Prohibiting juvenile access to tobacco: Violation rates, cigarette sales, and youth smoking

Background: Scholars who examine the efficacy of juvenile tobacco sales restrictions, especially the 1992 "Synar Amendment" that led all of fifty U.S. states to enact prohibitions on tobacco sales to minors, are notably divided as to impact on youth smoking. Some researchers claim that such policies have failed and ought to be abandoned (Craig & Boris, 2007; Etter, 2006; Glantz, 2002), while others insist that enforcement has indeed led to reduced tobacco use (DiFranza, 2011b; SAMHSA, 2011). The present study is the first to combine data on Synar violation rates from all states and years available since the amendment's implementation, assessing the connection to national rates of cigarette sales and youth smoking behavior. Methods: Using national data from the United States Substance Abuse and Mental Health Services Administration, the Tobacco Institute, and the Centers for Disease Control's Youth Risk Behavior Surveillance System across all U.S. states between 1996 and 2007, we employ hierarchical linear modeling to examine the connection between retailer Synar violations and youth smoking. Results: Controlling for state-level demographic variables, results indicate that retailer violation rates are significantly associated with greater youth smoking prevalence, as well as higher overall cigarette sales. Conclusion: While critiques of Synar policies are substantive and should be addressed, laws prohibiting the sale of tobacco to juveniles appear to have had some degree of success. (C) 2015 Elsevier B.V. All rights reserved.