title: Neighbourhood influences on narghile smoking among youth in Beirut.
abstract: BACKGROUND
  Increasingly neighbourhoods are identified as influencing health. Neighbourhood characteristics have been linked to cigarette use. In Lebanon, the water pipe (narghile) use is most frequent among youth. The current study is aimed at identifying differential neighbourhood influences on smoking narghile among youth.
  
  
  METHODS
  A quantitative interview was completed with 1294 adolescents, 13-20 years, in three urban disadvantaged neighbourhoods of Beirut. Individual and social factors, suggested by the literature, were associated with smoking narghile. The neighbourhood variation in the influence of these factors was then explored. Bivariate and stratified logistic regression analysis were conducted, neighbourhood being the stratification variable.
  
  
  RESULTS
  About 60% of respondents had ever tried a narghile, about one-fifth continued to smoke. Several individual-level and social variables predicted narghile smoking bivariately. The influences on narghile smoking varied by neighbourhood. Neighbourhood differences persisted at the multivariate level. Consistently across neighbourhoods, the influence of friends was the predominant predictor of narghile smoking. In one neighbourhood, maternal smoking was a risk factor for narghile smoking of youth, in another paternal smoking. Being female seems to be protective in two of the three neighbourhoods. Other factors also differentially influence narghile use by neighbourhood.
  
  
  CONCLUSIONS
  The mechanisms of influence of neighbourhoods on health are not clearly understood, but a transactional paradigm seems most fitting with the results found in this research. Interventions to prevent the narghile smoking should address multiple levels of influence; and must be tailored to the particular aspects of neighbourhoods which are influential in the uptake of this behaviour.
authors.affiliation: Department of Health Behavior and Education, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. ra15@aub.edu.lb
authors.forename: Rema A
authors.initials: RA
authors.lastname: Afifi
authors.forename: Joumana S
authors.initials: JS
authors.lastname: Yeretzian
authors.forename: Aida
authors.initials: A
authors.lastname: Rouhana
authors.forename: Mayssa T
authors.initials: MT
authors.lastname: Nehlawi
authors.forename: Alena
authors.initials: A
authors.lastname: Mack
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D007861:Lebanon; D008019:Life Style; D016015:Logistic Models; D008297:Male; D009330:Nebulizers and Vaporizers / Q000706:statistics & numerical data*; D010379:Peer Group; D015995:Prevalence; D012111:Residence Characteristics; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology / Q000523:psychology*; D012959:Socioeconomic Factors; D014029:Tobacco Use Disorder / Q000453:epidemiology; D055815:Young Adult