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Accessibility to Minors of Smokeless Tobacco Products -- Broward County, Florida, March-June 1996

Health consequences associated with use of smokeless tobacco (SLT) (i.e., snuff or loose-leaf or fine-cut chewing tobacco) products include halitosis, leukoplakia, and oral cancer (1). Periodontal degeneration and soft tissue lesions are early indicators of these conditions and diseases among persons who use SLT (1). Since October 1992, the sale of tobacco products to minors (i.e., persons aged less than 18 years) has been prohibited by law in Florida, and since May 1994, Florida law has required businesses to post warning signs stating that tobacco sales to minors are illegal and that proof of age is required to purchase tobacco products such as SLT. * To assess the impact of these laws on over-the-counter access to SLT by minors in Broward County (1990 population: 1,244,531), during March-June 1996 faculty from Florida Atlantic University's Department of Exercise Science/Wellness Education conducted a study to measure vendor compliance with tobacco minimum-age sale laws and with the sign statute. This report summarizes the findings of the assessments, which indicated that nearly one third of attempts by minors to purchase SLT products were successful.

The 1995-1996 Beverage License File maintained by the Florida Department of Business and Professional Regulation (DBPR) was used to identify five categories of businesses in the county: pharmacies, convenience stores, grocery stores, gas stations, and "smoke shops" (i.e., businesses where the predominant merchandise is tobacco or tobacco-related products) (n=1211). A map of the county was divided into 10 equally sized areas; within each of these areas, approximately 20% of the businesses were randomly selected to produce a total sample of 242 businesses. Of these 242, a total of 117 were excluded: they were not surveyed because of time constraints (67), were inaccurately surveyed (37), did not sell SLT (eight), or had closed (five). The remaining 125 businesses represented 10% of the 1211 county total and comprised 33 (13%) of the 246 pharmacies, 20 (8%) of the 268 convenience stores, 25 (7%) of the 381 grocery stores, 41 (14%) of the 297 gas stations, and six (32%) of the 19 smoke shops. The assessment employed five teams of volunteers, each comprising one minor and one adult; two of the minors were female (both aged 15 years), and three were male (one each aged 15, 16, and 17 years).

One purchase attempt was made at each of the 125 businesses. Purchase attempts used the following procedure (2): the adult member of the team entered the business first to note the presence of any clearly displayed signs stating that tobacco products would not be sold to minors. The adult then observed while the minor entered, selected an SLT product, and attempted to purchase the product. The attempt was considered successful if a sale was recorded on the cash register or the vendor placed the SLT product on the counter for purchase by the minor; the minor would then state that he or she had insufficient money for purchase and would immediately leave the store. The attempt also was considered successful if the vendor asked for age identification but was prepared to sell the SLT product. ** The attempt was considered unsuccessful if the minor was denied purchase outright or asked for age verification and denied purchase. The adult member noted the vendor's reasons for refusal at the time of attempted purchase; when no refusal reason was provided to the minor, the adult team member waited until the minor had departed and then asked the vendor about the reason for refusal.

Overall, minors were successful in purchasing SLT in 40 (32%) of 125 retail outlets (Table_1); of these successful purchase attempts, 14 (35%) occurred within one half mile of an elementary, middle, or high school. Success rates were similar among those aged less than 17 years and aged 17 years (34% {95% confidence interval (CI)=plus or minus 17.7%} versus 20% {95% CI=plus or minus 40.0%}, respectively), and among males and females (25 {33% (95% CI=plus or minus 21.2%)} of 75 attempts versus 15 {30% (95% CI=plus or minus 25.5%)} of 50 attempts, respectively). For each of the five categories of stores that sold SLT, attempts were successful at 10 (30% {95% CI=plus or minus 31.4%}) pharmacies, 17 (85% {95% CI=plus or minus 31.4%}) convenience stores, three (12% {95% CI=plus or minus 25.5%}) grocery stores, nine (22% {95% CI=plus or minus 25.5%}) gas stations, and one (17% {95% CI=plus or minus 59.6%}) smoke shop. Warning signs provided by the DBPR were posted and clearly visible in 96 (77%) of the 125 stores; 17 of these stores had signs provided by tobacco companies. Success rates were similar in businesses with and without signs (30 {31% (95% CI=plus or minus 18.4%)} of 96 versus 10 {35% (95% CI=plus or minus 34.5%)} of 29, respectively).

Single reasons specified by the vendors for 51 of the 85 unsuccessful attempts were that the minor had no proper identification (40 {47%}), the minor appeared to be underaged (nine {11%}), and that the sale of tobacco products to minors was illegal (two {2%}). Multiple reasons specified by the vendors for 34 unsuccessful attempts were that the sale of tobacco products to minors was illegal and the minor had no proper identification (11 {13%}), that the store had a policy prohibiting sales to minors and that the minor had no proper identification (eight {9%}), that the store had a policy prohibiting sales to minors and that the minor looked too young (six {7%}), and other reasons (nine {11%}).

Reported by: FS Bridges, EdD, Dept of Health, Leisure and Sports, The Univ of West Florida, Pensacola; BS Graves, EdD, Dept of Health Sciences, Florida Atlantic Univ, Davie, Florida.

Editorial Note

Editorial Note: In 1994, a report issued by the Surgeon General indicated that approximately 20% of high school males were current users of SLT products (1). In 1993, approximately one half of minors aged 12-17 years who had used SLT during the previous month usually purchased their own SLT; of those who usually purchased their own SLT, most (82%) often or sometimes bought from small businesses such as convenience stores (3). The success rate for minors in Broward County in attempts to purchase SLT (32%) was higher than that previously reported in Kansas (15%), similar to that reported in Palm Beach County, Florida (35%), and lower than that reported in Texas (59%) (2,4,5).

In this assessment and in previous reports (2,4), minors mimicked (i.e., attempted but did not complete) over-the-counter purchase of SLT; this method has been validated as an accurate measure of vendor compliance with tobacco minimum-age sale laws (6). However, the findings in this report are subject to at least two limitations. First, data were obtained from the files of the DBPR for only five types of businesses because they were most likely to sell SLT. However, businesses included in the analysis probably do not differ from businesses in other categories that were excluded. Second, 28% of the selected sample was not surveyed because of time constraints. Whether purchasing SLT at businesses that were not surveyed would have been more difficult could not be determined.

The Synar Amendment and implementing regulations require all states receiving federal funds to prevent and treat substance abuse to enact and enforce a law prohibiting the sale or distribution of tobacco to persons aged less than 18 years and to reduce the statewide illegal sales rate to less than or equal to 20% over several years *** (7). The findings of the assessment in this report may further assist tobacco-use-prevention coalitions and other organizations in developing approaches to educate parents and the public about the need to support enforcement of existing local, state, and federal laws restricting the sale of SLT and other tobacco products to minors.

References

  1. 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.

  2. Hoppock KC, Houston TP. Availability of tobacco products to minors. J Fam Pract 1990;30:174-6.

  3. CDC. Accessibility of tobacco products to youths aged 12-17 years -- United States, 1989 and 1993. MMWR 1996;45:125-30.

  4. CDC. Minors' access to smokeless tobacco -- Florida, 1994. MMWR 1995;44:839-41.

  5. CDC. Minors' access to tobacco -- Missouri, 1992, and Texas, 1993. MMWR 1993;42:125-8.

  6. Cummings KM, Saunders-Martin T, Clarke H, Perla J. Monitoring vendor compliance with tobacco sales laws: payment vs no payment approaches. Am J Public Health 1996;86:750-1.

  7. 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.

* Florida Revised Statutes 859.06-859.061.

** During one successful purchase attempt, the adult/minor team determined that although the minor stated that he did not have age identification, the vendor was prepared to sell the SLT product based on his placement of the SLT product on the counter and attempt to record the sale on the cash register.

*** Public Law 102-321, *** 1926 (42 USC *** 300x-26).


+------------------------------------------------------------------- ------+ |             | | Erratum: Vol. 45, No. 49 | |             | | SOURCE: MMWR 45(50);1106 DATE: Dec 20, 1996 | |             | | In the article "Accessibility to Minors of Smokeless Tobacco | | Products -- Broward County, Florida, March-June 1996" (page 1079), | | the confidence intervals (CIs) for the findings presented in the | | text and Table 1 were incorrect. Below is Table_1E with the | | corrected CIs; CIs in the text should have matched those presented | | in this table. | |             | +------------------------------------------------------------------- ------+




Table_1
Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Number of attempts and number and percentage of successful attempts
by minors * to purchase smokeless tobacco, + by category -- Broward County,
Florida, March-June 1996
==============================================================================
                                                Successful attemps
                                           -----------------------------
        Category    No. attempts             No.       (%)  (95% CI &)
------------------------------------------------------------------------------
       Age (yrs)
             <17           110                37    (33.6)  (+/-17.7%)
              17            15                 3    (20.0)  (+/-40.0%)

    Sex of minor
            Male            75                25    (33.3)  (+/-21.2%)
          Female            50                15    (30.0)  (+/-25.5%)

   Type of store
        Pharmacy            33                10    (30.3)  (+/-31.4%)
     Convenience            20                17    (85.0)  (+/-31.4%)
         Grocery            25                 3    (12.0)  (+/-25.5%)
             Gas            41                 9    (22.0)  (+/-25.5%)
    Smoke shops @            6                 1    (16.7)  (+/-59.6%)

    Warning sign
             Yes            96                30    (31.2)  (+/-18.4%)
              No            29                10    (34.5)  (+/-34.5%)

           Total           125                40    (32.0)  (+/-16.5%)

------------------------------------------------------------------------------
* Persons aged <18 years.
+ Snuff or loose-leaf or fine-cut chewing tobacco.
& Confidence interval.
@ Businesses where the predominant merchandise is tobacco or tobacco related
  products.
==============================================================================

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Table_1E
Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Number of attempts and number and percentage of successful attempts
by minors * to purchase smokeless tobacco, + by category -- Broward County,
Florida, March-June 1996
========================================================================================
                                     Successful attempts
                      No.        ---------------------------
Category            attempts     No.    (%)     (95% CI &)
------------------------------------------------------------
Age (yrs)
  <17                 110        37    (33.6)  (24.9%-43.3%)
  17                   15         3    (20.0)  ( 4.3%-48.1%)

Sex of minor
  Male                 75        25    (33.3)  (22.9%-45.2%)
  Female               50        15    (30.0)  (17.9%-44.6%)

Type of store
  Pharmacy             33        10    (30.3)  (15.6%-48.7%)
  Convenience          20        17    (85.0)  (62.1%-96.8%)
  Grocery              25         3    (12.0)  ( 2.5%-31.2%)
  Gas                  41         9    (22.0)  (10.6%-37.6%)
  Smoke shops @         6         1    (16.7)  ( 0.4%-64.1%)

Warning sign
  Yes                  96        30    (31.3)  (22.2%-41.5%)
  No                   29        10    (34.5)  (17.9%-54.3%)

Total                 125        40    (32.0)  (23.9%-40.9%)
------------------------------------------------------------
* Persons aged <18 years.
+ Snuff or loose-leaf or fine-cut chewing tobacco.
& Confidence interval.
@ Businesses where the predominant merchandise is tobacco or tobacco-related products.
========================================================================================

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