Research articleMethods, locations, and ease of cigarette access for American youth, 1997–2002
Introduction
Nationwide efforts to reduce minors' access to tobacco products have had limited success, including the 1992 Synar Amendment1, 2 and the Food and Drug Administration (FDA)3 attempt to regulate the sale and distribution of tobacco to minors. State and local efforts have fared somewhat better, including policies such as minimum purchase age, photo identification, vending machine bans, and random inspections.4 However, debate exists on the efficacy of such policies. Some argue that tobacco-access policies have shown no indications of effectiveness, and that anti-tobacco advocates should reject access measures in favor of other, more effective approaches.5, 6 Others believe that extensive and well-enforced youth access programs can significantly lower youth smoking by preventing youth from purchasing cigarettes directly, and/or strengthening social norms that discourage smoking behaviors and raise expectations that cigarettes will not be easy to obtain.7, 8, 9, 10 The majority of research has been mixed on the issue, highlighting unknowns in terminology, evaluation, outcomes, and enforcement.10, 11, 12, 13, 14 Given the developing body of policy focused on tobacco access, research is needed that can better evaluate the effectiveness of such efforts across policy types and smoking behaviors. However, a related need is for national documentation of tobacco access behaviors among American youth.
Both social and commercial cigarette sources play significant roles in youth smoking.11 Smoking consumption, gender, age, and ethnicity play important roles in social versus commercial cigarette sources. Regular smokers, males, older smokers, and whites are more likely to utilize commercial sources.15, 16, 17, 18, 19, 20, 21, 22 Commercial sources are not used equally. Gas stations and convenience stores are the primary retail suppliers of cigarettes to minors21, 22 (and also have the highest rates of pro-tobacco advertising and marketing, and self-service access to tobacco products).23
Underage commercial cigarette access also is affected by merchant requests for photo identification (ID) prior to sale. National studies have shown that only 30% to 40% of minors who purchased cigarettes from a store were asked to show proof of age,19, 22 and failure to request ID has been significantly associated with illegal sales.24 However, some research indicates that simple presentation of ID may actually be associated with increased illegal sales if clerks do not confirm identity or calculate age.25, 26
Attention to youth cigarette access began to grow in the early 1990s. However, few publications have addressed national tobacco access issues, and none has combined trend data for both middle and high school samples. Data on high school cigarette access as measured by the Youth Risk Behavior Surveillance study have been available since 1996,19, 27, 28, 29, 30 and findings on tobacco access among middle and high school students have been published using data from the 1999 National Youth Tobacco Survey22 and the 2001 National Household Survey on Drug Abuse.21 However, there remains a need for a national, multiyear summary of trends in tobacco access for both U.S. middle and high school youth. This paper provides such information by reporting on 6 years of cross-sectional data (from 1997 to 2002) on perceived ease, methods, and locations of cigarette access for nationally representative samples of 8th-, 10th-, and 12th-grade students. Results are examined for secular trends, as well as smoking consumption, gender, and racial/ethnic differences.
Section snippets
Methods
Data were obtained from the Monitoring the Future study,31, 32 and were collected yearly from 1997 to 2002 using self-completed, group-administered surveys with sampling representative of all 8th-, 10th-, and 12th-grade students in the 48 contiguous states. Response rates averaged 89% for 8th, 86% for 10th, and 83% for 12th grade. Only students aged <18 were retained for the present analyses (conducted in 2003).
Perceived ease of cigarette access was measured by asking 8th and 10th grade
Results
A total of 34,910 8th graders, 29,537 10th graders, and 6158 12th graders (aged <18) responded to forms containing tobacco-access related items. After removing cases with missing data on control variables, sample sizes were 27,740 8th graders, 25,598 10th graders, and 5573 12th graders. Student characteristics (combining grades and years) were 53% female, 13% black, 11% Hispanic, 66% white, and 10% other. Regional distribution was 19% Northeast, 26% North Central, 36% South, and 19% West. Mean
Discussion
The importance of reducing minors' access to cigarettes rests primarily on the assumption that less youth smoking will result, either overall or at specific points along the uptake continuum. Cigarette smoking prevalence among U.S. youth has dropped substantially since 1997 (although rates remain too high, with 25% of students becoming current smokers by 12th grade).32 These data indicate that perceived ease of cigarette access also showed an appreciable drop during the same period,
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