Multiple Community Strategies are Needed to Curb Youth Smoking

A new review of 35 studies found that the most effective way to reduce tobacco use among youth is to implement a variety of community-wide strategies, not just one. Strategies should include a mix of tactics—everything from retailer education to social norms campaigns.

The University of Oxford review, which was reported by the Health Behavior News Service, was aimed at determining whether programs targeting shopkeepers who sold tobacco to minors actually reduced how much teens smoked.

Reviewers determined that simply informing merchants about the law had no effect on reducing sales to minors. Rather, the most successful initiatives used a variety of tactics, including retailer education, personal visits from law enforcement personnel, and posters and public information campaigns to increase community awareness. The review concluded that intervening with retailers could be an effective part of a comprehensive tobacco control strategy, but not the whole answer. The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care.

The 35 included studies examined a variety of interventions focused on retailers including educating them about the law, checking up on them via sting operations, notifying them of compliance check results and punishing violators with fines or license suspensions. Studies also looked at community-based strategies, such as public information campaigns.

Getting access to cigarettes has gotten harder, but it is still relatively easy, according to the review: In 1996, 91 percent of kids surveyed said it was at least “fairly easy” to procure tobacco; a 2007 survey found that number had dropped to 78 percent.

The theory is that if kids cannot buy cigarettes or other tobacco products at stores, they will smoke less. The problem with focusing on retailers is that kids can also get tobacco in other ways: from their parents, siblings or friends — or even by stealing. Therefore, spending money on enforcement of laws against selling to minors might not be cost-effective.

Community support appears to be crucial for several reasons. For one, if adults do not think adolescent smoking is a problem, some are willing to buy cigarettes for the kids. For another, one study found that judges tended to suspend sentences on clerks, because they felt the penalties were too harsh. It is also important that laws and penalties are somewhat standardized across the region; otherwise, merchants might resent the loss of tobacco revenue to their competitors a few miles down the road.

“Even if access through retail outlets is effectively restricted, as we’ve been able to do in King County, Washington, an equally important issue is changing the culture that thinks it is OK for kids to get cigarettes from social sources,” said David Pearson, associate director of the Center for Community Health and Evaluation.

Lindsay Stead, one of the University of Oxford reviewers, said resources are better spent on community-wide efforts. “If you can change community norms and reduce smoking among adults — that will ultimately be more useful,” she said.

Visit www.cochrane.org for more information on the review.