Many "mom and pop" merchants continue to advertise and sell cigarettes to minors in low-income city neighborhoods despite laws and public health campaigns to stop teen-age smoking, a Johns Hopkins study suggests.
The findings underscore the need to enforce laws barring tobacco sales to minors, to persuade merchants to remove store-window advertisements that target youths and to strengthen public awareness of tobacco's health hazards, say researchers. The study, which was funded by the National Heart, Lung and Blood Institute, is published in the April issue of the American Journal of Public Health.
"A teen-ager's decision to start smoking involves a complex interplay of environmental, social and personal factors," says Carolyn C. Voorhees, Ph.D., lead author and an assistant professor of medicine. "One promising way to stop teen-age smoking is to keep them from getting cigarettes in the first place. That is why it is so important to reach the merchants as well as the youths."
Previous Hopkins studies have shown that most cigarettes are sold to customers of all ages in small, neighborhood stores. In the new study, "undercover" African-American and white boys and girls, ages 14 to 16, tried to buy cigarettes in 83 neighborhood stores in low-income, African-American and white sections of Baltimore.
The teens succeeded in 86 percent of the stores, nearly 60 percent of which had several cigarette poster advertisements in their front windows. Most of the sales occurred in stores with at least five window ads.
"It's discouraging that so many merchants enhance these sales by aggressively displaying seductive advertising that targets minors," says Voorhees. Furthermore, most of the sales occurred in stores where merchants and teen buyers were of different races, according to the results. Teens of both races bought cigarettes with equal ease, but the youths were eight times more likely to make a purchase when the merchant was of another race. The racial difference was 89 percent in stores in African-American neighborhoods and 72 percent in stores in white neighborhoods.
"We are not certain why racial difference between merchant and customer was a significant factor, but it may reflect a greater likelihood of some merchants not fully understanding the health concerns of youths in cultures other than their own," says Voorhees.
The study was conducted in 1994, the year before Maryland adopted a law prohibiting tobacco sales to minors, but years after the start of public health and school-based programs to reduce teen smoking. In a 1995 Hopkins survey involving half of all neighborhood merchants in East Baltimore, minors were still able to buy cigarettes from 97 percent of the stores. Undercover operations using minors to test compliance with the law are now illegal in Maryland. The Food and Drug Administration's ban on tobacco sales to youngsters under 18 went into effect Feb. 28.
"We've seen nothing to suggest that tobacco advertisers and merchants have done anything of late to stop these dangerous and illegal sales," says Voorhees.
Smoking among young adults, who usually begin smoking as teens, declined sharply in the United States in late 1970s, but has remained constant since the mid-1980s, researchers say. Possible explanations include an increase in cigarette ads targeting youths, teens having easy access to cigarettes, poor law enforcement and inadequate efforts to educate merchants, according to researchers. The federal Centers for Disease Control and Prevention estimates that one million teen-agers take up smoking each year and that a third of them will die of tobacco-related diseases if they do not quit.
Hopkins and several community groups have formed partnerships to improve the health of East Baltimore residents, including efforts to fight lung and heart disease by reducing smoking in all age groups.
Other authors were Diane M. Becker, Sc.D., Robert T. Swank, M.A., the Rev. Herbert W. Watson, Jr., M.Div., Frances A. Stillman, Ed.D. and Donna X. Harris, B.S.
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