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Report of the Tobacco Policy Research Study Group on Access to Tobacco Products in the United States
  1. David Altman,
  2. Julia Carol,
  3. Christine Chalkley,
  4. Joe Cherner,
  5. Joseph DiFranza,
  6. Ellen Feighery,
  7. Jean Forster,
  8. Sunil Gupta,
  9. John Records,
  10. John Slade,
  11. Bruce Talbot,
  12. Joe Tye
  1. Stanford University, Stanford, California
  2. Americans for Nonsmokers’ Rights, Berkeley, California
  3. Utah Department of Health, Salt Lake City, Utah
  4. SmokeFree Educational Services and Kidder Peabody, New York, New York
  5. University of Massachusetts, Fitchburg, Massachusetts
  6. Stanford University, Stanford, California
  7. University of Minnesota, Minneapolis, Minnesota
  8. Youth Representative
  9. North Bay Health Resources Center, Petaluma, California
  10. UMD-Robert Wood Johnson Medical School and St Peter’s Medical Center, New Brunswick, New Jersey
  11. Woodridge Police Department, Woodridge, Illinois
  12. Stop Teenage Addiction to Tobacco and Baystate Medical Center, Springfield, Massachusetts
  1. Correspondence to : Dr David Altman, Center for Research in Disease Prevention, Stanford University School of Medicine, 1000 Welch Rd, Palo Alto, California 94304-1885, USA

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There are many factors that influence young people to start and to continue smoking. Interventions to reduce tobacco use can focus on either limiting the supply or decreasing the demand for tobacco. Clearly, interventions of both kinds are necessary. Efforts to reduce access should be complemented by comprehensive prevention curricula in schools, making schools smokefree zones, and the elimination of tobacco advertising and promotions, to name a few activities of high priority. Access to tobacco may be thought of as a system, comprised of the environment (tobacco outlets, distributors, companies) the agent (tobacco), and hosts (smokers, especially young people). Efforts to prevent tobacco use early in life should consider each component of this system ; the eventual goal is a generation of young people who never start using tobacco.

This report summarises the body of research on access to tobacco by young people and outlines questions arising from this research.


Tobacco use by young people

Nicotine is a powerful drug with addictive properties broadly analogous to those of the so called “hard drugs”, cocaine and heroin.1. In 1990, roughly 53% of high school seniors who smoked at least half a pack a day had made an unsuccessful attempt to stop smoking. Moreover, whereas only 5% who smoked daily thought that they would still be smoking five years later, about three quarters were still smoking seven to nine years later.2 Use of smokeless tobacco, especially among young males, has risen rapidly in recent years. An extensive review of smokeless tobacco3 found that between 40–60% of males had tried smokeless tobacco and 10–20% of older teenagers reported recent use.4

Although alcohol consumption by teenagers generally receives more attention than their use of tobacco, tobacco is more often used by high school students on a daily basis.2 In the United States, the …

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