| Background. Most smokers begin tobacco use before the age of 18, and the younger a smoker is when he or she begins smoking, the more unlikely it is that he or she will be able to successfully quit. Minors obtain cigarettes commercially (through purchase at retail establishments) and socially (borrowing from friends, stealing, etc.). Retail-targeted enforcement of tobacco youth access laws has an effect on sales to youth, but there has been controversy about whether actively enforced laws can reduce youth smoking in an important way.; Objectives. This dissertation is composed of three manuscripts that address the following questions: (1) Are city demographic characteristics and strength of local ordinances associated with local variation in youth access enforcement? (2) Are local youth access control measures associated with social and/or commercial exchange of cigarettes? (3) Is there an association between local youth access control policy and the aggregate smoking rate of a city?; Methods. Youth from 105 Minnesota cities were surveyed by phone twice per year from October 2000--September 2003 about their smoking attitudes, behaviors, and perceptions in the Minnesota Adolescent Community Cohort (MACC) study. Additionally, city-level information on ordinances, enforcement practices, demographics, and tobacco prevention grant money allocation was collected. Both random coefficients techniques and Generalized Estimating Equations were used to calculate longitudinal and cross-sectional associations of predictors on the outcomes of interest.; Results. Self-reported commercial access of cigarettes declined over the observed years while social access increased. Adolescent smokers who use social access exclusively were significantly less likely to progress to heavy smoking than those who use commercial access. Longitudinally, use of both business targeted penalties and retail compliance checking was associated with relatively less increase in reported past month smoking. Large cities were more likely to use business penalties than smaller cities.; Conclusions. Although decreasing commercial access is accompanied by an increase in social access, this trend appears positive since those relying on social access exclusively were less likely to progress to heavier smoking. Strengthening youth access controls may reduce youth smoking when the focus of these efforts is placed on select strategies. |
