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. 2015 Apr 16;13(1):11.
doi: 10.1186/s12971-015-0036-9. eCollection 2015.

Factors associated with smoking in immigrants from non-western to western countries - what role does acculturation play? A systematic review

Katharina Reiss  1 , Jessica Lehnhardt  1 , Oliver Razum  1
Affiliations

Factors associated with smoking in immigrants from non-western to western countries - what role does acculturation play? A systematic review

Katharina Reiss et al. Tob Induc Dis. .

Abstract

Introduction: We aimed to identify factors associated with smoking among immigrants. In particular, we investigated the relationship between acculturation and smoking, taking into consideration the stage of the 'smoking epidemic' in the countries of origin and host countries of the immigrants.

Methods: We searched PubMed for peer-reviewed quantitative studies. Studies were included if they focused on smoking among adult immigrants (foreign-born) from non-western countries now residing in the USA, Canada, Ireland, Germany, the Netherlands, Norway, the UK, and Australia. Studies were excluded if, among others, a distinction between immigrants and their (native-born) offspring was not made.

Results: We retrieved 27 studies published between 1998 and 2013. 21 of the 27 studies focused on acculturation (using bidimensional multi-item scales particularly designed for the immigrant group under study and/or proxy measures such as language proficiency or length of stay in host country) and 16 of those found clear differences between men and women: whereas more acculturated women were more likely to smoke than less acculturated women, the contrary was observed among men.

Conclusion: Immigrants' countries of origin and host countries have reached different stages of the 'smoking epidemic' where, in addition, smoking among women lags behind that in men. Immigrants might 'move' between the stages as (I) the (non-western) countries of origin tend to be in the early phase, (II) the (western) host countries more in the advanced phase of the epidemic and (III) the arrival in the host countries initiates the acculturation process. This could explain the 'imported' high (men)/low (women) prevalence among less acculturated immigrants. The low (men)/high (women) prevalence among more acculturated immigrants indicates an adaptation towards the social norms of the host countries with ongoing acculturation.

Keywords: Acculturation; Immigrants; Smoking; Smoking epidemic; Systematic review.

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Figures

Figure 1
Figure 1
The stages of the ‘smoking epidemic’ proposed by Lopez et al. in 1994.
Figure 2
Figure 2
Schematic diagram on the association between the ‘smoking epidemic’ and acculturation.
Figure 3
Figure 3
Inclusion and exclusion of publications in the systematic review.
See this image and copyright information in PMC

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