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Restrict minor access to tobacco

Health Factors: Tobacco Use
Decision Makers: Businesses & Employers, Community Organizations, Government - Local, Government - State, Government - Federal
Evidence Rating: Some Evidence
Population Reach: 1-9% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Mechanisms to restrict minors' access to tobacco products include active enforcement of laws prohibiting sales of tobacco to youth, retailer education about laws and strategies for preventing illegal sales, penalties for youth who possess, use, or purchase tobacco (PUP laws), and community education about youth access to tobacco.

Expected Beneficial Outcomes

Reduced youth smoking
Reduced smoking uptake by youth
Reduced illegal sales to youth

Evidence of Effectiveness

There is some evidence that laws restricting minors' access to tobacco, when enforced, reduce youth smoking (Richardson 2009, Jason 2008, Chen 2006, DiFranza 2009, Tutt 2009, Levinson 2007), most notably for younger youth (Richardson 2009, Thomas 2008). Additional evidence is needed to confirm effects.

Multi-component interventions that include merchant and community education, regular inspections, vending machine bans or locks, and penalties for vendors who sell to minors have been shown to reduce illegal tobacco sales (Richardson 2009). Programs that reduce youth tobacco access can also decrease youth smoking (Chen 2006, Tutt 2009, Levinson 2007, Jason 2008, DiFranza 2009).

Community-based interventions (Chen 2006), interventions primarily penalizing vendors (Levinson 2007), and interventions penalizing youth violators (Jason 2008) have all been shown to reduce youth smoking in certain circumstances. Voluntary or weakly enforced restrictions, however, are unlikely to reduce smoking (Cochrane-Stead 2005, Main 2008).

Available research shows enforcement costs ranging from $16 per retailer per year (DiFranza 2001) to $16.55 per store contact (Levinson 2007).  

Implementation Examples

United States

Penalties for vendors who sell tobacco to youth range from $0 to $1500. Most states may also penalize youth for purchasing or possessing tobacco (CDC-STATE).

Wisconsin

Minors may not purchase or possess tobacco in Wisconsin (CDC-STATE). Retailers who violate this law may be fined up to $500. Currently, at least 5% of Wisconsin vendors sell tobacco to minors.  Wisconsin Wins is a comprehensive state program that uses positive reinforcement to reduce tobacco sales to minors (WI DHS-Tobacco). Some Wisconsin school districts such as Barron and Fond du Lac have implemented programs that educate the community and empower youth to conduct monitored stings at stores that sell tobacco (WI DPI-Wisconsin success stories). 

Implementation Resources

CDC-STATE - Centers for Disease Control and Prevention (CDC). State tobacco activities tracking and evaluation (STATE) system. Accessed on June 15, 2012
Webpage: http://apps.nccd.cdc.gov/statesystem/Default/Default.aspx

Citations - Evidence

Chen 2006* - Chen V, Forster JL. The long-term effect of local policies to restrict retail sale of tobacco to youth. Nicotine & Tobacco Research. 2006;8(3):371-7. Accessed on June 19, 2012
Webpage: http://ntr.oxfordjournals.org/content/8/3/371.short
Cochrane-Stead 2005* - Stead L, Lancaster T. Interventions for preventing tobacco sales to minors. Cochrane Database of Systematic Reviews. 2005;(1):CD001497. Accessed on June 19, 2012
Webpage: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001497.pub2/abstract?systemMessage=Wiley+Online+Library+will+be+disrupted+4+Feb+from+10-12+GMT+for+monthly+maintenance
DiFranza 2001* - DiFranza JR, Peck RM, Radecki TE, Savageau JA. What is the potential cost-fffectiveness of enforcing a prohibition on the sale of tobacco to minors? Preventive Medicine. 2001;32(2):168-74. Accessed on June 23, 2012
Webpage: http://www.sciencedirect.com/science/article/pii/S0091743500907953
DiFranza 2009 - DiFranza JR, Savageau JA, Fletcher KE. Enforcement of underage sales laws as a predictor of daily smoking among adolescents - A national study. BMC Public Health. 2009;9(107). Accessed on June 19, 2012
Webpage: http://www.biomedcentral.com/content/pdf/1471-2458-9-107.pdf
Jason 2008 - Jason L, Pokorny SB, Adams M. A randomized trial evaluating tobacco possession-use-purchase laws in the USA. Social Science & Medicine. 2008;67(11):1700-7. Accessed on June 20, 2012
Webpage: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169299/
Levinson 2007* - Levinson AH, Mickiewicz T. Reducing underage cigarette sales in an isolated community: The effect on adolescent cigarette supplies. Preventive Medicine. 2007;45(6):447-53. Accessed on June 20, 2012
Webpage: http://www.ncbi.nlm.nih.gov/pubmed/17804046
Main 2008 - Main C, Thomas S, Ogilvie D, et al. Population tobacco control interventions and their effects on social inequalities in smoking: Placing an equity lens on existing systematic reviews. BMC Public Health. 2008;8(178). Accessed on June 19, 2012
Webpage: http://www.biomedcentral.com/content/pdf/1471-2458-8-178.pdf
Richardson 2009* - Richardson L, Hemsing N, Greaves L, et al. Preventing smoking in young people: A systematic review of the impact of access interventions. International Journal of Environmental Research and Public Health. 2009;6(4):1485-514. Accessed on June 20, 2012
Webpage: http://www.mdpi.com/1660-4601/6/4/1485
Thomas 2008 - Thomas S, Fayter D, Misso K, et al. Population tobacco control interventions and their effects on social inequalities in smoking: Systematic review. Tobacco Control. 2008;17(4):230-7. Accessed on June 19, 2012
Webpage: http://tobaccocontrol.bmj.com/content/17/4/230.short
Tutt 2009* - Tutt D, Bauer L, Difranza J. Restricting the retail supply of tobacco to minors. Journal of Public Health Policy. 2009;30(1):68-82. Accessed on June 20, 2012
Webpage: http://www.ncbi.nlm.nih.gov/pubmed/19367302

Citations - Implementation Examples

CDC-STATE - Centers for Disease Control and Prevention (CDC). State tobacco activities tracking and evaluation (STATE) system. Accessed on June 15, 2012
Webpage: http://apps.nccd.cdc.gov/statesystem/Default/Default.aspx
WI DHS-Tobacco - Wisconsin Department of Health Services (DHS). Wisconsin tobacco prevention & control program. Accessed on June 20, 2012
Webpage: http://www.dhs.wisconsin.gov/tobacco/
WI DPI-Wisconsin success stories - Wisconsin Department of Public Instruction (DPI). Wisconsin success stories: Tobacco free youth. Madison: Wisconsin Department of Public Instruction (DPI); 2005. Accessed on January 16, 2013
Webpage: http://sspw.dpi.wi.gov/sspw_tobaccoprog

* Journal subscription may be required for access.

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Health Factors

Health Behaviors
Tobacco Use
Diet & Exercise
Alcohol Use
Sexual Activity
 Clinical Care
Access to Care
Quality of Care
 Social & Economic Factors
Education
Employment
Income
Family & Social Support
Community Safety
 Physical Environment
Environmental Quality
Built Environment

Decision Makers

Businesses & Employers
Community Organizations
Government - Local
Government - State
Government - Federal
Healthcare Organizations
Individuals
Schools

Evidence Rating

Level of effectiveness based on a scan of academic literature and key recommendations of leading organizations.

  • Scientifically Supported Numerous studies or systematic review(s) with positive results
  • Some Evidence Research suggests positive impacts; further study may be warranted
  • Expert Opinion Recommended by credible groups*; research evidence limited
  • Insufficient Evidence Evidence limited or unavailable; further study warranted
  • Mixed Evidence Evidence mixed; further study warranted
  • Evidence of Ineffectiveness Research consistently shows program is detrimental or has no effect

Although many policies and programs are recommended by credible groups, we apply the rating ‘expert opinion’ only when policies are recommended but limited scientific evidence of effectiveness is available.

* The American Heritage Dictionary defines credible as 'capable of being believed; plausible.' and 'worthy of confidence; reliable.' To be considered an 'expert recommendation,' policies and programs must be recommended by one or more organizations that are recognized for their impartial expertise in the area of interest and have limited evidence available.

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Population Reach

Portion of Wisconsin's population likely to be reached by a policy or program if implemented statewide, based on its characteristics (e.g., target population(s), geographic limitations, and potential implementers).

<1%   20-49%
1-9%   50-99%
10-19%   100%

Potential Impact on Health Disparities

Likely impact of a given policy or program on racial/ethnic, socioeconomic, geographic or other disparities in Wisconsin based on its characteristics (e.g., target audience, mode of delivery, etc.) and best available evidence related to disparities.

  • Likely to decrease disparities
  • No impact on disparities likely
  • Likely to increase disparities