RESEARCH ARTICLE Open Access Culture, acculturation and smoking use in Hmong, Khmer, Laotians, and Vietnamese communities in Minnesota Diana J Burgess 1,2* , Jeremiah Mock 3 , Barbara A Schillo 4 , Jessie E Saul 5 , Tam Phan 6 , Yanat Chhith 7 , Nina Alesci 8 and Steven S Foldes 9 Abstract Background: Southeast Asian communities in the United States have suffered from high rates of tobacco use and high rates of chronic diseases associated with firsthand and secondhand smoking. Research is needed on how best to reduce and prevent tobacco use and exposure to secondhand smoke in these communities. The objective of this study was to examine how tobacco use patterns in Minnesota’s Southeast Asian communities have been shaped by culture, immigration, and adjustment to life in America in order to inform future tobacco control strategies. Methods: The study consisted of semi-structured interviews with 60 formal and informal leaders from Minnesota’s Hmong, Khmer (Cambodian), Lao, and Vietnamese communities and incorporated principles of community-based participatory research. Results: Among Khmer, Lao and Vietnamese, tobacco in the homeland was a valued part of material culture and was used to signify social status, convey respect, and support social rituals among adult men (the only group for whom smoking was acceptable). Among the Hmong, regular consumption of tobacco was unacceptable and rarely seen until the civil war in Laos when a number of Hmong soldiers became smokers. In Minnesota, social norms have begun to shift, with smoking becoming less acceptable. Although older male smokers felt social pressure to quit, smoking functioned to reduce the stress of social isolation, economic hardship, prior trauma, and the loss of power and status. Youth and younger women no longer felt as constrained by culturally-rooted social prohibitions to smoke. Conclusions: Leaders from Minnesota’s Southeast Asian communities perceived key changes in tobacco-related attitudes, beliefs, and behaviors which were embedded in the context of shifting power, status, and gender roles within their communities. This has practical implications for developing policy and interventions. Older Southeast Asians are likely to benefit from culturally-tailored programs (e.g., that value politeness and the importance of acting in ways that benefit the family, community, and clan) and programs that work with existing social structures, as well as initiatives that address smokers’ psychological distress and social isolation. Leaders remained uncertain about how to address smoking uptake among youth, pointing to a need for additional research. Keywords: Tobacco, Smoking, Culture, Acculturation, Immigration, Southeast Asians, Hmong, Lao, Khmer, Cambodian, Vietnamese, Minnesota * Correspondence: Diana.Burgess@va.gov 1 Minneapolis Veterans Affairs Healthcare System, Center for Chronic Disease Outcomes Research (CCDOR), One Veterans Drive, 152/2E, Minneapolis, MN 55417, USA 2 Department of Medicine, University of Minnesota, Minneapolis, MN, USA Full list of author information is available at the end of the article © 2014 Burgess et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Burgess et al. BMC Public Health 2014, 14:791 http://www.biomedcentral.com/1471-2458/14/791