Research studies have shown cigarette-smoking rates in middle-eastern adolescents to range from 33 to 58 percent.
The aims of this community-based, theory-driven research are (a) to examine cultural, personal, social, and environmental forces operating in at risk for habitual tobacco use Arab American youths and (b) to test the effects of a cessation intervention on smoking behavior at three, six, and twelve months post intervention. Cigarette smoking is the chief avoidable cause of death and disease in the United States and in Michigan. In 1996, 25.9 percent of the Michigan adult population smoked cigarettes; Michigan has the 10th highest smoking rate in the nation (Michigan Critical Health Indicators, 1996). Direct medical care costs attributable to smoking were nearly $940 million in 1994. Contributing to tobacco use statistics in Michigan is a rapidly growing Arab American immigrant population. The highest concentration of Arab Americans, with an estimated population of 300,000, live in Michigan; more than 36 percent were born outside the United States. Pilot data showed a 25 percent smoking rate in Arab American youths ages 14-18. Arab Americans are one of the fastest growing cultural minorities in the U.S. and the health consequences of continued tobacco use in this population in terms of human suffering from tobacco-related illnesses and health care dollars is potentially very high. The setting for this study is the Arab Community Center for Economic and Social Services (ACCESS) Teen Health Center which services almost 2500 youth (visits each year). The majority of the people the clinic serves are poor, under-educated, live in extended families of 3-5 adults, are immigrants, and speak Arabic as a first language. A total of 2900 adolescents over 13 years will be asked to provide information on demographic and cultural variables, self-esteem, stress, family and peer tobacco use, intention to use tobacco, history of tobacco use, initial stage of change, and perceived health over three years. Youths with the highest risk for habitual tobacco use will be randomly assigned to Project Toward No Tobacco Use (Project TNT) intervention or Wait List Control. Further information will be obtained on stress, self-efficacy, barrier to cessation, and social support. A sample size of N=450 will be sought to test the study hypotheses. Project TNT was designed to target the primary causes of tobacco use among adolescents and has been shown to be effective in diverse cultural groups. It will be delivered in a small group basis by a bilingual health educator. An Arab American physician will provide the health education content. Follow up data will be collected at Sessions 1 & 4 and at 3, 6, and 12 months post-intervention. The hierarchical linear model, ordinal logistic regression and paired t-tests will be used to analyze the data.
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