Ashfaq Gulam starts his day behind the counter of a small convenience store not far from the Flushing subway station. This is the second store he’s worked at in the neighborhood; for eight years before this, he sold cigarettes, cigars, newspapers and soft drinks at another outlet on a busy stretch of Main Street. Centrally located retailers, he says, always get a steady flow of customers who come in to buy cigarettes. “I’d say I’ve been able to sell three to four cartons in a day,” he said.
Selling cigarettes may be a good business in Flushing, but it’s also the source of a major public health problem in the community. A 2013, Flushing Hospital Medical Center survey found that smoking cessation was the top concern among members of local Community Boards and physicians serving the Asian community, which makes up 70 percent of the population in the neighborhood.
Many of these residents come from countries like China and India, which have high rates of adult smoking compared to the U.S. Here, just fewer than 18 percent of adults are smokers, according to the Centers for Disease Control and Prevention. On the other hand, The World Health Organization estimates that nearly one-third of the population in China smokes. In India, it is estimated that over 34 percent of adults consume tobacco in some form or the other.
But for many of these residents, moving to the U.S. doesn’t mean kicking the habit. “Smoking is very prevalent among the Asian community in Flushing,” said Marilyn Bitterman, the district manager of Community Board 7, a former smoker herself who quit more than 40 years ago.
Gulam says many smokers want the same brands they knew at home, which has led to a thriving illegal business in smuggled cigarettes. “Some Chinese retailers bring in brands of cigarettes from their country which cost very little,” he said. “They might sell them for anything between $3 and $7. They make a profit, and also attract customers because it’s so much cheaper.”
Smokers say coming to a country with a much more negative attitude towards smoking can be a culture shock. Paul Chang, 73, migrated to America from Taiwan 30 years ago. He began smoking in his youth, and says he used to puff his way through a pack of cigarettes a day. Chang finally managed to kick the habit a decade after his move to the States. “I ended up quitting because my wife told me to,” he said. “She didn’t like the smell at all. It was easy for me to do, because I love my wife.”
In this country, Chang has noticed that attitudes towards smoking are less relaxed than they are back in Taiwan. “I see the number of smokers there just increasing all the time. I went back two years ago, and there were so many young people smoking on the streets. I told them – it’s not good for you,” he said, shaking his head.
But many others find it hard to quit. The Community Service Plan released by the Flushing Hospital Medical Center in 2013 cites research indicating that racial and ethnic minorities are more prone to developing illnesses related to tobacco consumption over time, including cancer and heart disease – both of which are ranked as leading causes of death in the Flushing-Clearview area. It suggests that one factor behind this disparity could be that ethnic minorities are less likely to receive the advice and aid that could help them stop smoking.
Language barriers, for instance, present a problem. A study conducted by the Cancer Center of the University of California demonstrated that introducing telephone counseling services in Chinese, Korean and Vietnamese increased the six-month abstinence rate of each language group. It’s vital that anti-tobacco outreach programs are multi-lingual, but there are mixed opinions on whether this is the case. Bitterman maintains that there are plenty of anti-tobacco advertisements in Chinese language newspapers, but Mohammed Iqbal, 40, who moved here from Bangladesh, said he has never seen a single ad in Bengali or Hindi. “Most of the advertisements I see are in English,” he said, “I’ve seen a couple in Spanish, maybe, but none in any other language.”
The Flushing Hospital Medical Center has been working with Queens Quits (a partnership between the Queens Health Network, the American Cancer Society and Memorial Sloan-Kettering Cancer Center) and has adopted different approaches to the issue, including spreading awareness with multi-lingual flyers, training tobacco cessation leaders and increasing the number of patients who are counseled on quitting smoking. In a progress report released in 2014, the hospital said that 55 percent of inpatients and 32 percent of outpatients were counseled on smoking cessation.
But how much of an impact do these measures have on habitual smokers? Statistics aren’t very reassuring – for instance, only 8.4 percent of outpatients at the hospital actually did quit smoking in 2014. Institutionalized methods, such as increasing the price of cigarettes or passing regulations on smoke-free housing, might have more success. A report released by the New York State Department of Health in 2006 highlights the fact that raising cigarette taxes is one of the most effective ways to discourage adult and youth smokers, estimating that a 10 percent increase in taxation could lead to a three to five percent decrease in adult cigarette consumption.
Tim Yu, a 60-year-old immigrant from Taiwan, says that sometimes it takes even more to convince a smoker to stop. A long-time resident of Flushing who has since relocated to New Jersey, Yu began smoking when he was 24 years old and continued to do so after moving to America. He attempted to quit once and managed to stay off cigarettes for two years, but says that he was soon back to smoking a pack a day. “Sure, I see advertisements telling me that smoking is bad for me. I understand that it isn’t good for my health – when I quit, I had much more energy,” he says. “But I still smoke when I drive and when I go fishing. It’s simple – I don’t want to quit.”
