Objectives: Although ethnic and gender differences in adolescent smoking have been well documented, factors influencing susceptibility to smoking and experimentation among the ethnic group of Muslim Arab-American youth have received little research attention. This study examines the smoking prevalence, the associations of known smoking risk factors, religious and cultural influences with adolescents' susceptibility to smoking and experimentation with cigarettes among the ethnic group of Muslim Arab-American adolescents, in an Islamic Academy in Fairfax County, Virginia.

Design: Cross-sectional survey data collected confidentially from a sample of 480, 7th to 12th grade students in Fairfax County, Virginia, during the 1998-99 school year. Outcome measures included self-reported susceptibility to smoking and smoking behavior.

Results: The overall prevalence of susceptibility to smoking, experimentation (ever smoking), 30 day and current smoking was 50%, 45%, 18% and 12%, respectively. Almost twice as many males as females were susceptible to smoking and reported to have experimented with cigarettes. Peers smoking was the most significant risk factor associated with both susceptibility and experimentation for both genders (OR=3.0, 95% CI=1.8-4.5; OR=3.0; 95% CI=1.8-4.6, respectively), while perceived peer norms were a risk factor for ever smoking but not for susceptibility to smoking. Religious influence and perceived negative consequences of smoking were protective against ever smoking for both genders (OR=0.7, 95% CI=0.5-0.9; OR=0.8, 95% CI=0.7-0.9, respectively). Culturally based gender-specific norms were significantly associated with increased risk of susceptibility to smoking for males only (OR=3, 95% CI=1.3-7), while religious influence was protective against susceptibility to smoking for females only (OR=0.6, 95% CI=0.4-0.8).

Conclusion: Social influences-based smoking prevention programs may be effective for adolescents from Muslim Arab cultures; however, they should be modified to address culturally based gender norms and may benefit from the incorporation of Islamic messages denouncing smoking behavior.