Limiting youth access to tobacco: a failed intervention.

For the last decade, the most widely used intervention to reduce adolescent smoking has been enactment of “youth access” laws, which make it illegal to sell cigarettes to teenagers. These laws have been required by the federal government to obtain funding for substance abuse programs [1] and were the primary enforcement element of the tobacco regulation proposed by the Food and Drug Administration [2] and struck down by the U.S. Supreme Court. The Centers for Disease Control and Prevention [3] and the Institute of Medicine [4] recommend youth access controls as part of a comprehensive tobacco control program. All 50 states and over 1000 local governments have passed youth access laws. Unfortunately, while these programs do make it difficult for teens to purchase cigarettes [5–7], they do not affect teen smoking prevalence [8]. The paper by Castrucci et al [9] in this issue of the Journal of Adolescent Health, together with previous studies that reached similar conclusions based on different data sets [10–14], explains why this seemingly logical intervention does not work: As youth access laws make it harder to purchase cigarettes, teens simply get their cigarettes elsewhere. Castrucci et al [9] recognize that it is likely impossible to block noncommercial sources and realistically, in contrast to others [14], do not recommend policies to block these “social sources.” The fact that youth access controls are not associated with lower teen smoking [8] is not surprising because, although most smokers start experimenting with cigarettes in their teens, few teens smoke daily, so do not need to procure many cigarettes, and as Castrucci et al [9] observe, it is these youngest experimenters who are most likely to obtain their cigarettes from noncommercial sources. It has been argued that even if they do not affect youth smoking prevalence, youth access programs are valuable because they are politically safer than policies involving clean indoor air or anti-tobacco media campaigns and that they engage the public and help build coalitions for tobacco control [5,15]. The tobacco industry, however, has done an even better job of using the threat of youth access legislation to organize a large grass-roots network of merchants which has helped the tobacco industry fight a wide variety of effective tobacco control policies, particularly clean indoor air laws [16], and shift the emphasis in tobacco control away from the tobacco industry’s marketing practices. For example, Philip Morris tobacco company is actively promoting messages telling parents to keep their cigarettes away from their kids [17, 18]. Castrucci et al [9] also conclude that “while limiting commercial sources of cigarettes remains an important part of a comprehensive approach to reduce tobacco use, adolescent smoking prevalence will likely only continue to decline with further implementation of policies that are known to decrease tobacco use.” No one can disagree with the second part of this statement—that we should seek implementation of policies that are known to decrease tobacco use: smokefree workplaces and homes [19–23], taxes [20–22, 24, 25], media campaigns [26], and secondhand smoke messages [27]. From the Center for Tobacco Control Research and Education, Institute for Health Policy Studies, Cardiovascular Research Institute, University of California, San Francisco, California This work was supported by NIH National Cancer Institute Grant CA-61021. Address correspondence to: Stanton A. Glantz, Ph.D., Professor of Medicine, Box 0130, University of California, San Francisco, CA 94142. E-mail: glantz@medicine.ucsf.edu. JOURNAL OF ADOLESCENT HEALTH 2002;31:301–302