Department of Public Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
UK Centre for Tobacco and Alcohol Studies, Usher Institute for Population Health Sciences and Informatics University of Edinburgh, Edinburgh, UK.
Nicotine Tob Res. 2020 Oct 29;22(11):1989-1996. doi: 10.1093/ntr/ntz180.
Despite widespread age-of-sale restrictions on tobacco, adolescents continue to obtain cigarettes and experiment with smoking. This mixed-methods study aimed to understand how European adolescents access cigarettes and how the policy context may influence this process, using a realist evaluation approach. This is the first study to assess access to cigarettes across various European contexts.
A survey of 4104 students was combined with qualitative data from focus groups among 319 adolescents aged 14-19 across seven European countries. Data were synthesized to explore mechanisms via which young people obtain cigarettes despite age-of-sale restrictions.
While purchasing cigarettes from supermarkets was widely regarded as difficult, many participants purchased cigarettes from noncompliant retailers (often in smaller shops or cafes). Other contra-mechanisms included circumventing age checks, proxy purchases, and/or social sources. Dominant forms of access differed across the seven contexts, with direct purchases more common where perceived enforcement was low (eg, Belgium) and proxy purchases more important where perceived enforcement of age-of-sale laws was high (eg, Finland). The effectiveness of age-of-sale restrictions in reducing youth access appears to be influenced by a range of contextual factors including retailer compliance, the availability of vending machines, and the specific minimum age-of-sale.
Our findings illustrate the relevance of programme theory in understanding the contra-mechanisms that undermine the effectiveness of age-of-sale laws in discouraging youth smoking. Young people's access to cigarettes could be further limited by addressing these contra-mechanisms, including an increase in the legal sales age (particularly in Belgium), banning vending machines, and strengthening enforcement.
Despite widespread implementation of age-of-sale laws, a substantial proportion of minors continue to access cigarettes. Young people use a number of contra-mechanisms to circumvent age-of-sale restrictions. These include accessing cigarettes via social sources, proxy sales or by circumventing age checks. Our findings show that in contexts where perceived enforcement of age-of-sale restrictions is high, young people are more reliant on irregular forms of access such as proxy sales. Young people's access to cigarettes may be further reduced by policy interventions that address these contra-mechanisms-for example, banning vending machines, strengthening enforcement of age-of-sale laws, and increasing the minimum age-of-sale.
尽管烟草销售年龄限制广泛，但青少年仍继续获得香烟并尝试吸烟。本混合方法研究旨在使用现实主义评估方法了解欧洲青少年如何获得香烟，以及政策环境如何影响这一过程。这是第一项评估各种欧洲背景下香烟获取途径的研究。
对 4104 名学生进行了调查，并结合了来自 7 个欧洲国家的 319 名 14-19 岁青少年的焦点小组的定性数据。综合数据以探索尽管有销售年龄限制，但年轻人仍获得香烟的机制。
尽管从超市购买香烟被广泛认为很困难，但许多参与者还是从不合规的零售商那里购买香烟（通常是在较小的商店或咖啡馆）。其他规避机制包括绕过年龄检查、代理购买和/或社会来源。在七个国家/地区中，主要的获取途径不同，在感知执法不力的地方（例如，比利时），直接购买更为常见，而在感知执法严格的地方（例如，芬兰），代理购买更为重要。销售年龄限制在减少青少年获取方面的有效性似乎受到一系列因素的影响，包括零售商的合规性、自动售货机的可用性以及特定的最低销售年龄。
我们的研究结果表明，方案理论在理解破坏销售年龄法在劝阻青少年吸烟方面的有效性的规避机制方面具有相关性。通过解决这些规避机制，可以进一步限制年轻人获得香烟的机会，包括提高法定销售年龄（尤其是在比利时）、禁止自动售货机和加强执法力度。
尽管广泛实施了销售年龄法，但仍有相当一部分未成年人继续获得香烟。青少年使用多种规避机制来规避销售年龄限制。这些机制包括通过社交来源、代理销售或绕过年龄检查来获取香烟。我们的研究结果表明，在销售年龄限制的感知执法力度较高的情况下，年轻人更依赖于代理销售等非正规获取途径。通过解决这些规避机制的政策干预措施，可以进一步减少年轻人获得香烟的机会，例如禁止自动售货机、加强销售年龄法的执法力度以及提高最低销售年龄。
