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Numerical scores rating the extensiveness of state laws on youth access to tobacco as of the years 1993–1996 were presented by Alciati and colleagues.1 The data were recently updated for 1997–1999 and corrected for 1993–1996. Notably, the current analysis captures more long term state legislative activity following implementation of the Synar Amendment2 and the attempted Food and Drug Administration (FDA) rule that included a number of youth access provisions.3
The results across the years 1993–1999 provide the opportunity for comparative benchmarking of state youth access laws based on recognised public health goals4 as well as for comparisons with state clean indoor air laws.5 Rating systems for both state youth access and clean indoor air laws were developed by an advisory committee of the National Cancer Institute's State Cancer Legislative Database Program using a comparable methodology.1, 5
In rating state youth access laws as of 1993–1999, the total score for each state reflected the sum of individual ratings on nine items: minimum age, packaging, clerk intervention, photo identification, vending machines, free distribution, graduated penalties, random inspections, and statewide enforcement. A state that met the target for all nine items would receive a summary score of 36 points (39 points if the target was exceeded on three items).1
Table 1 shows the summary scores by state and year. Summary scores ranged from a low of 0 points in 1993 to a high of 30 points in 1998 and 1999. Average summary scores ranged from 8.35 points in 1993 to 15.59 points in 1999. Separate, reduced scores are also listed (in parentheses) for states that enacted state based preemption measures. These states are highlighted in light of the significant public health policy arguments against preemptive state tobacco control laws.6 (Data for table 1 have been revised and reformatted from Alciati and colleagues1 to present primarily the summary scores without the preemption penalty to enable comparability with the clean indoor air scores presented in Chriqui and colleagues5).
While average scores rose from 1993 to 1999, the peak average score of 15.59 points in 1999 is still relatively low. State legislative activity that accounted for the increases that occurred in the late 1990s focused principally on new measures related to vending machines, clerk intervention, random inspections, and statewide enforcement. Restrictions on minors' access to tobacco products from vending machines and self service displays (that is, without clerk intervention) were covered under the 1996 FDA rule and literature on these topics is now in the mainstream.7, 8 Not surprisingly, a number of youth access enforcement provisions enacted by states appear to be framed to facilitate compliance with the Synar implementation regulations.2, 9
State measures on preemption doubled from 10 state laws in 1993 to 20 state laws in 1996; however, the trend showing enactment of a high volume of new preemption provisions did not continue into the late 1990s. Nevertheless, as of 1999, 22 states included some preemption measure, thereby continuing the overall trend in many of these states in which preemption has locked in relatively weak state youth access laws.
The research and writing of this letter was supported under contract numbers 282-98-0014, Task Order 8, and N02-PC-75007 from the National Cancer Institute (NCI) and utilised data from the NCI's State Cancer Legislative Database Program.