The Alliance of Boulder County
on Tobacco and Health

State Laws Do Little to Curb Teen Cigarette Use

Date: May 15, 2001

NEW YORK (Reuters Health) - Despite a nearly decade-old law encouraging states to prohibit the sale of cigarettes to minors, many teens have easy access to tobacco, a new study concludes.

According to Dr. Joseph R. DiFranza of the University of Massachusetts Medical School in Worcester, the federal government has failed to enforce the Synar Amendment enacted in 1992. The amendment requires that states receiving Department of Health and Human Services (DHHS) grants enact and enforce a law that prohibits the sale of tobacco to minors. The federal government can withhold money to states that do not enforce these laws.

But in 1998, 30 states reported no progress in reducing the number of merchants who continue to sell cigarettes to minors, while 16 states reported an increase in violations over the previous year.

"As a whole, there was no significant national progress toward reducing the availability of tobacco to youths," DiFranza writes in the May issue of the Archives of Pediatric and Adolescent Medicine.

The study also found that while all states had laws prohibiting the sale of tobacco to minors, many states do not enforce these laws. Montana store-owners cannot be penalized until their fifth violation within 3 years, for instance, and three states have laws that do not include penalties for violators, according to the report.

DiFranza blames the lack of progress in curbing teen smoking on the federal government, which does not enforce state laws.

"Like school systems that graduate students who cannot read, DHHS continues to allow many states to get by, year after year, without taking the measures that are necessary to implement effective enforcement of their laws," he concludes.

States reporting an increase in illegal cigarette sales to minors over the previous year included Arizona, Michigan, Mississippi, New Jersey, South Dakota, Tennessee and Wyoming, among others.

However, other states, including Florida, Maine, Vermont and Texas, reported violation rates of less than 10%.

From the Archives of Pediatric and Adolescent Medicine 2001;155:572-578 - - - -

Curtailing Youth Smoking
Vol. 155 No. 5, May 2001
by Abraham B. Bergman, MD
Archives of Pediatrics and Adolescent Medicine, 5/15/01

Most people agree that tobacco products should not be available to youths younger than 18 years of age. There is considerable disagreement, however, on how this objective should be achieved. In 1992, Congress passed an amendment named after the late Mike Synar, a Democratic representative from Oklahoma, requiring states to adopt and enforce laws establishing a minimum age limit for buyers of tobacco products and to show progressive reductions in the availability of tobacco products to minors. Failure to meet these requirements would result in forfeiture of federal block grant funds for substance abuse prevention and treatment. Funds were not provided to the states, however, to assist in tobacco law enforcement activities. Evaluation of the effects of the legislation were to be provided in the usual government fashion: yearly progress reports to the federal Department of Health and Human Services (DHHS).

Joseph DiFranza, a professor of family and community medicine at the University of Massachusetts (Worcester) has chosen to take on the task of monitoring the workings of the Synar Amendment in the 59 states and territories of the United States. He has written yearly report cards for the ARCHIVES1-3 and the grades are not good. Although several states made conscientious efforts to enforce tobacco sales laws, he says, "overall there was no national progress toward reducing the availability of tobacco to youth."1 DiFranza's report illustrates several influential points.


To gain information about the functioning of the Synar program, DiFranza had to prepare his own classification system and file a Freedom of Information request for the compliance report of each state. For the current article alone, that involved reviewing 4600 pages of bureaucratic prose.


It is rare for government agencies to issue reports that understate their progress, especially when those reports determine whether or not the federal fund spigot remains open. If the states themselves admit to failing in compliance efforts on youth tobacco sales, the actual status must be a lot worse.


In citing the success of 5 states that achieved violation rates of less than 10% for youths aged 16 to 17 years, DiFranza says "there is no acceptable excuse for why all states and territories have not implemented these enforcement programs that have proven so successful."1 He blames the DHHS and its previous secretary, Donna Shalala, for lack of toughness in invoking the sanctions. This view overestimates the power of a cabinet officer at a time when not only were the House and Senate controlled by another political party, but there was little support from the White House.


Getting laws passed is easy compared with seeing that they are properly implemented. A favorite political ploy is to "love a proposal to death." A bill passes the legislature (To grateful constituents: "See, we got your law passed.") but owing to lack of sufficient money or enforcement power, the program withers on the vine. (To grateful political contributors: "See, we gutted the program.") In the case of the Synar Amendment, the threat of cutting off substance-abuse block grant money did not persuade local police officers who view their main job as catching criminals. Most local communities are less than enthusiastic about spending their scarce resources on enforcing tobacco sales laws.


It must be appreciated that no matter what they utter publicly, the sole objective of tobacco companies is to increase the value of their shares. That they are investing in a lethal product is of no interest to shareholders. New tactics are always being tried by the tobacco companies to enhance their public image. Their campaigns focus on the charitable philanthropic and social activism of the companies. Philip Morris, for example, supports a variety of causes, including battered women's shelters. Concurrently they will spend $100 million to advertise about their charitable contributions.4 Because of campaign contributions and the lack of public scrutiny over its activities, the tobacco industry wields more power at the state level. Thus, the Synar Amendment was "easy pickings" once it reached the states. The Surgeon General stated:

A vigorous and multidimensional campaign has been mounted by the tobacco industry and its allies to prevent or undermine effective enforcement of minors access laws, and to resist the proposal that retailers be held accountable for their stores' compliance . . . (they) have lobbied successfully for the inclusion of language such as "knowingly" or "intentionally" in the law prohibiting sale of tobacco to minors; the impact of such language may be to render the law unenforceable. Industry interests have sought to include various restriction on how, how often, and by whom enforcement or compliance testing can be conducted.5

Where should future efforts at youth smoking prevention be directed? Not with school-based smoking prevention programs. An elegant 15-year controlled trial of such programs showed no effect on smoking prevalence.6 Tobacco control strategies must be comprehensive as outlined in the report of the Surgeon General for 2000.5 The state of California pioneered such an approach in 1988 by increasing the tax on cigarettes by $0.25 per package and allocating $0.05 of the tax toward an antitobacco campaign that involved, among other measures, hard-hitting commercials. The decline in the number of cigarettes sold and the prevalence of smoking as a result of this program have already resulted in fewer deaths of heart disease.7 The battle to counter the pervasive and aggressive promotions of the tobacco industry to our youth requires infinite amounts of energy and patience. It is a battle that we cannot afford to lose.

Abraham B. Bergman, MD
Harborview Medical Center
Box 359774
325 Ninth Ave
Seattle, WA 98104


1. DiFranza JR. State and federal compliance with the Synar Amendment: federal fiscal year 1998. Arch Pediatr Adolesc Med. 2001;155:572-578.

2. DiFranza JR. Are the federal and state governments complying with the Synar Amendment? Arch Pediatr Adolesc Med. 1999; 153:1089-1097.

3. DiFranza JR. State and federal compliance with the Synar Amendment: federal fiscal year 1997. Arch Pediatr Adolesc Med. 2000;154:936-942.

4. Elliott S. Tired of being a villain, Philip Morris works on it's image. New York Times. November 11, 1999:C12.

5. Reducing tobacco use: a report of the Surgeon General for 2000. Available at: Accessed January 11, 2000.

6. Peterson AV, Kealey KA, Mann SL, Marcek PM, Sarason IG. Hutchinson Smoking Prevention Project: long-term randomized trial in school-based tobacco use prevention: results on smoking. J Natl Cancer Inst. 2000;92:1979-1991.

7. Fichtenberg MS, Glantz SA. Association of the California tobacco control program with declines in cigarette consumption and mortality from heart disease. N Engl J Med. 2000;343: 1772-1777.

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