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.

This Free Life Campaign: Increasing Intention to Quit Among LGBTQ+ Young Adult Nondaily Smokers in Minneapolis.

PURPOSE: LGBTQ+ young adults smoke at disproportionately higher rates than their non-LGBTQ+ counterparts, but prevention efforts are limited. Furthermore, prior to This Free Life (TFL), no known campaigns target LGBTQ+ nondaily smokers. In this study Blue Cross and Blue Shield of Minnesota evaluated a local partnership extension of the Food and Drug Administration (FDA) Center for Tobacco Products' TFL campaign. METHODS: The intervention featured a variety of LGBTQ+-tailored events, social/digital media, and out-of-home media placed in locations with a high density of LGBTQ+ young adults. Cross-sectional surveys (n = 1215) were collected from LGBTQ+ young adult (18-26) nondaily smokers at 4 time points between 2016 and 2019. The national TFL campaign was tracked in a separate evaluation conducted by the FDA. RESULTS: 43.0% of nondaily LGBTQ+ smokers reported awareness of the campaign (n = 522), and 63.4% of those also engaged with TFL (n = 330). Engagement was highest for gay, lesbian and transgender participants, and for Asian and Black/African American participants. Each additional instance of campaign engagement increased participants' odds of intending to quit smoking by 20% (AOR = 1.20; 95% CI = 1.05, 1.36). The relationship between campaign engagement and intention to quit was fully mediated by the campaign's impact on attitudes against smoking and perceived normative trends, but not by perceived behavioral control. CONCLUSION: The local extension of TFL increased intentions to quit for LGBTQ+ nondaily smokers. Future research should further explore the relationship between perceived behavioral control and intentions to quit for nondaily smokers.

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.

The Tribal Tobacco Education and Policy Initiative: Findings From a Collaborative, Participatory Evaluation.

While the reduction in the overall U.S. smoking prevalence has been declared one of the top 10 public health achievements of the past century, the growing disparity in smoking between American Indians and the general population is one of the biggest challenges of the 21st century. Minnesota in particular has very high smoking rates among American Indians (59%). Tribal Nations in Minnesota share a past of attempted cultural genocide and a present of restoring the strength of their cultural teachings, including the prominence of traditional tobacco as a sacred "first medicine." The Tribal Tobacco Education and Policy initiative works to address this complex and challenging context. This article describes results of a participatory evaluation from 2010 to 2013 in four Minnesota Tribal Nations-three Ojibwe and one Dakota. Tribal Tobacco Education and Policy coordinators used their cultural knowledge to develop community-level strategies, identifying appropriate strategies from best practices on tobacco advocacy, while drawing on the strengths of their own sovereignty and sacred tobacco traditions. Tribal coordinators generated support for policy change by conducting culturally relevant education, engaging tribal members, and nurturing relationships. This approach resulted in norm changes, practices toward restoring traditional tobacco, informal policies, and tribal resolutions to advance smoke-free policies.

Developing leaders in priority populations to address tobacco disparities: results from a leadership institute.

CONTEXT: Few published evaluations documenting the results of community health leadership programs exist. Furthermore, few leadership programs specifically address cross-cultural issues or priority populations, and none have focused on the area of tobacco control. OBJECTIVE: The goal of the evaluation was to determine the effectiveness of the Leadership and Advocacy Institute to Advance Minnesota's Parity for Priority Populations Institute. Institute Fellows were recruited from 5 priority populations, including African/African American, American Indian, Asian American, Chicano Latino and Lesbian, Gay, Bisexual, and Transgender. The Institute's impact on the acquisition and application of particular leadership skills was assessed, along with its impact in building priority population capacity to engage in tobacco control activities. DESIGN AND MEASURE: Findings are based on mixed methods, including Fellows' completion of paper surveys prior, during, and post-Institute, and telephone interviews conducted post-Institute. RESULTS: Perceived skills increased in all areas assessed. Fellows reported applying specific skills acquired 16 months after the Institute. Furthermore, a high number of Fellows were more intensely involved in tobacco control work compared to baseline and reported involvement in cross-cultural collaborations or initiatives post-Institute. CONCLUSION: The Institute achieved both short-term and intermediate outcomes; skills were acquired during the Institute and sustained and applied in areas of tobacco control over 1 year later.