State youth-access tobacco control policies and youth smoking behavior in the United States

Abstract

Context: State policies aimed at controlling youth access to tobacco are an important component of public health efforts to reduce smoking prevalence among youth and prevent subsequent disease.

Objectives: This study sought to assess the extensiveness of state youth access tobacco control legislation in the United States, describe how state policies changed over a 4-year period, explore how various political and economic characteristics are related to state policies, and determine the relationship of youth smoking behavior to state youth tobacco control policies.

Design: This descriptive and correlational study utilized data from multiple national surveillance, economic, and sociodemographic data sets.

Participants: All 50 states and the District of Columbia provided economic and political data. A standard tobacco-control policy score was developed by an expert panel for each state. Aggregated state-level measures of youth smoking behavior were provided by 79,491 youth in 33 states and the District of Columbia.

Main Outcome Measures: Included were extent of state tobacco control policies and changes over time, relationship between state political and economic characteristics and tobacco control policies, and relationship between state policies and youth smoking behavior.

Results: State policy scores increased in variability and in mean value over the 4-year period, from a mean score of 7.2 in 1993 to 9.0 in 1996. State policy scores were significantly correlated with several state political and economic variables. States with more extensive tobacco control policies had significantly lower youth smoking rates. There was some evidence that a strong state tobacco economy may limit the effectiveness of tobacco control policies on youth smoking rates.

Conclusions: It is possible to reliably measure the extent to which states are achieving important public health goals in limiting youth access to tobacco products. Comprehensive state tobacco control policies are important for increasing prevention and cessation of smoking among youth.

Introduction

C igarette smoking is the “single most important preventable cause of premature death,”1 accounting for one of every five American deaths.2 Despite the overall decline in smoking over the past 40 years and decades of public health messages on the health risks of smoking, more than 1 million Americans become new smokers each year, most of whom are adolescents.1, 3 In 1997, 70% of high school students had tried cigarettes at some time in their lives, and 36% were current smokers.3 The proportion of current youth smokers increased from 28% in 1991 to 36% in 1997—an increase of almost 30% in just 6 years.3

Tobacco control policies work by altering the legal, economic, social, and physical environments that shape tobacco-use behavior. Specifically, they can influence smoking behavior among youth by limiting access and distribution of tobacco products, reducing exposure to environmental tobacco smoke through clean indoor air regulations, or reducing exposure to tobacco advertising and promotion. There is an emerging consensus that implementing and enforcing tobacco control policies will prove to be the most effective and efficient means to prevent youth smoking.4, 5 They can be less expensive to enact relative to preventive interventions, and generally reach much larger youth populations.6, 7

In 1995, there were 1238 state laws addressing tobacco use in effect, and that number has certainly increased since then.5, 8, 9 Although there are examples of empirical evaluations of one or two specific tobacco control policies (e.g., retail sales restrictions to minors),10, 11, 12 to the present there has been no comprehensive empirical evaluation of the sets of policies implemented by various states. In fact, most of the literature on tobacco control policy consists of discussion or theory pieces, focusing most often on policy proposals,7, 13, 14 or descriptions of the political process of policy implementation.15, 16 It is now time to assess the extent to which states are actually implementing sound tobacco control policies and, more importantly, to start evaluating the effect that these policies may be having on youth smoking.