Beginning in the mid-1970s in the United States, the cigarette smoking prevalence for both AA and white high school seniors was similar at approximately 40%.¹⁰ This trend began to change during the late 1970s to early 1980s, when cigarette smoking prevalence among both groups started to decline; however, this decline occurred much faster among AA students.^3,4 While the decline that occurred among white youth stabilized in the early 1980s, the decline among AA youth continued until the early 1990s^3,10; this decline was even more striking among AA female youth.¹⁰

However, in the early 1990s, the decline in cigarette smoking among both AA and white youth started to reverse. From 1991 to 1997, current cigarette smoking increased among both AA and white youth.^4,11–13 While the cigarette smoking prevalence among AA youth remained lower than whites, the magnitude of the increase was much greater among AA youth (particularly males) during this time period,¹³ with research showing the prevalence of cigarette smoking among AA youth almost doubling from 12.6% in 1991 to 22.7% in 1997.^13,14 Cigarette smoking prevalence started to decline again in the late 1990s, but the rate of decline began to slow down in 2003 for both AA and white youth. Since 2003, the rate of decline in current cigarette smoking slowed or leveled off for both AA and white youth.^3,13

Multiple protective factors appear to be responsible for the sharper decline in cigarette smoking prevalence that occurred in the late 1970s and continued until the early 1990s among AA youth.^3,4,15 One important factor that has been identified as being especially impactful on AA youth smoking behavior is cigarette price increases.^10,16 Cigarette prices have risen dramatically over the years since the late 1970s.^4,17 Younger AA smokers are more responsive to price increases and are more likely than white smokers to reduce or quit smoking in response to a price increase.¹⁶

Another factor that could have contributed to lower cigarette smoking prevalence among AA youth during this time period is religiosity. The Black church historically has played an important role in the health of AAs.¹⁵ Religion has been found to be a stronger protective factor against smoking among AA youth compared with whites.^4,15 AA youth attribute more importance to religion in their lives, and have a higher frequency of church attendance and involvement in religious activities than white youth.⁴ Increased religiosity among AA youth is probably largely due to parental influence.⁴ Parental opposition to cigarette smoking in AA households may have also played a role in curtailing the uptake of cigarette smoking among AA youth.¹⁸ Moreover, negative attitudes toward cigarette smoking have been generally held by AA youth, their peers, and the community as a whole.⁴

Often overlooked in assessing the protective factors against cigarette smoking among AA youth is the role of high school sports. Davis and colleagues found that AA male high school athletes were less likely to use tobacco compared to white male high school athletes.¹⁹ In addition, they found that AAs involved in high-intensity sports were less likely to be heavy smokers than those participating in low intensity sports.¹⁹ This is consistent with what Gardiner observed in his review of AA teen smoking; that is, many young AA males see participation in football, basketball, and track and field (high-intensity sports) as a means toward future employment and avenues for escaping depressed inner cities.¹⁵

Because tobacco industry marketing has been pervasive in AA communities for several decades, tobacco industry marketing may have played a major role in the larger increase in cigarette smoking prevalence that occurred among AA youth in the 1990s. For example, from 1992 to 1998, there was a 31% increase in cigarette smoking prevalence among white high school seniors compared to a 71% increase among AA high school seniors (Figure 1). This more marked increase in the prevalence of cigarette smoking among AA youth may reflect the increased targeted marketing to this population by the tobacco industry to establish the AA youth market during the “menthol wars” of the 1980s.²⁰ The “menthol wars” were waged in inner city communities where the major tobacco companies (ie, Lorillard, Brown and Williamson, Philip Morris and RJ Reynolds) dispatched company vans to give away free cigarettes in high traffic areas including community parks and street corners.²⁰ By the 1990s, the tobacco industry launched additional campaigns specifically targeted to AA youth. For example, the Marlboro Menthol Inner City Black Bar Program, developed in the late 1980s, expanded in the 1990s and included games, giveaways, and amateur Marlboro Music talent contests.²¹ In 1990, RJ Reynolds test-marketed Uptown menthol cigarettes in Philadelphia with the slogan “the uptown flavor with the downtown price” and sponsored several cultural and inner-city nightclub events with free pack giveaways. The Uptown theme focused on style, music, nightlife, and entertainment and was specifically targeted to the AA community.^22,23 Community anti-tobacco advocates formed a coalition to block the marketing of Uptown cigarettes. As a result of this public pressure, RJ Reynolds withdrew this product from the market.^24,25

The Fat Boys campaign, a Black inner city targeted brand, was launched by RJ Reynolds in the early 1990s.²⁶ The Fat Boys campaign focused on the “environment and interests of inner-city Blacks” as well as rap music. The product packaging had a brick wall and graffiti design. Advertising for the product featured young AA males that strongly resembled leading characters of the Fresh Prince of Bel-Air—a popular 1990s sitcom that appealed to many urban youth.²⁶ Like Uptown, Fat Boys were mentholated and available in packages of 10 to address price sensitivity for AA smokers.²⁶

During Black History Month in 1995, Menthol X cigarettes were launched by Stowebridge Brook Distributors in stores around Massachusetts.²⁷ This “new Black brand” featured red, black, and green colors, representing the Black liberation colors and displayed a large “X” on the front of the pack, a symbol that gained popularity after the 1992 movie Malcolm X debuted. During the late 1990s, Brown and Williamson’s B KOOL campaign featured “House of Menthol” promotions including playing cards featuring young, hip AAs, and concerts and music events at AA bars and nightclubs.²⁸ Even though tobacco control advocacy efforts in the AA community were successful in curtailing or stopping some of the tobacco industry activities (eg, Uptown and Menthol X), AA youth cigarette smoking rates still rose starkly in the 1990s.

The steeper decline in the prevalence of cigarette smoking observed among white youth during the late 1990s may have been the result of the enactment of the 1998 Master Settlement Agreement. As part of the Master Settlement Agreement between the state Attorneys General of 46 states, five US territories, the District of Columbia and the major US cigarette companies, both indirect and direct tobacco advertising targeting youth were prohibited. The types of targeted advertising that were restricted included advertising on billboards as well as advertising on or around public transit, stadiums, arenas, shopping malls, and video arcades.²⁹

While the Master Settlement Agreement banned tobacco advertising in certain media outlets and venues that are highly noticeable by youth, it did not restrict outdoor or indoor advertising at the point-of-sale (POS) on retailer property.²⁹ An overwhelming body of evidence has shown that tobacco advertising influences youth to initiate cigarette smoking as well as to continue its use, and that there is a positive association between exposure to POS tobacco promotion and increased smoking.^10,30–33 Exterior signage and interior POS advertising for tobacco products are especially pervasive in AA neighborhoods, particularly advertisements for mentholated cigarette brands. For example, several reports have documented how the tobacco industry has aggressively targeted the marketing of menthol cigarettes to AAs through placement of large numbers of interior and exterior signs in low income, AA communities.^34–37

Tobacco retail advertising at the POS encourages youth to smoke,^30–33 and there is more POS advertising in predominately AA communities.^32,36–38 Therefore, differential exposure to in-store marketing might have contributed to the different trends in cigarette smoking prevalence observed among white and AA youth. The protective factors that may have contributed to the larger decline in smoking among AA youth in the late 1970s and early 1980s might have lost some of their impact due in large part to more aggressive and effective tobacco industry marketing practices targeted toward this population.