A National Survey of Public Support for Restrictions on Youth Access to Tobacco

Article excerpt

Despite 30 years of publicity about the health consequences of smoking, following publication of the first Surgeon General's report on smoking and health,[1] and a substantial decline in overall smoking rates since 1964,[2] cigarette smoking still is a causative factor in about one in six deaths per year in the U.S. (about 434,000).[3] Further, nearly one-third of U.S. adults continue to smoke cigarettes.[4]

Despite extensive education and information campaigns, each year more than 1 million Americans begin smoking cigarettes (about 3,000 people per day).[4] Most new smokers are children and adolescents -- nearly 75% of current smokers began smoking before age 18.[2] In 1989, almost 1 billion packs of cigarettes were sold to persons younger than age 18.[5] Any long-term reduction in smoking prevalence must include a strategy for reducing the number of children and adolescents who begin smoking each year. In Healthy People 2000,[6] the U.S. Public Health Service established national health objectives to reduce tobacco use by youth (Objective 3.5), enact and enforce state laws against sales and distribution of tobacco products to youth (Objective 3.13), and to eliminate or severely restrict all forms of tobacco product advertising and promotion to which youth are exposed (Objective 3.15).

In addition to concerns about the direct health consequences of tobacco use, cigarette smoking also has been identified as a risk factor for the abuse of alcohol and other drugs by children and adolescents.[7-9] As a means of reducing this risk, in 1992, the U.S. Congress enacted the so-called "Synar amendment" to the authorization act providing block grant funding to states for alcohol and other drug abuse prevention and treatment programs, requiring states to enact and enforce laws restricting youth access to tobacco.[10] In response to the legislation, the Substance Abuse and Mental Health Services Administration (SAMHSA) proposed strict rules to require enforcement monitoring, including a regular system of "sting'; operations to test vendor compliance with the state laws.[11] The "Synar amendment" requirements caused extensive policymaking debate at the state level, with policymakers expressing concern over public support for strict restrictions on youth access to tobacco.[12]

Despite increasing public attention to problems associated with youth access to tobacco, ample evidence indicates 70% to 100% of minors attempting to purchase cigarettes have little trouble doing SO.[5,13-16] Despite state laws, now in effect in 49 of 50 states, that restrict sales to those younger than age 18,[11] enforcement of those laws is ineffective or non-existent in most communities.[5,13-16] In 1990, the U.S. Dept. of Health and Human Services endorsed a model law for states and local communities that would restrict minors' access to tobacco products.[17] The model law would (1) create a system of licensing retail vendors of tobacco, similar to the system used to license alcoholic beverage vendors, (2) use civil penalties and administrative sanctions to reduce impact on the criminal court system, (3) impose a graduated system of penalties, including fines and license suspensions, (4) set a minimum age of 19 for purchase of tobacco products, and (5) ban cigarette vending machines.[17]

Additional proposals to reduce tobacco use by minors include restrictions on advertising and promotion of tobacco products aimed at youth,[6] and removal of profits from underage sales through taxation or assessments. Empirical evidence suggests tobacco advertising has a disproportionate influence on children and adolescents, and may directly influence brand purchasing decisions. Cigarette excise taxes decrease demand for cigarettes, especially among youth.[22-25] Price increases in the cost of cigarettes can reduce demand by minors for cigarettes by up to 40%.[22-25]

Strict enforcement of existing laws restricting sales to minors, and implementation of licensing systems that are enforced, also can have a dramatic impact on youth access to tobacco. …