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.     

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。     

A baseline assessment of cigarette sales to minors in San Diego,California

This study reports the sales rate of cigarettes to minors in San Diego County, and investigates factors associated with cigarette sales to minors. Two hundred and ninety-four stores were identified and recruited to participate in a retailer education effort. To assess the baseline illegal sales rate of cigarettes to minors, selected stores were surveyed by 70 volunteer teams of adults and minors. Questionnaires were also administered to participating store owners or managers to assess retailers' knowledge about laws regulating minors' access to tobacco. Survey results indicated that minors were able to successfully purchase cigarettes in 68% of attempts. In addition, teen gender, community sociodemographics and cashier characteristics were associated with sales to minors. Analyses of the retailer questionnaire indicated retailers knew the legal age to purchase cigarettes, but few knew of the specific penalties associated with sales to minors. These findings indicate that minors have easy access to cigarettes and underscore the need for intensive tobacco sales education for retailers and enforcement of sales to minors laws.Ann D. Erickson is Assistant Intervention Coordinator, Susan I. Woodruff is Evaluation Coordinator, Marianne B. Wildey is Intervention Coordinator, and Erin Kenney is Principal Investigator, all at the Graduate School of Public Health, San Diego State University, Behavioral and Community Health Studies, 6363 Alvarado Ct. Ste. 225, San Diego, CA 92120.Funding was provided by the Tobacco Tax Health Protection Act of 1988-Proposition 99, under grant number 90-10960. The authors gratefully acknowledge the contributions of Felipe Castro, PhD, MSW and Nadia Campbell, MPH.     

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 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.     

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.     

An experimental study of effects on schoolchildren of exposure to point-of-sale cigarette advertising and pack displays

By creating a sense of familiarity with tobacco, cigarette advertising and bold packaging displays in stores where children often visit may help to pre-dispose them to smoking. A total of 605 ninth-grade students were randomly allocated to view a photograph of a typical convenience store point-of-sale which had been digitally manipulated to show either cigarette advertising and pack displays, pack displays only or no cigarettes. Students then completed a self-administered questionnaire. Compared with those who viewed the no cigarettes, students either in the display only condition or cigarette advertising condition perceived it would be easier to purchase tobacco from these stores. Those who saw the cigarette advertising perceived it would be less likely they would be asked for proof of age, and tended to think a greater number of stores would sell cigarettes to them, compared with respondents who saw no tobacco products. Respondents in the display only condition tended to recall displayed cigarette brands more often than respondents who saw no cigarettes. Cigarette advertising similarly influenced students, and tended to weaken students' resolve not to smoke in future. Retail tobacco advertising as well as cigarette pack displays may have adverse influences on youth, suggesting that tighter tobacco marketing restrictions are needed.     

Youth targeting by tobacco manufacturers since the Master Settlement Agreement

The 1998 Master Settlement Agreement (MSA) between tobacco manufacturers and forty-six states bans manufacturers from targeting minors through advertising. To determine how youth targeting in magazine cigarette advertisements changed after the MSA, we analyzed magazine readership and cigarette ads in U.S. magazines from 1997 to 2000. In 2000 all three major manufacturers (Philip Morris, R.J. Reynolds, and Brown and Williamson) failed to comply with the MSA's youth-targeting ban, selectively increasing their youth targeting. Banning all magazine advertising of cigarettes may be necessary to eliminate youth targeting in magazines.     

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.     

A comparison of the advertising and accessibility of cigars, cigarettes, chewing tobacco, and loose tobacco

BACKGROUND: Tobacco products were compared in regard to their price, point-of-purchase advertising, accessibility to shoplifters, and rate of sale to minors. METHODS: An experimental design compared the rates of illegal sales to minors of cigarettes, chewing tobacco, and cigars. Observational surveys of 102 stores measured the number of advertisements for four tobacco products, the manner in which products were displayed, and their accessibility to shoplifters. RESULTS: Illegal sales rates were similar for cigarettes, chewing tobacco, and cigars. Cigars were the least expensive. Cigarettes were the most heavily advertised product, followed by chewing tobacco, cigars, and loose tobacco. Cigarettes were the most accessible to shoplifters. All types of tobacco products were displayed to permit the package to serve as advertising. CONCLUSIONS: Point-of-purchase advertising for cigars may be increasing, and their lower price makes them more affordable to youths. Food and Drug Administration regulations that limit point-of-purchase advertising for tobacco products should be expanded to include cigars. Manufacturers pay retailers for the placement of product displays that allow the package to be used as an advertisement without the appearance of the Surgeon General's warning. Generic packaging may be necessary to protect children from point-of-purchase advertising.     

Bans on electronic cigarette sales to minors and smoking among high school students

Many states have banned electronic cigarette sales to minors under the rationale that using e-cigarettes leads to smoking traditional combustion cigarettes. Such sales bans would be counterproductive, however, if e-cigarettes and traditional cigarettes are substitutes, as bans might push teenagers back to smoking the more dangerous combustion cigarettes. We provide evidence that these sales bans reduce the incidence of smoking conventional cigarettes among high school seniors. Moreover, we provide evidence suggesting that sales bans reduced e-cigarette usage as well. This evidence suggests that not only are e-cigarettes and smoking regular cigarettes positively related and not substitutes for young people, banning retail sales to minors is an effective policy tool in reducing tobacco use.     

烟草商店向未成年人售烟情况及影响因素分析

目的了解烟草销售店向未成年人售烟情况及其影响因素。方法利用自填式问卷调查281名烟草销售人员向未成年人售烟的相关情况并分析影响因素。结果有效问卷共268份。烟草销售人员167人（62．3％）报告所工作的商店持有烟草专卖证，181人（67．5％）报告放置了“禁止向未成年人售烟”的标志。116人（43．3％）回答会询问或判断买烟者的年龄，146人（53．4％）表示会把香烟卖给中小学生或未成年人。以销售率较低的烟草专卖店和大超市为参照，小超市最高（0R=3．60），其次为杂货店（OR=2．52）；询问或判断买烟者年龄的销售率较低（0R=0．22）；认同青少年控烟责任的销售率较低（OR=0．85）。如商店类型不纳入方程，放置了禁止向未成年人售烟之类标志的销售率低（OR=0．52）。结论有烟草销售的商店非法向未成年人售烟的比例较高，尤其是小超市和杂货店。询问或判断买烟者的年龄、放置标志牌能降低向未成年人售烟的销售率。应制定非法向未成年人售烟的具体处罚措施。加强监督和管理力度，并对烟草销售人员进行法制教育。     

Sustained effects of an educational program to reduce sales of cigarettes to minors.

We report 1-year follow-up data from a sample of stores participating in a 6-month community-wide educational effort to reduce cigarette sales to minors in Santa Clara County, California. The proportion of over-the-counter sales to minors at the 1-year follow-up illustrated that although statistically significant reductions were maintained 6 months after the intervention ended, recidivism occurred. Suggestions for achieving long-term reductions in sales to minors are offered.     

Long-term findings from Woodridge in reducing illegal cigarette sales to older minors

The purpose of the present study is to assess the effectiveness of an enforcement program in reducing cigarette sales to older minors in a community that had been successful in reducing illegal sales of cigarettes to younger minors. Cigarette sales rates were monitored over a 3-year period with quarterly compliance testing in Woodridge, Illinois. Sales rates for older minors were found to be only slightly higher than those of younger minors with one exception. These findings suggest that the enforcement of cigarette control laws is an effective means by which access to cigarettes can be reduced for both younger and older minors.     

Smoking by adolescents: large revenue but little for prevention

Abstract: The purpose of this paper is to report on the government revenue gained from the sale of cigarettes to minors and the proportion of this revenue that is spent on attempting to prevent adolescents from taking up this habit Prevalence of smoking by minors was extrapolated for the individual states using Australian prevalence data; estimates of annual cigarette consumption were coupled with the respective cost of cigarettes in each state to derive an estimate of the total revenue accumulating from cigarette consumption by minors. From our analysis, approximately 211 000 Australian children under the legal age to purchase cigarettes consumed approximately 11.5 million packets of cigarettes in 1990. The estimated tax revenues to the federal and state governments from these sales were $8.42 million and $12.78 million respectively. While the average state revenue from cigarette consumption by minors during 1990 was just over $60 per under-age smoker, only $0.11 per under-age smoker was spent on anti-smoking campaigns in 1990. This is equivalent to approximately 0.002 per cent of state revenue from cigarette smoking by those under the legal purchase age being spent on discouraging adolescents from taking up this habit Clearly, there is an inequitable expenditure on antismoking activities, given the enormous resources obtained from sales to minors.     

Purchasing of cigarettes by New Zealand secondary students in 2000

OBJECTIVE: To examine the prevalence of under-age sales of cigarettes to New Zealand secondary school students in 2000 and to identify correlates of buying cigarettes. METHOD: A randomly selected sample of 53 secondary schools from five geographic regions took part, and 2,896 Year 10 and Year 12 students completed a self-report questionnaire. RESULTS: Some 30.3% reported smoking during the past 30 days and 61.8% of these students usually obtained cigarettes by purchasing from shops, from other students or from someone else buying them on their behalf. Local corner stores and service stations were the most popular source. Buying cigarettes was associated with more frequent smoking, more money to spend, a higher school decile rating and higher proportion of schoolmates also purchasing. CONCLUSIONS: Prohibition of cigarette sales to minors needs much greater attention in NZ than it is receiving at present if smoking among young people is to be reduced.     

The relationship of neighborhood demographic characteristics to point-of-sale tobacco advertising and marketing

Objectives. Exposure to tobacco marketing has been associated with an increased likelihood that youth start smoking and may interfere with tobacco cessation. We aimed to describe the prevalence, placement, and features of tobacco advertising at the point of sale by race, ethnicity, and other neighborhood demographics, as well as by store type.

Design. A cross-sectional assessment of the advertising environment in establishments that held tobacco licenses in our study region (a metropolitan area in the Midwest USA) was conducted in 2007. Stores were geocoded and linked with block group demographic data taken from the Year 2000 US census. We calculated associations between our hypothesized predictors, race, ethnicity, and other neighborhood demographics, and two types of outcomes (1) amount and (2) characteristics of the advertising.

Results. Tobacco advertising at the point of sale was most common in gas stations/convenience stores, liquor stores, and tobacco stores. A 10% difference in a block group's African-American/Black population was associated with 9% (95% confidence interval [CI]=3%, 16%) more ads as well as a greater likelihood that ads would be close to the ground (prevalence ratio [PR]=1.15 [95% CI=1.04, 1.28]). Block groups with greater African-American/Black, Asian, people on public assistance or below 150% of the poverty threshold, or people under the age of 18 years had more ads for menthol brands. Block groups with greater proportions of Whites were more likely to have ads that used health words, such as ‘light’ or ‘natural’ (PR for 10% difference in White population=1.41 [95% CI=1.17–1.70]). Chain stores were more likely to have greater amounts of advertising, ads close to the ground, ads for price deals, or ads that use words that imply health.

Conclusion. Tobacco advertising targets communities with various racial and ethnic profiles in different ways. Now that US Food and Drug Administration has the authority to regulate the marketing and sale of tobacco products, there is new opportunity to reduce the harmful impact of tobacco advertising.     

Reducing underage cigarette sales in an isolated community: The effect on adolescent cigarette supplies

Objective.The current study explored the practicality of preventing underage retail cigarette sales and the relationship to cigarette supplies among adolescents.Method.In Fort Morgan, Colorado, an isolated rural community with below-average socioeconomic status and a large Latino population, supervised teenaged employees repeatedly attempted to buy cigarettes from every store over a 9-month period in 2005. Repeated violations were penalized. Cigarette acquisition and exchange among community adolescents were assessed before and after intervention using a high school student survey.Results.The measured violation rate declined from 47% in the first week to 3.4% during the final three months, and high school student reliance on retail cigarette purchases declined. Adolescent cigarette supplies declined by approximately 15%.Conclusion.Isolated rural communities can reduce adolescent cigarette supplies by conducting consistent enforcement against retail cigarette sales to minors. Previous research suggests that reducing these sales may help reduce adolescent smoking. The current study demonstrates that enforcement is practical and effective.     

Smokers' beliefs and attitudes about purchasing cigarettes on the Internet

OBJECTIVES: Our objectives were to explore qualitatively how smokers find out about Internet cigarette sales and what factors motivate them to purchase cigarettes on-line, and to quantitatively describe the Internet cigarette purchasing behaviors and attitudes of Internet cigarette buyers. METHODS: Qualitative in-depth telephone interviews were conducted with 21 adult smokers who had purchased or contemplated purchasing cigarettes online. Findings from the qualitative study were used to develop a survey module on Internet cigarette purchasing behavior that was administered to 187 New Jersey adult smokers. RESULTS: Smokers who purchased cigarettes on-line were primarily motivated by lower prices, which occur because Internet vendors generally sell cigarettes without paying excise taxes for the destination state. Most Internet cigarette buyers first learned about on-line cigarette sales from interpersonal sources who had purchased on-line. New Jersey adult smokers who purchased cheaper cigarettes from the Internet and other lower-taxed sources significantly increased their consumption over time, compared to smokers who reported paying full-price at traditional bricks-and-mortar retail stores. CONCLUSIONS: Policies that have the effect of equalizing Internet cigarette prices with those at retail stores will likely deter smokers from purchasing cigarettes on-line. Internet cigarette vendors should be required to comply with the same provisions that apply to bricks-and-mortar retail vendors and charge appropriate state and local cigarette excise taxes. In the absence of such policies, the sales of cheaper, tax-free cigarettes on-line will undermine the public health benefit of raising cigarette prices.     

Inter-ethnic differences in youth tobacco language and cigarette brand preferences

Objective. To describe and understand variations in cigarette brand preferences between adolescents from varying ethnic and gender groups around the US. Design. A qualitative study where adolescents, both smokers and nonsmokers, were interviewed individually in depth. Setting. Schools and recreation centers in four sites: urban Maryland (Baltimore), urban Texas (Houston), rural Alabama and rural New Mexico. Participants. 121 adolescent volunteers 13-19 years of age, representing African American, white, American Indian and Hispanic ethnic groups, from both genders. Results. Considerable geographic and ethnic variation exists in terminology used by youth to refer to cigarettes and to their use. Clear patterns in brand preference by ethnic group were found that follow patterns of targeted marketing by ethnicity. White teens preferred Marlboro brand cigarettes, while African-American teens who smoke preferred Newports. Hispanic and American Indian teens were more likely to smoke Marlboro or Camel cigarettes. Hispanic teens were most likely to mention low price as a reason for choosing a particular brand or to state that the brand does not matter. Tobacco advertisements targeting ethnic groups and the use of promotional items to encourage teen smoking were also recognized as factors influencing brand preferences. Conclusions. These findings have implications for the design of intervention programs aimed at curbing teen smoking. When working with teens who already smoke, using youth language to target messages at perceived characteristics of commonly used brands may be more effective and meaningful than talking about cigarette use in general. Another implication of this work is to shed light on what impact an advertising ban would have on teen brand preferences, brand loyalty, and prevalence of smoking.