States with more stringent limits on teens purchasing tobacco have lower adult smoking rates, especially among women, according to a study by researchers at the Washington University School of Medicine in St. Louis, Missouri. Investigators also found that, compared with states that have fewer restrictions, the stricter states also tended to have fewer adult heavy smokers. Researchers evaluated data from an ongoing National Cancer Institute survey that monitors smoking behavior in all 50 states.
They reviewed data from 1998 to 2007 on 105,519 people aged 18 to 34 years. They considered whether people had ever smoked, were currently smoking, and, if they did smoke, whether they smoked more than 10 cigarettes per day. Researchers also examined the specific smoking restrictions that were in place when the participants were aged 17 years.
Although it has been illegal for many years in most states to sell cigarettes to people aged younger than 18 years, few provisions are in place to prevent such sales, according to the study's first author, Richard Grucza, PhD, associate professor of psychiatry at Washington University.
Dr. Grucza and his colleagues focused on 9 smoking-related policies and found that in states with enforcement policies, 17-year-olds not only had more difficulty purchasing cigarettes but were less likely to smoke in their 20s or 30s. They estimated that if all states had such policies in place, the prevalence of smoking could be reduced by approximately 14%, whereas the rates of heavy smoking would decline by 29%.
The most effective restrictions were those on cigarette vending machines, in which the machines were either eliminated or housed in locations inaccessible to people aged younger than 18 years; identification requirements for purchasing cigarettes; restrictions on repackaging cigarettes so that 5 or 10 can be sold at a time versus an entire 20-pack; and prohibiting the distribution of free cigarettes at public events.
Many of the more restrictive policies have been in place nationally since the FDA started regulating cigarettes in 2009, which may lead to a decline in future adult smoking rates, Dr. Grucza notes. He and his colleagues found that restrictive policies on youth access had a big impact on women but did not make much of difference with regard to smoking rates in men. They theorized that underage women in the past have had an easier time getting alcohol and tobacco and that new policies such as checking identification may have made it more difficult for underage women to buy cigarettes.
The last year of available data on states for the study was 2006. At that time, only 4 states required a photo identification and only 20 had any kind of identification requirements. As more states around the country adopt stricter policies, smoking rates are likely to decline, Dr. Grucza says.