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Table 4 Methodological quality assessment of the articles included in the review

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

No. Authors Year and country of study Study aim Immigrant group under study (definition of immigrants) Data source (secondary data) or sampling method (primary data) Data collection method Study design Number of immigrant participants Operational definition of variables used (DV = dependent variable; IV = independent variable) Statistical methods applied besides standard descriptive analyses Reported study limitations
1 Constantine, Rockwood, Schillo, Alesci, Foldes, Phan, Chhith, Saul [56] 2010 in USA To explore relationship between smoking and acculturation Hmong, Vietnamese, Cambodian and Laotian Americans (country of birth, self-identification) Sample construction via list of surnames common to specific community, utilization of telephone screener for recruitment where a household member was selected at random Interviewer- and telephone-administered survey (translated instrument, bilingual interviewers) Cross-sectional 1,615 (95% foreign-born) DV: current smoker vs. non-smoker IV: age, education, % of life lived in USA, acculturation Logistic regression Stratified by gender, for males also by nativity Self-reported tobacco use, underreporting of smoking among Vietnamese, Cambodian, and Lao populations possible, small sample size for within group (ethnicity and gender) analysis
2 Hu, Pallonen, Meshack [57] 2010 in USA To analyse impact of immigration status on tobacco use Chinese Americans (country of birth, country of residence before immigration) Chinese-American households with listed residential telephone numbers and list of Chinese surnames, random household selection by stratified probability sampling method with geographically proportional allocation, additional public relations work Self-administered (mail) and telephone-administered survey (translated instrument, bilingual interviewers) Cross-sectional 1,054 (94% foreign-born) DV: current smoker vs. non-smoker IV: age, income, education, years living in the USA Logistic regression Highest statistical analysis only for males Failure to reach two-thirds of all potential respondents, more than one-third of potential respondents in initial sampling frame denied they were Chinese, small sample size of female Chinese-American smokers
3 Al-Omari, Scheibmeir [58] 2009 in USA To describe relationship between tobacco use and psychological acculturation Arab American (country of birth) Convenience-sampling method: 2 grocery stores and one Islamic center were used to recruit participants Self-administered survey (instrument only in English, no information on presence of bilingual interviewers) Cross-sectional 96 (100% foreign-born) Nicotine dependence with tobacco exposure and acculturation (acculturation also by gender) Pearson correlation statistics Small number of participants and nonrandomised sampling, large overrepresentation of men in sample, instrument only available in English language
4 Stoddard [59] 2009 in USA To examine impact of social and structural factors on risk of smoking initiation among immigrants before and after immigration Mexican American (self-identification) Data source: National Health Interview Survey (NHIS) (nationally representative survey in the USA conducted annually) Interviewer-administered survey (translated instrument, bilingual interviewers) Cross-sectional 6,935 (58% foreign-born) DV: risk of regular smoking initiation IV: age, education, country of smoking initiation Discrete-time hazard analysis Stratified by gender Only limited analysis of social and structural factors, use of retrospective data on age at immigration and age of smoking initiation (recall bias due to cohort design possible), data on exact age at immigration were unavailable and had to be approximated or imputed
5 Maxwell, Garcia, Berman [60] 2007 in USA To examine knowledge, beliefs and attitudes towards smoking and to examine relationship between i.e. duration of stay and acculturation with smoking Male Filipino Americans (probably self-identification, not further specified) Sampling by approach of community-based organizations serving Filipino Americans, Filipino American associations, Christian churches, businesses Interviewer-administered survey (translated instrument, bilingual interviewers) Cross-sectional 318 (100% foreign-born) DV: current smoker vs. non-smoker IV: age, duration of residency in USA, English usage with friends, education, income, employment, health insurance, knowledge score, smoking beliefs score, perceived risk of lung cancer, perceived risk of smoking-related diseases, most friends smoke Logistic regression Community sampling, sample was restricted to Filipino men aged 40-75 years, cross-sectional design, assessment of some constructs with only single items to keep survey brief
6 An, Cochran, Mays, McCarthy [61] 2008 in USA To estimate effects of multiple acculturation indicators on current smoking, to compare gender- and ethnic subgroup-specific current smoking prevalence, to examine effects of other potential predictors of smoking behavior for men and women Chinese, Filipino, South Asian, Japanese, Korean, and Vietnamese Americans (probably self-identification, not further specified) Data source: 2001 and 2003 California Health Interview Survey (CHIS) (household survey conducted by random-digit dialing with oversampling of areas with high concentrations of specific ethnic groups) Telephone-administered survey (translated instrument, bilingual interviewers) Cross-sectional 8192 (foreign-born: Chinese 91%, Filipino 90%,South Asian 96%, Korea 94%, Vietnam 98%) DV: current smoker vs. non-smoker IV: education, marital status, alcohol consumption, poverty level, health care, insurance, language, length of stay, ethnicity Logistic regression Stratified by gender, not stratified by nativity South Asian American women use smokeless tobacco primarily (risk of underestimation of total tobacco use), cross-sectional design, use of existing data constrained investigators’ measures of acculturation (available measures did not capture multidimensional nature of acculturation)
7 Maxwell, Bernaards, McCarthy [62] 2005 in USA To report smoking rates among different ethnic groups and to compare correlates of smoking among Chinese & Filipino Americans and Hispanic Americans Chinese & Filipino Americans, Hispanic Americans, additionally African/Black Americans, American Indian/Alaska Natives, Pacific Islanders (probably self-identification, not further specified) Data source: 2001 California Health Interview Survey (CHIS) (household survey conducted by random-digit dialing with oversampling of areas with high concentrations of specific ethnic groups) Telephone-administered survey (translated instrument, bilingual interviewers) Cross-sectional 13,414 (foreign-born: Hispanics 65%, Asians 77%) DV: current smoker vs. non-smoker IV: age, marital status, education, employment, income, country of birth, years in the USA, level of spoken English Logistic regression Stratified by nativity and gender All data are based on self-report, cross-sectional design, only households were reached that had a telephone, only few items were available to assess acculturation, no questions about other tobacco products
8 Rahman, Luong, Divan, Jesser, Golz, Thirumalai, Reedy, Olivas [63] 2005 in USA To examine smoking prevalence as well as factorsthat may be associated with smoking Male Vietnamese Americans (probably self-identification, not further specified) Sample drawn from Vietnamese surnames listed in telephone directory, residential telephone numbers were eligible for sampling, random-digit-dialing sampling procedure Telephone-administered survey (translated instrument, bilingual interviewers) Cross-sectional 660 (100% foreign-born) DV: current smoker vs. non-smoker IV: age, income, education, marital status, English language proficiency, language used at home, language used with friends, length of stay in USA, blood cholesterol check, routine physical check up, binge drinker, multiple sex partners Logistic regression Random-digit-dialing methodology excluded potential respondents without telephones, self-report of smoking, findings may not be representative of the behavioural risk factors for Vietnamese who reside in other states than California
9 Wilkinson, Spitz, Strom, Prokhorov, Barcenas, Cao, Saunders, Bondy [64] 2005 in USA To analyze smoking by age, education, acculturation, and country of birth, to investigate differences in smoking behaviour among US- and foreign-born smokers and to examine role of exposure to US culture in smoking Mexican Americans (probably self-identification, not further specified) Data was used from ongoing cohort of Mexican American households (participants were recruited through random-digit dialing, “block walking”, “intercept” (i.e., recruiting individuals from e.g. community centers or local health clinics), and networking via already enrolled participants) Self-administered survey (translated instruments, bilingual interviewers present) Cross-sectional 5,030 (70% foreign-born) DV: current smoker vs. non-smokerIV: age, gender, education, acculturation, age at migration, contextual level (home ownership, Spanish speaking, more than high school education, US-born, median age), age at migration Logistic regression Stratified by country of birth (1 model for US-born persons, 2 models for Mexican-born persons) Cross-sectional design, unable to assess influence of family contexts on smoking, smoking was self-reported, other key variables (age at migration and country where smoking was initiated) were calculated on the basis of self-reports (not directly assessed)
10 Hofstetter, Hovell, Lee, Zakarian, Park, Paik, Irvin [65] 2004 in USA To examine tobacco use and its determinants with special emphasis on acculturation Korean Americans (probably self-identification, not further specified) Sampling frame based on residential telephones listed to Korean surnames, list was sorted into random order for interviewing Telephone-administered survey (translated instrument, bilingual interviewers) Cross-sectional 2,830 (94% foreign-born) DV: smoking; smoking uptake; age at first cigarette; smoke cigarette if offered by a friend (yes vs. no) IV: age, education, employment status, acculturation, social support, models who smoke Ordinary least squares analysis and logistic regression Interaction terms between gender and each IV Design as telephone survey where no information on persons without residential telephones was available, cross-sectional design
11 Shelley, Fahs, Scheinmann, Swain, Qu, Burton [66] 2004 in USA To describe tobacco use knowledge, attitudes and behaviours and to examine association between patterns of tobacco use and acculturation Chinese Americans (self-identification) List of Chinese surnames, application of stratified systematic sampling procedure (2 stages: first, sample cohort of Chinese American households was identified and data gathered of all adults within households; second, 3 sample groups of adults aged 18-64 years were selected for extended interview: (1) current smokers, (2) nonsmoking men, and (3) women Interviewer-administered survey (translated instrument, bilingual interviewers) Cross-sectional 712 (97% foreign-born) DV: current smoker vs. former smoker, never smoker vs. ever smoker IV: age, education, employment, marital status, insurance, health care use, knowledge of tobacco risks, English language used at home, reading of English newspapers Logistic regression Highest statistical analysis only for males Preliminary results to be confirmed by analysis of full sample, sampling frame was based on subjects living in households with listed telephones, self-reports were not validated
12 Fu, Ma, Tu, Siu, Metlay [67] 2003 in USA To assess whether greater level of acculturation was associated with decreased current cigarette smoking Chinese Americans (self-identification) Recruitment in medical practices with fluent Chinese-speaking providers Self-administered survey (translated instrument, bilingual interviewers present) Cross-sectional 541 (98% foreign-born) DV: current smoker vs. non-smoker IV: acculturation Adjusted for age, study site, education level, income Logistic regression Highest statistical analysis only for males Language proficiency only one dimension of acculturation, study subjects were a convenient sample of patients at medical or dental practices, differences between participating and non-participating clinics may limit validity of results, self-reported smoking behaviour, very small number of female cigarette smokers
13 Juon, Kim, Han, Ryu, Han [68] 2003 in USA To examine prevalence of smoking and the correlated factors of smoking Male Korean immigrants (country of birth) Community-based sampling in six Korean churches and two Korean grocery stores Self-administered survey (translated instrument, in exceptional cases interviewer-administered survey with bilingual interviewers) Cross-sectional 771 (100% foreign-born) DV: current smoker vs. never smoker; former smoker vs. never smoker IV: age, education, marital status, employment, length of stay, history of hypertension, regular check-up, alcohol use Logistic regression Exclusion of those who do not go to church or groceries, underreporting of smoking during survey in church, length of stay only one dimension of acculturation
14 Ma, Shive, Tan, Toubbeh [69] 2002 in USA To determine tobacco use rates and to determine demographic variables that are potential predictors of tobacco use Chinese, Korean, Vietnamese and Cambodian Americans (self-identification) Random selection and division of Asian American community organisations into clusters, stratification of selected organization clusters according to 4 ethnicity groups (Chinese, Korean, Vietnamese, Cambodian), use of proportional allocation procedure in which sample sizes were assigned proportionally to subgroups Interviewer-administered survey (bilingual interviewers, no information on translated instrument) Cross-sectional 1,174 (94% foreign-born) DV: current smoker vs. non-smoker IV: gender, age, education, marital status Logistic regression Not stratified by nativity Cross-sectional design, self-report procedure, modifications of the simple random sampling design had to be applied to facilitate greater access to the communities
15 Yu, Chen, Kim, Abdulrahim [70] 2002 in USA To describe and examine factors significantly associated with smoking Chinese Americans (self-identification) List of Chinatown residents was generated by merging compiled surnames, telephone directories and Chinese newspaper subscribers, two-stage probability sampling method to randomly select Chinese households Interviewer-administered survey (translated instrument, bilingual interviewers) Cross-sectional 644 (100% foreign-born) DV: current smoker vs. non-smoker IV: education, usual source of health care, knowledge of cancer warning signs Logistic regression Highest statistical analysis only for males No limitations reported Very small number of female smokers, cross-sectional design, selection bias due to sampling procedure, sample was restricted to Chinese men aged 40-69 years
16 Kim, Yu, Chen, Kim, Brintnall, Vance [71] 2000 in USA To examine smoking behaviour, knowledge and beliefs and to better understand tobacco-related factors Korean Americans (probably self-identification, not further specified) Compilation of list with Korean household names, Korean newspaper subscribers, participants in Korean community centre, two-stage probability sampling method to randomly select Korean households Interviewer-administered survey (translated instrument, bilingual interviewers) Cross-sectional 263 (100% foreign-born) DV: current smoker vs. non-smoker IV: age, education, religion, English proficiency, length of stay in USA Logistic regression Highest statistical analysis only for males No limitations reported Very small number of female smokers, cross-sectional design, selection bias due to sampling procedure, sample was restricted to Korean men aged 40-69 years
17 Shankar, Gutierrez-Mohamed, Alberg [72] 2000 in USA To describe smoking prevalence and to evaluate attitudes and beliefs towards smoking El Salvadoran immigrants (country of birth) Survey of Salvadoreans living in the Washington DC metropolitan area (not further specified, with reference to publication on sampling details) Interviewer-administered survey (bilingual interviewers, no information on translated instrument) Cross-sectional 1,458 (100% foreign-born) DV: prevalence difference (current vs. never; former vs. never) IV: age, gender, marital status, household size, employment status, income, years of schooling, age at migration Linear regression No limitations reported Very small number of female smokers, recently immigrated group and heavily weighted towards young persons, no association between smoking and socioeconomic status were found at all
18 King, Polednak, Bendel, Hovey [73] 1999 in USA To examine differences in smoking between foreign- and native-born persons and to examine impact of demographic and socioeconomic status on smoking African/Black Americans (country of birth, self-identification) Data source: National Health Interview Survey (NHIS) (nationally representative survey in the USA conducted annually), additional merging of Cancer Control Supplement (CCS) and Cancer Epidemiology Supplement (CES) to increase representation of African/Black Americans Interviewer-administered survey (no information on translated instrument or bilingual interviewers) Cross-sectional 16,738 (7% foreign-born) DV: current smoker vs. non-smoker IV: age, gender, education, income, length of stay in USA, nativity (native- vs. foreign-born), employment, marital status, region Logistic regression Possibility of underestimating smoking prevalence due to undocumented residents and non-respondent bias, sampling error due to undercoverage, NHIS data is cross-sectional
19 Wiecha, Lee, Hodgkins [74] 1998 in USA To measure prevalence and patterns of tobacco use and to identify smoking risk factors and readiness to quit smoking Male Vietnamese American (probably self-identification, not further specified) Vietnamese names were used to construct a search list, phone numbers of persons with one of these names were obtained by manual abstraction of directories representing communities with the largest Vietnamese populations Telephone-administered survey (bilingual interviewers, no information on translated instruments) Cross-sectional 774 (100% foreign-born) DV: current smoker vs. non-smoker IV: age, smoking parents, education, exercise, depression, health insurance, part of Vietnam raised in Logistic regression Restriction to males only, sampling frame was based on subjects living in households with listed telephones, depression measures used are likely to have been relatively imprecise
20 Hyman, Fenta, Noh [75] 2008 in Canada To present data on risk and protective factors associated with smoking Ethiopian immigrants (country of birth) Snowball technique (membership lists of Ethiopian organizations) and list of Ethiopian names was compiled using city telephone directory as sampling frame, household selection using simple random sampling method, additional public relations work Interviewer-administered survey (translated instrument, bilingual interviewers) Cross-sectional 342 (100% foreign-born) DV: current smoker vs. non-smoker IV: age, marital status, importance of religion, education, employment status, length of stay in Canada, exposure to pre-migration trauma, refugee camp internment, number of post-migration life events, satisfaction with social support Logistic regression Results presented from bivariate regression (multivariate analysis carried out only for males – results not presented) Bivariate analysis stratified by gender Exclusion of potential candidates if they had no telephone, stable address or membership status in Ethiopian organisations, small number of female smokers prevented further statistical analyses
21 Kabir, Clarke, Keogan, Currie, Zatonski, Clancy [76] 2008 in Ireland To identify significant predictors of smoking Polish immigrants (country of birth) Advertisement in Polish lifestyle magazine, 10 Polish interviewers were posted at busy intersection of the Dublin city area (with numerous Polish shops) Interviewer-administered survey (translated instrument, bilingual interviewer) Cross-sectional 1,545 (100% foreign-born) DV: current smoker vs. non-smoker IV: education, employment, duration of stay Adjusted analysis (variables not stated) Logistic regression Very constrained generalisability of study findings (high risk of selection bias due to sampling procedure)
22 Reiss, Spallek, Razum [77] 2010 in Germany To analyse whether smoking differs between groups with increasing duration of stay Ethnic German immigrants from Former Soviet Union countries (birth in Germany, citizenship, naturalization) Data source: German microcensus (annual countrywide census including 1% of all German households, participation in survey is obligatory) Interviewer-administered survey (no information on translated instrument or bilingual interviewers) Cross-sectional 13,158 (100% foreign-born) Smoking prevalence with different lengths of stay (3 categories) Descriptive analysis Chi-square-test Analysis stratified by gender, age and education Cross-section design, very small number of smokers aged 65 years and older, since survey is carried out on household level, ‘cluster effect’ cannot be ruled out
23 Reeske, Spallek, RazumGermany [78] 2009 in To investigate smoking patterns among groups with increasing duration of stay and among native-born persons Turkish immigrants (birth in Germany, citizenship, naturalization + information on parents) Data source: German microcensus (annual countrywide census including 1% of all German households, participation in survey is obligatory) Interviewer-administered survey (translated instrument, no information on bilingual interviewers) Cross-sectional 12,288 (59% foreign-born) Smoking prevalence among first- and second-generation immigrants and with different lengths of stay among first-generation immigrants (3 categories) Descriptive analysis Chi-square-test Analysis stratified by gender, age and education Cross-section design, partially very small number of smokers after stratification, since survey is carried out on household level, ‘cluster effect’ cannot be ruled out
24 Nierkens, de Vries, Stronks [79] 2006 in the Netherlands To assess smoking prevalence and its socioeconomic gradients among three immigrant populations Turkish, Moroccan, Surinamese immigrants (country of birth and parents’ country of birth) Data sources: (1) SUNSET study (Surinamese in the Netherlands: Study on Ethnicity and Health), general healh questionnaire carried out by the Munisipal Health Organisation Amsterdam (population surveys where samples were drawn from municipal population register) Interviewer-administered survey (translated instrument, bilingual interviewer) Cross-sectional 1,773 (100% foreign-born) Percentage of current smokers and former smokers by gender, age and education Descriptive analysis Percentages with 95% confidence intervals and Odds Ratios Cross-section design, self-reported smoking status, no figures about exact response rates of Turkish and Moroccan sample (selection bias cannot be ruled out)
25 Vedøy [80] 2013 in Norway To investigate the association between education and smoking status and to examine if associations fit the pattern predicted by the model of the cigarette epidemic Turkish, Iranian, Pakistani, Vietnamese, Sri Lankan immigrants (country of birth) Data source: HUBRO (Oslo Health Study) and Immigrant-HUBRO (population surveys where samples were drawn from municipal population register; citizens born in 1940, 1941, 1955, 1960 and 1970) Self-administered survey (translated instrument, no information on presence of bilingual interviewers) Cross-sectional 4,060 (100% foreign-born) DV: current smoker vs. non-smoker IV: country of birth, age, education, marital status Logistic regression Analyses stratified by gender Cross-section design, self-reported smoking status, low response rates among immigrants (selection bias cannot be ruled out), selection caused by variations in immigration history might have influenced differences between immigrant groups
26 White, Harland, Bhopal, Unwin, Alberti [81] 2001 in UK To present representative data on smoking Chinese immigrants (probably self-identification, not further specified) First, name analysis of Health Services register; second, publicity aimed at Chinese community; third, respondents identified other Chinese residents known to them Party self-administered, partly interviewer-administered survey (translated instrument, bilingual interviewer) Cross-sectional 380 (100% foreign-born) Percentage of current, ex, and never smokers by gender, age, social class, marital status Descriptive analysis Chi-square-test, Mantel-Haenszel test Age-standardisation (direct method) Due to the used methodology impossible to provide an accurate response rate, findings may not be representative for Chinese who reside in other areas of the UK, very small sample size, more detailed information needed on types and daily patterns, knowledge and attitude towards smoking
27 Girgis, Adily, Velasco, Garden, Zwar, Jalaludin, Ward [82] 2009 in Australia To determine associations of tobacco use and tobacco control indicators Arab immigrants (probably self-identification, not further specified) Recruitment of Arab immigrants (18-65 years) via Arab speaking general practitioners Self-administered survey (translated instrument, no information on presence of bilingual interviewers) Cross-sectional 1,371 (100% foreign-born) DV: current smoker vs. non-smoker, recall of cessation advice vs. no recall, nicotine dependence (scale), readiness to quit (scale) IV: age, gender, education, employment, marital status, health status Logistic regressions & linear regressions Selection bias due to sampling procedure via general practitioners (low response rate), self-reported tobacco use