Department of Community and Behavioral Health, Colorado School of Public Health, Aurora.
University of Colorado Cancer Center, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
JAMA Pediatr. 2018 Oct 1;172(10):966-972. doi: 10.1001/jamapediatrics.2018.2038.
Despite progress against tobacco sales to minors, retailers continue to violate state and federal laws and supply adolescent smokers with tobacco products. Government-sanctioned surveys underestimate the extent of the problem, and retailer associations use these data to block stricter enforcement policies.
To assess the validity of the US federal retailer violation rate (RVR) as an estimate of the proportion of retailers that sell tobacco to minors and to investigate what proportion always or almost always sells vs refuses to sell cigarettes to minors.
DESIGN, SETTING, AND PARTICIPANTS: This survey study was conducted October 6, 2012, to September 8, 2013; data were analyzed between September 28, 2017, and March 21, 2018. The setting was a suburban county adjacent to Denver, Colorado. Participants were a systematically selected, population-based cluster sample of retailers that stock cigarettes for sale. Retailers were masked to the survey.
Each retailer was visited 6 times by supervised minors who attempted to purchase cigarettes at each visit. The main outcome was whether cigarettes were sold. Other measures included whether government-issued photo identification (ID) was requested as required by law, how ID was examined, and what the demographic characteristics of study minors and clerks were.
The sample of 201 retailers (44.8% of the 449 listed population) included convenience stores (n = 77), liquor stores (n = 63), grocery stores/supermarkets (n = 33), pharmacies (n = 17), tobacco stores (n = 7), and stand-alone gas stations (n = 4). Bars, clubs, and adult establishments were excluded. A total of 1181 purchase attempts were analyzed; 25 (2.1%) were excluded for missing data. The mean RVR across 6 rounds of checks was 18.0% (95% CI, 14.7%-21.2%) and ranged from 13.7% to 28.0% per round. Most retailers (54.7% [110 of 201]) violated at least once in 6 visits, 26.4% (53 of 201) violated at least twice, and 11.9% (24 of 201) violated half or more times. How retailers examined proof of age largely determined whether violations occurred.
The proportion of retailers that sold cigarettes to a minor at least once in 6 attempts was 3 times higher than the mean RVR based on a single inspection per retailer. Larger replication studies are needed. Enforcement protocols should reflect the fact that each retailer does not respond consistently when adolescents try to buy tobacco products, and many retailers are not properly validating ID that shows proof of age.
尽管在禁止向未成年人销售烟草方面取得了进展，但零售商仍继续违反州和联邦法律，向青少年吸烟者供应烟草产品。政府批准的调查低估了问题的严重程度，而零售商协会则利用这些数据来阻止更严格的执法政策。
评估美国联邦零售商违规率（RVR）作为估计向未成年人销售烟草的零售商比例的有效性，并调查始终或几乎总是销售与拒绝向未成年人销售香烟的比例。
设计、地点和参与者：这项调查研究于 2012 年 10 月 6 日至 2013 年 9 月 8 日进行；数据分析于 2017 年 9 月 28 日至 2018 年 3 月 21 日进行。研究地点是科罗拉多州丹佛市附近的一个郊区县。参与者是一个系统选择的、基于人群的零售商集群样本，这些零售商储备香烟出售。零售商对调查不知情。
每个零售商在 6 次访问中都由经过监督的未成年人访问，这些未成年人每次访问都试图购买香烟。主要结果是是否出售香烟。其他措施包括是否按照法律要求要求出示政府签发的照片身份证（ID），如何检查 ID，以及研究未成年人和店员的人口统计学特征。
201 家零售商的样本（449 家上市零售商的 44.8%）包括便利店（n=77）、酒类商店（n=63）、杂货店/超市（n=33）、药店（n=17）、烟草店（n=7）和独立加油站（n=4）。酒吧、俱乐部和成人场所被排除在外。共分析了 1181 次购买尝试；25 次（2.1%）因数据缺失而被排除在外。6 轮检查的平均 RVR 为 18.0%（95%CI，14.7%-21.2%），每轮范围为 13.7%-28.0%。大多数零售商（54.7%[201 家中有 110 家]）在 6 次访问中至少违规一次，26.4%（201 家中有 53 家）至少违规两次，11.9%（201 家中有 24 家）违规一半或更多次。零售商检查年龄证明的方式在很大程度上决定了违规行为是否发生。
在 6 次尝试中至少有一次向未成年人出售香烟的零售商比例是基于对每个零售商进行一次检查的平均 RVR 的 3 倍。需要更大规模的复制研究。执法协议应反映出这样一个事实，即当青少年试图购买烟草产品时，每个零售商的反应并不一致，许多零售商没有正确验证显示年龄证明的身份证。
