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In recent years, countries such as the United States, Canada, and Australia have witnessed a slowing of the decline (or a levelling off or increase) in adult or teenage smoking prevalence.1-6 Searching for convincing explanations as to why this has been occurring, one is struck by the paucity of monitoring data on tobacco control activity or “inputs”. During the past decade, there has been a surge of interest in policy research, mostly examining the behavioural or economic consequences of such policies.7 8 Despite this, it is notable that there have been few published accounts of the measurement of the comprehensiveness and strength of policies.9-12
The article by Alciati et al 13 in this issue of Tobacco Control is an exception. Alciati and colleagues report on the results of an attempt to rate each of the 50 states and the District of Columbia on the extensiveness of legislative provisions to reduce youth access to tobacco. By combining the components of youth access laws—six relating to specific tobacco control provisions and three relating to enforcement provisions—into a single rating scale, the paper shows that state scores fall far short of what might be considered to be optimum legislation and that there has been minimal progress from 1993 to 1996. For some, these results may be unsurprising, but the careful method used to analyse and rate each of the states in deriving an index is worth further consideration. Several previous studies have compared states with respect to minor’s access to tobacco,12 14 15 but we are aware of only one other attempt16 to rate the stringency and comprehensiveness of each element of the provisions, or to arrive at a “summary score” to give an overall rating of the legislation. What is the potential value of such summary …
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