To determine best practices for enforcing public health laws prohibiting the sale of tobacco to minors.
The author compared annual merchant compliance surveys to identify the 10 highest and the 10 lowest performing states. State and federal documents describing state efforts to improve compliance with their laws from 1995 to 2004 were systematically reviewed for evidence concerning the effectiveness of 26 enforcement strategies. These were rated as essential, recommended as a best practice, not recommended, or unable to rate.
The following strategies appear essential to high performance: a law enforcement strategy with a state agency coordinating enforcement, state funding of test purchases for enforcement, prosecution of offenders with penalties for violating the law, and effective merchant education. The following features are not recommended: warnings in lieu of penalties for offenders, reliance upon nonfunded local enforcement, and limitations placed on enforcement authority or the conduct of test purchases.
Some states have achieved high compliance with the law by pursuing a variety of strategies employing common elements. Others have hampered their efforts by pursuing counterproductive strategies.
This article identifies best practices for enforcing public health laws prohibiting the sale of tobacco to minors. The 10 highest and the 10 lowest performing states were identified and the strategies used by them were rated as essential, recommended as a best practice, not recommended, or unable to rate.
Joseph R. DiFranza, MD, is Professor, Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester. His research has focused on youth and tobacco for over 20 years.
Corresponding author: Joseph R. DiFranza, MD, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Ave, Worcester, MA 01655 (e-mail: firstname.lastname@example.org).
The Robert Wood Johnson Foundation, Substance Abuse Policy Research Program, funded this project.