A Longitudinal Study of Perceptions of the Massachusetts Menthol Ban and Its Impact on Smoking Behaviors among Marginalized Individuals
Abstract
:1. Introduction
2. Materials and Methods
2.1. Recruitment and Enrollment
2.2. Study Design and Data Collection
Surveys and Qualitative Interviews
2.3. Data Analyses
3. Results
3.1. Pre-Ban Opinions on Why the Ban Was Enacted
- (1)
- General interest in promoting health: “It might be because they don’t want the people in Massachusetts to be smoking like they do” (P25);
- (2)
- Financial motivation: “I don’t really think it’s to save people. It’s probably about money. …Maybe there’s somebody who’s got their money in the non-menthol cigarettes, and they want all the game on non-menthol cigarettes” (P23)
- (3)
- Intent to reduce the youth smoking epidemic: “Mostly, I think, it’s for the younger people” (P15).
3.2. Quantitative and Qualitative Perceptions of the Menthol Ban over Time
3.2.1. Pre-Ban Perceptions
- (1)
- Ban would help individuals to stop smoking: “I will not be smoking them because I only smoke menthol. …Soon as June 1st come, I’m done. I’m not spending my money on something I don’t like” (P15)
- (2)
- Ban would benefit the community: “The young people smoke Newports. …[post-ban] they won’t be able to get ’em. I think that will help not only the young people, but the seniors as well as the middle age” (P25)
- (3)
- Ban would undo an injustice to the Black community: “It irritates me that I can’t buy a pack [of menthol cigarettes], but I know that they’ve been marketed, unfortunately, for people of color, so it’s possible that injustice will no longer be happening. It’s a good thing” (P26).
- (1)
- Some believed the ban to be an overreach of government policy: “I think they should leave the menthol cigarettes alone… They’re trying to delegitimize cigarettes in all. I don’t agree with it. I think it’s an overreach of government” (P24).
- (2)
- Others thought the ban unfairly targeted Black communities by limiting choices for products they enjoy: “There’s certain type of alcohols that African Americans drink that are being taken off the shelf also. The African Americans smoke menthols more than anyone else. …That’s where I see discrimination” (P6).
- (1)
- Unsanctioned re-selling of menthol cigarettes: “It’s not gonna stop people having [menthol] cigarettes. They’re gonna just go to New Hampshire, get [menthol] cigarettes and sell ‘em by the pack, by the carton” (P4)
- (2)
- Switching from menthol to non-menthol cigarettes: “If you go to the store, and they don’t got your brand, you go buy what they got on the shelf—cause most people who are addicted, they gonna smoke” (P22)
- (3)
- Traveling out of state to purchase menthol cigarettes: “I would drive and get me a couple of cartons then come home…I would take a ride if I wanted the cigarettes” (P8)
- (4)
- Manipulating substances to make a menthol cigarette: “people [will] figure out some way [of] smoking their menthol cigarettes. They buy some menthol products and put ’em on some non-menthol cigarettes and turn them into menthol cigarettes. Everybody come up with something” (P19).
3.2.2. Post-Ban Perceptions
3.3. Quantitative Comparisons of Smoking Behaviors and Purchase and Use of Tobacco Products Pre- vs. Post-Ban
3.4. Narratives of the Impact of the Menthol Ban: Anticipated Impact and Attitudes Pre-Ban Versus Actual Behaviors and Attitudes 6 Months Post-Ban
3.5. Participant Suggestions
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Baseline Assessments (n = 27) |
---|---|
Mean Age (SD) | 52 (12.4) |
Female | 10 (37%) |
Race | |
Black | 15 (55%) |
White | 8 (30%) |
Other | 3 (11%) |
Mixed race (2 or more races) | 1 (4%) |
Hispanic Ethnicity | 5 (19%) |
Medicaid Insurance | 26 (96%) |
Education | |
Less than high school | 11 (41%) |
High school/GED | 7 (26%) |
More than high school | 8 (30%) |
Experiencing homelessness | 9 (33%) |
Unmarried * | 24 (89%) |
Unemployed | 26 (96%) |
Yearly household income before taxes | |
USD 0–34,999 | 25 (92%) |
>USD 35,000 | 1 (4%) |
Prefer not to answer/Don’t know | 1 (4%) |
Depression and/or anxiety | 17 (63%) |
Current use of substances | |
Alcohol (5+ men, 4+ women in 1 day) | 9 (33%) |
Cocaine | 7 (26%) |
Opioids | 4 (15%) |
Marijuana | 5 (19%) |
Cigarette smoking characteristics | |
Years smoked (SD) | 33 (14.5) |
Smokes daily | 19 (70%) |
Smokes 10 or more cigarettes a day | 15 (55%) |
Mean Fagerstrom score (SD) ** | 4.4 (2.5) |
Menthol use exclusively | 20 (74%) |
Current use of other tobacco products | |
Electronic cigarettes | 1 (4%) |
Cigars | 1 (4%) |
No other tobacco product use | 25 (92.5%) |
Perceptions of Ban | Pre-Ban Perceptions (n = 14) | 6 m Post-Ban Perceptions (n = 14) |
---|---|---|
In Favor of the Ban on Menthol Cigarette Sales in Massachusetts | ||
Strongly agree | 1 (7%) | 5 (36%) |
Agree | 3 (21%) | 0 (0%) |
Neither agree nor disagree | 3 (21%) | 1 (7%) |
Disagree | 3 (21%) | 6 (43%) |
Strongly disagree | 4 (29%) | 2 (14%) |
In Favor of a Ban on Menthol Cigarette Sales Nationwide | ||
Strongly agree | 1 (7%) | 5 (36%) |
Agree | 3 (21%) | 1 (7%) |
Neither agree nor disagree | 3 (21%) | 0 (0%) |
Disagree | 3 (21%) | 6 (43%) |
Strongly disagree | 4 (29%) | 2 (14%) |
Anticipated/Perceived Impact of the Menthol Ban on Participant | ||
Negatively impact me | 1 (7%) | 2 (14%) |
Not impact me at all | 8 (57%) | 6 (43%) |
Positively impact me | 3 (21%) | 6 (43%) |
Did not answer/not sure | 2 (14%) | - |
Perceived Influence | 6 m Post-Ban Behavior (n = 14) |
---|---|
The ban encouraged me to stop using all tobacco products | |
Strongly agree/agree | 8 (57%) |
Neither agree nor disagree | 1 (7%) |
Strongly disagree/disagree | 5 (34%) |
The ban made me want to stop using all cigarettes | |
Strongly agree/agree | 5 (34%) |
Neither agree nor disagree | 2 (14%) |
Strongly disagree/disagree | 7 (50%) |
The menthol ban has led me to make a quit attempt | |
Yes | 7 (50%) |
No | 7 (50%) |
The menthol ban has led me to stop smoking | |
Yes | 2 (14%) |
No | 12 (86%) |
Impact of Ban on Purchase and Use of Menthol Cigarettes, Non-Menthol Cigarettes and Other Tobacco Products | ||
---|---|---|
Anticipated Behavior Pre-Ban (n = 14) | Actual Behavior 6 m Post-Ban (n = 14) | |
Purchase of non-menthol cigarettes | ||
Participants who purchase non-menthol and menthol | ||
Stop buying non-menthol cigarettes | 0 (0%) | 0 (0%) |
Buy fewer non-menthol cigarettes | 0 (0%) | 1 (7%) |
No change in how many non-menthol cigarettes I buy | 2 (14%) | 3 (21%) |
Buy more non-menthol cigarettes | 2 (14%) | 0 (0%) |
Participants who purchase exclusively menthol cigarettes | ||
Start buying non-menthol cigarettes | 1 (7%) | 3 (21%) |
Did not buy before and will not buy after | 7 (50%) | 7 (50%) |
Did not answer/not sure | 2 (14%) | 0 (0%) |
Non-menthol cigarette use | ||
Participants who smoke both non-menthol and menthol | ||
Stop smoking non-menthol cigarettes | 0 (0%) | 0 (0%) |
Smoke non-menthol cigarettes less | 0 (0%) | 2 (14%) |
No effect on how much I smoke non-menthol cigarettes | 3 (21%) | 1 (7%) |
Smoke non-menthol cigarettes more | 1 (7%) | 1(7%) |
Participants who smoke exclusively menthol cigarettes | ||
Start smoking non-menthol cigarettes | 1 (7%) | 2 (14%) |
Continue to refrain from non-menthol cigarettes | 7 (50%) | 8 (57%) |
Did not answer/not sure | 2 (14%) | 0 (0%) |
Purchase of menthol cigarettes | ||
Stop buying menthol cigarettes | 5 (36%) | 4 (29%) |
Buy fewer menthol cigarettes | 2 (14%) | 6 (43%) |
No change in how many menthol cigarettes I buy | 4 (29%) | 3 (21%) |
Buy more menthol cigarettes | 0 (0%) | 1 (7%) |
Did not answer/not sure | 3 (21%) | 0 (0%) |
Menthol cigarette use | ||
Stop smoking menthol cigarettes | 5 (36%) | 4 (29%) |
Smoke menthol cigarettes less | 2 (14%) | 6 (43%) |
No effect on how much I smoke menthol cigarettes | 4 (29%) | 3 (21%) |
Smoke menthol cigarettes more | 0 (0%) | 1 (7%) |
Did not answer/not sure | 3 (21%) | 0 (0%) |
Purchase of other tobacco products | ||
Buy more other tobacco products | 2 (14%) | 0 (0%) |
Start buying other tobacco products | 0 (0%) | 1 (7%) |
Continue to refrain from other tobacco products | 12 (85.7%) | 13 (93%) |
Tobacco product use | ||
Smoke other tobacco products more | 1 (7%) | 0 (0%) |
Start using other tobacco products | 1 (7%) | 1 (7%) |
Continue to refrain from other tobacco products | 12 (85.7%) | 13 (93%) |
Impact of ban on purchasing behaviors of menthol cigarettes | ||
Pre-ban behavior | 6 m post-ban behavior | |
State where menthol cigarettes are bought | ||
Massachusetts | 11 (79%) | 3 (21%) |
Other State | 2 (14%) | 11 (79%) |
Missing data | 1 (7%) | - |
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Booras, A.; Wiener, R.S.; Maccarone, J.; Stokes, A.C.; Fetterman, J.L.; Hamburg, N.M.; Singh, J.; Bulekova, K.; Kathuria, H. A Longitudinal Study of Perceptions of the Massachusetts Menthol Ban and Its Impact on Smoking Behaviors among Marginalized Individuals. Int. J. Environ. Res. Public Health 2023, 20, 5790. https://doi.org/10.3390/ijerph20105790
Booras A, Wiener RS, Maccarone J, Stokes AC, Fetterman JL, Hamburg NM, Singh J, Bulekova K, Kathuria H. A Longitudinal Study of Perceptions of the Massachusetts Menthol Ban and Its Impact on Smoking Behaviors among Marginalized Individuals. International Journal of Environmental Research and Public Health. 2023; 20(10):5790. https://doi.org/10.3390/ijerph20105790
Chicago/Turabian StyleBooras, Anna, Renda Soylemez Wiener, Jennifer Maccarone, Andrew C. Stokes, Jessica L. Fetterman, Naomi M. Hamburg, Johar Singh, Katia Bulekova, and Hasmeena Kathuria. 2023. "A Longitudinal Study of Perceptions of the Massachusetts Menthol Ban and Its Impact on Smoking Behaviors among Marginalized Individuals" International Journal of Environmental Research and Public Health 20, no. 10: 5790. https://doi.org/10.3390/ijerph20105790