Laying down the law: reducing illegal tobacco sales to minors in central Harlem.

OBJECTIVES: This study compared the impact of educational and enforcement interventions on retailers' sale of tobacco to minors in Central Harlem, New York. METHODS: In a randomized trial with repeated measures, 152 stores were randomly divided into control, education, and enforcement groups. RESULTS: Overall tobacco sales to 12- and 13-year-old minors at baseline (98%) were among the highest in the nation. At 6-month and 1-year follow-ups, decreases in rates of tobacco sales to minors were modest among education stores and substantial among enforcement stores. CONCLUSIONS: Effective reduction of tobacco sales to minors may require ongoing enforcement measures, including fines for retailers who violate state and local laws.     

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.     

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.     

Reducing cigarette sales to minors in an urban setting: Issues and opportunities for merchant intervention

Introduction: Intervention studies to reduce cigarette sales to minors have been conducted primarily in suburban settings. Little is known about sociocultural factors influencing cigarette sales to minors in urban settings. This study sought to determine sociodemographic and cultural factors that may play a role in cigarette sales and in efforts to reduce sales to minors in urban areas.Methods: Merchant education and follow-up surveys were conducted in small local stores in predominantly African-American urban census tracts in Baltimore. The stores had prior evidence of cigarette sales to minors.Results: Merchants reported hostility (66%) and foul language (64%) when they requested youth identification. Youthful-oriented advertising of cigarettes was highly prevalent in all stores and moreso in stores owned and staffed by Asian merchants. Advertising with specific youthful content was predictive (OR = 3.97; 95% CI = 1.70, 9.23; P = .0014) of higher requests for cigarettes from minors.Conclusions: Youth-oriented cigarette advertising is a prevalent environmental risk for urban youth. Differences between Asian and African-American merchants suggest socioethnic factors may be an influential component of illegal sales and educational campaigns to reduce smoking among minors.     

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.     

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.     

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.     

Evaluating the effects of a community coalition's efforts to reduce illegal sales of alcohol and tobacco products to minors

Minors' access to alcohol and tobacco is a major public health concern because of the many deaths and disabilities associated with use and the ease with which minors purchase these products. We evaluated the effects of a community-based substance abuse coalition's efforts to reduce alcohol and tobacco products to minors. The intervention —implemented entirely by coalition members—consisted of adults and minors issuing citations to clerks in supermarkets, convenience stores and liquor stores, who were willing to sell alcohol and tobacco products to minors and issuing commendations to clerks who refused to sell. For those liquor stores receiving the citizen's surveillance, there was a marked decrease in alcohol sales to minors, from 83% to 33%; and in those liquor stores not experiencing the intervention, there was a smaller decrease in alcohol sales, from 45% to 36%. This study's findings suggest that citizen surveillance and feedback may be effective in reducing alcohol sales to minors when the intervention is fully implemented, but may be ineffective, at least in these doses, with tobacco sales.     

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。     

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.     

Retail Impact of Raising Tobacco Sales Age to 21 Years

The majority of tobacco use emerges in individuals before they reach 21 years of age, and many adult distributors of tobacco to youths are young adults aged between 18 and 20 years. Raising the tobacco sales minimum age to 21 years across the United States would decrease tobacco retailer and industry sales by approximately 2% but could contribute to a substantial reduction in the prevalence of youths’ tobacco use and dependency by limiting access.Recent research has highlighted the susceptibility of the young adult brain to rapid nicotine addiction.1,2 While individuals are still experimenting with tobacco use and before they are aware of their own level of addiction, they first want, then crave, then need cigarettes, at which point they are unable to quit.1 Individuals who begin smoking at a young age are more likely to become addicted, progress to daily smoking, become heavier tobacco users as adults, and have difficulty quitting.3,4 The US Surgeon General has expressed concern about the potential long-term cognitive effects of exposure to nicotine during brain development with the potential for lasting adverse consequences.5For many years, public health strategies focused on preventing the onset of nicotine addiction by relying on the strict enforcement of laws that prevent the sale of tobacco to minors younger than 18 years. Indeed, successful efforts to limit tobacco access of minors by disrupting the sale of tobacco to minors have made an important contribution toward reductions in the prevalence of tobacco use among minors.6A factor that might limit the impact of preventing the sale of tobacco to minors is the fact that, in most communities, 18- to 20-year-olds who can legally purchase cigarettes provide them to younger friends and family members.7 The majority (59%) of 18- and 19-year-olds have been asked by someone younger than 18 years to buy cigarettes for them.8 Also, high-school students are less likely to have 21-year-old adults than 18- to 20-year-old adults in their social circles, suggesting reduced opportunities to access tobacco from older buyers.9 Inhibiting this well-established distribution cycle provides one rationale for increasing the legal age for tobacco sales to 21 years.Another rationale stems from the 2012 Surgeon General’s report finding that almost 90% of smokers in the United States began smoking before the age of 21 years.4,10 The report concludes that if young people can remain free of tobacco, most will never start to smoke. Currently, people who reach the age of 21 years as a nonsmoker have a minimal chance of ever becoming a smoker. For these reasons, there is interest in extending the benefits of restricting tobacco sales to individuals younger than 21 years.     

Laws prohibiting the sale of tobacco to minors: impact and adverse consequences

This paper discusses the consequences of laws that prohibit the sale of tobacco to minors. When enforced, such laws may decrease tobacco sales to minors, but local authorities are often reluctant to enforce these laws. However, the prohibition of tobacco sales to minors is often followed by an increase in the use of tobacco obtained from social sources, mainly family and friends. Importantly, these laws do not decrease smoking prevalence among minors. Several local laws prohibit youths from purchasing, using, and possessing tobacco. However, these laws shift responsibility from retailers to youth, criminalizing young smokers. Those who advocate this type of approach have not documented the adverse consequences of laws that prohibit minors from purchasing, using, or possessing tobacco. In conclusion, youth access laws are ineffective and are not based on sound science.     

Availability of cigarettes to minors

Abstract: Legislation banning the sale of cigarettes to minors is potentially a cost-effective means of reducing smoking rates among adolescents. Such legislation has been in existence in Australia for over 80 years. Two studies examined the retail industry's adherence to the sales ban in two regions of New South Wales in 1990. The first study was a survey of 1 849 12- to 15-year-old adolescents from 12 high schools in New South Wales, providing data on self-reported purchasing of cigarettes from retail outlets by minors. In all, 38 per cent reported having purchased cigarettes illegally. A second study was undertaken to determine the proportion of retail shops which sell cigarettes to apparently underage youth. Two 16-year-olds who looked young for their age attempted to purchase cigarettes from 101 different retail outlets in one region of New South Wales. No challenge about age was made for 70 per cent of purchases, and proof of age was requested on only 15 per cent of occasions. The results suggest that legislation banning sales of cigarettes to minors requires strong enforcement procedures to be effective.     

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.     

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.     

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.     

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.     

Preventing illegal tobacco and alcohol sales to minors through electronic age-verification devices: a field effectiveness study

Efforts to prohibit the sales of tobacco and alcohol products to minors are widespread. Electronic Age Verification (EAV) devices are one possible means to improve compliance with sales to minors laws. The purpose of this study was to evaluate the implementation and effectiveness of EAV devices in terms of the frequency and accuracy of age verification, as well as to examine the impact of EAV's on the retailer environment. Two study locations were selected: Tallahassee, Florida and Iowa City, Iowa. Retail stores were invited to participate in the study, producing a self-selected experimental group. Stores that did not elect to test the EAV's comprised the comparison group. The data sources included: 1) mystery shopper inspections: two pre- and five post-EAV installation mystery shopper inspections of tobacco and alcohol retailers; 2) retail clerk and manager interviews; and 3) customer interviews. The study found that installing EAV devices with minimal training and encouragement did not increase age verification and underage sales refusal. Surveyed clerks reported positive experiences using the electronic ID readers and customers reported almost no discomfort about being asked to swipe their IDs. Observations from this study support the need for a more comprehensive system for responsible retailing.     

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.     

How does electronic cigarette access affect adolescent smoking?

Understanding electronic cigarettes’ effect on tobacco smoking is a central economic and policy issue. This paper examines the causal impact of e-cigarette access on conventional cigarette use by adolescents. Regression analyses consider how state bans on e-cigarette sales to minors influence smoking rates among 12 to 17 year olds. Such bans yield a statistically significant 0.9 percentage point increase in recent smoking in this age group, relative to states without such bans. Results are robust to multiple specifications as well as several falsification and placebo checks. This effect is both consistent with e-cigarette access reducing smoking among minors, and large: banning electronic cigarette sales to minors counteracts 70 percent of the downward pre-trend in teen cigarette smoking for a given two-year period.