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Mind the Gap: Urban Youth Falling Through the Cracks of Public Health Policy

Dr. Craig Fryer investigates nicotine and marijuana dependence among urban youth of color

Dr. Craig Fryer is a behavioral scientist in the Department of Behavioral and Community Health in the School of Public Health. His current research, a K01 grant funded by the NIH's National Cancer Institute (NCI), is a mixed methods, community-engaged project aimed at understanding the role that smoking plays in the lives of young people in low-income urban neighborhoods. Dr. Fryer is conducting focus groups,  in-depth interviews, and using a comprehensive tobacco use survey with African American youth, 16-24 years of age, in Prince George’s County, Maryland and Washington DC to delineate their experiences with smoking and nicotine dependence.

Over the past decade there has been a decline in cigarette use among youth, but it may be premature to celebrate this trend as a public health victory because sales of little cigars/cigarillos (LCCs) are on the rise. Many tobacco researchers have hypothesized that LCCs, which are not currently regulated by the FDA, may be a substitute for cigarettes among urban youth. Dr. Fryer will explore this hypothesis and the intersection of tobacco and marijuana use in his research. Urban youth have a different experience with tobacco than young people who are in other communities because of a pro-smoking environment where disproportionate advertising, unbridled access to tobacco products, and a lack of resources for cessation shape tobacco use behavior. Health policy frequently fails to address the social determinants of health, which creates a toxic situation for urban youth, whose needs all too often remain invisible. Dr. Fryer hopes that a deeper understanding of the psychosocial and environmental factors that shape the smoking habits among urban youth will provide the scientific justification for the development of more evidenced-based public policy.

Among urban youth, the most popular smoking products are mentholated cigarettes and flavored little cigars and cigarillos. Marijuana users turn little cigars into “blunts” by cutting open the LCC removing the tobacco inside, and rolling marijuana into the empty tobacco leaf shell. Young people will often share a blunt among a group of friends, then smoke cigarettes afterward, thinking that the cigarettes will boost the mood-altering state from the marijuana. Dr. Fryer hopes to deconstruct these practices and develop analytics to monitor how common they are in the MD and the Washington DC area. He will also investigate how ideas about cigarette and marijuana use are socially constructed among youth.

Contrary to popular stereotypes about urban youth, the young people that participate in Dr. Fryer’s research are deeply engaged in helping to understand and solve problems of tobacco use and nicotine dependence among youth. Dr. Fryer says that young people often become very interested in the project because they appreciate being asked what they think about important issues. The idea that their opinions matter is a powerful one. “Young people of color are used to being characterized as part of the problem, and they have a strong desire to be part of the solution,” says Dr. Fryer.

Dr. Fryer hopes that his work will be instrumental in starting to address gaps in health policy that have ignored the needs of urban youth of color and the impact that smoking has on their health. Additionally, the role of the tobacco industry’s targeted marketing in minority communities must be addressed. Dr. Fryer is a Co-Investigator on a R21 grant funded by the FDA/NCI with colleagues at Georgia State University and the University of Hawaii working to develop a measure of risk perception for little cigars/cigarillos. Dr. Fryer says, “If we can better understand how LCCs are used, we can provide the FDA with the science they need to implement comprehensive and responsible regulatory authority over all tobacco products that cause disability and premature death.”

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