Social Ties and Behavioral Diffusion of Tobacco Use in Arab American Networks.

Arab Americans (AAs) exhibit elevated rates of tobacco use, often influenced by their social networks (SN). Despite this, research has not comprehensively explored the mechanisms through which these relationships sustain tobacco use, and broader studies on social SNs provide limited insight into the influential SN attributes and interactions affecting AA communities. Guided by Berkman et al.’s (2000) SN and health framework, this study examined associations between SN structure, composition, relational and communication dynamics, and tobacco use among AAs. Variables included network size, density, SN compositional and demographic characteristics, contact modality and frequency, and relationship closeness. Data were collected through a cross-sectional survey of 178 AA adults in Massachusetts and analyzed using multivariate logistic regression. Overall, 51.7% of participants were current tobacco users; 45.5% reported hookah use, 13.5% cigarette use, and 18.5% used multiple products. Features of SNs associated with decreased odds of tobacco use included having larger SNs (OR = 0.38, 95% CI: 0.20–0.70), higher proportions of non-tobacco users (OR = 0.98), frequent in-person interactions with non-tobacco users (OR = 0.71), and stronger ties to non-tobacco users (OR = 0.074). Networks with greater Arab representation initially appeared protective but, in adjusted models, were associated with higher use (OR = 1.45), suggesting cultural identity and affiliation may reinforce smoking norms. Gender patterns also differed : networks with more women initially appeared protective, but after adjustment this association reversed (OR = 1.53), highlighting nuanced sociocultural impacts on behavioral change among Arab men and women following migration. Conversely, increased tobacco use was associated with greater contact with tobacco users, particularly through virtual modalities (OR = 1.027), and closer relationships with tobacco users (OR = 5.54). The findings suggest that tobacco use is propagated through both imitation and social reinforcement within strongly connected, homogenous networks. The study offers valuable insights into overlooked SN attributes and relational mechanisms relevant to understanding the transmission of tobacco use behaviors within AA populations. Identifying specific relational attributes may inform culturally tailored cessation interventions that leverage influential network members and key actors, strong social ties, and targeted modes of interaction, both in-person and digital, to enhance tobacco control strategies in AA communities.