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Perceived Accessibility of Cigarettes Among Youth

A Prospective Cohort Study
  • Chyke A. Doubeni
    Correspondence
    Address correspondence and reprint requests to: Chyke A. Doubeni, MD, MPH, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester MA 01655
    Affiliations
    Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts

    Department of Medicine, and the Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Wenjun Li
    Affiliations
    Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Hassan Fouayzi
    Affiliations
    Department of Medicine, and the Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
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  • Joseph R. DiFranza
    Affiliations
    Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Massachusetts

    Department of Medicine, and the Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
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Published:January 22, 2009DOI:https://doi.org/10.1016/j.amepre.2008.11.006

      Background

      The accessibility of tobacco for youth is difficult to measure, partly because of the varied sources of cigarettes. Perceptions about the accessibility of cigarettes assesses availability from all potential sources and has been found to predict future smoking. This study examines the determinants of perceived accessibility from the perspective of a longitudinal study.

      Methods

      Data were derived from the second Development and Assessment of Nicotine Dependence in Youth study, a 4-year longitudinal study of 1246 sixth-grade students who underwent up to 11 in-person interviews from 2002 to 2006. Perceived accessibility was assessed prospectively by asking students whether they agreed or disagreed with the statement It would be easy for me to get a cigarette.

      Results

      At baseline, the average age was 12 years; 85% had never before smoked; more than 21% perceived that cigarettes were easy to obtain. Perceived accessibility increased over the 4 years among the cohort. Youth with friends who smoked or whose parents allowed the watching of R-rated movies were more likely to perceive easy accessibility of cigarettes. Among nonsmokers, there was a dose–response relationship between perceived accessibility and exposure to smoking in the family environment. Nonsmokers who knew commercial sources of cigarettes also had higher perceived accessibility.

      Conclusions

      Several potentially preventable exposures to tobacco in the family and social environment contribute to confidence among some youth that cigarettes are easy to obtain. Further studies are needed to determine if modifying these factors (e.g., through programs to reduce the exposure of youth to tobacco products in the home) might reduce perceived accessibility.
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      References

        • Stead L.T.
        • Lancaster T.
        Interventions for preventing tobacco sales to minors.
        Cochrane Database Syst Rev. 2005; 1 (CD001497)
        • Cummings K.M.
        • Sciandra E.
        • Pechacek T.F.
        • Orlandi M.
        • Lynn W.R.
        Where teenagers get their cigarettes: a survey of the purchasing habits of 13–16 year olds in 12 U.S. communities.
        Tob Control. 1992; 1: 264-267
        • DiFranza J.R.
        • Coleman M.
        Sources of tobacco for youths in communities with strong enforcement of youth access laws.
        Tob Control. 2001; 10: 323-328
        • Forster J.L.
        • Klepp K.
        • Jeffery R.W.
        Sources of cigarettes for tenth graders in two Minnesota cities.
        Health Educ Res. 1989; 4: 45-50
        • Marshall L.
        • Schooley M.
        • Ryan H.
        • et al.
        Youth tobacco surveillance—U. S., 2001–2002.
        Morb Mortal Wkly Rep 19. 2006; 55: 1-56
        • Johnston L.D.
        • O'Malley P.M.
        • Terry-McElrath Y.M.
        Methods, locations, and ease of cigarette access for American youth, 1997–2002.
        Am J Prev Med. 2004; 27: 267-276
        • Forster J.
        • Chen V.
        • Blaine T.
        • Perry C.
        • Toomey T.
        Social exchange of cigarettes by youth.
        Tob Control. 2003; 12: 148-154
        • Unger J.B.
        • Rohrbach L.A.
        • Ribisl K.M.
        Are adolescents attempting to buy cigarettes on the Internet?.
        Tob Control. 2001; 10: 360-363
        • Forster J.L.
        • Wolfson M.
        Youth access to tobacco: policies and politics.
        Annu Rev Public Health. 1998; 19: 203-235
        • Forster J.L.
        • Wolfson M.
        • Murray D.M.
        • Wagenaar A.C.
        • Claxton A.J.
        Perceived and measured availability of tobacco to youths in 14 Minnesota communities: the TPOP Study.
        Am J Prev Med. 1997; 13: 167-174
        • Ma G.X.
        • Shive S.
        • Legos P.
        • Tan Y.
        Ethnic differences in adolescent smoking behaviors, sources of tobacco, knowledge and attitudes toward restriction policies.
        Addict Behav. 2003; 28: 249-268
        • Bagott M.
        • Jordan C.
        • Wright C.
        • Jarvis S.
        How easy is it for young people to obtain cigarettes, and do test sales by trading standards have any effect?.
        Child Care Health Dev. 1998; 24: 207-216
        • Turner K.M.
        • Gordon J.
        • Young R.
        Cigarette access and pupil smoking rates: a circular relationship?.
        Health Promot Int. 2004; 19: 428-436
        • Doubeni C.A.
        • Li W.
        • Fouayzi H.
        • DiFranza J.R.
        Perceived accessibility as a predictor of youth smoking.
        Ann Fam Med. 2008; 6: 323-330
        • Speizer I.S.
        • Bean M.K.
        • Obando C.P.
        • Fries E.
        Middle school students' perceived access to cigarettes in Virginia.
        Am J Health Behav. 2008; 32: 399-410
        • DiFranza J.R.
        • Savageau J.A.
        • Fletcher K.
        • et al.
        Symptoms of tobacco dependence after brief intermittent use: the Development and Assessment of Nicotine Dependence in Youth-2 study.
        Arch Pediatr Adolesc Med. 2007; 161: 704-710
        • Hussong A.M.
        The settings of adolescent alcohol and drug use.
        J Youth Adolesc. 2000; 29: 107-119
        • Lipsitz S.R.
        • Kim K.
        • Zhao L.
        Analysis of repeated categorical data using generalized estimating equations.
        Stat Med. 1994; 13: 1149-1163
        • Ambler G.
        • Omar R.Z.
        • Royston P.
        A comparison of imputation techniques for handling missing predictor values in a risk model with a binary outcome.
        Stat Methods Med Res. 2007; 16: 277-298
        • Sargent J.D.
        • Beach M.L.
        • Dalton M.A.
        • et al.
        Effect of parental R-rated movie restriction on adolescent smoking initiation: a prospective study.
        Pediatrics. 2004; 114: 149-156
        • Sargent J.D.
        • Dalton M.A.
        • Beach M.L.
        • et al.
        Viewing tobacco use in movies: does it shape attitudes that mediate adolescent smoking?.
        Am J Prev Med. 2002; 22: 137-145
        • Sargent J.D.
        • Tanski S.E.
        • Gibson J.
        Exposure to movie smoking among U.S. adolescents aged 10 to 14 years: a population estimate.
        Pediatrics. 2007; 119: e1167-e1176
        • DiFranza J.R.
        • Wellman R.J.
        • Sargent J.D.
        • Weitzman M.
        • Hipple B.J.
        • Winickoff J.P.
        Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality.
        Pediatrics. 2006; 117: e1237-e1248
        • Wellman R.J.
        • Sugarman D.B.
        • DiFranza J.R.
        • Winickoff J.P.
        The extent to which tobacco marketing and tobacco use in films contribute to children's use of tobacco: a meta-analysis.
        Arch Pediatr Adolesc Med. 2006; 160: 1285-1296
        • While D.
        • Kelly S.
        • Huang W.
        • Charlton A.
        Cigarette advertising and onset of smoking in children: questionnaire survey.
        BMJ. 1996; 313: 398-399
        • Pokorny S.B.
        • Jason L.A.
        • Schoeny M.E.
        The relation of retail tobacco availability to initiation and continued smoking.
        J Clin Child Adolesc Psychol. 2003; 32: 193-204
        • Gilpin E.A.
        • Lee L.
        • Pierce J.P.
        Does adolescent perception of difficulty in getting cigarettes deter experimentation?.
        Prev Med. 2004; 38: 485-491
        • Siegel J.T.
        • Alvaro E.M.
        An evaluation of Arizona's youth tobacco access prevention media campaign.
        Am J Prev Med. 2006; 30: 284-291