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Abstract
Background Proper age verification can prevent minors from accessing tobacco products. For this reason, electronic locking devices based on a proof-of age system utilising cards were installed in almost every tobacco vending machine across Japan and Germany to restrict sales to minors.
Objective We aimed to clarify the associations between amount smoked by high school students and the usage of age verification cards by conducting a nationwide cross-sectional survey of students in Japan.
Methods This survey was conducted in 2008. We asked high school students, aged 13–18 years, in Japan about their smoking behaviour, where they purchase cigarettes, if or if not they have used age verification cards, and if yes, how they obtained this card.
Results As the amount smoked increased, the prevalence of purchasing cigarettes from vending machines also rose for both males and females. The percentage of those with experience of using an age verification card was also higher among those who smoked more. Somebody outside of family was the top source of obtaining cards. Surprisingly, around 5% of males and females belonging to the group with highest smoking levels applied for cards themselves.
Conclusions Age verification cards cannot fully prevent minors from accessing tobacco products. These findings suggest that a total ban of tobacco vending machines, not an age verification system, is needed to prevent sales to minors.
- Public policy
- surveillance and monitoring
- young adults
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Smoking among adolescents increases the risk of many diseases and also causes nicotine dependence.1 2 Restricting tobacco product sales to minors has been identified as an effective form of prevention of tobacco use.3–6 Countries that have ratified the Framework Convention on Tobacco Control (FCTC) must legally prohibit the introduction of tobacco vending machines to minors, and when appropriate, conduct a total ban of tobacco vending machines.7 This restriction has spread all over the world together with the implementation of FCTC.
Age verification at both retail stores and vending machines is very important for protecting minors from tobacco marketing. For this reason, electronic locking devices based on a proof-of age system that utilises cards were installed in almost every tobacco vending machine across Japan and Germany to restrict the sales of cigarettes to minors. Cigarettes can now only be purchased upon presentation of the card at vending machines. In Japan, the card is issued by the Tobacco Institute of Japan to people of legal smoking age, which is 20 years or older. A photo of the applicant and a copy of their official identification such as their driving licence are required to apply for the card. Proof-of-age systems on tobacco vending machines in Japan were first introduced on a limited scale in May 2004. This card-based system was then expanded and gradually introduced throughout Japan starting in March 2008. By July 2008, this electronic locking device had been installed in nearly every tobacco vending machine across the nation.
However, few reports study the effects of this card-based age verification mechanism with regard to under-age smoking.8 9 Thus, we aimed to clarify the relation between smoking behaviour among high school students and their usage of age verification cards by conducting a cross-sectional nationwide survey in Japan.
Methods
This survey was a random sampling survey of high schools across Japan in 2008. The methodological details of this survey have been previously reported.10–12 The number of schools sampled in the 2008 survey was 130 out of 10 955 junior high schools in Japan, and 110 out of 5115 senior high schools. Responses were obtained from 92 junior (school response rate 70.8%) and 80 senior high schools (72.7%). All students enrolled in the sampled schools were subjects of this study. Anonymous questionnaires and envelopes were handed to the students to complete during school hours. Upon completion, the questionnaires were sealed in the envelopes by the students themselves, collected by their teachers and returned to our research group unopened. Of 95 680 responses, 2980 did not have the complete data needed for analysis. Thus, 92 700 eligible responses (of which 46 975 males and 45 725 females) participated in this study. We conducted our survey in October 2008. Therefore, our results do not reflect a transitional phase, but rather a period that is 3 months following full national implementation of the age verification system.
Although Japanese laws forbid smoking by those younger than 20 years old, teenage smoking is frequently observed.12 Smoking levels among high school students were divided into four categories (non-smokers, occasional smokers, low daily smokers and high daily smokers) based on the questionnaires. Occasional smokers were defined as those who had smoked at least once over the past 30 days, but not on a daily basis. Low and high daily smokers were defined as those who smoked 1–10 cigarettes (low) or 11 cigarettes or more (high) on a daily basis over the past 30 days. On the questionnaire, we asked current smokers what their most common sources of cigarettes were, and gave examples such as vending machines. Responses pertaining to the prevalence of experiences using an age verification card, and the method of obtaining cards, were extracted from each questionnaire. For method of obtaining cards, we asked respondents to choose from four answers (took it from family without permission, borrowed it from family, borrowed it from somebody other than family and applied for card by him/herself). This study was reviewed and approved by the institutional review board of the Nihon University (No 19-5-0, approved 18 September, 2007).
Gender-specific analysis was performed. The distributions of the sample were also adjusted to reflect the distribution of all high schools in Japan using post-clustering weights. The weighted percentages in the table 1 were calculated by a weighting method based on one-stage stratified cluster sampling.13 Trend tests were used to analyse the differences in responses per smoking level group. A trend test is used in categorical data analysis when the aim is to assess for the presence of an association between a variable with two categories and a variable with one or more category. The trend test has higher statistical power than a χ2 test when the suspected trend is correct.14 Trend tests were also used to adjust data by grade. The Statistical Package for the Social Sciences (SPSS Japan Inc, version 16.0J) was used for the analyses. All probability values were two-tailed and at a 5% level of significance.
Use of vending machines and age verification cards for purchasing cigarettes, analysed by categories of smoking levels observed in a 2008 national survey of high school students in Japan
Results
The percentages of occasional smokers, low daily smokers and high daily smokers in this study were as follows. The percentage of occasional smoking among males, excluding those who smoke on a daily basis, was 1.9% for junior high school (JHS) and 4.8% for senior high school (SHS). The percentage of low daily smoking by males was 0.3% for JHS and 2.1% for SHS. The percentage of high daily smoking by males was 0.1% for JHS and 2.6% for SHS. The percentage of occasional smoking by females, excluding those who smoke on a daily basis, was 1.5% for JHS and 3.1% for SHS. The percentage of low daily smoking by females was 0.1% in JHS and 0.9% for SHS. The percentage of high daily smoking by males was 0.4% for JHS and 0.5% for SHS. These results were similar to recent studies on smoking rates among Japanese teenagers.15 The prevalence of those who had used an age verification card in the past was 963 (30.5%) out of 3158 male smokers and 424 (28.5%) out of 1490 female smokers. The most common source of cards was from somebody other than family, with 442 (14.0%) out of 3158 males responding thus, and 212 (14.2%) of 1490 females answering yes. The second most common source was from family (203 (6.4%) out of 3158 males and 103 (6.9%) out of 1490 females) and the third most common was taking it from family without permission (138 (4.4%) out of 3158 males and 66 (4.4%) out of 1490 females). Applied for card by him/herself came last, with 89 (2.8%) out of 3158 males and 22 (1.5%) out of 1490 females responding thus.
Table 1 shows the usage of vending machines and age verification cards to purchase cigarettes by each category of amount smoked among high school students. The prevalence of purchasing cigarettes mainly from vending machines became higher as the amount smoked increased for both males and females. The percentage of those who had also used an age verification card, together with smoking levels for both genders, was similar. Although overall numbers of female smokers were lower than males, the percentage of females who had used a card before was equal to or slightly higher than males. The most common source of obtaining cards was from somebody other than the family. For the highest level of smokers, around 5% of both males and females applied for the card themselves. There were statistically significant differences for all research questions, and the amount smoked for both genders by trend-test (p<0.01).
Discussion
We clarified that age verification cards were being used by minors to purchase tobacco from vending machines. The percentages of those using an age verification card increased with the amount smoked for both genders. The most common source of getting the card was from somebody other than family, followed by from family. Surprisingly, around 5% of both gender groups belonging to the highest level of smoking applied for the card themselves.
A previous paper reported that an effective method of preventing minors from smoking was to restrict sales at retailers.3 Based on such studies, the FCTC included the restriction of sales of cigarettes through vending machines as one of its regulations. Our results show that age verification cards cannot completely prevent minors from accessing tobacco products.
The percentage of those who had used an age verification card became higher with the increased amount smoked for both genders. An age verification card is only supposed to be issued upon confirming that the holder is of legal age. However, high school students were using these cards to purchase cigarettes through vending machines. We also found the popular source for purchasing cigarettes for teenage smokers was still tobacco vending machines. Despite it being forbidden to borrow or lend age verification cards, we think teenagers may be lending cards to one another because the most common source of cards for teenagers was from someone outside of their family. That being said, since the second most common source of cards was family, we relate this misuse on poor management within families. Although the cards were introduced with the aim of preventing minors from purchasing cigarettes from vending machines, it has not fully served its purpose yet. Surprisingly, 5% of students in both genders who were categorised in the highest level of smoking applied for the cards themselves. High school students may submit false statements to receive their cards, and although the cards are supposedly issued upon confirmation that the holders are adults with photo and official identification, the institute that issues the cards may not be verifying this information properly. We could not find details on how high school students received cards that they applied for by themselves. These cards may have been sent to the students owing to clerical error.
There are some limitations in this study. First, we could not assess changes in smoking behaviours among high school students after the introduction of this new card system. Second, our study is a cross-sectional one that does not prove any causal association between smoking behaviour and the use of an age verification card. Finally, our results may be underestimating the actual numbers since we were asking high school students about their smoking behaviours, despite youth tobacco smoking being forbidden by law.
In conclusion, our study showed that high school students who smoke use age verification cards to purchase cigarettes through vending machines. Age verification cards cannot entirely prevent minors from accessing tobacco products. We think there needs to be a total ban on tobacco vending machines, and not an age verification system, to prevent tobacco product sales to minors.
What this paper adds
FCTC includes the restriction to sales of cigarettes by tobacco vending machines. Age verification cards to restrict sales through tobacco vending machines were introduced nationally in Japan and Germany. This study shows that age verification cards cannot fully prevent minors from accessing tobacco products.
Acknowledgments
We are grateful to Takeo Tanihata, Junichiro Mori, Masumi Minowa and Kenji Suzuki for advising this study design and management of the study, and Mr Michita Nagatsuka for assembling and management of the data, and to Mr William McMichael for English editing of the manuscript.
Footnotes
Funding This study was supported by a Research Grant for Cardiovascular Disease from the Ministry of Health, Labor and Welfare.
Competing interests None.
Ethics approval This study was conducted with the approval of the Nihon University (No 19-5-0, approved 18 September, 2007).
Provenance and peer review Not commissioned; externally peer reviewed.