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SUBSTANCE USE AMONG VIETNAMESE AMERICAN COLLEGE STUDENTS.
Subject:
Substance abuse (Demographic aspects)
College students (Drug use)
Vietnamese Americans (Drug use)
Ethnic groups (Behavior)
Authors:
YI, JENNY K.
DANIEL, ANNE MARIE
Pub Date:
03/01/2001
Publication:
Name: College Student Journal Publisher: Project Innovation (Alabama) Audience: Academic Format: Magazine/Journal Subject: Education Copyright: COPYRIGHT 2001 Project Innovation (Alabama) ISSN: 0146-3934
Issue:
Date: March, 2001 Source Volume: 35 Source Issue: 1
Geographic:
Geographic Scope: United States Geographic Code: 1USA United States

Accession Number:
74221503
Full Text:
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.

Reference

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Gfroerer, J. C., Greenblatt, J. C. & Wright, D. A. (1997). Substances Use in the US College-Age Population: Differences According to Educational Status and Living Arrangement. American Journal of Public Health, 87(1), 62-65.

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Ja, D. Y. & Aoki, B. (1993). Substance Abuse Treatment: Cultural Barriers in the Asian-American Community. Journal of Psychoactive Drugs, 25(1), 61-71.

Jenkins, C. N. H., McPhee, S. J., Ha, N., Nam, T. V. & Chen, A. (1990). Cigarette Smoking Among Vietnamese Immigrants in California. Americans Journal of Health Promotion, 9(4), 254-256.

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O'Hare, Thomas. (1995). Differences in Asian and White Drinking: Consumption Level, Drinking Contexts, and Expectancies. Addictive Behaviors, 20(2), 261-266.

The Student and Faculty Directory of University of Houston. Published by University of Houston. Houston, Texas. 1995.

Suinn RM, Rickard-Figueroa K, Lew S, et al.(1987) The Suinn-Lew Asian Self-Identity Acculturation Scale: An Initial Report. Educational and Psychological Measurement. 47:401-407.

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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 test


Table 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
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Copyright 2001 Gale, Cengage Learning. All rights reserved.