Effective Tobacco Enforcement Proven to Reduce Youth Smoking

September 2017

Decades of research indicates that tobacco enforcement programs, particularly those focusing on youth access laws, are effective at reducing youth smoking.1-7 In contrast, very little evidence supports the notion that merely enacting youth access laws in the absence of proper enforcement support will impact prevalence rates of youth smoking in any way.2 Dating back to 1997, researchers studied the association between merchant compliance with the law. Current daily smoking was examined, and the results showed that states with a higher average of state merchant compliance predicted lower levels of current daily smoking among adolescents.

Although there are costs associated with preventive enforcement programs, the societal benefits of reducing youth smoking outweigh those costs. For instance, youth tobacco prevention programs, specifically those that focus on enforcement, are a much more cost-effective method for saving lives compared to the costs of medical provisions needed for tobacco-related deleterious health effects.4 Additionally, stricter enforcement of youth access laws can actually offset some of the costs of enforcement program implementation. As research indicates, a 25% increase in compliance with youth access laws would have approximately the same deterrent effect as increasing the price per cigarette pack by $2.00 (in 2006 dollars).4

Price and tax increases alone, however, are not sufficient to positively impact youth tobacco use. Enforcement efforts that disrupt the sale of tobacco to minors are the only deterrent method consistently associated with declines in youth smoking.1-4, 6 A meta-analysis of 424 government reports and published articles reported that every single study that demonstrated a significant reduction in commercial distribution (via access laws), also reported reduced youth smoking rates.2 Further, across studies, the only consistently effective method for reducing tobacco sales to minors was utilizing underage decoy buyers to measure merchant violation rates.1-4

Two reports by the Surgeon General and Department of Health and Human Resources, recommend the implementation of comprehensive youth smoking prevention strategies, defined as the restriction of tobacco supply to minors through both commercial (e.g., stores and vending machines) and social supply chains (e.g., peers or adults).8,9 Addressing the commercial supply requires taking appropriate steps to prevent illegal sales in the retail environment including better education for merchants and actively enforcing youth access laws.8,9 Tobacco enforcement programs are required, and in order to be effective it is necessary to properly implement and support those programs.7


1DiFranza, J. R. (2005). Best practices for enforcing state laws prohibiting the sale of tobacco to minors. Journal of Public Health Management and Practice, 11(6), 559-565.

2DiFranza, J. R. (2012) Which interventions against the sale of tobacco to minors can be expected to reduce smoking? Tobacco Control. 21(4), 436–442

3DiFranza, J. R., & Coleman, M. (2001). Sources of tobacco for youths in communities with strong enforcement of youth access laws. Tobacco Control, 10(4), 323-328.

4DiFranza, J. R., Savageau, J. A., & Fletcher, K. E. (2009). Enforcement of underage sales laws as a predictor of daily smoking among adolescents–a national study. BMC Public Health, 9(1), 107.

5Farrelly, M. C., Loomis, B. R., Han, B., Gfroerer, J., Kuiper, N., Couzens, G. L., Dube, S., & Caraballo, R. S. (2013). A comprehensive examination of the influence of state tobacco control programs and policies on youth smoking. American journal of public health, 103(3), 549-555.

6Jacobson, P. D., & Wasserman, J. (1999). The implementation and enforcement of tobacco control laws: policy implications for activists and the industry. Journal of Health Politics, Policy, and Law, 24(3), 567-598

7Kahende, J. W., Loomis, B. R., Adhikari, B., & Marshall, L. (2008). A review of economic evaluations of tobacco control programs. International Journal of Environmental Research and Public Health, 6(1), 51-68.

8US Department of Health and Human Services. (2012). Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 3.

9US Department of Health and Human Services. (2014). The health consequences of smoking—50 years of progress: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 17.