Buying and selling "loosies" in Baltimore: the informal exchange of cigarettes in the community context.

Since the release of the first Surgeon General's report, the proportion of adult smokers in the U.S. has been reduced by half (U.S. Department of Health and Human Services, 2004). This success has not, however, been equally felt across all social strata. Recent survey data from Baltimore show considerably elevated smoking rates within urban, African-American communities. Of particular concern was that in some communities, over half of the young adults (18-24 years old) smoke cigarettes. As yet, there has been little focus on understanding or preventing cigarette smoking among young adults, particularly for those seeking entry into the workforce rather than being engaged in higher education. In this paper, we explore community factors contributing to high young adult smoking prevalence. Our analysis is based on data from four focus groups conducted in 2004 as part of a community-based participatory research project with two urban education and job training organizations. The focus group data reflect the experiences and opinions of 28 young adult program participants (23 smokers and 5 nonsmokers). The data highlight a normalized practice of buying and selling single cigarettes ("loosies") within the community, with participants describing buying loose cigarettes as a preferred acquisition practice. We apply theories of informal economy and suggest that this alternative purchasing option may influence the smoking behavior of these young adults. We argue that public health efforts need to more closely consider the impact of community structures on program implementation. Overlooking key community characteristics such as the availability of single cigarettes may serve to intensify health disparities.