Ethno-specific preferences of cigarette smoking and smoking initiation among Canadian immigrants – A multi-level analysis

Background: Cigarette smoking is the leading cause of preventable morbidity and mortality worldwide. Over the last decade, increased immigration has significantly shifted Canada’s demographic profile. According to a 2011 National Household Survey, approximately 20.6% of the Canadian population was immigrants, the highest among the G8 countries. It is estimated that by 2031, one-in-three Canadian’s will be an immigrant. This study examined the ethno-specific preference of cigarette smoking and smoking initiation among Canadian immigrants. Methods: This study used data from the 2013 to 2014 combined cycles of the Canadian Community Health Survey. This was a nationally generalizable, telephone-based survey that included a total of 130,000 respondents, aged 12 years or older. Ethnic differences in the preference of cigarette use among Canadian immigrant groups were determined. A three-level mixed effects logistic regression model was used to estimate the effect of ethnicity on the likelihood of smoking initiation after migration to Canada. Results: In our study, 82% of respondents were native-born Canadians (one group), while the rest were immigrants (six groups=18%). Results of the logistic regression analysis revealed statistically significant differences in the number of cigarettes smoked daily (P=0.0001), age of smoking onset (P=0.0001), and smoking initiation (P=0.0001) between Canadian-born and immigrant participants. Immigrant smokers in Canada were significantly more likely to be younger, single, Caucasian, females with high income and post-secondary education (P=0.0001). Conclusion: The results of our study suggest that Caucasian female immigrants in Canada initiated smoking at a younger age and smoked more cigarettes than any other immigrant group or native-born Canadians. This is a particularly interesting finding as Caucasian female immigrants may not be considered a vulnerable or at-risk population. To be effective, tobacco strategies specifically tailored for this overlooked population would require increased awareness, culturally appropriate initiatives, and gender-specific interventions.