title: State and federal compliance with the Synar amendment: federal fiscal year 1997.
abstract: BACKGROUND
  The Synar Amendment requires states and territories to enact a law prohibiting the sale of tobacco to minors and to enforce that law in a manner that could reasonably be expected to decrease the availability of tobacco to minors.
  
  
  OBJECTIVE
  To determine whether the Department of Health and Human Services (DHHS) and applicant states and territories are complying with the Synar Amendment.
  
  
  METHODS
  Block grant applications from 59 states and territories describing activities during federal fiscal year 1997.
  
  
  METHODS
  Whether applicants had enacted a tobacco sales law without loopholes, conducted enforcement inspections, penalized violators, and conducted a valid statewide survey with violation rates below the permissible threshold, and whether DHHS actions were consistent with the statutory requirements of the Synar Amendment.
  
  
  RESULTS
  Three applicants had laws containing loopholes, 8 failed to conduct enforcement inspections, 8 failed to prosecute violators, 6 failed to conduct a valid survey, and 8 failed to demonstrate compliance with violation rate targets. Fifteen applicants failed 1 or more criteria, but none was ultimately penalized by DHHS. Fourteen sources of bias were identified in state survey protocols that could substantially lower reported violation rates.
  
  
  CONCLUSIONS
  A few states did a remarkable job with enforcement, while many others made little effort. Because the DHHS regulations are so weak and DHHS is willing to accept biased surveys, states can be in full compliance with the regulations without ever enforcing their laws or having any impact on the availability of tobacco to minors.
authors.affiliation: Department of Family Medicine and Community Health, 55 Lake Ave, University of Massachusetts Medical School, Worcester, MA 01655. difranzj@ummhc.org.
authors.forename: J R
authors.initials: JR
authors.lastname: DiFranza
mesh_terms: D000293:Adolescent; D015982:Bias; D002648:Child; D002669:Child Welfare / Q000331:legislation & jurisprudence*; D003415:Crime / Q000331:legislation & jurisprudence; D005161:Facility Regulation and Control / Q000331:legislation & jurisprudence*; D006801:Humans; D008330:Management Audit; D008389:Marketing of Health Services / Q000331:legislation & jurisprudence*; D012907:Smoking / Q000331:legislation & jurisprudence*; D000074606:Smoking Prevention; D013219:State Government; D019460:Tobacco Industry / Q000331:legislation & jurisprudence*; D014481:United States; D014483:United States Dept. of Health and Human Services / Q000331:legislation & jurisprudence*