Study Says Tougher Measures Needed to Curb Teen Smoking

A major new study in the New England Journal of Medicine indicates that considerably tougher enforcement programs and other measures will be needed to achieve significant reductions in teen smoking .

The study, to be released today, found that even when more than 80% of merchants in several Massachusetts communities obeyed a law prohibiting tobacco sales to minors, youths reported that they had little trouble buying cigarettes.

“Our findings suggest that reducing young people’s access to tobacco will require even better merchant compliance than the 82% rate achieved here,” said the study’s authors, Dr. Nancy Rigotti, director of tobacco research and treatment at Massachusetts General Hospital in Boston, and Dr. Joseph DiFranza, associate professor of family and community medicine at the University of Massachusetts.

The findings seem particularly noteworthy because they are the result of a two-year study in a state having one of the most vigorous tobacco control movements in the United States.

“This shows that even in a state where we’re aggressively addressing this issue, you really have to go after this problem,” said Greg Connolly, chief of Massachusetts’ tobacco control program. “We have to get the illegal sales rate down to 5%, increase fines and take away the licenses of merchants selling to minors.”

New federal policies adopted earlier this year call for states to lose block grants from the Department of Health and Human Services unless they ensure that at least 80% of merchants are not selling cigarettes to minors. But the New England Journal study indicates that “even if states meet that goal, the law cannot reasonably be expected to reduce the supply of tobacco to young people or alter their smoking behavior.”

The study investigated three Massachusetts communities with vigorous control programs and three other communities with less stringent programs but similar demographics. The study sent 16-year-old girls to stores in three of the six communities to try to buy cigarettes.

“As the study progressed, the rate of illegal sales by merchants declined dramatically in the communities that enforced the law, but youths living in those communities reported that they rarely had trouble buying tobacco, and their smoking rates did not decrease,” Rigotti said. “We suspect that some merchants didn’t stop selling tobacco to children. They simply learned to spot which young people were testing them for compliance.”

“We had several merchants tell our youths that they would be happy to sell them cigarettes if they would simply say they were 18 years old,” DiFranza said. “It only takes one dishonest merchant to supply an entire school system with tobacco.”

Ironically, the study is likely to give some comfort both to the cigarette companies and to some of their most vigorous adversaries.

The companies have said for months that even if they make the best possible efforts, it will be very difficult to reach the target goals for reducing youth smoking contained in the proposed $368.5-billion national tobacco settlement. If those goals--including a 30% reduction in five years--are not met, the companies would be subject to up to $2 billion a year in penalties.

On the other hand, the study also supports industry critics such as Stanton Glantz, a medical school professor at UC San Francisco, who has contended that tobacco foes are concentrating too much of their energy on reducing teen smoking, rather than having a more comprehensive strategy.

“I think the [proposed] national settlement somehow assumed we knew how to reduce teen smoking, but I’m not sure we have the full story,” Rigotti said. “We need a multifaceted program: raising cigarette prices, setting higher standards, doing more enforcement checks, imposing penalties on the companies and good counter counter-advertising that focuses on making it uncool to smoke.”

Rigotti said that Glantz was right when he contended that tobacco foes should put more of their energy into combating smoking by adults, because “a focus entirely on kids can make it seem OK for adults to smoke.”

Rigotti stressed that a commodity that is marketed as an adult product “makes it very attractive to kids and almost impossible to stop.”

David A. Kessler, the former commissioner of the Food and Drug Administration, said the study provides further evidence that “there has to be a comprehensive approach” to reducing teen smoking, including restricting access, raising prices and reducing appeal.”

“No one should be lulled into thinking this will be easy,” Kessler stressed. “You have decades and decades of advertising and promotion that you have to overcome. “

* MAKE THEM SMOKE?: Perhaps forcing teens to smoke would turn them off cigarettes, a nonsmoker writes. E1