Leap Mansy lives with her husband and seven children in a small apartment in Long Beach usually saturated with pungent white clouds of cigarette smoke.
Mansy said she and her children suffer colds, coughing and fever. She believes that her husband's two-pack-a-day habit is the culprit.
Yet the Cambodian refugee is uneasy even discussing the subject in her husband's presence. "I haven't asked him to stop, because I'm afraid he will get mad at me," she said, speaking nervously through an interpreter one recent afternoon as she waited for her husband, Nouphan Mansy, to return home.
The Cambodian health workers visiting her apartment had heard this sort of story before. They are part of the Southeast Asian Health Project's Tobacco Control Program, a new project based at St. Mary Medical Center aimed at educating Southeast Asians on the dangers of smoking.
Southeast Asians, especially men, are far more likely to smoke than most non-Asians, said Lillian Lew, director of the project, based at St. Mary Medical Center. She estimated that that up to 70% of the men are smokers--nearly three times the state average.
"It's very much part of their culture," Lew said. "It's viewed as (a symbol of) prestige, status and sophistication."
As part of the anti-smoking project, bilingual field workers are going door to door in the Southeast county Southeast Asian community, which consists primarily of Cambodians, to speak with smokers or members of their families. Lew said a worker has also been hired to canvass Latinos, another group with a high smoking rate.
The workers try to inform residents about the health hazards of smoking, sometimes inviting them to seminars for more information. At this point, their main objective is to change attitudes about smoking, rather than smoking habits, Lew said.
"With a culture that has been smoking for many many years," Lew said, "it would be culturally insensitive and ineffective to come in (immediately) with a smoking cessation program. What we're looking for is a softer approach."
The 17-month, $215,000 project is being funded from revenues generated by Proposition 99, the statewide initiative passed two years ago that imposed a 25-cent tax on cigarette sales, to be used to educate the public on the dangers of smoking.
Eventually, Lew said, she hopes to design a program tailored specifically to Southeast Asian men that will help them break the habit. In the meantime, she said, she wants to inform them and their families about the dangers of smoke and perhaps at least persuade smokers to confine their smoking to areas not inhabited by children and pregnant women.
There are lots of reasons besides status that prompt Southeast Asians to smoke, health workers say. In Cambodia, for instance, it is common for male children to spend a year, usually in their early teens, as apprentice monks. Young monks are given cigarettes by respectful members of the community and are expected to show their appreciation by smoking them in the givers' presence.
In Cambodian weddings, the guests traditionally receive cigarettes from the bride and groom.
Some Cambodians say smoking has long been the best way to ward off the swarms of mosquitoes that populate their native country.
Elderly Cambodian women sometimes acquire a taste for tobacco through years of chewing it, mixed with betel nuts in a traditional Southeast Asian concoction.
During long days of tending ox or working in the fields, both men and women often took to smoking raw, rolled tobacco leaves to ward off boredom.
While men have traditionally been the heaviest smokers among Cambodians, Lew said, large numbers of women--many of whom now live in the United States--took up the habit during the Pol Pot regime of the 1970s. Workers who toiled under slave-like conditions were allowed breaks only to take a smoke.
The policy produced tens of thousands of instant smokers, Lew said. Other women began smoking to mask their hunger or suppress their sorrow.
Lew's health workers hope to erode the community's seemingly widespread acceptance of smoking as a harmless pastime. Besides going door to door, they attend community events, visit the local Cambodian Buddhist temple and set up appointments with Asian visitors to the health project's clinic at St. Mary.
Everywhere they go, the workers leave brightly colored Khmer-language flyers bearing ominous pictures of skeletons leaning on cigarettes and containing information on smoke-induced hazards.
Eventually, Lew said, the workers plan to return to some of the estimated 550 people they have visited so far to determine whether attitudes or behaviors have changed.
For now, she said, they are content to keep knocking on doors, confident that ultimately the knowledge they impart will have an impact. "My experience has been that people are basically smart," Lew said, adding that most respond positively to the workers' visits.
That wasn't the case, however, during the team's recent visit to the Mansy household. Seeking to allay Leap Mansy's fears of confronting her husband, the health workers promised to stay long enough to speak to him themselves.
Nouphan Mansy arrived, puzzled to find so many strangers in his living room. He listened politely to the introductions and to the workers' presentation on the hazards of smoking, then shook his head.
"I know what's going on when I smoke," he said. "I want to stop, but I don't know how. Hearing more won't help me quit."