The relationship between tobacco access and use among adolescents: a four community study

The objective of this study was to examine the effectiveness of a longitudi nal community intervention on the reduction of tobacco sales to miners and subsequent effects on tobacco consumption by youths. The study was conducte d in Monterey County, CA. Four rural communities were randomized into treat ment and comparison arms of the study and middle and high school students i n each of these communities completed surveys assessing knowledge, attitude , and behavior. The main outcome measures were retail tobacco sales to mine rs as measured through store visits (tobacco purchase surveys) and self-rep orted consumption of tobacco. Over a three-year period, a diverse array of community interventions were implemented in the intervention communities. T hese included community education, merchant education, and voluntary policy change. In the treatment communities, the proportion of stores selling tob acco to miners dropped from 75% at baseline to 0% at the final post-test. I n the comparison communities, the proportions were 64% and 39%, respectivel y. Although the availability of tobacco through commercial outlets was redu ced substantially in intervention communities, youths reported still being able to obtain tobacco from other sources. Predicted treatment effects on r eported use of tobacco among youths were observed cross-sectionally and lon gitudinally for younger students (7th graders). The intervention did not im pact tobacco use among older students (9th and 11th graders) although the t rends were in the predicted direction for 9th graders. A significant interv ention effect was found for sex - females in the intervention communities w ere less likely to use tobacco post-intervention than females in the compar ison communities. Tobacco sales to miners can be reduced through a broad-ba sed intervention. To prevent or reduce tobacco use by youths, however, mult iple supply- and demand-focused strategies are needed. (C) 1999 Elsevier Sc ience Ltd. All rights reserved.