A systematic review of interventions for preventing tobacco sales to minors.
OBJECTIVE
To assess the effectiveness of interventions to reduce underage access to tobacco by deterring shopkeepers from making illegal sales.


METHODS
Systematic literature review.


METHODS
The Cochrane Tobacco Addiction group specialised register and Medline. Studies of interventions to alter retailer behaviour were identified. The terms used for searching combined terms for smoking and tobacco use with terms for minors, children or young people, and retailers, sales or commerce.


METHODS
Studies in which there was an intervention with retailers of tobacco, either through education about, or enforcement of, local ordinances. The outcomes were changes in retailer compliance with legislation (assessed by test purchasing), changes in young people's perceived ease of access to tobacco products, and changes in smoking behaviour. Controlled studies with or without random allocation of retail outlets or communities, and uncontrolled studies with pre- and post intervention assessment, were included.


METHODS
Two reviewers assessed studies for inclusion. One extracted data with checking by the second.


RESULTS
The results were synthesised qualitatively, with greater weight given to controlled studies. Thirteen of 27 included studies used controls.


RESULTS
Giving retailers information was less effective in reducing illegal sales than active enforcement and/or multicomponent educational strategies. No strategy achieved complete, sustained compliance. In three controlled trials, there was little effect of intervention on youth perceptions of access or prevalence of smoking.


CONCLUSIONS
Interventions with retailers can lead to large decreases in the number of outlets selling tobacco to youths. However, few of the communities studied in this review achieved sustained levels of high compliance. This may explain why there is limited evidence for an effect of intervention on youth perception of ease of access to tobacco, and on smoking behaviour.
Stead
L F
LF
Imperial Cancer Research Fund General Practice Research Group, Department of Primary Health Care, University of Oxford, UK. lindsay.stead@dphpc.ox.ac.uk
Lancaster
T
T
D000293:Adolescent; D002648:Child; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D008297:Male; D015397:Program Evaluation; D012907:Smoking / Q000331:legislation & jurisprudence; D000074606:Smoking Prevention; D014481:United States