Tobacco outlet density, retailer cigarette sales without ID checks and enforcement of underage tobacco laws: associations with youths’ cigarette smoking and beliefs

Abstract

Aims To estimate relationships of tobacco outlet density, cigarette sales without ID checks, and local enforcement of underage tobacco laws with youth’s lifetime cigarette smoking, perceived availability of tobacco and perceived enforcement of underage tobacco laws and changes over time. Design The study involved: (a) three annual telephone surveys, (b) two annual purchase surveys in 2,000 tobacco outlets, and (c) interviews with key informants from local law enforcement agencies. Analyses were multilevel models (city, individual, time). Setting A sample of 50 mid-sized non-contiguous cities in California, USA. Participants 1,478 youths (aged 13–16 at Wave 1, 52.2% male). 1,061 participated in all waves. Measurements Measures at the individual-level included lifetime cigarette smoking, perceived availability, and perceived enforcement. City-level measures included tobacco outlet density, cigarette sales without ID checks, and compliance checks. Findings Outlet density was positively associated with lifetime smoking (OR=1.12, p<.01). An interaction between outlet density and wave (OR=0.96, p<.05) suggested that higher density was more closely associated with lifetime smoking at the earlier waves when respondents were younger. Greater density was positively associated with perceived availability (β=0.02, p<.05) and negatively associated with perceived enforcement (β=−0.02, p<.01). Sales rate without checking IDs was related to greater perceived availability (β=0.01, p<.01) and less perceived enforcement (β=−0.01, p<.01). Enforcement of underage tobacco laws was positively related to perceived enforcement (β=0.06, p<.05). Conclusions Higher tobacco outlet density may contribute to lifetime smoking among youths. Density, sales without ID checks and enforcement levels may influence beliefs about access to cigarettes and enforcement of underage tobacco sales laws.

Commentary on Lipperman‐Kreda et al. (2016): Robust methods with a weak outcome measure still lead to consistent conclusions—even so, it may be time for recommendations to move from traditional tobacco control strategies to a relevant endgame strategy

“…The authors should be commended for the successful development, implementation and execution of such a large study, which incorporated valuable contextual information to supplement individual behavior measures across multiple jurisdictions over time. From this effort, they report that tobacco outlet density was associated positively with both life-time smoking and youth perceptions of tobacco availability, while associated negatively with perceived enforcement of age of majority laws [1]. These conclusions align appropriately with previous evidence [2][3][4][5][6][7].…”

“…The work by Lipperman-Kreda et al [1] presents a robust methodological study on which to strengthen the evidence base in support of this conclusion. The following is not a criticism of the quality of work or the recommendations made by the authors; rather, it is a critical reflection about a subtle but important detail overlooked in their methods and an important, but not so subtle, additional recommendation for action that I believe should not be overlooked in the future.…”

“…The recommendations made by Lipperman-Kreda et al [1] align with the more traditional paradigm of trying to control tobacco use, as they conclude that future efforts should focus upon controlling the density and location of retailers and more effective enforcement of underage sales laws. While reasonable, they are really designed simply to prevent underage youth from accessing tobacco until they reach the legal age of majority; tobacco use is delayed, but not entirely prevented.…”

“…Lipperman-Kreda et al [1] report on a large multiphase study that involved (a) sampling a large cohort of youth from 50 communities and following them over time, (b) a protocol testing tobacco retailer compliance within those 50 communities and (c) key informant interviews with local law-enforcement agencies in each community. The authors should be commended for the successful development, implementation and execution of such a large study, which incorporated valuable contextual information to supplement individual behavior measures across multiple jurisdictions over time.…”

“…Thirdly, a measure of ever use is not appropriate when looking at retailer access, given the social exchange of cigarettes among youth, especially nonestablished youth smokers who rarely access cigarettes from retailers [10]. It is not clear if other smoking behavior measures are available within the host study [1] but, if measures of experimentation or established smoking are available, they are worth exploring.…”