Cigarette smoking not only damages the health of adolescents, but also contributes to air pollution. The Tobacco Hazards Prevention Act in Taiwan stipulates that cigarettes should not be sold to persons younger than 18 years. Therefore, schools should actively educate students and raise awareness of the Tobacco Hazards Prevention Act to reduce the level of damage to the health of adolescents and maintain good air quality. This study had two main goals: (1) to evaluate the stipulation that no person shall provide tobacco products to persons under the age of 18 and the effects of counseling strategies on store managers confirming customer ages before tobacco sale in southern Taiwan; and (2) to evaluate the situation of tobacco hazard prevention education conducted by school in southern Taiwan. A cross-sectional design was adopted for this study. Study I: The investigation involved an analysis of 234 retailers including convenience stores (n = 70), grocery stores (n = 83), and betel nut stalls (n = 81). The results indicated that among the 234 retailers, 171 (73.1%) of them routinely failed to confirm the buyers’ ages before allowing them to purchase tobacco. The number of retailers who exhibited failure to confirm customer ages before selling tobacco products had decreased from 171 (73.1%) to 59 (25.2%) and that of those who confirmed customer ages before selling tobacco products had increased from 63 (26.9%) to 175 (74.8%) after counseling strategies had been provided, thereby revealing statistical significance (χ2 = 11.26, p < 0.001). Study II: A total of 476 (89.1%) participants had received tobacco hazards prevention education and 58 (10.9%) had not. Among the various residential areas, the highest percentage of participants that did not received tobacco hazards prevention education located in the plane regions (8.4%). The government organizations should continue to adopt counseling strategies to reduce the rate of disobedience of the Tobacco Hazards Prevention Act by selling tobacco products to minors. Schools should pay close attention to tobacco hazard prevention education for junior high school students to ensure that such students are adequately educated about tobacco hazard prevention.

Tobacco smoking and exposure to secondhand smoke are major environmental risk factors that negatively influence health. It is recommended that tobacco product manufacturers and retailers receive empowerment counseling programs to achieve adolescent health targets. The present study conducted an empowerment counseling session to counsel tobacco product retailers in refusing to sell tobacco products to minors. The three stages of this study were conducted from March 2015 to February 2017. The results revealed that 74% of retailers were selling tobacco products to minors at baseline, 40% at stage two and 15% at stage three. These represent significant reductions in selling tobacco products to minors (all stage differences p < 0.001). However, experimental design studies could be used to examine the empowerment counseling program for preventing tobacco sales to minors in the future. Moreover, health care providers should collaborate with tobacco product retailers to design unique empowerment counseling sessions for specific regions to improve retailers’ capabilities for self-management in terms of tobacco hazard prevention.