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Tobacco Use and Secondhand Smoke Exposure: Community Mobilization with Additional Interventions to Restrict Minors' Access to Tobacco Products

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What the Task Force Found

About The Systematic Review

The Task Force finding is based on evidence from a systematic review of 9 studies (search period through May 2000). The review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice, and policy related to reducing tobacco use and secondhand smoke exposure.

Context

There is no information for this section.

Summary of Results

Nine studies (10 intervention arms) qualified for the review.

  • Self-reported tobacco use among youths over follow-up periods of 24-48 months: median decrease of 5.8 percentage points (4 studies)
  • Retail tobacco sales to youth: median decrease of 33.5 percentage points (9 studies)

 

Summary of Economic Evidence

The study included in the economic review was a one-year study that modeled the cost effectiveness of active enforcement of tobacco sales to minors on a national level. The intervention included employing minors to attempt tobacco purchases, licensing tobacco vendors, and civil penalties for vendors who illegally sold tobacco products to minors.

  • Primary outcome measures consisted of four levels of reduction in youth tobacco use ranging from 5% to 50%. Cost-effectiveness ratios ranged from $44 to $3100 per year of life saved.
  • Program costs included personnel, salary, and benefits for minors and for adult inspectors; liability insurance; money to purchase tobacco; transportation; and overhead (analyses were based on enforcement costs of $50, $150, $250, and $350, where marginal expense is lowest at the community level and highest at the federal level).

Applicability

These findings should be applicable to a variety of settings and populations in the U.S., including urban, suburban, and rural communities and African-American, Hispanic, or white populations.

Evidence Gaps

Each Community Preventive Services Task Force (Task Force) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the Task Force finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the Task Force recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the Task Force recommendation is based.

Identified Evidence Gaps

The following outlines evidence gaps for these reviews of interventions to restrict minors’ access to tobacco products: Active Enforcement of Sales Laws Directed at Retailers When Used Alone; Community Mobilization with Additional Interventions; Community Education About Youth Access to Tobacco Products When Used Alone; Laws Directed at Minors' Purchase, Possession or Use of Tobacco Products When Used Alone; Retailer Education with Reinforcement and Information on Health Consequences When Used Alone; Retailer Education Without Reinforcement When Used Alone; Sales Laws Directed at Retailers When Used Alone.

Effectiveness

The studies identified in this review provide evidence of effectiveness of community mobilization when coordinated with other interventions in reducing both tobacco use among youth and youth access to tobacco from commercial sources. A better understanding of the relative impact of community mobilization on reducing youth demand for tobacco products would assist local programs significantly in setting priorities for future intervention efforts. Research issues identified by others overlap with the questions generated as the result of this review:

  • What intervention combinations, intensity, and duration are the minimum required to reduce youth tobacco use?
  • What effect, if any, do interventions to reduce youth access to tobacco products through commercial sources have on access through social sources? What effect, if any, do interventions to reduce youth access to tobacco products through social sources have on access through commercial sources?
  • What is the required intensity and duration of active enforcement components?
  • What effect does decreasing the number of outlets selling tobacco products have on youth access?
  • How do age verification devices (such as scanners) affect retailer sales compliance?

Applicability

Community mobilization interventions included efforts to identify and incorporate community concerns. When tailored to resonate with the sociocultural composition of the population, community mobilization combined with additional interventions should be applicable to most U.S. settings. Some questions remain regarding applicability of these interventions in settings and populations other than those studied.

  • Are there differences in the effectiveness of or barriers to these interventions in urban and rural settings or in communities that cross jurisdictions?

Other Positive or Negative Effects

This review did not identify any additional positive or negative effects of these interventions

Economic Evaluations

The information available for economic evaluation consisted of a single study evaluating one component (active enforcement directed at retailers) of an effective multicomponent intervention. Considerable research is, therefore, warranted regarding the following questions:

  • What are the costs of these interventions?
  • What is the cost-effectiveness of these intervention combinations?
  • What is the cost-effectiveness, net cost, or net benefit of these intervention combinations when cost-effectiveness analysis includes cost savings of illness averted?
  • What combination(s) of components are most cost effective?

Barriers

Significant barriers to implementing interventions to reduce youth access were noted in this review. Research issues important to communities and to local and state governments involving potential barriers include the following:

  • What components of community mobilization are most effective in building and maintaining support for retailer compliance with sales laws?
  • What components of community mobilization are most effective in building and maintaining support for active enforcement, including the consistent application of effective penalties?
  • What aspects of efforts to prevent or to overturn state preemption laws are effective?

Study Characteristics

  • The evaluated interventions either fostered or were coordinated with additional interventions, such as
    • stronger restrictions on retailer sales of tobacco products;
    • restrictions directed at youth purchase, possession, or use;
    • active enforcement of tobacco sales laws; and
    • retailer education interventions (with or without reinforcement).
  • Educational components included
    • community-wide assessments of compliance by tobacco retailers—with dissemination of the results through mass media events and news coverage
    • presentations to civic groups and local governments.
  • Community and school meetings and activities, as well as direct contact with local governments through testimony, petitions, letters, and phone calls, also occurred.
  • Interventions were conducted in a variety of settings and populations, including urban, suburban, and rural communities in the United States and Australia. In the United States, interventions were implemented in communities that included predominantly African-American, Hispanic or white populations.

Publications