Moving Towards a True Depiction of Tobacco Use among South Asians: Analyses from the California Asian Indian Tobacco Use Survey

Objective: Despite disproportionate burdens of tobacco-related disease, past reporting has largely concluded that tobacco use does not contribute to excess burden of illness among Asian Indians in the United States. Besides cigarettes, Asian Indians use culturally-specific tobacco products. We examine Asian Indian tobacco behavior in California, which has had a long-standing tobacco control program and the largest Asian American population.

Methods: We analyzed data from the 2004 California Asian Indian Tobacco Use Survey. In addition to examining cigarettes, we created a composite variable comprised of four culturally-specific tobacco products: bidis, hookah, paan, and gutka. Current prevalence rates were analyzed by gender among survey respondents.

Findings: The survey had 3228 respondents, of whom 89% were immigrants. For prevalence, 8.3% of men and 1.7% of women smoke cigarettes. However, 14% of men and 12% of women currently use any culturally-specific tobacco product. Most common were culturally-specific smokeless tobacco/betel-nut concoctions (paan and gutka), comprising 13% of the study sample (14% of men; 12% of women). Culturally-specific smoked tobacco products were used less frequently overall and by both genders: bidis (0.1%) and hookahs (0.4%). Implications/Conclusions: These analyses confirm that use of tobacco, particularly culturally-specific products, is a significant problem among Asian Indians in California, paralleling patterns found in other Asian Indian ethnic enclaves domestically and globally. Currently, statewide efforts do not focus on decreasing the prevalence of culturally-specific tobacco products. Enhanced surveillance measures and targeted interventions, especially for culturally-specific smokeless products, are needed to address tobacco-related disparities among Asian Indians in California and nationwide.