Illegal tobacco sales to minors
continue despite enforcement of laws
Federal standards prove inadequate
BOSTON October 8, 1997 Keeping teenagers from buying cigarettes may be more difficult than expected, according to a new study, published in the October 9 New England Journal of Medicine. The study, done by researchers from the Massachusetts General Hospital (MGH) and the University of Massachusetts Medical Center, found that even when 80 percent of merchants were obeying a law prohibiting tobacco sales to minors, youths reported that they had little trouble buying cigarettes. The findings suggest that keeping merchants from illegally selling tobacco to youths will require even more vigorous enforcement of the laws prohibiting tobacco sales to minors.
According to current federal law, states are required to curtail the illegal sale of tobacco to minors in order to be eligible for block grants from the Department of Health and Human Services. The federal government wants states to enforce the law with enough vigor to ensure that at least 80 percent of merchants are obeying the law. However, when that standard was met in three Massachusetts communities, the youths in those communities reported that it was still easy to buy tobacco from merchants. The new study suggests that new federal efforts aimed at reducing teen smoking, including the Food and Drug Administration regulations banning tobacco sales to minors nationwide that became effective on February 28, 1997, will require achieving a high level of compliance if they are to succeed in lowering youth smoking.
The study, which was supported through a grant from The Robert Wood Johnson Foundation,* was conducted by a team of researchers led by Nancy Rigotti, MD, director of Tobacco Research and Treatment at the MGH. The study involved six Massachusetts communities and surveys of over 7,000 high-school age youths. During the study's two years (1994-1996), officials in three of the six communities studied enforced the laws banning the sale of tobacco to minors by sending underage youths serving as decoys into stores to buy tobacco. This was not done in the other three communities. As the study progressed, the rate of illegal sales by merchants declined dramatically in the communities that enforced the law, but youths living in those communities reported that they rarely had trouble buying tobacco, and their smoking rates did not decrease.
"We suspect that some merchants didn't stop selling tobacco to children," said Rigotti, "they simply learned to spot which young people were testing them for compliance." Underage youths doing the inspections were not allowed to lie about their age, dress to look older or ask older people to buy cigarettes for them, as typical youths might do.
"We had several merchants tell our youths that they would be happy to sell them cigarettes if they would simply say that they were 18 years old," added Joseph DiFranza, MD, associate professor of family and community medicine at the University of Massachusetts and a study co-author. "Several clerks told our decoys that they could only sell cigarettes to kids that they knew."
According to Rigotti, "It appears that some merchants have learned to 'game' the system, to continue to sell tobacco illegally to their regular customers without getting caught." Another factor seems to be that underage smokers learn which merchants will sell them tobacco, and they return to the same store day after day. "It only takes one dishonest merchant to supply an entire school system with tobacco," said DiFranza. "In some communities underage youths are taking jobs in convenience stores to be able to supply their friends with tobacco."
"In previous studies, teen smoking has fallen in communities where more vigorous enforcement of the law curtailed the illegal sale of tobacco," said Rigotti. "Unfortunately, our study found that a compliance rate of 80 percent leaves too many places where youths can buy tobacco, and therefore it had no effect on the number of youths who were using tobacco in these communities."
Rigotti's and DiFranza's suggestions for improving compliance with the law include using as inspectors kids who act more like "real" kids, using older kids, increasing the frequency of inspections, making sure that clerks check identification properly, providing stiffer penalties for illegal sales, fining store clerks as well as store owners and prohibiting minors from selling tobacco.
The other study authors are YuChiao Chang, Ph.D., Thelma Tisdale, R.N., M.P.H., Becky Kemp, and Daniel E. Singer, M.D.
The Massachusetts General Hospital, established in 1811, is the oldest and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with a 1996 research budget of $197 million and major research centers in the neurosciences, cardiovascular research, cancer, cutaneous biology, transplantation biology and photomedicine. In 1994, the MGH joined with Brigham and Womens Hospital (BWH) to form Partners HealthCare System, Inc., which now also includes the North Shore Health System.
Contact Sue McGreevey in the MGH Public Affairs Office.
* Note to Editors: For more information on policy research in the areas of tobacco, alcohol and illegal drugs supported by the Robert Wood Johnson Foundation (RWJF), please contact Joe Marx or Joan Hollendonner at RWJF, (609) 243-5937, Ellen Wilson at Burness Communications, (301) 652-1558, or visit the RWJF website http://www.rwjf.org and look for the new Media Resource Guide on Tobacco, available October 9.
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