Smoking rates among rural Hawaiian women are particularly alarming, says Andrew Grandinetti, Ph.D., a member of the research team led by Healani Chang, Dr. P.H., at the Pacific Biomedical Research Center at the University of Hawaii at Manoa, Honolulu, Hawaii.
The study is the first step in an ongoing investigation to find out why so many Hawaiians smoke and why so many have trouble kicking the habit, says Grandinetti, an epidemiologist at the research center. "Some of the things we’ll be looking at are cultural identity, depression and quality of life," says Grandinetti, noting that as a group, rural Hawaiians tend to be of lower socioeconomic status than other ethnic groups.
The researchers investigated smoking behaviors among 1,459 people living in the rural area of Kohala on the Big Island of Hawaii from 1997 to 2000. About one-third were native Hawaiians, and the other two-thirds were classified as Japanese American, Filipino American, Caucasian or "other." The study showed that 24.7 percent of Hawaiians were current smokers – a rate higher than in any other ethnic group on the island.
Hawaiian women were also more likely to be current smokers – 24.9 percent. This was about double the rate of current female smokers among the second-place Filipino Americans, who came in at 14.4 percent. But Hawaiian men were no more likely to be current smokers than those in the Filipino or "other" categories. The rates were 24.4 percent for Hawaiian men, 26.9 percent for Filipino men and 26.5 percent for other men.
While the prevalence of smoking was generally higher for men than for women for each ethnic group, Hawaiian women were just as likely to smoke as their male counterparts, Grandinetti notes. To gain more insights into quitting habits, the investigators also looked at rates of "ever-smokers," defined as ex-smokers who had indulged in at least 100 cigarettes in their lifetime.
Japanese men had the highest number of past smokers at 54.1 percent, followed closely by Caucasian women, 45.8 percent.
The study also found that regardless of ethnicity, both age and education were associated with smoking status.
Just over 20 percent of the 18- to 29-year-old group smoked, compared with about 18 percent of those age 45 and older, Grandinetti says.
As for education, 17.8 percent of those who never graduated high school and 22.9 percent of high school graduates reported smoking, the study showed, compared with only 8 percent of those who went to college or beyond.
Statistical analysis that took into account age and education levels showed that native Hawaiians were nearly three times more likely to be current smokers than Caucasians in Hawaii.
"That’s who we have to target," Grandinetti says. "We need to come up with new strategies tailored to native Hawaiian culture."
The next step, he says, will be a study to determine which factors contribute to the high smoking rates and dismal quitting rates among Hawaiians. Then, the team plans to go into rural areas and talk to people in the community about what they think are the barriers to a smoke-free lifestyle, Grandinetti says.
"This research is just a first step," he says. "Anti-tobacco programs directed at other minority groups have worked, and we can make tailored messages work here too."