Tobacco Use: Community Mobilization with Additional Interventions to Restrict Minors’ Access to Tobacco Products

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Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends community mobilization combined with additional interventions such as stronger local laws directed at retailers, active enforcement of retailer sales laws, and retailer education with reinforcement on the basis of sufficient evidence of effectiveness in reducing youth tobacco use and access to tobacco products from commercial sources.

The full CPSTF Finding and Rationale Statement and supporting documents for Tobacco Use: Community Mobilization with Additional Interventions to Restrict Minors’ Access to Tobacco Products are available in The Community Guide Collection on CDC Stacks.

Intervention

These are community-wide interventions aimed at focusing public attention on the issue of youth access to tobacco products and mobilizing community support for additional efforts to reduce that access.

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 9 studies (search period through May 2000).

Study Characteristics

  • The evaluated interventions either fostered or were coordinated with additional interventions, such as stronger restrictions on retailer sales of tobacco products; restrictions directed at youth purchase, possession, or use; active enforcement of tobacco sales laws; and retailer education interventions (with or without reinforcement).
  • Educational components included community-wide assessments of compliance by tobacco retailers with dissemination of the results through mass media events and news coverage; presentations to civic groups and local governments.
  • Community and school meetings and activities, as well as direct contact with local governments through testimony, petitions, letters, and phone calls, also occurred.
  • Interventions were conducted in a variety of settings and populations, including urban, suburban, and rural communities in the United States and Australia. In the United States, interventions were implemented in communities that included predominantly African-American, Hispanic, or white populations.

Summary of Results

Nine studies (10 intervention arms) qualified for the review.

  • Self-reported tobacco use among youths over follow-up periods of 24-48 months: median decrease of 5.8 percentage points (4 studies)
  • Retail tobacco sales to youth: median decrease of 33.5 percentage points (9 studies)

Summary of Economic Evidence

The study included in the economic review was a one-year study that modeled the cost effectiveness of active enforcement of tobacco sales to minors on a national level. The intervention included employing minors to attempt tobacco purchases, licensing tobacco vendors, and civil penalties for vendors who illegally sold tobacco products to minors.

Primary outcome measures consisted of four levels of reduction in youth tobacco use ranging from 5% to 50%. Cost-effectiveness ratios ranged from $44 to $3,100 per year of life saved.

Program costs included personnel, salary, and benefits for minors and for adult inspectors; liability insurance; money to purchase tobacco; transportation; and overhead (analyses were based on enforcement costs of $50, $150, $250, and $350, where marginal expense is lowest at the community level and highest at the federal level).

Applicability

These findings should be applicable to a variety of settings and populations in the U.S., including urban, suburban, and rural communities and African American, Hispanic, or white populations.

Evidence Gaps

The following outlines evidence gaps for reviews of interventions to restrict minors’ access to tobacco products:

Effectiveness

The studies identified in this review provide evidence of effectiveness of community mobilization when coordinated with other interventions in reducing both tobacco use among youth and youth access to tobacco from commercial sources. A better understanding of the relative impact of community mobilization on reducing youth demand for tobacco products would assist local programs significantly in setting priorities for future intervention efforts. Research issues identified by others overlap with the questions generated as the result of this review:

  • What intervention combinations, intensity, and duration are the minimum required to reduce youth tobacco use?
  • What effect, if any, do interventions to reduce youth access to tobacco products through commercial sources have on access through social sources? What effect, if any, do interventions to reduce youth access to tobacco products through social sources have on access through commercial sources?
  • What is the required intensity and duration of active enforcement components?
  • What effect does decreasing the number of outlets selling tobacco products have on youth access?
  • How do age verification devices (such as scanners) affect retailer sales compliance?

Applicability

Community mobilization interventions included efforts to identify and incorporate community concerns. When tailored to resonate with the sociocultural composition of the population, community mobilization combined with additional interventions should be applicable to most U.S. settings. Some questions remain regarding applicability of these interventions in settings and populations other than those studied.

  • Are there differences in the effectiveness of or barriers to these interventions in urban and rural settings or in communities that cross jurisdictions?

Other Positive or Negative Effects

This review did not identify any additional positive or negative effects of these interventions.

Economic Evaluations

The information available for economic evaluation consisted of a single study evaluating one component (active enforcement directed at retailers) of an effective multicomponent intervention. Considerable research is, therefore, warranted regarding the following questions:

  • What are the costs of these interventions?
  • What is the cost-effectiveness of these intervention combinations?
  • What is the cost-effectiveness, net cost, or net benefit of these intervention combinations when cost-effectiveness analysis includes cost savings of illness averted?
  • What combination(s) of components are most cost effective?

Barriers

Significant barriers to implementing interventions to reduce youth access were noted in this review. Research issues important to communities and to local and state governments involving potential barriers include the following:

  • What components of community mobilization are most effective in building and maintaining support for retailer compliance with sales laws?
  • What components of community mobilization are most effective in building and maintaining support for active enforcement, including the consistent application of effective penalties?
  • What aspects of efforts to prevent or to overturn state preemption laws are effective?

Implementation Considerations and Resources

There are several barriers to implementing and sustaining these types of interventions:

  • The adoption or existence of a law at the state level that supersedes or precludes stronger local laws (preemption)
  • Opposition by retailers, retail associations, and the tobacco industry
  • Lack of resources or interest
  • Judicial nullification of penalties directed at retailers (other reviews have suggested that replacing criminal offense statutes with specified civil penalties [e.g., graduated fines or license suspension] would improve enforcement efforts and minimize court appearances)
  • Legislative efforts to weaken, replace, or prevent the implementation and conduct of interventions to reduce minors’ access

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.