In the United States today, more than 3 million children under the age of 18 regularly smoke cigarettes or use smokeless tobacco. More than 2 million others are actively experimenting with tobacco use and are at high risk for becoming regular users. Tobacco companies collect more than $1.25 billion annually from the sale of their products to minors (DiFranza, 1989).

More than half of all smokers begin before the age of 14, and 90 percent begin by the age of 19. Tobacco use by young people is a problem easily understandable in terms of economic demand and supply. A major factor in creating demand for tobacco within young age groups is tobacco industry advertising and promotion. Inadequate and unenforced laws assure that this demand is met with a readily available supply. In the 6 years following the introduction of Virginia Slims and other "feminine" cigarettes in 1968, the number of teenage girls who regularly smoke more than doubled. During the late 1970's, the rate of smoking among teenage boys decreased, whereas female smoking remained high.

Although 45 states and the District of Columbia prohibit the sale of tobacco to minors, most often defined as anyone under the age of 18, youngsters who want to obtain cigarettes find it easy to do so. An estimated 1 billion packs of cigarettes find it easy to do so. An estimated 1 billion packs of cigarettes are sold to minors under the age of 18 every year, usually in violation of the law (DiFranza and Tye, 1990). The National Adolescent Student Health Survey of 12,000 students found that 86 percent of respondents believed it would be easy for them to obtain cigarettes (American School. Health Association, 1989).

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There are many reasons to prevent minors from obtaining tobacco products. First, easy availability conveys a message that the substance is not really very harmful. Second, illegal tobacco sales to minors foster disrespect for the law and may help young people toward illegal purchases of alcohol or use of illicit drugs. Third and most obvious, the harder it is for young people to obtain tobacco, the fewer will use the substance.

Minors' Access To Tobacco

By 1990, 45 states had some legislation preventing minors' access to tobacco products. Only three, however (Indiana, Utah, and Idaho) are considered to meet the standards for even "basic" coverage, based on criteria established by the U.S. Office on Smoking and Health, meaning that in addition to establishing a minimum age for sale, there are penalties for merchants selling tobacco to minors and some restrictions on the placement of cigarette vending machines. Six states have no minimum age law whatsoever (Montana, Wyoming, New Mexico, Missouri, Louisiana, and Kentucky). No state law is considered to be "comprehensive," which in addition to the basic category's requirements would include a requirement for warning signs at the point of purchase, provision to revoke merchant licenses for violation, and a ban on distribution of free tobaccoproducts (Centers for Disease Control, 1990b).

A DHHS study of enforcement of laws prohibiting the sale of tobacco to minors was able to document only 32 instances of those laws having been enforced outside of Utah, which as a relatively good record (Office of the Inspector General, 1990). In his 1989 report, the Surgeon General state:

In marked contrast to the trends in virtually all other areas of smoking control policy, the number of legal restrictions on children's access to tobacco products has decreased over the past quarter-century. Studies indicate that compliance with minimum-age-of-purchase laws is the exception rather than the rule (US DHHS, 1989a).

Sales by Retail Stores

In studies across the country, it has been shown that, on average, 75 percent of retail stores sell tobacco to minors as young as age 12. In one Massachusetts community, an 11-year-old girl was successful in purchasing cigarettes at 75 out of 100 attempts (DiFranza et al., 1987). In the largest trial of this type, in Santa Clara County, California, 18 minors aged 14 to 16 visited 412 stores and 30 vending machines with the intent of purchasing cigarettes. They were successful at 74 percent of the stores and 100 percent of the vending machines (Altman et al., 1989). In Erie County, New York, minors purchased cigarettes in 77 percent of stores that had received a special mailing about the law prohibiting tobacco sales to minors, and in 88 percent of stores that did not receive the mailing (Skretny et al, 1990).

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Table 2

Survey of Minnesota 10th graders

___________________________________________________________________

Percentage of

Location Yes Responses*

___________________________________________________________________

Drug Store 42

Grocery Store 53

Convenience Store 68

Vending Machine 71

Gas Station 80

___________________________________________________________________

*Question: Have you purchased tobacco at these places?

Attempts to purchase tobacco products in at least 18 different communities have yielded similar results: On average, three of four retail stores will sell tobacco to minors, in violation of the laws of their state (Tobacco and Youth Reporter, 1989a).

Researchers asked 10th graders in two Minnesota communities "Have you ever purchased cigarettes from any of these places?," with the results shown in Table 2. Most teens thought it would be "very easy: (55 percent) or "fairly easy" (31 percent) to obtain cigarettes. Among teenage smokers, 90 percent thought it was "very easy: to obtain cigarettes (Forster et al., 1989).

Vending Machine Sales

As mentioned above, when minors aged 14 to 16 attempted to purchase cigarettes from 30 vending machines in Santa Clara County, California, they were successful in all 30 attempts. Even after a massive community education program had reduced illegal over-the-counter cigarette sales to minors by 50 percent, followup tests showed vending machine sales allowed minors to purchase cigarettes 100 percent of the time.

In a major study covering the three-state area surrounding Washington, D.C., Davis and colleagues escorted minors to 120 cigarette vending machines (twice each, for a total of 240 attempts). The children were successful in 100 percent of attempts to buy cigarettes (Davis et al,, 1989). Davis concluded that "teenagers have easy access to cigarette vending machines in three different jurisdictions in the Washington, D.C., area. There is every reason to believe that this reflects the situation across the country" (tobacco and Youth Reporter, 1989b). Identical results were obtained when minors were escorted to cigarette vending machines in New York,Colorado, and New Jersey.

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A study by the National Automatic Merchandising Association, the trade association for the cigarette vending machine business, confirms the impression that vending machines are the source of cigarette supply for many very young teenagers when they first begin to experiment with smoking. The study found that, while only 16 percent of teens regularly obtained their cigarettes from vending machines (which still represents more than half a million teenagers), vending machines are a key source of supply for young teens. Among the study's conclusions were:

• Thirteen-year-olds are 11 times as likely as 17-year-olds to buy cigarettes from vending machines (22 percent vs. 2 percent).

• Most teens (56 percent) say they use vending machines "because no one will stop me from buying cigarettes this way."

• Whereas virtually all teenage smokers (96 percent) had been stopped from buying cigarettes over the counter, only about 1 in 10 had ever been stopped from buying cigarettes from a vending machine.

• A growing trend is to sell cigarettes and candy from the same vending machines, which is likely to further encourage and facilitate cigarette sales to minors.

Free Cigarette Samples

Tobacco companies spent $265 million giving away cigarette samples through direct distribution or coupons during 1988, the most recent year for which data are available (Centers for Disease Control, 1990). One of the key functions of tobacco company giveaways is to provide young people with their first experimental packs of cigarettes or smokeless tobacco products at no cost and little risk of being caught. That young people are the target for many free cigarette distribution campaigns was made clear by a recent Camel advertisement that included a coupon with the encouragement to get a friend or a "kind-looking stranger" to redeem the pack for you if you are uncomfortable, an obvious come-on to underage youth.

Sean Marsee, the Oklahoma youth who died at age 18 of mouth cancer caused by using smokeless tobacco, got started when a tobacco company representative gave him a free pack of snuff at a rodeo. Indeed, giving free samples to young nonusers has been a foundation of the growth strategy of the U.S. Tobacco Company (makers of Skoal, Copenhagen, Happy days, and other smokeless tobacco products). The company has run advertisements in youth-oriented magazines offering free samples, complete with instructions for use, and give free samples to young people at music, sports, and other events.

Davis and colleagues asked a large number of young people if they had personally been given free tobacco samples;

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14 percent of the total and 20 percent of the high school students responded in the affirmative. Approximately half reported having seen other teenagers being given free cigarette samples (Davis and Jason, 1988).

DiFranza organized a group of young people to send coupons in response to tobacco company solicitations for free tobacco samples being sent through the mail. Fifteen of twenty were mailed free tobacco samples at home, in violation of Massachusetts state law (DiFranza, 1989).

Action at the Community Level

Over the past several years, there has been a flurry of activity to prevent the sale of tobacco to minors. Much of this action has been at the community level. For example, in Santa Clara County, California, a major community wide education campaign resulted in a 50 percent reduction in the number of stores selling tobacco to minors (from 74 percent to 38 percent), although there was no impact on the rate of sale by vending machines, which remained at 100 percent (US DHHS, 1989a).

In Woodridge, Illinois, police officer Bruce Talbott successfully pushed for enactment of a local ordinance requiring tobacco merchants to obtain a license and providing for fines and licensure revocation for violation of the law prohibiting sale of tobacco to minors under age 18. Compliance is monitored by means of "sting" operations in which a minor is escorted to stores. If cigarettes are sold to the minor, the store owner must pay a fine. Since enactment and enforcement of the law, the proportion of stores in Woodridge selling tobacco to minors has declined from 92 percent to 0.

In Minnesota, the town of White Bear Lake outlawed cigarette vending machines in 1989. Since that time, 8 other communities have followed suit, 11 have imposed more limited restrictions, and 10 others are considering restrictions. A tobacco company effort to enact state legislation that would preempt these local ordinances failed (Jean Forster, Ph.D., personal correspondence). The State of Utah, using evidence that lockout devices on cigarette vending machines in that state failed to prevent access by minors, outlawed cigarette vending machines from all areas accessible to minors. The law was upheld by the Supreme Judicial Court of Utah against a challenge from the vending machine industry.

A number of jurisdictions have outlawed the distribution of free tobacco samples. They are totally prohibited in Minnesota and Utah; it is illegal to distribute smokeless tobacco samples in Nebraska. Eight communities in Massachusetts prohibit giveaways of tobacco samples.

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Another step that is being taken by an increasing number of jurisdictions is to post signs that warn against tobacco sales to minors. This may be effective not only at warning would-be underage tobacco purchasers but also at reminding store personnel of the law.

A growing number of activists, impatient with the sometimes slow progress of enacting controls over the sale of tobacco to minors-often in the face of determined tobacco industry resistance-have taken to direct action against cigarette vending machines. For example, one antismoking organization published instructions for disabling cigarette vending machines, including the use of bent paperclips and coins dipped in Superglue. Another produces "out of order" stickers than can be placed over the coin slot of cigarette vending machines.

Stop Teenage Addiction to Tobacco (STATE) is a nonprofit educational organization that was founded in 1985 to eliminate tobacco addiction of adolescents by raising public awareness of how tobacco companies use sophisticated marketing campaigns to attract young people and how ready access increases tobacco consumption among young people. STAT has prepared model legislation that has served as the basis for legislative efforts in a number of communities around the country. Its "position Paper on Tobacco-Free Schools" has helped many jurisdictions eliminate school smoking. STAT is forming a national network of community organizers to implement strategies that will reduce the sale of tobacco to minors.

A Public Policy Agenda

Eliminating the sale of tobacco to minors is an essential step if we are to achieve the national public health goal of a smoke-free society. Based on research and review of what has been effective at the state and community levels, the following steps are probably necessary.

• All free distribution, "sampling" in tobacco industry parlance, must be outlawed. The offer of free cigarettes and smokeless tobacco products is reminiscent of the drug pusher who gives the first sample free to get his customer hooked.

• Legislation at either the state or local level should establish that any merchant must obtain a license prior to selling tobacco products. There must be a provision that repeated violation of the law prohibiting tobacco sales to minors will result in meaningful monetary fines and/or extended revocation of that license. There should be provision that enforcement will be ensured by means of sting operations conducted by either the police or health department of the jurisdiction (the Tennessee

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state law explicitly provides that it is not entrapment for a youth under official supervision to attempt to purchase cigarettes to monitor compliance with the law).

• In light of their potential to start young people on the course of tobacco addiction, cigarette vending machines must be outlawed. The Nation's 374,000 cigarette vending machines are an open invitation to addiction for the Nation's young people. A vast majority are located in areas where they cannot be effectively supervised. With the proliferation of 24-hour convenience stores over the past several decades, cigarette vending machines can no longer be justified.
• Signs should be required providing notice of the minimum-age-of-purchase law and of the store's intent to abide by the law
• The legal age for sale of tobacco should be raised to 21, making it consistent with the age for legal sale of alcohol. This will send an important message that tobacco is just as hazardous as alcohol. It will also make it simpler for merchants to monitor identification for sale of products that are legal for adults but not for minors by establishing a consistent age for both tobacco and alcohol. Perhaps most important, because relatively few high school students are friendly with 21-year-olds (though many know 18-year-olds), this would reduce access to tobacco products for high school students.
• Smoking by students should be prohibited in schools. In addition, smoking by adults should be prohibited on school campuses, establishing teachers a appropriate role models.
• Tobacco prices should be increased by means of taxation because young people are price sensitive in their demand for tobacco products. Ideally, revenue generated by increased taxes should be used for health education, as has been done with Proposition 99 tax revenues in California.

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