Social Networks and Cultural Factors Associated With Tobacco Use Among Arab Americans: A Cross-Sectional Study

Introduction: Tobacco use is disproportionately high among Arab Americans (AAs), with hookah normalized within social networks (SNs). Gaps remain in understanding how SNs, cultural norms, and migration-related identity shape tobacco use. This study examined how cultural norms, religion, and SNs are associated with tobacco use among AA adults. Methods: A cross-sectional survey of 178 Massachusetts-based AA adults assessed tobacco use, cultural attitudes, religiosity, and SN structural and compositional characteristics. Results: Current tobacco use was 51.69%, with hookah at 45.51%. Smoking, particularly hookah, was widely accepted within family and peer networks, with females reporting higher peer acceptability. Cultural norms, religious stance, and SN characteristics were significantly associated with tobacco use (p < .05). Discussion: Tobacco use reflected identity, belonging, and adaptation within migration contexts, serving as a sociocultural connector. Culturally congruent, gender-sensitive, and network-informed cessation strategies engaging families, peers, and faith communities are recommended to enhance intervention effectiveness among AAs.