SYSTEMATIC REVIEW Acculturation and smoking in North Americans of Chinese ancestry: A systematic review

OBJECTIVES:Many North American immigrants come from China. Given the critical impact of tobacco use on health, it is important to understand rates and correlates of smoking in this population. This systematic review addressed the question: based on current research, what is the association between acculturation and smoking behaviours in Chinese immigrants to North America? METHODS: The search was conducted in PubMed, Medline, Web of Science, and Academic Search Complete for papers published from 2005 to 2014. Data were extracted from Canadian and American studies for population characteristics, study design, measures of smoking and acculturation, and findings regarding smoking rates and associations between smoking and acculturation. SYNTHESIS: The literature search identified 147 articles, and 14 met inclusion criteria. Three studies were based on Canadian samples and the remaining 11 were from the United States. Of the 14 papers, 3 reported findings for youth and 11 for adults. Among adults, daily smoking rates were consistently much higher in men than women; for men, rates varied from 9% to 30%. Language use and time in North America were the most common indicators of acculturation. Almost all studies found a relationship between acculturation and smoking, such that more acculturated men smoke less and more acculturated women smoke more. CONCLUSION: The findings suggest that the association between acculturation and smoking is gender-specific. This correlation is found in youth and adults and in both Canada and the US. Increased acculturation has a protective effect on smoking for Chinese North American men, but a harmful effect for women. Tobacco control interventions need to develop targeted strategies appropriate to these different populations.