Rima Fakih of Dearborn, Mich., won the pageant at the Planet Hollywood Resort & Casino on the Las Vegas Strip after strutting confidently in an orange and gold bikini, wearing a strapless white gown that resembled a wedding dress and saying health insurance should cover birth control pills.
When asked how she felt about winning the crown, she said, "Ask me after I've had a pizza."
Fakih, a Lebanese immigrant, told pageant organizers her family celebrates both Muslim and Christian faiths. She moved to the United States as a baby and was raised in New York, where she attended a Catholic school. Her family moved to Michigan in 2003.
Pageant officials said historical pageant records were not detailed enough to show whether Fakih was the first Arab American, Muslim or immigrant to win the Miss USA title. The pageant started in 1952 as a local bathing suit competition in Long Beach, Calif.
Fakih told reporters she sold her car after graduating college in Michigan to help pay for her run in the Miss Michigan USA pageant.
She said she believed she had the title on Sunday after glancing at pageant owner Donald Trump as she awaited the results with the first runner-up, Miss Oklahoma USA Morgan Elizabeth Woolard.
"That's the same look that he gives them when he says, 'You're hired,"' on Trump's reality show "The Apprentice," she said.
"She's a great girl," said Trump, who owns the pageant with NBC in a joint venture.
In a moment that was replayed during the broadcast, Fakih nearly fell while finishing her walk in her gown because of the length of its train. But she made it without a spill and went on to win.
"I did it here, I better not do it at Miss Universe," she said. "Modeling does help, after all."
Fakih replaces Miss USA 2009 Kristen Dalton and won a spot representing the United States this summer in the 2010 Miss Universe pageant. She also gets a one-year lease in a New York apartment with living expenses, an undisclosed salary, and various health, professional and beauty services.
During the interview portion, Fakih was asked whether she thought birth control should be paid for by health insurance, and she said she believed it should because it's costly.
"I believe that birth control is just like every other medication even though it's a controlled substance," Fakih said.
Woolard handled the night's toughest question, about Arizona's new immigration law. Woolard said she supports the law, which requires police enforcing another law to verify a person's immigration status if there's "reasonable suspicion" that the person is in the country illegally.
She said she's against illegal immigration but is also against racial profiling.
"I'm a huge believer in states' rights. I think that's what's so wonderful about America," Woolard said. "So I think it's perfectly fine for Arizona to create that law."
"The Office" actor Oscar Nunez was booed as he asked the question and asked the audience to wait until he finished the question before they reacted. The panel of judges came up with the questions themselves.
Miss Virginia USA Samantha Evelyn Casey was the second runner-up, Miss Colorado USA Jessica Hartman was third runner-up, and Miss Maine USA Katherine Ashley Whittier was the fourth runner-up.
Most of the field of contestants from all 50 states and the District of Columbia were eliminated just after the pageant began and the entire group danced onstage to "TiK ToK" by Ke$ha.
A panel of eight judges, including NBA star Carmelo Anthony, Treasure Island casino-hotel owner Phil Ruffin and Olympic figure skater Johnny Weir, were judging the girls throughout the night.
After 15 contestants strutted in swimsuits, five were eliminated. Another five were eliminated after the evening gown competition.
Miss Nebraska USA Belinda Renee Wright won the Miss Congeniality award, roughly one week after her father was killed in a farm accident. Miss Alabama USA Audrey Moore won Miss Photogenic after an online fan vote.
The pageant aired live to East Coast viewers on NBC.
The competition, which is not affiliated with the Miss America pageant, was hosted by celebrity chef Curtis Stone and NBC correspondent Natalie Morales.