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loss of federal block grant substance abuse and treatment funding for noncomplying states. Under subsequently adopted Department of Health and Human Services (DHHS) regulations, states were required to reduce the rate of retailer violations of youth access laws to 20 percent or less by 2003 (DHHS 1996).

In a complementary mode, the Federal Drug Administration (FDA) adopted a comprehensive set of youth regulations in 1996 that included a major compliance check program under the auspices of the agency. The regulations had a short shelf-life, however: The FDA program was invalidated by the U.S. Supreme Court in 2000 on the grounds that tobacco regulation was outside the scope of the agency’s authority (FDA v. Brown & Williamson, 2000).

As mentioned above, every state has baseline legislation prohibiting sales to minors. Both the Synar Amendment and the failed FDA effort reflect the fact that in the 1990s, when attention came to focus on youth access, there was a widespread perception that states and localities were simply not enforcing these provisions with any vigor. Rigotti (2001) documents a considerable number of studies, beginning in 1987 and extending well into the 1990s, revealing widespread merchant indifference to the laws and a like indifference on the part of enforcement authorities (Rigotti 2001).

Indifference is, of course, quite a different matter from disagreement in principle, and Rigotti (2001) asserts that in fact there is widespread agreement among tobacco control activists and public health experts on the provisions that would be incorporated in a model access restriction law. In summary, the principal guideposts Rigotti (2001) mentions are: (1) establish a minimum age of at least 18, (2) require that retailers establish proof of age through checking identification, (3) create a tobacco sales licensing scheme, (4) require periodic tests of retailers’ compliance, (5) establish administrative or civil law penalties for illegal sales, and (6) prohibit self-service displays of tobacco products (IOM 1994).

The existing state and local laws on the books, as might be expected, incorporate many of these provisions. However, there were almost no data on ongoing enforcement levels, so it was impossible to conclude with any confidence whether enforcement practices had changed in any meaningful way from the rather dismal record of the period immediately before the Synar Amendment was enacted. Moreover, in a considerable number of instances, local ordinances that appeared strong, at least as written, were diluted by weaker state laws preempting inconsistent local provisions.

In 1996, once the Synar Amendment came into effect, the logical inquiry was whether it would exert an independent positive influence on state and local enforcement practices. In the early years, this appears not to have been the case. In an analysis of 1997 substance abuse block grant applications from all states, DiFranza (1999) concluded that “states and DHHS are violating the statutory requirements of the Synar Amendment rendering it ineffective” (DiFranza 1999). In a subsequent study of state Synar compliance through 2000, however, DiFranza and Dussault (2005) find a more positive state of affairs (DiFranza and Dussault 2005). Despite some leniency in holding states to established targets, as DHHS pressured some states to move from educational to compliance-testing strategies, states made considerable progress in achieving maximum 20 percent noncompliance goals.

In the late 1990s, a number of studies were conducted of communities that engaged in proactive enforcement, aimed at assessing the efficacy of these efforts. Initially, these studies generally took reduction in access as an outcome measure (i.e., merchant compliance rates, as measured by failed efforts by minors to successfully purchase tobacco products), rather than reduction in smoking initiation or prevalence. These earlier studies were generally uncontrolled, rather than

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