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- Title
Assessment of the US Federal Retailer Violation Rate as an Estimate of the Proportion of Retailers That Illegally Sell Tobacco to Adolescents.
- Authors
Levinson, Arnold H.; Ma, Ming; Jason, Leonard A.; Lee, Joseph G. L.; Landrine, Hope; Glueck, Deborah H.; DiFranza, Joseph R.
- Abstract
Key Points: Question: Are retailers that sell tobacco to adolescents as uncommon as government surveys find? Findings: In this survey study of 201 retailers, repeated tests of a population-level retail sample found that most retailers sold tobacco to minors at least once, while a mean of 18% of retailers sold in a single round of tests. Faulty examination of identification contributed to most violations. Meaning: Government surveys underestimate the proportion of retailers that sell tobacco to minors, and improved survey methods can reduce this bias. Importance: Despite progress against tobacco sales to minors, retailers continue to violate state and federal laws and supply adolescent smokers with tobacco products. Government-sanctioned surveys underestimate the extent of the problem, and retailer associations use these data to block stricter enforcement policies. Objectives: To assess the validity of the US federal retailer violation rate (RVR) as an estimate of the proportion of retailers that sell tobacco to minors and to investigate what proportion always or almost always sells vs refuses to sell cigarettes to minors. Design, Setting, and Participants: This survey study was conducted October 6, 2012, to September 8, 2013; data were analyzed between September 28, 2017, and March 21, 2018. The setting was a suburban county adjacent to Denver, Colorado. Participants were a systematically selected, population-based cluster sample of retailers that stock cigarettes for sale. Retailers were masked to the survey. Main Outcomes and Measures: Each retailer was visited 6 times by supervised minors who attempted to purchase cigarettes at each visit. The main outcome was whether cigarettes were sold. Other measures included whether government-issued photo identification (ID) was requested as required by law, how ID was examined, and what the demographic characteristics of study minors and clerks were. Results: The sample of 201 retailers (44.8% of the 449 listed population) included convenience stores (n = 77), liquor stores (n = 63), grocery stores/supermarkets (n = 33), pharmacies (n = 17), tobacco stores (n = 7), and stand-alone gas stations (n = 4). Bars, clubs, and adult establishments were excluded. A total of 1181 purchase attempts were analyzed; 25 (2.1%) were excluded for missing data. The mean RVR across 6 rounds of checks was 18.0% (95% CI, 14.7%-21.2%) and ranged from 13.7% to 28.0% per round. Most retailers (54.7% [110 of 201]) violated at least once in 6 visits, 26.4% (53 of 201) violated at least twice, and 11.9% (24 of 201) violated half or more times. How retailers examined proof of age largely determined whether violations occurred. Conclusions and Relevance: The proportion of retailers that sold cigarettes to a minor at least once in 6 attempts was 3 times higher than the mean RVR based on a single inspection per retailer. Larger replication studies are needed. Enforcement protocols should reflect the fact that each retailer does not respond consistently when adolescents try to buy tobacco products, and many retailers are not properly validating ID that shows proof of age. This survey study assesses the validity of the US federal retailer violation rate as an estimate of the proportion of retailers that sell tobacco to minors and investigates what proportion always or almost always sold vs refused to sell cigarettes to supervised minors who attempted to purchase cigarettes.
- Subjects
COLORADO; UNITED States; TOBACCO products; ATTITUDE (Psychology); CONFIDENCE intervals; DRUG laws; GROUP identity; MEDICAL protocols; HEALTH outcome assessment; SOCIAL skills; SUBURBS; SURVEYS; CLUSTER sampling; MARKETING; LAW; TOBACCO laws
- Publication
JAMA Pediatrics, 2018, Vol 172, Issue 10, p966
- ISSN
2168-6203
- Publication type
Article
- DOI
10.1001/jamapediatrics.2018.2038