Enforce Existing Youth Access Laws
Background
A solid body of scientific evidence indicates that tobacco use and addiction usually take root in adolescence or even childhood (13). In 2003, the Youth Risk Behavior Surveillance found that 58% of high school students had tried smoking, and 22% of students in grades 9-12 reported current cigarette smoking (3). Children and teenagers constitute the majority of all new smokers - more than 80% of adult smokers started smoking by age 18, and more than 90% began smoking during their teens (12). Therefore, it is imperative that steps are taken to limit youth access to tobacco, which may discourage youth from developing a lifelong tobacco habit.
The Synar Amendment (Section 1926 of Title XIX of the Federal Public Health Service Act), passed by federal lawmakers in 1992, formally requires that all 50 states and the District of Colombia have and enforce laws that prohibit sales of tobacco to individuals younger than 18 years of age. However, teens often have easy access to tobacco because merchants often do not ask to show proof of age to purchase the cigarettes.
The 2003 Youth Risk Behavior Surveillance survey of 9th and 12th graders found that 19% of teens purchased their cigarettes from a store or a gas station. Older students were more likely to obtain cigarettes via retail outlets than younger students (26% among 12th graders vs. 12% among 9th graders). Though the number of teens who purchase cigarettes from retail outlets may seem relatively low, it does not take into account the number of teens who buy or borrow cigarettes from friends or parents, or give money to older teens to buy tobacco products for them. Therefore, retailers supply cigarettes to a much greater number of teens than those to whom the cigarettes are sold directly (3).
Several studies have found that the use of consistent, surprise retailer compliance checks and the use of civil penalties can lead to reduced youth access to tobacco products (7, 9). However, such laws must be compulsory, not voluntary; many studies have shown that voluntary compliance programs for retailers do not affect youth smoking rates.
Policies
Achieve a high compliance rate with existing tobacco control laws to reduce minors' access to tobacco products.
Improving compliance with tobacco sales laws among tobacco retailers can reduce the availability of tobacco to young people. To be effective, access laws must be enforced at state and local levels, through unannounced compliance checks through which minors attempt to purchase tobacco products. In addition, there must be an adequate system of civil penalties, which can include temporary revocation of the tobacco license (2).
However, there are several constraints to effectively practicing enforcement. First, tobacco control laws may be relatively low on the list of enforcement priorities for many jurisdictions. Though health leaders and tobacco control advocates think that youth access to tobacco is a serious problem, one study found that in 1995 in California, only 25% of enforcement agency staff believed youth access to be an enforcement priority (8). Another potential problem is the quality of enforcement, such as whether tests are performed randomly and without prior notification, and the age and appearance of children who attempt to buy cigarettes as part of the enforcement tactic. For example, studies have shown that retailers are less likely to sell tobacco products to younger teens (ages 13-15), than older teens, so enforcement officers can bolster compliance rates by having younger children attempt to buy the tobacco products, which does not necessarily result in increased overall retailer compliance (4). Finally, several local jurisdictions are often hindered in enforcement efforts by weaker state laws that preempt local laws (1); laws that prohibit compliance checks unless they are performed by law enforcement officials; and laws that require enforcement officers to prove that merchants "knowingly and intentionally" sold tobacco products to a minor.
Despite such difficulties in implementing tobacco control law enforcement, several communities have successfully utilized enforcement strategies to reduce youth access to tobacco. In Woodridge, Ill., rates of merchant sales to minors decreased from a baseline of 70% before legislation, to less than five percent in one-and-a-half years of compliance checking after legislation. Student surveys in Woodridge showed that the rates of cigarette experimentation and regular use of cigarettes by adolescents were reduced by over 50% (9).
A randomized community trial in 14 Minnesota communities measured the effect of changes in ordinances, merchant policies and practices and enforcement practices to reduce youth access to tobacco. For the study, each community passed a comprehensive youth ordinance, and as a result, youth smoking rates were significantly lower than prior to the intervention (7).
To be successful, it is important that a community has specific laws to enforce tobacco control. While voluntary retailer programs combined with education for both retailers and community members can have some effect on youth access and smoking rates, there is no guarantee that initial decreases in youth access to tobacco will be sustained. There have been several voluntary youth access programs promoted by the tobacco industry in the past, such as "It's the Law," which provided signs to tobacco retailers stating that the retailer did not sell tobacco products to individuals younger than age 18, and supported voluntary restrictions on free sampling of tobacco products. Studies of programs such as this have found these efforts were not associated with a significant reduction in illegal retail sales (5).
Effectiveness Data
The greatest decrease in tobacco sales to under-aged buyers has been documented in communities that have active surveillance of retailers and substantial penalties for noncompliance (6, 8). By themselves, educational interventions directed at vendors have resulted in slight and temporary reductions in sales to minors (8, 10).
To reduce youth access to tobacco products, enforcement efforts must be carried out with sufficient vigor to ensure that as few merchants as possible are breaking the law as few times as possible. If even a small number of merchants in a community continue to break the law, youths will have little difficulty buying tobacco, especially if teens are aware of which retailers are willing to sell tobacco illegally to minors. Even if compliance rates in a community are high (at least 80%), this does not guarantee lower smoking rates among teens. A controlled study in six Massachusetts communities, three of which enforced tobacco-sales laws and three of which did not, found that 82% of merchants in the intervention communities complied with the laws, as opposed to 45% in the control communities. However, teens in the intervention communities had little trouble obtaining tobacco products, and smoking rates in the intervention and control communities were similar (11). Therefore, enforcement must be rigorous to ensure high rates of compliance among all retailers (not a certain percentage) at all times.
The more often compliance tests are conducted, the greater the proportion of merchants who stop violating the law (6). In several communities, it has been found that every merchant must be tested four times each year to maintain acceptable compliance rates. In locations where tobacco sales to minors have been curtailed, the prevalence of smoking by teenagers has decreased, particularly among the youngest age groups (6).
Contacts
Americans for Nonsmokers' Rights (ANR)
2530 San Pablo Avenue, Suite J
Berkeley, CA 94702
Phone: (510) 841-3032
Fax: (510)841-3071
Email: anr@no-smoke.org
Website: http://www.no-smoke.org
Campaign for Tobacco-Free Kids
(also known as National Center for Tobacco-Free Kids)
1400 Eye Street, Suite 1200
Washington, DC 20005
Phone: (202) 296-5469
http://www.tobaccofreekids.org
info@tobaccofreekids.org
Centers for Disease Control and Prevention,
Office on Smoking and Health
1600 Clifton Rd.
Atlanta, GA 30333
(404) 639-3311
http://www.cdc.gov/tobacco
Technical Assistance Legal Center
Public Health Institute
505 14th Street, Suite 810
Oakland, CA 94612.
Phone: (510) 444-8252.
Fax: (510) 444-8253.
E-mail: talc@phi.org.
Website: http://www.phi.org/talc
References
1. American Medical Association, Smokeless States, National Tobacco Policy Initiative. (2003). Preemption - Taking the Local out of Tobacco Control. Available online at: http://www.ama-assn.org/ama/pub/category/7323.html
2. Centers for Disease Control and Prevention. (1999). Best Practices for Comprehensive Tobacco Control Programs - August 1999. Atlanta, GA: Centers for Disease Control and Prevention.
3. Centers for Disease Control and Prevention. (2004, May 21). Youth Risk Behavior Surveillance - United States, 2003. Morbidity and Mortality Weekly Report. 53(SS02).
4. DiFranza, J., & Coleman, M. (2001). Is the standard compliance check protocol a valid measure of the accessibility of tobacco to underage smokers? Tobacco Control. 10(10):227-232.
5. DiFranza, J., Savageau, J., & Aisquith, B. (1996, February). Youth access to tobacco: the effects of age, gender, vending machine locks, and "it's the law" programs. American Journal of Public Health. 86(2):221-4.
6. Feighery, E., Altman, D., & Shaffer G. (1991). The Effects of Combining Education and Enforcement to Reduce Tobacco Sales to Minors. JAMA, 266: 3168-3171.
7. Forster, J., Murray, D., Wolfson, M., Blaine, T., Wagenaar, A., Hennrikus, D. (1998, August). The effects of community policies to reduce youth access to tobacco. American Journal of Public Health, 88(8):1193-8.
8. Independent Evaluation Consortium. (1998). Final Report, Independent Evaluation of the California Tobacco Control Prevention and Education Program: Wave 1 Data, 1996-97. Rockville, MD: The Gallup Organization.
9. Jason LA, et al. (1991). Active Enforcement of Cigarette Control Laws in the Prevention of Cigarette Sales to Minors. JAMA, 266: 3159-3161.
10. Jason LA, et al. (1996). Reducing the Illegal Sales of Cigarettes to Minors: Analysis of Alternative Enforcement Schedules. Journal of Applied Behavioral Analysis, 29: 333-344.
11. Rigotti, N., DiFranza, J., Chang, Y., Tisdale, T., Kemp, B., & Singer, D. (1997, October). The effect of enforcing tobacco sales laws on adolescents' access to tobacco and smoking behavior. New England Journal of Medicine, 338(7):472-3.
12. US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). (2002). Results from the 2002 National Survey on Drug Use and Health. Calculated based on 2002 data at: http://www.icspr.umich.edu:8080/SAMHDA-SERIES/00064.xml/#das.
13. US Department of Health and Human Services, Centers for Disease Control and Prevention. (1994). Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Available online at: http://www.cdc.gov/tobacco/sgr/sgr_1994.
Acknowledgements
Eric Lindblom, Manager for Policy Research, Campaign for Tobacco-Free Kids, Washington, DC
Abby Rosenthal, MPH, Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
The Center for Health Improvement also acknowledges the following reviewers for providing comments on the original version of this policy profile:
Michael P. Eriksen, Sc.D., Former Director, Office of Smoking on Health, Centers for Disease Control, Atlanta, GA
David Fleming, M.D., Former State Epidemiologist, Oregon Health Division, Portland, OR
Sally Herndon-Malek, Former Director, Project ASSIST, DHHS, Raleigh, NC
Philip Huang, M.D., M.P.H.,Chief, Bureau for Disease and Injury Prevention, Texas Department of Health, Austin, TX
Kevin Keane, Former Director, Cancer Control, American Cancer Society, California Division, Oakland, CA
Jon Lloyd, Director, Tobacco Control Program, Planning and Policy, California Department of Health Services, Sacramento, CA
Paul Minicucci, Former Executive Director, California Next Generation Tobacco Control Alliance, Sacramento, CA
Jane Pritzl, Field Director, Assist Project, Division of Prevention Programs, Colorado Department of Public Health and Environment, Colorado, UT
Randy Schwartz, American Cancer Society, New England
Updated 6/30/04
