Characteristics and prevalence of tobacco use among Somali youth in Minnesota.

BACKGROUND Somalis compose the largest African refugee group in the U.S., with more than 55,000 primary arrivals since 2000. Minnesota has the largest Somali population in the U.S. Despite its size, little research has been conducted to determine the extent of tobacco use among Somali youth. PURPOSE This paper reports the results from a knowledge, attitudes, and practices (KAP) survey designed to explore factors related to tobacco-use prevention, initiation, and cessation, and to reliably estimate tobacco-use prevalence among Somali youth in grades 9 through 12 in Minnesota. METHODS A KAP survey, modeled after validated state and national youth tobacco-use surveys, was adapted for Somali youth and administered to ethnically Somali youth (N = 302) from seven high schools in Minnesota in 2008. Participants were chosen through probability-proportional-to-size and multi-stage random sampling methods, and the results were analyzed in 2009. RESULTS Somali high school students' estimated prevalence for "ever-users" of cigarettes was 12.8%, and current use was 4.7%. This is one quarter of the reported statewide smoking prevalence for Minnesota high school students (19.1%) and half of the nationwide prevalence for blacks/African Americans (11.6%). Ever-users were more likely to have close friends or live with someone who smoked cigarettes (p < 0.01). Belief in the Islamic prohibition of tobacco affected future intention to use tobacco (p < 0.01), as did the belief that using hookah/sheisha is less risky than smoking cigarettes (p < 0.01). CONCLUSIONS Estimated cigarette use prevalence (4.7%) for Somali youth was substantially lower than among Minnesota high school students and also lower than perceived prevalence among Somalis. Positive peer pressure and religion appear to be protective factors in tobacco use and should be integrated into future Somali tobacco prevention and cessation programs, along with education on the risks of hookah/sheisha use.