children are appropriate, at a minimum, to establish a foundation for subsequent public health interventions.

The Community Environment

Community access to food products is ubiquitous and, before recommending restrictions or limitations on access in the community, it may be useful to examine the experience with attempting to restrict minors’ access to tobacco products. Because the sale, and frequently the possession, of tobacco products by minors is illegal, various steps have been enacted to enforce tobacco access restrictions. Federal legislation has been promulgated to require states to enforce a prohibition on the sale of tobacco products to minors, and some stores voluntarily restrict access to tobacco products by keeping inventory behind the counter and requiring a personal interaction between the sales clerk and the customer to obtain the product. The evidence, however, is unclear about the effectiveness of enforcement of minors’ access laws in reducing the use of tobacco products (Warner et al., 2003). Increasingly, minors have used other means (shoplifting, purchasing by friends, social acquisition) to obtain cigarettes. Whether or not these restrictions are effective by themselves, enforcement of laws to prevent the sale of tobacco products by minors sends a strong and consistent message on the hazard of tobacco use and should be considered as necessary, but not necessarily sufficient action, to prevent adolescent tobacco use.

Regarding calorie-dense or low-nutritional-quality foods, there is no restriction whatsoever on their retail and commercial availability. As is the case with cigarettes, these snack and fast food products are ubiquitously available—in vending machines, gas stations, convenience stores, and many other places. In fact, nearly every retail and commercial outlet sells gums, candies, crackers, cookies, and soft drinks. However, in reviewing the literature on the influence of availability on food choices, French and colleagues (1997) concluded that the relationship is inconsistent, particularly compared to the strong inverse relationship between price and consumption. Further research is needed to determine if restricting commercial access and availability would be effective in reducing the consumption of calorie-dense and low-nutritional-quality foods. As long as these products can be sold legally to minors, it is unlikely that widespread restriction of access to these products is feasible, and even if feasible, whether restriction would have a public health effect.

In addition to examining access to certain food products, it is perhaps more important to understand the changing patterns of consumption and how these patterns may inform interventions to reduce the risk of obesity. The published literature indicates that over the past few decades, and accelerating in the past few years, there have been increases in eating outside the



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