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Importance: 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., Objectives: 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., Main Outcomes and Measures: 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., Results: 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., Conclusions and Relevance: 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.

The authors examined the role of youth ethnicity in youth access to tobacco with large, random samples of stores and large samples of ethnically diverse youths for the first time. From 1999 through 2003, White, Black, Latino, and Asian youths made 3,361 cigarette purchase attempts (approximately 700 per year) statewide. Analyses revealed that Black youths had significantly higher access than other youths and that access rates for Black and Asian (but not Latino or White) youths exceeded the Synar-mandated < or = 20%. Clerks who failed to demand youth proof of age identification (ID) sold 95% of the tobacco that youths received and sold significantly more often to minorities and to girls, whereas clerks who demanded youth ID sold equally infrequently to all youths. These findings highlight significant ethnic disparities in youth access to tobacco and imply that those might be eliminated by policies and interventions that increase clerk demands for youth ID.

Objective: To examine the number, type (menthol vs non-menthol), brand (Black, White, Women's, Other), and size of cigarette ads in Black, Latino, and White magazines., Method: Analysis of digital photographs of 274 cigarette ads appearing in Ebony (Black), People (White), and People in Spanish (Latino) for the 4.5-year period of January 1998 to August 2002., Results: Black magazines were 9.8 times and Latino magazines 2.6 times more likely than White magazines to contain ads for menthol cigarettes. Black and Latino magazines also contained significantly more ads for brands (Virginia Slims) that target women., Conclusions: The tobacco industry continues to target Blacks with menthol cigarette ads, appears now to be targeting Latinos similarly, and targets Black and Latino women with additional, tailored cigarette ads.

The tobacco industry recently introduced a new set of "safe" cigarettes and nicotine delivery devices that purportedly entail reduced tobacco-related disease risk due to their lower level of some carcinogens and toxins. Little is know about the biological impact of these potential reduced exposure products (PREPs) and nothing is known about their advertising and availability. Hence, two pilot studies were conducted to examine the latter issues for the first time. In Study 1, we examined tobacco ads in 10 popular magazines 1998--2002 and found that only 1% of ads were for PREPs. In Study 2, we attempted to purchase PREPs in a random sample of 113 small stores and found that only 4.4% sold any PREP. These preliminary findings tentatively suggest that the industry might not yet be heavily invested in products that have the potential to increase tobacco use by decreasing its perceived harm. Studies with larger samples are recommended.

Despite the potential influence of sexual abuse in childhood and adulthood on smoking among women, few studies have examined these variables. In this exploratory study, 296 women completed an anonymous survey. Results revealed that women who were sexually abused as children were 3.8 times more likely than their non-abused counterparts to be current smokers and were 2.1 times more likely to have initiated smoking before the age of 14. In all analyses, sexual abuse was a better predictor of smoking than were status variables. These preliminary findings highlight sexual abuse in childhood as a gender-specific stressor that increases girls and women's risk for smoking. Hence, sexual abuse is worthy of further investigation as well as of inclusion in new gender-tailored smoking prevention and cessation programs.

When eight black and eight white children tried to purchase cigarettes in California, where purchase by minors is illegal, black children were sold cigarettes significantly more often, especially in black neighborhoods and by nonblack clerks, and adult customers made no effort to stop them. Implications for smoking prevention are discussed. (SLD)

Low socioeconomic status, racial discrimination, and low acculturation are the major sociocultural correlates of smoking among African-American adults. This study is the first to examine all three variables simultaneously and to analyze gender differences in their association with smoking. Results for the sample revealed that low education and low acculturation predicted smoking but racial discrimination did not. For women, low acculturation was the sole predictor of smoking, whereas for men, socioeconomic status variables were the sole predictors. This suggests that low acculturation may be associated with smoking among African-American women only. Hence, culturally specific smoking cessation programs designed for low-acculturated African-Americans might be effective for African-American women alone. [ABSTRACT FROM AUTHOR]

Objective: The Operant Model of Acculturation predicts that health behaviors that have a low prevalence (< 20%) among Traditional (low-acculturated) minorities increase in prevalence with acculturation and hence have a higher prevalence among their Acculturated counterparts. Alternatively, health behaviors that have a high prevalence (> 45%) among Traditional minorities decrease with acculturation and thereby have a lower prevalence among their acculturated cohorts. The purpose of this study was to test this model for the first time. Design: Data on the 7,249 Mexican American adults in the 2001 California Health Interview Survey (CHIS), a statewide, random-digit-dial telephone survey, were used. Main Outcome Measures: Two proxies for acculturation (nativity, language spoken at home) were predictors in analyses of cigarette smoking, exercise, and 5 + daily fruit/vegetable consumption. Results: For all three health behaviors, results were fully supportive of the Operant Model irrespective of acculturation-proxy and demographic variables. Conclusion: The Operant Model may provide a coherent framework for predicting and understanding the role of acculturation in ethnic minority health behavior. Findings are discussed in terms of tailoring and targeting interventions in a manner consistent with the acculturation-related changes in health behavior that are likely to occur. [ABSTRACT FROM AUTHOR]

This paper presents the General Ethnic Discrimination Scale, an 18-item measure of perceived ethnic discrimination that can be used in health research with any ethnic group. The 1569 participants (half college students, half community adults) completed the General Ethnic Discrimination scale and measures of cigarette smoking and of psychiatric symptoms. Results revealed that the General Ethnic Discrimination subscales model the latent construct of perceived ethnic discrimination equally well for Blacks, Latinos, Asians, and Whites. Discrimination was strongly related to psychiatric symptoms and to current cigarette smoking for ethnic minorities and Whites alike, but such relationships were stronger for ethnic minorities. Minorities who experienced frequent discrimination were 2.3 times more likely than their low-discrimination counterparts to be smokers. This 5th grade reading-level scale takes 10 min to complete and has sufficient, initial psychometric integrity for use in clinical and community health studies. [ABSTRACT FROM AUTHOR]

Objectives. We examined the standard compliance protocol and its validity as a measure of youth access to tobacco. Methods. In Study 1, youth smokers reported buying cigarettes in stores where they are regular customers. In Study 2, youths attempted to purchase cigarettes by using the Standard Protocol, in which they appeared at stores once for cigarettes, and by using the Familiarity Protocol, in which they were rendered regular customers by purchasing nontobacco items 4 times and then requested cigarettes during their fifth visit. Results. Sales to youths aged 17 years in the Familiarity Protocol were significantly higher than sales to the same age group in the Standard Protocols (62.5% vs. 6%, respectively). Conclusions. The Standard Protocol does not match how youths obtain cigarettes. Access is low for stranger youths within compliance studies, but access is high for familiar youths outside of compliance studies. (Am J Public Health. 2003;93:1883-1886) [ABSTRACT FROM AUTHOR]

Depressive symptoms play a major role in cigarette smoking among US White adults, but it is not known if this holds for US Blacks. Hence, the relationship between depressive symptoms and smoking was examined among 520 US Black adults sampled from 10 randomlyselected community census tracts. Results revealed no relationship between depression and smoking, but education levels did contribute; Black high school drop-outs were four times more likely than Black college graduates to be smokers. [ABSTRACT FROM AUTHOR]

This study explored the role of racial segregation in cigarette smoking among US blacks. Five hundred and twenty black adults sampled door-to-door in 10 randomly selected, southern California census tracts completed a survey assessing their degree of racial segregation, experiences with racial discrimination, smoking, and income. Results revealed that the prevalence of smoking among highly segregated blacks (32.9 percent) was significantly higher than that of their less segregated cohorts (19.9 percent). Income, gender, and experiences with racial discrimination did not play a role in smoking but low education levels contributed. Early childhood segregation appeared to be the specific segregation variable associated with smoking among black adults. [ABSTRACT FROM AUTHOR]

Presents a research letter to the editor on how easy it is for underage youths to buy tobacco products through the Internet; Selection of teens whose job it was to get cigarettes on line without adult help; Proof that it is very simple and less expensive to buy tobacco products online.