Family Influences on Asian Youth Smoking in the Context of Culture and Migration to New Zealand Grace Wong RCpN, BA, MPH A thesis submitted to Auckland University of Technology in fulfilment of the requirements for the degree of Doctor of Philosophy Nursing School of Health Care Practice Faculty of Health and Environmental Sciences Auckland University of Technology 2013 2 Table of Contents List of Figures ............................................................................................................. ix List of Tables .............................................................................................................. xi List of Abbreviations ................................................................................................ xiii Statement of Original Authorship ............................................................................. xv Acknowledgements ................................................................................................. xvii Abstract ..................................................................................................................... xix Chapter One: Introduction ........................................................................................... 1 Introduction ................................................................................................................... 1 Smoking ......................................................................................................................... 3 Personal Perspective and Health Promotion Values ..................................................... 4 Theoretical Frameworks ................................................................................................ 7 Human Ecology ......................................................................................................... 7 Ethnotheories ........................................................................................................... 13 Tobacco Control ...................................................................................................... 15 Epidemiology ........................................................................................................... 16 The Keeping Kids Smokefree Study (KKS) ............................................................... 18 PhD Study Overview ................................................................................................... 20 Chapter Overview ........................................................................................................ 20 Chapter Two: Context ............................................................................................... 23 Introduction ................................................................................................................. 23 Ethnicity ...................................................................................................................... 23 Post-positivist Perspectives of Ethnicity ................................................................. 23 Biological Perspectives of Ethnicity ........................................................................ 28 Social Perspectives of Ethnicity .............................................................................. 28 Culture ......................................................................................................................... 35 Culture and tobacco use ........................................................................................... 37 Macro-level and Culture .......................................................................................... 38 Meso-level and Culture ............................................................................................ 38 Micro-level and Culture ........................................................................................... 39 Limitations and Critique of Culture as an Explanatory Variable ............................ 41 Individualism and Collectivism ............................................................................... 42 Acculturation ............................................................................................................... 48 Critiques of Acculturation ....................................................................................... 53 Religion ....................................................................................................................... 55 Family .......................................................................................................................... 57 Families and Theory ................................................................................................ 58 Definition of Family ................................................................................................ 59 Children ....................................................................................................................... 62 iii Child Development .................................................................................................. 64 Parenting and Child Socialisation ............................................................................... 68 The New Zealand Context ........................................................................................... 70 The Treaty of Waitangi ............................................................................................ 70 The New Zealand Asian Population ............................................................................ 71 Migration ................................................................................................................. 71 Demographic Description ........................................................................................ 72 The Health of Asian New Zealanders ...................................................................... 75 Summary ..................................................................................................................... 77 Chapter Three: Literature Review ............................................................................. 79 Introduction ................................................................................................................. 79 Smoking and New Zealand Asian Peoples .............................................................. 79 Smoking and Asian New Zealand Youth ................................................................ 83 Quit Smoking Services and Asian New Zealanders ................................................ 86 Family and Youth Smoking ........................................................................................ 87 Family Socio-demographic Influences .................................................................... 89 Family and Smoking Specific Factors ..................................................................... 89 General Family Factors and Youth Smoking .......................................................... 92 Family, Peers and Asian Youth Smoking ................................................................... 95 Acculturation, Family and Youth Smoking ................................................................ 96 Interventions to Reduce Asian Youth Smoking .......................................................... 96 Summary ..................................................................................................................... 97 Research Questions ..................................................................................................... 97 Chapter Four: Methodology and Mixed Methods Research ..................................... 99 Introduction ................................................................................................................. 99 Methodology ............................................................................................................... 99 Quantitative and Qualitative Descriptive Research ................................................... 104 Mixed Methods .......................................................................................................... 105 Mixed Methods Research Design .......................................................................... 105 Mixed Methods Research and Rigour ................................................................... 108 Summary ................................................................................................................... 110 Chapter Five: Cross-cultural Research .................................................................... 111 Introduction ............................................................................................................... 111 Methodology and Cross-cultural Research ............................................................... 111 Cross cultural Research Methods .............................................................................. 113 Ethnocentrism ........................................................................................................ 113 Cultural Knowledge ............................................................................................... 114 Community Consultation and Advisors ................................................................. 115 Ethics and Cross-cultural Research ....................................................................... 117 Participant Recruitment ........................................................................................