Studies have shown that most children who smoke do not obtain their cigarettes from adult members or friends, but instead, buy them themselves in convenience, grocery, and other stores. Minors are successful at buying cigarettes 60-90% of the time, and purchase 1 billion packs per year, despite laws banning sales of cigarettes to minors. Other studies have shown that such easy access to cigarettes is one of the best predictors of a child becoming a regular smoker at a young age. Hence, many programs designed to prevent smoking among youth are directed at the merchants (store clerks and managers) who continue to sell cigarettes to minors despite the law: the logic is that, if we could reduce children's access to cigarettes, we would make progress toward preventing their smoking. Many such programs have been tried with merchants in the state: researchers have educated merchants about the dangers of smoking among children, have reminded them that selling cigarettes to children is illegal, and have threatened (and sometimes have followed through on that threat) to call the police and turn the merchant in. Unfortunately, these merchant-education programs have not been successful: minors still are able to buy cigarettes in stores after the intervention. The question then is: why don't these programs work?
We believe that merchant-education programs fail because the problem is not the merchant but is instead the community. In our prior study, we sent minors to 72 stores to attempt to buy cigarettes and observed not only what the merchant did but what the adult customers in the stores did as well. We found that adult customers who were standing in line and observed cigarettes being sold to our children 1700 times basically said and did nothing to stop the sale, and instead went about buying their own groceries. In 5 out of the 1700 times however, an adult in line said something and the clerk's response was to halt the sale of cigarettes to the child mid-transaction. From this we concluded that merchants continue to sell cigarettes to children because the community permits it. By watching such sales and saying nothing, communities send the message that they approve of the sales; and, by making purchases (spending money) in the store despite seeing the merchant sell cigarettes to children, the community also gives merchants concrete rewards for selling cigarettes to children.
Thus, in this project (CHALK: Community Health Alliance for Local Kids), we are conducting a new intervention that focuses not on the merchant, but on the community. Adults who live near the 72 stores and are regular customers will organize their communities to speak up and object whenever they see a merchant sell cigarettes to children, and encourage others to shop at stores that don’t sell cigarettes to children. Simultaneously, we will conduct a standard, merchant-education program in a separate group of stores. Then, we will send children into all stores to buy cigarettes to test the effectiveness of the new versus the traditional intervention. We believe that the new intervention will reduce minors' access to cigarettes to zero and be more effective than the merchant-education program. If so, we will have found a new, inexpensive, and simple strategy that can be used elsewhere to reduce minors' access to tobacco and thereby prevent their smoking. |
The purpose of this innovative, 3-year, community-intervention project was to reduce sales of cigarettes to youth. The project is innovative in the sense that we did not focus on the store clerks who sell cigarettes to minors, but instead, focused on the community of adults who observe such sales yet say and do nothing to stop them. Our goal was to motivate adults in the communities surrounding the stores to speak-up (to object) when they observe sales of tobacco to youth, and to shop only in stores that do not do so. This intervention was conducted, not by researchers, but by parents and adults from the community.
In Year 1, a random set of 72 small stores was identified to be the target of the intervention, with 24 stores each in Black, White, and Latino communities. Black, White, and Latino youth then attempted to purchase cigarettes in each of the 72 stores; these initial purchases established the baseline rate of sales of tobacco to youth prior to intervention. The 72 stores then were randomly assigned to three intervention groups (Wave 1, Wave 2, and Wave 3). For Year 2 and Year 3, the intervention was conducted (using a multiple-baseline design) first in the Wave 1, then in the Wave 2, and finally in the Wave 3 stores, with the rate , of sales of tobacco to youth assessed immediately after each intervention, and again 6 months after the end of the project.
Results revealed that sales to youth in the Wave 1 stores decreased from 10.4% at Baseline to 6.2% at final follow-up; in the Wave 2 stores, sales decreased from 16% at Baseline to 6.9% at final followup; and in the Wave 3 stores, sales decreased from 12% at Baseline to 4.6% at final follow-up. The decreases in sales in the Wave 1 and 2 stores did not occur immediately after the intervention however, but instead, later, suggesting a delayed intervention effect, and possible spill-over from intervening in neighboring stores. The intervention was most clearly successful in the Wave 3 stores, where sales decreased immediately after the intervention, and then remained low through final followup. Hence, only a portion of the decreases in sales of tobacco to youth can be attributed to the intervention.
These findings tentatively suggest that changing community attitudes and behaviors might be added to current merchant-education efforts to maximize the success of efforts to reduce youth access to tobacco. |