Reducing cigarette sales to minors in an urban setting

Reducing Cigarette Sales to Minors in an Urban Setting: Issues and Opportunities for Merchant Intervention Carolyn C. Voorhees,

PhD, Lisa R. Yanek, MPH, Frances A. Stillman, EdD, Diane M. Becker,

ScD, MPH

Introduction: Intervention studies to reduce cigarette sales to minors have been conducted primarily in suburban settings. Little is known about sociocultural factors influencing cigarette sales to minors in urban settings. This study sought to determine sociodemographic and cultural factors that may play a role in cigarette sales and in efforts to reduce sales to minors in urban areas. Methods:

Merchant education and follow-up surveys were conducted in small local stores in predominantly African-American urban census tracts in Baltimore. The stores had prior evidence of cigarette sales to minors.

Results

Merchants reported hostility (66%) and foul language (64%) when they requested youth identification. Youthful-oriented advertising of cigarettes was highly prevalent in all stores and moreso in stores owned and staffed by Asian merchants. Advertising with specific youthful content was predictive (OR = 3.97; 95% CI = 1.70, 9.23; P = .0014) of higher requests for cigarettes from minors.

Conclusions: Youth-oriented cigarette advertising is a prevalent environmental risk for urban youth. Differences between Asian and African-American merchants suggest socioethnic factors may be an influential component of illegal sales and educational campaigns to reduce smoking among minors. Medical Subject Headings (MeSH): cigarettes, sales, minors, advertising, at risk populations, government policy (Am J Prev Med 1998;14:138-142) 0 1998 American Journal of Preventive Medicine

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fforts to reduce cigarette sales to minors through retail outlets have been met with mixed results in many community settings.lm4 Recent data show that in low-income urban settings and in other settings, between 40% and 88%5-‘o of minors continue to make successful illegal purchases. Merchant education campaigns have been more effective in suburban communities than in most urban communities4 and among Hispanics and Caucasians than among African Americans. * Intervention studies suggest that retailer education alone does not reduce sales to minors.3,4 However, the context and cultural components of strategies used may make generalizability of such studies limited. Sustained community-driven education campaigns may counteract the public’s failure to recognize the imporFrom The Johns Hopkins University School of Medicine, Division of General Internal Medicine, Center for Health Promotion, Baltimore, Maryland. Address reprint requests to Dr. Voorhees, NHLBI/NIH, Division of Epidemiology and Clinical Applications, Prevention and Behavioral Medicine SRG, Rockledge 2, Room 8215, Bethesda, MD 20892-7936.

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tance of limiting cigarette sales to minors and may serve as an alternative to educational models that emphasize the punitive aspects of sales.” Effective interventions directed by the community at the retailer level need to consider sociocultural and local community norms. g,12-14 Operations that employ youths to purchase cigarettes are no longer legal in many states, Maryland being one such state, thus making it difficult to directly evaluate laws that limit sales to minors.15 Given the problems associated with evaluating educational campaigns, the qualitative aspects critical to the design of merchant interventions in urban environments have not been well studied. This study examined sociocultural factors associated with merchant behavior and the qualitative aspects of conditions related to conducting a nonpunitive merchant education campaign in an urban African-American community where minors have consistently had access to cigarettes.l’

0749~3797/98/$19.00 PII s0749-3797(97)00024x

WE DON’T SELL CIGARETTES

TO IT’S THE LAW

(counter-advertising for Newport advertisement slogan “Alive with Pleasure”) and Project BLESS identifying logo were included on the signs. Outdoor advertising data were also collected and coded for “youthful” content by visual review by trained community surveyors. Advertisements were considered “youthful” if they were judged by community surveyors to include models who appeared to be in their early twenties or younger. Prior to the campaign, investigators and community leaders met with Baltimore City school and health department officials regarding working with the campaign to assist in visible support and posteducation evaluation. Local officials were in support of this effort and, despite their understanding of the need for empirical data to monitor intervention effects and compliance with the laws, were unable to sanction an “illegal activity.” Follow-up Survey/Data Collection

Figure 1.

Signs posted in stores.

A total of 153 community small retail establishments in 18 low-income urban, predominately African-American census tracts in Baltimore were targeted based on earlier data showing 88% of youth were able to successfully purchase cigarettes in a random sample of these stores.‘” Large retail outlets and cigarette vending machines are uncommon in many low-income urban areas and are not the primary sources of illegal purchases. Merchant Contact/Education During a 4week period (February 1995) merchants were approached by indigenous community members trained by investigators in survey methods. Merchants were asked about their awareness of specific youth access laws and the fines associated with violation. Each merchant was given an informational pamphlet that included facts about tobacco use and children; about fines; specific community, city, and state leaders that actively support the laws; “facts the tobacco industry doesn’t what you to know”; and the goals of Project BLESS (Baltimore Leading Everyone to be Safe and Smoke-free). Details of pamphlet content were discussed with the merchants. Community members cited clergy in their census tracts that would be assigned to actively monitor specific merchants. In addition, merchants were asked to place signs (Figure 1) inside (small 14by-11-inch) and/or outside (large 24by-18inch) their store: “We don’t sell cigarettes to minors. Don’t even ask! It’s the law.” “Alive with Pride”

Two months after the initial merchant education visit, community surveyors revisited stores to monitor progress. Sales to minors could not be monitored legally owing to a recent law change that prohibited persons less than 18 years of age from purchasing cigarettes in Maryland. Indigenous community surveyors trained by investigators identified whether or not signs given out in the education period 2 months earlier were still posted, and they conducted merchant interviews regarding sales and sociocultural factors. Investigators were unable to legally monitor compliance by using undercover buying operations as had been conducted 12 months earlier. Data collected included most frequent reason sold to youth; response from youth when asked for identification; frequency of daily buying requests from minors; highest frequency brand sold to youth; whether access law affected sales; knowledge of specific fines associated with selling cigarettes to minors; surveyorestimated age, gender, ethnicity; and smoking status of the merchant.

Results Of the 153 stores targeted, 108 initially identified as making illegal sales in an earlier survey were provided with education and youth-deterrent signs. On followup, 103 stores were surveyed 2 months later; five stores had either gone out of business or were closed on two attempts. Of all merchants surveyed, 75% were Asian, 18% African-American, and 8% “other,” with most, 71%, being male. Most merchants (76%) reported owning the store. Stores reported frequent daily requests from probable minors for cigarettes (47%, l-4 requests/day; 40%, 5 or more requests/day). Newportbrand cigarettes were most often (84%) requested

Am.J Prev Med 1998;14(2)

139

(11% other, and 5% generic). Most merchants reported (96%) that when youth asked to purchase cigarettes they do not sell. The majority of merchants also believe smoking is bad for youth (95%) and agree with the law prohibiting sales to minors (94%), only 19% believe, however, that the law prohibiting sales to minors had reduced cigarette sales in their store. Merchants remained unaware of the specific nature and the amounts of fines associated with selling packs of cigarettes (88%) and loose (92%) cigarettes to minors. Cigarette advertisements were prevalent (47%, l-5 ads/store, 33%, 6-20 ads/store), with 55% of stores displaying between l-5 “youthful” ads. Merchants reported frequently (78%) asking “young” customers for identification. When they asked young customers for identification, merchants reported the following youth responses: overt hostility (66%), use of foul language (64%), no identification (59%), accepts and leaves peacefully (52%), begs and pleads (47%), or attempts to get an adult to buy for them (47%). Observation of the signs distributed during the campaign showed 61% of stores displaying no-smoking signs in “very visible” internal locations, with 81% of merchants retaining the indoor “don’t ask” signs in prominent locations. Stores missing signs (19; 47% of stores without signs) mostly reported that “someone else tore it down” as the major reason sign was not posted. Comparisons between all variables and merchant ethnicity (Asian vs. African-American) were made (Table 1). Statistically significant differences were found in overall advertising, youthful-oriented advertising, and daily requests for cigarettes. Asian merchants reported significantly more daily requests for cigarettes from youth, displayed more overall advertising, and had more youthful advertising compared with AfricanAmerican merchants. No statistical difference was ob served in the percentage by ethnic group in attitudes toward illegal sales or in the prominent display of signs prohibiting sales, although there was a higher probability that Asian merchants had campaign signs remaining. Merchant demographic, advertising, and youth response to a merchant’s request for identification variables were analyzed in a multiple logistic regression model to determine their significance in predicting higher cigarette purchase requests. Significant predictors were youthful cigarette ads (OR = 3.13; 95% CI = 1.29, 7.58; P = .OOl) and foul language (yes or no) used when identification was requested (OR = 3.9; 95% CI = 1.49, 10.23; P = .006) adjusting for merchant gender, estimated age, race, smoking status, and whether or not the merchant asks for identification. A logistic regression model predicting the presence or absence of “youthful cigarette advertising” demonstrated African-American merchants being less likely to display “youthful” ads (OR = 0.12; 95% CI = 0.028,

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0.48; P = .002) than Asian merchants when adjusting for non-youthful advertising, gender, estimated age, and smoking status of merchant and whether or not the merchant asks for identification. Goodness-of-fit test respectively (Hosmer-Lemeshow P = .818; P = .582) indicates a good fit.16

Discussion This study illustrates differences by merchant ethnicity in behavior in response to a community-initiated model to lower cigarette sales to minors. Ethnicity of the merchant proved to be the best predictor of compliance with a campaign to post visible signs prohibiting sales to minors and highlights specific areas for refining interventions to reduce/eliminate illegal cigarette sales to minors. Hostility and foul language were the most frequent responses by youth when the merchants requested identification for cigarette purchase. Others have shown that asking for identification may reduce sales.14 Asking for identification alone may be an inadequate action to reduce sales to minors given the negative behavior merchants are faced with and the real or perceived potential for violent retaliation by individuals or gangs. The violent culture in which many of these urban store owners/merchants operate their businesses, and the merchants’ “ethnic distance” from the youth in the cultural context, present special challenges for interventions. ’ It is also unlikely, given this scenario, that enforcement campaigns could be effective considering the strong negative feedback from neighborhood youth and the low probability that enforcement methods to limit cigarette sales would have a high enough priority to be applied frequently enough to overcome hostility and possible danger. Differences in merchant advertising practices by ethnic group showed overall more cigarette advertising outside Asian-owned compared to African-Americanowned/operated stores and specifically more targeted youth advertisements displayed on Asian stores. These differences may represent more aggressive business practices among Asian merchants or less identification with the neighborhood culture. Among African-American merchants, fewer advertisements may reflect concern for youth and “protection” of one’s own community. The finding that the more that youthful advertisements were displayed outside stores, the more that young people tried to buy cigarettes, is not surprising, but it is one that has not been previously examined empirically. Promising approaches to interventions with urban merchants might include initiatives that foster community action to monitor and encourage compliance by merchants as well as by potential youthful purchasers. Small businesses depend on the goodwill of the community. It is to their commercial advantage to support community goals to prevent nicotine

American Journal of Preventive Medicine, Volume 14, Number 2

Table 1. Merchant

survey:

Follow-up

responses

by merchant

ethnic

Variable/Merchant Ethnicitv Store Owners Yes Daily requests for cigarettes by minors I-4/day 5 or >/da\ Brand most often requested Newport Generic OtherSmoking is bad for kids Agree Agree with law prohibiting sales to minors Law has hurt cigarette sales Yes Able to correctly identify fine associated with selling to minors: Packs of cigarettes Single (“loose”) Ask for identification Yes Response from youth when merchant requests identification: hostility foul language don’t have ID with me begs and pleads attempts to get adult to buy Cigarette advertisements displayed outside store Any l-5 ads 6-20 ads Mean (SD) Median Cigxette advertisements with “youthful” content Any l-5 ads 6-20 Mean (SD) Median “No-smoking” signs displayed Yes “Don’t .&k” signs displayed

Yes Gender of merchant Female Agr of merchant (estimated) <40

addiction

in youth.

More

interventions

in urban

communities,

including

work

settings

on that

the

efficacy

mobilize

youth and retailers,

of

whole

is needed.

group

Merchant

Merchant

African-American (N = 18)

Asian (N = 77)

Difference P value

56% (10)

83% (63)

0.012”

29% (13) 35% (6)

51% (39) 41% (31)

0.008”

81% (15) 13% (2) 6% (1)

87% (66) 4% (3) 9% (7)

0.324’

89% (16) 89% (16)

96% (73) 96% (73)

0.243b 0.243’

6% (1)

21%’ (16)

0.179”

6% (1) 6% (1)

5% (4) 4% (3)

0.560b 0.815b

61% (11)

83% (62)

0.04%’

61% 44% 33% 50% 39%

(11) (8) (6) (9) (7)

67% 68% 64% 45% 48%

(50) (52) (34) (36) (37)

0.656” 0.057” 0.016” 0.721” 0.486;

61% 44% 17% 2.8

(11) (8) (3) (4.8) 1

88% 48% 35% 7.5

(68) (37) (27) (7.8) 5

0.006”

33% (6) 33% (6) 0 .89 (1.6) 0

70% 58% 12% 2.5

(54) (45) (9) (2.6) 2

0.004” 0.003’

47% (8)

64% (49)

0.183”

89% (16)

79% (60)

0.50gb

56% (IO)

23% (18)

0.007”

56% (IO)

36% (28)

0.135”

Rigorous

policy-oriented

needed

to reduce

include,

as the

youth Clinton

approaches access

0.006’ 0.002” 0.003’

0.002” 0.009’

are clearly also

to cigarettes’7-21

Administration

recently

and an-

Evaluation of interventions can include the use of non-completed purchases and requests by merchants

nounced, “far-reaching restrictions on tobacco advertising and sales to adolescents.“” Recent draft regulations

for identification as outcomes when local laws prohibit youth from completing purchases.

suggest a more aggressive stance on youth-oriented cigarette advertising and must include provisions for

Am J Prev Med

1998;14(2)

141

legally sanctioned to minors.

compliance

Depending

enforcement

activities is unlikely

to cigarettes.

Major

and entire

community,

counteract

the ability

ence youth

selling

only public

checks

actions health

that

to monitor

solely on merchants, to reduce

comprehensive

and purchasing will have

and

youth access

policy

state, and federal of tobacco

sales

youth,

initiatives

initiatives

advertising

to

to influ-

are likely to be the

a sufficient

impact

on a

level.

This research was supported by grant ROlHL436040651 from the National Heart, Lung and Blood Institute. The authors acknowledge Tyrinda Griffin, MBA, and Stanley Boone for their efforts, commitment, in Project BLESS; and CURE (Clergy United for Renewal in East Baltimore) for their insight and support.

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