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![]() Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Accessibility of Tobacco Products to Youths Aged 12-17 Years -- United States, 1989 and 1993Although the sale of tobacco products to minors is illegal in all states and the District of Columbia (1), the prevalence of cigarette smoking among adolescents has continued to increase (2), and most minors are able to purchase tobacco products (3). Reducing sales to minors is believed to be an effective measure for reducing the prevalence of tobacco use (4). To determine recent patterns of minors' access to tobacco products from retail outlets and vending machines, data were analyzed from the 1989 and 1993 Teenage Attitudes and Practices surveys (TAPS I and TAPS II). This report summarizes the results of that analysis, which indicate that most minors who use tobacco purchase their own tobacco and that small stores are the sources of most purchases. Samples for both TAPS I and II were drawn from households that participated in the National Health Interview Survey (NHIS), a continuing nationwide household survey that collects information from a representative sample of the U.S. civilian, noninstitutionalized population aged greater than or equal to 18 years. Both TAPS I and II collected information on adolescents' knowledge, attitudes, and practices regarding tobacco use. TAPS I data were collected by telephone interviews; TAPS II data were collected by telephone and personal interviews and included both a new probability sample and a follow-up of respondents from TAPS I. Data for persons aged 12-17 years in each survey were analyzed (n=7773 for TAPS I; n=6165 for TAPS II) and weighted to provide national estimates. SUDAAN was used to calculate standard errors for determining 95% confidence intervals (CIs) and to perform multivariate logistic regression analyses of TAPS II data; simultaneous adjustments were made for age, sex, race/ethnicity, and region of the country. Differences between TAPS I and TAPS II for selected estimates were assessed by using the Generalized Estimating Equations software (5). Adjustments were made for subject correlation and age. Adolescents in both TAPS I and II who were current smokers were asked about purchase practices, and all respondents were asked about perceived ease of purchase (6). In TAPS II, adolescents who usually bought, ever bought, or ever tried to buy their own cigarettes were asked, "Have you ever been asked to show proof of age when buying/trying to buy cigarettes?" With the exception of questions regarding purchase from vending machines, similar questions were asked of TAPS II adolescents regarding the purchase of smokeless tobacco (SLT) products. Data were analyzed by race/ethnicity because, after controlling for sociodemographic differences, the prevalence of cigarette smoking is higher among minors in some racial/ethnic groups (3). The overall percentage of smokers aged 12-17 years who usually bought their own cigarettes was higher in 1993 than in 1989 (Table_1). In 1993, minors residing in the Northeast (adjusted odds ratio {AOR}=2.2; 95% CI=1.2-3.8) and South (AOR=1.8; 95% CI=1.1-3.0) were more likely than minors residing in the West to report they usually bought their own cigarettes. * In addition to the 61.9% of U.S. smokers aged 12-17 years who usually bought their own cigarettes in 1993, 15.5% reported they ever (but not usually) had bought cigarettes, and 2.3% reported they ever had tried unsuccessfully to buy their own cigarettes. Among minors aged 12-17 years who usually bought their own cigarettes, 14.6% in 1989 and 12.7% in 1993 often or sometimes bought their cigarettes from vending machines; 49.6% in 1989 and 36.8% in 1993 often or sometimes bought from large stores; and 84.6% in 1989 and 88.5% in 1993 often or sometimes bought from small stores (Table_2). In 1993, minors aged 12-15 years were more likely than those aged 16-17 years (AOR=2.1; 95% CI=1.1-4.3) to often or sometimes use vending machines; those aged 12-15 years were less likely than those aged 16-17 years to often or sometimes buy their cigarettes from small stores (AOR=0.5; 95% CI=0.4-0.7). In 1993, 55.3% (95% CI=51.0%-59.6%) of minors aged 12-17 years reported ever having been asked to show proof of age when buying or trying to buy cigarettes. Blacks (AOR=0.4; 95% CI=0.2-0.9) were less likely than whites to ever have been asked for proof of age, and Hispanics (AOR=0.3; 95% CI=0.1-0.6) were less likely than non-Hispanics to ever have been asked for proof of age. ** Minors residing in the Northeast (AOR=0.4; 95% CI=0.2-0.7) or in the Midwest (AOR=0.4; 95% CI=0.2-0.8) were less likely than minors residing in the West to ever have been asked for proof of age. In 1993, among minors aged 12-17 years who never had smoked a cigarette, 44.6% (95% CI=42.8%-46.3%) believed it would be easy for them to buy cigarettes, including 34.4% (95% CI=32.4%-36.3%) of minors aged 12-15 years and 76.4% (95% CI=73.8%-79.0%) of minors aged 16-17 years. In 1993, 51.7% (95% CI=43.9%-59.5%) of minors aged 12-17 years who had used SLT on one or more of the 30 days preceding the survey usually purchased their own SLT; 18.3% of SLT users in 1993 ever (but not usually) had bought their own SLT, and 3.1% ever had tried unsuccessfully to buy SLT. Among minors aged 12-17 years who usually bought their own SLT, 82.1% (95% CI=74.2%- 90.0%) often or sometimes bought from small stores, and 40.5% (95% CI=33.3%-47.9%) often or sometimes bought from large stores. In 1993, 43.2% (95% CI=34.4%-52.0%) of minors aged 12-17 years reported ever having been asked to show proof of age when buying or trying to buy SLT. Among males aged 12-17 years who had never used SLT in 1993, 39.0% (95% CI=36.7%-41.4%) believed it would be easy for them to buy SLT, including 28.1% (95% CI=25.6%-30.7%) of minors aged 12-15 years and 70.7% (95% CI=67.0%-74.5%) of minors aged 16- 17 years. Reported by: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: The findings in this report are consistent with previous documentation of the ease with which minors can purchase tobacco products over the counter and from vending machines and of the more frequent use of vending machines by younger adolescents (3). In surveys of tobacco outlets using unannounced over-the-counter purchase attempts by minors, purchase rates were usually highest in small stores and gas stations (3). In addition, previous studies using self-reported surveys of minors' tobacco use indicate that these locations are the most common source of purchased cigarettes by minors (3,6). Differences in access among racial/ethnic groups may be influenced by differences in socioeconomic status and by racial and cultural phenomena. The substantial race/ethnicity-specific differences for some of the variables in this analysis indicate the need to examine factors including attitudes of vendors, enforcement practices, and community norms. Vendors' requiring proof of age is an important method of preventing tobacco sales to minors (3,4; CDC, unpublished data, 1994). Widespread adherence to laws requiring age verification should assist substantially in preventing tobacco sales to minors. However, in 1993, approximately half of minors who ever had attempted to purchase their own tobacco products reported they never had been asked to show proof of age. The findings in this report are subject to at least two limitations. First, TAPS II may be associated with nonresponse bias; for example, TAPS I respondents who were followed up in TAPS II were less likely to be smokers in 1989 than were those who could not be reinterviewed, possibly contributing to the lower smoking prevalence estimates in TAPS II when compared with other national surveys (CDC, unpublished data, 1993). Second, because the information was collected during telephone and personal interviews, young persons may have been reluctant to disclose tobacco-related behavior when a parent was in the household during the interview (3). Although all states have enacted youth access laws, enforcement of these laws varies and needs to be strengthened. In 1994, enforcement activities were maintained only in 24 (44%) states and territories (7). Federal regulations now require states to develop a strategy and a time frame for achieving an inspection failure rate of less than or equal to 20% (8). The establishment and enforcement of laws that prohibit sales to minors are consistent with and reinforce existing social norms (4). One of the national health objectives for the year 2000 is to enforce laws to reduce the sales rate observed during compliance checks to 20% (objective 3.13) (9). In the United States, approximately 70% of purchase attempts made by minors are successful (3). In August 1995, the Food and Drug Administration proposed regulations that could reduce for minors both access to and the appeal of nicotine-containing cigarettes and SLT products (10). The regulations would 1) require retailers to verify the age of persons who want to purchase cigarettes or SLT products; 2) eliminate "impersonal" methods of sale and distribution that do not readily allow age verifications (e.g., mail orders, self-service displays, free samples, and vending machines), 3) limit advertising to which minors may be exposed to a text-only format; 4) ban outdoor advertising of tobacco products within 1000 feet of schools and playgrounds; 5) prohibit the sale or distribution of brand-identifiable nontobacco items and services; and 6) prohibit the sponsorship of events in the brand name. FDA is reviewing public comments on the proposed regulations. References
* Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. ** Numbers for other racial/ethnic groups were too small to calculate precise estimates. Table_1 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 1. Percentage of smokers * aged 12-17 years + who usually bought their own cigarettes in 1989 and 1993, by selected characteristics -- United States, Teenage Attitudes and Practices Surveys I and II, 1989 & and 1993 & ===================================================================================== 1989 1993 ----------------------- ------------------------- % Point change Characteristic No. (%) (95% CI @) No. (%) (95% CI) 1989 to 1993 ------------------------------------------------------------------------------------- Age (yrs) 12-15 439 (45.4) (+/- 4.9%) 264 (52.4) (+/- 6.3%) + 7.0 16-17 559 (66.6) (+/- 4.1%) 446 (69.1) (+/- 4.3%) + 2.5 Sex Male 521 (59.6) (+/- 4.5%) 367 (63.6) (+/- 4.8%) + 4.0 Female 477 (55.3) (+/- 4.8%) 343 (60.5) (+/- 5.7%) + 5.2 Race ** White 914 (58.7) (+/- 3.3%) 639 (62.1) (+/- 4.0%) + 3.4 Black 64 (43.3) (+/-11.5%) 52 (64.1) (+/-14.3%) +20.8 Ethnicity ++ Hispanic 68 (41.3) (+/-12.8%) 56 (59.1) (+/-13.8%) +17.8 Non-Hispanic 924 (59.0) (+/- 3.3%) 654 (62.4) (+/- 3.9%) + 3.4 Region && Northeast 218 (58.8) (+/- 6.8%) 146 (68.4) (+/- 8.4%) + 9.6 Midwest 275 (55.0) (+/- 5.5%) 225 (61.6) (+/- 6.2%) + 6.6 South 305 (61.5) (+/- 5.9%) 201 (66.2) (+/- 6.2%) + 4.7 West 200 (53.6) (+/- 7.6%) 138 (50.9) (+/- 9.4%) - 2.7 Total 998 (57.5) (+/- 3.2%) 710 (61.9) (+ 3.9%) + 4.4 ------------------------------------------------------------------------------------- * Youths who reported smoking at least one cigarette during the 30 days preceding the survey. + As of November 1, 1989, or March 15, 1993. & Prevalence estimates were calculated from weighted data. @ Confidence interval. ** Excludes 39 persons of other, multiple, and unknown races because numbers were too small to calculate precise estimates. ++ Excludes six persons with unknown Hispanic origin. && Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. @@ The log odds ratio for the change in the overall prevalence of "bought own cigarettes" from 1989 to 1993 estimated using the Generalized Estimating Equations software is 0.21 (odds ratio=1.2) This log odds ratio was significantly different than zero at the 0.05 level. The logistic model used to calculate the above included age as a covariate. ===================================================================================== Return to top. Table_2 Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size. TABLE 2. Percentage of smokers * aged 12-17 years + who usually bought their own cigarettes and who often/sometimes purchased cigarettes from a vending machine, large store, or small store, by selected characteristics -- United States, Teenage Attitudes and Practices Survey, 1989 & and 1993 & ======================================================================================================= Vending machine Large store Small store ------------------------ ------------------------ ------------------------ % Point % Point % Point change change change Characteristic 1989 1993 1989 to 1993 1989 1993 1989 to 1993 1989 1993 1989 to 1993 ------------------------------------------------------------------------------------------------------- Age (yrs) 12-15 20 18 - 2.0 41 36 - 4.9 79 83 +3.5 16-17 12 10 - 2.3 54 37 -17.2 87 92 +4.7 Sex Male 18 12 - 5.8 51 36 -15.0 82 90 +8.3 Female 11 13 + 2.3 49 38 -10.9 88 88 -0.5 Region @ Northeast 15 18 + 3.3 50 30 -20.1 84 88 +3.8 Midwest 20 8 -12.2 51 33 -17.5 89 88 -0.8 South 12 15 + 2.3 50 44 - 6.2 85 90 +5.6 West 11 9 - 1.8 47 37 -10.3 80 88 +8.8 Total 15 13 - 2.1 50 37 -13.1 85 89 +4.2 ** ------------------------------------------------------------------------------------------------------- * Youths who reported smoking at least one cigarette during the 30 days preceding the survey. + As of November 1, 1989, or March 15, 1993 & Prevalence estimates were calculated with weighted data. @ Northeast=Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont; Midwest=Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South=Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virgina, and West Virginia; West=Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. ** The log odds ratio (LOR) for the change in the overall prevalence from 1989 to 1993 using the Generalized Estimating Equations software was calculated for those who usually bought their own cigarettes and who often/sometimes purchased cigarettes from a vending machine (LOR=0.17; odds ratio {OR}=1.18), large store (LOR=0.51; OR=1.67), or small store (LOR=0.34; OR=1.40). The LORs were significantly different than zero at the 0.01 level for large stores and at the 0.05 level for small stores. The logistic model used to calculate the above included age as a covariate. ======================================================================================================= Return to top. Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 09/19/98 |
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