offsetting some of the reduction in tobacco consumption associated with higher taxes (Ribisl et al., 2007). However, studies of tobacco smuggling, usually focused on interstate or cross-country smuggling, suggest that higher prices reduce the effect of smoking even in the presence of opportunities for smuggling (Chaloupka and Warner, 2000; IOM, 2007).

  • Military exchanges and commissaries sell tobacco products at a discount compared with civilian retail outlets.

  • VA no longer sells tobacco products at its facilities.

Access to Tobacco Products

The effectiveness of barriers to the purchase of cigarettes on adolescent smoking behavior is supported by reports from IOM (2007) and NCI (2005). The 2007 IOM report Ending the Tobacco Problem: Blueprint for the Nation called for licensing of retail sellers of tobacco. Such licensing prohibits self-service sales of cigarettes by unlicensed retailers. Although this licensing policy targets youth, such restrictions could apply to a broader population. However, a recent study examining stores that required clerk assistance to obtain tobacco products showed no significant effect of licensing on smoking behavior among youth (Slater et al., 2007).

There are many reasons to believe that small measures, such as requiring clerk assistance or requiring people to make an extra effort to purchase cigarettes in commissaries and exchanges, may work to reduce smoking. As described in Chapter 3, a robust literature in behavioral economics suggests that people can change their behavior dramatically in response to relatively small changes in their environment.

Conversely, the number of tobacco products or other nicotine-delivery products that can be used in tobacco-free areas is increasing. There are now several varieties of smokeless cigarettes that manufacturers advertise can be legally used in no-smoking areas because they do not emit smoke, but they still deliver a high dose of nicotine. Those products include snus (a moist tobacco powder for oral use), “dissolving” nicotine, and smokeless or electronic cigarettes, all of which allow smokers to maintain their nicotine concentrations in situations where they are unable to smoke.

Surveys of military personnel indicate that the use of smokeless tobacco is on the rise, particularly among deployed personnel (DoD, 2006). Although some military installations restrict access to tobacco

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