SUMMARY. In response to the prevalence of tobacco use by minors, policy makers have sought more effective ways to use public policy to reduce tobacco use initiation and consumption and to promote smoking cessation. While various tools are available for assessing tobacco control laws, they are limited by a narrow focus on retail sales and omit many components of a comprehensive, ecological approach to tobacco control. This article presents a measure for rating laws designed to control youth access to tobacco. The measure evaluates components of laws pertaining to retailer licensing, tobacco sales to minors and compliance with sales 16laws, distribution and location of tobacco products, and youth possession of tobacco. Data are presented that indicate the measure can detect differences in the comprehensiveness of tobacco control laws and that it is a reliable measure. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <[email protected]> Website: <https://www.HaworthPress.com" xmlns:xlink="https://www.w3.org/1999/xlink">https://www.HaworthPress.com> © 2002 by The Haworth Press, lnc. All rights reserved.]
Tobacco use by minors is a pervasive societal problem in the United States with significant health and economic consequences to both the individuals affected and the public. Recent population estimates indicate that each day in the United States 4,800 youth try smoking for the first time and almost 3,000 more become established smokers (Gilpin, Choice, Berry, & Pierce, 1999). In response to the prevalence of tobacco use by minors, policy makers have sought more effective ways to use public policy in reducing tobacco use initiation and consumption and to promote smoking cessation. The power of policy stems from its environmental approach that allows for relatively small changes in legislation and enforcement behavior to have a large public health impact (Jason, Biglan, & Katz, 1998). Therefore, policy initiatives for tobacco control are proposed to be immediate, inexpensive and powerful ways to impact adolescent tobacco use. One of the controversial issues in the regulation of tobacco use is the balance between individuals' freedom to use tobacco legally with society's obligation to limit the usage of lethal products (Jacobson, Wassermen, & Anderson, 1997). Fortunately, there is strong public support among both smokers and nonsmokers for the implementation and enforcement of laws that restrict youth access to tobacco (Jeffrey et al., 1990).
There is evidence that tobacco control legislation is an effective way to impact the smoking behavior of youth. A longitudinal, statewide study conducted in Massachusetts found that youth living in towns with local tobacco legislation were less likely to become established smokers than youth living in towns without a local ordinance (Siegel, Biener, & Rigotti, 1999). Additionally, a study in Minnesota assisted communities in an intervention group in developing local tobacco control ordinances and found that while both the intervention and control communities showed an increase in youth smoking, communities with local or17dinances showed a significantly lower net prevalence of youth smoking (Forster et al., 1998). Four broad policy areas that may be important for tobacco control are the licensing of tobacco retailers, tobacco sales to minors and compliance with sales laws, the distribution and location of tobacco products, and youth possession of tobacco. Each of these areas is discussed below.
Retailer licenses are a process by which a municipality requires the annual renewal of a paid license for all retailers who sell tobacco products, whether over-the-counter or through a vending machine. Suspension or revocation of a license, even temporarily, can result in a greater impact on retailer revenues than even a moderate fine, thereby creating a more substantial incentive for retailers to implement policies and procedures to minimize illegal tobacco sales in their places of business. Additionally, the cost of annual renewal of licenses can help to fund the municipality's tobacco sales enforcement operations. Therefore, even if no retailer is fined for illegally selling tobacco to a minor, the municipality is still ensured an annual source of revenue for funding compliance checks. Additionally, by limiting the number of licenses available, the municipality can reduce the availability and visibility of tobacco in the community. Retailer licensing has been shown to be an important component in reducing cigarette sales rates to minors to a minimal level and in reducing cigarette experimentation and regular smoking among youth (Jason, Ji, Anes, & Birkhead, 1991; Jason, Berk, Schnopp-Wyatt, & Talbot, 1999).
A comprehensive approach to limiting tobacco sales to minors extends beyond prohibiting the sale of tobacco products to persons under the age of 18 years and includes six aspects of sales to minors. First, the prohibition of the sale of tobacco products to persons under the age of 18 years can deter current smoking and intent to smoke among minors (Lewit, Hyland, Kerrebrock, & Cummings, 1997) Second, setting the minimum legal age to purchase tobacco at 18 years allows for the prosecution of minors who attempt to purchase tobacco. Third, in light of evidence that retailers who request age or photo identification make fewer illegal tobacco sales to minors (Arday et al., 1997; Curie, Pokorny, Jason, Schoeny, & Townsend, 2002; DiFranza, Savageua, & Aisquit, 1996), requiring merchants to request photo identification for customers who appear younger than 21 years of age can decrease the likelihood of illegal sales based on mistaken age assessments. Fourth, the prohibition against persons under the age of 18 years from misrepresenting their age or using any false or altered identification for the purpose of purchasing tobacco products can decrease the likelihood of retailers be18ing deceived about a customer's age. Fifth, requiring the posting of warning signs regarding sales to minors at the point of sale of tobacco products serves as a public reminder to both retailers and customers of the sales laws. Finally, allowing for the publication of the names of outlets that make illegal sales to minors can increase parental awareness of where youth may go to purchase tobacco and stimulate public pressure on retailers that illegally sell tobacco and public reinforcement for those retailers who do not.
In addition to prohibitions and requirements related to tobacco sales to minors, enforcement of the sales laws is necessary for reducing the sales rate to minors (Gemson et al., 1998; Rigotti et al., 1997). There are five issues related to enforcement of the minimum age of sales laws. First, the designation of a local agency that is primarily responsible for the enforcement of the law banning sales to minors can eliminate bureaucratic complications regarding enforcement responsibilities. Second, the requirement of annual, random, unannounced inspections of over-the-counter and vending machine tobacco sales can ensure that retailers will undergo a minimum number of inspections. Typically, these inspections are conducted with the assistance of underage youth who are paid to attempt to purchase tobacco under the supervision of the enforcement agency. Third, allowing for the owners or licensees to be held accountable for the actions of their employees can provide additional incentive for people in management positions to train their employees in how to avoid illegal sales and to implement procedures that reduce the likelihood of illegal sales. Fourth, the establishment of civil penalties (e.g., fines, license suspensions, etc.) rather than criminal penalties for those who violate the sales laws can increase the rate of enforcement since civil penalties generally require fewer prosecutorial resources and are usually met with less opposition from the community. The final provision involves the use of a graduated system of fines and license suspensions or revocations for retailers that sell tobacco products to minors and allows for greater accountability for repeat offenders.
In considering the mode of distribution and the location of tobacco products in stores, there are six issues pertaining to youth access to tobacco. First, the prohibition against persons under the age of 18 years from selling tobacco products is an attempt to reduce the pressure on teenage employees to sell tobacco to their peers who may exploit the peer relationship in attempting to purchase tobacco. Second, the ban on the sale of tobacco products within a specified distance from schools, child care facilities, or other educational/recreational facilities used by 19minors is aimed at reducing the amount youth are exposed to tobacco advertising and to make retail tobacco less accessible to youth. Third, limitations on tobacco/cigarette vending machines are a response to the easy access presented by vending machines. The most effective deterrent to youth access is a ban on all vending machines, regardless of location or locking device; however, the presence of a lock on vending machines presents at least a nominal deterrent (DiFranza et al., 1996; Forster et al., 1992). Fourth, the prohibition on the sale of tobacco products by self-service displays and the requirement that all tobacco products be kept in a locked case are associated with lower illegal sales rates to minors (Widley, Woodruff, Pamplone, & Conway, 1995) and can reduce the physical access to tobacco that facilitates shoplifting. DiFranza, Eddy, Brown, Ryan, and Bogojavlensky (1994) found that as many as 50 percent of young smokers admit to shoplifting tobacco at least once, and they suggest that shoplifting may become more prevalent as it becomes more difficult for youth to purchase tobacco. Fifth, the prohibition of the sale of cigarettes individually or in packages of less than 20 cigarettes and the ban on the distribution of free tobacco samples, coupons for free tobacco samples, or rebates (Lewit et al., 1997) can reduce the economic accommodation of youths' limited financial resources that these small size sales represent. The final provision provides for the ban on tobacco look-alike products (e.g., candy cigarettes, chewing gum packaged like chewing tobacco, etc.) and is an effort to reduce early reinforcement of tobacco use behavior among youth, including young children.
Penalizing youth for possessing tobacco is a controversial issue in which the tobacco industry is usually found in favor of such penalties and anti-tobacco advocates are usually found opposed to such penalties because of a perception that they relieve the industry of responsibility for youth smoking. Based on previous research (Jason et al., 1991; Jason et al., 1999), it is hypothesized that communities that actively enforce youth possession laws will show a greater reduction in youth tobacco use than communities that only enforce minimum age of sales laws due to a deterrent effect of the possession laws on experimental tobacco use.
While various tools are available for assessing tobacco control laws (Alciati et al., 1998; Klonoff et al., 1998), they are limited by a narrow focus on retail sales and the omission of many of the issues identified above. The measure developed by Alciati et al. (1998) assesses how extensive state laws are in reducing youth access to tobacco by rating tobacco control laws on nine items: minimum age of sales, packaging, 20clerk intervention, photo identification, vending machines, free distributions, graduated penalties, random inspections, and statewide enforcement. With the exception of statewide enforcement, these items can also be used to assess municipal ordinances. For each item, a target was specified that reflected public health objectives and ratings were completed based on the extent to which the target was met or exceeded. Ratings ranged from five ("exceeds target") to zero ("no effective provision").
While the simplicity of the measure facilitates ease of implementation, the lack of more specificity in the measure is a challenge when assessing a large number of statutes that lack uniformity. Additionally, the measure omits any assessment of the following tobacco control provisions: retailer licensing system, limitations on the number of tobacco outlets, establishing the minimum age to purchase tobacco at 18 years or older, prohibitions against minors misrepresenting their age or using false or altered identification for the purpose of purchasing tobacco, the publication of the names of retailers that make illegal sales to minors, allowing for the owner or licensee to be held accountable for the actions of employees, prohibitions against minors selling tobacco products, requirements that tobacco products be kept in a locked case, prohibitions against tobacco look-alike products, and any provisions concerning youth possession of tobacco.
The Assessment of the Comprehensiveness of Tobacco Laws Scale (Act-L Scale) developed by Klonoff et al. (1998) assesses tobacco control laws on 55 items. The Act-L Scale is divided into three subscales: environmental tobacco smoke, tobacco advertising and promotion, and youth access to tobacco. Each item is treated as a dichotomous variable with raters indicating that a law either does or does not contain specific provisions for tobacco control. The number of items included in the statute are summed to yield a score out of a possible total of 55 points. Statutes with a higher score are considered to be more comprehensive than statutes with a lower score. This measure is particularly useful to municipalities since it was developed to be used by individuals who have no prior training in the law or in tobacco control issues. With appropriate training on how to use the scale, raters should be able to rate statutes with a high degree of reliability.
While youth access subscale of the ACT-L Scale is more comprehensive than Alciati et al.'s measure, it also omits numerous provisions, including: requiring retailers to request photographic identification for customers who appear younger than the age of 21 years, prohibiting minors from misrepresenting their age or using any false or altered identi21fication for the purpose of purchasing tobacco, allowing for the owner or licensee to be held accountable for the actions of employees, prohibiting minors from selling tobacco, and any provisions concerning youth possession of tobacco.
In an effort to assist communities in controlling youth access to tobacco, a research group at DePaul University developed a measure for assessing the comprehensiveness of both state and municipal tobacco control laws. For over 12 years, the research group has been investigating methods of reducing youth access to tobacco at a community level (Jason et al., 1991; Jason et al., 1999). The current project is the Youth Tobacco Access Project (YTAP), which is a three-year, randomized trial, multi-community intervention designed to examine the effectiveness of both sales and possession enforcement strategies in reducing youth access to tobacco. Across both experimental and control communities, the project assumes an active intervention component. In response to community requests for assistance in strengthening their local tobacco control ordinances, the research team developed a measure for assessing the comprehensiveness of tobacco control laws that identifies the components of tobacco control policy that need to be added to an existing law in order to have a larger impact on youth behavior. The present study presents the measure for evaluating laws designed to control youth access to tobacco and analyzes inter-rater reliability for the measure.