Effects of publicity and a warning letter on illegal cigarette sales to minors. Larimer County Tobacco and Youth Project. Changes among retailers selling cigarettes to minors. Accessibility of cigarettes to minors in suburban Cook County, Illinois. The relationship between tobacco access and use among adolescents: a four community study. Youth tobacco sale compliance checks: impact on vendor practices and community policy. Evaluation of an enforcement program to reduce tobacco sales to minors. Laying down the law: reducing illegal tobacco sales to minors in central Harlem. Minors' access to tobacco before and after the California STAKE Act. The effects of combining education and enforcement to reduce tobacco sales to minors. A study of four northern California communities. Interventions with retailers to reduce cigarette sales to minors: a randomised controlled trial. Compliance for Kids: a community-based tobacco prevention project. Reducing underage cigarette sales in an isolated community: the effect on adolescent cigarette supplies. Active enforcement of cigarette control laws in the prevention of cigarette sales to minors. Reducing the illegal sale of cigarettes to minors. How easy is it for young people to obtain cigarettes, and do test sales by trading standards have any effect? A survey of two schools in Gateshead. Is restricting tobacco sales the answer to adolescent smoking? Reducing the illegal sales of cigarettes to minors: analysis of alternative enforcement schedules. The effects of licensing and inspection enforcement to reduce tobacco sales to minors in Greater Philadelphia, 1994-1998. Can non-prosecutory enforcement of public health legislation reduce smoking among high school students? The effects of community policies to reduce youth access to tobacco. Impact of a local ordinance banning tobacco sales to minors. Locking devices on cigarette vending machines: evaluation of a city ordinance. The effect of enforcing tobacco-sales laws on adolescents' access to tobacco and smoking behavior.
The study aimed to assess rates of illegal cigarette sales to children and the impact on these rates of publicity and a warning letter threatening prosecution. Children aged 12 and 13 made two repeat purchasing attempts, three months apart, at 255 randomly selected tobacco retail outlets in Sydney. A randomly selected 50 per cent of retail outlets which sold cigarettes illegally at the first attempt were sent warning letters threatening prosecution. Publicity about the undercover buying operation was organised between the attempts. At the first attempts, 39 per cent of shops sold cigarettes to the children and 32 per cent sold them at the second attempt. Shops which sold on the first occasion and received warning letters reduced selling by 69 per cent compared to the 40 per cent reduction in shops which sold cigarettes on the first attempt and were not sent warning letters, a net reduction of 29 per cent seemingly attributable to the warning letters (95 per cent confidence interval 8 per cent to 50 per cent). It is extremely easy for children as young as 12 to buy cigarettes. The combined effects of publicity about undercover buying operations and warning letters threatening prosecution seem capable of reducing selling by about 29 per cent. Because of inconsistencies in selling or refusals, future attempts to measure selling rates to children should use repeat purchasing attempts and classify outlets as 'selling', 'not selling' or 'sometimes selling'. nan This study analyzes changes over a three-year period among Ontario retailers selling cigarettes to minors. Under supervision, 13 and 14-year-old minors were sent into stores to attempt to buy cigarettes. These minor-purchase-events (MPEs) were carried out in a local health unit that had implemented a community-based intervention and in an adjoining comparison health unit. After the local program we observed a large reduction (from 46% to 6%) in merchants willing to sell tobacco to minors. In the neighbouring health unit, a high rate of selling continued until a federal program using a similar intervention was implemented, after which a large reduction (from 47% to 2%) was observed. This magnitude of change has been unprecedented, except when active enforcement was implemented by police officers. Thus, from a public health perspective, it is important to understand what is influencing the store operators. This study assessed the problem of under age sale of cigarettes, educated vendors about the law restricting the sale of tobacco to minors, and determined the effectiveness of a vendor education intervention. Twenty-one teen volunteers, 14 to 17 years in age, attempted to purchase cigarettes in suburban Cook County from over-the-counter merchants and vending machines. Of the 347 vendors that were checked, the minors were successful in 37.2% of their attempts to purchase cigarettes. After information was sent to each vendor about the State of Illinois law, follow up visits were made to all the vendors who were willing to sell cigarettes to the minors during the first visits. Approximately 50% of the vendors were again willing to sell cigarettes to minors. This study's findings suggest that minors can easily purchase cigarettes in suburban Cook County. The education intervention component of the study had a limited but promising effect on compliance rates of the vendors. The objective of this study was to examine the effectiveness of a longitudinal community intervention on the reduction of tobacco sales to minors and subsequent effects on tobacco consumption by youths. The study was conducted in Monterey County, CA. Four rural communities were randomized into treatment and comparison arms of the study and middle and high school students in each of these communities completed surveys assessing knowledge, attitude, and behavior. The main outcome measures were retail tobacco sales to minors as measured through store visits (tobacco purchase surveys) and self-reported consumption of tobacco. Over a three-year period, a diverse array of community interventions were implemented in the intervention communities. These included community education, merchant education, and voluntary policy change. In the treatment communities, the proportion of stores selling tobacco to minors dropped from 75% at baseline to 0% at the final post-test. In the comparison communities, the proportions were 64% and 39%, respectively. Although the availability of tobacco through commercial outlets was reduced substantially in intervention communities, youths reported still being able to obtain tobacco from other sources. Predicted treatment effects on reported use of tobacco among youths were observed cross-sectionally and longitudinally for younger students (7th graders). The intervention did not impact tobacco use among older students (9th and 11th graders) although the trends were in the predicted direction for 9th graders. A significant intervention effect was found for sex--females in the intervention communities were less likely to use tobacco post-intervention than females in the comparison communities. Tobacco sales to minors can be reduced through a broad-based intervention. To prevent or reduce tobacco use by youths, however, multiple supply-and demand-focused strategies are needed. nan This study evaluated an active enforcement program to increase retailers' compliance with the law prohibiting tobacco sales to minors.
                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.
                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.
                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. This study compared the impact of educational and enforcement interventions on retailers' sale of tobacco to minors in Central Harlem, New York.
                In a randomized trial with repeated measures, 152 stores were randomly divided into control, education, and enforcement groups.
                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.
                Effective reduction of tobacco sales to minors may require ongoing enforcement measures, including fines for retailers who violate state and local laws. To assess the effect of implementation and enforcement of the California STAKE Act on minors' access to tobacco by examining sales over time in the same stores.
                Sixteen year old girls and boys attempted to purchase cigarettes in the same 72 stores, in the same manner, in five time periods: August 1994 (before implementation of legislation); August 1995 (immediately after implementation); August 1996; March 1998; and January 1999 (all postimplementation).
                Percentage of successful cigarette purchases over time, in different ethnic communities.
                Minors' access rate decreased significantly from 41.2% before implementation of legislation (1994) to 12.7% after implementation (1998). The same stores were 3-5 times more likely to sell cigarettes to minors before than after the legislation was implemented, irrespective of ethnic census tract.
                The California STAKE Act and its enforcement have been effective in reducing minors' access to tobacco in all ethnic communities. To examine the effects of a community education and law enforcement intervention on illegal tobacco sales to minors.
                A 2-year, before and after trial with retail stores as the unit of analysis.
                Implementation occurred in four suburban California communities with populations of 25,000 to 100,000.
                All the retail stores in one intervention community and half the retail stores, randomly selected, in the other three intervention communities (n = 169) were visited by minors aged 14 to 16 years with the intent to purchase tobacco.
                Ongoing community and merchant education and four law enforcement operations were conducted.
                Over-the-counter and vending machine sales of tobacco to minors were the primary outcomes.
                Among a cohort of stores visited by minors at the pretest (n = 104) in June 1988, 71% sold tobacco over the counter and 92% sold tobacco through vending machines. At posttest 2 in May 1990, 24% sold tobacco over the counter and 93% sold tobacco through vending machines. Of the 31 stores issued citations, 16 were followed into the courts where the fines were dismissed or reduced.
                Education alone had a limited effect on reducing illegal tobacco sales to minors. It did promote community support for more aggressive enforcement strategies. Education plus enforcement decreased significantly over-the-counter sales; vending machine sales were unaffected by these interventions. The lack of support at the judicial level may temper the effectiveness of enforcement. Legislative remedies addressing judicial obstacles and vending machine sales are needed. We aimed to determine the relative effectiveness of an education intervention and a threat-of-enforcement intervention in reducing sales of cigarettes to under-age youth by randomly allocating 300 retailers in a nonmetropolitan region of New South Wales to: a control group with no intervention; a minimal-intervention group, which received an educational letter; and a maximal-intervention group, which received a threat of enforcement followed by a visit from a public health officer. Retailers were checked for compliance at pretest and post-test, six months apart, by twelve 18-year-olds who were judged by independent raters to look younger. The retailers were surveyed by telephone at both times for knowledge, attitudes and self-reported sales practices. Neither intervention achieved significant improvements for the two key behavioural outcomes: requiring proof of age and display of a warning sign. Neither was there an intervention effect on knowledge about the law. The greatest improvement in the proportion of retailers who believed that the legal age should be 18 or over was in the minimal-intervention group, and both intervention groups were less likely than the control group at post-test to think that it was acceptable to sell to a person who was nearly 18. There was poor overall compliance with the revised legislation at pre-test. The finding of a pretest-to-post-test improvement but no differential intervention effect highlights the methodological difficulties of such research. The interventions may, however, have been partly successful in modifying the attitudes of retailers. This article reports on the findings of a pre-test/post-test evaluation of the Compliance for Kids program carried out in three different communities. It demonstrates that it is indeed possible for a locally directed program to influence community standards of behaviour. It also suggests that in larger areas, such programs might better be implemented at the neighbourhood than at the city-wide level; and that merchants are influenced more by threat of enforcement than knowledge of laws. Such findings reinforce the need both for continued community programming and comprehensive legislation and enforcement. The current study explored the practicality of preventing underage retail cigarette sales and the relationship to cigarette supplies among adolescents.
                In Fort Morgan, Colorado, an isolated rural community with below-average socioeconomic status and a large Latino population, supervised teenaged employees repeatedly attempted to buy cigarettes from every store over a 9-month period in 2005. Repeated violations were penalized. Cigarette acquisition and exchange among community adolescents were assessed before and after intervention using a high school student survey.
                The measured violation rate declined from 47% in the first week to 3.4% during the final three months, and high school student reliance on retail cigarette purchases declined. Adolescent cigarette supplies declined by approximately 15%.
                Isolated rural communities can reduce adolescent cigarette supplies by conducting consistent enforcement against retail cigarette sales to minors. Previous research suggests that reducing these sales may help reduce adolescent smoking. The current study demonstrates that enforcement is practical and effective. To assess the effect that cigarette legislation would have on reducing merchant sales rates of cigarettes to minors and the affect on adolescent smoking behavior.
                Observational survey of merchant selling behaviors and adolescent smoking habits before and after passage of legislation.
                The setting for the merchant survey was Woodridge, Ill (population 25,200), a suburban community of Chicago. The surveys were distributed to adolescents in the local junior high school.
                Convenience sample of both merchants and adolescent students.
                Passage of community antismoking legislation.
                Percentage of stores selling cigarettes to minors in Woodridge and percentage of students who had experimented with cigarettes or were regular smokers.
                Merchant sales rates in Woodridge decreased from a baseline of 70% before legislation to less than 5% in 1.5 years of compliance checking after legislation. Student surveys showed that the rates of cigarette experimentation and regular use of cigarettes by adolescents were reduced by over 50%.
                Cigarette control laws can be effective in significantly reducing the rate of cigarettes sold by merchants and rates of cigarette use by adolescents. Key elements of successful legislation implementation are consistent compliance checking and heightened community awareness of the problems and prevalence of adolescent smoking. This study reports on an effort to stop the illegal sale of cigarettes to minors. In Santa Clara County, Calif, 412 stores and 30 vending machines were visited by 18 minors aged 14 through 16 years with the intent to purchase cigarettes; they were successful at 74% of the stores and 100% of the vending machines. After an aggressive six-month campaign using communitywide media, direct merchant education, contact with the chief executive officers of chain stores and franchise operations owned by major companies, and grassroots work with community organizations, the percentage of stores with illegal over-the-counter sale of cigarettes to minors was reduced to 39%. Sales from vending machines were not reduced. While much remains to be accomplished in stopping the illegal sale of tobacco to minors, data from this study illustrate that a well-designed community and merchant education campaign can significantly reduce such sales. Smoking prevalence among young people continues to rise and cigarettes are easily available from many shops. Test sales are used by trading standards departments to try to reduce under-age sales, but it is not known whether this has any real impact on cigarette purchase and consumption. This study aims to evaluate the impact of test sales on purchase and consumption of cigarettes by young people. A survey of two schools in Gateshead, one in the intervention area and one acting as a control was carried out. A series of test sales were targeted to shops within 1.5 km of the intervention school. A questionnaire was administered in both schools among year 10 pupils, age 14-15 years, prior to the intervention and again 1 year later. The outcomes measured were number of successful test sales, reported availability of cigarettes and change in smoking prevalence following the intervention. Some 224 pupils from both schools were surveyed in 1995 and 163 pupils from the new cohort of year 10 pupils in 1996. Prior to the intervention, the levels of regular smoking in the intervention school were 39% for girls and 26% for boys. In the control school these levels were 24% and 14%, respectively. The intervention by trading standards resulted in no purchases and hence no prosecutions, but children reported being able to buy cigarettes with ease from the nearby shops; only three (2.5%) reported sales refused in 1995 and five (5.8%) in 1996. Not surprisingly there was no significant change in smoking prevalence in either school in 1996. This study suggests that test sales may not be effective in modifying cigarette availability to young people and that they are not a reliable measure of access to cigarettes by children. Enforcement of legislation restricting retail access to tobacco is increasingly relied on to reduce adolescent smoking rates. In 1996, health authorities in the Northern Sydney Health Area began monitoring tobacco retailer compliance (PROOF program) with staged purchase attempts by adolescents below the legal age (18 years). Repeat cross-sectional surveys before (1995) and after (2000) the introduction of PROOF monitored changes in adolescent smoking behaviour. Students aged 12 to 17 years from 11 Northern Sydney metropolitan public secondary schools were surveyed for self-reported smoking and tobacco purchasing behavior in 1995 (n = 5,206) and 2000 (n = 4,120). Between 1996 and 2000, 545 retailer compliance checks found 34% unlawfully sold cigarettes to minors and 28% of these repeated the offence. Nine prosecutions resulted. Modelling revealed a significant association between the intervention and never having smoked (adjusted OR = 1.16, 95% CI = 1.01-1.33) although there was no significant association with being a current smoker. The odds of being a smoker were greater for students from coeducational schools, with this effect being modified by gender. There was no reduction in adolescent smoking with active enforcement of tobacco access laws despite an apparent increase in students who reported never to have smoked. The majority of adolescent smokers are able to purchase cigarettes even though laws prohibit the sale of cigarettes to minors (Radecki & Zdunich, 1993). The present study focused on merchant licensing, civil penalties, and monitoring of merchant behavior. Several different schedules of enforcement in the city of Chicago were evaluated to determine the optimal schedules to reduce the sale of cigarettes to minors in a major metropolitan area. Schedules of 2,4, and 6 months were effective in reducing illegal sales, from 86% to 19%, 87% to 34%, and 87% to 42%, respectively. In a control condition, illegal sales remained high (approximately 84%). Cigarette control laws that regularly enforce civil penalties for tobacco sales violations can successfully reduce minors' access to cigarettes. This study examined the changes in tobacco sales to minors after active enforcement of merchant compliance to the Synar regulation and the city of Philadelphia Youth Access to Tobacco Ordinance 732. Data for the present study were obtained through Tobacco-free Education and Action Coalition for Health (TEACH) Program in a 5-year, follow-up retail compliance check survey of 1649 stores in 14 cluster areas of Philadelphia, PA. Trend analysis was conducted ofthe sales of tobacco to minors by type of retail outlet, gender, and age of the buyer, and gender, age, and race of the store clerk, and whether restriction policy signs were posted. Analysis indicates that there was a reduction in tobacco sales to minors after implementation of enforcement; sales dropped from 85% in 1994 to 43% in 1998. There were less sales to minors when signs were posted. There were differences in sales if the buyer was asked his or her age and whether the minor was asked to show identification. In addition, the age of the buyer and the brand of cigarettes were associated with sales. Future research should focus on both commercial and social availability and provision of tobacco to minors. Smoking by adolescents has been identified as a major public health issue. Raising the legal age of cigarette purchase from 16 to 18 years has attempted to address the issue by restricting adolescents' access. METHODS/STRATEGY: A prospective study evaluating the impact of non-prosecutory enforcement of public health legislation involving 'beat police' was conducted in the Northern Sydney Health region. Secondary students, aged 12 to 17 years, from both intervention and control regions were surveyed about cigarette smoking habits by means of a self-completed questionnaire administered pre- and post-intervention.
                12,502 anonymous questionnaires were completed. At baseline, 19.3% of male students and 21.2% of female students indicated they were current smokers. Age and sex stratified chi-squared analysis revealed significantly lower post-intervention smoking prevalence for year 8 and 10 females and year 7 males among the intervention group. Higher post-intervention smoking prevalences were demonstrated for year 7 and 9 females and year 8 males among the intervention group and in year 10 males and year 11 females among the control group. The analysis of combined baseline and follow-up data from coeducational schools with logistic regression techniques demonstrated that the intervention had a significant effect in reducing smoking prevalence among year 7 students only (OR = 0.54).
                Our study demonstrates the difficulties in restricting high school students' access to cigarettes. Isolated non-prosecutory strategies are likely to only have a limited impact on reducing smoking prevalence among high school students. This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking.
                A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates.
                Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant.
                This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates. Most addictions to tobacco begin when a person is younger than age 18. Although the sale of tobacco to minors is illegal in most jurisdictions, there is often little enforcement of these laws, and minors can usually purchase tobacco easily. The impact of a local ordinance designed to prevent tobacco sales to minors was assessed by surveys of 10th grade students before and after the implementation of the ordinance. Tobacco use declined from 25.3 percent to 19.7 percent overall, with a significant (P = 0.004) decline from 26.4 percent to 11.5 percent among girls. There was also a significant (P = 0.008) increase from 29.3 percent to 61.5 percent in the proportion of students reporting they were asked for proof of age when they attempted to purchase tobacco. Local ordinances may be an effective tool for reducing tobacco use by adolescents. Policymakers, researchers, and citizens are beginning to recognize the need to limit minors' access to tobacco by restricting the sale of cigarettes through vending machines. One policy alternative that has been proposed by the tobacco industry is a requirement that vending machines be fitted with electronic locking devices. This study evaluates such a policy as enacted in St. Paul, Minn.
                A random sample of vending machine locations was selected for cigarette purchase attempts conducted before implementation and at 3 and 12 months postimplementation.
                The rate of noncompliance by merchants was 34% after 3 months and 30% after 1 year. The effect of the law was to reduce the ability of a minor to purchase cigarettes from locations originally selling cigarettes through vending machines from 86% at baseline to 36% at 3 months. The purchase rate at these locations rose to 48% at 1 year.
                Our results suggest that cigarette vending machine locking devices may not be as effective as vending machine bans and require additional enforcement to ensure compliance with the law. Enforcing laws banning tobacco sales to minors is widely advocated as a way to reduce young people's access to tobacco and tobacco use. Whether this approach is successful is not known.
                In a two-year controlled study, we assessed sales of tobacco to minors and young people's access to and use of tobacco in six Massachusetts communities. Three communities (the intervention group) enforced tobacco-sales laws, whereas three matched communities (the control group) did not. To assess compliance with the law, minors working for the study investigators attempted to purchase tobacco from all retail vendors in each community every six months. Three annual anonymous surveys of a total of 22,021 students in grades 9 through 12 (response rate, 84 percent) measured access to tobacco and smoking behavior.
                At base line, 68 percent of 487 vendors sold tobacco to minors. Compliance with the law improved significantly faster in the intervention communities than in the controls (P<0.001). By the study's end, 82 percent of the merchants in the intervention communities complied with the law, as compared with 45 percent in the control communities (P<0.001). However, adolescents under 18 years old reported only a small drop in their ability to purchase tobacco and no decline in its use. Communities with and those without enforcement programs did not differ with respect to these outcomes.
                Enforcing tobacco-sales laws improved merchants' compliance and reduced illegal sales to minors but did not alter adolescents' perceived access to tobacco or their smoking. Test purchases of tobacco do not accurately reflect adolescents' self-reported access to tobacco, and reducing illegal sales to less than 20 percent of attempts -- the goal of a new federal law-- may not decrease young people's access to or use of tobacco.
Interventions with retailers can lead to large decreases in the number of outlets selling tobacco to youths. However, few of the communities studied in this review achieved sustained levels of high compliance. This may explain why there is limited evidence for an effect of intervention on youth perception of ease of access to tobacco, and on smoking behaviour.