Impacts of Store and Community Cultural Competence on Youth Access to Tobacco

Introduction: Controlling access is one of the established strategies for reducing consumption of substances harmful to health. It is, however, not known how efficacious these access management strategies are. The literature shows a complex interaction of cultural variables and tobacco-sales-to-minors even in the light of laws that prevent youth access to tobacco. This study examines how market and store factors influence tobacco sales -to-minors in the context of the Assurances of Voluntary Compliance signed by Attorney Generals in 43 States.

Methods: Cross-sectional/longitudinal designs with multiple data sources: 1) sales associate and manager surveys, 2) census data and 3) quarterly mystery shopper inspections. The sample comprises 302 stores. The dependent variable is long-term longitudinal compliance defined as pooled 5-quarter compliance. 7) Independent variables are: 1) Sales Associate-market area racial concordance; 2) culturally sensitive-tailoring of store products; 3) Non-English signage store display and 4) culturally competent supervision style. Covariates are perceived procedural changes by CORS' Sales Associates and Managers; 2) respondents demographic variables including age, race/ethnicity and gender, smoking status, attitudinal variables.

Findings: Long-term consistent compliance is impacted by both market-area socio-economic characteristics and store-level characteristics. Non-English signage display and the number of inspections are the strongest predictors of long-term consistent compliance, independent of market type. Perceived peer compliance and minority area market are the second strongest predictors of long-term consistent compliance. Baseline compliance is not associated with long-term compliance.

Conclusion: Long-term sustainability of 100% consistent compliance will require managing of community factors and perhaps tailoring of training to the market area.