Is acculturation a risk factor for early smoking initiation among Chinese American minors? A comparative perspective.

OBJECTIVE To determine the extent to which Chinese American and white minors differ in age of smoking initiation, and to determine the effect of acculturation on smoking initiation. DESIGN Cross-sectional telephone surveys. SETTING Stratified random samples of the state of California, United States. SUBJECTS 347 Chinese American and 10 129 white adolescents aged 12 through 17 years, from the California Tobacco Survey (1990-93) and the California Youth Tobacco Survey (1994-96). OUTCOME MEASURES Hazards (risk) of smoking initiation by age, smoking initiation rate, cumulative smoking rate, mean age of smoking initiation, and acculturation status. STATISTICAL METHODS Life table methods, proportional hazards models, and chi(2) tests. RESULTS The risk of smoking initiation by age among Chinese American minors was about a third of that among white minors. The risk for Chinese Americans continued to rise even in later adolescence, in contrast to that for whites, which slowed after 15 years of age. Acculturation was associated significantly with smoking onset among Chinese Americans. Acculturation, smoking among social network members, attitudes toward smoking, and perceived benefits of smoking were associated with the difference in hazards of smoking onset between Chinese American minors and their white counterparts. CONCLUSIONS Chinese American adolescents had a lower level and a different pattern of smoking onset than white adolescents. Levels of acculturation and other known risk factors were associated with the hazards of smoking initiation among Chinese American minors and with the difference in smoking initiation between the Chinese and white adolescents. Tobacco prevention policies, strategies, and programmes for ethnically diverse populations should take acculturation factors into account.