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Developing A Menthol-Centric Smoking Cessation Intervention

Institution: Charles R. Drew University of Medicine & Science
Investigator(s): Bruce Allen, DrPH
Award Cycle: 2009 (Cycle 18) Grant #: 18XT-0190H Award: $374,975
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Exploratory/Developmental Award
Abstracts

Initial Award Abstract
African Americans died more often from heart disease, cancer and stroke compared to other racial and ethnic groups in the U.S. in 2005. We think that this may be due to their unique smoking pattern that includes a preference for menthol cigarettes. Some studies report that African Americans smoke fewer cigarettes a day; they absorb more nicotine per cigarette smoked; that menthol in tobacco smoke slows the breaking down of nicotine; and that African American menthol smokers are less successful in quitting smoking. However, few studies have investigated differences within a race between menthol and non-menthol smokers and fewer still have investigated the psychosocial and cultural factors that are associated with African American smokers’ preference for menthol cigarettes. The tobacco research team at Charles Drew University recently conducted such a study funded by TRDRP.

We recruited a pool of 2,854 adult, African American, male and female, menthol and non-menthol smokers. A total of 721 of them were randomly selected and completed a 30-minute telephone interview. We studied five areas that had been suggested might influence the preference for menthol cigarettes including physiological; psychological; social; environmental; and demographics. Most of the group (90%) had smoked menthol cigarettes in the past year; 63% reported being highly addicted to nicotine; and 12 was the mean number of cigarettes smoked per day. Most smokers (89%) wanted to quit. We also found that younger and lower income smokers were more likely to smoke menthols; and physiologically, those who liked the taste of menthols were more likely to smoke menthol cigarettes. Those who only smoked menthols reported liking the taste of menthols more, having more menthol smokers in their current social networks, having a stronger belief in the medicinal effects of menthol, and believing that menthols are less harmful than non-menthols, compared to those who only smoked non-menthol cigarettes. Those who smoked both menthols and non-menthol cigarettes generally held views in-between the only menthol and the only non-menthol cigarette smokers.

The principal investigator of this proposed study has spent much of his career in pursuit of understanding why African American smokers have such a strong liking for menthol cigarettes and what can be done to persuade them to quit. He and his team believes that the results of this study suggest the need to develop and pilot test an effective culturally appropriate smoking cessation program that takes advantage of these study findings. Therefore, we propose to (1) conduct eight focus groups to expand our understanding of the factors that encourage and discourage smoking cessation among African American menthol and non-menthol smokers; (2) use this information to develop a single-session motivational interviewing program for smoking cessation among African Americans that addresses menthol as well as general smoking cessation issues; (3) pilot test this motivational interviewing program in a sample of 40 African American menthol and non-menthol smokers; (4) evaluate the program’s acceptability, feasibility, and effect on short-term outcomes: motivation to quit, self-efficacy to quit, and intention to quit; and (5) make recommendations for a complete study of a brief motivational interviewing programs for African American smokers.

Motivational interviewing is a promising strategy to engage African American smokers to move toward quitting. This technique can be used in a single session and uses a client-centered approach to strengthen clients’ motivation, self-efficacy, and intentions to make behavioral changes. We believe that motivational interviewing could serve as a useful stand-alone technique to help African American smokers move toward readiness to quit or as an adjunct to existing evidence-based programs.

In summary, this study is designed to expand our understanding of why African American smokers like menthol cigarettes so much and what we can do to help them quit. By quitting smoking, African American would reduce the uneven burden of tobacco related diseases, such as heart disease, cancer and stroke.
Publications

Menthol and non-menthol cigarette use among Black smokers in Southern California.
Periodical: Nicotine and Tobacco Research Index Medicus:
Authors: Unger JB, Allen B, Jr, Leonard E, Wenten M, Cruz TB ART
Yr: 2010 Vol: 12 Nbr: 4 Abs: Pg: 398-407

Development and validation of a scale to assess attitudes and beliefs about menthol cigarettrs among African American smokers.
Periodical: Journal of Evaluation and the Health Professionals Index Medicus:
Authors: Allen B, Jr, Cruz TB, Leonard E, Unger JB ART
Yr: 2010 Vol: 33 Nbr: 4 Abs: Pg: 414-436