March 27, 1997
Many "mom and pop" merchants continue to advertise and sell cigarettes tominors in low-income city neighborhoods despite laws and public health campaigns tostop 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 tostrengthen 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 theApril issue of the American Journal of Public Health.
"A teen-ager's decision to start smoking involves a complex interplay ofenvironmental, social and personal factors," says Carolyn C. Voorhees, Ph.D., lead authorand an assistant professor of medicine. "One promising way to stop teen-age smoking isto keep them from getting cigarettes in the first place. That is why it is so important toreach the merchants as well as the youths."
Previous Hopkins studies have shown that most cigarettes are sold to customersof 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 83neighborhood 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 hadseveral cigarette poster advertisements in their front windows. Most of the sales occurredin stores with at least five window ads.
"It's discouraging that so many merchants enhance these sales by aggressivelydisplaying seductive advertising that targets minors," says Voorhees.
Furthermore, most of the sales occurred in stores where merchants and teenbuyers were of different races, according to the results. Teens of both races boughtcigarettes with equal ease, but the youths were eight times more likely to make a purchasewhen the merchant was of another race. The racial difference was 89 percent in stores inAfrican-American neighborhoods and 72 percent in stores in white neighborhoods.
"We are not certain why racial difference between merchant and customer was asignificant factor, but it may reflect a greater likelihood of some merchants not fullyunderstanding the health concerns of youths in cultures other than their own," saysVoorhees.
The study was conducted in 1994, the year before Maryland adopted a lawprohibiting 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 allneighborhood merchants in East Baltimore, minors were still able to buy cigarettes from97 percent of the stores. Undercover operations using minors to test compliance with thelaw are now illegal in Maryland. The Food and Drug Administration's ban on tobaccosales to youngsters under 18 went into effect Feb. 28.
"We've seen nothing to suggest that tobacco advertisers and merchants have doneanything of late to stop these dangerous and illegal sales," says Voorhees.
Smoking among young adults, who usually begin smoking as teens, declinedsharply 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 targetingyouths, teens having easy access to cigarettes, poor law enforcement and inadequateefforts to educate merchants, according to researchers. The federal Centers for DiseaseControl and Prevention estimates that one million teen-agers take up smoking each yearand 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 thehealth of East Baltimore residents, including efforts to fight lung and heart disease byreducing 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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