Sun S. Kim

The Sociocultural Context of Korean American Men’s Smoking Behavior

The purpose of this article is to explore the sociocultural context wherein Korean male immigrants learned and maintained smoking behavior. Participants were 11 current and 11 former cigarette smokers who resided in New York City. The participants attended one of four focus groups and talked about their experiences of smoking initiation, changes in smoking behavior over time, smoking in Korea and the United States, strategies used for smoking cessation, and suggestions for a smoking cessation program. The focus group interviews were audiotaped and transcribed verbatim. Themes were identified from answers to the five topic questions and then compared across the four focus groups. Smoking is a common thread in Korean men’s social world and a prime component of Korean men’s gender identity. In contrast, smoking in the United States is increasingly being stigmatized.

A systematic review of the Diagnostic and Statistical Manual diagnostic criteria for nicotine dependence

The Diagnostic and Statistical Manual diagnostic criteria for nicotine dependence (DSM-ND) are based on the proposition that dependence is a syndrome that can be diagnosed only when a minimum of 3 of the 7 proscribed features are present. The DSM-ND criteria are an accepted research measure, but the validity of these criteria has not been subjected to a systematic evaluation. To systematically review evidence of validity and reliability for the DSM-ND criteria, a literature search was conducted of 16 national and international databases. Each article with original data was independently reviewed by two or more reviewers. In total, 380 potentially relevant articles were examined and 169 were reviewed in depth. The DSM-ND criteria have seen wide use in research settings, but sensitivity and specificity are well below the accepted standards for clinical applications. Predictive validity is generally poor. The 7 DSM-ND criteria are regarded as having face validity, but no data support a 3-symptom ND diagnostic threshold, or a 4-symptom withdrawal syndrome threshold. The DSM incorrectly states that daily smoking is a prerequisite for withdrawal symptoms. The DSM shows poor to modest concurrence with all other measures of nicotine dependence, smoking behaviors and biological measures of tobacco use. The data support the DSM-ND criteria as a valid measure of nicotine dependence severity for research applications. However, the data do not support the central premise of a 3-symptom diagnostic threshold, and no data establish that the DSM-ND criteria provide an accurate diagnosis of nicotine dependence.

Psychometric properties of the alcohol use disorders identification test: a Korean version.

OBJECTIVE The Alcohol Use Disorders Identification Test (AUDIT) is an important screening tool but has never been administered to Korean Americans. This study was conducted to examine the psychometric properties of a Korean version of the AUDIT referred to as AUDIT-K and to determine which cutoff score of the scale would perform better in Korean Americans. METHOD Translation and backtranslation of the AUDIT-K were conducted to obtain a measure consistent with the Korean cultural understanding of alcohol use. Following satisfactory interrater agreements on each item about its Korean translation, the AUDIT-K was administered to 118 Korean American men (Time 1) and to 93 of the men approximately 1 month later (Time 2). Data were analyzed for internal consistency reliability, test-retest reliability, and construct validity. RESULTS Approximately 47.5% of Korean American men who participated in the study were identified as having drinking problems when using the World Health Organizations recommended cutoff score of 8, whereas approximately 20.3% were found to have problems with alcohol when using the cutoff score of 12, the one recommended for Koreans. Cronbachs alpha was .82 at Time 1 and was .80 at Time 2. Test-Retest reliability assessed via the intraclass correlation coefficient for the total AUDIT scale was .85. Principal components factor analysis with varimax orthogonal rotation revealed a two-factor solution, alcohol consumption and drinking problems, resulting in 57% of the explained variance. CONCLUSIONS The AUDIT-K was found to be internally consistent and stable over time and should be used in primary health care settings to screen Korean American men for alcohol use disorders to facilitate early interventions.

Predictors of Short‐Term Smoking Cessation Among Korean American Men

OBJECTIVES The purpose of this study was to examine which demographic, smoking behavior, and theoretical variables of theory of planned behavior would predict smoking cessation attempts among Korean American men. DESIGN This is a longitudinal study and data collection was conducted at baseline and 1-month follow-up. SAMPLE At baseline, 118 Korean adult male smokers were recruited into the study and of these, 93 participated at follow-up. MEASURES Study questionnaires consisted of demographic data, smoking behavior, and theoretical variables. ANALYSIS A multiple regression analysis was performed to identify correlates of behavioral intentions to quit smoking at baseline and binary logistic regression analysis for predictors of actual quitting behavior at follow-up. RESULTS Among smoking behavior variables, past-year quit attempts and average number of cigarettes smoked per day explained 15% of the variance in behavioral intentions to quit smoking ( p<.0001). Two theoretical variables attitudes and perceived family social norms increased the explanatory power by 22% ( p<.0001) with an overall of 37%. Religion and perceived family social norms had about 32% predictive power over actual quitting behavior ( p<.0001). CONCLUSIONS Any smoking cessation programs planned for Korean American men consider encouraging family members to affirm antismoking messages to this ethnic subgroup.

Tobacco Use and Dependence in Asian American and Pacific Islander Adolescents: A Review of the Literature

Abstract Purpose: This article identifies gaps in extant tobacco literature and areas for further research on Asian American adolescents. Methods: Research articles published until December 2005 were retrieved from computer-database and manual searches. Results: A total of 62 data based research articles were identified and most (N = 38, 61.3%) had been published within the past 5 years. Chinese, Filipino, and Japanese American adolescents were studied most frequently. In general, Asian-American adolescents initiated smoking later and had a lower prevalence rate than non-Asian American adolescents. However, the estimates of current smoking for Native Hawaiian, Pacific Islander, and Filipino American adolescents in Hawaii were higher than those for adolescents in any other racial and ethnic groups. Most risk factors for smoking initiation were found to be similar to other ethnic minority groups, including the positive association of smoking with acculturation. For this age group the three treatment studies evaluated culturally focused interventions, but did not find improved outcomes. Conclusion: Further research is needed to identify factors associated with the growing use of cigarettes and other tobacco products in late adolescence and young adulthood within the population, including treatment outcome studies. Research recommendations are suggested.

Cross-Cultural Validation of a Smoking Abstinence Self-Efficacy Scale in Korean American Men

The main purpose of the study was to examine the psychometric properties of a Smoking Abstinence Self-Efficacy Scale with Korean men in the US. The scale was modified to reflect the Korean cultural practice of smoking behavior and was cross-culturally validated with a panel of 10 professionals. An 11-item Korean version of the scale was administered twice over a one-month period. Data were analyzed for internal consistency reliability, stability, and construct validity. After the deletion of one item, an exploratory factor analysis yielded two factors, which explained 62% of the variance. Internal consistency was satisfactory for the total scale (.89), Factor I (.88), and Factor II (.80) but intraclass correlation coefficient for the total scale (.57) was low. Nicotine dependence and nicotine withdrawal showed modest but statistically significant correlations with the scale.

Korean American Women's Experiences with Smoking and Factors Associated with Their Quit Intentions

This study explored Korean American womens experiences with smoking and tested the theory of planned behavior to identify factors associated with their intentions to quit smoking. It employed a mixed-methods research design, using qualitative and quantitative data. Participants were recruited via a combination of random (N = 49) and convenience (N = 45) sampling techniques. Women in this study initiated smoking at age of 23 on average, and nearly half smoked at indoor houses. They initiated smoking out of curiosity about the effect and belief that smoking would relieve their stress. Reasons for continued smoking were (a) to avoid nicotine withdrawal symptoms, (b) to cope with life stressors, including acculturative stress, and (c) to fulfill ones destiny as a lifetime smoker. Many attempted to quit due to health issues and pregnancy. Fear of disclosure and limited English proficiency were found to be major barriers to seeking help for quitting. Past-year quit attempt(s), attitudes toward quitting, and perceived family norm favoring quitting explained 25% of the variance in intentions to quit smoking (F [3,90] = 11.58, P < 0.001). Findings suggest that gender- and culture-specific intervention strategies are needed to assist Korean American women in smoking cessation.

Factors associated with alcohol problems among Asian American college students: gender, ethnicity, smoking and depressed mood

Objective: This study examined gender, ethnicity and psychological factors associated with alcohol problems among Asian American college students, using the CAGE questionnaire. Method: The study is a cross-sectional, school-based survey. College students who self-identified as Asian, participated. Results: The sample comprised 258 Asian American college students (132 men and 126 women). In all, 17.7% of males and 8.9% of females had alcohol problems based on CAGE score of 2 or more; yet, the difference was marginally significant (χ2 [1, N = 225] = 3.7, p = 0.08). Chinese and Vietnamese males tended to have more alcohol problems than females in their respective ethnic subgroups. Among Koreans, more females (33%) had the problems than males (11%). Male students did not differ in alcohol problems by ethnicity, whereas Korean females were more likely to have the problems (χ2 [4, N = 112] = 13.0, p = 0.01) than females in the other groups. After controlling for gender, Asian American college students who were older (≥25), smoking currently and reporting depressed mood were more likely to have alcohol problems. Conclusions: College health center workers should monitor more closely Asian students who have the risk factors for early detection of and treatment for alcohol problems.

Psychometric properties of the Minnesota Nicotine Withdrawal Scale: a Korean version.

Smoking is considerably more common among Korean American male individuals compared with all U.S. males, but no reliable and valid nicotine withdrawal scale has been available to measure withdrawal symptoms from the Korean American perspective, which is the aim of the present study. Translation and back-translation of the Minnesota Nicotine Withdrawal Scale (MNWS) was conducted to obtain a measure consistent with the Korean cultural understanding of smoking withdrawal symptoms. Following satisfactory interrater agreements, the Korean version (MNWS-K) was administered to 118 Korean American male smokers. Data were analyzed for internal consistency reliability and stability as well as construct validity. Internal consistency reliability was satisfactory for the total scale and factors (.88, .88, .79) and intraclass correlation coefficient (ICC) for the total score over a 1-month period was fair (r = .51). Exploratory factor analysis with orthogonal rotation yielded two factors. Together, Factor I, early-occurring disturbances in mental functioning, and Factor II, disturbances in physiological functioning and late-occurring disturbances in mental functioning, explained 66% of the variance in the scale. Theoretically related variables to the MNWS-K, number of smoking quit attempts and self-efficacy, showed modest but statistically significant correlations with the MNWS-K total and factored scales. Satisfactory internal consistency coefficients together with the validity findings suggest the MNWS-K warrants use with the Korean American population.

Culture and Smoking Among Vietnamese Americans in Central Massachusetts

The study was conducted (a) to assess use of any smoking cessation medications, (b) to identify factors associated with smoking, and (c) to assess knowledge of the health effects of smoking and attitudes toward smoking and seeking help for quitting among Vietnamese Americans. This is a descriptive study conducted with a nonrepresentative sample of 163 Vietnamese Americans. Current and former smokers constituted 24.4% and 25.6% of men and 1.2% and 3.5% of women, respectively. Of 20 current smokers, 17 (85%) reported use of cessation medications in their past quit attempts. Acculturation was the only significant correlate of ever smoking (vs. never smoking) in multivariate logistic regression analyses. Men who were less acculturated had more than 5 times the odds of being ever smokers (odds ratio = 5.33, 95% confidence interval = 1.37-20.78) compared with more acculturated men. Most participants had correct knowledge of the health effects of smoking regardless of age, education level, and smoking status. Attitudes toward smoking differed by age and education level but not by smoking status. Nurses working with Vietnamese Americans should be aware of the high rate of smoking among male immigrants and provide smoking cessation interventions.