Reducing Smoking in the Chinese Community

(Photo by Mike Hong for Voices of NY)

Chinese-American Patrick Kwan, who until last May was the director of NYC Smoke-Free, has battled for years against smoking – advocating in communities across the city for smoking cessation but also mindful of the need for this effort within his own community. The smoking rate among Asian Americans in New York City was 25.4 percent in 2015, buoyed, experts believe, in part by tradition and in part by the ready availability of cheap, smuggled cigarettes. The smoking rate for all city residents is 14.3 percent.

Kwan believes that the long history of using tobacco products in the Chinese community is a key factor behind the high rate of smoking in the community. “Our families still give tobacco as a gift,” said Kwan. “If you have kids growing up smelling secondhand smoke and seeing people smoking around them, they’re more likely to use tobacco, because their brains become addicted to that, and tobacco addiction becomes more acceptable. So we will have generation after generation keep using it.”

From 2000 to 2014, lung cancer deaths decreased 16.4 percent in New York City, but increased 70 percent among Chinese New Yorkers, the New York City Department of Health and Mental Hygiene reported in June, in their first-ever report on the leading causes of death and premature mortality rates among Chinese New Yorkers. Smoking, long associated with lung cancer incidence, is the unsurprising culprit.

“We know that tobacco use is one of the leading causes of cancer in New York City and a significant driver of mortality in the Chinese community,” Health Commissioner Dr. Mary T. Bassett said at a press conference on June 28.

For many, the widespread acceptance of smoking in Chinese communities is at the root of the deadly statistics. As Leo Li, a health coach with the Quit Smoking Program offered by the Charles B. Wang Community Health Center, observed: “I found out most Chinese smokers started smoking at a really, really young age, some even started at 12, 14 when they were in China.” He mentioned that when he asked some Chinese smokers why they like to smoke, “they just said, ‘I don’t know, I’ve just been doing it for a long time.’” Added Li: “So when they immigrated here, they just keep the old habit with them everyday.”

Based on his experience with consulting Chinese smokers, Li also found that “more than half of the patients I consulted work in a Chinese restaurant.” Li adds that it’s part of the Chinese restaurant culture: “Whenever they take a break, they smoke; many of their co-workers smoke too. It’s like peer pressure.” Li continued, “And some patients working in restaurants told me their lives are pretty boring. Many of them are new immigrants living alone, so they just smoke to pass time and to make themselves feel better and relax.”

An open secret

Another major reason for the high smoking rates among Chinese Americans is that rampant smuggling makes cigarettes relatively cheap in the community. About 46 percent of Chinese-American smokers surveyed by the Charles B. Wang Community Health Center and the NYU Langone Medical Center paid between $1 to $5 per pack, said Regina Lee, the Charles B. Wang Center’s director of health education, in testimony at the City Council hearings on tobacco control last April. The average price paid was $7.62. The base retail price for a pack of cigarettes is currently $10.50, but is slated to rise to a minimum of $13.00 thanks to a recent bill passed by the City Council. That anti-smoking bill, introduced in April, includes other measures such as banning the sale of tobacco products at pharmacies.

In New York City’s Chinese community, the way to purchase smuggled cigarettes is an open secret. Buyers and sellers communicate via phone or WeChat, the popular Chinese social media platform, and only in Chinese. According to insiders, the whole transaction is always conducted in front of big shopping malls or busy public areas, but never in private homes or in quiet neighborhoods. The vendors normally arrive early and wander around the selected location, to make sure they aren’t been watched by police. The cigarettes are put in opaque plastic bags and swiftly handed to the buyer, then the money is paid. The whole transaction is over in the blink of an eye.

Rachelle Ocampo, the associate director of health education at the Charles B. Wang Community Health Center (Photo by Mike Hong for Voices of NY)

The sheriff of New York City is in charge of seizing illegal tobacco products, but with 150 deputies and detectives monitoring nearly 9,000 tobacco stores, it is hard enough for the sheriff to inspect them for smuggled cigarettes, let alone track down those using “guerrilla tactics” to sell on the street and communicating with each other in a foreign language via a social media tool. “There are not many things the sheriff can do,” said Rachelle Ocampo, the associate director of health education at the Charles B. Wang Center.

“It’s hard to knock down every black market for cigarettes, so we try to tackle it in other ways, like providing free quit smoking resources and changing the social norms,” said Ocampo. “What we can do is to break up that habit and denormalize the smoking.”

“Smoking is not just an issue, it’s a behavior. We treat it as a behavior, which connected with other issues from work and family, then we can try to change it,” said Richeng Li, a certified tobacco treatment specialist at the Charles B. Wang Center.

“We need comprehensive tobacco control,” Kwan said. “We have to have resources for people to quit, we have to have education, and we have to have policies.”

At the press conference in June, Commissioner Bassett announced that the health department will partner with community organizations to increase anti-smoking messages directed to the Chinese community.

“All of us, physicians, hospitals, health clinics, the health department, community leaders, and our elected officials, need to work together to reduce tobacco use in the community,” said Dr. Warren Chin, the executive director of the Chinese American Medical Society. “We need to provide better education to the community about health risks related to smoking, as well as improve access to cessation services.”

Mike Hong is a reporter for World Journal. This article was written as part of the Health Reporting Fellowship of the Center for Community and Ethnic Media and funded by a grant from News Corp.

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