Accessibility of Cigarettes to Youths Aged 12-17 Years -- United States, 1989

Rates of tobacco-related diseases are higher for persons who initiate smoking at younger ages than for those who begin at older ages (1). Restricted access to tobacco products may delay or prevent the decision by adolescents to initiate tobacco use (1,2). This report summarizes findings from the Teenage Attitudes and Practices Survey (TAPS) regarding minors' access to cigarettes during 1989.

TAPS obtained data from a national household sample of adolescents aged 12-18 years regarding knowledge, attitudes, and practices associated with tobacco use (3). Data were collected using computer-assisted telephone interviewing (CATI) during September-December 1989 and, for those who could not be reached by telephone, through a mailed questionnaire. Only CATI respondents were asked about their access to cigarettes. The data for this report were obtained from 9135 CATI respondents and weighted to provide national estimates. Confidence intervals (CIs) were calculated using the Software for Survey Data Analysis (SUDAAN) (4).

Because most states have established a minimum age of 18 years for the purchase of cigarettes (5), only the 7773 respondents aged less than or equal to 17 years were included in this study. Respondents who were current smokers (i.e., those who had smoked cigarettes on one or more of the 30 days preceding the survey) were asked, "Do you usually buy your own cigarettes?" Those who answered "yes" were asked the frequency (i.e., often, sometimes, rarely, or never) with which they bought cigarettes from a vending machine, large store (e.g., supermarket), or small store (e.g., convenience store or gas station). If the response to the question "Have you ever smoked a cigarette?" was "no," respondents were asked, "Do you think it would be easy or hard for you to get cigarettes if you wanted some?"

Among the estimated 2.6 million current U.S. smokers aged 12-17 years in 1989, approximately 1.5 million (57.5%) usually bought their own cigarettes (Table 1). Smokers aged 16-17 years were more likely to have bought their own cigarettes (66.6%) than were smokers aged 12-15 years (45.3%). Those who had smoked during the week preceding the survey were also more likely to have bought their own cigarettes (72.7%) than were those who had smoked sometime that month but not as recently as that week (27.1%).

Among youths aged 12-17 years who usually bought their own cigarettes, an estimated 1.3 million (84.5%) often or sometimes purchased their cigarettes from a small store, approximately 730,000 (49.5%) purchased cigarettes often or sometimes from a large store, and about 210,000 (14.5%) purchased cigarettes often or sometimes from a vending machine (Table 2). Of the estimated 13.9 million youths aged 12-17 years who had not smoked a cigarette, an estimated 8.7 million (62.4%), including 52.7% aged 12-15 years and 88.3% aged 16-17 years, believed it would be easy for them to obtain cigarettes.

Reported by: JP Pierce, PhD, Univ of California at San Diego. SL Mills, MD, DR Shopland, National Cancer Institute; SE Marcus, PhD, National Institute of Dental Research, National Institutes of Health. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion; Div of Analysis, Office of Analysis and Epidemiology, Div of Health Interview Statistics, and Office of Vital and Health Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: After substantial declines in the 1970s, the prevalence of cigarette smoking among U.S. high school seniors has been stable since 1981 (1; L.D. Johnston, J.G. Bachman, P.M. O'Malley, University of Michigan, unpublished data, 1991). The findings in this report are consistent with results of local investigations documenting the widespread direct purchase of cigarettes by teenagers (6,7). Despite laws in 48 states and the District of Columbia prohibiting the sale of tobacco products to minors (CDC, unpublished data, June 1992), underaged youth have been successful in 70%-100% of attempts to purchase tobacco (7). Small stores and gas stations are the major source of cigarettes for underaged buyers; vending machines play a lesser role probably because of higher purchase prices and easy access to over-the-counter sales.

Educational interventions directed at vendors to decrease retail tobacco sales to minors have resulted in slight and temporary reductions (6,7). The greatest decrease in tobacco sales to underaged buyers has been documented in communities that have active surveillance of retailers and substantial penalties for noncompliance (7,8). In locations where tobacco sales to underaged persons have been curtailed, the prevalence of smoking by teenagers has decreased, particularly among the youngest age groups (8). Active and vigorous enforcement of minors' access laws in these communities has augmented health education and awareness programs aimed at students and parents (8).

In response to a 1990 report indicating limited effective enforcement of existing state laws prohibiting tobacco sales to minors (9), the Secretary of Health and Human Services (HHS) proposed to all states a "Model Sale of Tobacco Products to Minors Control Act" containing six major provisions. The proposed legislation includes 1) instituting 19 years as the minimum age for legal tobacco sales; 2) creating a tobacco sales licensing system similar to that used for alcoholic beverages; 3) establishing a graduated schedule of penalties for illegal sales, with separate penalties for failure to post a sign regarding legal age of purchase; 4) placing primary responsibility for enforcement with a designated state agency, with participation and input from local law enforcement and public health officials; 5) using civil penalties and local courts to assess fines; and 6) banning vending machines (10). The HHS proposal also contains provisions to minimize the economic and administrative burdens on retail outlets.

One of the national health objectives for the year 2000 sets a nationwide goal to enact and enforce state laws prohibiting the sale and distribution of tobacco products to youth aged less than 19 years (objective 3.13) (2). This national health objective and the findings from TAPS underscore the need for state and local public health agencies to consider mechanisms such as the model tobacco control act to deter minors from initiating and sustaining tobacco use. A commitment to active surveillance and enforcement of tobacco retail restrictions is essential to reduce the prevalence of smoking among teenagers and its detrimental impact on the health of teenagers and adults.

References

1. CDC. Reducing the health consequences of smoking: 25 years of progress -- a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, 1989; DHHS publication no. (CDC)89-8411.

2. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

3. Allen K, Moss A, Botman S, Winn D, Giovino G, Pierce J. Teenage attitudes and practices survey "TAPS": methodology and response rates (Abstract). In: Program and abstracts of the 119th annual meeting of the American Public Health Association. Washington, DC: American Public Health Association, 1991.

4. Shah BV. Software for Survey Data Analysis (SUDAAN) version 5.30 (software documentation). Research Triangle Park, North Carolina: Research Triangle Institute, 1989.

5. CDC. State laws restricting minors' access to tobacco. MMWR 1990;39:349-53.

6. Altman DG, Rasenick-Douss L, Foster V, Tye J. Sustained effects of an educational program to reduce sales of cigarettes to minors. Am J Public Health 1991;81:891-3.

7. Feighery E, Altman DG, Shaffer G. The effects of combining education and enforcement to reduce tobacco sales to minors. JAMA 1991;266:3168-71.

8. Jason LA, Ji PY, Anes MD, Birkhead SH. Active enforcement of cigarette control laws in the prevention of cigarette sales to minors. JAMA 1991;266:3159-61.

9. Office of Evaluation and Inspections. Youth access to cigarettes. New York: US Department of Health and Human Services, Office of Inspector General, 1990; publication no. OEI-02-90-02310.

10. Public Health Service. Model Sale of Tobacco Products to Minors Control Act. Washington, DC: US Department of Health and Human Services, Public Health Service, 1990.

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