Availability of cigarettes to underage youth in three communities.

BACKGROUND. Underage youth report that they primarily obtain cigarettes from commercial sources. Thus policies that effectively prevent purchase by minors could have an effect on the prevalence of young people's cigarette use. METHODS. In this study, 12- to 15-year-old male and female confederates attempted to purchase cigarettes from all cigarette outlets in three communities. RESULTS. A success rate of 53% over the counter and 79% from vending machines was achieved. These results show that minors can purchase cigarettes in all types of businesses, even those characterized as "adult" locations. Boys in this study had more difficulty than girls in purchasing cigarettes over the counter, and younger individuals had more difficulty than 15-year-olds. However, these differences were not found in vending machine sales. Similarly, over-the-counter sales of cigarettes were significantly reduced following a state-wide increase in the penalty for tobacco sales to minors, but vending machine sales were not affected. CONCLUSIONS. These results support stringent and universal controls over the sale of cigarettes as an essential part of any tobacco use prevention strategy.     

Methods, locations, and ease of cigarette access for American youth, 1997-2002

BACKGROUND: The purpose of this paper is to examine trends in middle and high school students' perceived ease, methods, and locations of access to cigarettes, and to assess differences related to their sociodemographic characteristics and smoking status. METHODS: Annual data from nationally representative samples of 8th-, 10th-, and 12th-grade students were analyzed for the 1997-2002 period. Analyses were conducted in 2003. RESULTS: Perceived ease of access decreased significantly among never and past smokers. Decreased individual purchasing in retail outlets, as well as decreased purchasing from vending machines, were reported by 8th- and 10th-grade students. All grades reported decreased purchasing from self-service placements of cigarettes. Decreases in access were not reported across all retailer types, and no significant increases were seen in the percent of underage purchasers who reported being asked to show identification. Both gender and ethnicity were significantly related to where and how underage youth reported obtaining cigarettes. CONCLUSIONS: Cigarette access for minors has been declining, but remains high. Findings show that (1) perceived access to cigarettes clearly increases with level of smoking, and (2) policies to reduce such access may be having an impact as evidenced by decreased retail and vending machine purchases and self-service purchases. However, states should continue to strengthen efforts to reduce youth cigarette access, especially in the areas of confirming buyer age via identification checks, and should make efforts to decrease access across all retailer types. Federal regulations like those previously implemented by the Food and Drug Administration might strongly assist in reducing youth access to cigarettes.     

State but not District Nutrition Policies Are Associated with Less Junk Food in Vending Machines and School Stores in US Public Schools

Background

Policy that targets the school food environment has been advanced as one way to increase the availability of healthy food at schools and healthy food choice by students. Although both state- and district-level policy initiatives have focused on school nutrition standards, it remains to be seen whether these policies translate into healthy food practices at the school level, where student behavior will be impacted.

Objective

To examine whether state- and district-level nutrition policies addressing junk food in school vending machines and school stores were associated with less junk food in school vending machines and school stores. Junk food was defined as foods and beverages with low nutrient density that provide calories primarily through fats and added sugars.

Design

A cross-sectional study design was used to assess self-report data collected by computer-assisted telephone interviews or self-administered mail questionnaires from state-, district-, and school-level respondents participating in the School Health Policies and Programs Study 2006. The School Health Policies and Programs Study, administered every 6 years since 1994 by the Centers for Disease Control and Prevention, is considered the largest, most comprehensive assessment of school health policies and programs in the United States.

Subjects/setting

A nationally representative sample (n=563) of public elementary, middle, and high schools was studied.

Statistical analysis

Logistic regression adjusted for school characteristics, sampling weights, and clustering was used to analyze data. Policies were assessed for strength (required, recommended, neither required nor recommended prohibiting junk food) and whether strength was similar for school vending machines and school stores.

Results

School vending machines and school stores were more prevalent in high schools (93%) than middle (84%) and elementary (30%) schools. For state policies, elementary schools that required prohibiting junk food in school vending machines and school stores offered less junk food than elementary schools that neither required nor recommended prohibiting junk food (13% vs 37%; P=0.006). Middle schools that required prohibiting junk food in vending machines and school stores offered less junk food than middle schools that recommended prohibiting junk food (71% vs 87%; P=0.07). Similar associations were not evident for district-level polices or high schools.

Conclusions

Policy may be an effective tool to decrease junk food in schools, particularly in elementary and middle schools.     

Die kartenbasierte Alterskontrolle an Zigarettenautomaten

Until recently, 700,000 tobacco vending machines provided uncontrolled access to cigarettes for children and adolescents in Germany. On January 1, 2007, a card-based electronic locking device was attached to all tobacco vending machines to prevent the purchase of cigarettes by children and adolescents under 16. Starting in 2009, only persons older than 18 are able to buy cigarettes from tobacco vending machines. The aim of the present investigation (SToP Study: “Sources of Tobacco for Pupils” Study) was to assess changes in the number of tobacco vending machines after the introduction of these new technical devices (supplier’s reaction). In addition, the ways smoking adolescents make purchases were assessed (consumer’s reaction). We registered and mapped the total number of tobacco points of sale (tobacco POS) before and after the introduction of the card-based electronic locking device in two selected districts of the city of Cologne. Furthermore, pupils from local schools (response rate: 83%) were asked about their tobacco consumption and ways of purchase using a questionnaire. Results indicated that in the area investigated the total number of tobacco POSs decreased from 315 in 2005 to 277 in 2007. The rates of decrease were 48% for outdoor vending machines and 8% for indoor vending machines. Adolescents reported circumventing the card-based electronic locking devices (e.g., by using cards from older friends) and using other tobacco POSs (especially newspaper kiosks) or relying on their social network (mainly friends). The decreasing number of tobacco vending machines has not had a significant impact on cigarette acquisition by adolescent smokers as they tend to circumvent the newly introduced security measures.     

Tobacco use among middle and high school students--Florida, 1998 and 1999

Tobacco use is the single leading preventable cause of death in the United States, and an estimated $2 billion is spent annually in Florida to treat disease caused by smoking. Florida appropriated $23 million in fiscal year 1997 and $70 million in fiscal year 1998 to fund the Florida Pilot Program on Tobacco Control to prevent and reduce tobacco use among Florida youth. To determine the prevalence of cigarette, cigar, and smokeless tobacco (i.e., chewing tobacco and snuff) use among Florida middle and high school students in public schools, the Florida Department of Health conducted the Florida Youth Tobacco Survey (FYTS) in February 1998 and February 1999. The purpose of these surveys was to establish baseline parameters and monitor the progress of the pilot program, which began in April 1998. This report summarizes advance data from the surveys, which indicate that, from 1998 to 1999, the percentage of Florida public middle and high school students who smoked cigarettes decreased significantly and that the percentage of middle school students who smoked cigars and used smokeless tobacco products decreased significantly.     

Measuring statewide merchant compliance with tobacco minimum age laws: the Massachusetts experience.

OBJECTIVES: This study evaluated merchant compliance with laws prohibiting the sale of tobacco to minors in Massachusetts. METHODS: Stratified cluster sampling was used to select outlets from which youths aged 13 to 17 years attempted to purchase tobacco. RESULTS: Illegal sales were more common when the youth purchasing the tobacco was older, when the clerk was male, and when tobacco was obtained from a self-service display or unlocked vending machine. Failure to request proof of age was the strongest predictor of illegal sales. CONCLUSIONS: Measured compliance rates are strongly influenced by the age of the youths used to purchase tobacco.     

School vending machine use and fast-food restaurant use are associated with sugar-sweetened beverage intake in youth

OBJECTIVE: To examine associations between use of school vending machines and fast-food restaurants and youth intake of sugar-sweetened beverages. DESIGN: A cross-sectional observational study. SUBJECTS/SETTING: From a group randomized obesity intervention, we analyzed baseline data from 1,474 students in 10 Massachusetts middle schools with vending machines that sold soda and/or other sweetened drinks. MAIN OUTCOME MEASURES: Daily sugar-sweetened beverage consumption (regular soda, fruit drinks, and iced tea), purchases from school vending machines, and visits to fast-food restaurants in the preceding 7 days were estimated by self-report. STATISTICAL ANALYSES PERFORMED: Chi(2) and nonparametric tests were performed on unadjusted data; multivariable models adjusted for sex, grade, body mass index, and race/ethnicity, and accounted for clustering within schools. RESULTS: Among 646 students who reported using school vending machines, 456 (71%) reported purchasing sugar-sweetened beverages. Overall, 977 students (66%) reported eating at a fast-food restaurant. Sugar-sweetened beverage intakes averaged 1.2 servings per day. In adjusted models, relative to no vending machine purchases, servings per day increased by 0.21 for one to three purchases per week (P=0.0057), and 0.71 with four or more purchases (P<0.0001). Relative to no fast-food restaurant visits, sugar-sweetened beverage servings per day increased by 0.13 with one visit per week (P=0.07), 0.49 with two to three visits (P=0.0013), and by 1.64 with four or more visits (P=0.0016). CONCLUSIONS: Among students who use school vending machines, more report buying sugar-sweetened beverages than any other product category examined. Both school vending machine and fast-food restaurant use are associated with overall sugar-sweetened beverage intake. Reduction in added dietary sugars may be attainable by reducing use of these sources or changing product availability.     

Sustained effects of educating retailers to reduce cigarette sales to minors.

Despite state laws prohibiting the purchase of tobacco by minors, the ease with which underage youth can purchase cigarettes has been documented nationwide. The public health community as well as policy makers have called for a combination of retailer education and enforcement of laws prohibiting tobacco sales to minors. Enforcement activity may not be feasible in many communities, however, and an educational intervention may be the only option. This paper reports results of a 6-month followup assessment following a face-to-face education intervention with retailers to reduce cigarettes sales to minors in San Diego County, CA. A control-experimental group, pre-post design was employed to study the sustained effects of the program on the illegal sale of cigarettes to minors. A total of 236 stores were visited by minors, ages 14-17 years, with the intent of purchasing cigarettes. Information was collected three times: pre-test, immediately following the intervention, and 6 months after the intervention ended. The groups included a no-treatment control group of 108 stores and an intervention group of 128 that received three educational visits from project staff over a 1-year period. Community education via media and informational presentations was also conducted. As previously reported, a 68-percent pretest sales rate was found for stores overall. Immediately following the intervention, 32 percent of the intervention group and 59 percent of the control group sold cigarettes to minors. These results were maintained 6 months following the conclusion of the intervention. Results are discussed in terms of education versus use of enforcement.     

The illegal sale of cigarettes to US minors: estimates by state.

Data available from recent national surveys on the cigarette consumption and purchasing practices of teenage smokers were used to generate state-specific estimates of the number of teenage smokers and cigarette sales to minors. In 1991, approximately 2.7 million teenage cigarette smokers consumed an average of 28.3 million cigarettes per day (516 million packs per year). An estimated 255 million packs of cigarettes were sold illegally to minors in 1991. To make cigarettes and other tobacco products less accessible to minors, policymakers should consider implementing various legislative and economic measures such as banning cigarette vending machines and raising tobacco excise taxes.     

Tobacco use among middle and high school students--United States, 2002

Each day in the United States, approximately 4,400 youths aged 12-17 years try their first cigarette. An estimated one third of these young smokers are expected to die from a smoking-related disease. The National Youth Tobacco Survey (NYTS), conducted by the American Legacy Foundation, provides estimates of usage among U.S. middle and high school students for various tobacco products (i.e., cigarettes, cigars, smokeless tobacco, pipes, bidis [leaf-wrapped, flavored cigarettes from India], and kreteks [clove cigarettes]). This report summarizes tobacco use prevalence estimates from the 2002 NYTS and describes changes in prevalence since 2000. Both tobacco use and cigarette smoking among students in high school (i.e., grades 9-12) decreased by approximately 18% during 2000-2002; however, a decrease among students in middle school (i.e., grades 6-8) was not statistically significant. The lack of progress among middle school students suggests that health officials should improve implementation of proven antismoking strategies and develop new strategies to promote continued declines in youth smoking.     

北京市朝阳区普通中学校外烟草售卖点情况调查

目的：了解北京市朝阳区普通中学校门周边100米范围内烟草售卖点的分布情况及其向中学生售烟情况。方法采取单纯随机抽样的方法,抽取朝阳区32所普通中学,对校门周边100米范围内烟草售卖点的分布情况和对学生售烟情况进行调查。结果71.9%(23/32)的普通中学校门口100米范围内存在烟草售卖点,平均每所中学校外有1.50±1.37家烟草售卖点。烟草售卖点离校门的平均距离为45.8±27.2米,所售烟草的最低价格为4.19±1.50元/包。56.3%(27/48)的烟草售卖点悬挂有烟草专卖零售许可证,35.4%(17/48)烟草售卖点的工作人员知晓禁止向未成年人售烟和禁止在校门口100米内设立卷烟零售点的政策,25.0%(12/48)的烟草售卖点张贴禁止向未成年人售烟的标识,72.9%(35/48)的烟草售卖点向中学生售烟。有烟草专卖零售许可证的正规烟草售卖点对禁售政策知晓率、标识的张贴率和向中学生拒售烟草的比例,显著高于非正规烟草售卖点。结论北京市朝阳区中学生烟草易得性较高,有必要加强控烟政策法规的宣传和执法力度。     

Locking devices on cigarette vending machines: evaluation of a city ordinance.

OBJECTIVES. Policymakers, researchers, and citizens are beginning to recognize the need to limit minors' access to tobacco by restricting the sale of cigarettes through vending machines. One policy alternative that has been proposed by the tobacco industry is a requirement that vending machines be fitted with electronic locking devices. This study evaluates such a policy as enacted in St. Paul, Minn. METHODS. A random sample of vending machine locations was selected for cigarette purchase attempts conducted before implementation and at 3 and 12 months postimplementation. RESULTS. The rate of noncompliance by merchants was 34% after 3 months and 30% after 1 year. The effect of the law was to reduce the ability of a minor to purchase cigarettes from locations originally selling cigarettes through vending machines from 86% at baseline to 36% at 3 months. The purchase rate at these locations rose to 48% at 1 year. CONCLUSIONS. Our results suggest that cigarette vending machine locking devices may not be as effective as vending machine bans and require additional enforcement to ensure compliance with the law.     

Improvements in middle school student dietary intake after implementation of the Texas Public School Nutrition Policy

Objectives. We assessed the effect of the Texas Public School Nutrition Policy on middle school student lunchtime food consumption.Methods. Three years of lunch food records were collected from middle school students in southeast Texas: baseline (2001–2002), after local district changes (2002–2003), and 1 year after implementation of the Texas Public School Nutrition Policy (2005–2006). Students recorded amount and source of foods and beverages they consumed. Analysis of variance and covariance and nonparametric tests were used to compare intake after the policy change with intake during the 2 previous years.Results. After implementation of the nutrition policy, student lunch consumption of vegetables, milk, and several nutrients increased (protein, fiber, vitamins A and C, calcium, and sodium), and consumption of less desirable items (sweetened beverages, snack chips) decreased, as did percentage of energy from fat. Most of the desired nutrients and foods (vegetables and milk) were obtained from the National School Lunch Program meal. Fewer sweetened beverages, candy, chips, and dessert foods were purchased and consumed, but more of these items were brought from home and purchased from the snack bar.Conclusions. Overall, state school nutrition policies can improve the healthfulness of foods consumed by students at lunch.Public health efforts to reduce the increasing rates of childhood obesity1 have recently focused on school food environments.2 Although regulations exist for National School Lunch Program (NSLP) meals, there are no federal rules for competitive foods sold elsewhere in the school such as in snack bars and vending machines, except for foods of minimal nutritional value (e.g., soda).3 This has become an issue because the school environment influences dietary behavior.4 For example, middle school students with access to snack bar and a la carte foods consumed more sweetened beverages and french fries, and fewer fruit and vegetables compared with elementary school students without snack bars.5^,6 The number of snack vending machines was negatively related to daily fruit consumption among middle school youth.7 In high schools where soft drink machines were turned off during lunch, students purchased fewer soft drinks compared with students in schools where these machines were on during lunch.8 Improving types and portion sizes of foods available in school snack bars and a la carte could reduce the source of kilojoules available for student purchase and possibly improve energy balance.9States, school districts, and individual schools have enacted laws and policies regarding foods and beverages available in school food environments.10 The beverage industry also developed a voluntary beverage vending policy for schools.11 Such changes are controversial, and barriers to improving school food environments exist. These include the revenue generated from vending and snack bar and a la carte sales,12 school staff, student and parent attitudes toward types of foods expected in schools,13 and the concern that limiting access to these foods at school will not improve overall student dietary intake.14 Critics suggest that if these items are not available in schools, students will compensate by increasing consumption of desired foods in out-of-school environments.14Few data exist for the effect of policy changes on actual food consumption by students at school. One recent study documented significant improvements in food consumption by Texas middle school students (more milk, calcium, and vitamin A; fewer sweetened beverages) after a local school district enacted a snack bar food policy change.15 Consumption of chips purchased from the snack bar declined, but consumption of chips from vending machines increased, because the school administration, which was responsible for vending machines, made no changes. These results suggest that all school food sources have to make similar changes to favorably influence consumption.The Texas Public School Nutrition Policy, an unfunded mandate to promote a healthy school environment for Texas students, was implemented statewide in the fall of 2004. The guidelines apply to all school food sources, including vending machines.16 For middle schools, the policy restricts the portion sizes of high-fat and sugar snacks (limits vary by food group), sweetened beverages (≤ 12 oz), and the fat content of all foods served (≤ 28 grams of fat per serving no more than 2 times per week). It also sets limits on the frequency of serving high-fat vegetables such as french fries (3 oz per serving no more than 3 times per week). We report the results of a naturalistic study that assessed the effect of the Texas Public School Nutrition Policy on lunch consumption of middle school students in southeast Texas. Student lunch consumption data for 2 previous years were available for comparison.15     

Middle school students' perceived access to cigarettes in Virginia

OBJECTIVE: To examine correlates of perceived access to cigarettes at home, school, and the store among youth. METHODS: Virginia middle school youth were surveyed before beginning tobacco prevention programs. Multivariate analyses examined household smoking, peer smoking, and perceived community tobacco use for their relationship to perceived access at home, school, and the store. RESULTS: Perceived access at home was associated with parent, sibling, and friend smoking. Perceived access at school and stores was associated with perceived peer and community smoking. CONCLUSIONS: Youth tobacco prevention programs should target the commercial and social sources of tobacco access to reduce experimentation, adoption, and addiction among youth.     

The Impact of the Availability of School Vending Machines on Eating Behavior during Lunch: The Youth Physical Activity and Nutrition Survey

Childhood obesity is a major public health concern and is associated with substantial morbidities. Access to less-healthy foods might facilitate dietary behaviors that contribute to obesity. However, less-healthy foods are usually available in school vending machines. This cross-sectional study examined the prevalence of students buying snacks or beverages from school vending machines instead of buying school lunch and predictors of this behavior. Analyses were based on the 2003 Florida Youth Physical Activity and Nutrition Survey using a representative sample of 4,322 students in grades six through eight in 73 Florida public middle schools. Analyses included χ² tests and logistic regression. The outcome measure was buying a snack or beverage from vending machines 2 or more days during the previous 5 days instead of buying lunch. The survey response rate was 72%. Eighteen percent of respondents reported purchasing a snack or beverage from a vending machine 2 or more days during the previous 5 school days instead of buying school lunch. Although healthier options were available, the most commonly purchased vending machine items were chips, pretzels/crackers, candy bars, soda, and sport drinks. More students chose snacks or beverages instead of lunch in schools where beverage vending machines were also available than did students in schools where beverage vending machines were unavailable: 19% and 7%, respectively (P≤0.05). The strongest risk factor for buying snacks or beverages from vending machines instead of buying school lunch was availability of beverage vending machines in schools (adjusted odds ratio=3.5; 95% confidence interval, 2.2 to 5.7). Other statistically significant risk factors were smoking, non-Hispanic black race/ethnicity, Hispanic ethnicity, and older age. Although healthier choices were available, the most common choices were the less-healthy foods. Schools should consider developing policies to reduce the availability of less-healthy choices in vending machines and to reduce access to beverage vending machines.     

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.     

Accessibility of Cigarettes to Minors in Suburban Cook County, Illinois

This study assessed the problem of under age sale of cigarettes, educated vendors about the law restricting the sale of tobacco to minors, and determined the effectiveness of a vendor education intervention. Twenty-one teen volunteers, 14 to 17 years in age, attempted to purchase cigarettes in suburban Cook County from over-the-counter merchants and vending machines. Of the 347 vendors that were checked, the minors were successful in 37.2% of their attempts to purchase cigarettes. After information was sent to each vendor about the State of Illinois law, follow up visits were made to all the vendors who were willing to sell cigarettes to the minors during the first visits. Approximately 50% of the vendors were again willing to sell cigarettes to minors. This study's findings suggest that minors can easily purchase cigarettes in suburban Cook County. The education intervention component of the study had a limited but promising effect on compliance rates of the vendors.     

Impact of Survey Setting on Current Tobacco Product Use: National Youth Tobacco Survey, 2021

PurposeTo examine whether survey setting was associated with youth reporting of current (past 30-day) use of any tobacco product, e-cigarettes, cigarettes, and cigars.MethodsData from the 2021 National Youth Tobacco Survey (NYTS) were used to estimate the prevalence of current use of any tobacco product, e-cigarettes, cigarettes, and cigars by survey setting, sociodemographic characteristics, peer tobacco use, and other tobacco product use. Multivariable regression was used to test the impact of survey setting on current tobacco use. Tobacco access sources among current users were compared by survey setting.ResultsAmong students who participated in the 2021 NYTS, 50.8% reported taking the survey on school campus and 49.2% at home/other place. The prevalence of current use of any tobacco product, e-cigarettes, cigarettes, and cigars was higher among students completing the survey on school campus than at home/other place. After adjusting for covariates, this association persisted only for current use of any tobacco product (adjusted odds ratio = 1.57; 95% confidence interval, 1.28–1.91) and e-cigarettes (adjusted odds ratio = 1.43; 95% confidence interval, 1.20–1.71). Current users reported similar sources of access to tobacco products, regardless of survey setting.DiscussionThe likelihood of youth reporting current use of any tobacco product and e-cigarettes differed by survey setting. Such differences could be due to lack of privacy at home, peer influence in school settings, and other unmeasured characteristics. Methodological changes were made due to COVID-19; caution is warranted in comparing results from the 2021 NYTS with those of previous or future NYTS conducted primarily on school campus.     

Density of Tobacco Retailers Near Schools: Effects on Tobacco Use Among Students

Objectives. We examined the relationship between students'' tobacco use and the density and proximity of tobacco retailers near their schools.Methods. We used data from the 2003–2004 California Student Tobacco Survey and California retail licensing data. Measures included students'' self-reported tobacco use and geocoded state-reported locations of tobacco retailers. We used random-intercept generalized linear mixed modeling to jointly evaluate individual-level and school-level predictors.Results. Density of retailers was associated with experimental smoking (odds ratio [OR] = 1.11; 95% confidence interval [CI] = 1.02, 1.21) but not established smoking (OR = 1.06; 95% CI = 0.94, 1.20). The effects on experimental smoking were confined to high school students (OR = 1.17; 95% CI = 1.06, 1.29) in urban areas (OR = 1.11; 95% CI = 1.01, 1.21); no effects were observed among middle school students or in rural schools. High school students were more likely to obtain cigarettes from a retailer; middle school students relied more heavily on social sources.Conclusions. Our results support the plausibility of reducing rates of students'' experimental smoking, but not established smoking, by restricting their access to commercial sources of tobacco in urban areas.The dominant approach to minimizing illicit drug use among adolescents in the United States has been supply reduction, often dubbed the “war on drugs.” By contrast, the dominant approach to minimizing tobacco use among underaged children and adolescents has been demand reduction. However, tobacco control activists have been showing increased interest in supply reduction as a complement to existing prevention efforts and in response to evidence that perceived availability of tobacco is perhaps the most important predictor of tobacco use initiation among young people.¹One way to reduce adolescents'' access to tobacco is to advocate for the licensing of tobacco retailers and the revocation of licenses if retailers sell tobacco to minors.² But the consensus seems to be that enforcement of state laws against selling tobacco products to minors as the way to prevent underaged adolescents from purchasing these products has been insufficiently effective in terms of reducing adolescent tobacco use.³ Such efforts have not been without impact, however, because they appear to have influenced adolescents to obtain their tobacco primarily from social sources, such as older siblings and older friends, as opposed to commercial sources.^3–5Tobacco control activists have begun exploring another way to prevent underaged adolescents from purchasing tobacco. The Institute of Medicine recently called for states to limit the number of tobacco retail outlets for the express purpose of reducing tobacco use through reduced access.⁶ Activists are beginning to recommend that communities adopt zoning restrictions and conditional use permits to limit sales of tobacco products near schools.⁷ Although such an approach might help reduce access to tobacco products among students, it is unclear whether reducing access would lead to actual reductions in tobacco use. Evidence of the positive impact of reductions in the density of alcohol outlets on alcohol-related problems (e.g., violent assaults) encourages those who believe that reducing the density of tobacco outlets could reduce problems related to tobacco use.^6,8Existing observational data can be used to begin evaluating the premise that proximity of tobacco retailers to school sites might influence student tobacco use. The limited research in this area suggests that presence of tobacco retailers near homes and schools may influence adolescent tobacco use by making cigarettes easier to procure. Novak and associates⁹ reported recently that, after control for census tract–derived school neighborhood characteristics, the density of tobacco retailers in the Chicago area was associated with students'' reported tobacco use. Novak and his associates were not able to provide data on adolescents'' tobacco purchasing patterns or gauge their perceived ease of obtaining tobacco products. Leatherdale and Strath⁴ found that increased density of tobacco retailers near schools in Ontario, Canada, was associated with a greater likelihood that student smokers would purchase cigarettes rather than obtaining them from social sources.Evidence also suggests that the density and proximity of tobacco retailers influence adults'' smoking behaviors, including number of cigarettes smoked per day.¹⁰ One non-school-based study¹¹ confirmed that retail tobacco availability, defined as the number of retailers that illegally sold tobacco per 1000 young people residing in the community, was associated with initiation of tobacco use but not with rates of established smoking.Using a large statewide survey of students in randomly sampled California schools, we investigated whether similar effects would be found for the geographically and demographically more heterogeneous California student population. If increased adolescent tobacco use were found to be associated with tobacco retailer density near schools in California, such findings should be pertinent to most other states as well. The reason is that the situation in these other states is similar to that in California as a result of the Congressional mandate called “the Synar amendment”¹²; that is, laws and enforcement standards are in place in these states to sanction adolescent possession, use, or purchase of tobacco.¹³In theory, the Synar amendment requires all states to enforce prohibitions on the sale of tobacco products to minors and document that no more than 20% of their tobacco retailers are selling tobacco products to minors or be faced with the loss of millions of dollars of federal aid. If tobacco retailers were totally compliant with state prohibitions on the sale of tobacco products to minors, then student tobacco users would have to rely on older individuals procuring cigarettes for them, and student tobacco use rates would be unaffected by the density of tobacco retailers around schools. Annual evaluations in which underaged confederates have been used to purchase cigarettes continue to show significant noncompliance, however (e.g., see http://ww2.cdph.ca.gov/programs/tobacco/Documents/CTCPResultsYouthTobaccoPurchaseSurvey2008.pdf).We attempted to extend current research by evaluating measures of tobacco retailer density and proximity in relation to student tobacco use, tobacco purchasing patterns, and perceived ease of obtaining cigarettes, as assessed through random sample surveys of adolescent students in California and use of geocoded information on state licensing of tobacco retailers. In addition to including diverse neighborhoods in our study, ranging from densely populated urban centers to sparsely populated rural areas, we assessed various neighborhood-level (e.g., tobacco retailer density), school-level, and student-level characteristics given that they can contribute to students'' susceptibility to tobacco use. Age, gender, and racial/ethnic background are all student-level characteristics that have been shown to influence tobacco use.¹⁴ Thus, we included these variables along with parental educational attainment, another consistent correlate of adolescent tobacco use.¹⁵ We also assessed students'' perceptions of the prevalence of tobacco use among their peers.     

Tobacco use, access, and exposure to tobacco in media among middle and high school students--United States, 2004

Two of the national health objectives for 2010 are to reduce the prevalence of any tobacco use during the preceding month to < or =21% and the prevalence of current cigarette use to < or =16% among high school students (objectives 27-2a and 27-2b). The National Youth Tobacco Survey (NYTS), conducted by CDC in 2004, provided estimates of current use of tobacco products and selected indicators related to tobacco use, including youth exposure to tobacco-related media and access to cigarettes. This report summarizes data from the 2004 NYTS and describes changes in tobacco use and indicators related to tobacco use since 2002. During 2002-2004, middle school students reported decreases in pipe use, seeing actors using tobacco on television or in movies, and seeing advertisements for tobacco products on the Internet. Among high school students, no changes were observed in the use of tobacco or in access to tobacco products; however, seeing actors using tobacco on television or in movies declined slightly, and seeing advertisements for tobacco products on the Internet increased. The lack of substantial decreases in the use of almost all tobacco products among middle and high school students underscores the need to fully implement evidence-based strategies (e.g., increasing the retail price of tobacco products, implementing smoking-prevention media campaigns, and decreasing minors' access as part of comprehensive tobacco-control programs) that are effective in preventing youth tobacco use.