Nativity Status Predicts Tobacco Use: A Comparative Analysis of US-Born and Foreign-Born Adults From the Health Information National Trends Survey (HINTS)

Introduction Tobacco smoking remains one of the leading causes of morbidity and mortality globally and in the United States (USA). We hypothesize that US-born naturals have higher odds of tobacco smoking compared to their foreign-born counterparts, and our study aims to assess the relationship between nativity status and odds of tobacco smoking using a nationally representative sample. Methods We utilized the Health Information National Trends Survey (HINTS) 5 Cycle 1 (2017) and Cycle 2 (2018) for this study. Our main outcome variable was smoking status divided as ever smoker and never smoker. The main predictor was US birth status. We controlled for sociodemographic characteristics such as age, race, gender, educational status, and marital status. We performed weighted descriptive statistics and bivariate analysis with chi-square for our variables. Unadjusted and adjusted logistic regression was used to ascertain the odds of our outcome given our predictor. Significance was set at 95% confidence, and the alpha level was set to 0.05. All analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA). Results Our final sample consisted of 5,677 individuals (weighted: 429,613,693). Of our sample, 36.89% were ever smokers, females were 50.73%, and the majority (57.90%) were high school graduates. In terms of nativity status, those born in the USA were 85.65%, while the non-US-born population was 14.35%. After adjusting for confounders, we found that non-US-born respondents had 42% lower odds of being ever smokers compared to their US-born counterparts (adjusted odds ratio (AOR) = 0.576; 95% confidence interval (CI) = 0.388-0.854; P = 0.0062). Females were 24% less likely to be ever smokers compared to males (AOR = 0.758; 95% CI = 0.644-0.893; P = 0.0010). Having a bachelor's degree or a graduate degree was associated with 42% and 53% lower odds of being ever smokers compared to high school graduates (AOR = 0.583; 95% CI = 0.474-0.717; P < 0.0001) (AOR = 0.471; 95% CI = 0.377-0.588; P < 0.0001). Whites had 97% higher odds of being ever smokers compared to Hispanics (AOR = 1.977; 95% CI = 1.459-2.679; P < 0.0001). Conclusion Our finding of lower odds of tobacco use among foreign-born nationals compared to US-born nationals is consistent with previous studies and suggests the need for equity in tobacco use prevention between the two populations assessed in our study. This is poised to improve overall tobacco use burden, morbidity, and mortality.