Knowledge, attitudes, and prevalence of tobacco use among Somali adults in Minnesota

Background: In 2008, the Minnesota Department of Health reported that one in five Minnesota adults were smokers, indicating that tobacco use continues to be a problem. Somalis compose the largest African refugee group in the U.S., with more than 55,000 primary arrivals since fiscal year 2000. Minnesota has the largest Somali population in the U.S. and informal tobacco use prevalence estimates range from 13% to 37%. Little research has been conducted to determine the extent of tobacco use among Somalis. Methods: A knowledge, attitude and practice (KAP) survey, modeled after validated state and national tobacco use surveys was adapted for Somalis and administered to ethnically Somali adults (n=392) from 25 neighborhood clusters in the Twin Cities and greater Minnesota. Participants were chosen through probability proportional to size and multistage random sampling methods. Results: Estimated prevalence for cigarette use among Somalis was 24%, which is higher than the reported state-wide smoking prevalence for Minnesota adults, although much lower than perceived prevalence (37%). Ever users were significantly more likely to be male, have attended college, and have friends who used cigarettes (p<0.0001). Belief in Islamic prohibition of tobacco was protective and affected current use and future intention to use tobacco (p<0.0001). Conclusions: Estimated cigarette use prevalence was lower than perceived prevalence. Contrary to typical results, greater smoking prevalence was found among Somalis with higher education levels. Positive peer pressure and religion are protective factors in tobacco use and should be integrated into any future prevention and cessation programs.