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To fully understand tobacco use among AANHPI, representation in research matters

May is Asian American, Native Hawaiian, and Pacific Islander (AANHPI) month, a time to celebrate the remarkable role this community has played in our nation’s history. It’s also a time to learn about the challenges those who identify as AANHPI face, and push for better inclusion and representation — including in research on disparities in tobacco use.

The AANHPI category poses a particular challenge for researchers because it encompasses people with a wide range of ethnicities and nationalities. The term AANHPI refers to people from more than 50 distinct ethnic backgrounds, and yet they have been lumped together under one umbrella category. With over 20 million Americans identifying as AANHPI, such categorization risks generalizing an extremely varied population.

The tobacco industry has long marketed its products to underrepresented racial and ethnic groups, and the AANHPI community is no different. While smoking prevalence is relatively low within the AANHPI community compared to other groups, commercial tobacco still poses a danger — one that is exacerbated by underrepresentation in tobacco research.

Tobacco use threatens the health of all racial groups. Specific data are critical to developing tailored interventions to address tobacco use in each community. Whenever possible, researchers should study tobacco use (or any behavior or health indicator) across more specific groups to better identify use patterns and make recommendations for action.

Understanding specific groups is an important step in addressing tobacco use disparities

AANHPI populations are among the many ethnic and racial groups that are underrepresented in tobacco research. On top of that, the amalgamation of many populations into one group may mask critical tobacco-related disparities that exist between diverse and distinct subgroups. Understanding tobacco use prevalence within specific groups is an important first step in addressing tobacco-related disparities.

For example, a study analyzing survey data from Monitoring the Future (2018-2019) found that Native Hawaiian and Pacific Islander youth were nearly three times more likely to report current use e-cigarettes, compared to youth who identified as Asian American. Results highlight disparities among subgroups of Asian American, Native Hawaiian, and Pacific Islanders (AANHPI), while also emphasizing the need to increase the sample sizes of other AANHPI subgroups in national health surveys to allow for more robust data and health behavior reporting.

More research is needed to protect groups historically targeted by the tobacco industry

The tobacco industry has long targeted AANHPI and other underrepresented racial and ethnic groups. The industry saw an opportunity to target the AANHPI community due to high smoking prevalence in their countries of origin, increasing population growth and purchasing power, and a brand loyalty to American products. The industry went on to sponsor activities linked with cultural traditions, such as Chinese New Year, to aid its recruitment of this population.

With e-cigarettes now the tobacco product of choice among young people, more research is needed into how, and why, young people from specific subgroups are vaping nicotine or using other tobacco products. With more precise representation in research, health advocates can more fully serve and protect vulnerable populations, address health disparities, and help increase the overall health of the nation.