In Canada, similar decreases in the prevalence of smoking followed a substantial increase in cigarette taxes, one even greater than that in California. The prevalence of smoking among adults dropped from 36 percent to 26 percent between 1981 and 1991 when the taxes were significantly raised, and the proportion of adolescents ages 15 to 19 who smoked daily plummeted from 40 percent to 16 percent (Sweanor et al., 1993). Although there is no way to determine the extent to which decreases in adult smoking in California or Canada can be attributed to the higher costs of cigarettes or the public education program, the results suggest that when taxes are raised, and the resulting revenues used for public education campaigns, there can be considerable benefit to public health (Sweanor et al., 1992; Thompson, 1994). A study in Great Britain showed that both women and men in lower socioeconomic groups were more sensitive to the price of cigarettes than to health publicity campaigns, and that women were more sensitive to price in general than were men (Townsend et al., 1994).

Access/Server Intervention

Access to alcohol and cigarettes can be limited in a variety of ways. Decisions about the locations of liquor stores, the granting of liquor licenses to restaurants, the training of bartenders and waiters to limit alcohol consumption, and the locations of cigarette vending machines and cigarettes in stores can all serve to limit access.

There is statistical evidence of an association between the number of outlets that sell alcoholic beverages and the levels of alcohol consumption and alcohol-related deaths (DHHS, 1993). However, more research is needed to determine if the increased availability of alcohol is responsible.

Server intervention seeks to reduce a customer's likelihood of intoxication or driving while intoxicated by influencing the incentives and behaviors of those serving beverages. For example, servers can be trained to promote nonalcoholic beverages and food or to delay serving an alcoholic beverage if it would be likely to intoxicate the patron. There is some research evidence that these interventions are effective (IOM, 1989). In addition, a bar or restaurant can charge more for alcoholic drinks than soft drinks, serve smaller drinks, and stop selling pitchers of beer.

The newly completed FDA regulations will, among other measures, ban cigarette vending machines and self-service displays except in nightclubs and other facilities that are totally inaccessible to persons under 18. Such a ban has been characterized as a law enforcement approach to reduce access to tobacco by children and youth and studies suggest that a law enforcement approach by itself may not be effective (DiFranza et al., 1996; Feighery et al., 1991). In addition, some have argued that the focus on youth access and law enforcement may have unintended consequences in part by emphasizing that smoking is for adults—therefore, something for adolescents to aspire to (Glantz, 1996). Most



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