This study showed that smoke-free-home rules are associated with former smoking—particularly among recent immigrants—lighter smoking among long-term residents. These results are consistent with a previous study demonstrating that home smoking restrictions are associated with former and lighter smoking in the general California population.9
The novel aspect of these findings is that the study demonstrates that this association with cessation is stronger for more-recent Asian-American immigrants, reflecting the change in smoke-free social norms. The contradictory finding that smoke-free-home rules were not associated with lighter smoking for recent immigrants may be due to the fact that the recent male immigrants in the study tended to be lighter smokers than longer-term residents, and the addition of a smoke-free-home rule may not have made a significant difference in reducing smoking. Previous evidence demonstrates that Asian-American smokers are more likely to increase their cigarette consumption with greater time in the U.S.15
Smoke-free environments and their health benefits should be emphasized for Asian Americans, especially for recent immigrants. Secondhand-smoke exposure is high among Asian Americans outside of California (38% at home, 40% at work).16
Chinese Americans in New York City with smoke-free-home rules reported significantly less 30-day exposure to secondhand smoke than those living in homes with a partial ban or no ban.17
Secondhand-smoke screening and counseling, which have usually been employed to encourage parents to stop smoking for the benefit of their children,18
may be a promising behavioral smoking-cessation strategy for Asian-American smokers. Almost all Californian Chinese and Korean smokers state that their families want them to quit,19,20
and the largest percentage of California quit-line callers who called for help on behalf of another smoker were Asian-speaking Asians (35%, compared to 5% for English-speaking whites).12
Limitations of this study include lack of access to a telephone by recent immigrants or lack of desire to participate in a survey asking for personal information. Smoking status is from self-report and was not verified with a biochemical test. The survey represents Californian Asian Americans only, and did not over-sample or conduct the survey in-language for all Asian national-origin groups. The survey is cross-sectional, and whether the associations with smoke-free-home rules and immigration are causal for former or lighter smoking cannot be determined because, for example, former smokers may enact no-smoking rules in their homes only after they quit.
Future research should investigate a smoke-free behavioral-cessation approach for Asian smokers in the U.S. and in Asia. Prospective studies of smoke-free-home rules might help establish whether these effects encourage cessation and reduce consumption. The effect of smoke-free-home rules and immigration may be investigated in other ethnicities.