Approximately 75% of adults who have regularly smoked cigarettes tried their first cigarette before their 18th birthday, and about half became regular smokers by age 18 years (1). Despite the importance of reducing smoking among adolescents, the prevalence of smoking among high school seniors has not decreased substantially from 1981 through 1991 (2). National health objectives for the year 2000 have targeted substantial reductions in smoking among persons aged less than 20 years (3), and reducing access to cigarettes through laws or statutes (4) is an important strategy in reaching this goal. This report describes the results of efforts in two states -- Missouri and Texas -- to characterize access of minors to cigarettes and other tobacco products.

Missouri

On August 28, 1992, a Missouri law (Missouri Revised Statute 407.925-407.932) went into effect prohibiting the sale of tobacco products to minors. From August 24 through August 27, before implementation of the law, the Missouri Coalition on Smoking and Health, the St. Louis University School of Public Health, and the Missouri Department of Health assessed how minors could purchase cigarettes over the counter (i.e., other than through vending machines).

The 1992-1993 Missouri Business Directory was used to identify businesses that sold cigarettes -- including convenience and grocery stores, pharmacies, and gasoline stations (stores that sold cigarettes only through vending machines were excluded) -- in five central Missouri towns (1990 population range: 5600 - 21,000). In these communities, there were no ordinances prohibiting the sale of tobacco products to minors. Advance notification was given to the city attorney's office in each town.

Teams consisting of two minors (from among seven minors aged 13-14 years) and one adult were used for the assessment. Only one purchase attempt was made at each of 89 stores. During each purchase attempt, the adult entered the store first and noted whether there was any clearly displayed sign stating that cigarettes would not be sold to minors. The adult then observed while one of the minors entered the store and attempted to purchase cigarettes. A purchase attempt was considered successful if the vendor recorded the sale on the cash register and unsuccessful if the vendor refused to sell cigarettes for any reason. If the vendor recorded the sale, the minor stated that he or she did not have enough money and left the store. In 16 stores where the vendor refused to sell to the minor, the adult team member waited until the minor had left and then asked the vendor his or her reasons for refusing.

Of the 89 attempts, 41 (46.1%) were successful (Table 1). Girls were more successful than boys (55.6% versus 36.4%, respectively {p=0.1}). Convenience and grocery stores were less likely to sell cigarettes to minors, although the number of other businesses (e.g., gasoline stations and pharmacies) included in the study was small. The likelihood of success was not significantly different for stores with and without warning signs (36.3% versus 47.4%, respectively {p=0.7}), nor for stores that sold cigarettes from behind the counter only compared with stores with self-service displays (60.5% versus 40.7%, respectively {p=0.2}).

Reasons vendors gave for not selling cigarettes to the minors included belief in the existence of a federal law, a state law, or "some type of law"; a store policy prohibiting sales to minors; and the opinion that some of the minors "just looked too young."

Texas

The sale of tobacco products to persons aged less than 18 years has been prohibited by law in Texas since September 1989 (Texas Health and Safety Code, Title 2, Sections 161.081-161.082). This law requires cigarette sales outlets to post signs stating the illegality of tobacco product sales to persons aged less than 18 years and that merchants convicted for such violations can be fined a maximum of $200. In January 1993, the Texas Department of Health conducted a study in the Austin metropolitan area (1990 population: 781,572) to assess 1) minors' access to tobacco products (including smokeless tobacco) not sold in vending machines and 2) tobacco vendors' compliance with the sign ordinance.

The health department obtained a list of licensed tobacco vendors (excluding stores that sold cigarettes through vending machines only) from the Texas Department of the Treasury for the city of Austin and four nearby rural communities. Teams consisted of one to three minors (from among 16 minors aged 14-15 years and one aged 17 years) and one adult. Surveys were conducted in the same manner as those in Missouri.

Of 94 attempts to purchase cigarettes, 59 (62.8%) were successful; girls and boys were almost equally likely to succeed (63.2% versus 61.5%, respectively {p=0.9}) (Table 1). The type of store where the purchase attempt occurred was not associated with the minors' ability to purchase cigarettes. Warning signs required by state law were posted in 28 (29.8%) stores; attempts were equally successful in stores with and without signs (64.3% versus 62.5%, respectively {p=0.9}). Vendors asked minors their age in 15 (18.5%) of 81 attempts, asked to see age identification in 19 (22.8%) of 87 attempts, and asked who the tobacco was for in one (1.3%) of 79 attempts; in all of these queried attempts, the minors failed to purchase cigarettes.

Of the 71 attempts to buy smokeless tobacco products, 42 (59.2%) were successful. The likelihood of successful purchase attempts was similar for stores with and without warning signs (53.8% versus 63.0%, respectively {p=0.7}). Reported by: Missouri Coalition on Smoking and Health, Columbia; JC Romeis, PhD, St. Louis Univ School of Public Health, St. Louis; RC Brownson, PhD, JR Davis, PhD, LR Cooperstock, MPH, Div of Chronic Disease Prevention and Health Promotion, Missouri Dept of Health. PP Huang, MD, Bur of Chronic Disease Prevention and Control, R Todd, Office of Smoking and Health, DM Simpson, MD, State Epidemiologist, Texas Dept of Health. Div of Field Epidemiology, Epidemiology Program Office; Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: The findings in Missouri and Texas are consistent with previous reports: cigarettes could be readily purchased by minors (5,6), and the presence of warning signs did not affect minors' success in purchasing cigarettes (7). Differences in the findings in the two states may reflect variations in the ages of minors, as well as the media coverage of the law in Missouri following passage in the state legislature.

In 1988, up to $221 million (3% of tobacco industry profits) resulted from cigarette sales to youth, an activity illegal in most states (8). While most states have laws in place that restrict minors' access to tobacco, these laws are rarely enforced (9). Prevention of youth smoking may be enhanced by the recently enacted Synar Amendment to the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act*. The Synar Amendment requires that all states enact and enforce a law prohibiting the sale or distribution of tobacco products to minors (persons aged less than 18 years) as a condition of receiving full Substance Abuse and Mental Health Services Administration block grant funds.

To reduce the use of tobacco products among minors, public policymakers (e.g., legislators, public health officials, and school officials) should consider the following strategies: 1) initiate efforts such as those in Missouri and Texas to monitor minors' ability to purchase tobacco products; 2) require individual tobacco-sales outlets to obtain licenses that may be revoked if tobacco products are sold to minors and require the levying of an established civil fine; 3) impose separate fines for failure to post warning signs stating the legal age of purchase; 4) require retailers to ask all purchasers of tobacco products to show proof of age; 5) increase excise taxes on tobacco products because higher prices can reduce consumption by minors; 6) restrict tobacco-product advertising targeted toward minors; and 7) ensure that health-education curricula in all primary, middle, and secondary schools include discussion of addiction, the short- and long-term risks of tobacco use, refusal skills, social factors influencing use, and the social consequences of use (3-5,10).

In Missouri, findings from the survey described in this report and a follow-up survey in August 1993 will be used to assess the impact of the new law and to strengthen efforts to reduce minors' access to tobacco products. In Texas, these findings will be used to support legislation for stronger enforcement of laws and penalties to restrict minors' access to tobacco products.

References

1. CDC. Cigarette smoking among youth -- United States, 1989. MMWR 1991;40:712-5.

2. Johnston LD, O'Malley PM, Bachman JG. Smoking, drinking, and illicit drug use among American secondary school students, college students, and young adults, 1975-1991. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Drug Abuse, 1992.

3. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Dept of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50213.

4. 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.

5. CDC. Cigarette sales to minors -- Colorado, 1989. MMWR 1990;39:794-5,801.

6. Altman D, Carol J, Chalkley C, et al. Report of the Tobacco Policy Research Study Group on access to tobacco products in the United States. Tobacco Control 1992;1(suppl):S45-S51.

7. DiFranza JR, Brown LJ. The Tobacco Institute's "It's the Law" campaign: has it halted illegal sales of tobacco to children? Am J Public Health 1992;82:1271-3.

8. DiFranza JR, Tye JB. Who profits from tobacco sales to children? JAMA 1990;263:2784-7.

9. Office of Evaluations and Inspections. Youth access to tobacco. Washington, DC: US Department of Health and Human Services, Office of the Inspector General, 1992; DHHS publication no. (OEI-02)91-00880.

10. 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.

• Public Law 102-31.

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