Monday, April 04, 2005

10 Years After Synar: CDC Study Shows Youths Still Able to Purchase Cigarettes

Ten years after tobacco control efforts began to focus heavily on interventions to reduce youth access to tobacco products, a CDC study released last week reveals that the majority of minors (age <18) are still easily able to obtain cigarettes. Nationally in 2004, of current smokers less than 18 years old, 64% were not asked to show proof of age and 62% were not refused purchase due to their age. These results show that national efforts to reduce youth access to cigarettes over the past decade have been largely unsuccessful in preventing youths from obtaining cigarettes and thereby reducing youth smoking.

The Rest of the Story

Ten years is long enough for an experiment that as early as 1996, Dr. Stan Glantz suggested to us was an unfortunate diversion of resources (see: Glantz SA. Preventing tobacco use--the youth access trap. American Journal of Public Health 1996; 86(2):156-158). No matter how reluctant we are, it is time to conclude that the experiment has failed.

There simply is not evidence that as implemented in widespread practice, youth access laws and their enforcement have any significant effect on youth smoking. While there have been a few studies that found an effect, these were generally in specific communities that implemented an unusually aggressive program that cannot likely be sustained or easily replicated elsewhere. The totality of the evidence, in my opinion, documents that youth access interventions do not significantly decrease youth smoking (see, in particular: Fichtenberg CM. Glantz SA. Youth access interventions do not affect youth smoking. Pediatrics 2002; 109(6):1088-1092).

Research conducted here in Massachusetts, where a heavily-funded statewide tobacco control program with a huge emphasis on youth access interventions (including enforcement) was in place for a decade (from 1993-2003), revealed that these initiatives had no effect on youth smoking behavior (see: Thomson CC, Gokhale M, Biener L, Siegel MB, Rigotti NA. Statewide evaluation of youth access ordinances in practice: Effects of the implementation of community-level regulations in Massachusetts. Journal of Public Health Management and Practice 2004; 10:481-489).

There are a number of reasons why widespread efforts to restrict the sale of tobacco products to minors would not be expected to be effective in reducing youth smoking:
  • Youths have a wide variety of sources of access to cigarettes, and half of youth smokers do not even rely on purchasing their own cigarettes. If youths want to smoke, they can obtain cigarettes even if unable to purchase for themselves.
  • Compliance checks as conducted by tobacco control groups are essentially meaningless exercises, because they do not simulate real-life conditions, in which youths are able to lie about their age or present false identification.
  • Even if there were no alternate sources of cigarettes other than purchasing in a store, compliance would have to reach extremely high levels to reduce youth access to cigarettes. If even one store in a community sells to minors, youths have ready access to cigarettes.
There are now a number of interventions that have been so well documented to reduce youth smoking that it makes no sense to place our resources into a losing strategy. It is time to heed Dr. Glantz's warning from 1996 and avoid the youth access trap. Resources should be shifted into programs that we know work.

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