Predictors of Tobacco Use Behaviors Among Syrian Americans

Background This study examines the prevalence and predictors of cigarette and hookah smoking among Syrian Americans, a growing U.S. immigrant population with historically high tobacco use. Objectives To assess tobacco use behaviors and identify demographic and behavioral predictors of cigarette and hookah use, as well as key motivators for tobacco use, among Syrian American adults. Design A cross-sectional survey study of Syrian American adults in 2 U.S. states. Methods Data were collected from 919 Syrian American adults in Southern California and Florida between 2018 and 2019. Multinomial regression analyses were used to identify demographic and behavioral predictors of cigarette and hookah use. Results Among participants, 16% were current cigarette users, and 37% were current hookah users, both exceeding U.S. national averages. Social occasions and flavored tobacco were key motivators for hookah use, with most participants perceiving hookah as equally or more harmful than cigarettes. Male gender, older age, longer U.S. residency among females, alcohol use, and lower education levels predicted cigarette smoking. Hookah use was associated with younger age, alcohol consumption, and the perception that hookah is less harmful than cigarettes, while health insurance and higher education were protective factors. Cigarette users were less likely to use hookah, whereas former cigarette users had a higher likelihood of hookah use. Education was a key factor in quitting both cigarettes and hookah. Individuals with health insurance were more likely to quit hookah, while those who perceived hookah as less harmful were less likely to quit. Conclusion These findings emphasize the need for culturally tailored tobacco prevention and cessation programs for Syrian Americans, addressing misperceptions of hookah harms and leveraging community-specific motivators to develop effective interventions.