girl smoking
Filipinas in Hawai‘i are picking up their first cigarettes as much as two years before their peers do, according to the Hawaii Youth Tobacco Survey.

Culture and family influence on smoking in Filipina girls

Smoking rates for youth in the U.S. have been declining, but the trend does not hold true for some Asian American ethnicities.  Recent results from Hawai‘i’s Youth Tobacco Survey indicate that 20.1% of Filipina high school girls smoke, compared to only 5.6% of Japanese and 5.3% of Chinese girls.  In fact, Filipinas in Hawai‘i are picking up their first cigarettes as much as two years before their peers do.

Matthew Lim first became aware of these alarming facts as an undergraduate at the UH Mānoa.  Born and raised on Oahu, Lim found that he wanted to learn more about culture and health practices after taking Ilokano classes at UHM.

Matthew Lim
Matthew Lim began his research as part of UHM’s Undergraduate Research Opportunities Program (UROP).

“At the time, I was going through a new kind of cultural awareness,” Lim said.  “I was figuring out what I could do, not only for myself but for the community I belong to: the Ilokanos here in Hawai‘i.”

“I realized that language could be a major barrier to better health care—and not just language, but also culture.”

His professor pointed him in the direction of Charlene Cuaresma, MPH, a program coordinator at the UHM Student Equity, Excellence and Diversity (SEED) program.  Then SEED helped Lim to connect with Dr. Angela Sy, a UHM assistant professor in the School of Nursing and research director of the Asian American Network of Cancer Awareness, Research and Training – Hawai‘i funded by the National Institutes of Health

“Charlene was the one who opened my eyes to public health and epidemiology,” said Lim, who says he has wanted to be a doctor since the fourth grade. “The best treatment is prevention.”

Lim learned about the work that Dr. Sy had done conducting focus groups with Filipina girls following the Hawai‘i Youth Tobacco Survey in 2009.  Two interesting themes had emerged from her conversations.  On one hand, a strong cultural identity seemed to be a protective factor against smoking—something that helped Filipina girls stay strong and resist the temptation of tobacco.  On the other hand, family relationships appeared to have a negative impact—that is, if the family accepted tobacco use, then Filipina girls were also likely to accept it and thus were more amenable to an early start.

For his honors research project, Lim sough to investigate both sides of this family/culture coin.  With support from the Undergraduate Research Opportunities Program (UROP) at UHM, he began the work of creating a culturally sensitive survey tool that could be rolled out to local youth.

Lim’s goal was not only to measure hard targets—such as individual smoking status and number of cigarettes smoked each day—but also some of softer-side questions about home environment, neighborhood influences, and other cultural factors.

“In the Philippines there are no smoking laws,” Lim said.  A Filipina girl growing up in Hawai‘i might be the daughter of immigrants who are not aware that U.S. regulations treat minors differently when it comes to smoking.  Parental acceptance and other cues such as the smoking status of siblings in the same home could all could affect a young girl’s choice to start smoking.

Lim developed a detailed 23-page survey that he used to collect data from 100 volunteers that he found through an after-school wellness program.

Following this successful pilot study, Lim is seeking approval from the Hawai‘i State Department of Education to introduce the survey at his own high school alma mater, Waipahu High School (though the principal has already chimed in with his support).

The reasons why Filipina girls smoke may or may not be the same as youth in general.

“Studies with girls of other ethnic groups such as Latinas, African Americans, and Native Americans have found specific reasons why they smoke or do not smoke,” said Lim’s mentor, Dr. Sy.  “Matthew’s research uses validated measures to follow up on what we had found in the focus groups with Filipina girls.”  His focus is on examining whether cultural identity and family influences relate to smoking among Filipina girls.

“Filipinos are the third largest ethnic group in Hawaii, and the research results can be used to develop smoking prevention programs tailored to Filipina girls,” Sy said. “Matthew’s personal and professional interests and research abilities are the perfect fit for this health research topic.  I am grateful to Charlene, Matthew, and the SEED program for bringing us together to address this health issue.”

Along the way, Lim has learned a great deal about what it takes to conduct this type of research with human subjects and especially vulnerable populations such as minors.

“I got excited because not only was I learning more about research in epidemiology, but I was also learning about my own culture,” Lim said.

Lim’s ultimate goal is to become a pediatrician.  He is now halfway through the Masters in Public Health program at UH Mānoa, and is aiming for an MD / PhD program after that. His next career step will likely take him away from the islands, but the lessons he has learned here with the Filipina community in Hawaii will stay with him.

“Everyone here has stories,” said Lim.  “You have the power to relate with someone or share something on a different level.  If it’s on a more personal level, it can allow you to be more comfortable, and to help someone in a way that other people can’t help them.”