Tobacco outlet density, retailer cigarette sales without ID checks, and enforcement of underage tobacco laws: associations with Youths' cigarette smoking and beliefs

AimsTo estimate the relationships of tobacco outlet density, cigarette sales without ID checks and local enforcement of underage tobacco laws with youth's life-time cigarette smoking, perceived availability of tobacco and perceived enforcement of underage tobacco laws and changes over time. DesignThe study involved: (a) three annual telephone surveys, (b) two annual purchase surveys in 2000 tobacco outlets and (c) interviews with key informants from local law enforcement agencies. Analyses were multi-level models (city, individual, time). SettingA sample of 50 mid-sized non-contiguous cities in California, USA. ParticipantsA total of 1478 youths (aged 13-16 at wave 1, 52.2% male); 1061 participated in all waves. MeasurementsMeasures at the individual level included life-time cigarette smoking, perceived availability and perceived enforcement. City-level measures included tobacco outlet density, cigarette sales without ID checks and compliance checks. FindingsOutlet density was associated positively with life-time smoking [OR=1.12, P<0.01]. An interaction between outlet density and wave (OR=0.96, P<0.05) suggested that higher density was associated more closely with life-time smoking at the earlier waves when respondents were younger. Greater density was associated positively with perceived availability (=0.02, P<0.05) and negatively with perceived enforcement (=-0.02, P<0.01). Sales rate without checking IDs was related to greater perceived availability (=0.01, P<0.01) and less perceived enforcement (=-0.01, P<0.01). Enforcement of underage tobacco laws was related positively to perceived enforcement (=0.06, P<0.05). ConclusionsHigher tobacco outlet density may contribute to life-time smoking among youths. Density, sales without ID checks and enforcement levels may influence beliefs about access to cigarettes and enforcement of underage tobacco sales laws.