Agenda Packets - 2018/08/06 - Laserfiche WebLink

Home Browse Search

Downloaded from http://tobaccocontrol.bmj.com/ on December 12, 2016 - Published by group.bmj.com non -Caucasian youth, and for students in grades 10, 11 and 12. These trends were significant from 2006 to 2010, but not from 2010 to 2012, suggesting that raising the minimum purchase age may contribute to a greater decline in smoking in the years immediately following its adoption. As the smoking rate decreased in Needham, floor effects might have slowed the rate of decline in the period from 2010 to 2012; however, the smoking rate still declined by 18% in that final period. In addition to lower levels of smoking, Needham youth also reported a significantly greater decline in purchasing cigarettes from stores in the years immediately following the legislation. This was true despite the fact that the youth population in Needham is very mobile, and closely neighbouring suburban communities maintained a minimum sales age of 18 throughout the study period. The decline in smoking in Needham may have been even more pronounced if surrounding communities had also increased the tobacco sales age to 21, as this would have further limited access. Youth who purchase cigarettes are more likely to supply cigarettes to other youth, 12 13 and these social sources of tobacco have become more common as commercial restrictions have increased. -5 Our findings suggest that by suc- cessfully reducing commercial availability of cigarettes to Needham youth, there was a decrease in underage purchases, as well as a potential disruption of the social availability of cigar- ettes to other youth, resulting in less smoking. Also notable was the fact that alcohol use did not decline sig- nificantly more in Needham relative to the comparison commu- nities during any portion of the study period. This indicates that the observed pattern of change appears to be specific to cigar- ette smoking and not due to a broader decline in substance use or reporting patterns. Enforcement may partially explain the apparent .success of raising the minimum tobacco sales age in Needham. Effective enforcement is important in the success of laws designed to prevent tobacco sales to minors. 14 In 2008, more than 18 000 compliance checks for cigarette sales to adolescents under the age of 18 were conducted in Massachusetts towns with state - funded tobacco control programmes, with an illegal sales rate of 8.3%. In Needham, 57 compliance checks were conducted, with zero illegal sales to those under the age of 18 occurring. 15 Increasing the tobacco sales age to 21 may have made it less likely that adolescents under the age of 18 would have been sold tobacco. Several limitations are worth noting. First, this study was not initially designed to evaluate the minimum sales age legislation; the 2006 survey was administered more than 1 year after the legislation was adopted in April of 2005; therefore, there is no baseline measure of youth smoking. It also does not take into account the fact that the minimum sales age in Needham was increased in phases: it was first raised from 18 to 19 in April of 2003, then to 20 in April of 2004, and finally to 21 in April of 2003. Data reported from the Youth Risk Behavior Survey con- ducted in Needham (Needham Youth Risk Behavior Survey, unpublished raw data, 2001-2005) and the state of Massachusetts16 in 2001, 2003 and 2005 provide some infor- mation on trends prior to the current study. In Needham, current smoking was similar in 2001 (21%) and 2003 (20%), and then dropped to 1S% in 2005, corresponding with the first two increases in the minimum sales age. During the same time period, smoking decreased in Massachusetts from 26% to 21% during 2001-2003, and then was stable at 21% in 2005. This suggests that the greater decline in smoking in Needham in this study may be a continuation of a trend that began earlier, pos- sibly around the time when the minimum sales age was initially raised. Second, Needham also passed a law in 2009 prohibiting tobacco sales in pharmacies, which may have contributed to the smoking decline after the 2008 survey. With the exception of one other study community that banned pharmacy sales in 2011, neither Needham nor any of the comparison communi- ties adopted any of the Massachusetts Tobacco Control Program's five priority prevention policies during the study period (banning pharmacy sales, capping tobacco licenses, regu- lating single cigar purchases, banning flavoured tobacco sales and regulating electronic cigarette purchases) (M Paskowky, Director of Surveillance and Evaluation, Massachusetts Tobacco Cessation and Prevention Program, Massachusetts Department of Public Health, personal communication, 6 November 2014). This study did not account for non -policy -related programmes in Needham or the other communities. Finally, this study ana- lysed the use of cigarettes only and did not examine the use of other tobacco products. Despite these limitations, this study shows promising results on the potential impact of raising the minimum sales age of tobacco. Further, raising the minimum age is relatively simple to implement given the existing mechanisms to restrict tobacco purchases and conduct compliance checks." As this approach is considered in more and more localities, our findings provide strong evidence of its potential to save lives by preventing youth access, initiation and ultimately addiction. What this paper add -i ► An increasing number of communities are implementing policies to raise the minimum sales age of tobacco to 21, but there is little direct evidence regarding whether this strategy is effective in reducing youth smoking. ► We have demonstrated that, after raising the minimum sales age in Needham, Massachusetts, smoking and cigarette purchases declined significantly more in Needham relative to 16 comparison communities. ► These findings are valuable to localities that are considering raising the minimum age, in showing that this approach has the potential to reduce youth access and initiation, with potentially life-saving benefits. Acknowledgements The authors express their gratitude to the MetroWest Health Foundation, specifically Martin Cohen, CEO/president, and Rebecca Donham, senior program officer, for funding the MetroWest Adolescent Health Survey (MWAHS) initiative and encouraging Education Development Center's (EDC) efforts to conduct this analysis. They thank the Needham Public Schools and Needham Health Department for permitting public use of the Needham data and assisting with documentation of local substance use prevention activities. They also acknowledge Dr Robert Crane for encouraging them to engage in this analysis, and Professor George Papandanatos and Dr Michelle Rogers for biostatistical and programming guidance. Finally, they thank the MWAHS team at EDC, including Erin Smith, Robert Coulter and Olivia Alford, and the many school administrators and staff who worked to ensure the successful administration of the MWAHS since 2006. Contributors All authors participated in the study conceptualisation. SKS originated the study, oversaw data collection and drafted portions of the manuscript. SLB and KD oversaw the analysis and contributed substantially to the manuscript writing. JPW contributed to the conceptualisation and manuscript editing. LO contributed substantially to the study design and manuscript writing. Funding The MetroWest Adolescent Health Survey data collection was funded by the MetroWest Health Foundation in Framingham, Massachusetts, USA (grant numbers P150, P182, P192 and P225). Competing interests None declared. Ethics approval The study was approved in all years by the Institutional Review Board at Education Development Center, Inc, Waltham, Massachusetts, USA. 358 Kessel Schneider S, et al. Tob Control 2016;25:355-359. doi:10.1136/tobaccocontrol-2014-052207