Publication Date: 
Wednesday, July 31, 2019

The Problem: Tobacco use is a source of chronic and fatal illnesses for users and persons with secondary exposureindividuals who receive secondary exposure. Smoking is responsible for approximately one in five deaths in the United States, causing 480,000 deaths annually. Smoking increases risk for stroke by up to four times, coronary heart disease by up to four times, lung cancer by about 25 times, and lowers overall health. Quitting smoking vastly reduces health risks; within 2-5 years of cessation, risk of stroke drops to that of a non-smoker. CDC: Health Effects of Cigarette Smoke. Initiation of smoking and other tobacco use generally starts in adolescence; more than 90% of adult smokers started smoking as young children or teenagers. CDC: Youth Tobacco Use Fact Sheet.

The Law: Pursuant to the 1997 federal “Synar law” states must prohibit the sale of tobacco products to children and take steps to ensure effective enforcement. 42U.S.C. 300x-26, 45 C.F.R. 96.130.  States and localities have adopted numerous legal interventions to increase compliance with this prohibition. For example, some states prohibit the handling of tobacco products by minors working in retail and require posting of signs explicitly prohibiting sale of tobacco products to minors (Oklahoma, 37 O.S. §600.1-§600.12). Under age purchasers of tobacco face fines and community service (Washington, RCW 70.155.080). To increase compliance with youth access laws, localities and states also conduct compliance investigations (Missouri, 21 CFR 1140.14)

The Evidence: Stead and Lancaster systematically reviewed studies assessing the effect of laws restricting youth access to tobacco and interventions aimed at increasing compliance with youth access laws. Lindsay F Stead and Tim Lancaster. A systematic review of interventions for preventing tobacco sales to minors. Tob Control 2000 9: 169-176. The reviewers identified 27 studies that fit their criteria of employing either experimental or observational designs with data both before and after the adoption of a law or compliance intervention. The studied laws included requirements for compliance checks; the evaluated interventions included experiments with compliance checks and education campaigns with retailers about fines and enforcement of youth access laws. Most of the included studies found reductions in prevalence of smoking among youths or decreases in reported ease of purchasing tobacco for minors. Although the reviewers were cautious because of methodological limitations in the studies such as the inability to control for potentially confounding effects from other youth smoking prevention programs and the possibility that effects wane over time, they view the collective body of studies as sufficient evidence to conclude that laws restricting youth access and interventions aimed at increasing compliance do indeed reduce access to tobacco for minors. The reviewers observed that greater levels of compliance activity – such as personal visits to retailers – were more likely to result in greater reductions in smoking or access.

The Bottom Line: According to the authors of a peer-reviewed systematic review, there is sufficient evidence to support the effectiveness of youth access laws and interventions aimed at increasing compliance as a means of decreasing juvenile smoking behaviors.

Impact: Effective