Differential effects of social status and social functioning on smoking behavior among Vietnamese men living in Vietnam and in the US

Background/Significance: Smoking prevalence among Vietnamese men is among the highest in the world. Smoking behavior is grounded in the particular social context in which it occurs. High social status is likely to have a very different relationship with smoking behavior in Vietnam, where smoking is widely engaged in as part of normal male socializing across a range of social status; compared to the U.S., where smoking has become much more concentrated among the less privileged.

Objective/Purpose: Our principal objective is to discern how social status and social functioning differentially affect patterns of smoking among Vietnamese men living in Vietnam and in the U.S. A secondary objective is to examine the relationship between smoking and acculturation to American society among Vietnamese immigrants.

Methods: We use a natural experiment approach to control for the potentially confounding effects of selection, and include samples of male Vietnamese immigrants, returnees, and never-leavers in our multivariate analyses of ever and current smoking.

Results: We find differences in the influence of key smoking determinants—social status and social functioning—upon smoking in the two settings (Vietnam and the United States). As anticipated, relatively high social status had less of a (negative) influence on smoking prevalence in Vietnam than it did in the United States. Also, and again as expected, high social functioning was correlated with smoking in Vietnam but not in the United States. Third, and again as expected, longer length of residence in the United States and higher acculturation into American society has strong negative (protective) influences upon smoking among immigrant Vietnamese men.

Discussion/Conclusions: Among Vietnamese Americans, acculturation and the pursuit of higher education are likely to have facilitated declines in smoking. No such relationships are available to facilitate a smoking decline in Vietnam, which will likely require massive shifts in laws, norms, and pricing.