UCLA

BackgroundAfrican American smokers continue to experience health outcomes linked to inequities within both society and the healthcare system. Although overall smoking rates have declined in the U.S., African American light smokers (AALS), defined as those smoking ≤10 cigarettes per day, remain an understudied subgroup, despite representing nearly half of the 5.2 million African American smokers nationwide. This dissertation examines the behavioral, social and structural factors influencing tobacco use and cessation among AALS, with a focus on the impacts of the California menthol ban and tobacco use patterns. Methods A scoping review (1991-2022) was conducted to assess existing literature on AALS’ smoking behaviors and cessation practices. Informed by these findings, and supported by a pre-doctoral award from the Tobacco-related Disease Research Program, six focus groups (N=24) were conducted with self-identified AALS in Southern California (January-October 2023). Discussions explored participants’ attitudes, experiences and perceptions related to tobacco use and cessation practices within their social and environmental contexts. Narrative data were analyzed using Braun and Clarke’s 6-phase thematic analysis, guided by Grounded Theory Methodology. Results Participants identified key themes influencing their tobacco use and cessation behaviors: (1) Menthol cigarette use, with many AALS maintaining access through illicit markets or in some cases trying alternative products such as flavored hookah and blunts; (2) Barriers to cessation, including structural inequities, social smoking norms, and skepticism toward existing cessation resources; and (3) Divergent reactions to policy, with some participants expressing resentment over feeling targeted by the menthol ban, while others envisioned it as an opportunity to quit, despite their continued use. Despite a high prevalence of quit attempts, sustained cessation remains elusive, often due to the cultural salience of menthol tobacco and limited support tailored to AALS. Conclusions AALS continue to experience disproportionate tobacco-related disparities exacerbated by the intersection of social determinants of health and inequitable access to cessation recourses. The mixed impact of the menthol ban underscores the need for culturally tailored, evidence-based cessation strategies. Future research should prioritize intervention studies that integrate behavioral support, pharmacotherapy efficacy, and policy-driven approaches to advance equity and reduce preventable harm in this high-risk population.