Cigarette smoking is the chief avoidable cause of death and disease in Michigan, the United States, and the world. In 1996, 25.9% of the Michigan adult population smoked cigarettes; Michigan has the 10th highest smoking rate in the nation. When the indirect costs of lost income due to smoking-related illnesses and premature death are added to the cost of medical care, tobacco use costs Michigan citizens more than $2.6 billion per year (Michigan Department of Community Health (MDCH), 1996). Contributing to tobacco use statistics in Michigan is a rapidly growing Arab American immigrant population.

Studies have shown cigarette smoking rates in Middle-Eastern adolescents range from 33% to 58%. This study will examine cultural, personal, social, and environmental forces operating in Arab American youths at risk for habitual tobacco use. The study will also test the effects of a smoking cessation/prevention intervention on smoking behavior.

The settings for this study are the Arab Community Center for Economic and Social Services (ACCESS) Teen Health Center, which services almost 2,500 youth visits each year, and local high schools with a significant population of Arab American youth. The majority of the people served by the clinic are poor, under-educated, live in extended families of 3 to 5 adults, are immigrants, and speak Arabic as a first language. A total of 4,000 adolescents over 14 years old will be asked to provide information on demographic and cultural variables, self-esteem, stress, family and peer tobacco use, intention to use tobacco, history of tobacco use, initial stage of change, and perceived health.

Youths with the highest risk for tobacco use will be randomly assigned to either a Modified Project Toward No Tobacco Use (Project TNT) intervention or a wait list control group. Project TNT, the precursor to the Arab American-specific modified Project TNT, was designed to target the primary causes of tobacco use among adolescents and has been shown to be effective in diverse cultural groups. The modified Project TNT consists of weekly 40-minute sessions with a health educator over 4 weeks. Bilingual health educators will deliver the intervention in a small group (four to six adolescents) or classroom context. Follow-up data will be collected at 3, 6, and 12 months after the program is completed. Youth assigned to the wait list control group will participate in the modified Project TNT after the Month 6 follow-up data is collected from the first group.