Public Health Implications of Raising the Minimum Age of Legal Access to Tobacco Products (2015) / Chapter Skim
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6 Evidence on the Effects of Youth Access Restrictions
6 Evidence on the Effects of Youth Access Restrictions
Pages 155-192
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From page 155... ...
To address the question whether and to what extent raising the MLA would reduce underage tobacco use, this chapter first reviews the limited international studies investigating the effect of raising the MLA for tobacco and then reviews evidence relating to the effects of raising the minimum legal drinking age for alcohol as an analogous policy intervention in a parallel domain. The remainder of the chapter reviews the body of literature 1 Although Needham, Massachusetts, the first jurisdiction in the United States to raise the MLA to 21, has been cited as having seen significant declines in tobacco use and tobaccorelated disease, there are no published data on these outcomes.
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From page 156... ...
It is used in Chapter 7 to inform the committee's judgment about the probable effects of raising the MLA on the initiation of tobacco use by underage youth. THE IMPACT OF ENACTING OR RAISING THE MINIMUM LEGAL AGE TO PURCHASE TOBACCO PRODUCTS Only a small number of studies have examined the effects of enacting or raising an MLA on underage tobacco use.
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From page 157... ...
. In sum, these findings suggest that, among adolescents, raising the MLA decreased the amount of tobacco available from commercial sources, increased difficulty of obtaining tobacco, and reduced tobacco use despite adolescents having continued access to social sources.
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From page 158... ...
The United States had direct experience with raising the minimum legal drinking age (MLDA) for alcohol from roughly 18 (with some variation across states)
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From page 159... ...
126) go so far as to say, "No traffic safety policy, with the possible exception of motorcycle safety helmet laws, has more evidence for its effectiveness than do the minimum legal drinking age laws." Of course, underage drinking still occurs, and it seems clear that if the MLA for tobacco is increased, there will still be some tobacco use by those under the legal age.
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From page 160... ...
Specifically, the rates of drinking and binge drinking among those under 21 have been in sustained long-term decline since the MLA was raised, the death rates of 18- to 20-year-olds in nighttime driving accidents have fallen, and the rates of problem alcohol use are lower in the United States than they are in Europe, where drinking ages are lower. However, such correlations could be coincidental.
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From page 161... ...
As such, U.S. and international experience with enacting and raising the minimum legal drinking age may provide insights into the potential effects of raising the minimum age of legal access to tobacco products.
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From page 162... ...
Figure 6-2 shows a somewhat expanded view of the logic model detailing these enforcement mechanisms. Decreased Decreased Minimum Increased Active retail tobacco underage legal age retailer enforcement availability to tobacco policy compliance underage youth use FIGURE 6-1 Simplified logic model of the effects of prescribing and enforcing a minimum age of legal access to tobacco products.
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From page 163... ...
, tobacco availability to underage consumers from commercial retail sources will likely be reduced. If these effects were complete, underage users would not be able to obtain tobacco from retailers.
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From page 164... ...
, it is likely that any decrease in retail tobacco availability will result in a corresponding increase in access from social sources, although this shift is likely to be incomplete. Nevertheless, if overall tobacco supply to underage users is successfully reduced, it is likely that the overall cost of tobacco will increase to the underage users who purchase tobacco outside the retail market.
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From page 165... ...
. Presumably, however large the deterrent effect for illegal drugs, it could well be smaller for underage tobacco use because the sanctions imposed under purchase–use–possession laws tend to be much less severe than the maximum sentences permitted for possession of illegal drugs (see IOM, 2007)
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From page 166... ...
Threat of determinants enforcement of penalty for minor FIGURE 6-3 Complete logic model of the effects of prescribing and enforcing a minimum age of legal access to tobacco products.
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From page 167... ...
Thus, this chapter also reviews literature on the effects of an MLA policy and its enforcement in the context of other tobacco control programs aimed at preventing or reducing tobacco use among adolescents and young adults and across the population at large. EFFECTS OF RETAILER INTERVENTIONS ON ACCESS TO AND USE OF TOBACCO Within the framework of the logic model, this section reviews the scientific literature bearing on the effects of retailer interventions on underage access to and use of tobacco.
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From page 168... ...
However, both the sales rates reported to Synar and the limited scientific evidence suggest that active enforcement of youth access restrictions using compliance checks paired with penalties for violations are effective at increasing retailer compliance with youth access laws. However, evidence bearing on the relationship between the intensity of enforcement and the rate of compliance is inconsistent.
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From page 169... ...
Retailer Education Targeted retailer education has also been employed as a strategy to increase retailer compliance with the MLA laws, either in lieu of or in addi ion to active enforcement. Such education may include direct mailings t with information about the MLA law and potential penalties for violations, personal visits delivering education kits and other resources, phone calls presenting information, and letters from senior government officials (e.g., the mayor or police chief)
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From page 170... ...
Finding 6-2: Active enforcement of restrictions on the minimum age of legal access to tobacco products, including meaningful penalties for violations, increases retailer compliance, and a reasonable inference can be drawn that enforcement decreases the availability of retail tobacco to underage persons. These effects can be increased by coupling en forcement with retailer and community education programs and media campaigns about the minimum age policy.
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From page 171... ...
Studies of retailer compliance are similar to those evaluating active enforcement, but rather than investigating whether any enforcement efforts affect underage tobacco use, studies of retailer compliance typically examine the relationship between tobacco sales rates or retailer compliance rates (as well as changes in those rates) and underage tobacco use.
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From page 172... ...
Consequently, the rates of tobacco sales to underage persons reported through Synar and observed in enforcement interventions may underestimate the true rates of sales to minors. Furthermore, if enforcement interventions are unlikely to reduce commercial availability, they are also unlikely to reduce overall tobacco availability to underage individuals or the actual use of tobacco products.
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From page 173... ...
On the other hand, the older students may have been more likely to have social networks that included those who were old enough to buy tobacco products on their behalf. It seems clear that curtailing retail access will lead to greater use of social sources.
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From page 174... ...
assessed perceived availability in reference to specific sources and found that the intervention decreased the perceived availability from commercial but not social sources. This suggests that the MLA laws and their enforcement, as expected, may increase the difficulty of obtaining tobacco from commercial sources, but they do not have an impact on social sources.
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From page 175... ...
The authors therefore suggest that perceived availability was less a reflection of opportunities to obtain tobacco than of the declarative effect of the tobacco control program changing social norms and thereby decreasing demand to take up tobacco use. Finally, a cross-sectional study (Speizer et al., 2008)
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From page 176... ...
However, the level of substitution by social sources is likely to be lowest for the youngest underage users. UNDERAGE ACCESS RESTRICTIONS IN THE CONTEXT OF OTHER TOBACCO CONTROL POLICIES It is unlikely that any revised MLA laws will be aggressively enforced in isolation, so examining the LA laws and their enforcement in the context M of other tobacco control policies can help elucidate their likely effects in circumstances that more closely resemble the likely real world scenarios in which an MLA increase would be implemented.
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From page 177... ...
examined the effect of a minimum legal drinking age on fatal traffic accidents when states were implementing an MLDA of 21 in a patchwork while the national MLDA remained 18. Their analysis of county-level data found no reduction in fatal traffic crashes involving youth in counties with an MLDA of 21 that were within 25 miles of a state with a lower minimum drinking age, but significant reductions in fatal traffic crashes involving youth in counties further from the state borders.
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From page 178... ...
(2010) examined the effects of tobacco control policies, including an index of the strength of youth tobacco sales restrictions on adolescent smoking cessation, and found that youth access restrictions slightly increased the odds of non-continuation of smoking, but they were not associated with any other cessation measure.
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From page 179... ...
Summary Evidence on the independent effect of youth access policies in the context of other tobacco control policies is mixed. However, studies of multiple statewide retailer interventions that include active enforcement of the MLA restrictions suggest that these interventions are effective in reducing underage use.
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From page 180... ...
As noted in Chapter 5, the laws of 44 states and the District of Columbia penalize underage indi viduals for purchasing, using, or possessing tobacco products, typically by civil fines or community service. Proponents of the laws argue that PUP laws are another effective strategy for deterring underage tobacco use (e.g., Jason et al., 2009b; Lazovich et al., 2007; Livingood et al., 2001)
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From page 181... ...
Despite lax enforcement efforts, limited empirical data suggest that active enforcement of PUP laws in addition to active enforcement of youth tobacco sales restrictions may be effective at reducing tobacco sales to under ge persons and, ultimately, at reducing underage tobacco consump a tion. Most of these findings come from a series of studies conducted by Jason and colleagues in a convenience sample of small, suburban towns in Illinois, which may not be representative of the rest of the state or the country as a whole.
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From page 182... ...
Although a small number of studies suggest that enforcing these laws, in combination with strategies that limit retail tobacco sales, can reduce use, they also raise concerns about fair enforcement. SUMMARY This chapter reviewed the existing evidence on the effects of raising the minimum legal age to purchase tobacco products, in particular the effect on underage tobacco use.
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From page 183... ...
2009. Tobacco control policy and adolescent cigarette smoking status in the United States.
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From page 184... ...
2014b. Best practices for comprehensive tobacco control programs -- 2014.
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From page 185... ...
2013. A comprehensive examination of the influence of state tobacco control programs and policies on youth smoking.
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From page 186... ...
2000. The rela tionship between youth tobacco control enforcement and crime rates in a Midwestern county.
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From page 187... ...
Tobacco Control 2(2)
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From page 188... ...
2000. State youth-access tobacco control policies and youth smoking behavior in the United States.
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From page 189... ...
2003. Peer effects, tobacco control policies, and youth smoking behavior.
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From page 190... ...
2005. Tobacco control policies and youth smoking: Evidence from a new era.
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From page 191... ...
2010. State-level tobacco control policies and youth smoking cessation measures.
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