Necessary but not sufficient: The influence of tobacco control policies on urban African American young adults

Background: African-American young adults have some of the highest rates of tobacco use in the country (Washington DC~25%, Baltimore~50%) a discrepancy compounded by income, educational and occupational disparities. Though tobacco policies have lowered smoking rates at a population level, they remain high among disadvantaged, urban young adults. This highlights the need to explore reactions to policy among this group.

Objective: To describe tobacco use patterns among African-American young adults in the context of tobacco policies in Baltimore/Washington DC.

Methods: Using survey data (n=109) and in-depth interviews (n=20) with African-American young adults in Baltimore/Washington DC we explored tobacco acquisition practices and responses to environmental tobacco smoke (ETS) exposure in light of local policies regulating tobacco taxation and ETS. Descriptive statistics and content analysis were conducted to identify reactions to these policies.

Results: Emergent themes and descriptive statistics produced similar findings. Taxation policies affected tobacco acquisition as young adults reported purchasing single cigarettes (52.8%), acquiring cigarettes without cost (e.g. from friends(72%)), and switching to cheaper brands or flavored cigars. Local ETS policies may have indirectly influenced personal behaviors with respondents reporting avoiding locations with ETS policies. However, 84% reported instituting home smoking bans.

Conclusions: High tobacco use among urban African-American young adults, and their reported circumvention of tobacco policies, highlights the need for additional research to explore policy responses across social, economic, and cultural contexts. Our findings suggest that, while valuable at the population level, policy-based tobacco control strategies may have limited reach among certain populations, especially those enduring extensive health disparities.