and Abstract The plummeting prevalence of cigarette smoking in the US in the last decade is a profound and ongoing public health accomplishment. This has been largely driven by policies, such as taxation, which effectively make tobacco more costly or otherwise difficult to obtain. However, while consumption of non-menthol cigarettes has declined, menthol cigarette use has actually increased in recent years, suggesting that these policies may have had a lesser impact on groups that overwhelmingly favor menthol cigarettes, such as African American smokers. African Americans bear a highly disproportionate burden from various smoking-related conditions including heart disease, stroke, and lung cancer when compared to other racial/ethnic groups in the US. Given the central role that menthol cigarettes play in causing tobacco-related disease disparities, and acknowledging that policy has been the critical lever for reducing smoking prevalence in the general population, there is an urgent need to better understand how emerging policy opportunities might influence cigarette consumption among African Americans. In recent years, policies that would fully or partially remove menthol-flavored tobacco from the market have been considered at both the local and federal level, however it is unclear what kind of real-world impact a menthol tobacco sales restriction might have on tobacco use prevalence and disparities. The objective of this application is to determine how a city-wide restriction on the sale of menthol tobacco products impacts smoking among African American adults living in the metropolitan area. Presently there is a unique opportunity to evaluate a city-initiated menthol tobacco sales restriction policy. Starting on August 1, 2018, a menthol tobacco sales restriction goes into effect in Minneapolis, MN. We propose an innovative case-cohort study design, utilizing online recruitment and surveying, to measure this policy's impact on African American's smoking. One year after the policy goes into effect, we will recruit, from the population of Twin Cities, MN metropolitan area African Americans, ?cases? who have smoked in the previous two years but not recently, as well as ?controls? who are current smokers. The main exposures of interest will be geographic (i.e. residing within vs. outside of Minneapolis, distance to city border, etc.) We will accomplish the proposal's objective through these specific aims: 1) Determine how a policy banning menthol-flavored tobacco relates to cigarette consumption among African American smokers in the Twin Cities, MN metropolitan region. 2) Identify how the impact of a policy banning menthol flavored tobacco within Minneapolis may be modified by factors related to geography and individuals' life patterns. It is anticipated that these aims will yield the following expected outcomes. First, they will illuminate the effects of a menthol-ban policy on African American adults' smoking. Second, they will provide direction for how such a policy could be optimized to prevent disease and reduce disparities.
These aims are expected to have positive impact because an evidence basis is critical for implementing prudent tobacco control policies.
The proposed research is relevant to the public's health because it will provide evidence for whether policies that restrict the sale of cigarettes with menthol flavoring impact tobacco use among African American adults. The discovery of policy options that promote tobacco-free lifestyles, reduce chronic disease risk, and thus enhance health in populations that bear a disproportionate burden of disease is relevant to the NIH's mission.
