Reducing access to tobacco is regarded as a component of effective programs to reduce smoking among young people,1,2 although there is some debate in the literature as to the extent of its importance and effectiveness as a means of reducing uptake.3–8
National data (2008) showed that the most common ways for adolescents to access cigarettes was through friends (45% of current smokers) and asking someone else to buy them (17% of current smokers).9
However 20% of current smokers aged 12–17 years bought their last cigarette in 2008 (compared with 23% in 2005). Around 12% of smokers aged 12–15 years had bought their own cigarettes, and 20% of teenagers aged 16–17 years had made their own purchases. Male smokers were more likely to buy cigarettes for themselves than female smokers. In general, the likelihood of having made a personal purchase increases with age, and with frequency of smoking behaviour.9 The proportion of children buying their cigarettes varies across jurisdictions. For example, in New South Wales in 2008, fewer than 1 in 10 students (8.7%) aged 12–17 years purchased their last cigarette10 (compared with 22% in 2002)11. In South Australia 15% of students aged 12–17 years purchased their last cigarette in 2008 (compared with 19% in 2002).12
The same survey showed that among current smokers aged 12–17, 49% of males and 38% of female students thought it would be easy (or very easy) to buy their own cigarettes, and 81% believed it would be easy (or very easy) to get someone else to buy cigarettes for them.9 However, the overall proportion of current smokers aged 12–17 years buying their own cigarettes has declined substantially over time. In 1987 more than half of students aged 12–17 years purchased their last cigarette compared with 20% in 2008.
The proportion of current smokers aged between 12 and 15 years buying their cigarettes decreased between 1987 and 2002, increased slightly between 2002 and 2005 and then decreased between 2005 and 2008.
Among older current smokers buying their own cigarettes, the decrease in the proportion that commenced between 1990 and 1993 continued to 2005 and stabilised in 2008.
The proportion of younger current smokers getting others to buy cigarettes for them in 2008 was similar to the proportion found in 2005. There was a slight increase in the proportion of older current smokers getting others to buy cigarettes for them between 2005 and 2008.
Percentage of current smokers aged 12–15 and 16 to 17 buying cigarettes for themselves, 1987 to 2008
It is illegal to sell tobacco products to children under the age of 18 years in all states and territories of Australia. Efforts to more vigorously enforce laws banning the sale of tobacco to minors began in some states in the early 1990s–notably in Western Australia and New South Wales. These efforts focused on monitoring compliance with the legislation, retailer education, issuing warning notices and where necessary, prosecution of offenders. Compliance monitoring and enforcement efforts generally utilised 'controlled purchase activities' where children attempt to purchase tobacco under the supervision of an adult
In 2011 the majority of states and territories–New South Wales, Western Australia, Victoria, South Australia, Tasmania, the Australian Capital Territory and the Northern Territory–conduct random compliance monitoring activities as described above. Queensland employs covert surveillance operations both opportunistically, and in response to complaints to monitor and enforce the legislation.
Most states and territories have introduced strict proof-of-age requirements for the sale of tobacco, requiring the seller to request and sight approved photo ID to determine the age of a person attempting to purchase tobacco. Acceptable forms of photo ID generally include drivers licence, passport or an official 'proof of age' card. Some jurisdictions prosecute retailers caught selling tobacco, while others have introduced an expiation system for these offences.
As noted in Section 5.11, many adolescents obtain their cigarettes through informal social sources, which are very difficult to control. This, and the fact that interventions aimed at reducing sales of tobacco to minors have had mixed results on reducing tobacco use, has led to questions about the usefulness of access restrictions.3 However the 'symbolic' imperative of targeting access and supply is sometimes overlooked in this debate. After all, widespread availability and ready access to tobacco products can send young people mixed messages about the social acceptability and dangers of smoking.13 A counter argument to this is that tighter controls on access may, in fact, make tobacco more appealing to young people (as 'forbidden fruit'),14 although this premise is not supported by data that have shown continued declines in smoking prevalence in young people during a sustained period of enforcement of this legislation.10–12 Research also shows that perceived availability increases the risk for smoking among young people and has a stronger effect among those with smoking peers.8,15
There are reports in the literature of some sales to minors programs (particularly early programs) that have had little impact on youth smoking rates or little influence on retailer selling habits.16
In general, programs with weak legislative restrictions and ineffective enforcement are less likely to be effective both in influencing retailer behaviour, and therefore unlikely to impact on smoking rates.6,7,8 Studies have demonstrated that strong enforcement programs have reduced illegal sales and can contribute to reductions in youth smoking rates.17,18
To be effective, legislative measures to reduce access need to: 6,19 be regularly enforced, in order to ensure high compliance rates
A systematic review conducted in 2009 on the effectiveness of interventions to reduce access to tobacco found that access restriction interventions may produce significant reductions in the rate of illegal tobacco sales to youth. However, lack of enforcement and the ability of youth to acquire cigarettes from social sources can undermine the effectiveness of these interventions.7
A US study explored the association between state-level tobacco-control policies and youth smoking cessation behaviours from 1991 to 2006. The study found that the strength of sales to minors laws was associated with lower progression to continued smoking among young people in grades 10 and 12.20
A study of over 13 000 students in the US showed those students living in states with no or minimal restrictions were more likely to be daily smokers than students living in states with strict regulations. These effects were somewhat reduced when logistic regressions were adjusted for socio-demographic characteristics and cigarette price, suggesting that higher cigarette prices may discourage youth to access and consume cigarettes independent of other tobacco-control measures.8
A further US study found that higher retailer compliance in the period 1997–2003 predicted lower levels of current daily smoking among adolescents. The odds ratio for daily smoking was reduced by 2% for each 1% increase in merchant compliance. After controlling for price changes, media campaigns and smoking restrictions, a 21% reduction in the odds of smoking among students in Grade 10 in 2003 was attributed to the observed improvement in retailer compliance between 1997 and 2003. This study concluded that enforcement efforts by states to prevent the sale of tobacco to minors appear to have made an important contribution to the observed decline in smoking among youth in the US.17
An Australian study by Tutt and Bauer and colleagues in 2009 examined the impact of sustained and vigorous enforcement of sales to minors legislation. The study compared the New South Wales Central Coast intervention area to the rest of New South Wales and Australia. The proportion of youth who made recent purchase attempts declined by almost three-quarters (74%) between 1993 and 2002, providing evidence that young people had felt the impact of the enforcement program. Among smokers, the proportion who had made purchase attempts declined from 83% to 45%. Between 1993 and 1996 the prevalence of smoking declined in the Central Coast intervention area, while remaining unchanged in New South Wales as a whole and nationally. Between 1993 and 2002, the prevalence of current smoking in the intervention area was reduced by half. This study found that effective enforcement of an age-restricted tobacco sales law was accompanied by a substantial reduction in attempted purchases of tobacco and of smoking by youth. The impact of the intervention was not only sustained but also increased with time.6
A 2008 study examined the impact of tobacco-control policies, cigarette price and tobacco-control program funding on Australian adolescents' smoking over a 15-year period.21 The study found that stricter controls on youth access to cigarettes were associated with lower smoking prevalence in unadjusted analyses but this policy area was not associated with smoking after adjusting for other policies, demographics and survey year. However, as noted by the authors the policy measure did not include an indicator of the strength of regulation enforcement, as these data were not available. As enforcement is important in determining the effectiveness of youth access policies, this may have influenced the results.
In the US, state legislation restricting sale of tobacco to minors often includes legislative restrictions for possession, use or purchase of tobacco by minors, however these laws (sometimes referred to as 'PUP laws') appear to have little impact on reducing smoking prevalence. One study found no difference in smoking rates between the control and experimental group but did report more young people in the control group smoking more than 20 cigarettes per day.22,23 Many tobacco-control experts in Australia have recommended caution in regard to this policy approach, arguing that rather than placing the onus on the seller, such laws criminalise purchases by young people, which may have other negative unforeseen consequences.
Licensing of tobacco retailers has been advocated as a means of further regulating the availability of tobacco and curbing sales to minors. This can allow for a graduated system of penalties, with infringements ranging from warnings and fines to an ultimate loss of licence.19 All states and territories except Victoria and Queensland have introduced some form of tobacco licensing system. Some jurisdictions have a positive licensing system that requires retailers to apply for and annually renew their license with an associated licensing fee. Other jurisdictions have implemented what is commonly referred to as a 'negative licence scheme' where retailers may be prohibited from selling tobacco products if found guilty of selling these to young people. A negative licensing system may also be complemented by a notification system such as the one in place in New South Wales, where retailers are required to notify a government agency that they will be selling tobacco.
The tobacco industry in Australia and overseas has championed programs aimed at educating tobacco retailers and the general public about sales to minors regulations (see Chapter 10, Section 10.13.1), initiatives thought by critics to be more likely to serve industry ends than to improve public health.24
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2. US Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General, 1994. Atlanta, Georgia: Public Health Service, Centers for Disease Control and Prevention, Office on Smoking and Health, 1994. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_1994/index.htm
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13. Ministerial Council on Drug Strategy and Department of Health and Ageing. National Tobacco Strategy 2004-2009 Canberra: Commonwealth of Australia, 2005. Available from: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/phd-pub-tobacco-tobccstrat2-cnt.htm
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18. Chen V and Forster J. The long-term effect of local policies to restrict retail sale of tobacco to youth. Nicotine & Tobacco Research 2006;8(3):371-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16801295
19. Stead L and Lancaster T. A systematic review of interventions for preventing tobacco sales to minors. Tobacco Control 2000;9(2):169–76. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/9/2/169
20. Tworek C, Yamaguchi R, Kloska D, Emery S, Barker D, Giovino G, et al. State-level tobacco control policies and youth smoking cessation measures. Health Policy 2010;97(2-3):136-44. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20483500
21. White V, Warne C, Spittal M, Durkin S, Purcell K and Wakefield M. What impact have tobacco control policies, cigarette price and tobacco control program funding had on Australian adolescents' smoking? Findings over a 15-year period. Addiction 2011;106(8):1493-502. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03429.x/pdf
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