Beyond Acculturation: Ethnic Identity, Tobacco and Nicotine Product Use, and Health Among Arab Americans.

Background: Arab Americans are one of the fastest-growing immigrant populations in the United States, yet they remain largely invisible in tobacco surveillance and prevention efforts due to their classification as "White" in national data. Despite evidence of elevated tobacco use and chronic disease burden, limited research has examined how cultural, psychological, and social factors shape tobacco-related health risks in this community. Objectives: This study examined associations between ethnic identity, tobacco use, and health outcomes (self-rated health, chronic disease diagnosis) among Arab American adults, and tested whether ethnic identity moderated the association between tobacco use and health outcomes. Methods: In a cross-sectional study, a convenience sample of 112 Arab American adults residing in Central California completed a survey assessing ethnic identity, tobacco use, and health. Ethnic identity was measured using an abbreviated, Arabic-translated adaptation of Phinney's Multigroup Ethnic Identity Measure. Tobacco use was categorized as non-use, single-product use, or multi-product use. Multivariable regression models assessed associations and potential moderating effects of ethnic identity on health outcomes. Results: Over 48% of study participants reported current use, defined as at least some use or more, of at least one tobacco or nicotine product, including cigarettes, e-cigarettes (which may contain synthetic rather than tobacco-derived nicotine), and hookah. Higher ethnic identity scores were associated with significantly lower odds of tobacco use (adjusted OR = 0.35, 95% CI: 0.15-0.83). Single-product users had 75% lower odds of reporting better self-rated health compared to non-users (OR = 0.25, 95% CI: 0.07-0.96). No significant associations were found for multi-product use or chronic disease in adjusted models, and ethnic identity did not significantly moderate associations with health outcomes. Conclusion: Ethnic identity is associated with lower tobacco use among Arab Americans, though its protective effects on health outcomes remain less clear. These findings underscore the need to move beyond acculturation-based frameworks and incorporate identity-informed, culturally responsive approaches to tobacco control in marginalized immigrant communities.