Surveillance of Tobacco Use Among South Asians in the US: Are We Underestimating Prevalence?

Abstract

This study employed a randomized split sample survey to assess the accuracy of standard tobacco surveillance measures among South Asians living in the US. 219 South Asian adults completed a web-based survey of "standard" tobacco use questions, as they appear in national surveillance surveys, and half were randomly assigned to also receive questions about South Asian tobacco products. Prevalence of tobacco use was compared by experimental condition, assessed by only the standard questions for the control group (N=116) and by both standard and South Asian questions for the experimental group (N=103). Among the experimental group, sensitivity and negative predictive value (NPV) of the standard use definitions were calculated, considering the inclusive definitions as the "gold standard." Prevalence of any tobacco product use was higher among the experimental group, as was prevalence of smokeless tobacco (SLT) use, relative to the control group (34.7 vs. 17.2% and 21.2 vs. 4.3%, respectively). 70.6 and 33.3% of true tobacco users (any product) and SLT users were correctly classified by the respective standard product questions. A majority of gutka, paan with tobacco, and supari with tobacco users (69, 86, and 75%, respectively) did not otherwise endorse the standard SLT questions. Current tobacco surveillance measures may underestimate the use of tobacco in the South Asian population residing in the US. These results indicate that careful consideration must be given to how tobacco-related questions are presented to minority populations.