Smoking among Immigrant Groups in the United States: Prevalence, Education Gradients, and Male-to-Female Ratios.

Introduction: Immigrants in the United States are less likely to smoke than those born in the U.S, but studies have not fully described the diversity of their smoking patterns. We investigate smoking by world region of birth and duration of residence in the United States, with a comprehensive approach covering current prevalence levels, education gradients, and male-to-female ratios.

Methods: The data originate from the National Health Interview Surveys, 2000-2015, and the sample of 365,404 includes both U.S.-born and foreign-born respondents ages 25-70. World region of birth and duration of residence in the United States measure immigrant characteristics. Current cigarette smoking was analyzed using logistic regression.

Results: Immigrant groups were protected from smoking and had weaker education gradients in smoking and larger male-to-female smoking ratios than the U.S.-born population. However, large differences emerged among the immigrant groups for region of birth but less so for duration of residence in the United States. For example, immigrants from sub-Saharan Africa and the Indian sub-continent have low prevalence, weak education gradients, and high male-to-female ratios. Immigrants from Europe have the opposite pattern, and immigrants from Latin America fall between those two extremes.

Conclusion: The stage of the cigarette epidemic in the region of birth helps explain the diverse group profiles. Duration of residence in the United States does less to account for the differences in smoking than region of birth. The findings illustrate the heterogeneity of immigrant populations originating from diverse regions across the world, and limited convergence with the host population after immigration.

Implications: The study identifies immigrant groups that, because of high smoking prevalence related to levels in the host country, should be targeted for cessation efforts. It also identifies immigrant groups with low prevalence for which anti-smoking programs should encourage maintenance of healthy habits. Many immigrant groups show strong education disparities in smoking, further suggesting that smokers with lower levels of education be targeted by public health programs.