Contextual and community factors associated with youth access to cigarettes through commercial sources

Abstract

Objectives This study examines contextual and community level characteristics associated with youth access to tobacco through commercial sources in 50 non-contiguous mid-sized California communities. Methods The study is based on data from access surveys conducted by 4 confederate buyers (2 males and 2 females) in 997 tobacco outlets. City demographics, adult smoking prevalence and measures of tobacco outlet density, local tobacco retailer licensing and cigarette tax were included. Results Multilevel regression analyses indicated that buyer actual age, a male clerk and asking young buyers about their age were related to successful cigarette purchases. Buyer actual age and minimum age signs increased the likelihood that clerks will request an ID. At the community level, higher percentage of minors, higher education, and a greater percentage of African Americans were associated with increased likelihood of a successful purchase. Lower percentage of minors, lower education, lower percentage of African Americans, and having a local tobacco retailer licensing were associated with retailer asked for ID. Additionally, supermarkets charged significantly more for a pack of cigarettes than small markets whereas smoke/tobacco shops and drug stores/pharmacies charged less. Higher prices were associated with higher median household income and greater percentage of Hispanics. Findings about community characteristics, however, differed by cigarette brand. Conclusions This study enhances our understanding of the associations between contextual and community characteristics and youth access to tobacco through commercial sources which can help policymakers to identify and target at-risk communities and outlets to decrease youth access to tobacco.

Equity impact of interventions and policies to reduce smoking in youth: systematic review

“…Settings included primary and secondary schools, university, child healthcare centres, paediatric practices, hospitals, a US Navy recruitment centre, and vehicles. SES variables included education,28 – 35 parental education,24 36 – 41 household income,33 42 – 44 Family Affluence Scale (FAS),21 – 23 25 45 family socioeconomic classification,22 free school meal (FSM) eligibility,25 46 47 income/spending money,26 41 48 and occupation 49. Measures of area deprivation included the Index of Multiple Deprivation/area deprivation,25 50 – 54 Index of Relative Socio-Economic Disadvantage,54 household education and income level at ‘zip’ code level,55 56 percentage of population with a college education, 32 33 55 percentage of youth unemployment, percentage receiving social welfare and attending ‘low-qualifying’ schools, 35 53 percentage below 150% poverty level,32 57 and school census tract data 58…”

“…Five studies33 41 47 53 57 examined the equity impact of controls on access to tobacco, including age-of-sale legislation33 57 and electronic locking devices on cigarette vending machines 53. A US study41 examined the impact of several policy elements including: statewide enforcement, random inspections, graduated penalties, photo identification, free distribution, minimum age, packaging, vending machines, and clerk intervention.…”

“…A US study41 examined the impact of several policy elements including: statewide enforcement, random inspections, graduated penalties, photo identification, free distribution, minimum age, packaging, vending machines, and clerk intervention. Two studies demonstrated a positive equity impact,33 41 two studies a neutral a neutral equity impact,33 47 57 and one a negative impact 53. Stronger (ie comprehensive and enforced) state-level tobacco policies on age-of-sale were associated with lower smoking initiation and adverse transition among low SES adolescent girls (positive equity impact), though the effect sizes were small 41…”

“…Only seven studies, all in the USA, showed the potential to produce a positive equity impact. These included four studies of increasing the price/tax of tobacco products,36 37 42 48 two studies on control of youth access to cigarettes,33 41 and one text-messaging cessation intervention 44…”

Racial and Ethnic Differences in What Smokers Report Paying for Their Cigarettes

“…A study in California also documented higher prices in cities with greater percentages of Hispanic residents. 40 The role of the local cigarette market in producing racial and ethnic variation in cigarette pricing deserves future attention.…”