If young people are unable to purchase cigarettes it may reduce the number who start to smoke. Various interventions including warnings and fines for retailers who illegally make sales to underage youth have been shown to reduce the proportion of retailers who are willing to sell tobacco during compliance checks. However it has been difficult to demonstrate a clear effect on young smokers' perceptions of how easily they can buy cigarettes, or on their smoking behaviour.
Interventions with retailers can lead to large decreases in the number of outlets selling tobacco to youths. However, few of the communities studied in this review achieved sustained levels of high compliance. This may explain why there is limited evidence for an effect of intervention on youth perception of ease of access to tobacco, and on smoking behaviour.
Laws restricting sales of tobacco products to minors exist in many countries, but young people may still purchase cigarettes easily.
The review assesses the effects of interventions to reduce underage access to tobacco by deterring shopkeepers from making illegal sales.
We searched the Cochrane Tobacco Addiction group trials register, MEDLINE and EMBASE. Date of the most recent searches: April 2008.
We included controlled trials and uncontrolled studies with pre- and post-intervention assessment of interventions to change retailers' behaviour. The outcomes were changes in retailer compliance with legislation (assessed by test purchasing), and changes in young people's smoking behaviour and their perceived ease of access to tobacco products.
Studies were prescreened for relevance by one person and assessed for inclusion by two people independently. Data from included studies were extracted by one person and checked by a second. Study designs and types of intervention were heterogeneous so results were synthesised narratively, with greater weight given to controlled studies.
We identified 35 studies of which 14 had data from a control group for at least one outcome. Giving retailers information was less effective in reducing illegal sales than active enforcement and/or multicomponent educational strategies. No strategy achieved complete, sustained compliance. In three controlled trials, there was little effect of intervention on youth perceptions of access to tobacco products or prevalence of youth smoking.