Is the standard compliance check protocol a valid measure of the accessibility of tobacco to underage smokers?

Objective-To determine if the standard compliance check protocol is a valid measure of the experience of underage smokers when purchasing tobacco in u nfamiliar communities. Setting-160 tobacco outlets in eight Massachusetts communities where undera ge tobacco sales laws are vigorously enforced. Procedure-Completed purchase rates were compared between underage smokers w ho behaved normally and inexperienced non-smoking youths who were not allow ed to fie or present proof of age (ID). Results-The "smoker protocol" increased the likelihood of a sale nearly six fold over that for the non-smokers (odds ratio (OR) 5.7, 95% confidence int erval (Cl) 1.5 to 22). When the youths presented an ID with an underage bir th date, the odds of a completed sale increased dramatically (OR 27, 95% CI 3.4 to 212). Clerks judged to be under 21 years of age were seven times mo re likely to make an illegal sale (OR 7.6, 95% Cl 2.4 to 24.0). Conclusions-Commonly used compliance check protocols are too artificial to reflect accurately the experience of underage smokers. The validity of comp liance checks might be improved by having youths present ID, and by employi ng either tobacco users, or non-tobacco users who are sufficiently experien ced to mimic the self confidence exhibited by tobacco users in this situati on. Consideration should be given to prohibiting the sale of tobacco by ind ividuals under 21 years of age.