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Effect of local youth-access regulations on progression to established smoking among youths in Massachusetts
  1. Carey Conley Thomson1,2,
  2. William L Hamilton3,
  3. Michael B Siegel4,
  4. Lois Biener5,
  5. Nancy A Rigotti1
  1. 1From the Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Medicine, Mount Auburn Hospital Cambridge, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
  3. 3CNU Associates, Lincoln, Massachusetts, USA
  4. 4Social and Behavioral Sciences Department, Boston University School of Public Health, Boston, Massachusetts, USA
  5. 5Center for Survey Research, University of Massachusetts Boston all in Boston, Massachusetts, USA
  1. Correspondence to:
 Dr N A Rigotti
 Tobacco Research and Treatment Center, 50 Staniford Street, 9th Floor, Boston, MA 02114, USA; nrigotti{at}


Objective: To test whether community-level restrictions on youth access to tobacco (including both ordinances and enforcement) are associated with less smoking initiation or less progression to established smoking among adolescents.

Design: Prospective cohort study of a random sample of adolescents in Massachusetts whose smoking status was assessed by telephone interviews at baseline and 2-year follow-up, and linked to a state-wide database of town-level youth-access ordinances and enforcement practices.

Participants: A random sample of 2623 adolescents aged 12–17 years who lived in 295 towns in Massachusetts in 2001–2 and were followed in 2003–4.

Main outcome measures: The relationship between the strength of local youth access restrictions (including both ordinances and level of enforcement) and (1) never-smokers’ smoking initiation rates and (2) experimenters’ rate of progression to established smoking was tested in a multilevel analysis that accounted for town-level clustering and adjusted for potential individual, household and town-level confounders.

Results: Over 2 years, 21% of 1986 never-smokers initiated smoking and 25% of 518 experimenters became established smokers. The adjusted odds ratio (OR) for smoking initiation was 0.89 (95% CI 0.61 to 1.31) for strong versus weak youth-access policies and 0.93 (95% CI 0.67 to 1.29) for medium versus weak policies. The adjusted OR for progression to established smoking among adolescents who had experimented with smoking was 0.79 (95% CI 0.45 to 1.39) for strong versus weak local smoking restrictions and 0.85 (95% CI 0.50 to 1.45) for medium versus weak restrictions.

Conclusions: This prospective cohort study found no association between community-level youth-access restrictions and adolescents’ rate of smoking initiation or progression to established smoking over 2 years.

  • MTCP, Massachusetts Tobacco-Control Program

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  • i MTCP guidance suggested that towns conduct compliance checks each calendar quarter, though not necessarily that all vendors should be checked this frequently. About onethird of towns reported averages of two or more compliance checks per vendor per year.

  • Competing interests: None declared.