Abstract

The prevalence of substance use among emerging adults is substantial and increases risk for social, personal, and health consequences. Past research suggests considerable variation across gender and ethnic groups, but little of this research focuses on young Arab Americans. Participants were 179 emerging Arab American adults (68.7% male; mean age = 24) who identify as Muslim. Participants were recruited through Amazon Mechanical Turk (MTurk) to complete an online survey that focused on lifetime, past year, and past month tobacco, alcohol and marijuana use. Tobacco use was very common with over half of the men and a quarter of women reporting past year use. Despite religious and cultural prohibitions, rates of alcohol and marijuana use were also substantial. Men were more likely than women to report any use of each substance at each time point. And men, as compared to women, tended to report more frequent use of each substance at each time point. Higher levels of religiosity were related to lower levels of alcohol and marijuana use for both men and women. Religiosity was unrelated to tobacco use for males, but was related to less tobacco use for females. Religiosity did not significantly moderate the relationship between gender and any of the three types of substances, suggesting that gender and religiosity independently influence substance use rates. Implications for future research, education, and treatment are discussed.

Keywords: Arab American, emerging adulthood, substance use, gender, religiosity

Substance use increases risk for a number of personal, social, and health consequences, especially among emerging adults (Andrews & Westling, 2015). This study examines the rates of tobacco, alcohol, and marijuana use by emerging Arab American adults who identify as Muslim. It also explores how features of gender and religiosity are associated with use within this population.

Age, Ethnicity, and Substance Use

Age. Emerging adulthood refers to the period between adolescence and adulthood (18 through 29). This stage involves new freedoms and experimentation that foster identity development (Arnett, 2000). This period of transition involves risks including a heightened risk for substance use (Arnett, 2005). In their review of literature focused on substance use following high school, Kirst and colleagues (2014) reported higher rates of cigarette smoking, alcohol consumption, and cannabis use during emerging adulthood; these rates were especially significant among young men. The National Survey on Drug Use and Health (NSDUH) found that drug use is highest among emerging adults, as compared to adolescents or older adults (Substance Abuse and Mental Health Services Administration [SAMHSA], 2018).

Ethnicity. National prevalence rates for substance use do not always generalize to its minority populations, and rates of substance use and abuse differ across ethnic groups (Rote & Taylor, 2014). Such differences among ethnic groups in the United States reflect differences in community norms, differences in attitudes toward substance use, disparities in access to substance abuse treatment, and socioeconomic disparities (Lewis, Hoffman, Garcia, & Nixon, 2018).

The Arab American population, reflecting those who have ancestry in one of 22 Arab countries, is large and diverse (Arab American Institute [AAI], 2018b). Cultural norms among Arab Americans and between them and other ethnic groups within the U.S. may contribute to differences in substance use rates, especially during emerging adulthood. The U.S. Census Bureau does not recognize Arab American as a separate ethnic group (AAI, 2018a). Thus, most studies of prevalence classify Arab Americans as “white,” making some experiences of this group invisible. The research that does exist for this population has made use of small community samples and often focuses on adults or immigrants (for reviews see Arfken & Ahmed, 2016 and Ghadban et al., 2016). Few studies focus on the experiences of young Arab Americans or those who were born or predominantly raised in the U.S. (e.g., Abu-Ras, Ahmed, & Arfken, 2010; Ahmed, Abu-Ras, & Arfken, 2014; Arkfen, Abu-Ras, & Ahmed. 2015; Arfken, Ahmed, & Abu-Ras, 2013; Islam & Johnson, 2003; Grekin & Ayna, 2008: Weglicki et al., 2008). This is unfortunate as this is a growing population (AAI, 2018a) and it is unclear if substance use prevalence rates based on other emerging adult ethnic groups generalize to this population.

There are a number of reasons to suspect that Arab American substance use during emerging adulthood may differ from the rates for other ethnic groups, considering some factors may reduce risk for use. For example, Arab Americans are more likely than mainstream populations to embrace collectivist cultural norms, which prioritize family and community over the individual (Abdel-Salam, Rifkin, Smith, & Zaki, 2019; Amer & Awad, 2016). A collectivist orientation has been shown to reduce risk for substance abuse in some groups (Le, Godebert, & Wallen, 2009; Tyson & Hubert, 2003). Further, Arab American parents tend to view substance use as a negative consequence of American culture (Abudabbeh & Hamid, 2001). Thus, collectivist cultural orientations may lead Arab American youth to abstain from substances during emerging adulthood to avoid potentially jeopardizing family relations (Arfken & Grekin, 2016; Kayyali, 2006).

However, in some cases, Arab American youth may be at increased risk relative to the general population. For example, waterpipe use and smoking tend to be more socially acceptable in Arab culture (Haddad & Johnson, 2016). Waterpipe tobacco smoking is an alternative form of tobacco use comparable to or worse than smoking cigarettes (Haddad & Johnson, 2016). The use of the waterpipe (often called a hookah or narghile) is a rapidly growing trend in Arab culture (Haddad & Johnson, 2016) and among Arab college students more generally (Grekin & Ayna, 2012). As such, Arab American youth may be at higher risk for tobacco use relative to other groups.

Religiosity, Gender, and Intersectional Influences among Arab American Youth

Ethnicity often interacts with developmental stage and other factors to influence rates of use (Vasilenko, Evans-Polce, & Lanza, 2017). The majority of studies examining factors associated with risk for use among groups, however, compare U.S. Caucasians with African Americans and Hispanic Americans (Ensminger et al., 2016). The lack of inclusion of Arab Americans in such studies makes ascertaining specific risk factors challenging, which has led experts to call for studies focusing on use in Arab American populations (e.g., Arfken & Grekin, 2016). Two factors often associated with use rates in emerging adults within other ethnic groups are religiosity and gender.

Religiosity. Religiosity is a protective factor against substance use in a number of ethnic groups (Chitwood, Weiss, & Leukefeld, 2008). Studies assessing general religiosity (i.e., a person’s involvement with spiritual issues and concerns with God on a day-to-day basis and in times of crisis) and those focusing on social religiosity (i.e., interaction with other religious individuals and frequency of attendance at services) find that religiosity is related to lower levels of usage of numerous substances such as nicotine, alcohol, marijuana, cocaine, and other illicit drugs (Miller, Davies, & Greenwald, 2000).

Arab Americans have a significant number of Muslim adherents among them. Islam discourages the use of intoxicants (Abudabbeh & Hamid, 2001; Kayyali, 2006). In fact, countries with Muslim majorities have the lowest rates of per capita alcohol consumption in the world (Arfken & Ahmed, 2016; World Health Organization [WHO], 2018). Within the U.S., Muslim youth generally report less frequent substance use than non-Muslim counterparts (Unlu & Sahin, 2016). As with other religions, however, there is considerable variance regarding religious beliefs and behaviors among those identifying as Muslim. As such, considering differences in rates of religiosity within Muslim Arab American youth is important when considering risks for using substances.

Muslims with higher levels of religiosity report less alcohol and drug use (Arfken & Ahmed, 2016). Among U.S. college students, Muslims with higher rates of religiosity use alcohol less than those with lower levels of religiosity (Abu-Ras et al., 2010; Arfken et al., 2013). Thus, like other ethnic groups and religions (Koenig & Larson, 2001; Rote & Stark, 2010), religiosity may be a protective factor for young Muslim Americans.

Gender. Across many countries and cultures, gender is related to risk for substance use, with men being more likely than women to use substances at most ages (SAMHSA, 2014; Vasilenko et al., 2017). Recent reviews of studies within the U.S. have concluded that men are more likely to use tobacco products (Higgins et al., 2015), consume alcohol, experience problems with alcohol (Erol & Karpyak, 2015), and use marijuana more frequently (Carliner et al., 2017). Differences in how men and women in the U.S. are socialized are thought to contribute to differing rates of substance use (Wilkinson, Fleming, Halpern, Herring, & Harris, 2018). Social norms regarding risky behaviors may render these behaviors less acceptable for women (e.g., Atkinson, Kirton, & Sumnall, 2012; Iwamoto, Corbin, Lejuez, & MacPherson, 2014; Vandello & Bosson, 2013). For example, a large longitudinal study by Clinkinbeard and Barnum (2017) found that gendered self-concept was related to alcohol consumption. Emerging adults (both males and females) who endorse dominant masculinity tended to engage in heavier drinking and report more negative alcohol consequences, whereas stereotypically feminine characteristics tended to be related to less drinking and social consequences. As with several factors noted above, the dearth of studies on Arab American and Muslim youth render it challenging to ascertain if a gender gap exists within this population.

Intersectional Influences on Substance Use. Although age, ethnicity, religiosity, and gender may each contribute to risk of substance use, it is also important to consider the intersectionality of these influences. Among Arab American Muslim youth, cultural and religious factors may work together to reduce the likelihood of alcohol and drug use given the prohibitions inherent in Islam and the cultural stigma associated with these “Western” behaviors. Conversely, these same factors might actually increase the likelihood of waterpipe tobacco use that often occurs in social and familial settings.

It is also important to consider the influence and the potential intersections of ethnicity, religion, and gender. For example, cultural gender norms that dictate appropriate behavior may differ from religious teachings, with cultural norms sometimes being more or less restrictive (Mahmood, 2012). Peralta (2010) examined racial and gendered disparities in alcohol use using interview data to consider how social contexts may serve to discourage drinking by women and racial minorities. In particular, public drinking by women and racial minorities may be viewed as “immoral” behavior that is met with stigmatization, denigration, and even threats of violence. Thus, the influence of these disinhibitory factors is likely quite strong for young Muslim Arab Americans in general and for young Muslim women in particular as many of the religious and cultural expectations related to substance use are strongly gendered. The traditional gender roles and the focus on maintaining reputation that are a part of both the Arab American culture and Islam might make it particularly stigmatizing for a young Muslim woman to engage in alcohol or drug use (Abdel-Salam et al., 2019; Mahmood, 2012). However, the intersectional influences of culture, religion, and gender are less clear for tobacco use. For example, although cigarette smoking is typically frowned upon for Arab women, waterpipe tobacco use is generally considered to be more acceptable and often occurs in family settings (Kassem et al., 2015).

Although there is some research that considers prevalence and risk factors associated with substance use among Arab Americans, little focuses on emerging adults. Additionally, some prior studies include samples of Arab Americans of various religious orientations without explicitly focusing on Muslims. Fewer still consider the potentially moderating effects of religiosity within this group. Thus, the present study extends the prior literature by focusing solely on young Arab Americans who identify as Muslim, while also considering the influence of religiosity on substance use in this group. Below, we briefly review the existing studies.

Prevalence of Substance Use in the Arab American Community

Obtaining accurate prevalence statistics related to tobacco, alcohol, and drug use among Arab Americans, especially Muslim Arab Americans, is difficult. Below, we briefly review research on rates of use for emerging adults within the U.S. population and, where possible, among Arab Americans and those identifying as Muslim.

Tobacco Use. Data from the 2016 National Survey on Drug Use and Health (NSDUH; Center for Behavioral Health Statistics and Quality [CBHSQ], 2017) found tobacco use to be quite common among emerging adults in the U.S. Two-thirds of males (66.5%) and over half of females (52%) reported tobacco use in their lifetimes and almost half of males (49.2%) and almost a third of females (31.8%) reported use in the past year (CBHSQ, 2017). In their review of 26 studies across different communities, Ghadban and colleagues (2016) suggest that rates of tobacco use among Arab Americans is also high (with studies reporting rates for current smoking ranging from 39% to 69%). Arab American men were more likely to use tobacco than women. However, Arab American communities tend to differ from the general population in terms of tobacco delivery.

Research on tobacco use among Arab American adolescents and emerging adults is limited. Still, existing studies suggest that rates of use may be high among this population, especially with regard to use of waterpipes. Using a sample of 1,671 adolescents, Rice and colleagues (2006) found that 29% reported having tried cigarette smoking, 27% had used a waterpipe, and 14% of the oldest adolescents were current smokers. In a sample of university students, Grekin and Ayna (2008) reported that 61.8% of Arab American students reported using a waterpipe to smoke tobacco at least once in their lifetime and 52.7% reported use in the past year; lifetime cigarette use was 32.7% and past year cigarette use was 21.4%. A meta-analysis by El-Sayed and Galea (2009) found water-pipe smoking was reported to be more prevalent among Arab American youth than among the general U.S. adolescent population.

Similar patterns emerge in research focusing on rates of use among Muslims. Using data from Harvard’s 2001 College Alcohol Study, Ahmed and colleagues (2014) found that 37.3% of students raised in Muslim families reported using tobacco, with use reported by males (43.7%) being significantly higher than rates of use for females (25.5%). Among college students identifying as Muslim in the Midwest, Arkfen and colleagues (2015) found that the lifetime rate for cigarette smoking was 28.3% and 44.3% for waterpipe smoking. Lifetime waterpipe smoking was associated with male gender, alcohol use, and cigarette smoking (but was unrelated to religiosity). Using a sample of Muslim Arab American high school students in Virginia, Islam and Johnson (2003) reported lifetime smoking rates of 45%, with males having significantly higher lifetime, past month, and current smoking rates than females. Religiosity was a protective factor for both genders in this study.

Alcohol Use. Lifetime and past year alcohol use is very common among emerging adults in the U.S. In 2016, 80.6% of males and 82.1% of females reported lifetime alcohol use, while 74% of males and 74.8% of the females reported past year alcohol use (CBHSQ, 2017). Reported rates of alcohol use are lower among Arab American populations (Arfken & Grekin, 2016). Using immigrants’ place of birth as a proxy for ethnicity, Arfken and colleagues (2011) examined NSDUH data from 2002 through 2008, reporting that among immigrants 50.8% (60.9% for males; 34.2% for females) reported lifetime alcohol use and 26.4% reported past month use. Using data from the 2000 to 2003 National Health Interview Surveys (NHIS), Dallo and Borrell (2006) reported similar rates for Arab American immigrants.

Studies suggest that religiosity reduces risk for alcohol use among younger Muslims within the U.S. Recent qualitative findings suggest Muslim youth may view drinking in general, and heavy episodic drinking in particular, as normative for their age group, but feel such habits should end when people get married and have children (Arfken, Owens, & Said, 2012). Indeed, a study by Abu-Ras and colleagues (2010) assessing alcohol use among U.S Muslim college students found that roughly 46% reported drinking in the past year; however, this rate was less than the over 80% rate reported by non-Muslim students. Further, religiosity was associated with less use in the Muslim students. In a separate study, Arkfen and colleagues (2013) found that private religiosity and personal proscriptive religious beliefs were linked to lower risk for alcohol use among Muslim students in the U.S.

Marijuana Use. In the general population of emerging adults in the U.S., about half of the men (53.4%) and women (50.1%) reported that they had used marijuana in their lifetimes (CBHSQ, 2017). Men (36%) were more likely to have used marijuana in the past year relative to women (29.9%; CBHSQ, 2017). Studies suggest that Arab American youth, particularly those who identify as Muslim, use marijuana at lower rates than the general U.S. population. For example, in the secondary analysis of the data from the 2001 Harvard School of Public Health College Alcohol Study described above (Ahmed et al., 2014), 31.9% of the Muslim university students reported having used marijuana, while 23.9% reported marijuana use in the past year. Though they did not consider religious identity in their study of university students, Grekin and Ayna (2008) found both lifetime and past year marijuana use to be more common among non-Arab college students (39.2% and 21.4%, respectively) relative to Arab students (12.7% and 10.9%, respectively). Findings do vary across studies. For example, Pro, Sahker, and Marzell (2018) found rates of regular marijuana use (defined as monthly use or greater) to be similar for Arab American (30.8%) and other ethnic groups (31.6%).

Present Study

There are a dearth of studies examining rates of alcohol, tobacco, and marijuana use among Arab American youth. This is due in part to failures to differentiate Arab Americans among Caucasians in U.S. studies. The present study builds on prior work by examining reported rates of three types of substance use (tobacco, alcohol, and marijuana), and the roles of religiosity and gender in affecting use, in a sample of Arab American emerging adults that spent all or the majority of their lives in the United States. All identified their faith as Muslim. Gender and religiosity were expected to influence levels of substance use (while controlling for the effects of social desirability response bias) such that:

1. Male participants would report more overall use and more frequent use of all three types of substances than female participants.
2. Higher levels of religiosity would be associated with less use of all three types of substances.
3. Gender and religiosity would interact such that at high levels of religiosity the relationship between gender and substance use would be diminished (i.e., religious men and women would use all three substances at very low levels).

Methods

Results

Discussion

This study focused on three types of substance use (tobacco, alcohol, and marijuana) in a sample of emerging Arab American adults, ages 18 to 29, who identified as Muslim, and were born or raised in the United States. Substance use was reported somewhat frequently in this sample and both gender and religiosity were related to use.

Past U.S. research with emerging adults reveals that tobacco, alcohol, and marijuana use is quite common (Kirst et al., 2014; SAMHSA, 2018). Cultural, religious, and gender prohibitions have been shown to influence the use of substances in emerging adults (Atkinson et al., 2012; Peralta, 2010; Vasilenko et al., 2017). In the present study, these variables were also shown to impact use in a highly specific sample of Arab American Muslim emerging adults

Tobacco Use. Rates of tobacco use in our sample matched or exceed what has been reported in other studies for the general emerging adult American population (e.g., CBHSQ, 2017). Tobacco use was high within our sample for the past year (men: 51.8%; women: 28.6%) and past month (men: 43.4%; women: 21.4%). All tobacco use, however, is not the same. Although some individuals reported frequent tobacco use, the average frequency of tobacco use in the present study was quite low, with the average man reporting three to five occasions and the average woman reporting one to two occasions in their lifetimes. Still, a fair portion of the sample reported using tobacco on 40 or more occasions (28.5% of men; 10.7% of women). Thus, frequency of use varied considerably across sample participants.

Rates of lifetime and past year tobacco use in the present study are similar to prior studies (Grekin & Ayna, 2008), while rates of past year smoking in the present study were slightly higher for men than has been reported by others (e.g., Ahmed et al., 2014). Importantly, our finding that Arab American Muslim men report more lifetime, past year, and past month smoking relative to women counterparts is clearly consistent with findings for similar populations and for the American population at large (Arfken et al., 2015; CBHSQ, 2017; Islam & Johnson, 2003). This suggests that risks associated with gender during emerging adulthood do cross ethnic and religious lines to affect this population. High rates of tobacco use in young Arab American Muslims may, in part, be attributed to the cultural acceptance of tobacco use, particularly waterpipe smoking (Haddad & Johnson, 2016; Kassem et al., 2015). However, higher rates of smoking by men in this study likely reflect both gender differences in the acceptability of smoking for men in this group (Kassem et al., 2015) and American culture more generally (Higgins et al., 2015), as well as biological sex differences that may predispose men to be more likely to smoke (e.g., Dumais et al., 2017).

Alcohol Use. Alcohol use is common in the general American emerging adult population. Our results suggest that drinking is also common among Arab American youth identifying as Muslim (CBHSQ, 2017). Although lifetime alcohol use for our sample was lower than in the general population, a majority of men and women from our sample reported consuming alcohol at least once in their lifetime and at least once in the past year. Further, 56.9% of the male participants and 41.1% of the female participants reported past month alcohol use. Young Muslim American men were significantly more likely to report past month alcohol use (compared to young Muslim American women). Again, overall frequency of alcohol consumption was quite low (e.g., mean number of occasions of lifetime use were 6 to 9 occasions for men and 3 to 5 occasions for women). However, there was substantial variation with a significant proportion of both men and women reporting 40 or more occasions of lifetime alcohol consumption (men: 31.7%; women: 23.2%).

The rates of alcohol use in the present study were higher than rates reported in past research for similar populations. For example, the rates of past year alcohol use for both male and female Arab American Muslims in the present study (63.4% and 51.8%, respectively) exceed the 46.6% of Muslim students who reported drinking in the past year in the study by Abu-Ras and colleagues (2010). Higher rates of alcohol use in the present study may stem from the participants being of a general population rather than a student population, that the average age of our sample was somewhat older (average age of 24), and that most of our participants had been born in the United States. It is also possible that norms are changing within this population. Focus group studies with young Muslim Americans suggest that norms regarding alcohol consumption during emerging adulthood are becoming more acceptable, though the expectation that such behaviors should be discontinued in adulthood remains (Arfken et al., 2012). Thus, it is also possible that differences in our rates reflect a softening of norms around alcohol use within this population.

Marijuana Use. In our study, marijuana use was less common than tobacco or alcohol use, which is consistent with the general population. As predicted, men were significantly more likely to report marijuana use and more occasions of marijuana use at each time point than women and the gender gap was quite pronounced. Almost half (45.5%) of the young Muslim Arab American men reported lifetime marijuana use compared to 25% of young Muslim Arab American women. About a third of the young Muslim men in this sample reported past year (36.1%) and past month (32.5%) marijuana use, while young Muslim American women reported lower rates of past year (16.7%) and past month (8.9%) use. Although overall frequency of marijuana use was very low, there was substantial variation particularly among men. For example, 18.7% of the young men had used marijuana on 40 or more occasions in their lifetimes.

To date, only a few studies have examined self-reported rates of marijuana use in similar populations and findings have been mixed. Less than a quarter of Arab American participants reported marijuana use in the past year in the 2001 Harvard School of Public Health College Alcohol Study (Ahmed et al., 2014). Only one-tenth of the students in the Grekin and Ayna (2008) study reported using marijuana in the past year. Both men and women in our sample reported higher rates of use. While student identity was not directly examined in the present study, it is possible that differences across studies reflect differences in the samples, as our study did not rely exclusively on students.

Regarding gender, study results support our hypotheses that young Arab American Muslim women report marijuana use at rates that are significantly lower than their male counterparts. Despite religious prohibitions regarding marijuana use, young Arab American Muslim men appear to be using marijuana at rates that are similar to rates found in the general population of emerging adult men. The results for male participants differ from much of the earlier research with Arab Americans but are similar to the recent study by Pro and colleagues (2018), perhaps the result of recent changes in both laws and attitudes regarding marijuana in the United States (Hartig & Geiger, 2018)

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  Correspondence concerning this article should be addressed to Pam McAuslan, Department of Behavioral Sciences, University of Michigan-Dearborn, 4901 Evergreen Road, Dearborn, MI 48128. Email: [email protected]