Joseph R. DiFranza MD

AGE - As youths grow older it becomes progressively easier for them to buy tobacco.

• Altman DG, Foster V, Rasenick-Douss L. Tye JB. Reducing the illegal sale of cigarettes to minors. JAMA 1989; 261:80-83
  
• Forster JL, Hourigan M, McGovern P. Availability of cigarettes to underage youth in three communities. Prevent Med 1992;21:320-328.
  
• Wakefield M, Carrangis J, Wilson D, Reynolds C. Illegal cigarette sales to children in South Australia. Tobacco Control 1992;1:114-117.
  
• Andrews B, McKay E, Hahn A, Stephenson J. Cigarette sales to juveniles: retailer compliance in Dubbo, NSW. Health Promot J Australia. 1994;4(1):13- 17.
  
  

Gender- Several authors report that girls have less difficulty buying tobacco than do boys.

• Altman DG, Foster V, Rasenick-Douss L, Tye JB. Reducing the illegal sale of cigarettes to minors. JAMA 1989;261:80-83.
  
• Forster JL, Hourigan M, McGovern P. Availability of cigarettes to underage youth in three communities. Prevent Med 1992;21:320-328.
  
• Wakefield M,Carrangis J. Wilson D, Reynolds C. Illegal cigarette sales to children in South australia. Tobacco Control 1992;1:114-117.
  
• Erickson AD, Woodruff SI, Wildey MB, Kenney E. A baseline assessment of cigarette sales to minors in San Diego County, California. J Commun Health1993;18(4):213-224.
  

Others have not found gender differences.

• Skrethny MT, Cummings M, Sciandra R, Marshall J. An intervention to reduce the sale of cigarettes to minors. NY State J Med 1990;90:54-55.
  
• Centers for Disease Control. Minors' access to tobacco-Missouri, 1992, and Texas, 1993. MMWR 1993;42(7):125-128
  
  

...or have found girls to be more successful in some comparisons but not others.

• Altman DG, Rasenick-Douss L. Foster V, Tye JB. Sustained effects of an educational program to reduce sales of cigarettes to minros. Am J Public Health 1991;81:891-893.
  
• Keay KD, Woodruff SI, Wildey M, Kenney EM. Effect of a retailer intervention on cigarette sales to minors in San Diego County, California. Tobacco Control 1993;2:145-151.
  
• Cismoski J. Sheridan M. Availability of cigarettes to under-age youth in Fond du Lac, Wisconsin. Wis Med J. 1993;92 (11):626-630.
  

Type of retailer-Youths have consistently had more success purchasing cigarettes from vending machines than from OTC sources.

• Altman DG, Foster V, Rasenick-Douss L, Tye JB. Reudcing the illegal sale of cigarettes to minors. JAMA 1989;261:80-83.
  
• Hoppock KC, Houston, TP. Availability of tobacco products to minors. J Fam Pract. 1990;30:174-176.
  
• Forster JL, Hourigan M, McGovern P. Availaibility of cigarettes to underage youth in threee communities. Prevent Med 1992;21:320-328.
  
• Wakefield M, Carrangis J. Wilson D, Reym\nolds C. Illegal cigarette sales to children in South Australia. Tobacco Control 1992;1:114-117.
  
• Cismoski J, Sheridan M. Availaibility of cigarettes to under-age youth in fond du Lac, Wisconsin. Wis Med J. 1993;92(11):626-630.
  

Locks on vending machines-Only one study has evaluated the effectiveness of lock-out devices in preventing illegal sales. Three months after a local law requiring lock-out dvices an all mchines went into force, a minor was able to purchase tobacco from 19% of vending machines equipped with locks compared to 65% of machines without locks. One year later in the same community, minors were able to purchase from 39% of mahcines with locks compared to 91% of those without locks.

• Forster JL, Hourigan ME, Kelder S. Locking devices on cigarette vending machines: evaluation of city ordinance. Am J Public Health 1992;82:1217-1219.
  

It's the Law program-The only previous evaluation of the effectiveness of the "It's the Law" program was conducted in Massachusetts in 1991. Only seven of the 156 retailers visited were participating in these programs (4.5%). Six of the seven participating merchants were willing to sell tobacco to a minor (86%), compared to 88% of the 149 who were not participating.

• DiFranza JR, Brown LJ. The Tobacco Institute's "It's the Law" compaign, has it halted illegal sales of tobacco to children? Am J Public Health. 1992;82:1271-1273
  

METHODOLOGY

Six boys and six girls ages 12, 13, 14, 15, 16 and 17 made 480 attempts to purchase tobacco from 40 matched pairs of OTC retailers and vending machines. Some vending machines had lock-out devices. Half the vendors were participating in "It's the Law" programs.

RESULTS

The overall success rate was 33%. You might conclude that 67% of the merchants obeyed the law. But in fact, out of the six opportunities to sell, only 28% of vendors never sold, 23% sold once, 16% sold twice, 9% sold three times, 13% sold four times, 6% sold five tiems, and 6% sold at every opportunity. Conclusion: most vendors break the law on some occasions and not others. A single round of compliance checks cannot be used to divide merchants into those who do, or do not, sell tobacco to minors.

Girls and boys both made 240 attempts to purchase tobacco. Girls were successful in 37% of attempts compared to 28% of attempts for boys (p>0.05). This persisted as a trend when controlled for how old the youths appeared. Conclusion: complaince rates will likely be slightly lower when girls are used exclusively.

The youths were rated to determine their apparent age. 280 attempts to purchase were made by youths appearing less than 16 and 200 were made by youths appearing 16 or older. The more youthful appearing youths were successful 25% of the time compared to 48% of the time for the older appearing youths (p<0.001). Conclusion: the age of the youth can have a daramatic impact on compliance rates. Although the age of 16 was the apparent cut-off point in this study, it could well be higher or lower in other locales depending on the level of law enforcement.

Attempts to purchase were made 138 times from over-the-counter sources and 138 times from vending machines without locks located in the smae cities. Youths were successful in 25% of attempts to purchase OTC and 62% of attempts to purchase from vending machines (p<0.001). Conclusion: vending machines without locks are more accessible to minors.