Tobacco Use Among Muslim Adolescent Girls of Arab and South Asian Descent

Background and Purpose: Arab, South Asian, and Muslim youth have lower rates of engagement in risk behaviors common to their age group (Bradby, 2006; Bradby, 2007; Islam & Johnson, 2003). However, though still lower than their Caucasian counterparts, tobacco use is an exception to these general trends (Islam & Johnson, 2003). Research further indicates that adolescent Muslim girls have far lower substance use and sexual experience rates as compared Arab, South Asian, and Muslim boys (Bradby, 2006; Bradby & Williams, 1999; Bradby & Williams, 2006; Islam & Johnson). Yet, again, tobacco use is the exception to this trend (Bradby, 2007). However, limited studies have explored this phenomenon. This qualitative study explored the tobacco use, including hookah use, among a sample of first and second generation Muslim girls of South Asian and Arab descent, including some of the cultural and contextual factors that may explain its use among this group. Methods: Three focus groups were conducted (n=36) consisting of first and second generation young Muslim women in their late teens and early twenties. Participants were recruited using purposive sampling from Muslim Students Associations, Mosques, and schools. Participants were interviewed using a semi-structured questionnaire. Due to several limitations around utilizing focus groups, participants were also provided the opportunity to submit confidential written responses. Focus groups were recorded and data were analyzed using Atalas.ti software. Results: In general a little over one-third (38%) of the respondents reported having ever used tobacco, with a majority of the use occurring in hookah bars and lounges. The over two-thirds (72%) of respondents who reported not using tobacco indicated that health concerns, practice of Islam, and parental rules were critical factors in their abstention. Thematic analysis revealed five key themes related to tobacco use: (1) hookah bars and socialization; (2) parental monitoring; (3) cultural factors that impact tobacco use; (4) gender identity and tobacco use and; (5) perceptions of health risks. Key findings indicate that about half (47%) of the respondents reported that their parents were aware of their visits to hookah bars and lounges. However, not all respondents used sheesha/hookah while frequenting hookah bars and lounges. Nearly all (94%) affirmed literature indicating tobacco and hookah use by young Muslim men is far less stigmatized than tobacco use by young Muslim women, and that it was considered “un-lady like.” Implications: It appears that hookah and cigarette use among adolescent Muslim Americans is becoming normalized. The shifts that have occurred in tobacco use among young Muslim women indicate that some of the protective factors are eroding. This presentation provides some insight into how these young women understand tobacco use, the pressures that they face, and how they make decisions around abstention. This type of information: (1) improves practitioners' cultural competence by providing them insight into the psychosocial influences that impact these young women, and (2) provides researchers with the groundwork for more rigorous studies to measure the impact of factors related to tobacco use, and for the development of culturally relevant interventions.