A study published in this month's issue of Tobacco Control reports a substantial reduction in the rate of illegal sales to minors, as measured by compliance checks conducted in accordance with the 1992 Synar Amendment. Violation rates in the 50 states dropped from a high of 73% in 1996 to a high of only 36% in 2000. And while in 1996, only one state reported a violation rate below 10%, seven states reached single digit violation rates in 2000. An additional 22 states had violation rates below 20% in 2000, compared to only two in 1996. The article concludes by calling for a continued emphasis on enforcement of youth tobacco sales laws.
The Rest of the Story
What the study does not reveal is that the compliance checks used in complying with Synar are an artificial exercise that is not consistent with reality and therefore tell us very little about what the actual rates of illegal sales to minors are.
The chief problem is that youths testing for violations are: (1) not allowed to lie about their age; (2) not allowed to present false identification or make up excuses about where their identification is; (3) not actually trying to purchase cigarettes for themselves and therefore not fully motivated to do what is necessary to obtain them; and (4) not based on "on-the-street" knowledge of youths about what outlets are likely to sell to minors and therefore not representative of the proportion of youth cigarette purchase attempts that take place at a given outlet.
Thus, the fact that violation rates in compliance checks in some states were as low as 6% does not mean that 94% of actual cigarette purchase attempts by youths are unsuccessful (or anything close to that).
When actually buying cigarettes, youths can lie about their age, present false identification, make up excuses about where their identification is, or rely on a host of other factors, such as honing in on outlets that are known to sell to minors, taking advantage of particular sellers, such as friends or acquaintances who they know will sell to them, purchasing cigarettes as part of a group of youths, some of whom may be known to the cashier, and many others.
It is also important to note that purchasing cigarettes is only one way that youths can obtain them, and in recent surveys, represents the mode of access for only about half of the cigarettes that youths smoke.
It is perhaps for these reasons that studies of the effect of youth access laws on youth smoking have shown no consistent impact on smoking initiation as well as no consistent relationship between violation rates in compliance checks and youth smoking (see, in particular: Fichtenberg CM. Glantz SA. Youth access interventions do not affect youth smoking. Pediatrics 2002; 109(6):1088-1092 and 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).
While this particular article calls for a continued emphasis on youth access programs, it is not clear to me why such an emphasis would be warranted based on what I feel are convincing data that these programs, as actually implemented on a widespread national basis, work.
Three years ago, Ling et al. called for an end to youth access tobacco programs (see: Ling PM, Landman A, Glantz SA. It is time to abandon youth access tobacco programmes. Tobacco Control 2002;11:3-6). I have seen nothing published in the past three years that would call that recommendation into question and a considerable amount of evidence that reinforces it.
I believe that youth access programs served an important purpose during the past decade: mainly, they served as an intervention around which community coalitions could mobilize and thus they helped create a community tobacco control infrastructure. Now it is time to use that infrastructure to implement interventions that work.