Synar amendment, which requires that states have sales-to-minor rates of no greater than 20 percent in order to receive federal Substance Abuse Prevention and Treatment Block Grant awards. By 2000, only 25 states had achieved this level of compliance.

  • States should impose tobacco-licensing requirements for merchants selling tobacco products, as recommended in the 2000 report of the Surgeon General (U.S. Department of Health and Human Services and Office of Disease Prevention and Health Promotion, 2000). The threat of revocation of the license as a consequence of selling tobacco products to minors could provide a strong incentive for merchants to comply with existing laws. Further, requiring that merchants pay for a license to sell tobacco could provide needed funds for monitoring and enforcement.

  • Internet sales of tobacco products are not covered by the Synar amendment, which leaves a significant opening for minors to have access to tobacco. More than 90 websites sell cigarettes in the United States, and the number is expected to grow. Furthermore, tobacco products sold over the Internet are often not subject to state sales taxes, making them much less expensive than their counterparts sold in retail stores. Congress should therefore act to prohibit the promotion, sale, and distribution of tobacco products over the Internet to individuals under the age of 18.

  • Regulations at the state level vary greatly across the country. Until the passage of federal legislation, state and local legislatures should increase their regulatory efforts related to environmental tobacco smoke by establishing smoke-free indoor workplaces, public buildings, and restaurants. Eight states still have no restrictions on state government worksites, and 30 states have no restrictions on smoking in nongovernmental workplaces. For local jurisdictions, clean air legislation may be difficult to enact because of state preemption rules that make it unlawful for local governments to enact clean air restrictions that are more stringent than those imposed at the state level. If a state has no restrictions on worksite smoking, for example, it may be impossible for a local community to ban smoking in restaurants or other workplaces. Preemption laws need to be overturned to give local governments the right to protect their communities.

  • Further restrictions are needed to reduce tobacco promotion and advertising, which compromises youth tobacco prevention efforts. Restrictions now in place include a mix of voluntary agreements, restrictions resulting from settlements of law suits, and prohibitions defined by state or local ordinances, but some efforts have been hampered by protection of commercial speech (Bayer et al., 2002; Morrison, 2002). The Board urges renewed national consideration of how to address these issues.

The Board’s proposed recommendations are consistent with meeting the tobacco-related objectives outlined in Healthy People 2010 (US DHHS and Office of Disease Prevention and Health Promotion, 2000) (Box 11.2).

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