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Does tobacco advertising target young people to start smoking? Pierce JP, Gilpin E, Burns DM, Whalen E, Rosbrook B, Shopland D et

al. PopulationStudiesfor Cancer Prevention. University of California, 2251 San Diego Ave. Son Diego, CA 92110. J Am Med Assoc

1991;266:3154-8.

Objective. - To evaluate whether tobacco advertising encourages

teenagers younger than 18 years to start smoking. Design. -Comparison

of 199OCalifomia telephonesurveydata withdata from a 1986national

telephone survey (both used a random-digit dialing system); 95%

confidence intervals werecalculated. To test our hypothesis, we consid-

ered whether the perception of advertising was related to age, whether

the pattern of market share across age and sex groups followed the

pattern of perceived advertising, and whether changes in market share

paralleled changes in advertising as perceived by the youngest age

group. Participants. - There were 24 296 adults and 5040 teenagers.

Results. - The most advertised brands of cigarettes were Marlboro,

according to 33.6% of adults and 41.8% of teenagers, and Camel,

according to 13.7% of adults and 28.5% of teenagers-named most often

by 12- to 13.year- olds (34.2%). The brands that were purchased most

often were Marlboro and Camel. Together these were the brands of

choice of 79.9% of males and 8.5% of females aged 12 through 17 years.

Marlboro’s market share increased in youths and young adults up to age

24 years and then decreased gradually with age; Camel’s market share

decreased abruptly with age: it was the brand of choice of 24.5%*5.8%

of males aged 12 through 17 years but was chosen by only 12.7%f3.6%

of malesaged 18 through 24 years; for females, 21.7%i13.7% aged 12

through 17 yearschoseCamels,whileonly5.S%f3.2%aged 18 through

24 years preferred this brand. Both Marlboro and Camel brands had a

higher market share in California in 1990 compared with that for the

United States in 1986. Of interest is that the market share for Camel

increased among the younger smokers but was more evenly distributed

for Marlboro. Conclusions. -Perception of advertising is higher among

young smokers; market-share patterns across age and sex groups follow

the perceived advertising patterns; and changes in market share result-

ing from advertising occur mainly in younger smokers. Cigarette

advertising encourages youth to smoke and should be banned.

Active enforcement of cigarette control laws in the prevention of cigarette sales to minors Jason LA, Ji PY, Anes MD, Birkhead SH. Department of Psychology, DePaul University, 2323 N Seminary Ave. Chicago, IL 60614. J Am

Med Assoc 1991;266:3159-61.

Objective. -To assess the effect that cigarette legislation would have

on reducing merchant sales rates of cigarettes to minors and the affect

on adolescent smoking behavior. Design. Observational survey of

merchant selling behaviors and adolescent smoking habits before and

after passage of legislation. Setting. The setting for the merchant

survey was Woodridge. III (population 25 200). a suburban community

of Chicago. The surveys were distributed to adolescents in the local

junior high school. Participants. _ Convenience sample of both mer-

chants and adolescent students. Intervention. Passage of community

antismoking legislation. Main Outcome Measures. - Percentage of

stores selling cigarettes to minors in Woodridge and percentage of

students who had experimented with cigarettes or were regular smok-

ers. Results. - Merchant sales rates in Woodridge decreased from a

baseline of 70% before legislation to less than 5% in 1.5 years of

compliance checking after legislation. Student surveys showed that the

rates of cigarette experimentation and regular use of cigarettes by

adolescents were reduced by over 50%. Conclusion. -Cigarette control

laws can be effective in significantly reducing the rate of cigarettes sold

by merchants and rates of cigarette use by adolescents. Key elements of

successfullegislation implementationareconsistentcompliancecheck-

ing and heightened community awareness of the problems and preva-

lence of adolescent smoking.

No-smoking laws in the United States: An analysis of state and city actions to limit smoking in public places and workplaces RigottiNA,PashosCL.GeneralInternalMedicineUnit, Massachusetts General Hospital, Fruit Street, Boston, MA 02114. J Am Med Assoc 1991;266:3162-7.

Objective. - To assess the prevalence, content, and growth of state

and city laws restricting smoking in public places and workplaces in the United States and to identify factors associated with their passage.

Design. - A mailed survey of city clerks in US cities with a population

of 25 000 or greater (N = 980) and review of existing data sources

confirmed the status of smoking restrictions in 902 (92%) of the cities

in the sample. State laws were identified by contacting each state’s

Legislative Reference Bureau (100% response). Content of laws was

coded using previously developed categories. Main Outcome Meas-

ures. - Prevalence, comprehensiveness, and cumulative incidence of

no-smoking laws in states and in cities with a popularton of 25 OC@ or

greater. Results. -By July 1989.44 statesand 500(51%) of thecities in

oar sample had adopted some smoking restriction, but content varied

widely. While 42% of cities limited smoking in government buildings,

27% in public places, 24% in restaurants, and 18% in private workpla-

ces, only 17% of cities and 20% of states had comprehensive laws

restricting smoking in all four of these sites. The number of city no-

smoking laws increased tenfold from 1980 to 1989. City no-smoking

laws were independently associated with population size, geography,

state tobacco production, and adult smoking prevalence. Laws were

more common in larger cities, Western cities, and states with fewer

adult smokers. Laws were less common in tobacco-producing states and

in the South. Conclusions. -No-smoking laws are more widespread than

previously appreciated, especially at the local Icvel, reflecting a rapid

pace of city government action in the 1980s. Noncthelcss, comprehen-

sive laws, which are most likely to provide meaningful protection from

environmental tobacco smoke exposure, remain uncommon and repre-

sent a major gap in smoking control policy. Laws are most needed in

smaller and non- Western cities and in states that produce tobacco and

have a higher proportion of smokers.

The effects of combining education and enforcement to reduce tobacco sales to minors: A study of four northern California com- munities Feighery E, Altman DG, Shaffer G. Center for Research in Disease Prevention. Stanford University School of Medicine, 1000 Welch Rd. Palo Alto, CA 94303. J Am Med Assoc. 1991;266:3168-71.

Objective. - To examine the effects of a community education and

law enforcement intervention on illegal tobacco sales to minors. De-

sign. - A 2- year, before and after trial with retail stores as the unit of

analysis. Setting. Implementation occurred in four suburban Califor-

nia communities with populations of 25 000 to 100 000. Participants.

All the retail stores in one intervention community and half the retail

stores, randomly selected, in the other three intervention communities

(n = 169) were visited by minors aged 14 to 16 years with the intent to

purchase tobacco. Intervention. - Ongoing community and merchant

education and four law enforcement operations were conducted. Main

Outcome Measures. - Over-the-counter and vending machine sales of

tobacco to minors were the primary outcomes. Results. Among a cohort of stores visited by minors at the pretest (n = 104) in June 1988,

71% sold tobacco over the counter and 92% sold tobacco through

vending machines. At posttest 2 in May 1990,24% sold tobacco over

the counter and 93% sold tobacco through vending machmes. Of the 3 I

stores issued citations, 16 were followed into the courts where the fines

were dismissed or reduced. Conclusions. - Education alone had a

limited effect on reducing illegal tobacco sales to minors. It did promote communitysupponformoreaggressiveenforcementsuategies. Educa-

tion plus enforcement decreased significantly over-the-counter sales:

vending machine sales were unaffected by these interventions. The lack

of support at the judicial level may temper the effectiveness of enforce-

ment. Legislative remedies addressing judicial obstacles and vending

machine sales are needed.