标题：Risk of Cigarette Smoking Initiation During Adolescence Among US-Born and Non–US-Born Hispanics/Latinos: The Hispanic Community Health Study/Study of Latinos
摘要：Objectives. We assessed risk of cigarette smoking initiation among Hispanics/Latinos during adolescence by migration status and gender. Methods. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) surveyed persons aged 18 to 74 years in 2008 to 2011. Our cohort analysis (n = 2801 US-born, 13 200 non–US-born) reconstructed participants’ adolescence from 10 to 18 years of age. We assessed the association between migration status and length of US residence and risk of cigarette smoking initiation during adolescence, along with effects of gender and Hispanic/Latino background. Results. Among individuals who migrated by 18 years of age, median age and year of arrival were 13 years and 1980, respectively. Among women, but not men, risk of smoking initiation during adolescence was higher among the US-born (hazard ratio [HR] = 2.10; 95% confidence interval [CI] = 1.73, 2.57; P < .001), and those who had resided in the United States for 2 or more years (HR = 1.47; 95% CI = 1.11, 1.96; P = .01) than among persons who lived outside the United States. Conclusions. Research examining why some adolescents begin smoking after moving to the United States could inform targeted interventions. Cigarette smoking and tobacco exposure account for nearly 500 000 deaths in the United States each year, or 20% of US deaths annually. 1 Every day in the United States nearly 4000 people aged 12 to 17 years smoke their first cigarette, and about 1000 youths become daily cigarette smokers. 2 People who begin smoking regularly during adolescence often become addicted by 20 years of age, 3 which underscores the importance of examining risk factors for smoking initiation in adolescents. In 2012, the prevalence of cigarette smoking among Hispanic/Latino persons aged 12 to 17 years was estimated to be less than that of non-Hispanic Whites, but higher than among non-Hispanic Blacks and Asians. 4 Among Hispanics/Latinos, 5% of youths aged 12 to 17 years, 25% of adults aged 18 to 25 years, and 17% of adults aged 26 years and older were current cigarette smokers. 4 Several studies have examined the association of cigarette smoking and birthplace among US Hispanics/Latinos. Most have reported a higher proportion of smokers among US-born than non–US-born Hispanics/Latinos, especially among women. One study found that the risk of smoking initiation was lower for Mexican immigrants who were living in the United States than for the same individuals before migration. 5 Several others have suggested that exposure and acculturation to the US environment may increase cigarette smoking behavior in non–US-born populations. 6–9 However, these studies did not focus specifically on adolescents. Few data exist on individuals from different Hispanic/Latino backgrounds. For instance, Puerto Ricans have a high smoking prevalence, are the second-largest group of US Hispanics/Latinos, and frequently migrate between the US mainland and the US territory of Puerto Rico. 10 A recent study reported differences in smoking prevalence among adult Hispanics/Latinos by gender and background. For instance, men and women of Puerto Rican and Cuban descent had a higher prevalence of smoking than was found in national data on non-Hispanic Whites. Women of Mexican and Central American background had a lower smoking prevalence than other racial/ethnic groups in the United States. 11 A combination of factors, including but not limited to migration to the United States, country or region of origin, and gender, likely affect risk of cigarette smoking initiation and persistence in Hispanics/Latinos. We assessed the association between migration and time to smoking initiation during adolescence and whether risk of smoking initiation increased with time since migration. We also assessed whether this association differed by gender and Hispanic/Latino background. The Hispanic Community Health Study/Study of Latinos (HCHS/SOL) provided data on large groups of Hispanics/Latinos of various ethnocultural backgrounds. HCHS/SOL participants were aged 18 to 74 years, but we were able to use questionnaire data to determine smoking history during adolescence. We hypothesized that the risk of cigarette smoking initiation during adolescence would be higher in US-born Hispanics/Latinos than in those born outside the 50 states and Washington, DC; that among individuals born outside the United States, this risk would increase with time since migration to the mainland United States; and that the risk of smoking initiation during adolescence might be modified by gender and Hispanic/Latino background. The HCHS/SOL cohort provided a unique opportunity to address this question in a heterogeneous group of Hispanics/Latinos and to compare associations across many different backgrounds.
