Date of Award


Document Type

Campus Access Dissertation

Degree Name

Doctor of Philosophy (PhD)



First Advisor

Ling Shi

Second Advisor

Suha Ballout

Third Advisor

Rosalyn Negron


Background: Arabs tobacco use behavior has been traced back to countries of origin where smoking rates are alarmingly high, and smoking is a socially normative behavior. Very little is known about the influential characteristics of social networks (SNs) on Arabs’ tobacco use in the US. Examining SNs in relation to tobacco use can help understand how tobacco spread through social interaction, connectedness, and social acceptability or sanctions against behaviors.

Sample: A total sample 178, self-identified as Arabs who migrated or born in the U.S., were recruited using convenience sampling from cultural, faith based and restaurant settings. Method: This is a cross-sectional study guided by Berkman’s and colleagues’ social network framework to examine the associations between SN structure and composition, and social tie features in addition to social influence factors (social acceptability and religious stance ), in relation to tobacco use among Arab adults in the US. Univariate and multivariable logistic regressions are used to examine factors associated with tobacco use.

Results: Hookah and cigarettes were found to be the most often used tobacco forms among Arabs (45.51% & 13.48%). Country of origin was found to be associate with Arabs tobacco use and reflect the rates in the countries. Being a female, an older adult, married or have been ever married, with higher religiosity were the protective factors against tobacco use among Arab adults in the US. Larger SNs, with more close/intimate members, having higher proportion of non- tobacco users in SNs, more contact with non- tobacco users, both in person and virtually, and more close non-tobacco users significantly protected against tobacco use. On the other hand, having more contact with tobacco users either in person or virtually, and have close relation with tobacco users, were all associated with higher likelihood of tobacco use. Family social norms had a consistently significant influence on tobacco use. Religious prohibition of tobacco protected against tobacco use.

Conclusion: The findings of the study underscore that Arabs’ tobacco use behavior is multi-faceted where different sets of socio-cultural and social norms made them more exposed to tobacco by SNs’ members with whom Arabs have the strongest ties and frequent contact. Multi-level culturally tailored interventions that start earlier, target family and peers, reinforce religious belief impacts and integrate the strongest ties and more frequent contacted members, are recommended with special attention is needed to examine hookah.


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