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Asthma Incidence and Smoking among Immigrants in California

Problem Statement

For a long time, researchers and medical experts have investigated the relationship between asthma and cigarette smoking (Cho & Paik, 2016; Koyun & Eroğlu, 2014). This relationship is founded on the fact that cigarette smoking causes the settlement of irritating factors on the air pathways, thereby worsening asthma attacks, or causing their resurgence (Tamimi, Serdarevic, & Hanania, 2012). Similarly, smoking often damages small hair-like structures (cilia) on the air pathways, which should clean the airway off dust and excessive mucus. From this destruction, the cilia are unable to operate normally, thereby triggering asthma attacks (Tamimi et al., 2012).

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In addition, smoking causes excessive production of mucus in the lungs, which may lead to the blockage of air pathways, causing asthma attacks. According to Currie and Baker (2012), 25% of asthma victims are cigarette smokers. Based on the aforementioned factors, a combination of smoking habits and asthma often causes the severity of symptoms associated with the disease. Lung dysfunction and impaired short-term therapeutic responses are also other negative effects of smoking, which are associated with asthma.

Although asthma is a significant public health problem in America, its relationship with smoking is influenced by different socioeconomic factors that vary across gender lines, education levels, and cultures (just to mention a few) (Rottem, Geller-Bernstein, & Shoenfeld, 2015). Numerous studies have investigated the relationship between asthma incidence and smoking among different races and different genders.

For example, studies by Corlin et al. (2014) have assessed the relationship between asthma incidences among Chinese immigrants living in Canada and their smoking behaviors. Other studies have also investigated this relationship, relative to patients’ country of origin, area of residence, and education studies. For example, Gatrell and Elliott (2014) have explored the relationship between geographic differences and health status among immigrant groups in the US. Studies by Tienda and Adserà (2012) have similarly investigated the incidence of asthma among different socioeconomic groups and across different groups of people with different accesses to health care services.

These researchers have pointed out that genetics, socio-demographic factors, and environmental factors have a profound impact on the incidence of asthma across the aforementioned demographic profiles. Most of their studies are generalized in the sense that they explain the relationship between asthma incidences and smoking through cross-national surveys. Furthermore, most of them are based in developed countries that do not have many immigrant groups.

Some of their studies are also outdated and do not represent ethnic and racial changes that characterize different immigrant groups today. Thus, few of these studies reflect the continuing changes in immigrant status or explain the relationship between smoking behaviors and asthma cases in states or regions that have multiple immigrant population groups, such as New York and California. The proposed study seeks to fill this research gap by exploring the relationship between asthma incidence and smoking among immigrants in California. The independent variable is asthma incidence, and the dependent variable is smoking.

Significance of the Study

The findings of the proposed study would help to fill the research gap identified above by identifying unique attributes about the demographic profiles of immigrant populations in California, which affect the relationship between asthma incidence and tobacco smoking. This way, it would be easy to formulate health interventions that address these attributes to achieve the highest levels of success in smoking reduction. Indeed, by formulating interventions that touch on the core of the relationship between smoking and asthma incidence, it would be easier for health providers to focus their attention on only those areas that are bound to yield the best results in reducing the incidence of asthma cases.

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The findings of the study would also help to support professional practice focused on asthma management through the reduction of risk factors associated with its incidence. More importantly, the findings of this study would help health experts to develop focused interventions that appeal to unique immigrant dynamics as a strategy to minimize the effects of smoking on the overall health of the immigrants. The resultant findings could also create positive social change by promoting healthy lifestyle habits among the target population by minimizing harmful behaviors, such as smoking. This could occur through increased sensitization about the relationship between asthma incidence and smoking among immigrant populations.

Lastly, this study would help to point out whether changes in immigrant status within the target population have created significant differences in the relationship between the two variables discussed. In other words, by evaluating our findings and those of past studies, we would be able to establish whether they are consistent with past findings, or not.


The following listed articles will be explored to provide background information regarding the relationship between asthma incidence and smoking among immigrants in California.

  1. Al-sheyab, Gallagher, Gallagher, and Shah (2013) explored the relationship between smoking and asthma incidences among high school students in Jordan. The purpose of the study was to investigate the impact of a peer-led education program on the ability of students who were suffering from asthma to stop smoking and improve the quality of their life. The researchers found that there is a need to develop early interventions for smoking prevention among Jordanian males, who were suffering from Asthma because their likelihood of engaging in the habit is high.
  2. Shani et al. (2013) explored the relationship between Asthma incidences among Ethiopian born immigrants and of those living in western countries. They found that the intensity of asthma increased after their travel to western countries. The researchers used 1,217 matched controls for a population sample of the same number of immigrants and found that asthma incidences among second-generation immigrants did not significantly differ from those of the native population. The findings affirm the view that environmental exposures affected asthma incidences.
  3. Polosa and Thomson (2013) did a study to explore the relationship between smoking and asthma incidences and found that the two share a positive relationship because smoking increases the incidence of asthma. The study also found that smokers who suffer from asthma had more trouble managing their condition compared to those that did not smoke.
  4. Tamimi et al. (2012) also conducted a different study to explore the relationship between smoking, asthma and COPD cases by demonstrating that the inflammatory symptoms caused by smoking in asthmatic patients could as well lead to the creation of inflammatory symptoms in COPD.
  5. Cho and Paik (2016) conducted a different study to investigate the same research issue but assessed it by investigating the relationship between e-cigarettes among South Korean immigrants, as the chosen study population. After assessing a sample of 35,904 students, the researchers pointed out that there is a positive relationship between e-cigarette consumption and increased asthma incidences.
  6. Corlin et al. (2014) conducted a study to investigate immigrant health by comparing the health status of Chinese immigrants to America and White natives. The authors found that Chinese-born immigrants had better health than their hosts did because they were less exposed to cigarette smoke.
  7. Poureslami, Shum, and FitzGerald (2015) explored the reasons why Chinese immigrants in Vancouver continued smoking and found that their cultural inclinations provided less internal incentive to stop smoking.
  8. Corlin and Brugge (2014) conducted an independent research study to investigate the incidence of asthma among immigrant populations and found that there is a “silent epidemic” of asthma among immigrant subpopulations in America. The authors said the epidemic was largely unreported because of poor access to health care services within this immigrant population.
  9. In a study conducted by Garcia-Marcos et al. (2014) to assess the relationship between immigration and asthma, a positive correlation between the two variables sufficed. The authors argued that immigration status significantly affected the incidence of asthma.
  10. Gatrell and Elliott (2014) also conducted a similar study by exploring the relationship between geography and health status among immigrants. Although the study assessed different health variables, it found that geographical differences significantly affected the incidences of asthma among immigrants.
  11. In an article titled, “Immigrant Advantage,” Kolker (2013) says that Americans could learn how to reduce the incidence of diseases, such as asthma, by emulating the dietary practices and discipline that some immigrants exude from their culture. The authors drew attention to the high incidence of smoking and alcoholism in America as significant contributors to asthma cases in the country.
  12. In another book titled, “The Immigrant Health,” Loue (2013), shows the flip side of immigrant health by saying socioeconomic factors have always made it difficult for immigrant populations to gain access to health care services, thereby increasing their incidence of asthma.
  13. Streja et al. (2014) also contributed to this discussion by saying poor living conditions have increased secondary smoke exposure to children born in immigrant families, thereby increasing their incidence of asthma.


The selected theoretical model for the proposed study would be the trans-theoretical model. It is used to assess people’s willingness to improve their health by adopting positive behavioral changes. The selection of the trans-theoretical model is informed by our research question, which is focused on understanding the relationship between asthma incidences and smoking among immigrants in California. Smoking is a behavioral issue that could easily be addressed by the trans-theoretical framework because the model focuses on behavioral change measures to promote health. Since it could affect health outcomes through variations in asthma incidence, it is easy to see how it aligns with our research topic.

Because the gist of the paper is centered on evaluating smoking habits as a predictor of asthma incidence, it was necessary to use a theoretical framework that has a lot of efficacy in interrogating behavior change. The trans-theoretical theory has such a record because researchers have demonstrated its efficacy in promoting smoking cessations (Koyun & Eroğlu, 2014). It has also been used to guide clinicians in helping people to stop smoking (Koyun & Eroğlu, 2014).

Usually, when adopted in the context of smoking cessation, clinicians help smokers to desist from the habit using the five stages of this theory, which are pre-contemplation, contemplation, preparation, action, and maintenance (Koyun & Eroğlu, 2014). The use of the proposed theoretical framework for this study will provide insight into behavioral patterns among immigrants that contribute to their smoking behaviors and the incidence of asthma within the population.

Research Question and Hypotheses

At the onset of this study, we pointed out that our research purpose would be to explore the relationship between asthma incidence and smoking among immigrants in California. The research question stems from the same purpose. It appears below:

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  • RQ: Is there an association between asthma incidence and smoking among immigrants in California?
  • Null Hypotheses: Asthma incidence has no relationship with smoking among immigrants in California.
  • Alternative Hypothesis: There is a positive relationship between asthma incidences and smoking among immigrants in California.

Approach for the Study

According to Rovai, Baker, and Ponton (2013), there are two main research approaches – qualitative and quantitative approaches. I will use the quantitative approach in the proposed study. This approach aligns with our research question, which is investigating if there is an association between asthma incidence and smoking among immigrants in California. The incidence of asthma is a quantitative measure because data on asthma reporting is usually presented in numbers. Similarly, smoking is often measured in terms of the number of people who do it. These two sets of data are quantitative in nature. Therefore, the selection of the quantitative technique is a natural process based on the nature and characteristics of the variables we measure.

Secondary Data Types or Sources of Information

The proposed study would incorporate secondary data as the main source of information. The secondary data would come from different sources of information, including state records, information from federal databases, national health surveys, and information from health agencies. The main source of data for this paper would be the California Health Interview Survey (CHIS). Other sources of information for the proposed study would be

  • Behavioral Risk Factor Surveillance System (BRFSS);
  • Inter-university Consortium for Political and Social Research (ICPSR);
  • National Addiction & HIV Data Archive Program (NAHDAP);
  • Centers for Disease Control and Prevention (CDC).

Analytical Strategies

The proposed data analysis techniques would be employed to organize and statistically analyze the secondary information outlined above. To analyze the data, I will use ANOVA, Chi-Square, and bivariate analysis methods. The bi-variate analysis would be useful in analyzing the two variables of the study – asthma and smoking behaviors (Babbie, Wagner, & Zaino, 2015). The Chi-Square tests would be used to analyze the observed and expected frequencies of asthma incidences and smoking behaviors within the immigrant population (Babbie et al., 2015).

This way, the researcher would be able to investigate if there are disparities, or areas of convergence, between the variables under analysis to support a relationship between them. The ANOVA technique would be instrumental in testing group differences between smokers, as one group, and people who suffer from asthma, as another group.

Other Relevant Information

It is important to understand that the differences in cultures and smoking habits among immigrants living in California could be a limitation to our study because California is comprised of different immigrant groups, including (but not limited to) Hispanics, Africans, and Asians. These groups have unique cultural differences that affect their smoking habits. The same differences may impede our understanding of the relationship between smoking and asthma because we depict them as one target group of analysis.

Reference List

Al-sheyab, N., Gallagher, R., Gallagher, P., & Shah, S. (2013). Cigarette smoking in adolescents with asthma in Jordan: Impact of peer-led education in high schools. Journal of Nursing Education and Practice, 3(9), 13-21.

Babbie, E., Wagner, W., & Zaino, J. (2015). Adventures in social research: Data analysis using IBM® SPSS® Statistics. London, UK: SAGE Publications.

Cho, J.H., & Paik, S.Y. (2016). Association between electronic cigarette use and asthma among high school students in South Korea. PLoS ONE, 11(3), 1-13.

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Corlin, L., & Brugge, D. (2014). The hidden asthma epidemic in immigrant subpopulations. Web.

Corlin, L., Woodin, M., Thanikachalam, M., Lowe, L., & Brugge, D. (2014). Evidence for the healthy immigrant effect in older Chinese immigrants: A cross-sectional study. BMC Public Health, 14(603), 1-8.

Currie, G., & Baker, J. (2012). Asthma. Oxford, UK: OUP Oxford.

Garcia-Marcos, L., Robertson, C.F., Ross, A.H., Ellwood, P., Williams, H.C., & Wong, G.W. (2014). Does migration affect asthma, rhinoconjunctivitis and eczema prevalence? Global findings from the international study of asthma and allergies in childhood. Int J Epidemiol., 43(6), 1846-54. Web.

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

Kolker, C. (2013). The immigrant advantage: What we can learn from newcomers to America about health, happiness and hope. New York, NY: Simon and Schuster.

Koyun, A., & Eroğlu, K. (2014). The transtheoretical model use for smoking cessation. European Journal of Research on Education, 21, 130-134.

Loue, S. (2013). Handbook of immigrant health. New York, NY: Springer Science & Business Media.

Polosa, R., & Thomson, N. (2013). Smoking and asthma: Dangerous liaisons. Eur Respir J., 41, 716–726.

Poureslami, I., Shum, J., & FitzGerald, M. (2015). Why do Chinese people with COPD continue smoking: The attitudes and beliefs of Chinese residents of Vancouver, Canada? Diversity and Equality in Health and Care, 12(1), 18-27.

Rottem, M., Geller-Bernstein, C., & Shoenfeld, Y. (2015). Atopy and asthma in migrants: The function of parasites. Int Arch Allergy Immunol, 167, 41-46.

Rovai, A., Baker, J., & Ponton, M. (2013). Social science research design and statistics: A practitioner’s guide to research methods and IBM SPSS. New York, NY: Watertree Press LLC.

Shani, M., Band, Y., Kidon, M., Segel, M., Rosenberg, R., Nakar, S., … Vinker, S. (2013). The second generation and asthma: Prevalence of asthma among Israeli born children of Ethiopian origin. Respiratory Medicine, 107, 519-523.

Streja, L., Crespi, C.M., Bastani, R., Wong, G., Jones, C., Bernert, J., … Tashkin, J. (2014). Can a minimal intervention reduce secondhand smoke exposure among children with asthma from low-income minority families? Results of a randomized trial. Immigrant Minority Health, 16, 256. Web.

Tamimi, A., Serdarevic, D., & Hanania, N. (2012). The effects of cigarette smoke on airway inflammation in asthma and COPD: Therapeutic implications. Respiratory Medicine, 106, 319-328.

Tienda, M., & Adserà, A. (2012). Migrant youths and children of migrants in a globalized world. London, UK: SAGE.

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