Abstract P185: Risk of Smoking Initiation among US-born and US Immigrant Hispanic Adolescents: Results from the Hispanic Community Health Study / Study of Latinos
Introduction: Every day nearly 4,000 US adolescents smoke their first cigarette, and about 1,000 become daily smokers. Among Hispanics, 7% of adolescents and 23% of adults are current smokers. Hispanics are the largest ethnic minority group, and are a growing segment of the US population. Therefore it is important to understand the factors that may lead to cigarette smoking among Hispanic adolescents.
Hypothesis: We hypothesize that risk of smoking initiation is higher in US-born than immigrant Hispanics, and that among foreign-born (FB) Hispanics, risk of smoking initiation during adolescence increases with time since immigration to the US.
Methods: We included 16,001 (2,801 US-born and 13,200 FB) participants from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) between 18 and 76 years of age. We constructed a time-to-event data set defined by person-years at risk of smoking initiation between 10 and 18 years of age, using age as a discrete variable as the time metric. Age at smoking initiation was the event of interest, defined as the age one began smoking regularly if ever smoked 100+ cigarettes. Immigration status was included as a time-dependent, 4-level categorical variable: FB and living in one’s native country (reference group); FB and in the US for 0-2 years; FB and in the US for 2+ years; and US-born. Cox proportional hazards regression models were used to assess the association between immigration status and time to smoking initiation, adjusting for gender, Hispanic heritage and birth decade. We included interaction terms for each gender and Hispanic heritage with immigration status, to obtain estimates by subgroup. Analyses were properly adjusted for the complex survey design of HCHS/SOL.
Results: Both gender and Hispanic heritage modified the association between immigration status and time to smoking initiation. Among females, being born in the US and living in the US for 2 or more years (compared to not having yet migrated) were associated with increased risk of smoking initiation (hazard ratio [HR]= 2.10, P<0.0001 and HR=1.47, P=.01, respectively). Hispanic heritage subgroup analyses revealed that Dominican, Mexican, and Puerto Rican females exhibited this same pattern. Among males, there was no significant association between immigration status and smoking initiation.
Conclusion: Among US-born and US immigrant Hispanics, immigration status was associated with risk of smoking initiation between the ages of 10 and 18, and was modified by gender and Hispanic heritage. While assessing these factors is outside the scope of this study, smoking initiation within gender and Hispanic heritage subgroups may be influenced by various factors, including cultural norms. Additional studies to examine why certain subgroups begin smoking would be useful in creating targeted intervention and prevention programs.
- © 2013 by American Heart Association, Inc.