Transcending Racial/Ethnic Borders: A Conceptual Framework to Understand Smoking Disparities among Asian Americans

Eliminating racial/ethnic disparities in health is a major goal of Healthy People 2010. While this is a noble goal, we must transcend racial/ethnic borders and place a greater emphasis on the contextual factors that interact with race/ethnicity that create these disparities. For example, some Asian-American subgroups, such as Koreans and Filipinos, have higher smoking rates compared to other racial/ethnic groups. However, it is not inherently being a Korean or Filipino that lead to higher smoking rates, but rather it is the interaction of gender, socioeconomic status, and acculturation levels that are associated with smoking behavior. But why are some racial/ethnic groups worse off than others in terms of health-risk behaviors?

To address this research question, we used an inductive approach. We reviewed 15 quantitative and qualitative studies on specific Asian-American subgroups on the topic of smoking behavior development. We investigated factors beyond race/ethnicity that are associated with the group's behaviors. From our findings, we then developed a conceptual framework that takes these factors into account. This framework posits that understanding racial/ethnic disparities in health behavior requires a holistic analysis of the physical, institutional, social, and cultural environment experienced by a certain racial/ethnic group and its relation with gender, socioeconomic status, personal and social history, lifestyle, biology, and cognitive factors.

Eliminating racial/ethnic disparities in health requires a deeper understanding of how race/ethnicity relates to and interacts with environmental, interpersonal, and intrapersonal factors, which could be achieved through more qualitative studies and sophisticated statistical modeling techniques.