Ethnic differences in trends and determinants of cigarette smoking in Hawaii.
BACKGROUND
The prevalence of smoking continues to be higher in some ethnic groups than in others, despite the overall decrease of smoking during the last 30 years. The goal of this project was to investigate the trends and predictors of cigarette smoking among a population of Caucasians, Japanese, Chinese, Filipino, and Native Hawaiians.


METHODS
We combined data from 19 earlier studies conducted in Hawaii between 1975 and 2001. After excluding 1,885 individuals without smoking data, 158,629 subjects (40.0% Japanese, 30.3% Caucasian, 14.3% Hawaiian, 8.1% Filipino, 3.0% Chinese) were included in the analysis. The prevalence of current smoking and past smoking was estimated for 5-year periods by sex and ethnicity and age-adjusted to the state's population. We calculated odds ratios and 95% confidence intervals by using polytomous logistic regression to explore determinants of smoking, while controlling for clustering by study.


RESULTS
Men were more likely to smoke than women throughout the study period, but they experienced a greater decline in smoking until 1994. We observed a small increase in smoking prevalence thereafter. Native Hawaiians reported the highest smoking prevalence, Japanese the lowest, and Caucasians intermediate levels. Graduate level education had the strongest inverse association with current and past smoking. Older age at interview, being married, and a higher body weight were related to lower smoking prevalence.


CONCLUSIONS
Our data suggest a modest reversal in the declining smoking prevalence during the late 1990s. The persistent ethnic differences require new approaches that reach those groups who remain at high risk for adverse health effects from smoking.
Maskarinec
Gertraud
G
Cancer Research Center of Hawaii, Honolulu, Hawaii 96813, USA. gertraud@crch.hawaii.edu
Dhakal
Sanjaya
S
Pagano
Ian
I
Carlin
Linda
L
Goodman
Marc T
MT
Le Marchand
Loic
L
Nomura
Abraham
A
Wilkens
Lynne R
LR
Kolonel
Laurence N
LN
D000328:Adult; D000368:Aged; D001213:Asian / Q000523:psychology*; D001294:Attitude to Health / Q000208:ethnology*; D040343:Behavioral Risk Factor Surveillance System; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D015438:Health Behavior / Q000208:ethnology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D044468:Native Hawaiian or Pacific Islander / Q000523:psychology*; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000208:ethnology*; D016540:Smoking Cessation / Q000208:ethnology; D044465:White People / Q000523:psychology*