African Americans and Mentholated Cigarettes: Socio-Cultural Determinants

1. African Americans and Mentholated Cigarettes: Socio-Cultural Determinants Bruce Allen, Jr., Dr.P.H. Assistant Professor, OB/GYN Charles R. Drew University Los Angeles, CA

2. Background African Americans • prefer menthol cigarettes (~75% vs. ~25%) • higher death rates of smoking-related diseases (heart disease 29%; cancer 25%; stroke 40%; and chronic pulmonary diseases 26%) • higher prevalence of hypertension and diabetes

3. Specific Aims • To identify socio-cultural determinants of African Americans preference for menthol cigarettes. • To assess intra-racial biochemical effects of smoking menthol cigarettes.

4. Research Design • Descriptive Cross-Sectional • Convenient Sample • Informed Consent • Survey Questionnaire • Height and Weight Measurements • Expired Carbon Monoxide • Saliva Sample

5. Eligibility Criteria • > 18 years old • African American • Smoked > 5 CPD during past year • > 7 PPM expired carbon monoxide

6. Recruitment Sites • Medical Center • Rehabilitation Centers • Shopping Centers

7. Data Collection 93-item Survey Questionnaire • Demographics • Smoking Behavior • Tobacco Use Environment • Medications and Caffeine Use • Psycho-social and Cultural Factors • Biochemical and Physical Measurements

8. Sample Demographics • N = 432 • 40.7 years - Mean Age (Range 18-79) • 53.9% - Female • 76.7% - High School Grad & Higher • 58.6% - Single • 33.0% - Employed • 68.0% - Grew Up in the West

9. Percent Smokers by Cigarette Type

10. Percent Menthol Smokers by Gender

11. Percent Menthol Smokersby Age Group

12. Percent Filter Smokersby Cigarettes Type

13. Percent Filter Smokersby Gender

14. Study Findings • Do you most often smoke cigarettes that have a filter? (OR = 38.3) • If there were no non-menthol cigarette available, would you smoke menthols? (OR = 4.1) • When you first started to smoke regularly, did you smoke menthols or non-menthols? (OR = 2.9)

15. Study Findings • Did other members of your family smoke menthols or non-menthols? (OR = 2.8) • Gender of respondents? (OR = 2.5) • Did your father smoke menthols or non-menthols? (OR = 2.4)

16. Study Findings • Have you ever changed from smoking non-menthols to menthols? (OR = 2.3) • Did your mother smoke menthols or non-menthols? (OR = 2.1) • Did your friend smoke menthols or non-menthols? (OR = 2.0)

17. Study Findings • What kind of cigarette did your friend smoke? (OR = 2.0) • Currently the ads you see most often are for menthols or non-menthols? (OR = 1.8) • Age group (< 40 vs > 40 years) (OR = 1.8)

18. Study Findings • Do you believe that smoking menthols is a black thing? (OR = 0.6) • Are there any medications that you take daily? (OR = 0.6) • Employment status (full-time vs all others) (OR = 0.5)

19. Study Findings • How long have you smoked cigarettes? (< 24 vs > 24 years) (OR = 0.4) • Have you ever changed from menthol to non-menthol cigarettes? (OR = 0.1)

20. Odds Ratio & Confidence Interval of Predictors of Smoking Menthols

22. Discussion • In a convenient sample of 432 adult African American smokers we found: • 17 socio-cultural determinants of menthol cigarette smoking • the strongest determinant was smoking filtered cigarettes • the odds of smoking menthols were doubled or greater for 10 of the 17 determinants

23. Discussion • A randomized cross-sectional study among African American smokers is needed to confirm the pilot study findings • Following the successful completion of the study above, a randomized cross-sectional study among smokers of all racial and ethnic groups should be conducted

24. Acknowledgments • Funding Agency • University of California, Tobacco-Related Disease Research Program (UC-TRDRP) • Co-Investigators • Neal Benowitz, MD, PhD • Catherine Carpenter, PhD • Hope Landrine, PhD