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...smoked cigarettes. Experimentation with narghile was 27%; it increased from 23% at 14 years to 40% at 18 years. All trends were significant (p < .001). Logistic regression analyses found 11 predictors for having smoked a cigarette in the past 30 days and 9 and 7 predictors, respectively, for having ever smoked a cigarette or the narghile. Tobacco use by friends and family members was the strongest predictor of cigarette and narghile smoking. Narghile use supported cigarette smoking.
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Tobacco use, primarily cigarette smoking, is a major preventable public health risk in most of the world's developing countries (World Health Organization [WHO] Tobacco Free Initiative, 2005a), even as rates are slowly declining in developed countries like the United States (U.S. Department of Health and Human Services [USDHHS], 2004). The WHO reports smoking as the second leading cause of death and disability worldwide; it found smoking to be responsible for the death of one in ten adults. There are approximately 1.1 billion smokers in the world--about one-third of the global population age 15 years and over. More than half of the people who smoke today--that is, about 650 million people--will eventually die as a result of smoking-related health problems (WHO Tobacco Free Initiative, 2005a).
Since 1964, numerous U.S. Surgeon Generals' Reports have identified tobacco use as the leading source of preventable morbidity and premature death (U.S. Department of Health, Education, and Welfare, 1964), including Preventing Tobacco Use Among Young People (USDHHS, 1994) and The Health Consequences of Smoking (USDHHS, 2004). Tobacco use is one of the 10 leading health indicators for the Healthy People 2010 agenda. One of its objectives is to reduce tobacco use among adults and adolescents to less than 12% (Lurie, 2000; USDHHS, 2000).
Treatment of tobacco-related diseases costs the United States more than $75.5 billion annually in direct medical costs and an additional $92 billion for smoking-related lost productivity (Armour, Woollery, Malarcher, Pechacek, & Husten, 2005). On average, smokers die 13 to 14 years earlier than nonsmokers (USDHHS, 2004). An estimated 45.8 million American adults (22.5%) are current smokers; approximately 82% smoke every day. Rates of cigarette smoking are somewhat similar for males (25.2%) and females (20.0%) but are inversely related to age. The highest use is among 18- to 24-year-olds (28.5%), and the lowest (9.3%) is among those 65 years and older (Troschair, Caraballo, Malarcher, Husten, & Pechace, 2005).
Clearly, tobacco use is a risk behavior of the young. Worldwide, more than half of the adolescents 18 years and under have experimented with smoking (WHO Tobacco Free Initiative, 2005a). In the United States, 21.9% of all high school students are current smokers, with equal numbers of boys and girls. More than half of those began before the age of 14. Every day approximately 2,000 young people in the United States experiment with smoking. Twenty-seven percent of 12th graders are current users; one in four is a regular smoker by the time he or she leaves high school (Allen et al., 2003).
Differences in tobacco use have been noted for adults and adolescents in the United States by racial/ethnic identity. Among adults, American Indians/Alaskan Natives (39.9%) and African Americans (22.8%) reported higher smoking rates than Hispanics (22.3%) and Asian/Pacific Islanders (16.6%) (Centers for Disease Control and Prevention [CDC], 2004). Cigarette-smoking rates among teens declined during the 1970s and 1980s, but they increased in the early to mid-1990s among White, African American, and Hispanic high school students, especially girls (Johnston, O'Malley, Bachman, & Schulenberg, 2004). On the whole, Hispanic high school students were higher tobacco users (18.4%) in the previous month than African American (15.1%) or Asian American youth (12.8 %) (Johnston, O'Malley, Bachman, & Schulenberg, 2003).
Differences in racial/ethnic values and beliefs about tobacco use also have been noted. Dornelas et al. (2005) reported that black teens emphasized the familial and social pressures of smoking, higher rates of acceptance of smoking by family members, role modeling by household members, more prevalent beliefs that smoking is a way to achieve belonging, and lack of perceived support for quitting by friends compared to White and Hispanic youth. Few smoking behavior data are available for other ethnic minorities, such as Arab Americans.
Arab Americans number almost 4 million and are one of the fastest-growing immigrant groups, mainly due to the war and political unrest in the Middle East. They live in all 50 states; 66% reside in 10 states. One-third of the total live in Michigan, California, and New York, and approximately 94% live in large metropolitan areas, including Detroit, Los Angeles, New York City, Chicago, Washington, DC, and northeastern New Jersey. Almost 490,000 Arab Americans live in Michigan, and of those more than one-third (36%) identify Lebanon as their country of origin (Abraham & Shryock, 2000; Arab American Institute, 2005). Many Arab Americans come from Middle Eastern countries where tobacco use is high. On average, 45% of the men and 5% of the women in the Middle East smoke cigarettes. Tobacco use by women in the Middle East was traditionally very low, but it is now on the rise. The Middle Eastern nations with the highest adult cigarette-smoking rates include Iraq (40%), Yemen...
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