Accessibility to minors of smokeless tobacco products - Broward County, Florida, March-June 1996

Morbidity and Mortality Weekly Report, Dec 13, 1996

Health consequences associated with use of smokeless tobacco (SLT) (i.e., snuff or loose-leaf or fine-cut chewing tobacco) products include halitosis, leukoplakia, and oral cancer (1). Periodontal degeneration and soft tissue lesions are early indicators of these conditions and diseases among persons who use SLT (1). Since October 1992, the sale of tobacco products to minors (i.e., persons aged <18 years) has been prohibited by law in Florida, and since May 1994, Florida law has required businesses to post warning signs stating that tobacco sales to minors are illegal and that proof of age is required to purchase tobacco products such as SLT.* To assess the impact of these laws on over-the-counter access to SLT by minors in Broward County (1990 population: 1,244,531), during March-June 1996 faculty from Florida Atlantic University's Department of Exercise Science/Wellness Education conducted a study to measure vendor compliance with tobacco minimum-age sale laws and with the sign statute. This report summarizes the findings of the assessments, which indicated that nearly one third of attempts by minors to purchase SLT products were successful.

The 1995-1996 Beverage License File maintained by the Florida Department of Business and Professional Regulation (DBPR) was used to identify five categories of businesses in the county: pharmacies, convenience stores, grocery stores, gas stations, and "smoke shops" (i.e., businesses where the predominant merchandise is tobacco or tobacco-related products) (n = 1211). A map of the county was divided into 10 equally sized areas; within each of these areas, approximately 20% of the businesses were randomly selected to produce a total sample of 242 businesses. Of these 242, a total of 117 were excluded: they were not surveyed because of time constraint (67), were inaccurately surveyed (37), did not sell SLT (eight), or had closed (five). The remaining 125 businesses represented 10% of the 1211 county total and comprised 33 (13%) of the 246 pharmacies, 20 (8%) of the 268 convenience stores, 25 (7%) of the 381 grocery stores, 41 (14%) of the 297 gas stations, and six (32%) of the 19 smoke shops. The assessment employed five teams of volunteers, each comprising one minor and one adult; two of the minors were female (both aged 15 years), and three were male (one each aged 15, 16, and 17 years).

One purchase attempt was made at each of the 125 businesses. Purchase attempts used the following procedure (2): the adult member of the team entered the business first to note the presence of any clearly displayed signs stating that tobacco products would not be sold to minors. The adult then observed while the minor entered, selected an SLT product, and attempted to purchase the product. The attempt was considered successful if a sale was recorded on the cash register or the vendor placed the SLT product on the counter for purchase by the minor; the minor would then state that he or she had insufficient money for purchase and would immediately leave the store. The attempt also was considered successful if the vendor asked for age identification but was prepared to sell the SLT product. The attempt was considered unsuccessful if the minor was denied purchase outright or asked for age verification and denied purchase. The adult member noted the vendor's reasons for refusal at the time of attempted purchase; when no refusal reason was provided to the minor, the adult team member waited until the minor had departed and then asked the vendor about the reason for refusal.

Overall, minors were successful in purchasing SLT in 40 (32%) of 125 retail outlets (Table 1); of these successful purchase attempts, 14 (35%) occurred within one half mile of an elementary, middle, or high school. Success rates were similar among those aged <17 years and aged 17 years (34% [95% confidence interval (Cl)=[ or -] 17.7%] versus 20% [95% Cl=[ or -]40.0%], respectively), and among males and females (25 [33% (95% Cl=[ or -]21.2%)] of 75 attempts versus 15 [30% (95% Cl=[ or -]25.5%)] of 50 attempts, respectively). For each of the five categories of stores that sold SLT, attempts were successful at 10 (30% [95% Cl=[ or -]31.4%]) pharmacies, 17 (85% [95% Cl=[ or -]31.4%]) convenience stores, three (12% [95% Cl=[ or -]25.5%]) grocery stores, nine (22% [95% Cl=[ or -]25.5%]) gas stations, and one (17% [95% Cl=[ or -]59.6%]) smoke shop. Warning signs provided by the DBPR were posted and clearly visible in 96 (77%) of the 125 stores; 17 of these stores had signs provided by tobacco companies. Success rates were similar in businesses with and without signs (30 [31% (95% Cl=[ or -]18.4%)] of 96 versus 10 [35% (95% Cl=[ or -]34.5%)] of 29, respectively).

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Single reasons specified by the vendors for 51 of the 85 unsuccessful attempts were that the minor had no proper identification (40 [47%]), the minor appeared to be underaged (nine [11%]), and that the sale of tobacco products to minors was illegal (two [2%]). Multiple reasons specified by the vendors for 34 unsuccessful attempts were that the sale of tobacco products to minors was illegal and the minor had no proper identification (11 [13%]), that the store had a policy prohibiting sales to minors and that the minor had no proper identification (eight [19%]), that the store had a policy prohibiting sales to minors and that the minor looked too young (six [7%]), and other reasons (nine [11%]). Reported by.- FS Bridges, EdD, Dept of Health, Leisure and Sports, The Univ of West Florida, Pensacola, BS Graves, EdD, Dept of Health Sciences, Florida Atlantic Univ, Davie, Florida. Editorial Note: in 1994, a report issued by the Surgeon General indicated that approximately 20% of high school males were current users of SLT products (1). in 1993, approximately one half of minors aged 12-17 years who had used SLT during the previous month usually purchased their own SLT, of those who usually purchased their own SLT, most (82%) often or sometimes bought from small businesses such as convenience stores (3). The success rate for minors in Broward County in attempts to purchase SLT (32%) was higher than that previously reported in Kansas (15%), similar to that reported in Palm Beach County, Florida 35%), and lower than that reported in Texas (59%) (2,4,5).