title: Effect of Length of Stay on Smoking among Turkish and Eastern European Immigrants in Germany--Interpretation in the Light of the Smoking Epidemic Model and the Acculturation Theory.
abstract: BACKGROUND
  We analyzed changes in smoking by length of stay among immigrants in Germany and related them to the "smoking epidemic" model and the acculturation theory.
  
  
  METHODS
  We used data from a longitudinal survey (German Socio-economic Panel). Immigrants were identified by country of birth (Turkey: respondents n = 828, observations n = 3871; Eastern Europe: respondents n = 2009, observations n = 7202; non-immigrants: respondents n = 34,011, observations n = 140,701). Smoking status data was available for nine years between 1998 and 2012. Length of stay (LOS, in years) was used as proxy for acculturation. We calculated smoking prevalences, prevalence ratios and a random intercept multilevel logistic regression model.
  
  
  RESULTS
  With each year spent in Germany, smoking prevalence increases among Turkish women (OR = 1.14 (95%CI = 1.06-1.21)) and slightly decreases among men. Recently immigrated Turkish women smoke less than non-immigrant women (0-5 years: SPR = 0.25 (95%CI = 0.10-0.57)); prevalences converge with increasing LOS (31+ years: SPR = 1.25 (95%CI = 1.06-1.48)). Among Eastern European immigrants no significant changes were apparent.
  
  
  CONCLUSIONS
  Immigrants from Turkey "import" their smoking prevalence from a country which is in the earlier stages of the "smoking epidemic". With increasing LOS (thus, advancing acculturation), they "move" to the later stages. Anti-smoking interventions should consider different smoking attitudes in Turkey/Germany and need to discourage women from initiating smoking. Future research should also identify reasons for the possible differences between immigrant groups.
authors.affiliation: Department of Epidemiology &amp; International Public Health, Bielefeld School of Public Health, Bielefeld University, P.O. Box 100131, Bielefeld 33501, Germany. katharina.reiss@uni-bielefeld.de.|Aid Information Service on Food, Agriculture, Consumer Protection, Heilsbachstraße 16, Bonn 53123, Germany. katharina.reiss@uni-bielefeld.de.
authors.forename: Katharina
authors.initials: K
authors.lastname: Reiss
authors.affiliation: Department of Sociology, Bielefeld University, P.O. Box 100131, Bielefeld 33501, Germany. reinhard.schunck@uni-bielefeld.de.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Schunck
authors.affiliation: Department of Epidemiology &amp; International Public Health, Bielefeld School of Public Health, Bielefeld University, P.O. Box 100131, Bielefeld 33501, Germany. oliver.razum@uni-bielefeld.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Razum
mesh_terms: D000069:Acculturation; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D054242:Emigrants and Immigrants / Q000523:psychology* / Q000706:statistics & numerical data*; D005061:Europe, Eastern / Q000453:epidemiology; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D044469:Racial Groups / Q000523:psychology*; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors; D013997:Time Factors; D014421:Turkey / Q000208:ethnology; D055815:Young Adult
keywords: acculturation; emigrants and immigrants; length of stay; longitudinal studies; smoking