Cigarette Smoking among Kanaka Maoli

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Cigarette Smoking among Kanaka Maoli

• J. Keaweaimoku Kaholokula, PhD
• Department of Native Hawaiian Health
• John A. Burns School of Medicine
• University of Hawaii at Manoa

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Prevalence of Ever Smoked1 by Ethnicity
1996-20062
1Ever smoked former and current smokers 2Data
from Hawaii Department of Health Behavioral Risk
Factor Surveillance System
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Prevalence of Current Smoking by Ethnicity
1996-20061
1Data from Hawaii Department of Health
Behavioral Risk Factor Surveillance System
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Ethnic-by-Gender Differences in Having Ever Smoked
Kaholokula, J.K., Braun, K.L., Kanaiaupuni, S.,
Grandinetti, A., Chang, H.K. (2006).
Ethnic-by-gender differences in cigarette smoking
among Asian and Pacific Islanders. Nicotine
Tobacco Research, 8(2), 275-286.
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Prevalence of Smoking during Pregnancy
Goebert, D., Morland, L., Frattarelli, L., Onoye,
J., Matsu, C. (2007). Mental health during
pregnancy A study comparing Asian, Caucasian,
and Native Hawaiian women. Maternal Child Health
Journal, 11, 249-255.
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Questions

• What leads to smoking initiation among Kanaka
  Maoli?
• What factors maintain smoking among Kanaka Maoli?
• Why do Kanaka Maoli women smoke more than women
  of other ethnic groups?
• What kinds of interventions are most effective
  for Kanaka Maoli?

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What leads to smoking initiation among Kanaka
Maoli?

• Kanaka Maoli with a traditional (66) and
  marginalized (63) mode of acculturation are more
  likely to have ever smoked compared to those
  with an integrated (54) or assimilated (55)
  mode.1

• Greater Kanaka Maoli identity associated with
  smoking among Kanaka Maoli teens.2
• What is it about having a greater Kanaka Maoli
  identity that is associated with smoking?

Hawaiian Cultural Heritage
American Cultural Heritage
1Data from the Native Hawaiian Health Research
Project, University of Hawaii (RR03061) 2Glanz,
K., Mau, M., Steffen, A., Maskarinec, G.,
Arriola, KJ. (2005). Tobacco use among Native
Hawaiian middle school students its prevalence,
correlates and implications. Ethnicity Health,
12, 227-244.
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What correlates with smoking initiation among
Kanaka Maoli youth?

• Greater sense of Hawaiian identity?
• Sense of coherence1
• View that the world makes sense and that one can
  mobilize the resources needed to cope with
  stressors that arise.
• Social influences2
• Peer and parental smoking and attending public
  school

1Glanz, K., Maskarinec, G., Carlin, L. (2005).
Ethnicity, sense of coherence, and tobacco use
among Adolescents. Annals of Behavioral Medicine,
29, 192-199. 2Glanz, K., Mau, M., Steffen, A.,
Maskarinec, G., Arriola, KJ. (2005). Tobacco
use among Native Hawaiian middle school students
its prevalence, correlates and implications.
Ethnicity Health, 12, 227-244.
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What factors are related to the maintenance of
smoking among Kanaka Maoli?

• Emotional distress1, 2
• Lower socioeconomic status1
• Poor social support1
• Presence of other smokers1

1Kaholokula, J.K., Grandinetti, A., Crabbe, K.M.,
Chang, H.K., Kenui, C.K. (1999). Depressive
symptoms and cigarette smoking among Native
Hawaiians. Asia-Pacific Journal of Public
Health,11(2), 60-64. 2Kaholokula, J.K., Braun,
K.L., Santos, J.I., Chang, H.K. (in press).
Culturally-tailored smoking cessation strategies
for Native Hawaiians. Nicotine Tobacco Research.
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What kinds of interventions are most effective
for Kanaka Maoli?

• Multi-component cognitive-behavioral
  interventions
• Combined behavioral and pharmacological
  strategies
• Consider a persons spiritual/religious beliefs
• Health and well-being of family members as a
  motivator to quitting (more so among older
  adults)
• Culturally-focused interventions
• Increasing sense of coherence
• Active coping skills to deal with perceived
  oppression discrimination and other
  psychosocial stressors
• Multi-level intervention strategies
• Individual
• Family/community
• Socio-political

Kaholokula, J.K., Braun, K.L., Santos, J.I.,
Chang, H.K. (in press). Culturally-tailored
smoking cessation strategies for Native
Hawaiians. Nicotine Tobacco Research.
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Social Conditions, Acculturative Stressors and
Smoking
Kanaka Maoli Identity
Emotional Distress
Kanaka Maoli Identity
Psychological Social Stressors
Sense of Coherence
Socioeconomic Status
Smoking Initiation
Smoking Maintenance
Peer Parent Smoking
Public School Attendance
Peer Smoking