Underage Cigarette Sales and High School Smoking

1
Underage Cigarette Sales andHigh School Smoking

• An intervention study
• in Fort Morgan, Colo.

Theresa Mickiewicz, MSPHDetective Loren
SharpArnold Levinson, PhD
2
Background

• Laws against selling cigarettes
• to minors (under age 18).
• Surveys show teens buy anyway.
• Conventional enforcement ineffective.
• If underage sales truly stop,
• what happens to teen smoking
• and cigarette sharing?

3
Research questions

• Can we really stop underage sales?
• If yes
• what happens to supplies?
• what happens to social exchange?
• what happens to smoking?

4
Fort Morgan Intervention

• Non-smoking minors with good grades and
  citizenship.
• Supervised by undercover officer.
• Enter stores alone, ask for cigarettes.
• Allowed to become regular customer first (buy a
  beverage, small snack).

5
Intervention, cont.

• Clerk violators warned first time, ticketed for
  both sales second time.
• Store violators state penalties.

6
Enforcement data

• All stores in city (34), 2 in Morgan County.
• 768 total purchase attempts (average 23 per
  store).
• 43 total violations.

7
Pattern of underage sales

• INSERT CHART HERE

8
Interpretation

• Underage sales greatly reduced?
• Cover blown in study operation?

9
Annual student survey

• Smoking history and status.
• How students get cigarettes.
• Social exchange of cigarettes.
• Analyzed ages 14-17, Anglo or Hispanic.
• Adjusted for age, sex, ethnicity.

10
Usual ways to get cigs (current),2004 vs. 2005
2004-05 difference, p 11
Usual ways to get cigs (frequent),2004 vs. 2005
2004-05 difference, p 12
Clerk behaviors
2004-05 difference, p0.05
13
Clerk behaviors
2004-05 difference, p 14
Store behaviors
p 15
Social distribution of cigarettes,2004 vs. 2005

• No change in frequency ( days in the last month)
  of carrying cigarettes ...
• BUT
• ... scarcer supplies when carrying (10.5 cigs
  vs. 13.3 cigs, p0.001)
• reduced supply by 21

16
More asking, more refusing, 2004 vs. 2005
pp 17
Not as easy to ask for a cigarette, 2004 vs. 2005
p0.002
18
Smoking status,2004 vs. 2005
p0.002
p0.02
19
Current smokers

• No change in smoking frequency or amount ...
• BUT ...
• Increase in serious quit attempts, 50 vs. 60
  (p

20
Conclusions

• Rigorous enforcement of cigarette sales
  regulations is associated with
• increased clerk monitoring of age
• reduced cigarette sales to minors
• no clear source-shifting
• reduced number of violating stores
• reduced cigarette supplies in the social-exchange
  marketplace
• reduced teen smoking
• increased teen quit attempts

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Limitations / Next Steps

• Study design cant prove enforcement caused
  changes
• Long-term effects unknown
• stores stay compliant?
• adult smoking prevented? delayed? unaffected?
• Cost-benefit balance unknown
• Tobacco tax effects?
• Above unknowns should be studied

22
Acknowledgements

• This research was supported by the Colorado
  Alcohol and Drug Abuse Division.
• Enforcement was conducted by the
• Fort Morgan Police Department and the Colorado
  Tobacco Enforcement Unit.
• Special thanks to the anonymous Fort Morgan teens
  who helped protect adolescents from cigarette
  addiction.