Youth access to tobacco: the effects of age, gender, vending machine locks, and "it's the law" programs.

OBJECTIVES. This study evaluated the influence of age, gender, vending machine lockout devices, and tobacco industry-sponsored voluntary compliance programs ("It's the Law" programs) on underage youths' ability to purchase tobacco. METHODS. Twelve youths made 480 attempts to purchase tobacco in Massachusetts from over-the-counter retailers and vending machines with and without remote control lockout devices. Half the vendors were participating in It's the Law programs. RESULTS. In communities with no requirements for lockout devices, illegal sales were far more likely from vending machines than from over-the-counter sources (odds ratio [OR] = 5.9, 95% confidence interval [CI] = 3.3, 10.3). Locks on vending machines made them equivalent to over-the-counter sources in terms of illegal sales to youths. Vendors participating in It's the Law programs were as likely to make illegal sales as nonparticipants (OR = 0.87, 95% CI = 0.57, 1.35). Girls and youths 16 years of age and older were more successful at purchasing tobacco. CONCLUSIONS. The It's the Law programs are ineffective in preventing illegal sales. While locks made vending machines equivalent to over-the-counter sources in their compliance with the law, they are not a substitute for law enforcement.     

Validity of assessments of youth access to tobacco: the familiarity effect

OBJECTIVES: We examined the standard compliance protocol and its validity as a measure of youth access to tobacco. METHODS: In Study 1, youth smokers reported buying cigarettes in stores where they are regular customers. In Study 2, youths attempted to purchase cigarettes by using the Standard Protocol, in which they appeared at stores once for cigarettes, and by using the Familiarity Protocol, in which they were rendered regular customers by purchasing nontobacco items 4 times and then requested cigarettes during their fifth visit. RESULTS: Sales to youths aged 17 years in the Familiarity Protocol were significantly higher than sales to the same age group in the Standard Protocols (62.5% vs. 6%, respectively). CONCLUSIONS: The Standard Protocol does not match how youths obtain cigarettes. Access is low for stranger youths within compliance studies, but access is high for familiar youths outside of compliance studies.     

Enhanced enforcement of laws to prevent alcohol sales to underage persons--New Hampshire, 1999-2004

In 1984, the National Minimum Drinking Age Act (Public Law 98-363) was passed, requiring states to raise to 21 years the minimum age to purchase and publicly possess alcohol. Although the law has contributed to substantial reductions in underage drinking and alcohol-related motor-vehicle crashes, alcohol use and binge drinking rates among youths remain high in the United States, and efforts by youths to purchase alcohol from licensed establishments frequently are successful. To reduce alcohol sales to persons aged <21 years in Concord (2000 population: 40,687), New Hampshire, the Concord Police Department (CPD) and New Hampshire Liquor Commission (NHLC) conducted a pilot program of enhanced law enforcement with quarterly compliance checks of alcohol licenses during March 2002-February 2004. This report summarizes the results of that program, which indicated that enhanced enforcement 1) resulted in a 64% reduction in retail alcohol sales to underage youths and 2) was temporally associated with declines in alcohol use and binge drinking among Concord high school students. These findings emphasize the potential effectiveness of enhanced enforcement of minimum drinking age laws to reduce consumption of alcohol by underage youths.     

The relationship of point-of-sale tobacco advertising and neighborhood characteristics to underage sales of tobacco

Our objective was to determine how point-of-sale tobacco marketing may relate to sales to minors. The authors used data from a 2007 cross-sectional study of the retail tobacco marketing environments in the St. Paul, MN metropolitan area matched with a database of age-of-sale compliance checks (random, covert test purchases by a minor, coordinated by law enforcement) of tobacco retailers and U.S. Census data to test whether certain characteristics of advertising or neighborhoods were associated with compliance check failure. The authors found that tobacco stores were the most likely type of store to fail compliance checks (44% failure), supermarkets were least likely (3%). Aside from a marginally significant association with Hispanic population proportion, there was no other association between either store advertising characteristics or neighborhood demographics and stores' compliance check failure. Though our findings were null, the relationship between advertising and real youth sales may be more nuanced as compliance checks do not perfectly simulate the way youth attempt to purchase cigarettes.     

The relationship between tobacco access and use among adolescents: a four community study

The objective of this study was to examine the effectiveness of a longitudinal community intervention on the reduction of tobacco sales to minors and subsequent effects on tobacco consumption by youths. The study was conducted in Monterey County, CA. Four rural communities were randomized into treatment and comparison arms of the study and middle and high school students in each of these communities completed surveys assessing knowledge, attitude, and behavior. The main outcome measures were retail tobacco sales to minors as measured through store visits (tobacco purchase surveys) and self-reported consumption of tobacco. Over a three-year period, a diverse array of community interventions were implemented in the intervention communities. These included community education, merchant education, and voluntary policy change. In the treatment communities, the proportion of stores selling tobacco to minors dropped from 75% at baseline to 0% at the final post-test. In the comparison communities, the proportions were 64% and 39%, respectively. Although the availability of tobacco through commercial outlets was reduced substantially in intervention communities, youths reported still being able to obtain tobacco from other sources. Predicted treatment effects on reported use of tobacco among youths were observed cross-sectionally and longitudinally for younger students (7th graders). The intervention did not impact tobacco use among older students (9th and 11th graders) although the trends were in the predicted direction for 9th graders. A significant intervention effect was found for sex--females in the intervention communities were less likely to use tobacco post-intervention than females in the comparison communities. Tobacco sales to minors can be reduced through a broad-based intervention. To prevent or reduce tobacco use by youths, however, multiple supply-and demand-focused strategies are needed.     

Reducing minors' access to tobacco: eight years' experience in Hawaii

OBJECTIVE: This paper reports the findings of annual Synar inspections to assess compliance with federal and state legislation to limit minors' access to tobacco products in Hawaii. We also report on factors associated with selling tobacco to minors for the most recent year of inspections (2003). METHODS: Annual, random, unannounced inspections were conducted by minors (ages 14-17 years) over an 8-year period (1996-2003). Stores were randomly selected from a list of stores that sell tobacco products in Hawaii. RESULTS: There was a significant decrease in the percent of successful purchases made over the period from 1996 (44.5%) to 2003 (6.2%). Based on multivariate analyses, only two variables were associated with whether a successful purchase was made in 2003: whether the minor's identification or age was requested. CONCLUSION: Findings suggest that surveillance, education, and enforcement efforts in Hawaii have been successful at making substantial reductions in noncompliance rates. Even with the current low rate of sales to minors, failing to request the minor's identification or age was associated with making a successful purchase, while characteristics of the minor and retail environment were not.     

Impact of a local ordinance banning tobacco sales to minors.

Most addictions to tobacco begin when a person is younger than age 18. Although the sale of tobacco to minors is illegal in most jurisdictions, there is often little enforcement of these laws, and minors can usually purchase tobacco easily. The impact of a local ordinance designed to prevent tobacco sales to minors was assessed by surveys of 10th grade students before and after the implementation of the ordinance. Tobacco use declined from 25.3 percent to 19.7 percent overall, with a significant (P = 0.004) decline from 26.4 percent to 11.5 percent among girls. There was also a significant (P = 0.008) increase from 29.3 percent to 61.5 percent in the proportion of students reporting they were asked for proof of age when they attempted to purchase tobacco. Local ordinances may be an effective tool for reducing tobacco use by adolescents.     

Cigarette sales to African-American and white minors in low-income areas of Baltimore.

OBJECTIVES: This study documented illegal sales of cigarettes to minors in low-income African-American and White urban areas in East Baltimore. METHODS: Six youths, aged 14 through 16 years, were sent to a random sample of 83 corner stores to attempt to purchase cigarettes. The youths provided the investigators with data on merchant, store, and purchase characteristics. RESULTS: The youths successfully purchased cigarettes in 85.5% of the stores; 58% of the stores displayed five or more cigarette advertisements outside their premises. CONCLUSIONS: Cigarette sales to minors and associated advertising remain prevalent in this urban community.     

Fiscal revenues derived from tobacco sales to young people in France

This article examines the public revenues for France from tobacco sales to youths in 1997. The result is compared to the means of prevention the same year. Public revenues are estimated from: the number of adolescents divided into age groups (range: 12 to 19), the smoking rates by age group, the number of cigarettes smoked daily in each age group, the price of a cigarettes pack and the percentage of taxes. In 1997, almost 1.7 million youths were smokers and they smoked 240 million of cigarette boxes annually. This sale represented 4.7 billion of French Francs (FF): 3.615 billion of taxes, 380 million for tobacconists' and 762 million for the tobacco industry. The same year prevention represented less than FF 0.5 per year and inhabitant, one of the lowest ratios in developed countries.     

广州市201名小学生尝试买烟成功率及其影响因素

目的了解广州地区未成年人的烟草可及性以及影响因素。方法组织201名六年级小学生参加尝试买烟模拟试验,以是否买烟成功为因变量,商店、销售商和学生的特征为自变量进行因素分析。结果共有165名学生成功买到香烟,买烟失败36人,成功率为82.1%。学生年龄、学生身高、商店类型、售烟者的性别、售烟者的年龄、是否张贴有烟草广告、是否放置"禁止向未成年人售烟"警示牌、售烟者有无询问学生具体年龄、售烟者有无询问学生买烟给谁吸等9个变量与尝试买烟成功有统计学意义的关联。多因素分析筛选3个有意义的变量:学生年龄、商店类型和放置"禁止向未成年人售烟"警示牌。结论未成年人很容易通过自己购买而获得香烟,杂货店和小超市是重点,应加强对烟草零售商向未成年人售烟的监督和管制工作。     

Youth tobacco sales in a metropolitan county: factors associated with compliance

OBJECTIVE: To describe and identify factors associated with tobacco sales in a metropolitan county. SETTING: King County, Washington is the largest county in Washington State with an estimated population of 1.8 million or about 30% of the state's population. DATA SOURCE: The data analysis is based on compliance checks in King County between January 2001 and March 2005. The 8879 checks were conducted by 91 youth operatives aged 14-17. Analysis of data was completed in 2006. STATISTICAL ANALYSIS: The outcome variable for this analysis was whether "a sale was made" to a youth operative during a compliance check. Associations between independent variables and the outcome variable were examined using 2 x 2 tables, univariate (unadjusted) logistic regression, and multivariate (adjusted) logistic regression analysis. RESULTS: Overall tobacco sales during the 4-year and 3-month period was 7.7%. Convenience stores selling gas were significantly more likely to sell tobacco products to minors, whereas restaurants, bars, and tobacco discount stores were less likely to sell to minors. Other factors that were significantly associated with sales are described. CONCLUSIONS: In a county that has adopted many of the required youth access laws, opportunities still exist to reduce sales of tobacco products to minors. Asking for age and photo identification still appears to be an effective strategy in reducing sales of tobacco products to minors.     

Evaluation of an enforcement program to reduce tobacco sales to minors.

OBJECTIVES: This study evaluated an active enforcement program to increase retailers' compliance with the law prohibiting tobacco sales to minors. METHODS: Tobacco sales to minors were monitored in 319 outlets in 6 pairs of communities in Erie County, New York. One community in each pair was randomly assigned to an enforcement intervention. RESULTS: Retailers' compliance with the law increased from 35% in 1994 to 73% in 1995. However, the change in compliance rates was roughly the same for stores in the enforcement and nonenforcement communities. CONCLUSIONS: Active compliance checking of retail outlets as a strategy to reduce illegal tobacco sales to minors may only be necessary insofar as it contributes to an increase in retailers' perception that the threat of enforcement is real.     

Trends in Underage Tobacco Sales: An Update on the Past Decade of Compliance Checks in Hawai‘i

Tobacco use remains the leading cause of preventable death in the United States and is a major concern in the adolescent population. Preventing youth from starting to smoke is a key public health priority, as a majority of adult smokers started smoking by age 18. Controlling access to tobacco in retail outlets has been shown to be an effective measure for reducing the use of tobacco among minors. In order to control the sales of tobacco to minors in the retail environment, the Synar Amendment requires states to conduct annual, random, and unannounced tobacco sales compliance inspections. Synar compliance inspections started in Hawai‘i in 1996, reducing the sales of tobacco to minors almost 40.0% by 2003. The current paper aims to expand on past surveillance findings to examine the Synar compliance inspection results in Hawai‘i from 2004 to 2013 and to identify factors associated with minors'' successfully purchasing tobacco. Surveillance of the past ten years showed that noncompliance rates remained low, ranging from a high of 11.2% in 2008 to a low of 4.3% in 2012; this number was 7.5% in 2013. Three factors were significantly associated with successful tobacco purchases by a minor in 2013: whether a clerk requested a minor''s identification, the gender of the minor, and whether self-service of tobacco products was available. Other significant factors varied by year. Findings from this study are needed for continued surveillance, to implement effective anti-tobacco policies, and to develop policies aimed at emerging tobacco products, such as electronic cigarettes.     

Ethnic disparities in youth access to tobacco: California statewide results, 1999-2003

The authors examined the role of youth ethnicity in youth access to tobacco with large, random samples of stores and large samples of ethnically diverse youths for the first time. From 1999 through 2003, White, Black, Latino, and Asian youths made 3,361 cigarette purchase attempts (approximately 700 per year) statewide. Analyses revealed that Black youths had significantly higher access than other youths and that access rates for Black and Asian (but not Latino or White) youths exceeded the Synar-mandated < or = 20%. Clerks who failed to demand youth proof of age identification (ID) sold 95% of the tobacco that youths received and sold significantly more often to minorities and to girls, whereas clerks who demanded youth ID sold equally infrequently to all youths. These findings highlight significant ethnic disparities in youth access to tobacco and imply that those might be eliminated by policies and interventions that increase clerk demands for youth ID.     

The effect of local tobacco sales laws on adolescent smoking initiation

BACKGROUND: More than 700 communities have en acted laws prohibiting the sale of tobacco to minors, but little is known about the impact of such laws on youth smoking behavior. The objective of this study was to determine whether local tobacco sales laws de crease the rate of progression to established smoking among adolescents. METHODS: We conducted a prospective cohort study of 592 Massachusetts youths who did not smoke and were ages 12-15 years at the time of a baseline, random-digit-dial, telephone survey in 1993 and who were reinterviewed in 1997. RESULTS: Youths living in towns with a local tobacco sales ordinance at baseline were significantly less likely to progress to established smoking (defined as having smoked at least 100 cigarettes in one's life) than youths living in a town without an ordinance (odds ratio = 0.60; 95% confidence interval 0. 37, 0.97). The magnitude of this effect was unchanged after control ling for potential confounding variables. However, there was no relationship between living in a town with an ordinance and youths' perceived access to tobacco. CONCLUSIONS: Local tobacco sales laws are associated with reduced rates of adolescent smoking initiation, but in this setting, this effect did not appear to be mediated through reduced access to cigarettes.     

Evaluating the effects of enforcements and fines on youth smoking

Restricting access to retail sources of tobacco and fining minors for possession of tobacco products were evaluated as possible strategies to reduce the rising rates of teenage smoking. Four towns were assigned to enforce both tobacco minimum-age-of sales laws and tobacco possession laws (P). The remaining four towns were assigned to enforce only tobacco minimum-age-of sales laws (NP). Tobacco use among sixth-, seventh- and eighth-grade students was assessed. White youth who lived in communities with strict enforcement of tobacco sales and possession laws had significantly fewer increases in tobacco use than those living in communities with only moderate enforcement of tobacco sales laws. Public health interventions that involve police fining minors along with very high merchant compliance rates might decrease rates of tobacco use of white youth during a developmental time when they are susceptible to experimentation and use of tobacco products.     

Enforcement of regional bans on tobacco sales to minors in Switzerland--example of missed opportunity?

Tobacco control policies, aiming at reducing youth's access to tobacco, revealed positive outcomes and were implemented in most of the European countries. A naturalistic field study was conducted to assess retailer compliance with a regional ban forbidding selling tobacco products to youths under the age of 18 in a Swiss canton. Results revealed that, 20 months after implementation, the ban was respected by about one out of seven retailers and compliance did not improve significantly over the following 24-month period. Potentials for concrete improvements were observed and a call for stronger implementation at the regional and local levels was made.     

Propensity for Illegal Alcohol Sales to Underage Youth in Chicago

To assess youth’s ability to purchase alcohol in a city previously not assessed—Chicago, Illinois—we hired individuals aged 21 and older who appeared to be aged 18–20 (i.e., pseudo-underage buyers) to make alcohol purchase attempts without age identification in off-premise licensed alcohol establishments. We conducted two purchase attempts at each establishment across 44 community areas, resulting in a total of 652 purchase attempts. Our dependent variable was purchase attempt outcome (purchase, no purchase) and we used four categories of independent variables: characteristics of sellers, establishments, purchase attempts, and community areas. We analyzed our data using a logistic regression model, with purchase attempt outcome regressed on the independent variables. The overall purchase rate was 35.1%, ranging from 0% to 72% across community areas. Buyers were less likely to purchase alcohol in community areas that had populations with higher percentages of Hispanics (OR = 0.99; CI = 0.98, 1.0), and more likely to purchase alcohol in establishments that had more expensive beer (OR = 2.0; CI = 1.50, 2.67) and in areas with higher percentages of unemployed individuals (OR = 1.1; CI = 1.07, 1.14). Although progress has been made since the early 1990s in reducing sales to underage youth, youth still have relatively easy access to alcohol from licensed establishments. We recommend increased use of compliance checks—underage youth attempt to purchase alcohol under the supervision of enforcement agents; if alcohol is sold, the server/seller and/or license holder are penalized—which scientific studies have shown to be the most effective strategy in reducing sales to minors.