Youth and Young Adult Awareness of and Perceptions About Tobacco Marketing as a Social Justice Issue.

INTRODUCTION: Systemic racism and tobacco-industry targeting contribute to disparities in communities of color. However, understanding tobacco as a social justice issue and the industry's role in perpetuating inequities remains limited. This study explored youth and young adult awareness of tobacco marketing and perceptions of tobacco marketing as a social justice issue. AIMS AND METHODS: Focus groups were conducted with youth and young adults in 2020 and 2021, including individuals who used tobacco and e-cigarettes and those who did not use either. Online surveys were conducted in 2021 with youth (n = 1227) and young adults (n = 2643) using AmeriSpeak's nationally representative panel, oversampling for black and Hispanic Americans and people who smoke. Perceptions of flavor bans, social justice, and industry marketing were assessed. RESULTS: Most (>80%) survey respondents agreed that tobacco companies target youth. However, only 20% saw tobacco as a social justice issue. Focus group participants regardless of their tobacco or e-cigarette use, reported higher prevalence of tobacco advertising in their communities relative to survey respondents but did not view it as targeting communities of color. Black non-Hispanic (20.9%) and Hispanic (21.4%) survey respondents perceived tobacco as a social justice issue more than white non-Hispanic (16.1%) respondents. The majority (>60%) of survey respondents supported bans on menthol and flavored tobacco, regardless of race or ethnicity. CONCLUSIONS: Respondents broadly supported menthol and flavored tobacco bans and recognized tobacco-industry influence on youth. Low awareness of tobacco as a social justice issue highlights the need to raise awareness of the underlying factors driving tobacco-related disparities. IMPLICATIONS: The majority of young people see the tobacco industry as targeting them. Most young people support bans on menthol and flavored tobacco bans, with support across racial and ethnic groups. While few young respondents perceived tobacco as a social justice issue, some perceived tobacco companies as targeting low-income and communities of color. Black non-Hispanic and Hispanic respondents were more likely to perceive tobacco as a social justice issue than white non-Hispanic respondents. Efforts to raise awareness among young people of tobacco as a social justice issue may be key in addressing tobacco disparities and advancing support for flavor tobacco bans.

Youth Perspectives on Menthol Sales Restrictions in Minneapolis and Duluth, Minnesota.

Although menthol cigarettes are a starter product for youth, menthol was exempted from the 2009 Tobacco Control Act, which banned all other characterizing flavors. Minneapolis and Duluth, Minnesota, implemented menthol tobacco sales restrictions in 2018 to advance health equity for youth, African American, lesbian, gay, bisexual, trans, and queer (LGBTQ), and other communities adversely affected by menthol. This evaluation assesses the policy impact on youth access to menthol tobacco, exposure to menthol advertising, and tobacco use. A core group of youth aged 14 to 17 years (n = 30) was recruited from Minneapolis and Duluth to gather data through photo voice and peer interviews 2 months before and after policy implementation. This evaluation shares the results of focus groups with these core youth where they reflected on what they observed in the community and heard from peers. The core youth identified and categorized emergent themes using the evaluation questions. Following the focus groups, the evaluation staff used these preliminary themes and coded remaining transcripts. The core youth had mixed reactions to the impact of policies on access and use because many tobacco users in their age group obtain tobacco informally through peers, family members, and online. They observed decreases in retail advertising of menthol cigarettes, although many felt e-cigarettes and online advertising were more significant issues for their age group. Findings show a need for increased education and more comprehensive policy approaches, including addressing use of flavored e-cigarettes, online tobacco sales, and informal access, making youth access to tobacco more difficult.

Expanding local sales restrictions on flavoured tobacco products to include menthol: retail sales changes in two Minnesota cities.

BACKGROUND: In 2018, Minneapolis and St. Paul, Minnesota, expanded existing local sales restrictions on flavoured (non-menthol/mint/wintergreen) tobacco products ('flavour policies') to include menthol/mint/wintergreen-flavoured tobacco products ('menthol policies'). All policies included exemptions for certain store types. METHODS: We obtained weekly retail tobacco product sales for 2015 through 2019 from NielsenIQ for convenience stores and other outlets in the policy jurisdictions and two comparison areas (rest of the state of Minnesota and total USA). We standardised unit sales across product categories and used NielsenIQ-provided descriptors to classify products as menthol (including mint/wintergreen) or flavoured (non-menthol/non-tobacco). Using single group interrupted time series models, we analysed unit sales by product category and by flavour separately for each geography to assess associations between menthol policy implementation and trends in tobacco product unit sales. RESULTS: Following menthol policy implementation, unit sales of menthol cigarettes and menthol smokeless tobacco decreased in both cities, with smaller decreases in comparison areas. Flavoured cigar sales-which decreased following the flavour policies-further decreased after the menthol policies, while sales of menthol electronic nicotine delivery systems (ENDS) increased in both cities and sales of flavoured ENDS increased in St. Paul. CONCLUSION: Expanding flavour policies to include menthol/mint/wintergreen was associated with significant decreases in unit sales of most menthol products and in total unit sales by tobacco product category. Increases in menthol and flavoured ENDS sales in these cities may be associated with legal sales by exempted retailers and/or illicit sales by non-compliant retailers, highlighting opportunities for retailer education and enforcement.

Restricting Sales of Menthol Tobacco Products: Lessons Learned from Policy Passage and Implementation in Minneapolis, St. Paul, and Duluth, Minnesota.

Purpose: Commercial tobacco products have historically been target marketed to African American, Latinx, Asian American Pacific Islander, Indigenous, and Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) communities, as well as to youth. Menthol cigarettes increase smoking initiation and decrease smoking cessation, particularly among African Americans who smoke menthol cigarettes at higher rates than their white peers. Due to disproportionate tobacco-related health consequences for members of these communities, effective tobacco control policies that restrict availability of menthol products by focusing on retail sales are an important element of addressing health disparities, and require policy efforts informed by leadership and the voice of communities most impacted. This study examines the organizing efforts of three successful policy initiatives in 2017-2018 in Minneapolis, St. Paul, and Duluth, Minnesota, and identifies facilitators and barriers of these campaigns. Methods: We conducted 50 key informant interviews with city council/staff, advocates, and community members and analyzed them for emerging themes. The analysis employed a process-oriented qualitative matrix process to identify emerging themes and divergent perspectives. Results: Following policy implementation, outlets selling commercial menthol tobacco products substantially decreased. Facilitators included strong city council support, leadership from impacted communities, community awareness-building campaigns, and understanding tobacco industry counter-tactics. Challenges included the need to counter tobacco industry misinformation and retailer attempts to circumvent the intent of restrictions. Conclusion: Well-planned advocacy campaigns led by community members most impacted by commercial tobacco can overcome opposition and challenges to restrict sales of menthol tobacco products and successfully reduce availability of these products in their communities.

Examining Use and Dual Use of Tobacco Products and Marijuana among Minnesota Adults.

BACKGROUND: An increasing number of states are legalizing the medicinal and/or recreational use of marijuana. Adult perceptions of harm have decreased and marijuana use has increased. This is in contrast to declining cigarette smoking. In this article we examine independent use and dual use of marijuana and tobacco products. METHODS: Data are from the 2018 Minnesota Adult Tobacco Survey (N = 6055). Estimates were calibrated on sex, race, location, and education from the American Community Survey. RESULTS: In 2018, 15.4% of adults smoked cigarettes in the past 30 days, 7.6% used marijuana and 6.0%, 3.0%, and 1.1% used e-cigarettes, cigars, and waterpipe, respectively. Use of marijuana and cigarettes was 3.3% and use of marijuana and e-cigarettes was 2.2%. Among past 30-day marijuana users, 89.7% smoked it as a joint, blunt, or in waterpipes, 22.1% vaped it in an e-cigarette or a vaping device. Across multinomial regression models, marijuana use and dual use with tobacco products was more likely among males, younger age groups, and African Americans. CONCLUSIONS: As policies to expand the sale and use of marijuana are considered, states should anticipate the need to monitor trends and to plan surveys of sufficient sample size with specific questions on marijuana use. Understanding the proportion of the population that uses both marijuana and tobacco has implications for prevention and treatment of both substances.

Utilizing Reach Ratios to Assess Menthol Cigarette Smoker Enrollment in Quitline Services.

INTRODUCTION: Increasing the reach of evidence-based cessation services is a longstanding public health priority, especially for subgroups who may be most at risk. Little research has examined whether quitlines are reaching menthol cigarette smokers who may have increased difficulty quitting compared with nonmenthol cigarette smokers. This study aims to understand whether quitline services are reaching menthol cigarette smokers. METHODS: The study sample included adult smokers enrolled in Minnesota's quitline program, QUITPLAN Services, between May 2017 and April 2018 (N=10,999). Cigarette smokers were asked about the usual cigarette type (menthol versus nonmenthol). Reach ratios were calculated by dividing the percentage of program enrollees who are menthol smokers by the percentage of Minnesota smokers who are menthol smokers. Differences in demographic, tobacco use, and utilization characteristics between menthol and nonmenthol smokers were assessed using chi-square and t-tests. Analyses were conducted in March 2019. RESULTS: Among QUITPLAN Services enrollees, 30.7% of smokers reported using menthol cigarettes. The reach ratio was 1.12 (95% CI=0.99, 1.25). Menthol smokers were more likely to be younger, be female, be Black/African American, be Hispanic, and live in an urban area than nonmenthol smokers. Although menthol smokers were more likely than nonmenthol smokers to enroll in text messaging, no other significant differences in service utilization were found. CONCLUSIONS: The findings suggest that menthol smokers are proportionately represented among quitline enrollees. State quitlines should assess menthol smoking status at intake and allocate resources to reach and better serve menthol smokers.

Perceptions of Menthol Cigarettes and Reasons for Unsuccessful Quits in an African American Community Sample.

This study aimed to better understand African Americans' perceptions of menthol tobacco and reasons for unsuccessful quit attempts among menthol smokers. A cross-sectional survey of 407 U.S.-born African American adults from Minnesota assessed menthol perceptions and experiences trying to quit menthol cigarettes. A majority of the sample (59%) was either unsure of the relative harm of menthol cigarettes or perceived that menthol cigarettes are less harmful than non-menthol cigarettes. Menthol smokers were more likely than nonsmokers to perceive that menthol makes it easier to start smoking and harder to quit, and that menthol cigarettes are marketed to African Americans more than other groups (ps < .05). Nearly half (45%) of menthol smokers who reported a failed quit attempt identified cravings as a reason why they were unsuccessful. Media campaigns and educational interventions that highlight the dangers of menthol and promote cessation resources are needed to help reduce the pernicious effects of menthol in the African American community.

"Because There's Just Something About That Menthol": Exploring African American Smokers' Perspectives on Menthol Smoking and Local Menthol Sales Restrictions.

INTRODUCTION: Local governments are pursuing policies to limit the availability of menthol cigarettes at the point-of-sale. Although African Americans are disproportionately impacted by menthol cigarettes, little is known about African American smokers' perspectives on emerging menthol policy. The purpose of this study was to fill a gap in the literature by exploring African American adult (25+) smoker perspectives on menthol and a local menthol sales restriction. METHODS: In-depth semi-structured interviews were conducted with African American smokers (n = 27) in the Minneapolis-St. Paul area June-September 2017. Interviews explored smoking behaviors, harm perceptions, perspectives of menthol in the community and reactions to local menthol sales restrictions. The framework method guided identification of key themes and synthesis of findings. RESULTS: Almost all (96%) participants smoked Newport cigarettes. The majority of participants indicated that menthol cigarettes were more harmful than non-menthol cigarettes, citing strength and additives and because they were targeted to African Americans. Some participants were receptive to policy change while others viewed the policy as inconvenient and unfair. Overall, there was a lack of understanding of the policy's intended public health impact. Some participants indicated that the policy would have no impact on their purchasing or smoking behaviors while others who were contemplating quitting noted that a menthol restriction was encouragement to prompt a quit attempt. CONCLUSIONS: Sales restrictions can provide a unique opportunity to persuade menthol smokers to quit. Efforts are needed to increase awareness and support of these policies as well as to support African American menthol smokers achieve cessation. IMPLICATIONS: There is growing momentum to restrict local menthol tobacco sales; however, little is known about perceptions among populations most impacted. In Minneapolis-St. Paul, where menthol restrictions were passed in 2017, African American smokers expressed limited awareness and uneven policy support. While some participants were unconvinced the restriction would impact smoking, others indicated it would encourage decreased consumption and prompt quit attempts. There is a need for public education to increase awareness of menthol's harms, to help menthol smokers quit, and to increase support for menthol policies.

Local sales restrictions significantly reduce the availability of menthol tobacco: findings from four Minnesota cities.

BACKGROUND: In 2017 and 2018, Minneapolis, St. Paul, Duluth and Falcon Heights, Minnesota were among the first US cities to restrict the sale of menthol tobacco to adult-only stores. The study examined changes in the availability and marketing of these products following policy implementation. METHODS: Retail store audits were conducted approximately 2 months pre-policy and post-policy implementation. Tobacco retail stores (n=299) were sampled from tobacco licensing lists in Minneapolis, St. Paul, Duluth and Falcon Heights, as well as six comparison cities without menthol policies. The presence of menthol tobacco was assessed, along with the number of interior and exterior tobacco ads and promotions at each store. RESULTS: The majority of policy intervention stores (grocery, convenience stores and pharmacies) were compliant (Minneapolis, 84.4%; Duluth, 97.5%; and St. Paul and Falcon Heights, 100.0%) and did not sell menthol tobacco. In contrast, menthol tobacco was available in all comparison city stores, and most (96.0%) exempted tobacco shops and liquor stores post-policy implementation. Two Minneapolis convenience stores added interior tobacco shops, allowing them to continue selling menthol tobacco. Significant decreases in menthol tobacco marketing post-policy were observed in the stores' interior in Minneapolis, St. Paul and Duluth (p<0.001) and on the stores' exterior in Duluth (p=0.023). CONCLUSIONS: Findings demonstrate high rates of compliance, indicating that sales restrictions can significantly reduce the availability of menthol tobacco. However, challenges to policy adherence underscore the need for continued monitoring and enforcement action.

Perceived harm of menthol cigarettes and quitting behaviors among menthol smokers in Minnesota.

Although overall smoking prevalence in Minnesota has declined, the proportion of current smokers who smoke menthol cigarettes has increased. While studies have examined associations between smokers' perceived risks of smoking and quitting, similar studies on menthol smoking are lacking. This study examined whether perceived harm of menthol cigarettes was associated with menthol smokers' quitting behaviors. Data from the 2018 Minnesota Adult Tobacco Survey were examined. Respondents were categorized as current menthol smokers (n = 200), current nonmenthol smokers (n = 527), or nonsmokers (n = 5324). All were asked four questions to assess their perceptions of menthol cigarettes' harm compared to nonmenthols. Sum scores were calculated (range 0-4); higher scores indicated perceptions of similar or greater harm. Data on menthol smokers' quitting behaviors were analyzed to identify associations between sum scores and quitting behavior. Data were analyzed using Wilcoxon Rank Sum tests and Spearman Rank Correlation tests. Additional analyses examined whether gender, age, race/ethnicity, education or income moderated the association between sum scores and past 12-month quit attempts. Menthol smokers were less likely to answer the harm perception questions correctly than nonmenthol smokers. Among menthol smokers, perceived harm of menthol cigarettes was positively associated with past 12-month quit attempts (p = 0.006), use of counseling/behavioral support (p = 0.012), and number of quit attempts (p = 0.004). No demographic characteristics moderated the association between sum scores and past 12-month quit attempts. Findings suggest that efforts to increase menthol smokers' perceptions of menthol cigarettes' harm may potentially increase quitting behaviors. Understanding this association can inform interventions to increase quit attempts.

Marijuana risk perceptions are associated with past-month marijuana use among Black first-year college students at a historically Black university.

To examine the relationship between marijuana risk perceptions and marijuana use, and assess the potential moderating role of stress among Black students from a historically Black university, a convenience sample of students (n = 213) was surveyed. The majority (87.9%) of the sample was Black and 52% were female. Over a third (35.1%) reported past 30-day marijuana use, and a majority (58.4%) reported no or slight risk from using marijuana once or twice weekly. Higher marijuana risk perceptions were associated with lower odds of marijuana use (OR = .45, 95% CI [0.32, 0.64]). No significant relationship between stress and marijuana use was found. Perception of marijuana risk warrants further examination as a predictor of marijuana use.

Menthol Smoking Patterns and Smoking Perceptions Among Youth: Findings From the Population Assessment of Tobacco and Health Study.

INTRODUCTION: Youth may be attracted to menthol cigarettes because they are perceived as less harmful and harsh to smoke relative to non-menthol cigarettes. This study examined demographic factors and menthol cigarette smoking patterns as correlates of youth harm perceptions of cigarette smoking and ease of smoking menthol versus non-menthol cigarettes. METHODS: Data were from the Wave 1 (2013-2014) youth sample of the Population Assessment of Tobacco and Health Study. Weighted multivariable logistic regression models were used to examine correlations between demographic factors and menthol cigarette smoking patterns (menthol initiation, past 30-day menthol cigarette smoking, and menthol cigarette brand preference), with harm perceptions of cigarette smoking and ease of smoking a menthol cigarette. RESULTS: Nearly half of ever cigarette smoking youth (43%) first used a menthol cigarette; 21% reported past 30-day menthol cigarette smoking; and 42% of past 30-day smokers providing brand information used a menthol cigarette as their preferred brand. In bivariate analyses, initiation with a menthol cigarette and menthol brand preference (versus non-menthol) were correlated with black race, older age at initiation, and past 30-day menthol cigarette smoking. In adjusted models, past 30-day menthol cigarette smoking and menthol cigarette brand preference, but not menthol initiation, were correlated with the perception that menthol cigarettes are easier to smoke. CONCLUSIONS: Youth who smoke menthol cigarettes perceive them as easier to smoke, even after adjusting for other factors. Age of initiation and black race emerged as correlates of menthol cigarette initiation, brand preference, and cigarette harm perceptions, and may inform future prevention campaigns.

Perceived racial/ethnic discrimination, marketing, and substance use among young adults.

Perceived experiences of discrimination have been linked to negative health behaviors including tobacco, alcohol, and marijuana use across various racial/ethnic groups. Tobacco and alcohol marketing exposure have also been linked with substance use. This study examined the independent and interacting effects of perceived experiences of discrimination and exposure to alcohol and tobacco marketing, and receptivity to marijuana marketing on substance use in an online survey of a multiethnic sample of young adults in 6 metropolitan areas (n = 505). African Americans (mean (M) = 1.96, 9% 5CI [1.84, 2.09]) and Hispanics (M = 1.98, 95% CI [1.87, 2.09]) reported higher levels of perceived discrimination than Whites (M = 1.52, 95% CI [1.40, 1.64]), p < .001. African Americans had higher levels of exposure to tobacco and alcohol marketing; Hispanics reported higher levels of exposure to alcohol marketing and receptivity to marijuana promotion. Discrimination and marketing exposure were independently associated with higher odds of all 3 outcomes, controlling for covariates (AOR from 2.1 to 3.4 for discrimination; AOR from 1.4 to 13.8 for marketing). Models showed a significant interaction of discrimination and tobacco marketing on past 30-day cigarette use (F = 5.5; p = .02). Individuals with high levels of tobacco marketing exposure were likely to report high past 30-day cigarette use regardless of level of discrimination, while those with low exposure were only at increased risk of reporting cigarette use at higher levels of discrimination. Both perceived discrimination and marketing exposure play a role in substance use. Interventions should consider discrimination as a significant risk factor underlying vulnerability to substance use among young adults.

A tale of two cities: exploring the retail impact of flavoured tobacco restrictions in the twin cities of Minneapolis and Saint Paul, Minnesota.

BACKGROUND: Flavoured tobacco is increasingly popular with youth. The twin cities of Minneapolis and Saint Paul, Minnesota restricted the sale of flavoured tobacco to adult-only tobacco shops in an effort to reduce youth access and exposure to these products. This observational study explores the impact of these policies on the retail environment. METHODS: Between November 2015 and April 2017, observational assessments were conducted at convenience and grocery stores preimplementation and postimplementation of flavoured tobacco restrictions in Minneapolis (n=41), Saint Paul (n=37) and the comparison city of Brooklyn Park, Minnesota (n=14). RESULTS: After policy implementation, significantly fewer of the convenience and grocery stores sold flavoured tobacco in Minneapolis (85.4% vs 39.0%, p<0.001, n=41) and Saint Paul (97.3% vs 8.1%, p<0.001, n=37). The average proportion of tobacco inventory that was unflavoured increased significantly in Minneapolis (42.9%±2.7% vs 56.7%±3.1%, p=0.002) and Saint Paul (40.8%±2.5% vs 70.3%±1.9%, p<0.001). Flavoured tobacco was available at significantly fewer convenience and grocery stores in Minneapolis (39.0%, p<0.001) and Saint Paul (8.1%, p<0.001) than in the comparison city of Brooklyn Park (100%, n=14). Most retailers complied with these policies by removing flavoured tobacco from their shelves. CONCLUSIONS: Policies that restrict the sale of flavoured tobacco to adult-only tobacco shops are associated with decreased availability of flavoured tobacco in convenience and grocery stores and increased proportion of tobacco inventory that is unflavoured.

Changing patterns in E-cigarette use among Minnesota adults between 2014 and 2018.

Minnesota has observed declining combustible tobacco use and a large increase in e-cigarette use among youth and young adults. Less is known about adult e-cigarette users' frequency of use, smoking status, use of flavors, and demographic differences. The Minnesota Adult Tobacco Survey (MATS) is a cross-sectional, random digit-dial telephone survey representative of Minnesotans aged 18 and over. MATS measured e-cigarette use in 2014 (N = 9304) and 2018 (N = 6065). In 2018, 6.0% of adult Minnesotans used an e-cigarette in the past 30 days; this was unchanged from 2014 (5.9%). While past 30-day e-cigarette use declined for current smokers (2014: 27.3%; 2018: 16.1% p < 0.001), it increased for never smokers (2014: 1.2%; 2018: 4.4% p < 0.001) and 18-24-year-olds (2014: 12.8%; 2018: 21.9% p = 0.001). Daily e-cigarette use increased from 2014 to 2018 for current smokers (p = 0.001), 25-44-year-olds (p < 0.001), females (p = 0.001), and those with a high-school education (p = 0.006). Among e-cigarette users in 2018, use of flavored e-cigarettes was associated with smoking status (p = 0.041), age (p < 0.001), and using e-cigarettes to quit smoking (p = 0.011). E-cigarettes appeal primarily to younger adults. Of concern are increases in never smokers initiating e-cigarette use, increasing their exposure to nicotine, addiction, and the risk of future combustible tobacco use. Simultaneously, fewer smokers are using e-cigarettes but those who do are using them more frequently. Use of flavored e-cigarettes was common and correlated with interest in quitting combustible cigarettes. These findings can inform recent calls for additional tobacco control policy and programs aimed at reducing e-cigarette use.

Tobacco industry misappropriation of American Indian culture and traditional tobacco.

OBJECTIVE: Describe the extent to which tobacco industry marketing tactics incorporated American Indian culture and traditional tobacco. METHODS: A keyword search of industry documents was conducted using document archives from the Truth Tobacco Documents Library. Tobacco industry documents (n=76) were analysed for themes. RESULTS: Tobacco industry marketing tactics have incorporated American Indian culture and traditional tobacco since at least the 1930s, with these tactics prominently highlighted during the 1990s with Natural American Spirit cigarettes. Documents revealed the use of American Indian imagery such as traditional headdresses and other cultural symbols in product branding and the portrayal of harmful stereotypes of Native people in advertising. The historical and cultural significance of traditional tobacco was used to validate commercially available tobacco. CONCLUSIONS: The tobacco industry has misappropriated culture and traditional tobacco by misrepresenting American Indian traditions, values and beliefs to market and sell their products for profit. Findings underscore the need for ongoing monitoring of tobacco industry marketing tactics directed at exploiting Native culture and counter-marketing tactics that raise awareness about the distinction between commercial and traditional tobacco use. Such efforts should be embedded within a culturally sensitive framework to reduce the burden of commercial tobacco use.

Differences in Subjective Experiences to First Use of Menthol and Nonmenthol Cigarettes in a National Sample of Young Adult Cigarette Smokers.

Purpose: Menthol has been hypothesized to ease the harshness of cigarette smoke. Thus, sensory experiences at first cigarette use may be one mechanism by which menthol facilitates progression to regular smoking. This study examined differences in subjective experiences to the first use of a menthol versus nonmenthol cigarette among new young adult smokers. Methods: Data were drawn from waves 5-8 of the Truth Initiative Young Adult Cohort Study, a national sample of 18-34 year olds assessed every 6 months. Analyses included a subset of young adult current smokers (n = 251) who initiated smoking in the past 6 months. Subjective responses to first cigarette use were assessed across menthol and nonmenthol initiators in bivariate analyses and adjusted models controlling for smoking correlates. Results: Fifty-two percent of new young adult smokers used a menthol cigarette at first use. First use of a menthol cigarette was higher in those aged 18-24 (vs. 25-34). Most black smokers (93.1%) were menthol initiators compared to 43.9% of white smokers. More than half of menthol and nonmenthol initiates felt relaxed or calm, dizzy, lightheaded, liking the taste and a rush or buzz at first use. Menthol initiators were less likely in bivariate and multivariable analyses to experience feeling nauseated at first use (adjusted odds ratio = 0.45; p = .020) compared to nonmenthol initiators. Conclusions: While few differences were found between menthol and nonmenthol initiators in their subjective experiences, fewer menthol initiates felt nauseated at first cigarette use. Future research needs to identify additional mechanisms linking menthol initiation to smoking progression. Implications: Menthol initiators were more likely to be younger (18-24 vs. 25-34), and black (vs. white) compared to nonmenthol initiators. Our finding that menthol initiators were less likely to feel nauseated at first cigarette use compared to nonmenthol initiators suggests that menthol may reduce aversion to early cigarette use among young smokers and thus has the potential to facilitate continued experimentation. Interventions and policy approaches to reduce tobacco use initiation and progression are urgently needed in young people.

Disparities in cigarette smoking and use of other tobacco products in Minnesota, 2003-14.

Background: Despite efforts to reduce disadvantages across society, widening health disparities have been observed in Minnesota. This research examined whether observed declines in state-wide smoking prevalence were experienced equally by all adults with varying educational attainment. Methods: Serial cross-sectional data from the 2003, 2007, 2010 and 2014 Minnesota Adult Tobacco Survey (MATS) were analyzed. Weighted regression analyses for smoking status, time to first cigarette, cigarettes per day and non-cigarette other tobacco products (OTP) were conducted across education levels. Results: Controlling for age and gender, a decreased rate of smoking among high and middle education groups was offset by an increase in the low education group. Dependence (time to first cigarette) was twice as high in the lowest education group compared to highest, yet dependence did not decline over time for any group. There was a decline in cigarettes per day in all education groups, but an increase in OTP use in the lowest and middle education groups. Conclusions: Given existing smoking disparities, novel efforts are urgently needed. Complementing known population-level strategies with community and individual-level approaches will be necessary to eliminate the widening gap in smoking disparities and to end the burden of tobacco-related disease.