Little is known about substance use among Vietnamese American
College students. Previous studies showed that substance use is more
prevalent among White, African-Americans and Hispanics, than in Asian
Americans in the US. As a result, many believe that all Asian Americans
can be classified as a low health risk group. This study examined the
prevalence of substance use (cigarette, alcohol, and marijuana) and
factors associated with substance use among Vietnamese American college
students. Data were collected through a mail survey and a telephone
survey. A total of 412 usable surveys were completed. The results of
this study indicated that gender and degree of acculturation are
significantly related to substance use. Vietnamese male students are
more likely to use substance than are Vietnamese female students.
Overall, acculturated Vietnamese American students were more likely to
use substance (alcohol and Marijuana) than those less acculturated
Vietnamese American students. However, cigarette smoking was not
significantly related to acculturation among female students. Future
studies should examine the gender differences in the acceptance and
perception toward substance use.
Introduction
Many researchers have reported significant differences in the
prevalence of substance use among various ethnic groups in the United
States. A frequent finding reported in these studies is that substance
use is more prevalent among White, African-Americans and Hispanics, than
in Asian Americans in the US (Gillmore et al., 1990; Collins, 1993;
O'Hare, 1995; Ellickson et al, 1996). As a result, many believe
that substance use is not an important health issue for the Asian
Americans population, and continue to uphold the stereotypical view that
all Asian American can be classified as a low health risk group.
Although this comparatively low rate of substance use exhibited by Asian
Americans, may indeed be accurate for some subgroups of Asian Americans
in the US, it may not be an accurate representation for all Asian ethnic
groups (Ja and Aoki, 1993). The Asian-American population is a rather
heterogeneous one, consisting of many different ethnic groups, each with
its unique set of cultural standards, beliefs, values and traditions,
hence with varied health risk behaviors. As such, it may not be
appropriate to examine their life-style behaviors collectively, but
rather to focus on the health behaviors of individual subgroups, to
examine their patterns of alcohol and drug use, and to determine the
extent to which this may represent an important health concern for that
particular Asian ethnic sub-group. All Asian subgroups are usually
lumped together under one single category, "Asians," thus
making difficult the generalization of findings to all groups because
there are some subgroup differences.
Furthermore, previous studies (Cho and Faulkner, 1993; Higuchi et
al., 1994; Izuno et al., 1992; Zane and Sasao, 1992) on substance use
among Asian- Americans raise a number of methodological problems that
make it difficult to assess the prevalence and the factors associated
with use among different Asian ethnic groups. These studies typically
represent more acculturated groups like Chinese and Japanese. Absent
from most of these studies are those who are at high risk such as
immigrants, refugees, and economically marginalized. There is a need to
know more about the people who do not fall into these groups. It is
highly likely that they are significantly different in their rates of
use and use patterns than those who do fall into these study groups and
whose results get reported. Overall, adequate data and information about
substance abuse by Asian Americans is scarce. This scarcity exists in
part because a relatively small proportion of substance abuse resources
have been allocated to research resigned for the understanding of Asian
Americans and their problems associated with substance abuse. Also,
information from national data sets is not automatically broken down by
different racial and ethnic groups so that comparisons of substance use
can be made different Asian and Americans.
Although the Vietnamese population in the United States has grown
tremendously within the last 20 years, with US census figures showing
that they are the fastest growing Asian/ Pacific Islander ethnic group
(US Census, 1992), very few studies (Jenkins et al, 1990; Wiecha, 1996)
have focused on the prevalence of substance use among this subgroup of
Asian Americans. The purpose of this study was to examine the prevalence
of substance use among Vietnamese American College students. This study
also examined the relationship between acculturation to substance use
among Vietnamese American college students. Several studies have found
that acculturation of recently arrived immigrant groups into American
society (i.e., westernization) is associated with increases in substance
use in these groups. For example, acculturation have been found to be
positively correlated with alcohol use among Hispanic-Americans in
general (Caetano, 1987; Gilbert and Cervante, 1986) and Asian Americans
living on the US mainland (Zane and Sasao, 1992). This study
hypothesizes that acculturated Vietnamese American students are more
likely to use substances than less acculturated Vietnamese American
students. Presumably, greater levels of acculturation by Vietnamese
American students into the majority American culture, with the
associated changes in diet and other lifestyle changes, result in
greater health risk (e.g., substance use). This study will provide
empirical data specific to Vietnamese American college students and will
help to narrow the information gap, which currently impedes efforts to
develop culturally sensitive substance abuse education programs.
Methods
Vietnamese students at the University of Houston were the
participants of this study. They were chosen because they represent the
largest group (13.5%) of Asian Americans at the University. The sampling
frame was formed by use of Vietnamese names listed in the student
directory. The investigator identified 30 Vietnamese family names that
account for the majority of all ethnic Vietnamese. The final sampling
frame consisted of 847 Vietnamese students. A total of 412 survey was
completed from a 779 eligible sample list. The final response rate among
eligible students was 53%. The refusal rate was 9% of the total
contacts. The subject sample for this analysis includes only students
who identified themselves as Vietnamese. Those who didn't identify
themselves as Vietnamese were excluded from this study. Data were
collected through two methods. Using the mail survey method, students
were sent a letter requesting them to complete a questionnaire and
return it in an enclosed self-addressed stamped envelope. An attempt was
made to telephone interview those who did not return a survey. Lack of
correct (known) telephone numbers was the most common reason for
nonresponse.
Demographic information, including, gender, age, marital status,
location raised and birthplace was collected. Respondents were asked a
series of questions aimed at assessing degrees of acculturation to US.
society. This study used a modified version of the Suinn-Lew Asian
Self-Identity Acculturation Scale. (Suinn et al., 1987) The areas
covered by this scale were the following: language use and preference
(range 7-21), ethnic identification (range 2-6), and sociocultural
preferences (range 3-9). Higher scores indicate higher acculturation. As
anticipated, there were positive correlations between language use and
ethnic identity (r=0.47, p=[is less than] 0.001) and between the length
of residence in the US and language use (r=0.48, p= [is less than]
0.001). Language use also showed a positive correlation with ethnic
identity (r=0.53, p= [is less than] 0.001). Respondents who have lived
in the US for a longer period were more likely to use English than those
who have lived in the US for a shorter period. These correlations are in
the expected direction and provide some construct validity of the scale.
In addition to demographic and acculturation questions students
were asked about their use of substances: alcohol, cigarettes, and
marijuana, amphetamines, cocaine, and heroin. Use of alcohol and
cigarette were scored as dichotomies: current uses or nonuse. Use of
illicit substance was scored as dichotomies: never used or ever used.
Use of amphetamines, cocaine, and heroin are not reported here because
of very small numbers. Data were analyzed using SPSS statistical
analysis system. Tests of significance included chi-square for cross
tabulations and t-tests for continuous variables. Bivariate associations
between the dependent variable and the independent variables were
examined to identify subgroups within Vietnamese students who are most
likely to use substance. Finally, logistic regression analyses were
performed to determine factors associated with each substance.
Results
Demographic characteristics
The respondents were students (205 men and 207 women) ranging in
age from 17 to 48 and with a mean age of 23 years. Of those students
responding to the age questions, 24.5% were aged 17-20 and 75% were aged
21 or older. The majority of students were young and single. More than
sixty percent (65.8%) of the respondents were employed. Of those
employed, approximately 60% worked 11-30 hours per week. Majority (81%)
is living at home with parents. Buddhist students made up 42.7% of the
sample and Catholics 33.3%. Approximately 13% of the Vietnamese
responded that they had no religious affiliation.
The average length of residence in the US was 14.7 years with a
standard deviation of 5.8 years, ranging from 2 months to 26 years.
Nearly ninety percent (89.6%) of the students surveyed were born outside
the US mainland. Although a majority of respondents were born in
Vietnam, more than 60% of the respondents were raised mostly in the
United States.
Cigarette Smoking
Table 1 summarizes the relationship between substance use and
sociodemographic characteristics. Only 11% of the Vietnamese students
are current smokers. Male students (16.1%) were significantly more
likely than female students (6.3%) to report current cigarette use.
Bivariate analysis revealed that location raised was significantly
related to cigarette smoking. For example, those who were raised mostly
in the US (14.2%) were significantly more likely than those students
raised in Vietnam (4.9%) or those raised equally in Vietnam and US
(8.2%) to report current cigarette use. There were no significant
relationships between age, religion, and living arrangement and
cigarette smoking. The only acculturation variable, which showed a
significant relationship, was length of stay in the US. For example, the
mean length of residence in the US of current smokers and nonsmokers
were significantly (p [is less than] .05) different. When examined by
gender, there were significant relationship between length of residence
in the US and cigarette smoking among male students but not among female
students. The findings suggest that acculturated Vietnamese male
students were more likely to smoke cigarettes than less acculturated
Vietnamese male students. In the final logistic regression model, sex
and placed raised were important predictors of current cigarette
smoking. The dependent variable is the current use or nonuse of
cigarette. The adjusted odds ratios for this model indicate that male
students were more likely to be current smoker than female students (Odd
Ratio (OR)= 3.26; 95% Confidence Interval (CI)=6.47, 1.65). Those
students who were raised mostly in the US were more likely to smoke
cigarette than those who were raised mostly in Vietnam or equally in
Vietnam and US (OR=3.06; 95% CI=6.63, 1.42). Length of residence in the
US did not reach significance in the regression once birthplace is
controlled in the model.
Alcohol Use
More than one-third (34.7%) reported current alcohol use. Male
students (42.0%) were significantly more likely than female students
(27.5%) to report current alcohol use. Religion seems to be influencing
the drinking patterns of Vietnamese students. Those students, who are
affiliated to Buddhist or Catholic faith, are less at risk for alcohol
problems. As expected, Vietnamese students not living with parents were
more likely to drink than those living with parents. More than one-third
(34%) of the underage male students and 26% of the underage female
students drank. There were no significant differences between underage
students and legal-age students on alcohol use. Native born Vietnamese
students (32.8%) were significantly (p [is less than] .05) more likely
to be current drinkers than foreign born Vietnamese students (51.2%).
Students who were raised mostly in the US reported significantly higher
rates of alcohol use (44.1%) than those raised mostly in Vietnamese
(18.6%) or equally in Vietnam and the US (18.4%). As expected,
acculturated students were more likely to drink than less acculturated
students. (Table 2) For both male and female students, results show that
more acculturated students have lower rate of abstention than those in
the low acculturation category. In contrast to cigarette use, the
relationship between acculturation and drinking is significant among
female students, with acculturation positively associated with drinking.
In the final logistic regression model, sex, location raised, and class
level were important predictors of current alcohol use. The adjusted
odds ratios for this model indicate that male students were more likely
to drink than female students (OR=2.41; 95% CI=3.76, 1.58). Those
students who were raised mostly in the US were more likely to drink than
those who were raised mostly in Vietnam or equally in both US and
Vietnam (OR=4.18; 95% CI=6.91, 2.53). Undergraduate students were less
likely to be a current drinker than those who were in graduate or
professional programs (OR=.51; 95% CI=.90, .28).
Indicators of acculturation didn't have any predictive value
for alcohol use once place raised is controlled in the model. For
example, length of residence in the US and language use did not reach
significance in the regression when it was introduced to the model.
Marijuana Use
The only drug other than alcohol and tobacco commonly used by
Vietnamese students was marijuana. Less than 10% of Vietnamese student
in this study had tried marijuana during their lifetime (i.e., lifetime
marijuana use). Male students (11.7%) were significantly more likely
than female students (5.3%) to report lifetime marijuana use. As
expected, the more students were acculturated into the American culture,
the more they tried marijuana in the past. Vietnamese who were born in
US (25.6%) were significantly (p [is less than] .001) more likely to
have tried marijuana than Vietnamese who were born in Vietnam (6.5%).
Students who were raised mostly in the US reported significantly higher
rates of lifetime marijuana use (12.3%) than those raised mostly in
Vietnamese (2.0%) or equally in Vietnam and the US (2.1%). The findings
showed that younger and acculturated students were more likely to have
tried marijuana in the past than older and less acculturated students.
In the final logistic regression model, sex, location raised, and
births place were important predictors of past use of marijuana. The
adjusted odds ratios for this model indicate that male students were
more likely to have experimented with marijuana than female students
(OR=2.73; 95% CI=5.92, 1.26). Those students who were raised mostly in
the US were more likely to experimented with marijuana than those who
were raised mostly in Vietnam or equally in Vietnam and US (OR=6.36; 95%
CI=22.56,1.80). Those US born students were more likely to experimented
with marijuana than those who were foreign-born students (OR=3.3; 95%
CI=8.36, 1.35). All acculturation variables were significantly related
to marijuana use in the past. (Table 2) However, indicators of
acculturation didn't have any predictive value for marijuana use
once birth place is controlled in the model.
Discussion
This study shows that substance use is less prevalent in Vietnamese
American students compared to nationwide data (CDC MMWR, 1997).
Approximately 88% of college students (including those under age 21)
have used alcohol, compared to 34.7% of Vietnamese students in this
study. Less than 10% of Vietnamese students had used marijuana during
their lifetime, compared to 4.8.7% of college students nationwide.
Nationwide, 16.5% of college students are current cigarette users. In
this study, only 11.2% reported current cigarette use.
The results of this study indicate that gender and degree of
acculturation are significantly related to substance use. Results showed
a significant relationship between gender and use of cigarettes,
marijuana, and alcohol, with a higher percentage of males admitting to
use than females. Overall, Vietnamese female students showed
considerably lower rates of substance use than do Vietnamese male
students. The more acculturated Vietnamese female students tend to use
more alcohol and Marijuana than their less acculturated counterparts.
However, cigarette smoking was not significantly related to
acculturation. It is possible that for drinking by Vietnamese female is
more acceptable behavior than cigarette smoking. These findings are
similar to those of past studies that examined the role of gender in
alcohol abuse. This may be attributed to the stereotyped role of women
in society, or to Vietnamese cultural values. In many cultures it is
acceptable for men to spend leisure time drinking with friends but
similar behavior in women may be socially unacceptable. Gender
differences in the acceptance and perceptions toward substance use
needed to be examined in the future study.
As expected, Vietnamese students who are more acculturated to
Western culture were more likely to be current drinkers and more likely
to experimented marijuana. These results suggest the effects of
acculturation on alcohol and marijuana use among Vietnamese students,
with higher acculturation scores related to higher rates of alcohol and
substance use. It should be noted that we found no significant
relationship between cigarette smoking and acculturation among
Vietnamese students. The length of residence in the US among male
students was the only acculturation variable significantly related to
current cigarette use. It is evident that exposure to the American
culture greatly influences patterns of alcohol consumption and marijuana
use in the past among Vietnamese students. However, this seems to be not
true for cigarette smoking. This may reflect the results of tobacco use
prevention programs in the US. Future study should examine possible
differences in US and Vietnamese societal norms and attitudes towards
substance use
Although one-fourth of the sample were age 17-20, no statistically
significant relationship between age and substance use was found. Nearly
one-third (29.7%) of this age group admitted to past use of alcohol
despite a legal drinking age of 21 in Texas. We found the alcohol
consumption of underage students was similar to their legal-age
counterparts. Similar to previous study (Gfroerer et al, 1997),
Vietnamese students living away from their parents were significantly
more likely than students living with their parents to drink. This
clearly suggests that the campus environment influence student drinking
behaviors. Furthermore, parental influence may play an important role in
students, decisions to use alcohol. This may also be related to
parents' attitudes toward alcohol use by students, as well as their
own patterns of alcohol use. It should be noted that cigarette and
marijuana use rates showed no difference between students living with
parents and away from parents. Buddhism and Catholicism were the most
frequently professed religions among the respondents. Where-as 29.0% of
those whose religious preference was Buddhism and 31.4% of respondents
who were Catholic reported alcohol use, 50% of those who professed
"other" religious beliefs and 49% of those who had no
religious preferences reported alcohol use. Religious beliefs may
significantly affect attitudes and as a result behaviors will be
affected. Those who professed to be Catholics and Buddhists had the
lowest rates of alcohol use possibly because they have been influenced
by the teachings of their religion. Additionally, those with religious
preferences are more likely to participate in religious activities that
may not involve alcohol than those without religion. It should also
point out that religious preferences were significantly related to
acculturation. Those who reported as a Buddhist were the least
acculturated students.
This study is limited in several ways. One limitation of this study
is that substance use was based on self-reports. Given the exploratory
nature of this study, reported use should be taken as an index rather
than an estimate of actual use. The surveys are limited because of the
respondents' reluctance to answer questions regarding use of any
substance, particularly illegal drugs, given the stigma our society
attaches to drug use, especially by women. Thus it is possible that
respondents were less likely to have reported their behavior accurately.
For instance, respondents may deliberately provide inaccurate data to
hide risky health behavior. In addition, there are no data available on
the non-respondents and those who have dropped out of school are clearly
high-risk populations. The sampling frame was limited and based on
student listings. For these reasons, we need to be cautious in
generalizing from the data presented here to the population of
Vietnamese or other Asians students as a whole. Furthermore, it is
important to note that the concept of Asian refers to a diverse group of
people with origins from a large geographic region and must proceed with
a sense of caution when speaking of the Asian Americans. Asian Americans
are comprised of people from much different ethnic background who vary
within and across groups in language, education and social status.
Despite these limitations, study findings underscore the importance of
offering culturally relevant health education in schools that serve
large Vietnamese and other Asian American populations. The programs
targeting Asian students must be relevant to their culture and messages
must be sensitive to the particular culture of the audience.
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Table 1
Relationship between past use of substance abuse and selected
sociodemographic characteristics
Characteristics Cigarettes Marijuana Alcohol
% p % p % p
Total 11.2 8.5 34.7
n
Gender .002 .020 .002
Male 205 16.1 11.7 42.0
Female 207 6.3 5.3 27.5
Age .668 .401 .411
17-20 101 8.9 10.9 29.7
21-25 234 11.5 8.6 37.2
26+ 77 13.00 5.2 33.8
Birth Place .919 .000 .017
Foreign-born 369 11.1 6.5 32.8
US born 43 11.6 25.6 51.2
Location Raised .032 .002 .000
Mostly in Vietnam 102 4.9 2.0 18.6
Equally in Vietnam & US 49 8.2 2.1 18.4
Mostly in US 261 14.2 12.3 44.1
Class .377 .418 .040
Undergraduate 349 11.8 8.0 32.7
Graduate/Professional 63 8.0 11.1 46.0
Religion .304 .085 .005
Buddhist 176 8.0 4.6 29.0
Catholic 137 12.4 12.4 31.4
Other 46 15.2 10.90 50.0
None 53 15.1 9.4 49.0
Living Arrangement .606 .284 .036
Live with parents 334 10.8 7.8 32.3
Not live with parents 78 12.8 11.5 44.9
p value by Chi-square testTable 2
Mean scores by substance use and acculturation variables by sex
Acculturation variables
Length of
Language use/ Ethnic Sociocultural residence
preference(a) Identity(b) preference(c) in the
US (yrs)
(n)
Cigarettes
Male p .28 .28 .16 .01
No (172) 18.3 3.6 4.9 14.1
Yes (33) 18.8 3.8 5.4 17.1
Female p .82 .61 .55 .59
No(194) 17.9 3.7 4.9 14.7
Yes(13) 17.8 3.5 5.1 15.4
All p .34 .35 .07 .02
No(366) 18.1 3.6 4.9 14.5
Yes(46) 18.5 3.8 5.2 16.6
Marijuana
Male p .19 .03 .03 .00
No(181) 18.2 3.5 4.9 14.2
Yes(24) 19.0 4.0 5.7 17.7
Female p .12 .00 .09 .01
No(181) 17.9 3.7 4.9 14.6
Yes(24) 19.0 4.4 5.6 18.0
All p .03 .00 .00 .00
No(377) 18.0 3.6 4.9 13.3
Yes(35) 19.0 4.1 5.6 17.8
Alcohol
Male p .06 .00 .01 .00
No(119) 18.1 3.4 4.8 13.4
Yes(86) 18.7 3.9 5.3 16.1
Female p .00 .00 .15 .00
No(150) 17.3 3.6 4.8 13.5
Yes(57) 19.5 4.1 5.0 18.2
All p .00 .00 .00 .00
No(269) 17.6 3.5 4.8 13.5
Yes(143) 19.0 4.0 5.2 16.9
(a.) Ratings could range from 7-21 (Higher scores indicating higher
acculturation.)
(b.) Ratings could range from 2-6 (Higher scores indicating higher
acculturation.)
(c.) Ratings could range from 3-9 (Higher scores indicating higher
acculturation.)JENNY K. YI, PH.D., H.R.H.
Associate Professor
Department of Health and Human Performance
ANNE MARIE DANIEL, M.ED
Doctoral Candidate in Allied Health Education
University of Houston