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Estimates of Retailers Willing to Sell Tobacco to Minors -- California, August-September 1995 and June-July 1996

The prevalence of tobacco use among adolescents is increasing, and the most common source of tobacco products for persons aged less than 18 years (minors) is retail stores (1). In 1991, an estimated 29.6 million packs of cigarettes were sold illegally to minors in California, and an estimated 255 million packs were sold illegally to minors nationwide (2). Federal law (i.e., the Synar Amendment *) enacted in July 1992 requires all states that receive federal funds for prevention and treatment of substance abuse to have and enforce laws prohibiting the sale or distribution of tobacco to minors, conduct annual statewide inspections of over-the-counter tobacco outlets and vending machines to assess the statewide rate of illegal tobacco sales to minors, and develop a plan to decrease the illegal sales rate to less than or equal to 20% over several years (3). On September 28, 1994, California enacted the Stop Tobacco Access to Kids Enforcement (STAKE) Act **, which requires that 1) tobacco retailers (i.e., vendors) post warning signs at each point of purchase and check the identification of persons who appear aged less than 18 years; 2) the California Department of Health Services (CDHS) develop a statewide enforcement program and establish a toll-free telephone number for reporting observed illegal tobacco sales to minors; and 3) CDHS annually assess and report the rate of illegal sales of tobacco products to minors. This report describes the retailer education and enforcement program and summarizes the results of the first two annual assessments (Youth Tobacco Purchase Surveys {YTPSs}). The findings indicate that, from August-September 1995 to June-July 1996, among over-the-counter tobacco outlets the percentage of retailers who asked for age identification increased substantially, the percentage of stores displaying warning signs on age restrictions increased, and the percentage of retailers willing to sell tobacco products to minors decreased. Education About and Enforcement of Youth Access Laws

In response to provisions of the STAKE Act, in August 1995 CDHS initiated an ongoing public and retailer education program before the enforcement of the law began on December 27, 1995. The education program consisted of an advertisement in a retail trade journal; a statewide press conference; paid radio and television commercials and billboard advertisements promoting a toll-free telephone number; a direct mailing of educational materials and warning signs to approximately 27,000 retailers; and educational materials provided to local government officials, retail trade groups, local health groups, chambers of commerce, and state legislators. In addition, 120 local and regional community organizations conducted educational, policy development, and media activities to stimulate compliance with youth access laws.

The STAKE Act requires that the CDHS statewide enforcement program include 15- and 16-year-old minors for unannounced inspections of tobacco retailers. Civil penalties of $200-$6000 can be levied against the business owner depending on the number of offenses during a 5-year period. During December 27, 1995-June 10, 1996 (the period before the second YTPS began), CDHS conducted 865 unannounced inspections in 22 of the state's 58 counties. As of December 16, 1996, fines totaling $65,550 had been paid by 258 business owners among the 286 who were in violation of the STAKE Act during December 27, 1995-June 10, 1996, and 28 business owners are involved in litigation or further administrative processing with CDHS. Youth Tobacco Purchase Surveys

The 1995 YTPS was the first state-representative random survey in California of illegal tobacco sales to minors and was conducted during August 2-September 7, 1995. A second YTPS was conducted during June 11-July 26, 1996, after initiation of the retailer education campaign and enforcement program. The YTPS methodology was designed to permit statistically valid statewide estimates and year-to-year comparisons of over-the-counter tobacco sales to minors. The California State Board of Equalization provided a list of businesses most likely to sell tobacco over the counter, including all convenience stores, gas stations, drug stores, liquor stores, supermarkets, and cigar stores in California. Using simple random sampling, sample sizes of 405 for 1995 and 434 for 1996 were obtained after eliminating stores that were no longer in business, were not tobacco outlets, could not be located (four in 1995 and 21 in 1996), or were considered unsafe by the survey teams (none in 1995 and nine in 1996). Odds ratios and p values were calculated for the change from 1995 to 1996. The odds ratios for asking age and/or for identification, presence of warning signs, and total sales were adjusted for store type.

Newspaper advertisements and contacts in local health departments, tobacco-control organizations, and community programs were used to recruit the 63 minors aged 15-16 years (including 31 males and 32 females) who participated in the 1995 YTPS and 67 minors aged 15-16 years (including 29 males and 38 females) who participated in the 1996 YTPS. The adult escorts included staff members from local tobacco-control organizations. Teams consisting of one or two adults and two minors made one purchase attempt per store using the following protocol: an adult escort entered the store immediately before or shortly after one of the minors entered the store. The adult observed the transaction between the retailer and the minor and noted age-restriction signs posted inside the store. The minors could choose either cigarettes or smokeless tobacco. If asked by retailers, the minors were required to truthfully state their age and that they carried no age identification. Retailers were considered to be willing to sell tobacco products to minors if they recorded a sale on a cash register or placed the tobacco on the counter and asked for money. Retailers who refused to sell tobacco to the minor for any reason were considered to be not willing to illegally sell tobacco to the minor. If the retailer was willing to sell tobacco to the minor, the minor stated that he or she did not have enough money and left the store.

Overall, the percentage of retailers willing to sell tobacco to minors decreased from the assessment period in 1995 (37.0%) to 1996 (29.3%) (adjusted odds ratio {AOR}, adjusted by type of store=0.7, p less than 0.05) (Table_1). Although sales to minors decreased in most types of stores, the decrease was statistically significant only for convenience stores selling gasoline (from 48.6% to 28.9%; odds ratio=0.4, p= less than 0.01). From 1995 to 1996, there were similar percentages of retailers willing to sell tobacco to minors when the retailer asked for identification (2.4% in 1995 compared with 3.5% in 1996) or when the retailer asked either the minor's age or for identification (4.4% in 1995 compared with 3.3% in 1996).

However, the percentage of stores in which retailers asked minors for identification increased from 41.7% to 53.5% (AOR, adjusted by type of store=1.6, p less than 0.05), and the percentage of stores in which the retailer asked either the minor's age or for identification increased from 61.7% to 70.3% (AOR=1.5, p less than 0.01). The percentage of stores that displayed age-of-sale warning signs increased from 32.6% to 63.8% (AOR=3.6, p less than 0.01).

Reported by: Z Weinbaum, PhD, V Quinn, MEd, A Roeseler, MSPH, V Foster, MPH, N Bagnato, MPH, M Johnson, PhD, DG Bal, MD, Tobacco Control Section; D Walsh, Food and Drug Br, California Dept of Health Svcs; R Kropp, MA, J Keller, MPH, North Bay Health Resources Center, Petaluma. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in this report are consistent with previous reports indicating that illegal sales to minors may be effectively decreased by the combination of increased merchant education and enforcement of laws prohibiting sales of tobacco to minors, and that the requirement of proof of age by retailers is associated with very low sales rates (4-7). In this report, sales were less likely in both years when age was asked and/or identification was requested and when warning signs were present.

The findings in this report are subject to at least two limitations. First, because comparable data are available for only 2 years, they may not indicate a trend. Second, because the STAKE Act required statewide implementation, an evaluation design using control communities was not possible, and further assessment is needed to examine the possible influences of other factors on the rate of illegal sales to minors.

The efforts of government and the private sector in California provide one model approach for reducing tobacco sales to minors. For example, the STAKE Act contains strengthening provisions that were not specifically required by the Synar Amendment. In addition, the STAKE Act was amended in 1995 to prohibit the sale of tobacco products from vending machines except those in bars not adjoining restaurants, while a different law *** bans the sale of individual cigarettes from open packages. Despite these efforts, the findings in this report indicate that, for 1996, one third of stores did not post warning signs, minors were not asked for proof of age identification in approximately half of stores, and retailers were willing to sell tobacco to minors in almost one third of purchase attempts.

On August 28, 1996, the Food and Drug Administration (FDA) issued regulations that prohibit sales of tobacco to persons aged less than 18 years, require retailers to request photographic identification to verify the age of all persons aged less than 27 years who request tobacco, ban vending machines and self-service displays except in facilities where only adults are permitted, ban sales of single cigarettes and packages with less than 20 cigarettes, and eliminate free samples of cigarettes and smokeless tobacco products (8). The effective date for the provisions prohibiting tobacco sales to minors and requiring photographic identification is February 28, 1997, and the effective date for the provisions affecting sales through vending machines, self-service displays, single cigarettes sales, and distribution of free samples is August 28, 1997. The FDA rule should further enhance state and local efforts to decrease illegal sales of tobacco to minors. In addition, the Substance Abuse and Mental Health Services Administration has developed technical-assistance guidelines addressing statewide sampling methodologies, inspections (i.e., compliance checks), and interventions; these guidelines can be used by states to develop programs that comply with requirements of the Synar Amendment (9).

References

  1. CDC. Tobacco use and usual source of cigarettes among high school students -- United States, 1995. MMWR 1996;45:413-8.

  2. Cummings KM, Pechacek T, Shopland D. The illegal sale of cigarettes to US minors: estimates by state. Am J Public Health 1994;84:300-2.

  3. Substance Abuse and Mental Health Services Administration. Final regulations to implement section 1926 of the Public Health Service Act regarding the sale and distribution of tobacco products to individuals under the age of 18. Federal Register 1996;13:1492-500.

  4. Feighery E, Altman DG, Shaffer G. The effects of combining education and enforcement to reduce tobacco sales to minors: a study of four northern California communities. JAMA 1991;266:3168-78.

  5. US Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.

  6. Landrine H, Klonoff EA, Alcaraz R. Asking age identification may decrease minors' access to tobacco. Prev Med 1996;25:301-6.

  7. DiFranza JR, Savageau JA, Aisquith BF. Youth access to tobacco: the effects of age, gender, vending machine locks, and "It's the Law" programs. Am J Public Health 1996;86:221-4.

  8. Food and Drug Administration. Regulations restricting the sale and distribution of cigarettes and smokeless tobacco products to protect children and adolescents: final rule. Federal Register 1996;61:41,314-75.

  9. Substance Abuse and Mental Health Services Administration. Synar regulation guidance series: sampling, inspection, and change strategies. Rockville, Maryland: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, 1996.

* Public Law 102-321, section 1926 of the Public Health Service Act (42 USC section 300x-26).

** Stop Tobacco Access to Kids Enforcement (STAKE) Act: SB1927, September 28, 1994. California Business and Professional Code, Sections 22950-9.

*** California Penal Code, Section 308.2.




Table_1
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TABLE 1. Number and percentage of store visits and number and percentage of retailers willing to sell tobacco products to minors *, by category and year, August-September 1995 and June-July
1996, and percentage point change from 1995 to 1996 of retailers willing to sell tobacco to minors -- California
==============================================================================================================================================================================================
                                                       1995                                                          1996
                                 -----------------------------------------------------------   --------------------------------------------------------

                                      Store                          Retailers                     Store                        Retailers                               % Point change
                                      visits                         willing to                    visits                    willing to sell                             from 1995 to
                                                                    sell tobacco                                                  tobacco                                   1996
                                 ----------------           --------------------------------    --------------            ----------------------------        --------------------------------
Category                          No.         (%)             No.        (%)    p value +       No.       (%)              No.        (%)   p value +               %       OR &   p value @
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Type of store
  Drug store/pharmacy              36     (  8.9)               8     (22.2)                     31   (  7.1)                7     (22.6)                      + 0.4       1.0          NS **
  Gas/convenience                  70     ( 17.3)              34     (48.6)       <0.05        121   ( 27.9)               35     (28.9)         NS           -19.7       0.4       <0.01
  Gas station only                 19     (  4.7)               9     (47.4)                     11   (  2.5)                5     (45.5)                      - 1.9       0.9          NS
  Liquor store                     61     ( 15.1)              27     (44.3)                     77   ( 17.7)               27     (35.1)                      - 9.2       0.7          NS
  Small grocery/convenience       133     ( 32.8)              49     (36.8)                    141   ( 32.5)               42     (29.8)                      - 7.0       0.7          NS
  Supermarket                      69     ( 17.0)              17     (24.6)                     45   ( 10.4)                9     (20.0)                      - 4.6       0.8          NS
  Other ++                         17     (  4.2)               6     (35.3)                      8   (  1.8)                2     (25.0)                      -10.3       0.6          NS

Clerk asked age
  No                              301     ( 74.3)             143     (47.5)       <0.05        337   ( 77.7)              124     (36.8)      <0.05           -10.7       0.6       <0.01
  Yes                             104     ( 25.7)               7     ( 6.7)                     97   ( 22.4)                3     ( 3.1)                      - 3.1       0.5          NS

Clerk asked for identification
  No                              236     ( 58.3)             146     (61.9)       <0.05        202   ( 46.5)              119     (58.9)      <0.05           - 3.0       0.9          NS
  Yes                             169     ( 41.7)               4     ( 2.4)                    232   ( 53.5)                8     ( 3.5)                      + 1.1       1.5          NS

Clerk asked age
 or for identification
  No                              155     ( 38.3)             139     (89.7)       <0.05        129   ( 29.7)              117     (90.7)      <0.05           + 1.0       1.1          NS
  Yes                             250     ( 61.7)              11     ( 4.4)                    305   ( 70.3)               10     ( 3.3)                      - 1.1       0.7          NS

Warning signs in the store
  No                              273     ( 67.4)             115     (42.1)       <0.05        157   ( 36.2)               69     (44.0)      <0.05           + 1.9       1.0          NS
  Yes                             132     ( 32.6)              35     (26.5)                    277   ( 63.8)               58     (20.9)                      - 5.6       0.7          NS

Total                             405     (100.0)             150     (37.0)                    434   (100.0)              127     (29.3)                      - 8.2       0.7       <0.05
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
*  Persons aged <18 years.
+  Tests for the difference within the same year in the number of retailers willing to sell tobacco to minors between store types, whether or not retailer asked for age and/or
   identification, and presence or absence of warning signs.
&  Odds ratio (OR) for change in number of retailers willing to sell tobacco to minors from 1995 to 1996. OR for asking age and/or asking for identidication, presence of warning
   signs, and total number of retailers willing to sell tobacco to minors were adjusted for store type.
@  Tests for the difference from 1995 to 1996 in the number of retailers willing to sell tobacco to minors.
** Not significant.
++ Includes other store types listed by the California State Board of Equalization as selling tobacco products (e.g., gift stores and cigar stores).
==============================================================================================================================================================================================

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