title: Arab-American Hookah Smokers: Initiation, and Pros and Cons of Hookah Use.
abstract: OBJECTIVE
  To examine initiation, pros and cons of hookah tobacco smoking among Arab Americans.
  
  
  METHODS
  In this descriptive cross-sectional study, we recruited a community-based convenience sample of 458 adult Arab-American hookah smokers, mean age 28.4 years, who completed self-administered questionnaires.
  
  
  RESULTS
  Irrespective of sex, most participants initiated hookah tobacco use by young adulthood in private homes or hookah lounges influenced by friends and family. Women initiated hookah use later than men. Ever dual smokers (hookah smokers who ever smoked a cigarette) initiated hookah use later than cigarettes; however, early hookah initiators < 18 years initiated hookah and cigarettes concurrently. Participants enjoyed the flavors of hookah tobacco, and complained about coughing, dizziness, and headaches.
  
  
  CONCLUSIONS
  Early and late initiation of hookah tobacco use warrant prevention programs targeting the youth and older adults in communities, colleges, and middle and high schools that include health education campaigns, and encouragement of voluntary smokefree home rules. Tobacco control policies aimed to prevent initiation of hookah use should include regulation of hookah tobacco flavors, and should target the physical environments in neighborhoods, especially around schools and colleges, to reduce the proliferation of hookah lounges. Dual hookah tobacco and cigarette use warrant continuous monitoring.
authors.affiliation: Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA. nadakassem@hotmail.com.
authors.forename: Nada O F
authors.initials: NO
authors.lastname: Kassem
authors.affiliation: Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA.
authors.forename: Noura O
authors.initials: NO
authors.lastname: Kassem
authors.affiliation: Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA.
authors.forename: Sheila R
authors.initials: SR
authors.lastname: Jackson
authors.affiliation: Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA.
authors.forename: Reem M
authors.initials: RM
authors.lastname: Daffa
authors.affiliation: Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA.
authors.forename: Sandy
authors.initials: S
authors.lastname: Liles
authors.affiliation: Center for Behavioral Epidemiology and Community Health (CBEACH), San Diego State University Research Foundation, San Diego, CA, USA.
authors.forename: Melbourne F
authors.initials: MF
authors.lastname: Hovell
mesh_terms: D000328:Adult; D000367:Age Factors; D018912:Arabs / Q000208:ethnology* / Q000523:psychology / Q000706:statistics & numerical data*; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult