OBJECTIVE To provide a comprehensive review of interventions and policies aimed at reducing youth cigarette smoking in the United States, including strategies that have undergone evaluation and emerging innovations that have not yet been assessed for efficacy. DATA SOURCES Medline literature searches, books, reports, electronic list servers, and interviews with tobacco control advocates. DATA SYNTHESIS Interventions and policy approaches that have been assessed or evaluated were categorised using a typology with seven categories (school based, community interventions, mass media/public education, advertising restrictions, youth access restrictions, tobacco excise taxes, and direct restrictions on smoking). Novel and largely untested interventions were described using nine categories. CONCLUSIONS Youth smoking prevention and control efforts have had mixed results. However, this review suggests a number of prevention strategies that are promising, especially if conducted in a coordinated way to take advantage of potential synergies across interventions. Several types of strategies warrant additional attention and evaluation, including aggressive media campaigns, teen smoking cessation programmes, social environment changes, community interventions, and increasing cigarette prices. A significant proportion of the resources obtained from the recent settlement between 46 US states and the tobacco industry should be devoted to expanding, improving and evaluating “youth centred” tobacco prevention and control activities.

https://tobaccocontrol.bmj.com/content/tobaccocontrol/9/1/47.full.pdf

Investing in youth tobacco control: a review of smoking prevention and control strategies

This article reviews studies of the effect of tobacco control policies on smoking rates with the aim of providing guidance on the importance of different policies. Based on past studies, we estimate the magnitude of effects of major tobacco control policies, how their effects depend on the manner in which the policies are implemented, the relationship between the different policies, and the barriers to implementation. The most successful campaigns have implemented a combination of tobacco control policies. Of those policies, substantial evidence indicates that higher taxes and clean air laws can have a large impact on smoking rates. Evidence also indicates that media campaigns when implemented with other policies are important. Research on greater access to treatment and telephone support hotlines indicates a strong potential to increase quit rates and may be important in affecting heavier smokers. Direct evidence on the effects of advertising bans and health warnings is mixed, but these policies appear to be important in some of the countries that have had success in reducing smoking rates. School education programs and limits on retail sales are not likely to have much impact if implemented alone, but may be more important when combined with other policies.

The effects of tobacco control policies on smoking rates: a tobacco control scorecard.

A Structural Model of Health Behavior: A Pragmatic Approach to Explain and Influence Health Behaviors at the Population Level

This paper examines the effectiveness of several tobacco control policies in discouraging cigarette smoking among youths. These policies include increased cigarette excise taxes (which result in higher cigarette prices), restrictions on smoking in public places and at private worksites, and limits on the availability of tobacco products to youths, The data employed in this research are taken from the 1992, 1993, and 1994 surveys of eighth, tenth, and twelfth grade students conducted by the University of Michigan’s Institute for Social Research as part of the Monitoring the Future Project. Site specific cigarette prices and measures of tobacco related policies are added to the survey data. The results indicate that tobacco control policies can be effective in reducing youth cigarette smoking. The average overall estimated price elasticity of youth cigarette demand of -1,313 indicates that large increases in cigarette excise taxes would lead to sharp reductions in youth smoking. Similarly, strong restrictions on smoking in public places would reduce the prevalence of smoking among youths, while limits on smoking in schools would reduce average cigarette consumption among young smokers, However, limits on youth access to tobacco products appear to have little impact on youth cigarette smoking. This is most likely the result of the relatively weak enforcement of these laws.

/pdf/price-tobacco-control-policies-and-youth-smoking-zyskhcnhfi.pdf

Price, tobacco control policies and youth smoking

Background Enforcing laws banning tobacco sales to minors is widely advocated as a way to reduce young people's access to tobacco and tobacco use. Whether this approach is successful is not known. Methods In a two-year controlled study, we assessed sales of tobacco to minors and young people's access to and use of tobacco in six Massachusetts communities. Three communities (the intervention group) enforced tobacco-sales laws, whereas three matched communities (the control group) did not. To assess compliance with the law, minors working for the study investigators attempted to purchase tobacco from all retail vendors in each community every six months. Three annual anonymous surveys of a total of 22,021 students in grades 9 through 12 (response rate, 84 percent) measured access to tobacco and smoking behavior. Results At base line, 68 percent of 487 vendors sold tobacco to minors. Compliance with the law improved significantly faster in the intervention communities than in the controls (P<0.001). By the s...

The Effect of Enforcing Tobacco-Sales Laws on Adolescents' Access to Tobacco and Smoking Behavior

Objective. —To assess the effect that cigarette legislation would have on reducing merchant sales rates of cigarettes to minors and the affect on adolescent smoking behavior. Design. —Observational survey of merchant selling behaviors and adolescent smoking habits before and after passage of legislation. Setting. —The setting for the merchant survey was Woodridge, Ill (population 25 200), a suburban community of Chicago. The surveys were distributed to adolescents in the local junior high school. Participants. —Convenience sample of both merchants and adolescent students. Intervention. —Passage of community antismoking legislation. Main Outcome Measures. —Percentage of stores selling cigarettes to minors in Woodridge and percentage of students who had experimented with cigarettes or were regular smokers. Results. —Merchant sales rates in Woodridge decreased from a baseline of 70% before legislation to less than 5% in 1.5 years of compliance checking after legislation. Student surveys showed that the rates of cigarette experimentation and regular use of cigarettes by adolescents were reduced by over 50%. Conclusion. —Cigarette control laws can be effective in significantly reducing the rate of cigarettes sold by merchants and rates of cigarette use by adolescents. Key elements of successful legislation implementation are consistent compliance checking and heightened community awareness of the problems and prevalence of adolescent smoking. ( JAMA . 1991;266:3159-3161)

https://jamanetwork.com/journals/JAMA/articlepdf/393822/jama_266_22_030.pdf

Scott H. Birkhead

Papers

Active enforcement of cigarette control laws in the prevention of cigarette sales to minors.