Article
Tobacco Use and Cessation Among Somalis in Minnesota

https://doi.org/10.1016/j.amepre.2008.09.006Get rights and content

Background

Somalis compose the largest African refugee group living in the U.S., with more than 10,330 primary arrivals in fiscal year 2006 alone. Half of all Somalis in the U.S. live in Minnesota. Although tobacco use is a considerable problem among Somalis, especially among men, little research has examined factors affecting tobacco use and cessation.

Methods

A sequential exploratory design informed the overall study methodology. Key informant interviews (n=20) and focus group discussions (13 groups; n=91) were conducted with Somali adults and youth in the fall of 2006 and the summer of 2007, respectively. Participants were asked about tobacco-use prevalence, prevention, and cessation, and the marketing of tobacco.

Results

Perceived prevalence of tobacco use by Somalis is high at 50%. The main reason for initiating tobacco use was the influence of friends or peer pressure and included other social factors. Prevention and cessation messages suggested by participants include medical advice, education on the negative health effects of tobacco use, religion, and the support of family and friends. Barriers to cessation include lack of insurance coverage, lack of knowledge on where to find assistance, and lack of cessation support groups. Severe social stigma for Somali female smokers poses specific challenges to prevention and intervention efforts. Water-pipe smoking is perceived to be prevalent, particularly among female youth.

Conclusions

Somalis view tobacco use as an important issue in their community. Religious and social support and demographically targeted approaches should be key factors in creating effective prevention and cessation programs and must address water-pipe smoking.

Section snippets

Background

Somalis compose the largest African refugee group living in the U.S., with more than 10,330 primary arrivals in fiscal year 2006 alone.1 The largest population (most recently estimated at 25,000 in 2004) resides in Minnesota.2 Similar to other refugee and immigrant groups, Somalis face unique health concerns and barriers such as lack of healthcare coverage (approximately 36% of Somali men have no health insurance)3; language; low literacy rates (of both English and Somali); transportation

Key Informant Interviews

Key informant interviews were the first in a series of exploratory methods employed to understand tobacco use and cessation among Somalis in Minnesota. The aim was to collect qualitative data to give direction to subsequent research and inform future programmatic work. Twenty informants were selected from known Somali community leaders and members and non-Somali professionals based on occupational connections to the Somali community in the areas of health, social services, and education. Other

Demographics

Eleven men and nine women were interviewed as key informants (n=20; Table 1). The majority of informants had college or advanced degrees (n=15). By contrast, the majority of the 45 men and 46 women (n=91; Table 2, Table 3) interviewed during focus groups had less than a high school education (n=72), which is more representative of the Somali population. Of the focus group participants, 32 men and 32 women were current smokers. Among focus group participants who smoked (n=63; 1 missing), the

Discussion

Due to the dearth of information available on the Somali population and the concern of community leaders over tobacco use, this study was carried out to improve prevention and cessation efforts. It offers groundbreaking results as current literature on this population is limited to prevalence estimates. It was found that Somalis perceive tobacco use as a widespread practice in their community. Many smokers view smoking as a social activity, and detrimental health effects are often unknown.

While

Conclusion

It is clear that the Somali community identifies tobacco use as problematic and widespread. New public health endeavors within the Somali community will need to find unconventional ways to address tobacco use and should utilize pre-established social networks, particularly the medical and religious community, in designing and implementing programs and challenging social norms. Due to the harsh social stigma, female smokers require specific interventions and prevention efforts. The growing

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