Enforcement of underage sales laws as a predictor of daily smoking among adolescents: a national study.
BACKGROUND
With a goal to reduce youth smoking rates, the U.S. federal government mandated that states enforce laws prohibiting underage tobacco sales. Our objective was to determine if state compliance with tobacco sales laws is associated with a decreased risk of current daily smoking among adolescents.


METHODS
Data on tobacco use were obtained from a nationally representative sample of 16,244 adolescents from the 2003 Monitoring the Future survey. The association between merchant compliance with the law from 1997-2003 and current daily smoking was examined using logistic regression while controlling for cigarette prices, state restaurant smoking policies, anti-tobacco media, and demographic variables.


RESULTS
Higher average state merchant compliance from 1997-2003 predicted lower levels of current daily smoking among adolescents when controlled for all other factors. The odds ratio for daily smoking was reduced by 2% for each 1% increase in merchant compliance. After controlling for price changes, media campaigns and smoking restrictions, a 20.8% reduction in the odds of smoking among 10th graders in 2003 was attributed to the observed improvement in merchant compliance between 1997 and 2003. A 47% reduction in the odds of daily smoking could be attributed to price increases over this period.


CONCLUSIONS
Federally mandated enforcement efforts by states to prevent the sale of tobacco to minors appear to have made an important contribution to the observed decline in smoking among youth in the U.S. Given similar results from long-term enforcement efforts in Australia, other countries should be encouraged to adopt the World Health Organization Framework on Tobacco Control strategies to reduce the sale of tobacco to minors.
DiFranza
Joseph R
JR
Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, USA. difranzj@ummhc.org
Savageau
Judith A
JA
Fletcher
Kenneth E
KE
D000293:Adolescent; D000294:Adolescent Behavior; D002648:Child; D005260:Female; D019983:Guideline Adherence / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D035846:Law Enforcement; D016015:Logistic Models; D008297:Male; D040541:Marketing / Q000191:economics / Q000331:legislation & jurisprudence; D015995:Prevalence; D011446:Prospective Studies; D012147:Restaurants / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D012907:Smoking / Q000191:economics / Q000453:epidemiology* / Q000331:legislation & jurisprudence*; D000074606:Smoking Prevention; D019460:Tobacco Industry / Q000191:economics / Q000331:legislation & jurisprudence*; D014028:Tobacco Smoke Pollution / Q000191:economics / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D014481:United States
D014028:Tobacco Smoke Pollution