Study: Regulations to cut teen smoking may be ineffective

By BARNABY J. FEDER
New York Times

Regulations adopted by the federal government last year to make it harder
for children to buy cigarettes and chewing tobacco are unlikely to have any
effect on teenage tobacco use, according to a study of six Massachusetts
communities published today in The New England Journal of Medicine.

The federal rules known as the Synar regulations, for the late Rep. Mike
Synar, the Oklahoma Democrat who sponsored the 1992 law on which they are
based threaten states with the loss of government grants for drug abuse
programs unless they reduce the frequency of tobacco sales to minors to
fewer than 20 percent of attempts. The rules recommend that performance be
measured by local authorities' use of children in sting operations aimed at
tobacco retailers.

But the Massachusetts researchers found that even in communities with
enforcement programs strong enough to have cut the frequency of reported
illegal sales below the federal standard, teenagers surveyed said they had
little trouble obtaining tobacco.

Fiftyeight percent of underage youths who tried to buy tobacco in
Somerville, Brookline and Needham towns where successful illegal
attempts, as measured by sting operations, were below 20 percent of all
such attempts said they were hardly refused. That was not much lower
than the 63 percent who responded that way when surveyed in Quincy,
Winchester and Arlington, the three towns with no enforcement programs at
all against tobacco sales to teen agers.

In all, 70 percent of underage youths who tried to buy tobacco said they
succeeded most of the time.

In each of the six towns, teenagers reported that a growing number of
retailers had declined to sell to them. They compensated by shopping in
other towns or asking smokers of legal age to buy for them.

Over all, access was so easy that the researchers could find no impact on
youths' tobacco use from local efforts to enforce the state's minimum
smoking age, 18. In fact, while tobacco use among high school students in
the three towns with no enforcement programs remained roughly level, it
rose in the three towns where enforcement, as measured by the stings, made
illegal sales less frequent.

The findings, some of which were presented to the American Public Health
Association and reported in The New York Times last November, are being
cited by tobaccocontrol advocates as evidence of a need for the far more
sweeping tobacco marketing restrictions issued by the Food and Drug
Administration early this year. Tobacco opponents say the results also lend
support to calls for sharply higher tobacco taxes to increase the cost of
smoking, an approach that has been the most effective way of discouraging
minors in the past.

"We need a comprehensive program beyond attacking youth access," said
William Novelli, president of the National Center for TobaccoFree Kids, an
antismoking organization in Washington.

Tobacco industry officials said they had not read the study and so could
not comment on it specifically. But Thomas Lauria, a spokesman for the
Tobacco Institute, the industry's trade association, said no one could be
surprised that teenagers were finding ways to dodge the intent of the
Synar regulations.

"You can't pass a law ordering teenagers to stop being teenagers," Lauria
said.

Teenage smoking has become a focus of the tobacco wars because nearly 9 of
10 smokers start before they turn 18, teenage smoking rates have been
creeping up, and research shows that the earlier a smoker starts, the more
likely to develop health problems later. Some 3,000 American children begin
smoking each day, according to the federal government, and as many as a
third of them are expected to die of tobaccorelated illnesses.

The FDA regulations are being challenged in court by the tobacco, retailing
and advertising industries. One provision of those regulations that has
already taken effect, reinforcing the Synar rules' intent to reduce youth
access, sets a nationwide ban on sales to anyone younger than 18 and
requires retailers to demand photo identification of all tobacco buyers who
look younger than 30.

Research in other communities, most notably Woodridge, Ill., has suggested
that teenagers can be discouraged from smoking if the frequency of illegal
sales can be cut to lower than 10 percent of attempts. But none of the
Massachusetts towns in the latest study enforced their ordinances so
vigorously as Woodridge, and they did not follow Woodridge's policy of
fining minors caught with tobacco.

"I've become convinced that fining minors is an important piece of the
solution," said Leonard Jason, a DePaul University researcher who has
studied Woodridge and several other Illinois towns.

The results of the Massachusetts research, which covered the period from
1994 to 1996, suggest that the Synar standards can be undermined by
retailers who have figured out how to avoid being caught in sting
operations, said the leader of the research team, Dr. Nancy Rigotti,
director of tobacco research and treatment at Massachusetts General Hospital.

One problem is that child participants in sting operations have been easy
to pick out because they are forbidden by the authorities to show false
identifications or lie about their age. Another is that retailers either
intentionally or unwittingly employ clerks who follow the law when dealing
with strangers but freely sell tobacco to underage customers they know.

Teenagers quickly discover which stores in a community will sell to them,
and they return there repeatedly, the researchers said. As a result, buying
tobacco can be easy even where the vast majority of retailers obey the law.

"Compliance tests grossly overestimate actual compliance," said Dr. Joseph
DiFranza, a coauthor of the study.