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Asthma Incidence and Smoking among African Immigrants in California

Problem Statement

African immigrants suffer a high risk of asthma fatalities compared to major ethnic groups in California. This is large because of socioeconomic disadvantages, poor housing conditions, and the lack of proper access to health care services (Findley & Matos, 2015). Smoking is also a contributor to this outcome because different studies have shown that many African immigrants often continue their smoking habits after arriving in the US (Amer & Awad, 2015).

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Studies that have further investigated this issue point out that, West African immigrants experience fewer inhibitions to smoking because of a group-based cultural identity theory, which presupposes that they are free to smoke in America because of fewer social inhibitions that often prevented them from doing so in their home countries (Gatrell & Elliott, 2014). Nonetheless, this habit contributes to their poor health outcome.

Another set of contributors to the poor health outcome among African immigrants is the nature of jobs that they do in America. In this paper, we refer to these contributors as mediating factors. As shown by Braback, Vogt, and Hjern (2011), most immigrants often work in low-paying jobs that expose them to indoor and outdoor air pollution, which affects their overall health. Most of these jobs are concentrated in the agricultural, construction, and service sectors (Gatrell & Elliott, 2014).

Some of the materials used in these industries contain harmful chemicals that further jeopardize their general health. For example, glues, insulation, and wood products contain harmful chemicals that are known to negatively influence the health of people exposed to them (Braback et al., 2011). Paints, cleaning products, and carpets also contain similar harmful chemicals, such as formaldehyde, which cause respiratory health complications.

Although there are different types of African immigrants residing in the US, many health studies have often categorized them as African-Americans, thereby failing to draw the distinction between their health outcomes and those of native-born African-Americans (Schenker, Casta–eda, & Rodriguez-Lainz, 2014). Furthermore, this population group is the most understudied in the area of immigrant health because researchers have mostly focused on studying Hispanics and Asian immigrants.

The neglect of African immigrants, as a significant health cohort worth studying, betrays the spirit of public health, which promotes the provision of a holistic picture of health management (Moreland-Russell & Brownson, 2016). The proposed study seeks to fill this research gap by exploring the association between asthma incidence and smoking among African immigrants in California.


The findings of the proposed study would have immense contributions to the field of public health because the discipline focuses on disease prevention and prolonging human life through the formulation and implementation of organized and informed public health decisions (Rose, 2017). The proposed study would help to satisfy the second criterion (informing public health decisions) because it would be easy for public health practitioners to formulate targeted and informed public health strategies about how to reduce the incidence of asthma within this demographic by understanding the association between asthma incidences and smoking among African immigrants (Drazen, 2016). By extension, this contribution would improve the respiratory health of the larger national populace.

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The findings of the proposed study would also contribute to the professional practice by informing policy decisions about smoking and outlining the mediating factors affecting the relationship between this variable with asthma. Mistakes made in the past highlight this fact because it took up to 50 or 60 years of research on tobacco use before governments started implementing policy decisions that reflected their findings (Pattanayak, Sunita, & Anshu, 2016). The proposed research would provide a reliable basis for the formulation of public health decisions affecting asthma management through an understanding of its relationship with smoking.

Lastly, the findings of the proposed study would help to promote positive social change by reducing the incidence of asthma attacks nationwide because African immigrants are among the worst affected, but the most understudied group. Indeed, exploring the relationship between the independent and dependent variables within this demographic would be the first step in managing the disease. Comprehensively, health care service providers will be able to have a holistic approach to asthma management that will consider all immigrant groups and not just the frequently studied ones –Asian immigrants and Hispanic immigrants.


  1. Bosdriesz et al. (2013) explored the prevalence of smoking behaviors among immigrant groups by comparing such trends to smoking behaviors in their host countries and with the general US population. They found that the prevalence of smoking behaviors among immigrant groups was lower than the prevalence of smoking among the US population. These findings will be instrumental in our proposed study because they would help us to understand smoking behaviors among immigrant groups.
  2. Becerra, Scroggins, and Becerra (2014) explored the relationship between asthma and obesity among Asian immigrants in America and found a positive correlation between asthma and overweight status. The findings of this paper would help us to contextualize the prevalence of asthma incidences among immigrant groups.
  3. Iqbal, Oraka, Chew, and Flanders (2014) explored the relationship between birthplace dynamics and asthma incidences among immigrant groups in the US and found that there is a higher incidence of the condition among immigrants born in the US compared to those born elsewhere. The findings of this paper would help us understand the impact of the environment and acculturation factors on asthma incidences among immigrant groups.
  4. Celedón (2016) investigated health inequality between immigrants and US-born citizens and found out that there are significant health disparities between the two groups. Her findings would be instrumental in our proposed study because they would help us understand the impact of socioeconomic factors on health outcomes among immigrant groups.
  5. Bostean, Ro, and Fleischer (2017) investigated smoking trends among US-born and foreign-born Latino immigrants and found that the latter group had a lower incidence of smoking compared to the former. The findings of this paper would be helpful in understanding the disparities in smoking behaviors among foreign-born and US-born immigrants.
  6. The findings of Hamilton, Cardoso, Hummer, and Padilla (2011) would be useful to our proposed study because they would explain how immigration affects the health outcomes of immigrants in California. Their findings stem from a review of how assimilation has affected the health outcomes of immigrant children in America.

Theoretical/Conceptual Framework

The socio-ecological model will be the main conceptual framework for the proposed study. It is ideal because it provides a holistic understanding of our research topic. Moreover, it takes into account the environmental factors that could affect the relationship between asthma incidences and smoking (Sharma, 2016). The multifaceted nature of the model is appropriate for our review because we explore the impact of several mediating factors, such as education, work, age, sex, and income (among other factors) in exploring the association between asthma incidences and smoking among African immigrants in California (Coutts, 2016).

In this regard, the model aligns with the variables of the study. The model also incorporates our understanding of sociocultural factors that affect smoking behaviors among African immigrants because, as shown by previous studies, the smoking habits of this group of immigrants is partly caused by cultural factors (Bosdriesz et al., 2013). The socio-ecological model would help us to understand this bit of the analysis as well.

Lastly, this model fits with the significance of our study, which is to inform public health policies and strategies regarding asthma management because it doubles up as a framework for preventing health problems. For example, some scholars have demonstrated its efficacy in the prevention of violence (CDC, 2016). In the context of our study, it will be used in the prevention of asthma cases through an understanding of the different levels of factors that influence the relationship between smoking and asthma.

Analytical Strategies

Our choice of data analysis is informed by the nature of the proposed study. More importantly, the research questions and the variables of interest in the study guide the selection of the data analysis techniques. Using these factors as the main decision-making criteria, we choose to use both descriptive and inferential analyses in the proposed study. The inferential analysis will incorporate two main approaches – binary logistic and multiple logistic regression analyses.

The justification for choosing these methods is the dichotomous nature of the dependent variable (asthma). In other words, it assumes two states – yes or no. Consequently, we will conduct an analysis of asthma for two groups of immigrants – smokers and non-smokers. A similar analysis of asthma on African immigrants and other immigrant smokers in California will be done to get a contextual understanding of how the findings would compare with other immigrant smokers in California. In the descriptive analysis section, we will analyze different factors, including the measures of central tendency, measures of spread, and visual representation tools, such as tables, graphs, and charts.

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Amer, M., & Awad, G. (2015). Handbook of Arab-American psychology. London, UK: Routledge.

Becerra, B.J., Scroggins, C.M., & Becerra, M.B. (2014). Association between Asthma and obesity among immigrant Asian Americans, California health interview survey, 2001–2011. Preventing Chronic Disease. 11, 1-6.

Bosdriesz, J.R, Lichthart, N., Witvliet, M.I, Busschers, W.B., Stronks, K., & Kunst, A.E. (2013). Smoking prevalence among migrants in the US compared to the US-born and the population in countries of origin. PLoS ONE, 8(3): 1-13.

Bostean, G., Ro, A., & Fleischer, N. L. (2017). Smoking trends among U.S. Latinos, 1998–2013: The impact of immigrant arrival cohort. International Journal of Environmental Research and Public Health, 14(3), 1-12.

Braback, L., Vogt, H., & Hjern, A. (2011). Migration and asthma medication in international adoptees and immigrant families in Sweden. Clinical and Experimental Allergy, 41(8), 1108-1115.

CDC. (2016). The social-ecological model: A framework for prevention. Web.

Celedón, J. (2016). Achieving respiratory health equality: A United States perspective. New York, NY: Humana Press.

Coutts, C. (2016). Green infrastructure and public health. London, UK: Routledge.

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Drazen, J. (2016). Five-lipoxygenase products in asthma. New York, NY: CRC Press.

Findley, S., & Matos, S. (2015). Bridging the gap: How community health workers promote the health of immigrants. Oxford, UK: Oxford University Press, Incorporated.

Gatrell, A., & Elliott, S. (2014). Geographies of health: An introduction. London, UK: John Wiley & Sons.

Hamilton, E., Cardoso, J., Hummer, R., & Padilla, Y. (2011). Assimilation and emerging health disparities among new generations of U.S. children. Demographic Research, 25(25), 781-818.

Iqbal, S., Oraka, E., Chew, G. L., & Flanders, W. D. (2014). Association between birthplace and current asthma: The role of environment and acculturation. American Journal of Public Health, 104 (l1), 175–182.

Moreland-Russell, S., & Brownson, R. (2016). Prevention, policy, and public health. Oxford, UK: Oxford University Press.

Pattanayak, S., Sunita, P., & Anshu, S. (2016). Role of Cd4+T cell sub-populations in allergic asthma: A new strategy of natural flavonoids to ameliorate asthma. New York, NY: GRIN Verlag.

Rose, P. (2017). Health disparities, diversity, and inclusion. London, UK: Jones & Bartlett Learning.

Schenker, M., Casta–eda, X., & Rodriguez-Lainz, A. (2014). Migration and health: A research methods handbook. Oakland, CA: University of California Press.

Sharma, M. (2016). Theoretical foundations of health education and health promotion. London, UK: Jones & Bartlett Publishers.

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