Assessing trends and healthy migrant paradox in cigarette smoking among U.S. immigrant adults

Sunday Azagba, Lingpeng Shan, Keely Latham

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9 Scopus citations


The healthy migrant paradox suggests that immigrants to developed countries are, on average, healthier than the native born of the host country, with some finding that health advantages diminish after 10–20 years. This study examined trends in immigrant cigarette smoking trends, as well as smoking by the length of residence in the U.S. Data were drawn from the 1995–2015 Tobacco Use Supplement to the Current Population Survey (n = 140,254). Cochran–Armitage tests were used to assess changes in the prevalence of smoking over time in the population, as well by demographic characteristics. Multivariable logistic regression was used to compare cigarette smoking differences between immigrants' length of residence in the U.S. and the native-born population. The prevalence of immigrants' cigarette smoking significantly decreased from 15.0% in 1995/96 to 6.9% in 2014/15. Cigarette smoking rates for males and females significantly decreased from 20.8% and 9.1%% in 2007, respectively, to 10.4% and 3.6% in 2017. Differences in cigarette smoking appeared to have narrowed over time by the length of stay in the U.S. Multivariable analysis showed that immigrants had significantly lower odds of cigarette smoking (length of stay ≤5 years, Odds Ratio = 0.40, 95% Confidence Interval = 0.32–0.51; 6–10, OR = 0.39, CI =0.31–0.49; 11–20, OR = 0.39, CI =0.34–0.45; 20+, OR = 0.47, CI =0.43–0.53) compared to the native-born population. Findings show that immigrants consistently have lower smoking rates than native born, and this healthy behavior advantage did not appear to diminish based on years living in the U.S.

Original languageEnglish (US)
Article number105830
JournalPreventive Medicine
StatePublished - Dec 2019

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Public Health, Environmental and Occupational Health


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