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A Gadget Can't Fix What's Wrong With the
Tobacco Distribution System
DiFranza, Joseph R
WHEN the commercial availability of tobacco to youth is effectively
restricted, their use of tobacco drops substantially (1-3).
Consequently, the sale of tobacco to minors has been outlawed in all
50 states and in many other countries. Enforcement of such laws is
occurring to some degree in every state, and national surveys show
youth smoking rates declining steadily for the past several years (4).
However, the full public health benefit of access restrictions has not
been realized, since minors are successful in about 1 out of 5
attempts to purchase tobacco, according to state surveys (5).
States have invested heavily in merchant education. Such programs
seek to convince store owners of the importance of complying with the
law. Responsible retailers have instituted training programs for their
employees. Sales clerks are taught the specifics of the law and are
trained to challenge customers for proof of age. The tobacco
manufacturers have stepped in to provide free signage and
date-of-birth calendars to assist clerks in identifying underage
customers. Compliance with the law is encouraged through enforcement
inspections that employ minors as shoppers. Despite these efforts,
clerks continue to sell to minors at unacceptably high rates.
Many clerks find it difficult to determine, based on a claimed date
of birth, whether a customer has reached the legal age limit. Faced
with the task of performing the mental arithmetic, many clerks simply
fake it and sell tobacco to anyone who can produce an ID. This leads
to the paradoxical observation that youths are more likely to be sold
tobacco if they hand the clerk an ID that proves that they are
underage than if they produce no ID at all.
To eliminate the need for such calculations, many states have
incorporated age verification aids into the design of their drivers'
licenses. Underage status may be indicated by different colors,
borders, text, and photo or text orientation. Those changes cost
states next to nothing to implement, but their effectiveness has not
been evaluated.
The study by Krevor et al. in this issue is the first to evaluate a
technological fix for the problem of age verification. Electronic age
verification devices offer a high-tech cure for math anxiety and ID
authenticity. Clerks simply have to swipe the ID through the card
reader, and the microprocessor will tell them whether or not to make
the sale. Approval of the devices by customers and clerks was high,
but they had no impact on the rate of age verification. Although the
devices worked as intended, the clerks simply did not use them
consistently enough to reduce the rate of inappropriate sales. The
critical factor was not how well the age verification devices
performed their job, but how well the clerks performed theirs. While
we should continue to do everything we can to reduce the opportunity
for human error, in the end the level of tobacco sales to minors will
always depend on how consistently clerks obey the law.
One approach to influencing retail clerk behavior is to penalize
clerks for their illegal sales. However, to hold clerks solely
responsible for illegal sales may be unfair, because store-owners
enjoy the profits from illegal sales and are responsible for training
and supervising their employees. On the other hand, underage clerks
have told me that they often disregard their training and written
store policies. Perhaps the fairest and most effective approach may be
to penalize both the clerk and the owner. However, the effectiveness
of various penalty strategies has not been evaluated.
Some might argue that current rates of illegal sales to minors are
just something we have to accept as an intractable problem, since
various enforcement mechanisms have not been effective at
significantly reducing such sales. However, all current efforts to
curtail illegal sales amount to little more than tinkering around with
the edges of a distribution system that was originally designed to
remove all restrictions on the availability of tobacco products,
making them available anywhere, anytime. The epitome of that
distribution system was the cigarette vending machine that for years
sat in our hospital lobby. Removal of such vending machines was
bitterly fought by the tobacco industry, yet in the end that access
point was removed. If the tobacco industry is unable to bring itself
into compliance with the retail sales laws, it would likewise be
appropriate for the public health community to consider new and more
effective policies that would create a distribution system for tobacco
products designed to better block their availability to minors.
In the current system, the final sales decision falls on the clerk.
The clerks have poor pay and little or no benefits, and they last an
average of only 88 days on the job, staying only until they are fired
or find a better situation. Under those circumstances, clerks may have
little personal or career motivation to play the role of public health
agent. Yet we entrust the sale of a product, that is the most common
preventable cause of death in the developed world, to people who are
at or very near the bottom rung of the corporate ladder.
Tobacco sales, and the welfare of our children, are too important
to be entrusted to such a weak link. Consider the outrage that would
ensue if 1 of 5 prescriptions were dispensed incorrectly. But at the
cash register in the front of the pharmacy, you would likely find that
1 of 5 minors were sold tobacco. This double standard is unacceptable.
The same professionalism that is applied to the sale of prescription
drugs should be applied to the sale of age-restricted products like
tobacco.
The lack of professionalism is highlighted by the fact that in
almost all states, children who are themselves too young to purchase
tobacco products are entrusted with the responsibility of selling
them. The result is that those minors often supply their friends and
acquaintances with tobacco right under the noses of their supervisors
(6). The first step in professionalizing the sale of tobacco would be
to eliminate the loophole that allows high school students to sell
tobacco. Although many 18-year-olds graduate from high school and
enter the work world, a minimum age of 21 should be set for tobacco
sales personnel, as is required by most states in alcohol sales.
Licensing of tobacco clerks would be the next step in
professionalizing tobacco sales. All drivers must pass both written
and performance exams before getting behind the wheel alone. Tobacco
sales clerks should have to pass written and performance exams to
become licensed to get behind the tobacco counter. A tobacco-seller's
license could be suspended or revoked if violations occur, weeding out
incompetent, careless or scofflaw clerks from future employment in
selling tobacco.
Another approach to professionalizing tobacco sales would be to
require the tobacco companies to restrict the distribution of their
products to corporately licensed dealerships, following the model of
the automobile industry. The manufacturers would be accountable for
training and monitoring their dealerships. Manufacturers, who reap the
profits from cigarette sales, would bear the burden of ensuring
compliance of their dealerships. That is an approach that the Food and
Drug Administration could require if granted the authority to regulate
tobacco products.
To the extent that geographical density of tobacco sources impacts
on the effectiveness of access restrictions, reducing the density of
retail outlets might further contribute to reducing availability to
minors. If a community needs only one hospital, does it really need
150 tobacco retailers? Communities limit the number of liquor licenses
that they issue; the same policy could be extended to tobacco
licensing. There could be a moratorium on the issuing of new tobacco
licenses until the number of outlets is deemed appropriate for the
community. Having fewer outlets would reduce the burden and expense of
conducting enforcement inspections. Perhaps the sale of tobacco should
be limited to a few tobacconist shops, where tobacco and smoking
paraphernalia are the only products sold, and minors are denied entry.
Those few shops could be more easily and closely monitored by law
enforcement officials.
If all else fails, the sale of tobacco could be restricted to
state-owned facilities, as is the case in many states with the sale of
hard liquor. Well-paid and well-trained career professionals could
sell tobacco, with the understanding that the prevention of sales to
minors is the most important aspect of their job. Historically,
however, potential resistance to the establishment of state-owned
liquor stores was probably reduced by the preceding transitional
period, called Prohibition. So, despite the appeal of having all
tobacco sales under tight governmental control, achieving such a goal
may not be politically feasible, given the political clout of the
tobacco retailers.
Given the financial and political interests invested in the current
tobacco distribution system, our initial efforts should continue to be
to work within the current system to curtail the illegal sale of
tobacco to minors. However, if the current system cannot meet the
challenge, we should not give up or settle for mediocre compliance.
Instead, we should start thinking outside the box. The box is a
distribution system that was designed to maximize the availability of
tobacco. Future policies may need to reshape the tobacco distribution
system into one that increases accountability and minimizes the
illegal sale of tobacco to minors, while allowing tobacco
manufacturers and their adult customers to conduct business.
REFERENCES
1. Forster JL, Murray DM, Wolfson M, Blaine TM, Wagenaar AC,
Hennrikus DJ. The effects of community policies to reduce youth access
to tobacco. Am. J. Pub. Health: 88 (1998): 1193-1198.
2. Jason LA, Katz R, Vavra J, Schnopp-Wyatt DL, Talbot B. Long term
follow-up of youth access laws' impact on smoking prevalence. Journal
of Human Behavior in the Social Environment (1999); 2:1-13.
3. Tutt D, Bauer L, Edwards C, Cook D. Reducing adolescent smoking
rates. Maintaining high retail compliance results in substantial
improvements. Health Promotion journal of Australia (2000); 10:20-24.
4. Johnston LD, O'Malley PM, Bachman JG. (December 16, 2002). Teen
smoking declines sharply in 2002, more than offsetting large increases
in the early 1990s. University of Michigan News and Information
Services: Ann Arbor, MI.[On-line]. accessed 08/11/02, Available:
www.monitoringthefuture.org.
5. Substance Abuse and Mental Health Services Administration,
Center for Substance Abuse Prevention, Department of Health and Human
Services. State Synar Non-Compliance Rate Table, FFY 1997-FFY 2002.
[On-line]. Available: http://prevention.samhsa.gov/tobacco/o1synartable.asp6.
6. DiFranza JR, Coleman M. Sources of tobacco for youths in
communities with vigorous enforcement of tobacco sales laws. Tobacco
Control (2001); 10:323-328.
This article can be found online at:
http://www.findarticles.com/p/articles/mi_qa4020/is_200301/ai_n9205496
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