The federal initiative to halt the sale of tobacco to children--the Synar Amendment, 1992-2000: lessons learned.
BACKGROUND
The Synar Amendment was enacted by the US Congress in 1992 to require states and territories to establish and enforce laws prohibiting the sale of tobacco to minors.


OBJECTIVE
To describe state and federal efforts to comply with the Synar mandate.


METHODS
State and federal actions were examined for the eight years following enactment.


METHODS
Federal documents from 1992-2003, annual block grant applications from 59 states and territories describing activities during federal fiscal years 1995-2000.


METHODS
Whether applicants made a good faith effort to comply by enacting a law, enforcing it with inspections and penalties, conducting a valid survey and meeting violation rate targets set by the Department of Health and Human Services (DHHS).


RESULTS
Between 1996 and 2000, 26 states had made a good faith effort to comply with Synar every year. In 2000, 57 jurisdictions (excluding Maryland and Montana) had established laws without loopholes, 57 conducted a valid survey, and 54 actively enforced their laws. By 2002, violation rates had dropped substantially everywhere but Alaska and a few small territories. No state reached the violation rate goal of 20% without penalising violators.


CONCLUSIONS
The Synar Amendment has resulted in the universal adoption of laws prohibiting tobacco sales to minors and almost universal enforcement of those laws, resulting in dramatically reduced violation rates. Implementation was slowed significantly by a lack of good faith effort in many states and by DHHS's decision not to require states to enforce their laws by penalising lawbreakers.
DiFranza
J R
JR
Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA. difranzj@ummhc.org
Dussault
G F
GF
D000293:Adolescent; D002648:Child; D003132:Commerce / Q000331:legislation & jurisprudence*; D005381:Financing, Organized / Q000379:methods; D033161:Government Regulation; D006801:Humans; D035846:Law Enforcement / Q000379:methods; D011159:Population Surveillance / Q000379:methods; D012907:Smoking / Q000331:legislation & jurisprudence*; D000074606:Smoking Prevention; D013219:State Government; D014481:United States