The effect of immigrant generation on smoking

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Social Science & Medicine 61 (2005) 1223–1242 www.elsevier.com/locate/socscimed

The effect of immigrant generation on smoking Dolores Acevedo-Garciaa,, Jocelyn Panb, Hee-Jin Juna,c, Theresa L. Osypuka, Karen M. Emmonsa,d a

Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, 7th Floor, Boston, MA 02115, USA b Community Health Program, Tufts University, USA c Harvard Medical School/Brigham & Women’s Hospital, USA d Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA Available online 18 April 2005

Abstract Immigrants to the US are not only an increasingly significant demographic group but overall they also have lower socioeconomic status (SES) than the native-born. It is known that tobacco use is a major health risk for groups that have low SES. However, there is some evidence that tobacco use among certain immigrant groups is lower than among the respective native-born ethnic group, and that immigrant assimilation is positively related to tobacco use. We investigated the relationship between immigrant generation and daily smoking, using the Tobacco Use Supplement of the Current Population Survey (TUS-CPS), 1995–96, a national data set representative of the US general and immigrant populations. Our multivariate logistic regression analysis of the relationship between immigrant generation and daily smoker status (n ¼ 221; 798) showed that after controlling for age, gender, race/ethnicity, SES variables (i.e. equivalized household income, education, occupation), and central-city residence, the odds of being a daily smoker were highest among US-born individuals of US-born parents (reference group) and lowest among foreign-born individuals (95% CI: 0.54–0.62). Being a second-generation immigrant (i.e. US born) with two immigrant parents also conferred a protective effective from smoking (95% CI: 0.64–0.77). However, having only one foreign-born parent was not protective against smoking. Testing for interaction effects, we also found that being foreign born and being second generation with two immigrant parents were especially protective against smoking among females (vis-a`-vis males); racial/ethnic minorities (vis-a`-vis whites); and low-income individuals (vis-a`-vis high-income individuals). We discuss possible mechanisms that may explain the protective effect against smoking of being foreign born and being second generation with two immigrant parents, including differences in the stage of the tobacco epidemic between immigrants’ countries of origin and the US, the ‘‘healthy immigrant effect’’, and anti-smoking socialization in immigrant families. r 2005 Elsevier Ltd. All rights reserved. Keywords: Immigrants; Smoking; USA

Introduction Corresponding author. Tel.: +1 617 432 4486;

fax: +1 617 432 3123. E-mail address: [email protected] (D. Acevedo-Garcia).

In 2002, 32.5 million foreign-born individuals (i.e. first-generation immigrants) represented 11.5% of the total US population (Schmidley & US Census Bureau,

0277-9536/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2005.01.027

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2003)—the largest absolute number of immigrants ever and the highest proportion foreign born since the 1930s. US-born individuals of foreign-born parents (i.e. second-generation immigrants) represented about 10% of the US population (Foner, Rumbaut, & Gold, 2000). Cigarette smoking, the single most preventable cause of premature death in the US (Centers for Disease Control and Prevention, 2002), is a major health risk for groups of low socioeconomic status (SES) (Centers for Disease Control and Prevention, 2000; Pamuk, Makuc, Heck, Reuben, & Lochner, 1998). Although among immigrants some national-origin groups have considerably higher poverty rates and lower educational status than the US born (Schmidley & US Census Bureau, 2003; US Census Bureau, 2000a), seemingly contradictory, there is some evidence that within certain groups, tobacco use is lower among the foreign born than among the US born, and that tobacco use is positively correlated with measures of immigrant assimilation (Acevedo, 2000; Amaro, Whitaker, Coffman, & Heeren, 1990; Baluja, Park, & Myers, 2003; Chen, Unger, Cruz, & Johnson, 1999a; Chen, Unger, & Johnson, 1999b; Cobas, Balcazar, Benin, Keith, & Chong, 1996; Coonrod, Balcazar, Brady, Garcia, & Van Tine, 1999; Gfroerer & Tan, 2003; Harris, 1999; Perez-Stable et al., 2001). However, since US national health surveys frequently do not include information about immigrant status and/or are not representative of the immigrant population, much of the empirical evidence on tobacco use among immigrants has been fragmentary, i.e. studies have focused on a single state/community, a single national origin/ethnic group, and/or convenience samples. The Current Population Survey (CPS), a labor-force survey of the civilian non-institutionalized population conducted monthly by the US Census Bureau, is the only nationally representative survey that permits the study of both first-generation and second-generation immigrants (Hirschman, 1996; Schmidley & Robinson, 1998). Additionally, since 1992, in selected months, the CPS has included a 46-item Tobacco Use Supplement (TUS) developed by the National Cancer Institute (US Census Bureau, 2000b). The unique combination of information on immigrant status and tobacco use makes the Tobacco Use Supplement of the Current Population Survey (TUS-CPS) a highly valuable resource for studying tobacco outcomes among the US immigrant population (Baluja et al., 2003) In this paper, we report the results of new multivariate analyses of the CPS to examine the role of immigrant generation in tobacco use (i.e. daily smoking).

The second generation In addition to distinguishing the foreign-born population, we examine daily smoking status among five

groups according to their generation in the US: USborn individuals of US-born parents (i.e. the third (and higher) generation); US-born individuals with a foreignborn mother (and a US-born father), US-born individuals with a foreign-born father (and a US-born mother), and US-born individuals with two foreignborn parents (i.e. the second generation); and foreignborn individuals (i.e. the first generation). This approach is informed by the segmented assimilation theory, which emphasizes both the importance of the second generation, and the role of immigrant families in examining the adaptation of US immigrants (Portes & Rumbaut, 2001; Rumbaut, 1996; Suarez-Orozco & Suarez-Orozco, 2001). Since the 1980s, the classical immigrant assimilation model (marked by acculturation, socioeconomic advancement, intermarriage, and absence of discrimination from the host society (Gordon, 1964)) has been found insufficient to explain the incorporation patterns of recent immigrant groups (Portes, 1995, 1996b). Immigration scholars have proposed that although the traditional linear of assimilation model of ‘‘Americanization’’ may still apply to various groups of the immigrant population, alternative assimilation paths have emerged, including selective assimilation (i.e. preservation of an ethnic identity accompanied by socioeconomic advancement) and downward assimilation (Portes, 1996b; Portes & Rumbaut, 2000; Rumbaut, 1996). Sociologists of immigration debate the extent to which linear assimilation may apply to contemporary immigrants vis-a`-vis other assimilation pathways (Alba & Nee, 2003). The segmented assimilation model emphasizes the role of the social context in shaping immigrant adaptation. Family structure and intergenerational patterns within immigrant families mediate the influence of the social context, and may act as a buffer against external obstacles such as adverse labor markets, discrimination, and inner-city ‘‘adversarial’’ subcultures (Portes & Rumbaut, 2000; Rumbaut, 1996). US research on immigrant health has hardly incorporated sociological theories of immigrant adaptation (Acevedo-Garcia, 2004). Although health research has applied the anthropological concept of acculturation (convergence in immigrants’ values and norms toward those of the dominant culture) to the study of immigrant health, it generally lacks a strong theoretical foundation (Acevedo-Garcia, 2004; Gutmann, 1999; Hunt, 1999; Hunt, Schneider, & Corner, 2004). The term ‘‘acculturation’’ is often used to characterize individuals according to their nativity status (i.e. US born vs. foreign born); their length of stay in the US (if foreign born); their generation in the US; and/or their perception of how well they speak the native language (i.e. English). In the classical assimilation model (Gordon, 1964), acculturation is only one aspect of assimilation. In the more

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recent segmented assimilation model, there are various possible forms of acculturation and in turn assimilation to the US. The lack of data on immigrant health is a significant limitation. For instance, in the CPS data (Jasso, Massey, Rosenzweig, & Smith, 2000) and other surveys available for health research (Hunt, 1999; Loue & Bunce, 1999), it is not possible to capture the immigrant acculturation and assimilation process. Instead of suggesting that cross-sectional differences across immigrant generation groups are a proxy for acculturation/assimilation, we prefer to characterize our analysis in more straightforward terms as a description of intergenerational differences in tobacco use. In the discussion section, we speculate about some possible reasons why we may observe these differences. However, we make it explicit that it is not warranted to attribute cross-sectional differences in smoking to the immigrant acculturation/ assimilation process, nor to differences in the degree of acculturation/assimilation among immigrant generations. Although the CPS is not a survey of immigrant adaptation, it allows us to examine tobacco use patterns across immigrant generations, instead of focusing only on the foreign-born population. Looking at smoking across immigrant generations is a starting point for understanding some possible explanations of why immigrant and their children may be less (or more) likely to engage in health risk behaviors. Our analysis has three objectives: (i) to assess the effect of immigrant generation on daily smoking status; (ii) to examine whether demographic and socioeconomic variables mediate the effect of immigrant generation on smoking; and (iii) to examine whether gender, race/ethnicity, and SES moderate the effect of immigrant generation on smoking.

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than the average smoking rate for US women (The World Bank Group, 2000). Therefore, for women, immigration to the US may represent exposure to higher smoking rates and a higher social acceptability of smoking compared to the context facing them in their countries of origin. Previous studies have documented that in some ethnic/national-origin groups (Epstein, Botvin, & Diaz, 1998; Marin, Perez-Stable, & Marin, 1989; Perez-Stable et al., 2001; Shankar, GutierrezMohamed, & Alberg, 2000), acculturation is positively associated with smoking among women but negatively associated with smoking among men. Socioeconomic status Among the general US population, there is an inverse gradient between SES (i.e. income (Centers for Disease Control and Prevention, 2000; Pamuk et al., 1998), education (Centers for Disease Control and Prevention, 2000; Pamuk et al., 1998), and occupation (Giovino, Pederson, & Trosclai, 2000; Nelson et al., 1994)) and smoking prevalence. A few studies have shown a negative social gradient between SES and smoking among certain immigrant groups (Perez-Stable et al., 2001; Samet, Howard, Coultas, & Skipper, 1992; Wiecha, Lee, & Hodgkins, 1998), while others have found that SES indicators are not associated with smoking (Shankar et al., 2000). Shankar et al. (2000) hypothesized that the lack of a negative gradient between SES and smoking among some immigrant groups may reflect that their countries of origin are undergoing the first stages of the tobacco epidemic, during which higher SES individuals are more likely to smoke compared to those of lower SES (Lopez, Collishaw, & Piha, 1994).

Race The segmented assimilation theory postulates that given the salience of race in the US, and the changing racial/ethnic composition of the US immigrant population (away from Europe toward a far greater representation from Asia and Latin America (US Census Bureau, 2000a)), race is a key variable in explaining the adaptation of various immigrant groups (Portes & Rumbaut, 2001; Rumbaut, 1996; Waters, 1996). Specifically, rather than a single linear assimilation pathway toward an American identity and socioeconomic advancement, due to racial stratification and discrimination, various racial/ethnic groups may have distinct adaptation pathways (Portes & Rumbaut, 2001; Waters, 1996). Gender In developing countries, smoking rates for women are considerably lower than for men, and are also lower

Data The CPS is a national, monthly labor-force survey. The universe consists of all civilian, noninstitutionalized persons living in households. The probability sample selected to represent the universe consists of about 57,000 occupied households throughout the US (US Census Bureau, 2000b). The Population Division of the US Census Bureau has determined that the CPS provides reliable data about the foreignborn population at the national level and state level (90% level of confidence) (Schmidley & Robinson, 1998). As recommended by the Census Bureau, to maximize statistical power, we combined the September 1995, January 1996 and May 1996 CPS-TUSs, which combined constitute a sample of 245,868 individuals aged 15+ (US Census Bureau, 2000b). For these 3 months, the average response rate for the TUS was

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85.5%.1 We included in the sample only those observations without missing values for any of the variables of interest (n ¼ 221; 798). Of the 46 items in the CPS-TUS, 39 required selfresponse, while seven allowed for proxy responses. In this paper, we analyzed information on smoking status for which proxy responses were allowed. Self-response rates varied across age groups. While for the age groups above 25, the self-response rate was 80+%, in the 15–19 and 20–24 age groups it was only 57% and 67%, respectively. Self-response rates also were lower among the foreign born (72% vs. about 80% in the other four immigrant generation groups). To address these differentials in self-response and avoid resulting potential biases, we focused on self-responses, i.e. we used the CPS-TUS self-response adjustment weights (US Census Bureau, 2000c). We accounted for the CPS complex multistage sampling design by applying (i) the CPS-TUS selfresponse weights to obtain proper design-based regression coefficient estimates as indicated in the CPS-TUS technical documentation (US Census Bureau, 2000b, 2002); and (ii) standard error adjustment factors provided by the US Census Bureau, Demographic Statistical Methods Division (StataCorp, 2001). We performed all statistical analyses in Stata 7.0 (Stata Corporation, College Station, TX). Variables Daily smoking The outcome variable is daily smoking derived from the CPS-TUS recode variable ‘‘smoking status’’, where code 1 is a ‘‘never smoker’’, code 2 is an ‘‘every day smoker’’, code 3 is a ‘‘some-days smoker’’, and code 4 is a ‘‘former smoker’’. We collapsed these four categories to form a dichotomous outcome of daily smoker status coded ‘‘1’’ for daily smokers (i.e. individuals who had smoked at least 100 cigarettes in their entire life, and smoked daily at the time of the survey), and ‘‘0’’ for never smokers, former smokers, and some-days smokers. We chose to focus on daily smoking as opposed to current smoking (defined as having smoked at least 100 cigarettes in one’s lifetime and currently smoking every day or some days) because the prevalence of non-daily smoking in the overall sample is 4.2% while the prevalence of daily smoking is 22.1%. Additionally, 1 The proportion of the CPS respondents who did not respond to the TUS or whose smoking status was indeterminate was higher among the second generation with two immigrant parents and the foreign born (17.1% and 19.3%, respectively) than among the US born (14.3%), the second generation with an immigrant mother (13.9%), and the second generation with an immigrant father (13.2%).

since daily smoking is a narrower definition than current smoking, it makes comparisons across subgroups more appropriate. Finally, research has shown that patterns in non-daily smoking should be analyzed separately (Hassmiller, Warner, Mendez, Levy, & Romano, 2003). The direction and magnitude of all the results reported in the paper for ‘‘daily smoking’’ hold for ‘‘current smoking’’ (results not shown). Immigrant generation Since 1994, the CPS includes the country of origin of the sample person, as well as the country of origin of his/ her mother and father. Therefore, it is possible to determine whether an individual is a first- or secondgeneration immigrant. Immigrant generation, the main explanatory variable of interest, comprises five categories, US born, second generation (broken down into US born with a foreign-born mother, US born with a foreign-born father, or US born with two foreign-born parents), and foreign born. In breaking down the second generation into three groups according to parental nativity, we followed the segmented assimilation framework (Portes, 1996b) and recent empirical analyses of the CPS (Jensen, 2001), which suggest the need for a thorough assessment of the second generation by family structure (i.e. whether only one or both parents are foreign born), as well as a comparison with both the first and the third generation. Demographic variables For the general US population, age, gender, and racial/ethnic differences in smoking rates have been documented (Anderson & Burns, 2000; Geronimus, Neidert, & Bound, 1993; Johnson & Hoffmann, 2000). Additionally, as discussed earlier, given prior empirical work on immigrant adaptation, we expected smoking rates among immigrants to vary by gender, and race/ ethnicity. Therefore, our statistical models included age, gender, and race/ethnicity (coded as non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and Hispanics of any race). We excluded Native Americans from the analysis because of the small sample size (n ¼ 2502) and the small proportion foreign born among this group (2.9%). Socioeconomic status We used three categorical measures of SES, i.e. equivalized household income (defined as in the Luxembourg Income Study, i.e. household income divided by the square root of the number of household members (Kawachi & Kennedy, 1997)) in quartiles, educational attainment, and occupation (see variable categories in Table 1). Occupational categories were defined according to standard occupational groups as coded in the CPS (US Census Bureau, 2000b). Individuals not in the labor force included those retired,

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disabled and others if they had not worked in the past 12 months or more. The unemployed on layoff and looking for work were assigned an occupational category. Central-city residence According to the segmented assimilation theory, residence in an inner-city urban environment may expose immigrants to ‘‘adversarial subcultures’’ (Portes & Rumbaut, 2001; Rumbaut, 1996), which in turn may have negative implications for the adoption of risk behaviors such as smoking. US immigrants are more likely to live in urban areas and within central cities than the general population (Jensen, 2001). Therefore, we examine the role of central-city residence (coded as a categorical variable) in daily smoking. Given that the CPS does not include neighborhood (i.e. census tract) identifiers, we cannot account for the effect of residence in ethnic enclaves, which has been proposed as an important factor in immigrant adaptation (Fernandez Kelly & Schauffler, 1996; Menjivar, 2000; Zhou & Banston III, 1996).

Results Table 1 presents the age, racial/ethnic, and SES distribution of our sample by gender and generation. Nearly 80% of the sample was US born of US-born parents, while 11.4% was foreign born. The second generation included those with a foreign-born mother (2.0%), those with a foreign-born father (2.6%), and those with two foreign-born parents (4.3%). There are some important differences in the sample composition, which are indicative of differences in the US population. First, the second generation with two immigrant parents has a considerable older age distribution than the other generation groups.2 Second, while the majority of nonHispanic whites (87%) and non-Hispanic blacks (92.3%) is US born of US-born parents, 76.4% of Asians, and 49% of Hispanics are foreign born. While, nearly 10% of Asians and about 11% of Hispanics are second generation with two immigrant parents, only about 4% of whites and less than 1% of blacks belong to this group. Third, the foreign born and the second generation with two immigrant parents have considerably lower SES. In terms of occupation, the large proportion of the second generation that is not in the labor force reflects the older age distribution among this group. Fourth, the foreign born are more likely to live in central cities. As shown in Table 2, the prevalence of daily smoking decreases across immigrant generations for both men 2 Jensen (2001) noted this older age distribution among the second generation with two foreign-born parents in his analysis of the 1994–97 CPS.

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and women, and is lower for women than for men within each generation. Importantly, being second generation with two immigrant parents appears as protective as being foreign born, i.e. among men, the proportion of daily smokers is lowest among the second generation with two immigrant parents. Among women, the daily smoking rate is lowest among the foreign born. Smoking increases more with immigrant generation among women than among men. While the daily smoking rate is about 1.6 times higher among US-born men than among foreign-born men, it is 2.6 times higher among US-born women than among foreign-born women. Within each racial/ethnic group, in most cases, smoking rates are lower among the second generation with two immigrant parents (white, Asian, and Hispanic men; and white women), or the foreign born (black and Hispanic women). Both being second generation with two immigrant parents and being foreign born have a protective effect against smoking across SES groups. Both among men and women, within each income group, daily smoking is lower among the second generation with two immigrant parents and among the foreign born. Of special interest is the strong protective effect of belonging to these two groups among individuals in the lowest-income group. While the smoking rate among US-born men in the lowest household income group is 32.3%, it is only 13.5% and 15%, respectively, among second-generation men with two immigrant parents and foreign-born men in the same income group. The respective figures for women are 25.2%, 7.3%, and 6.8%. Also note that for men (females) smoking rates among the second generation with two immigrant parents and among the foreign born in the lowest-income group are comparable (lower) to those among the US born in the highest-income group. An alternative way of looking at these data is to examine the strength of the income gradient in smoking across generation groups. The income gradient is less pronounced among the second generation with two immigrant parents and among the foreign born than among the US born. That is, in relation to smoking behavior, increasing income appears to have a stronger protective effect for the US born and for the second generation with only one immigrant parent. Education level shows a similar pattern. For both men and women in three of the four lowest education groups (i.e. some high school, high school, and some college education), smoking rates among the second generation with two immigrant parents and among the foreign born are lower than among their US-born counterparts. In all generation groups, those in the lowest educational level, i.e. elementary education, smoke less than those in the next three educational levels. In regard to occupation, among all generation groups, professionals tend to have the lowest smoking rates and

1228 Table 1 Sample descriptive statistics: selected demographic and socioeconomic characteristics by gender and immigrant generation status, 1995–96 CPS-TUS; percentages (weighted) (men: n ¼ 102; 896; women: n ¼ 118; 902; total: n ¼ 221; 798; unweighted) Men US born

Women US born/ US born/ US born/ Foreign US FBM FBF FBP born born

All

US born/ US born/ US born/ Foreign US FBM FBF FBP born born

US born/ US born/ US born/ Foreign FBM FBF FBP born

4341 4.4

10,352 96,033 2439 11.9 80.1 2.0

3270 2.7

5144 4.3

12,016 179,300 4642 10.9 79.6 2.0

6003 2.6

9485 4.3

22,368 11.4

Age 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–59 60–69 70–79 80+

9.0 8.6 10.0 11.2 11.8 11.2 9.6 12.6 8.6 5.7 1.7

9.4 9.3 8.5 12.0 10.3 9.0 9.0 10.6 10.6 8.8 2.5

8.4 5.9 6.2 6.7 7.8 6.8 8.4 16.5 17.0 11.5 4.8

11.6 8.2 6.0 5.4 4.4 3.6 3.1 7.7 18.7 21.7 9.6

6.3 10.5 12.8 15.0 13.2 10.4 8.2 10.6 6.9 4.0 2.1

8.4 8.7 9.8 10.8 11.3 10.6 9.3 12.2 9.0 7.0 3.1

8.6 10.1 9.6 9.9 9.7 8.1 8.0 10.2 11.5 10.6 3.8

6.7 6.4 5.3 5.8 7.7 6.7 7.4 16.3 17.3 14.3 6.1

8.3 7.1 6.0 5.1 4.1 3.2 2.5 6.1 16.8 26.2 14.5

5.9 9.7 11.3 13.3 13.1 10.4 8.3 11.5 8.2 5.2 3.1

8.7 8.7 9.9 11.0 11.5 10.8 9.4 12.4 8.8 6.3 2.4

9.0 9.7 9.1 10.9 10.0 8.5 8.5 10.4 11.1 9.7 3.2

7.5 6.1 5.7 6.2 7.7 6.8 7.9 16.4 17.2 13.0 5.5

9.9 7.7 6.0 5.3 4.2 3.4 2.8 6.9 17.7 24.0 12.1

6.1 10.1 12.1 14.2 13.2 10.4 8.2 11.0 7.6 4.6 2.6

Race/ethnicity N–H White (75.31) N–H Black (11.48) N–H Asian/PI (3.36) Hispanic (any race) (9.84)

87.2 91.2 9.0 30.4

2.2 0.5 2.0 3.2

2.6 0.4 2.0 4.1

3.7 0.7 10.7 10.7

4.3 7.2 76.3 51.6

86.8 93.1 10.5 34.8

2.1 0.5 1.9 3.0

2.9 0.6 2.0 4.6

3.9 0.7 9.0 11.2

4.4 5.1 76.6 46.4

87.0 92.3 9.8 32.6

2.1 0.5 2.0 3.1

2.8 0.5 2.0 4.4

3.8 0.7 9.8 11.0

4.3 6.1 76.4 49.0

Equivalized household income $0–11,250 $11,251–19,445 $19,446–31,819 $31,820+

20.9 19.7 27.3 32.1

18.3 19.3 26.4 36.1

19.6 16.4 25.3 29.3

25.1 22.1 23.4 29.3

39.0 20.4 20.3 20.3

28.6 20.1 25.0 26.3

24.4 19.4 25.6 30.6

27.7 18.5 23.9 29.9

34.4 22.8 22.2 20.6

42.6 19.5 19.0 18.9

24.9 19.9 26.1 29.1

21.4 19.3 26.0 33.3

23.9 17.5 24.5 34.0

29.9 22.5 22.8 24.8

40.8 20.0 19.7 19.6

Educationa Elementary Some high school High school Some college/AD College Postgraduate Still in school

5.0 11.9 30.7 24.9 15.7 8.3 3.5

3.3 9.9 27.0 29.0 16.6 10.5 3.8

5.8 11.0 27.7 24.4 16.4 10.9 3.9

9.8 14.0 25.1 21.9 13.7 9.3 6.2

20.2 12.0 20.1 17.5 15.1 11.3 3.9

4.9 13.0 33.1 26.6 14.0 5.5 3.0

4.4 12.3 31.4 26.2 15.3 7.4 3.0

5.9 12.7 31.9 27.0 13.2 6.8 2.5

11.8 16.1 33.5 19.5 9.9 4.8 4.5

21.4 11.2 23.4 19.6 14.6 6.2 3.6

4.9 12.5 31.9 25.8 14.8 6.8 3.3

3.9 11.1 29.2 27.6 15.9 8.9 3.4

5.9 11.9 29.9 25.8 14.7 8.7 3.1

10.8 15.1 29.4 20.7 11.7 7.0 5.3

20.8 11.6 21.7 18.5 14.8 8.8 3.7

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All 83,267 2203 Unweighted n weighted percentage 79.1 2.1

ARTICLE IN PRESS Note: All reported percentages were weighted using the CPS-TUS (1995–96) self-response weights, as indicated in the CPS technical documentation. Percentages for each variable were calculated only for those observations with no missing values for any of the variables of interest (n ¼ 221; 798). Immigrant generation: US born: US born of US-born parents; US born/FBM: US born of US-born father and foreign-born mother; US born/FBF: US born of US-born mother and foreign-born father; US born/FBP: US born of (two) foreign-born parents; Foreign born: foreign born. a Education: ‘‘Still in school’’ category includes respondents aged o25 who were still in school. b Central-city residence was not ascertained for 14% of the individuals included in this analysis (‘‘metropolitan-not identified’’)—their residence in a metropolitan area was determined but not whether they lived in the central city or the suburban portion of the metropolitan area.

6.0 9.1 43.9 41.0 8.4 11.8 49.2 30.6 13.9 13.0 48.0 25.1 22.3 14.8 40.9 22.0 Central-city residenceb Non-metropolitan Metropolitan-not identified Metropolitan-suburban Metropolitan-central city

13.5 16.1 47.1 23.3

13.9 13.2 47.9 25.0

8.3 11.7 49.4 30.6

6.0 8.6 44.0 41.4

22.9 15.1 39.6 22.4

12.2 15.3 49.1 23.4

14.0 12.8 48.1 25.2

8.5 11.9 49.0 30.7

6.1 9.6 43.8 40.6

22.6 15.0 40.3 22.2

12.8 15.7 48.1 23.3

6.7 6.6 14.4 5.3 8.3 1.0 57.7 10.4 11.5 15.5 7.7 29.6 3.0 22.3 Occupation Professional Managerial Technicians Service Blue collar Agriculture Not in labor force

11.8 12.7 17.6 7.7 20.8 2.1 27.3

11.0 11.7 14.9 6.4 18.7 2.3 35.1

7.1 7.9 12.8 6.0 14.8 1.8 49.7

10.8 8.9 13.0 11.4 30.2 5.1 20.6

11.0 8.2 26.4 11.0 6.0 0.8 36.6

12.3 8.4 24.0 9.6 4.2 0.5 41.1

9.3 7.7 22.7 7.5 3.4 0.5 48.9

6.3 5.4 15.9 4.7 2.2 0.3 65.2

8.2 5.7 18.2 12.9 8.3 1.0 45.7

10.7 9.8 21.2 9.4 17.3 1.8 29.7

12.1 10.5 20.9 8.7 12.4 1.3 34.3

10.1 9.5 19.1 7.0 10.5 1.3 42.5

9.5 7.3 15.6 12.1 19.4 3.1 33.0

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blue-collar workers tend to have the highest. Among professional men and women, the daily smoking rate is lowest for the foreign born (7.0% and 5.3%, respectively). The smoking rate for blue-collar male and female workers is considerably lower among the second generation with two immigrant parents and among the foreign born than among the US born. The same pattern appears for male and female workers in the service sector. Logistic regression results Table 3 shows the odds ratios (OR) of being a daily smoker for each immigrant generation under various logistic regression models; US-born individuals of USborn parents are the reference group. The first column shows the OR of being a daily smoker in univariate models for each of the explanatory variables of interest. The univariate model for immigrant generation indicates that, before controlling for any other factors, the odds of daily smoking are 22% lower among the second generation with an immigrant mother than among the US born: 26% lower among the second generation with an immigrant father; 60% lower among the second generation with two immigrant parents; and 53% lower among the foreign born. Model 1 controls for gender, age, and race/ethnicity. The three demographic factors in Model 1 mediate part of the effect of immigrant generation on smoking, but immigrant generation still has a strong, significant independent effect. Including gender, age, and race/ ethnicity decreases the protective effect of being second generation with two immigrant parents with respect to the univariate immigrant generation model (from OR ¼ 0.40 without demographic controls to OR ¼ 0.63 in Model 1). Controlling for demographic factors also reduces the protective effect of being foreign born (from OR ¼ 0.47 without demographic controls to OR ¼ 0.60 in Model 1). Generation and race/ethnicity have significant, protective, independent effects. After controlling for generation in the US, the effect of race/ethnicity on smoking for African Americans in Model 1 is about the same as in the univariate model. This is expected given that only a small fraction of this group is foreign born or second generation. A more interesting result is that the protective effects of Asian and Hispanic ethnicity are partially mediated (i.e. reduced) by immigrant generation. In Model 2, we keep the demographic controls of Model 1, and introduce equivalized household family income; then in Model 3, we also control for education, occupation, and central-city residence. The effect of immigrant generation on smoking remains strong and significant after accounting for income. Also, in Model 2, controlling for household income increases the

Men

Women

1230

Table 2 Daily smoker status (percent) by gender, immigrant generation status, and selected demographic and socioeconomic variables, 1995–96 CPS-TUS (men: n ¼ 102; 896; women: n ¼ 118; 902; total: n ¼ 221; 798) All

US US born/ US born/ US born/ Foreign US US born/ US born/ US born/ Foreign US US born/ US born/ US born/ Foreign born FBM FBF FBP born born FBM FBF FBP born born FBM FBF FBP born 18.1

16.3

11.0

14.4

19.3

15.7

16.1

8.0

7.6

20.7

16.9

16.2

9.5

11.0

Age 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–59 60–69 70–79 80+

14.2 24.8 21.5 24.6 26.5 26.8 26.5 24.0 17.6 10.5 5.5

8.3 20.1 16.9 22.9 21.1 21.5 22.9 21.6 16.9 10.4 —

13.7 20.1 12.2 21.3 23.9 19.2 21.9 18.0 15.4 7.6 6.0

5.2 8.0 8.9 21.6 19.7 18.5 24.9 12.7 13.6 8.2 4.6

6.7 13.2 12.6 15.1 17.6 19.2 18.1 14.5 12.9 8.7 3.7

13.3 21.5 21.4 23.6 23.7 21.1 21.9 20.9 15.5 9.5 3.4

13.0 17.0 15.8 19.2 16.8 23.5 16.3 15.8 16.2 9.2 4.7

11.8 18.7 20.3 20.2 19.7 16.7 15.5 18.7 18.0 11.6 3.8

1.6 8.0 8.4 11.2 14.9 15.4 14.1 18.5 9.4 6.2 3.2

3.9 5.4 5.5 8.8 8.0 9.1 8.3 11.2 7.1 7.1 2.6

13.7 23.1 21.5 24.1 25.0 23.9 24.2 22.4 16.7 9.9 4.1

10.5 18.4 16.3 21.2 19.0 22.5 19.8 18.7 16.5 9.8 4.6

12.8 19.3 16.3 20.8 21.6 17.9 18.7 18.4 16.8 10.0 4.7

3.6 8.0 8.6 16.4 17.3 17.0 19.8 15.3 11.5 7.1 3.7

5.4 9.5 9.3 12.2 12.9 14.2 13.2 12.8 9.8 7.9 3.1

Race/ethnicity N–H White N–H Black N–H Asian/PI Hispanic (any race)

22.5 21.8 21.4 18.0

19.3 — — 12.0

16.0 — — 18.2

11.8 — 8.6 9.5

17.1 9.5 16.4 12.3

20.3 15.2 16.0 13.2

17.7 — — 6.6

16.5 — — 14.4

9.2 — 4.1 5.8

14.4 3.9 3.9 5.1

21.4 18.1 18.5 15.4

18.5 16.1 12.8 9.4

16.3 13.0 15.1 16.2

10.4 12.0 6.5 7.6

15.7 6.9 10.1 8.9

Equivalized household income $0–11,250 32.3 $11,251–19,445 26.2 $19,446–31,819 20.2 $31,820+ 14.9

24.5 20.8 16.8 14.4

23.2 20.7 14.6 12.0

13.5 11.6 10.6 8.8

15.0 15.5 14.3 12.0

25.2 21.6 17.5 12.7

21.0 17.1 16.0 10.3

19.5 18.8 17.5 10.1

7.3 9.3 7.9 7.9

6.8 8.0 8.5 7.8

28.1 23.8 18.9 13.9

22.5 18.9 16.4 12.5

20.9 19.6 16.1 11.1

9.9 10.4 9.2 8.4

10.8 11.9 11.5 10.0

Educationa Elementary Some high school High school Some college/AD College Postgraduate Still in school

25.4 32.2 30.0 21.9 10.3 6.2 9.4

11.9 21.3 26.4 20.1 9.8 5.8 —

18.0 25.8 21.3 17.1 9.3 6.4 —

10.0 11.1 16.1 11.7 8.6 4.8 4.0

15.9 16.0 16.3 16.9 11.8 8.1 7.2

17.0 27.5 24.4 18.7 8.5 6.6 9.2

3.9 21.2 20.9 17.7 6.4 3.7 —

12.7 23.4 18.8 17.1 8.2 3.9 —

4.2 9.7 9.1 9.6 7.5 4.7 1.7

5.0 8.0 10.9 10.1 4.5 4.6 3.0

21.1 29.6 27.0 20.2 9.4 6.3 9.3

7.3 21.2 23.4 19.0 8.1 4.9 13.0

15.1 24.5 19.8 17.1 8.8 5.4 8.6

6.7 10.3 12.0 10.7 8.1 4.8 3.0

10.4 12.2 13.4 13.4 8.3 6.9 5.2

Occupation Professional Managerial Technicians, etc.

8.8 16.2 19.3

7.0 14.8 17.9

7.1 14.4 18.2

7.2 9.0 9.6

7.0 15.3 14.8

9.8 17.6 20.3

7.9 15.9 15.5

8.3 15.1 16.6

8.3 11.7 10.8

5.3 10.6 9.5

9.3 16.8 20.0

7.5 15.3 16.5

7.7 14.7 17.2

7.8 10.1 10.3

6.3 13.5 11.7

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All

ARTICLE IN PRESS Note: All reported percentages were weighted using the CPS-TUS (1995–96) self-response weights, as indicated in the CPS technical documentation. Percentages for each variable were calculated only for those observations with no missing values for any of the variables of interest (n ¼ 221; 798). ‘‘—’’ Data not shown; calculation based on fewer than 100 cases (before applying CPS-TUS self-response weights). Immigrant generation: US born: US born of US-born parents; US born/FBM: US born of US-born father and foreign-born mother; US born/FBF: US born of US-born mother and foreign-born father; US born/FBP: US born of (two) foreign-born parents; Foreign born: foreign born. a Education: ‘‘Still in school’’ category includes respondents aged o25 who were still in school. b Central-city residence was not ascertained for 14% of the individuals included in this analysis (‘‘metropolitan-not identified’’)—their residence in a metropolitan area was determined but not whether they lived in the inner city or the rest of the MA.

15.2 13.1 10.3 10.6 10.3 9.6 9.1 9.8 18.1 15.1 15.0 17.8 20.4 14.7 17.1 15.9 23.1 20.4 19.4 20.7 12.6 10.0 7.9 5.9 9.0 9.1 8.0 7.4 16.5 16.8 15.5 16.6 16.1 13.3 15.8 16.7 21.3 19.2 18.4 18.9 17.7 16.5 12.7 15.2 11.8 10.2 10.3 12.2 20.0 13.2 14.5 19.2 25.2 21.7 20.5 22.8 Central-city residenceb Non-metropolitan Metropolitan-not identified Metropolitan-balance Metropolitan-central city

24.4 16.2 18.4 15.1

16.8 19.5 — 9.0 26.2 31.7 23.5 19.5 Service Blue collar Agriculture Not in labor force

23.3 28.0 — 16.2

24.7 24.8 — 13.3

16.7 17.5 14.1 11.7

27.3 31.4 19.2 17.4

21.5 — — 15.3

19.4 33.3 — 15.6

9.8 13.3 — 6.7

8.6 9.9 2.0 6.2

26.8 31.6 22.5 18.1

22.3 28.0 — 15.6

21.7 26.3 — 14.7

13.6 18.7 10.2 7.7

12.5 15.9 12.2 7.9

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protective effect of black and Hispanic race/ethnicity. A large proportion of individuals in these two racial/ethnic groups are in the lowest-income category (48% and 52%, respectively vs. 20% of whites and 27% of Asian/ PI). Although a large proportion of Asians belong to the highest-income group (29% vs. 33% of whites, 14% of blacks, and 10% of Hispanics), there is an independent protective effect of Asian ethnicity, which is not mediated by income. Model 3 includes all the variables in Model 2 plus education, occupation, and central-city residence. The sequential addition of each SES variable significantly improved the fit of Model 3. The effect on smoking of all SES variables in Model 3 is strong, significant and in the expected direction. After controlling for all the demographic and SES factors in Model 3, the OR for daily smoking for the second generation with only one foreign-born parent are virtually one. That is, the protective effect of being second generation with one immigrant parent evident in the univariate immigrant generation model is fully mediated by demographic and SES variables. In contrast, although some of the protective effect of being second generation with two immigrant parents or being foreign born is mediated by these factors, there is still a significant independent effect on smoking in Model 3. After introducing all the demographic and SES controls, the odds of being a daily smoker are 30% lower for the second generation with two immigrant parents compared with the US born, and 42% lower for the foreign born compared with the US born. For the US born with two immigrant parents, the effect of generation is partially mediated by the SES variables (OR ¼ 0.63 in Model 1 vs. OR ¼ 0.70 in Model 3), but there remains a strong independent effect of generation. The protective effect of being foreign born does not appear to be mediated by SES factors. If anything, accounting for SES slightly enhances such protective effect (OR ¼ 0.60 in Model 1 vs. OR ¼ 0.58 in Model 3). Language use The CPS includes only two language use items, Spanish monolingualism and interview language. However, these variables did not provide significant additional information (results not shown). Among the foreign born, the only group with a large proportion of Spanish-only households (10.7% vs. less than 1.5% in the other generation groups), the proportion of daily smokers was 8.6% among individuals from Spanishonly households, and 11.3% among other households. Among the foreign born (the only group in which a large proportion of the interviews was conducted in Spanish or another foreign language, 24.4% vs. less than 3.5% in the other generation groups), the proportion of daily smokers was similar across different categories of

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Table 3 Logistic regression models of daily smoker status on immigrant generation, demographic variables, and socioeconomic variables, OR [95% CI] CPS-TUS 1995–96 (men: n ¼ 102; 896; women: n ¼ 118; 902; total: n ¼ 221; 798) Univariate models

Model 1

Model 2

Model 3

Immigrant generation US born (reference) US born/FBM US born/FBF US born/FBP Foreign born

— 0.78 0.74 0.40 0.47

— 0.84 0.88 0.63 0.60

— 0.91 0.94 0.67 0.56

— 0.96 0.98 0.70 0.58

Gender Men (reference) Women

— 0.81 [0.79,0.83]

— 0.83 [0.81–0.85]

— 0.77 [0.75–0.79]

— 0.79 [0.77–0.82]

Age 15–19 (reference) 20–24 25–29 30–34 35–39 40–44 45–49 50–59 60–69 70–79 80+

— 1.82 1.68 1.99 2.12 2.06 2.07 1.87 1.29 0.73 0.29

— 1.88 1.71 2.03 2.12 2.02 2.01 1.82 1.27 0.72 0.30

— 1.73 1.81 2.27 2.46 2.45 2.61 2.32 1.33 0.64 0.23

— 2.13 2.39 2.90 3.14 3.19 3.35 2.66 1.51 0.72 0.26

Race/ethnicity N–H White (reference) N–H Black N–H Asian/PI Hispanic (any race)

— 0.81 [0.77–0.85] 0.46 [0.42–0.51] 0.49 [0.46–0.52]

[0.71–0.86] [0.68–0.81] [0.37–0.44] [0.45–0.50]

[1.67–1.98] [1.55–1.82] [1.85–2.15] [1.96–2.29] [1.90–2.22] [1.92–2.24] [1.74–2.02] [1.19–1.40] [0.66–0.80] [0.25–0.34]

[0.76–0.93] [0.80–0.96] [0.57–0.68] [0.56–0.64]

[1.73–2.04] [1.58–1.85] [1.88–2.19] [1.96–2.29] [1.87–2.18] [1.86–2.17] [1.69–1.97] [1.17–1.38] [0.66–0.79] [0.25–0.35]

[0.82–1.00] [0.86–1.03] [0.62–0.74] [0.52–0.60]

[1.59–1.88] [1.67–1.97] [2.10–2.45] [2.28–2.68] [2.27–2.65] [2.41–2.82] [2.15–2.50] [1.22–1.44] [0.59–0.71] [0.20–0.28]

[0.87–1.07] [0.89–1.08] [0.64–0.77] [0.54–0.62]

[1.94–2.33] [2.18–2.61] [2.66–3.17] [2.88–3.43] [2.92–3.48] [3.06–3.66] [2.45–2.90] [1.38–1.65] [0.65–0.80] [0.22–0.31]

— 0.78 [0.75–0.82] 0.64 [0.57–0.71] 0.59 [0.55–0.64]

— 0.58 [0.55–0.61] 0.60 [0.53–0.67] 0.43 [0.40–0.46]

— 0.51 [0.48–0.54] 0.66 [0.58–0.74] 0.35 [0.32–0.37]

Equivalized household family income (quartiles) $0–11,250 (reference) — $11,251–19,445 0.87 [0.84–0.90] $19,446–31,820 0.65 [0.62–0.67] $31,821+ 0.43 [0.41–0.45]

— — — —

— 0.69 [0.66–0.72] 0.46 [0.44–0.48] 0.29 [0.28–0.30]

— 0.74 [0.71–0.77] 0.56 [0.54–0.58] 0.47 [0.45–0.49]

Education Elementary (reference) Some high school High school Some college/AD College Postgraduate Still in school

— 1.86 1.73 1.22 0.52 0.35 0.48

[1.74–1.99] [1.63–1.84] [1.15–1.30] [0.49–0.56] [0.32–0.38] [0.42–0.55]

— — — — — — —

— — — — — — —

— 1.37 0.96 0.70 0.33 0.25 0.54

[1.28–1.47] [0.90–1.03] [0.65–0.75] [0.31–0.37] [0.23–0.28] [0.47–0.63]

Occupation Professional (reference) Managerial Technicians, etc. Service Blue collar Agriculture Not in labor force

— 1.98 2.37 3.28 4.22 2.58 1.94

[1.85–2.13] [2.23–2.53] [3.06–3.52] [3.96–4.50] [2.29–2.90] [1.83–2.06]

— — — — — — —

— — — — — — —

— 1.43 1.38 1.64 1.76 1.21 1.43

[1.33–1.55] [1.29–1.48] [1.51–1.77] [1.64–1.90] [1.07–1.37] [1.33–1.54]

Central-city residence Non-metropolitan (reference) Metropolitan-not identified Metropolitan-balance

— 0.82 [0.78–08.6] 0.74 [0.71–0.76]

— — —

— — —

— 1.01 [0.96–1.06] 1.04 [1.00–1.08]

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Table 3 (continued ) Univariate models Metropolitan-central city Log-likelihood ratio test (d.f.)

Model 1

Model 2

Model 3

5571** (3)

1.17 [1.12–1.22] 7192** (15)

0.76 [0.73–0.79] a

5269**,

b

(14)

Note: All regression models weighted using CPS-TUS (1995–96) self-response weights; all standard errors adjusted using correction factors provided by US Census Bureau, Demographic Statistical Methods Division. Immigrant generation: US born: US born of US-born parents; US born/FBM: US born of US-born father and foreign-born mother; US born/FBF: US born of US-born mother and foreign-born father; US born/FBP: US born of (two) foreign-born parents; Foreign born: foreign born. Education: ‘‘Still in school’’ category includes respondents aged o25 who were not in the labor force because they were still in school. **Log-likelihood ratio tests for Models 1–3 were statistically significant (po0:01). a All log-likelihood ratio tests for univariate models (compared with null model) were statistically significant (po0:01). b The log-likelihood ratio test for Model 1 is with respect to the univariate immigrant generation model.

US born (reference group)

1.20 1.00

1.04

1.00

1.00

US born/FBM

0.92 0.98

0.95

0.78

0.80

0.75

0.60

0.64

US born/FBF

0.40 0.41

US born/FBP

0.20 Foreign born

0.00 Men

Women

Fig. 1. Daily smoker status by immigrant generation and gender, CPS-TUS, 1995–96. Notes: Based on a model that includes all the variables in Model 3 (Table 3) plus the interaction between immigrant generation and gender. All regression models weighted using CPS-TUS (1995–96) self-response weights; all standard errors adjusted using correction factors provided by US Census Bureau, Demographic Statistical Methods Division. Immigrant generation: US born: US born of US-born parents; US born/FBM: US born of US-born father and foreign-born mother; US born/FBF: US born of US-born mother and foreign-born father; US born/FBP: US born of (two) foreign-born parents; Foreign born: foreign born.

interview language (10.96% among respondents who were interviewed in English; 9.14% Spanish; and 12.65% in other language). So although language has been used as a marker for acculturation in other studies, the CPS language variables were not helpful for explaining daily smoking behavior. Interaction effects Figs. 1–3 summarize the results of three logistic regression models that, in addition to controlling for the demographic and SES variables, include a statistically significant (po0:05) interaction effect between immigrant generation and various variables of interest. These additional logistic models include all explanatory variables from Model 3, plus the respective interaction term. Fig. 1 shows the interaction between immigrant generation and gender. For both genders, the odds of

being a daily smoker for those who are second generation with only one immigrant parent are not different than the odds for the US born. Among men, in comparison with the US born, being second generation with two immigrant parents lowers the odds of smoking by about 22%, and being foreign born lowers the odds by about 25%. Being second generation with two immigrant parents and being foreign born is also protective for women, but the protective effect is stronger than for men. For women being second generation with two immigrant parents reduces the odds of smoking by about 36% in comparison with the US born, while being foreign born reduces the odds by 59%. Fig. 2 shows the interaction between immigrant generation and race/ethnicity. The protective effect of being second generation with two immigrant parents and of being foreign born varies across racial/ethnic groups. For whites, Asians and Hispanics being second

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1.40

US born (reference group) US born/FBM

1.25

1.20

1.08

1.00

1.00

0.92 1.00 0.73

0.80

1.00 1.14 0.86

1.00

1.00 0.89

US born/FBF 0.58

0.77

0.60

0.68 0.44

0.64

US born/FBP

0.40

0.45

0.42

0.32

0.20

Foreign born

0.00 Whites

Blacks

Asians

Hispanics

Fig. 2. Daily smoker status by immigrant generation and race/ethnicity, CPS-TUS, 1995–96. Notes: Based on a model that includes all the variables in Model 3 (Table 3) plus the interaction between immigrant generation and race/ethnicity. All regression models weighted using CPS-TUS (1995–96) self-response weights; all standard errors adjusted using correction factors provided by US Census Bureau, Demographic Statistical Methods Division. Immigrant generation: US born: US born of US-born parents; US born/FBM: US born of US-born father and foreign-born mother; US born/FBF: US born of US-born mother and foreign-born father; US born/FBP: US born of (two) foreign-born parents; Foreign born: foreign born.

1.20

1.09 1.00

1.00

1.00

1.00

1.00

0.93 0.98 0.91

0.80 0.60

1.05

0.97 0.79 0.69 0.79

0.57

US born (reference group)

0.89 0.98 0.97 0.84

US born/FBM

US born/FBF

0.58

0.40

US born/FBP

0.39 0.20

Foreign born

0.00 $0-11,250

$11,251-19,445 $19,446-31,820

$31,821+

Fig. 3. Daily smoker status by equivalized household income (quartiles), CPS-TUS, 1995–96. Notes: Based on a model that includes all the variables in Model 3 (Table 3) plus the interaction between immigrant generation and household income. All regression models weighted using CPS-TUS (1995–96) self-response weights; all standard errors adjusted using correction factors provided by US Census Bureau, Demographic Statistical Methods Division. Immigrant generation: US born: US born of US-born parents; US born/FBM: US born of US-born father and foreign-born mother; US born/FBF: US born of US-born mother and foreign-born father; US born/FBP: US born of (two) foreign-born parents; Foreign born: foreign born.

generation with two immigrant parents and being foreign born are similarly protective against smoking. In contrast, for blacks, while being foreign born is highly protective, being second generation with two immigrant parents is not. Also, the protective effect of foreign-born status is highest for blacks (OR ¼ 0.32) and lowest for whites (OR ¼ 0.77), while Asians (OR ¼ 0.45) and Hispanics (OR ¼ 0.42) fall in the middle. Importantly, being foreign born is the only immigrant generation category imparting protective effects across all racial/ ethnic groups.

Fig. 3 shows the interaction between (equivalized) household income and generation. Being second generation with two immigrant parents and being foreign born are the most protective against smoking (vis-a`-vis being US born) among individuals in the lowest-income group (OR ¼ 0.57 and 0.39), respectively. These protective effects gradually decrease as household income increases, until in the highest-income group, the odds of daily smoking are similar across generation groups. Thus, we found evidence that gender, race/ethnicity, and household income modify the effect of immigrant

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generation on smoking behavior. Specifically, being second generation with two immigrant parents and being foreign born are especially protective against smoking among women (vis-a`-vis men); racial/ethnic minorities (vis-a`-vis whites); and low-income individuals (vis-a`-vis high-income individuals). Finally, Table 4 shows estimated probabilities of daily smoking given the three interaction effect models discussed above, i.e. by immigrant generation and (1) gender, (2) race/ethnicity, and (3) income. We estimated the probabilities of smoking both using the actual value of the other covariates in the model, and setting the value of the other covariates at the level that represented the highest risk of smoking. We refer to these estimated probabilities, respectively, as ‘‘estimate of actual smoking prevalence’’ and ‘‘estimate of smoking prevalence given all risk factors for smoking’’. For instance, for the interaction between immigrant generation and race/ ethnicity (Model 5), the estimated actual smoking prevalence is 13.1% among US-born Hispanics vs. 7.4% among foreign-born Hispanics. The estimated daily smoking prevalence assuming the highest risk factors for smoking (i.e. male gender, aged 25–29, lowest-income group, high school education, blue-collar occupation, and central-city residence) is 26.7% among US-born Hispanics vs. 13.3% among foreign-born Hispanics, i.e. even assuming high risk factors for smoking, being foreign born confers a strong protective effect against smoking.

Discussion Our results suggest that the protective effect of immigrant status against smoking is only partially mediated by demographic and socioeconomic factors. After controlling for age, gender, race/ethnicity, SES variables, and central-city residence, we found that the odds of being a daily smoker are highest among USborn individuals of US-born parents and lowest among foreign-born individuals. Being second generation with two immigrant parents also confers a protective effective from smoking. Interestingly, though, being second generation with only one foreign-born parent is not protective against smoking after controlling for demographic and SES factors. Previous analyses have not distinguished between second-generation individuals from families where only one parent is foreign born from those where two parents are foreign born. This may indicate that when examining immigrant health, in addition to considering generation, we should pay attention to family structure, which is consistent with recent sociological research on immigrant adaptation, i.e. segmented assimilation theory. Our systematic analysis of the impact of immigrant generation status on smoking is an important step given

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that the CPS-TUS has national coverage, and is representative of immigrants. Despite its novel aspects, our analysis has some limitations due to the characteristics of the CPS-TUS data. Due to the lack of data on immigrant adaptation and the cross-sectional nature of the CPS, we were not able to test specific mechanisms through which being second generation with two immigrant parents and being foreign born may protect individuals against smoking. The CPS does not contain information on individual (e.g. depression), household (e.g. parent–child relationships), or contextual factors (e.g. residence in an ethnic enclave) that may mediate the relationship between the immigrant adaptation process and tobacco use. Therefore, although segmented assimilation theory guided our choice of immigrant generation as our main explanatory variable, and of race as a central variable, we were unable to test more complex pathways informed by segmented assimilation such as the effects of role reversal, discrimination, and co-ethnic peer networks on immigrant smoking. The reported effect of immigrant generation may be consistent with acculturation, linear assimilation, or segmented assimilation theory. Additionally, in a cross-sectional sample such as the CPS, we can only compare different generation groups. Cross-sectional data though are not adequate for studying the dynamics of the assimilation process (Jasso et al., 2000). Presently there are no alternative longitudinal surveys to assess tobacco use among immigrants. The ideal data set for examining the relationship between assimilation and tobacco use would be a longitudinal survey, representative of immigrants at the national and state level, that had both a tobacco use module and an immigrant adaptation module, or, at least, rich information on individual, family and community level factors that may mediate the relationship between immigrant adaptation and tobacco use. Information on country of origin background factors would also be important, both in relation to individuals’ SES and smoking behavior in their country of origin, as well as on smoking prevalence and the SES patterning of smoking in the country of origin. Such data would allow us to study smoking behavior over time, before and after immigration to the US, and its relation to the process of immigrant adaptation. New surveys, such as the New Immigrant Survey (Jasso et al., 2000) and the National Latino and Asian American Survey (Alegria et al., 2004) (still in the process of data collection), will eventually allow a richer analysis of the pathways between immigrant adaptation and smoking. For the time being the CPS-TUS offers the best possibility to examine some important patterns in smoking behavior by immigrant generation. We turn now to reviewing some mechanisms that could be related to the smoking patterns we have documented in our analysis.

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Table 4 Estimated probability of smoking from logistic regression models of daily smoker status on immigrant generation, demographic variables, and socioeconomic variables, including interaction terms between immigrant generation and (i) gender (Model 4), (ii) race/ ethnicity (Model 5), and (iii) income (Model 6), probability [95% CI] CPS-TUS 1995–96 (men: n ¼ 102; 896; women: n ¼ 118; 902; total: n ¼ 221; 798) Immigrant generation US born

US born/USM

US born/USF

US born/USP

Foreign born

Estimated of actual daily smoking prevalence Gender (Model 4) Men 0.197 [0.193,0.200] 0.157 [0.138,0.178] Women 0.165 [0.162,0.168] 0.129 [0.115,0.146]

0.138 [0.122,0.156] 0.134 [0.121,0.149]

0.090 [0.081,0.101] 0.065 [0.058,0.073]

0.124 [0.116,0.132] 0.062 [0.057,0.067]

Race/ethnicity (Model 5) N–H White 0.185 N–H Black 0.149 N–H Asian 0.162 Hispanic 0.131

a

[0.182,0.188] [0.143,0.156] [0.133,0.197] [0.121,0.142]

0.155 0.126 0.102 0.075

[0.141,0.170] [0.069,0.219] [0.054,0.186] [0.053,0.106]

0.133 0.104 0.135 0.141

[0.122,0.145] [0.057,0.183] [0.081,0.216] [0.111,0.178]

0.083 0.105 0.051 0.062

[0.076,0.091] [0.058,0.182] [0.036,0.074] [0.050,0.077]

0.13 [0.121,0.140] 0.054 [0.040,0.072] 0.082 [0.073,0.093] 0.074 [0.068,0.081]

Household income (Model 6) $0–11,250 0.256 [0.251,0.262] $11,251–19,445 0.215 [0.210,0.221] $19,446–31,820 0.166 [0.161,0.170] $31,821+ 0.118 [0.115,0.122]

0.198 0.162 0.140 0.103

[0.167,0.232] [0.134,0.195] [0.118,0.165] [0.087,0.122]

0.177 0.170 0.139 0.091

[0.154,0.203] [0.142,0.203] [0.119,0.163] [0.077,0.106]

0.083 0.085 0.076 0.066

[0.072,0.096] [0.072,0.101] [0.064,0.090] [0.055,0.078]

0.093 0.105 0.100 0.086

[0.085,0.101] [0.094,0.117] [0.089,0.111] [0.076,0.096]

Estimated daily smoking prevalence assuming all risk factors for smokingb Gender (Model 4) Men 0.470 [0.453,0.487] 0.464 [0.423,0.504] 0.448 [0.410,0.487] Women 0.424 [0.407,0.442] 0.412 [0.375,0.450] 0.434 [0.401,0.469]

0.407 [0.373,0.443] 0.319 [0.289,0.350]

0.400 [0.375,0.425] 0.231 [0.211,0.253]

Race/ethnicity (Model 5) N–H White 0.473 N–H Black 0.320 N–H Asian 0.427 Hispanic 0.267

[0.456,0.490] [0.304,0.337] [0.368,0.487] [0.246,0.289]

0.474 0.350 0.337 0.189

[0.442,0.505] [0.216,0.512] [0.202,0.505] [0.136,0.255]

0.453 0.289 0.400 0.313

[0.424,0.483] [0.174,0.439] [0.273,0.541] [0.255,0.376]

0.396 0.337 0.247 0.175

[0.368,0.425] [0.211,0.492] [0.182,0.326] [0.143,0.212]

0.410 0.130 0.253 0.133

[0.385,0.436] [0.098,0.169] [0.226,0.281] [0.120,0.147]

Household income (Model 6) $0–11,250 0.488 [0.471,0.506] $11,251–19,445 0.401 [0.385,0.418] $19,446–31,820 0.334 [0.319,0.349] $31,821+ 0.293 [0.279,0.309]

0.484 0.378 0.326 0.288

[0.430,0.537] [0.325,0.434] [0.283,0.372] [0.249,0.332]

0.471 0.423 0.344 0.269

[0.426,0.516] [0.369,0.477] [0.302,0.389] [0.233,0.308]

0.351 0.317 0.283 0.258

[0.313,0.392] [0.277,0.360] [0.245,0.325] [0.223,0.297]

0.272 0.281 0.285 0.287

[0.249,0.296] [0.255,0.310] [0.257,0.313] [0.259,0.318]

Note: Logistic regression models including interaction effects of immigrant generation and gender (Model 4), race/ethnicity (Model 5), and household income (Model 6). All models also include the main effects of immigrant generation, gender, age, race/ethnicity, income, education, occupation, and central-city residence (addition of each interaction term to model including only the main effects of all variables above (Model 3) was statistically significant (po0:01)). All regression models weighted using CPS-TUS (1995–96) self-response weights; all standard errors adjusted using correction factors provided by US Census Bureau, Demographic Statistical Methods Division. Immigrant generation: US born: US born of US-born parents; US born/FBM: US born of US-born father and foreign-born mother; US born/FBF: US born of US-born mother and foreign-born father; US born/FBP: US born of (two) foreign-born parents; Foreign born: foreign born. a Estimated probability of daily smoking as predicted by each model (Models 4–6) by immigrant generation and the other variable in the interaction term. b Estimated probability of daily smoking as predicted by each model (Models 4–6) by immigrant generation and the other variable in the interaction term, holding the values of all the other variables constant at the category that represents the highest risk factor for smoking (i.e. male gender, age group: 25–29; N–H White race/ethnicity, lowest-income group, high school education, blue-collar occupation, and central-city residence).

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The protective effect of foreign-born status against smoking The protective effect of foreign-born status may be explained by differences in the smoking epidemic between the US and immigrants’ countries of origin. The sharp differences we found in smoking rates between foreign-born men and women support this hypothesis, since in developing countries there is a much stronger differential in smoking rates between men and women than in the US (Lopez et al., 1994). For instance, in the US, a 1993 national survey of persons age 18 and older reported a smoking prevalence (daily and occasional smoking) among men of 27.7.1%, and among women of 22.5%, with overall prevalence of 25.7% (World Health Organization & Tobacco or Health Programme, 1997). In contrast, in Mexico, a 1990 national survey of 13,000 urban residents reported overall smoking prevalence at 26%, with 38.3% among men and 14.4% among women (World Health Organization & Tobacco or Health Programme, 1997). Similarly, in the Philippines, according to a 1987 national prevalence study, 43% of adult men and 8% of adult women smoked (World Health Organization & Tobacco or Health Programme, 1997). Mexico and the Philippines are the two main countries sending immigrants to the US (25.2% and 5.1% of the foreign born in the 1995–96 CPS-TUS). In sum, some of the differential smoking patterns between the foreign born and the US born that we observed in the CPS-TUS may reflect the influence of smoking patterns prevalent in the immigrants’ countries of origin. Besides large differences between smoking rates among foreign-born men and foreign-born women (14.4% vs. 7.6% on average), we found foreign-born status to be protective against smoking (vis-a`-vis the US born) among both men and women, although, as discussed above, overall smoking rates among men in the US are lower than in developing countries. A possible explanation of the protective effect of foreignborn status among men (and women) is the healthy immigrant hypothesis, which predicts that on average immigrants are healthier individuals than the population in their countries of origin. Thus, individuals with low health risk behaviors such as smoking may be more likely to emigrate. In turn, healthier immigrants are more likely to stay in the destination country (AbraidoLanza, Dohrenwend, Ng-Mak, & Turner, 1999; Franzini, Ribble, & Keddie, 2001; Soldo, Wong, & Palloni, 2002). For example, some research evidence suggests that Mexican immigrants who remain in the US have better health than those who return to their country of origin (Soldo et al., 2002). In the 1995–96 CPS-TUS, the smoking rate for Mexican men who had entered the US less than 5 years before the survey was about 10% (data not shown; n ¼

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400; unweighted), while the respective figure for their female counterparts was about 4% (n ¼ 431; unweighted). In contrast, as mentioned earlier, the 1990 national smoking prevalence in Mexico was 38.3% among men and 14.4% among women. Although these figures seem to indicate a healthy immigrant effect in relation to smoking among Mexicans, it is simply not possible to examine this question across national-origin groups with the CPS data, as there is insufficient statistical power once the data on the foreign born are broken down by length of stay to allow meaningful comparisons with smoking prevalence data by country of origin. Even if sample sizes were adequate, the CPS does not have enough information about the country of origin backgrounds of the foreign born to permit sound comparisons between US immigrants and their nonimmigrant compatriots. For instance, although the discussion above suggests that Mexican immigrants to the US smoke less than Mexicans in Mexico, these aggregate figures may reflect differences in the smoking epidemic among subgroups (e.g. rural vs. urban) of the Mexican population. The majority of Mexican immigrants to the US come from rural areas in Mexico (Cuellar, 2002). It is not possible to disentangle such differences given the lack of country of origin background variables in the CPS. The protective effect against smoking of being second generation with two immigrant parents In addition to the protective effect of foreign-born status, our analysis showed that US-born individuals with two foreign-born parents are less likely to smoke than their US-born counterparts with US-born parents or only one foreign-born parent. Are different factors at play in explaining the lower smoking prevalence among the second generation? In relation to the protective effect against smoking among the foreign born, we have examined the possible contribution of the influence of the smoking epidemic in the country of origin, as well as the healthy immigrant hypothesis. These factors are less likely to be operating among the second generation since those individuals may be less likely to have contact with their parents’ country of origin than the first generation, and since they were not self-selected into the migration process for being healthy. Sociologists debate the extent to which first-generation immigrants maintain ties to their countries of origin (Levitt, 1998, 2001; Portes, 1996a; SuarezOrozco & Suarez-Orozco, 2001). The strength of transnational ties among the second generation is even more debated (Levitt & Waters, 2002; Suarez-Orozco & Suarez-Orozco, 2001). Therefore, we can only speculate that possibly the low smoking prevalence among second-generation women with two immigrant parents may be due to their keeping ties with their parents

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countries of origin, where smoking among women is not socially acceptable. Additionally, some authors have argued that healthy immigrants may pass on their health behavior advantages to the next generation, so that positive health behaviors among the second generation may be linked to a healthy immigrant effect (Franzini et al., 2001). Our analysis did not examine the influence of tobacco prevalence in the country of origin, nor the healthy immigrant hypothesis. However, the fact that both foreign-born status and being second generation with two immigrant parents confer an important protective effect may indicate that in addition to possible country of origin factors, there are protective factors associated with families with two immigrant parents. The theory of segmented assimilation emphasizes the importance of family relations in shaping the adaptation of the second generation (Portes & Rumbaut, 2001). When children assimilate faster than their parents (dissonant acculturation), role reversal may occur. Role reversal is a shift of authority from immigrant parents to their children due to a greater competence of the children in navigating US society, culture and institutions (Menjivar, 2000; Office of Refugee and Immigrant Health & Massachusetts Department of Public Health, 1999; Portes & Rumbaut, 2000). This greater competence may arise for example from the better Englishlanguage proficiency of the children vis-a`-vis their parents (Portes & Rumbaut, 2000). Research has shown that anti-tobacco socialization within families may be an important determinant of tobacco use (Clark, Scarisbrick-Hauser, Gautam, & Wirk, 1999; Jackson & Henriksen, 1997; Jackson, Henriksen, Dickinson, & Levine, 1997; Sargent & Dalton, 2001). In immigrant families, role reversal may weaken parental control and thus the anti-smoking socialization process within the family, leading youth to engage in smoking and other health risk behaviors. For instance, for youth, pressures from friends and peers are related to smoking (Botvin, Epstein, Schinke, & Diaz, 1994). Certain immigrant youth may be more susceptible to pressures from their social networks due to role reversal and the associated inability of immigrant parents to supervise their children (Menjivar, 2000). Although unfortunately we cannot test the above mechanisms with the CPS-TUS data, the protective effect against smoking of being second generation with two immigrant parents suggests that the socialization process in those immigrant families (vis-a`-vis those where only one parent is foreign born) may protect individuals against health risk behaviors such as smoking. To date only a few studies have addressed whether familial factors may mediate the effect of assimilation/acculturation on smoking (Coonrod et al., 1999; Harris, 1999). In addition to the effect of immigrant generation, future research on health beha-

viors among immigrants should examine the role of family structure and relations. Factors such as stronger anti-smoking socialization in immigrant families with two foreign-born parents may protect children from taking up smoking. Socioeconomic gradients in smoking among immigrants Our descriptive analysis showed that socioeconomic gradients in smoking are less pronounced among the second generation with two immigrant parents and among foreign born compared to the US born, and that second-generation and foreign-born individuals in low SES groups had lower smoking rates than their US-born counterparts. Differences in the smoking epidemic between sending countries and the US may help explain the pattern of attenuated socioeconomic gradients in smoking among the foreign born. According to the model of the smoking epidemic proposed by Lopez et al. (1994), in countries in Stage II of the epidemic (e.g. Mexico, Arillo-Santilla´n et al., 2002) smoking prevalence may be similar among different socioeconomic classes. However, it is puzzling that SES gradients also seem attenuated among the second generation with two immigrant parents since we would expect those born in the US to adopt the socioeconomic gradient prevalent in the US. An alternate explanation for attenuated SES gradients among these two groups of immigrant generations may be poor measurement. For example, mismeasurement of SES may occur if occupation/income in the US does not capture well immigrants’ previous social position in their country of origin. Segmented assimilation? The differential effect of secondgeneration status across racial/ethnic groups Sociologists of segmented assimilation have shown that due to the preeminence of ‘‘race’’ in the US, the advancement prospects for second-generation blacks may be limited (Fernandez Kelly & Schauffler, 1996; Waters, 1996). For example, due to the impediments associated with discrimination and racial residential segregation, Haitian immigrants may assimilate to the African American subculture of inner-city neighborhoods (Waters, 1996). Our empirical analysis suggested that being second generation with two immigrant parents is protective against smoking among whites, Hispanics and Asians, but not among blacks. One could speculate that the erosion of this protective effect among second-generation blacks (relative to the first generation) may be associated with stronger downward assimilation pressures associated with the racialized context facing black immigrants. However, the cross-sectional nature of the CPS prevents us from giving such interpretation to our

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results. Future studies of immigrant health should examine further whether the protective effects of foreign-born and second-generation status vary by race/ethnicity.

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participants at the 2002 NCI Annual Small Grants Meeting, and two anonymous reviewers for helpful comments.

Global tobacco control Tobacco use is increasingly seen as a global health issue (Bartecchi, MacKenzie, & Schrier, 1995; Lopez et al., 1994; Mackay, 1998; Rafei, 1999; World Health Organization, 1999). Of major concern are the disparities in tobacco use patterns between developed and less-developed countries. In developed countries, tobacco use has declined in the last 45 years and is becoming socially unacceptable, while in less-developed countries, use has increased along with the social acceptability of smoking (International Consultation on Tobacco and Youth & World Health Organization, 1999; Lopez et al., 1994). For example, in the US, smoking prevalence among adults decreased from 42% in 1965 to 24% in 1998 (Centers for Disease Control and Prevention, 2000). In developing countries, between the mid-1950s and the mid-1990s, smoking prevalence increased from 20% to 50% for men, and from virtually 0% to 8% for women (International Consultation on Tobacco and Youth & World Health Organization, 1999). As the domestic policy environment becomes less favorable to tobacco interests, the US tobacco industry is intensifying its operations in less-developed countries (Jenkins et al., 1997; Mackay, 1997; Stebbins, 1987). The majority of recent US immigrants come from less-developed countries in Asia and Latin America, where tobacco use is becoming more widespread. Additionally, as reported elsewhere, we have found evidence of the tobacco industry’s efforts to achieve a sophisticated characterization of tobacco use among Asian and Hispanic immigrants to the US according to their geographic location, assimilation level, and smoking patterns in their countries of origin (Acevedo-Garcia, Barbeau, Bishop, Pan, & Emmons, 2004). Therefore, although the present analysis suggests that US immigrants smoke less than their US-born counterparts, over time, the rising tobacco epidemic in developing countries and the marketing efforts of the tobacco industry in those countries as well as among US immigrant groups may change the protective effect of immigrant status, which provides further support both for global tobacco control and for smoking prevention programs aimed at immigrants.

Acknowledgements This work was supported by the National Cancer Institute (NCI) through a grant (1 R03 CA093198-01) to the author. The authors would like to thank Lisa Bates,

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