This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Jason, L. A. Articles by Glantz, S. A. Search for Related Content PubMed PubMed Citation Articles by Jason, L. A. Articles by Glantz, S. A. Social Bookmarking                         What's this?

PEDIATRICS Vol. 111 No. 4 April 2003, pp. 920-921

It Is Premature to Abandon Youth Access to Tobacco Programs

In a recent meta-analysis study, Fichtenberg and Glantz¹ argue that youth access tobacco programs do not affect teen smoking prevalence because as fewer merchants sell tobacco to minors, teens will use social sources to obtain tobacco. They conclude, as well as in a recent editorial,² that it is time to abandon youth access tobacco programs. The likely result of reversing this policy would be that the majority of merchants would once again sell minors tobacco, thereby providing them easy access to this dangerous substance.

Previous studies that have investigated the relation of retail tobacco availability (RTA) to youth tobacco use have measured this factor as the proportion of retailers assessed who illegally sold cigarettes.^3–6 Fichtenberg and Glantz⁷ concur that this is the most commonly used metric for assessing youth access programs, and if this is not an accurate reflection of youth access, "then none of the studies of youth access that base their effectiveness on merchant compliance are valid." Unfortunately, this approach does not account for the relative density of tobacco retailers in each community, which may affect the likelihood that a youth will encounter a retailer who is not compliant with the tobacco sales law. As an example, in one town we recently studied,⁸ 17% of retailers sold tobacco to minors, and thus this town would be seen as in compliance with the Synar amendment, which stipulates that states need to keep merchant illegal sales rates of tobacco to minors under 20%.⁹ In contrast, a second town had rates of illegal sales of 36%. However, the number of retailers who made illegal sales per 1000 youth was higher in the town with the lower violation rate. This suggests that a more appropriate measure of risk exposure would reflect the number of retailers who illegally sell tobacco as a function of the youth population (ie, youth between the ages of 10 and 17) within each community.

A recent study examined individual, social, and environmental influences on smoking initiation and continued smoking among sixth, seventh, and eighth grade students using this new RTA index.⁸ Greater RTA was positively associated with smoking initiation but not continued cigarette use. Restrictions in RTA may prevent youth from initiating smoking, but may have less impact on those addicted to tobacco. Fichtenberg and Glantz’s (2002) meta-analysis only examined current smoking rather than smoking initiation.

Typically, youth who conduct retail tobacco access assessments are not permitted to lie about their age, use an ID card, dress to appear older, purchase other items, or engage the clerk in irrelevant friendly conversation. It is with these types of procedures that low rates of merchant sales rates have been found. This research protocol may be more similar to methods used by youth who are less experienced at purchasing cigarettes. However, when youth who are experienced at purchasing tobacco are allowed to use their usual purchase methods (eg, appear as they want, purchase other items, lie about their age, present a valid underage ID, and engage the clerk in conversation), they are 6 times more likely to obtain cigarettes from clerks than youth who use methods required by standard assessment protocols.¹⁰ In other words, efforts to restrict RTA might be most successful in limiting relatively inexperienced smokers from purchasing cigarettes, but these efforts are probably less successful for addicted and experienced smokers. The fact that young smokers are beginning to shift to social sources for tobacco¹¹ suggests that, for some, the barriers to purchasing retail tobacco are strengthening. Rather than reducing these obstacles to youth access to tobacco, it might be more appropriate to assess the effects of even tougher barriers to retail and social sources of tobacco.

Several studies have found that tobacco-control policies, which might be influencing norms that impact retail and social sources, have reduced prevalence of youth smoking. Jason and colleagues¹² found that high school youths who lived in communities with regular enforcement of youth access policies had significantly lower rates of smoking compared with youths who lived in communities without such enforcement. A longitudinal, statewide study in Massachusetts found that youths living in communities with local tobacco sales laws were less likely to progress to established smoking over a 4-year period than were youths living in communities without such laws.¹³ In addition, a national study of state youth tobacco control policies found that youths living in states with more comprehensive policies had significantly lower rates of smoking than did youths living in states without such policies.¹⁴

It is too early to eliminate youth access programs, as they represent one of the more popular vehicles for galvanizing public support for antismoking activities and establishing social norms against youth tobacco use. Moreover, given the methodologic limitations of the current research,¹⁵ future research with more rigorous and controlled designs might indicate that such interventions, particularly those that change social norms, might even have a role in reducing smoking initiation and prevalence rates.

Leonard A. Jason, PhD
Steven B. Pokorny, MD
Michael E. Schoeny, MD
Center for Community Research
DePaul University
Chicago, IL 60614, USA
University of Illinois at Chicago
Chicago, IL, USA

REFERENCES

1. Fichtenberg CM, Glantz SA. Youth access interventions do not affect youth smoking. Pediatrics.2002; 109 :1087 –1091
2. Ling PM, Landman A, Glantz SA. Is it time to abandon youth access tobacco programmes. Tobacco Control.2002; 11 :3 –6[Free Full Text]
3. Forster JL, Murray DM, Wolfson M, et al. The effects of community policies to reduce youth access to tobacco. Am J Public Health.1998; 88 :1193 –1198[Abstract/Free Full Text]
4. Jason LA, Ji PY, Anes M, et al. Active enforcement of cigarette control laws in the prevention of cigarette sales to minors. J Am Med Assoc.1991; 266 :3159 –3161[Abstract/Free Full Text]
5. Altman DG, Wheelis AY, McFarlane M, et al. The relationship between tobacco access and use among adolescents: a four community study. Soc Sci Med.1999; 48 :759 –775
6. Rigotti NA, DiFranza JR, Chang Y, et al. The effect of enforcing tobacco-sales laws on adolescents’ access to tobacco and smoking behavior. N Engl J Med.1997; 337 :1044 –1051[Abstract/Free Full Text]
7. Fichtenberg CM, Glantz SA. Fichtenberg and Glantz respond. Tobacco Control. 2002;May 29 [electronic letter to the editor]
8. Pokorny SB, Jason LA, Schoeny ME. Effects of retail tobacco availability on initiation and continued cigarette smoking. J Clin Child Adolesc Psychol. In press
9. Jacobson PD, Wassermen J, Anderson JR. Historical overview of tobacco legislation. J Soc Iss.1997; 53 :75 –95[CrossRef][Web of Science]
10. DiFranza JR, Savageau JA, Bouchard J. Is the standard compliance check protocol a valid measure of the accessibility of tobacco to underage smokers? Tobacco Control.2001; 10 :227 –232[Abstract/Free Full Text]
11. Jones SE, Sharp DJ, Husten CG, et al. Cigarette acquisition and proof of age among US high school students who smoke. Tobacco Control.2002; 11 :20 –25[Abstract/Free Full Text]
12. Jason LA, Berk M, Schnopp-Wyatt D, et al. Effects of enforcement of youth access laws on smoking prevalence. Am J Commun Psychol.1999; 27 :143 –160[CrossRef][Web of Science][Medline]
13. Siegel M, Biener L, Rigotti NA. The effect of local tobacco sales laws on adolescent smoking initiation. Prev Med.1999; 29 :334 –342[CrossRef][Web of Science][Medline]
14. Luke DA, Stamatakis KA, Brownson RC. State youth-access tobacco control policies and youth smoking behavior in the United States. Am J Prev Med.2000; 19 :180 –187[CrossRef][Web of Science][Medline]
15. DiFranza JR. It is time to abandon bad science. Tobacco Control. 2002;May 13 [electronic letter to the editor]

---

 
In Reply.—

Jason et al¹ argue that it is premature to abandon youth access programs despite the fact that they do not affect youth smoking prevalence because the studies of youth access are so seriously flawed methodologically that we cannot use them to support policy-making on this issue. This is not a compelling argument for continuing to devote substantial resources to this intervention. Rather than the convoluted explanations for the fact that youth access laws are not associated with reductions in youth smoking that Jason et al (and other defenders of this politically popular policy) offer, there is a simple empirically validated explanation for this result: as you make it harder to buy cigarettes, youth get them in other ways.^2–7

In addition, youth access interventions are counterproductive because they reinforce the tobacco industry’s "smoking is a way to look adult" message⁸ as well as assist the tobacco industry in its local organizing efforts.⁹

If youth access were a drug or vaccine to prevent nicotine addiction and the manufacturer was to offer such an explanation for the failure to demonstrate efficacy to the Food and Drug Administration, the Food and Drug Administration would never approve it. We should be putting our limited tobacco control resources¹⁰ into programs of proven effectiveness, such as media campaigns^11,12 and clean indoor air.^13,14

Caroline M. Fichtenberg, MS
Stanton A. Glantz, PhD
Department of Epidemiology
Johns Hopkins University
Baltimore, MD 21287, USA
Department of Medicine
University of California San Francisco
San Francisco, CA, USA 94143-1390

REFERENCES

1. Jason LA, Pokorny SB, Schoeny ME. Is it premature to abandon youth access to tobacco programs? [letter]. Pediatrics.2003; 111 :920[Free Full Text]
2. Forster J, Murray D, Wolfson M, Blaine T, Wagenaar A, Hennrikus D. The effects of community policies to reduce youth access to tobacco. Am J Public Health.1998; 88 :1193 –1198
3. Cummings K, Hyland A, Perla J, Giovino G. Does increasing retailer compliance with minor’s access laws reduce youth smoking? Nicotine Tobacco Res. 2001. In press
4. Hinds M. Impact of local ordinance banning tobacco sales to minors. Public Health Rep.1992; 82 :355 –358
5. DiFranza JR, Coleman M. Sources of tobacco for youths in communities with strong enforcement of youth access laws. Tobacco Control.2001; 10 :323 –328[Abstract/Free Full Text]
6. Jones SE, Sharp DJ, Husten CG, Crossett LS. Cigarette acquisition and proof of age among U.S. high school students who smoke. Tobacco Control.2002; 11 :20 –25
7. Castrucci B, Gerlach K, Kaufman N, Orleans C. Adolescents’ acquisition of cigarettes through non-commercial sources. J Adolesc Health. 2002. In press
8. Glantz SA. Preventing tobacco use—the youth access trap [editorial; see comments]. Am J Public Health.1996; 86 :156 –158[Free Full Text]
9. Ling PM, Landman A, Glantz SA. It is time to abandon youth access tobacco programmes. Tobacco Control.2002; 11 :3 –6
10. Campaign for Tobacco Free Kids, American Lung Association, American Cancer Society, American Heart Association. Show us the money: a mid-year update on the states’ allocation of the tobacco settlement dollars: National Center for Tobacco Free Kids. July 22, 2002. Available at: http://www.tobaccofreekids.org/reports/settlements/2002mid/2002midreport.pdf. Accessed August 4, 2002
11. Goldman L, Glantz S. Evaluation of antismoking advertising campaigns. JAMA.1998; 279 :772 –777[Abstract/Free Full Text]
12. Farrelly MC, Healton CG, Davis KC, Messeri P, Hersey JC, Haviland ML. Getting to the truth: evaluating national tobacco countermarketing campaigns. Am J Public Health.2002; 92 :901 –907[Abstract/Free Full Text]
13. Fichtenberg CM, Glantz SA. Effect of smoke-free workplaces on smoking behaviour: systematic review. BMJ.2002; 325(7357) :188 –191[Abstract/Free Full Text]
14. Glantz SA, Jamieson P. Attitudes toward secondhand smoke, smoking, and quitting among young people. Pediatrics.2000; 106(6) . Available at: http://www.pediatrics.org/cgi/content/full/106/6/e82

---

PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. J. Craig and N. W. Boris Youth Tobacco Access Restrictions: Time to Shift Resources to Other Interventions? Health Promot Pract, January 1, 2007; 8(1): 22 - 27. [Abstract] [PDF]

				L. A. Jason, S. B. Pokorny, M. E. Schoeny, C. M. Fichtenberg, and S. A. Glantz It Is Premature to Abandon Youth Access to Tobacco Programs Pediatrics, April 1, 2003; 111(4): 920 - 921. [Full Text] [PDF]

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Web of Science (7) Citing Articles via Google Scholar Google Scholar Articles by Jason, L. A. Articles by Glantz, S. A. Search for Related Content PubMed PubMed Citation Articles by Jason, L. A. Articles by Glantz, S. A. Social Bookmarking                         What's this?