State laws to keep tobacco products out of the hands of minors have prevented many people, particularly women, from becoming smokers well into adulthood, NIDA-supported researchers have found. Dr. Richard Grucza and colleagues at Washington University Medical School estimated that 4 such policies, when implemented together, could reduce smoking prevalence by 14 percent among 18- to 34-year-old women. The policies are:
- Banning cigarette vending machines or restricting their placement to sites with limited youth access
- Requiring vendors to request ID confirmation of legal purchasing age before selling tobacco products to anyone who appears to be under 21 years old
- Prohibiting the sale of cigarettes singly or in packages of less than 20
- Forbidding the distribution of free sample cigarettes
Dr. Grucza says that his team’s study provides the strongest evidence to date for maintaining or extending policies to restrict youth access to tobacco. The results accord with other evidence that delaying drug use past adolescence can often permanently deter tobacco use.
Pursuant to an Act of Congress
From 1990 to 2002, most states implemented new policies aimed at preventing youth under age 18 from buying tobacco. Much of this legislative activity occurred in response to Congress’ 1992 passage of the Synar Amendment to the Federal Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act. That amendment tied states’ eligibility for some Federal block grant funding to their efforts to prohibit youths under age 18 from buying tobacco products.
States varied in the specific policies they chose, and in their pace of implementation (see Figure). Dr. Grucza and colleagues examined the impact of 9 of the most frequently adopted laws (see full list).
The study participants were 100,000 men and women who were born between 1973 and 1986 and responded to the 1998‒2007 iterations of a nationwide survey on smoking (the Tobacco Use Supplement of the Current Population Survey). The eldest of these individuals turned 18 in 1992, before most of the laws came into effect, and were 34 years old when they responded to the 2007 survey. The youngest turned 18 in 2002, and so were affected by all the laws passed in their respective states during the period studied.
The researchers matched each participant’s smoking behaviors with the set of policies to which he or she had been exposed at age 17. They then compared smoking rates among those who had been affected by each policy to smoking rates among those who had not.
Figure. States Implemented Youth Access to Tobacco Prevention Policies at Different Rates By clicking either of these images, you can see how many states in a given year had adopted the 9 policies to reduce youth access to tobacco.
After you click the image of the map, use the dropdown menus to choose a year and a policy to see which states had adopted that policy at that time.
After you click the image of the line graph, use the dropdown boxes to customize your view. You can choose to see data related to all of the policies at once; or, unclick "All" and choose individual policies. You also can customize the date, from 1991 to 2006.
Text Description of Graphic
Dr. Grucza and colleagues’ analysis of the data found that 4 policies correlated with reduced prevalence of smoking among women. Restricting the placement of vending machines and requiring young-looking purchasers to show identification both were associated with reductions in the odds that a woman ever smoked, was a current smoker, or currently smoked heavily (11 or more cigarettes per day). Also, among women, outlawing sample cigarette giveaways was associated with lower odds of ever smoking, and prohibiting the sale of cigarettes other than in their original packaging appeared to reduce current smoking.
The researchers estimated that a woman’s odds of ever having smoked fell 3.6 points for each one of these 4 policies that was in effect in her state when she was 17 years old. Compared to women in states with none of the policies, women whose states had implemented all 4 had 14 percent lower odds of ever having smoked, and 16 percent lower odds of being current smokers. Those who did smoke were 29 percent less likely to smoke heavily.
Dr. Grucza and colleagues hypothesized that the 5 remaining policies might make differences that were individually too small for their analysis to capture, but cumulatively significant. To explore this possibility, they examined the relationship between the number of policies a woman was exposed to at age 17 and her odds of smoking. The results were consistent with the hypothesis that many or all of the 9 policies contributed small effects.
Dr. Grucza says that the success of the policies in reducing smoking among women is especially important. While the Nation’s overall smoking rate has declined in recent decades, the decline among women has lagged behind that among men.
A Gender Gap
In contrast to the findings among women, only 1 youth tobacco restriction policy appeared to definitely affect men’s smoking: Requiring sellers to post warning signs stating the age requirement for buying tobacco was associated with a significant reduction in the odds that a man who smoked would smoke heavily. According to the researchers, the data do not rule out the possibility that the other policies that were studied reduce men’s smoking, but show that their main effect is on women’s smoking.
Dr. Grucza and colleagues suggest that one factor underlying the gender difference is that when restrictions are absent, adolescent girls have an easier time buying tobacco products than boys do. If this is so—and studies have suggested that it is—girls’ access has further to fall, compared to boys’, when states impose restrictions.
Further, Dr. Grucza speculates, “By restricting access for people under age 18, we’ve probably made it a lot harder for 14- and 15-year-olds to get cigarettes. Some surveys suggest that girls age 15 and younger actually have higher rates of smoking than boys. If that’s correct, then these laws would prevent more very young girls than very young boys from obtaining cigarettes. At ages 16 and 17, boys smoke at higher rates than girls, so more boys might be affected by the laws. However, by this age teens have established peer networks that probably make the laws less effective at restricting access.
“Moreover, earlier smoking initiation correlates with greater risk of addiction. For that reason, keeping cigarettes from 14- and 15-year-old girls will reduce their lifetime smoking more than keeping cigarettes from 16- and 17-year-old boys will reduce their lifetime smoking.”
More of a Good Thing
The presence of youth tobacco restriction policies nationwide was strengthened in 2010, when the Food and Drug Administration began to mandate adoption of several policies, including bans and restrictions on vending machines, prohibiting distribution of free samples, and repackaging restrictions. Nevertheless, Dr. Grucza notes, more than one-third of states still have not implemented one of the strongest policies, requiring tobacco vendors to ask for identification from underage-appearing customers.
Although it will be difficult for research to distinguish the effects of these policies from effects stemming from other ongoing changes in smoking policies nationwide, Dr. Grucza believes that an important question will be whether sources of cigarettes for underage youth change. “Studies need to ask where kids are getting their cigarettes now. And we need to design policies that restrict these methods too,” he says.
Dr. Aria Crump of NIDA’s Prevention Research Branch believes that the researchers’ suggestion that young girls have an easier time buying tobacco may be a key to understanding how the policies produce their effects. “It is incredibly important that we understand what the impact of these policies is,” she says.
“The policy landscape is always shifting, so there will always be questions regarding the impact,” Dr. Crump notes. For example, she believes that the study results raise questions about whether other approaches may be needed to have a significant impact on the incidence of heavy smoking among people who smoke. The impact of the policies studied “is modest but meaningful,” Dr. Crump concludes. “This work shows that policy is an important part of a multifaceted approach to smoking prevention.”
Nine Policies To Restrict Youth Access to Tobacco
- Signage: Requirements that retailers post a warning sign about minimum age for buying tobacco products
- Vending machine restrictions: Bans or location restrictions on cigarette machines
- Inspection requirements: Random inspections of retailers to ensure compliance with youth access laws
- Graduated penalties: A series of increasingly steep fines on retailers who violate youth access laws
- Identification requirements: Requirements for retailers to request identification from people who appear to be age 21 or younger
- Repackaging restrictions: Restrictions on the sale of single cigarettes or small, inexpensive packages of cigarettes
- Statewide enforcement authority for tobacco sales
- Free distribution restrictions: Bans on free samples of tobacco products
- Clerk intervention requirements: Requirements that a clerk retrieve tobacco products for customers instead of allowing customers to take them off shelves themselves
This study was supported by NIH grants: DA025733, DA021237, CA089392, CA89392, AA017444, DA026911, DA031288, DA032843, DA0269112, DA031288, DA026612, DA0266, DA007313, and DA07313.
Grucza, R.A. et al. Long-term effects of laws governing youth access to tobacco. American Journal of Public Health 103(8):1493-1499, 2013. Abstract