City adults who lived in very high poverty neighborhoods smoked more (14%) compared to adults who live in neighborhoods with low poverty (9%).[2]
SMOKING INEQUITIES AMONG ASIAN AMERICANS & PACIFIC ISLANDERS
SMOKING INEQUITIES AMONG ASIAN AMERICANS & PACIFIC ISLANDERS
The societal, community and neighborhood, network, and individual factors create varying smoking patterns between racial groups. For the Asian and Pacific Islander community, the differences include:
● Birth Origin
○ In a 2019 - 2020 New York City survey, Asian and Pacific Islander men born outside of the U.S. had a higher smoking rate than Asian and Pacific Islander men born in the U.S. (20% vs. 5%).[2]
○ Asian and Pacific Islander and Latino immigrants in New York City share similar smoking rates (7.1% vs. 5.8%). Both populations have higher smoking rates than Black immigrants (4.2%) and lower smoking rates than White immigrants (12.1%).[16]
● Gender
○ In New York City, Asian and Pacific Islander men are six times more likely to smoke than Asian and Pacific Islander women (23% vs. 3%).[17]
○ Smoking prevalence among New York City Korean males (35.5%) was higher compared to Korean women (11.2%). Additionally, smoking prevalence among New York City Asian Indian males (10.1%) was higher compared to Asian Indian females (0.7%).[10]
● Desire to Quit Smoking[18]
○ Compared to the Black population (73%), White population (68%), Hispanic population (67%) and American Indian and Alaska Native population (34%) in the U.S., 70% of the Asian population say that they want to quit smoking.
○ However, only 34% of Asians who smoke report getting advice to quit from a healthcare provider.
● Treatment Uptake
○ In 2016, Asian and Pacific Islanders living in New York City used nicotine replacement therapy the least compared to other racial or ethnic groups. Asian and Pacific Islander adults (9%) were two to three times less likely to engage in treatments for quitting smoking than White (20%), Black (24%), and Latinx (26%) adults.[2]
● Vaping Among the Youth[17]
○ Among the New York City high school student population, 5% smoke and 17% vape.
○ Within the New York City high school student population that smoke and vape, 3% of the Asian and Pacific Islander student smoke and 11% vape.
○ 1 in 9 Asian and Pacific Islander high school students use an electronic cigarette or similar product.
● Consumption of Menthol Cigarettes
○ In 2011, Asian American smokers (31.2%) were more likely to smoke menthol cigarettes than White American smokers (23.8%) in the U.S.[13]
○ Additionally, Asian American youth are the second most populous group to smoke menthol cigarettes (51.5 to 58%) compared to Black youth (71.9%) in the U.S.[13]
○ In 2020, 25% of New York City Asian and Pacific Islander adults smoke menthol cigarettes.[2]
In addition, even though overall smoking behaviors for Asian Americans differ from other racial groups, the smoking prevalence between Asians also vary because of the diversity of the ethnic subgroups. These differences can help inform development of tailored interventions and outreach about smoking cessation.
In the United States:[10]
● 24-34% Chinese American males smoke
● 27-36% Korean American males smoke
● 24.4% Cambodian American males smoke
● 24.4 - 40% Vietnamese American males smoke
● 24 - 35% Filipino American males smoke
REFERENCES
REFERENCES
[1] Adams, E., & Castro, M. (n.d.). 2023 ANNUAL REPORT ON NEW YORK CITY’S IMMIGRANT POPULATION AND INITIATIVES OF THE OFFICE. https://www.nyc.gov/assets/immigrants/downloads/pdf/MOIA-Annual-Report-2023_Final.pdf
[2] Merizier, J., Orkin-Prol, L., Talati, A., Jasek, J., & Debchoudhury, I. (2022). Addressing New York City’s Smoking Inequities. NYC Vital Signs. https://www.nyc.gov/assets/doh/downloads/pdf/survey/tobacco-inequities-2022.pdf
[3] New York State Department of Health. (2024, November). A Guide for Retail Tobacco and Vapor Product Dealers and New York State’s Youth Access Tobacco Control Laws (Public Health Law Article 13-F). Health.ny.gov. https://health.ny.gov/prevention/tobacco_control/retail_tobacco_dealers_guide.htm
[4] New York City Department of Health. (n.d.). Flavored Tobacco and Recreational Nicotine Products. www.nyc.gov. https://www.nyc.gov/site/doh/health/health-topics/flavored-tobacco-and-vaping-products.page
[5] Public Health Solutions. (n.d.). Smoke-free Outdoor Air. Retrieved November 25, 2024, from https://www.healthsolutions.org/wp-content/uploads/2018/12/Outdoor-Air-2018.pdf
[6] New York City Department of Health. (2018). Secondhand Smoke and Smoke-Free Housing in New York City. https://www.nyc.gov/assets/doh/downloads/pdf/survey/smoke-free-housing.pdf
[7] Okoli, C. T., Rayens, M. K., Wiggins, A. T., Ickes, M. J., Butler, K. M., & Hahn, E. J. (2016). Secondhand tobacco smoke exposure and susceptibility to smoking, perceived addiction, and psychobehavioral symptoms among college students. Journal of American college health : J of ACH, 64(2), 96–103. https://doi.org/10.1080/07448481.2015.1074240
[8] Shareck, M., Kestens, Y., Vallée, J., Datta, G., & Frohlich, K. L. (2016). The added value of accounting for activity space when examining the association between tobacco retailer availability and smoking among young adults. Tobacco control, 25(4), 406–412. https://doi.org/10.1136/tobaccocontrol-2014-052194
[9] Tobacco Free New York State. (2024). TOBACCO MARKETING. Tobaccofreenys.org. https://tobaccofreenys.org/our-initiatives/tobacco-marketing/
[10] Li, S., Kwon, S. C., Weerasinghe, I., Rey, M. J., & Trinh-Shevrin, C. (2013). Smoking among Asian Americans: acculturation and gender in the context of tobacco control policies in New York City. Health promotion practice, 14(5 Suppl), 18S–28S. https://doi.org/10.1177/1524839913485757
[11] Ra, C. K., Pehlivan, N., Kim, H., Sussman, S., Unger, J. B., & Businelle, M. S. (2022). Smoking prevalence among Asian Americans: Associations with education, acculturation, and gender. Preventive medicine reports, 30, 102035. https://doi.org/10.1016/j.pmedr.2022.102035
[12] Gotay, C. C., Reid, M. S., Dawson, M. Y., & Wang, S. (2015). Acculturation and smoking in North Americans of Chinese ancestry: A systematic review. Canadian journal of public health = Revue canadienne de sante publique, 106(5), e333–e340. https://doi.org/10.17269/cjph.106.4762
[13] Asian Pacific Partners for Empowerment, Advocacy & Leadership. (2014). Tobacco Use in Asian American Communities. https://appealforhealth.org/wp-content/uploads/2014/06/6135_APPEAL_AsianAmerican_factsheet_FINAL.pdf
[14] Blok, D. J., de Vlas, S. J., van Empelen, P., & van Lenthe, F. J. (2017). The role of smoking in social networks on smoking cessation and relapse among adults: A longitudinal study. Preventive medicine, 99, 105–110. https://doi.org/10.1016/j.ypmed.2017.02.012
[15] Denney, J. T., Sharp, G., & Kimbro, R. T. (2022). Community social environments and cigarette smoking. SSM - population health, 19, 101167. https://doi.org/10.1016/j.ssmph.2022.101167
[16] Fajobi, O., Hunter, L., & Peluso, C. (2024, April). Behavioral Risk Factor Surveillance System Brief: Cigarette Smoking, New York State Adults, 2022 (No. 2024-09). New York State Department of Health, Division of Chronic Disease Prevention, Bureau of Chronic Disease Evaluation and Research
[17] King, L., Deng, W. Q., Hinterland, K., Rahman, M., Wong, B. C., Mai, C., & Gould, L. H. (2021). Health of Asians and Pacific Islanders in New York City. New York City Department of Health and Mental Hygiene. https://www.nyc.gov/assets/doh/downloads/pdf/episrv/asian-pacific-islander-health-2021.pdf
[18] CDC. (2024, May 16). Asian, Native Hawaiian, and Pacific Islander People Encounter Barriers to Quitting Successfully. Tobacco - Health Equity. https://www.cdc.gov/tobacco-health-equity/collection/anhpi-quitting-tobacco.html
Page updated
Report abuse