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Namratha R. Kandula, MD, MPH, Ming Wen, PhD, Elizabeth A. Jacobs, MD, MPP and Diane S. Lauderdale, PhD

Namratha R. Kandula is with the Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. Ming Wen is with the Department of Sociology, University of Utah, Salt Lake City. Elizabeth A. Jacobs is with the Collaborative Research Unit, John H. Stroger Jr Hospital of Cook County & Rush University Medical Center, Chicago. Diane S. Lauderdale is with the Department of Health Studies, University of Chicago, Chicago.

Correspondence: Requests for reprints should be sent to Namratha R. Kandula, Northwestern University, 750 North Lakeshore Dr, 10th floor, Chicago, IL 60611 (e-mail: n-kandula{at}northwestern.edu).

Objectives. To study neighborhood-level determinants of smoking among Asian Americans, we examined 3 neighborhood factors (ethnic enclave, socioeconomics, and perceived social cohesion) and smoking prevalence in a population-based sample.

Methods. We linked data from the 2003 California Health Interview Survey to tract-level data from the 2000 Census. We used multivariate logistic regression models to estimate the associations between smoking and neighborhood-level factors, independent of individual factors.

Results. Twenty-two percent of 1693 Asian men and 6% of 2174 Asian women reported current smoking. Women living in an Asian enclave were less likely to smoke (adjusted odds ratio [AOR] = 0.27; 95% confidence interval [CI] = 0.08, 0.88). Among men, higher levels of perceived neighborhood social cohesion were associated with lower odds of smoking (AOR = 0.74; 95% CI = 0.61, 0.91).

Conclusions. The association between contextual factors and smoking differed for men and women. For women, living in an Asian enclave may represent cultural behavioral norms. For men, neighborhood trust and cohesiveness may buffer stress. Smoking prevention and cessation interventions among Asian Americans may be more effective if they address contextual factors.

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