Table 1

Studies that demonstrated a disruption of commercial distribution to minors (1991–2011)

Studies (listed by first author)Design and settingImpact on commercial distribution*Association with youth tobacco use*
Altman23A 3-year randomised controlled study of community mobilisation and merchant education without enforcement involving four Arizona communitiesThe intervention produced a temporary reduction in purchases by 7th graders but not by 9th and 11th gradersDuring the period when 7th graders made fewer purchases smoking was reduced by 23% in this age group. Neither purchases nor smoking were reduced among older youth.
Chaloupka47Cross-sectional survey of impact of vending machine restrictions and statewide compliance checks across states (US)Violation rates varied by stateAggressive statewide approaches to measuring compliance coupled with higher retailer compliance reduced youth smoking. Complying with Synar Amendment requirements of 80% compliance and aggressive enforcement would reduce smoking by 18%.
Dent48Cross-sectional evaluation of the impact of varying compliance rates across 75 communities in OregonInexplicably, higher violation rates were associated with less reliance on commercial sources among 8th gradersReliance on commercial sources was related to smoking among 8th graders. Increasing compliance from 0% to 100% would be associated with a 7.9% reduction in past 30-day smoking for 11th graders and a 4.1% reduction in daily smoking. The 11th graders in communities with lower illegal sales rates had increased reliance on social sources but decreased smoking.
DiFranza49A 2-year single community study of enforcement of a local ordinance in MassachusettsViolations dropped from 75% to 16%Smoking declined by 31% among youth ages 12–19 years
DiFranza35Longitudinal study of state enforcement in TexasReliance on commercial sources among middle school students declined from 20.8% to 7%The prevalence of smoking in middle school declined from 20.0% to 14.8%. High school students showed no decline in commercial access and no decline in the prevalence of smoking.
DiFranza50National longitudinal study of the impact of 7 years of state enforcement (US)Violation rates decreased across all states across the study periodFor each 2% increase in compliance, the prevalence of smoking in 10th graders decreased by 1%
Forster36, Chen51A 7-year randomised controlled study of 14 Minnesota communities with half assigned to enact and enforce a lawViolation rates improved in both groups. Decreased commercial source for the most recent cigarette. Recent purchases declined by a relative 51.6% among all youths.Approximate 28% decrease in daily smoking, approximate 25% decrease in weekly smoking, approximate 22% decrease in monthly smoking. The impact on daily smoking persisted for 5 years, at which point the control communities caught up in terms of implementing restrictions.
Jason41, Jason42An 8-year single community study of enforcement of a local ordinance in IllinoisViolation rates decreased from 19% to 3%. Only 6% of current smokers reported commercial access in town.Experimentation decreased from 46% to 23% and regular use from 16% to 5%
Jason52Controlled cross-sectional study of two towns with good enforcement and three Illinois towns with poor enforcementFewer youths in the enforcement communities obtained cigarettes from stores (27.8%) than in the non-enforcement communities (46.5%)Regular smoking was 8.1% in the intervention communities and 15.5% in the non-enforcement communities. Lifetime use of smokeless tobacco was 8.7% vs 16.7%.
Jason53A 3-year randomised controlled study of four Illinois communities with strong access and possession laws versus four with moderate enforcement of access land possession lawsViolation rates improved from 21% to 4% in the intervention communities and from 31% to 17% in the control communities. Children in the intervention community felt it was harder to get tobacco.For Caucasians, over 3 years tobacco use increased by 15.6% in the control communities and by 4.1% in the intervention communities. Cigarettes smoked per month increased from 0.4 to 27.4 in the control group and from 1.1 to 6.3 in the intervention group, a difference of 81%.
Levinson33A 9-month study of local enforcement in a Colorado communityUsual way of getting cigarettes from stores decreased from 22.6% to 3.5%. Current smokers who had ever bought cigarettes decreased from 26.4% to 13.8%. Fewer smokers carried cigarettes most days. Smokers carried fewer cigarettes at a time. It became harder to ask strangers for cigarettes.Smoking in the past 30 days decreased from 22% to 15% among 14–15 year olds
Perla54, Cummings39Cross-sectional analysis of 12 New York communities originally randomised to enforcement or control groupsReliance on commercial sources declined by 54% in communities with violation rates <20% and by 43% in communities with violation rates >20%Violation rates <20% were associated with a 44% reduction in smoking 20 or more of the past 30 days
Pokorny55Cross-sectional analysis of the impact of the density of non-compliant retailers in Illinois communitiesRetailer violation rates varied across townsViolation rates influenced initiation but not continuation
Ross56, Powell57National cross-sectional analysis of differences in state violation rates (US)Violation rates varied across statesRoss: Lower violation rates, vending machine restrictions and graduated fines each reduced smoking prevalence and intensity. Powell: The impact of access policies on youth smoking was mediated through peers.
Staff22A 9-month non-randomised evaluation of the impact of merchant education only in a single region and control (Sydney, Australia)Male students rated it harder to purchase from petrol stations after the interventionThe likelihood of current smoking was reduced by almost half in 7th year students only, OR=0.54. The likelihood of being a daily smoker versus occasional or non-smoker was OR=0.39 for 7th year only. No impact on years 8–11.
Staff43A 5-year evaluation of an extraordinarily weak enforcement programme in a single area with no control group (Sydney, Australia)Compliance was 66%. A slight decrease in the proportion of students who had purchased tobacco from small stores (19.2% vs 16.8%). There was a small increase in perceived difficulty of purchasing, but at follow-up 82% of students rated it easy or very easy to purchase tobacco from small stores.There was a slight increase in the number of never smokers (OR=1.16). There was no change in the number of current smokers.
Tutt37, Tutt38A 9-year longitudinal controlled study of aggressive enforcement in New ZealandCompliance was 96-100%. Attempts to purchase tobacco in the intervention area declined by 73.6% between 1993 and 2002.The prevalence of monthly smoking among students in years 7–12 was reduced by 50% from 26% to 13%
Verdonk-Kleinjan58A 4-year prospective study of enacting a new law in The NetherlandsThe proportion of youth that smoked and bought their own tobacco fell from 13.5% to 6.4%The prevalence of smoking among youth 13–15 years old fell from 20.3% to 7.4%
Widome40A 3-year longitudinal study of local enforcement of Minnesota lawsCommercial purchases decreased and reliance on social sources increasedYouths who had no commercial access were less likely to progress to heavier smoking
  • * All reported findings were statistically significant.