Does tobacco youth access policy lead to fewer youth smokers?

BACKGROUND: Policies that attempt to stem the supply of cigarettes available to adolescents have been a key focus in tobacco prevention initiatives. OBJECTIVES: The objectives of this study are to assess associations of local youth access ordinance strength; use of business penalties; and use of possession, use, and purchase (PUP) enforcement penalties with youth smoking progression. METHODS: Youth from 105 Minnesota cities were surveyed 6 times over 3 years about smoking attitudes, behaviors, and perceptions in the Minnesota Adolescent Community Cohort (MACC) study. Additionally, city-level information on ordinances, enforcement practices, demographics, and allocation of grant money for tobacco prevention was collected over the same time period. We used a partial random coefficients technique to calculate longitudinal associations of policy and enforcement predictors on youth smoking outcomes. RESULTS: Over time, use of business penalties and compliance checking was associated with a relative decrease in reported past month smoking (business penalties p < 0.001, compliance checking p = 0.006) and weekly smoking (business penalties p = 0.038). PUP penalties were significantly associated with a relatively greater increase in past week smoking (p = 0.036). However the latter association was reversed and became non-significant after adjusting for business penalty use over time. Ordinance strength was not associated with any longitudinal trend in smoking behavior. CONCLUSIONS: Business penalties and use of compliance checking may curtail youth smoking even in the modern environment of strengthened youth access restrictions. Use of PUP penalties should not distract cities from strictly enforcing youth access laws on tobacco retailers.