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Journal of the New Zealand Medical Association, 15-April-2005, Vol 118 No 1213

Access to tobacco products by New Zealand youth

Helen Darling, Anthony Reeder, Rob McGee, Sheila Williams

Abstract

Aims To describe the sources of cigarettes for under-age youth who had smoked in the previous month, the frequency of their purchases and the revenue generated.

Methods A self-report questionnaire was administered to 3434 secondary school students from 82 schools, randomly selected using multi-stage cluster sampling.

Results Over one-third of the students who smoked had purchased tobacco products from commercial sources in the month before the survey; most frequently from dairies and service stations. For more than one-third of smokers (35.7%), being younger than 18 years was not a barrier to purchasing tobacco products. During 2002, the retail value of tobacco sales to those 14–16 years, alone, was estimated to be in excess of $18 million, with around $12.5 million of this going to the Government as taxes.

Conclusions Policies that restrict youth access to tobacco products can only be effective if they are rigorously enforced. Many young New Zealanders have no difficulty in purchasing tobacco products, thereby generating significant revenue. Total sales to all smokers under 18 years would be likely to exceed of $24 million, with around $17 million in taxes. Current legislation and enforcement is not a sufficient deterrent to ensure retailer compliance with age restrictions. It would be appropriate to use at least some of the revenue from under-age sales to fund health promotion programmes to reduce tobacco smoking and other health-compromising behaviours among youth. Nationally collated data on monitoring visits, prosecutions, and fines for under-age sales are currently not readily available, thereby limiting opportunities for evaluation.

In recent months, the World Health Organization has confirmed that the health burden attributable to addictive substances is greatest for tobacco.1 Dependence most often begins during adolescence,2 but the most serious consequences usually occur in later life. It is, therefore, logical to prevent dependence in the first place. Direct prevention programmes for youth have traditionally taken place in school settings, through mass media interventions, and through restricted access to tobacco products. Encouraging parents to stop smoking may (indirectly) reduce youth smoking through decreasing exposure to secondhand smoke and access to tobacco products.3

A study, based on data from the US national Youth Risk Behaviour Survey, reported that nearly one-quarter of smokers purchased tobacco products from a store, despite legislation to prevent this.4 Difficulties in achieving high levels of compliance appear common,5 and this may be due, in part, to obstacles to enforcement, such as retailer opposition, and the cost of compliance monitoring.6

In 1996, New Zealand (NZ) legislation was amended to make it illegal for persons under the age of 18 years to purchase tobacco products after July 1997 (previously the lower age limit was 16 years).7 Restricting access to tobacco products is a relatively controversial preventive measure.8,9 It has been argued that restricting the sale of tobacco to those under 18 years of age reinforces the perception of smoking as an ‘adult’ behaviour, thereby making it more desirable among youth who aspire to adult status.10 Similarly, in the absence of commercial sources of tobacco, young people may seek and develop other sources, thereby negating access restrictions as an intervention.11,12

In NZ, Laugesen and Scragg (1999) reported changes in youth purchasing behaviour between 1992 and 1997.13 There was a substantial decrease in the proportion of under-age youth purchasing cigarettes from commercial outlets. In spite of the decrease, it was estimated that the retail value for these cigarette purchases was $8.7 million per year, and the risk of retailer prosecution was considered minimal at that time. Purchasing from retail outlets continued to be the main source of cigarettes for NZ youth. A recent study of purchasing behaviour found that commercial outlets were the usual source of cigarettes for 61.8% of those reporting recent smoking.14 The estimated retail value, including taxes, of cigarette purchases by underage youth in 2000 was in excess of $25.8 million.15

The aims of this present study are to address the following questions:

What are the primary sources of tobacco products for under-age youth in NZ?
Are under-age youth asked for identification to prove their age, and, are they refused sales?
What revenue was generated from under-age sales of tobacco in NZ during 2002?

Methods

Sample—Data for this study came from the Health Sponsorship Council’s 2002 Youth Lifestyle Study (YLS), a biennial survey of tobacco-related attitudes and behaviours. The procedures for this study have been described in detail elsewhere.16 In summary, using a multi-stage cluster sampling approach, secondary schools and school classes were randomly selected from within six geographical regions. Probability weights were assigned at the individual student level.

Procedures—The YLS was piloted by HD and the study proper conducted in two waves during May and November 2002. As a consequence of high student absence rates in some schools in May (due, in part, to industrial action by students and teachers, snow, and flooding), the survey was completed in November using the same sampling method.

The survey was administered by trained interviewers. Participants were advised that their answers were confidential and anonymous, but that their survey form would be checked for completeness by the interviewer. On average, the questionnaire took 40 minutes to complete.

Measures—The YLS questionnaire contained six sections: demographic data; interests; use of the media; tobacco smoking beliefs, attitudes, and behaviours; exposure to health promotion messages; and, a measure of self-concept.

Smoking status was determined by response to the question—How often do you smoke now? Participants who reported smoking at least once a day... week...or month were categorised as current smokers for the purpose of these analyses. Data were collected on purchasing tobacco products. Participants were asked—In the last 30 days (1 month) how did you usually get your own cigarettes?

The response categories provided are presented in Table 1. To identify specific commercial sources of cigarettes, participants were asked—which places did you buy cigarettes from in the last 30 days (one month)? The response categories (never, once, 2-3 times, 4 times or more) were provided for each of the places listed in Table 2. Participants were also asked—When you bought, or tried to buy cigarettes, in a store during the last 30 days (one month), were you ever asked to show proof of age? Response categories provided were: I did not try to buy cigarettes in a store during the last 30 day; Yes, I was asked to show proof of age (ID); No, I was not asked to show proof of age (ID).

Responses to the question - During the past 30 days (1 month) what brand of cigarettes did you usually smoke? - were used to identify the most popular brand of cigarette. Prices for all brands included in the responses to this question were obtained from a selection of Dunedin retail outlets during May 2002.

Table 1. Usual sources of cigarettes for all smokers and daily smokers

Source

All smokers
2000 YLS 14
%

All smokers
2002 YLS
% (95% CI)

Daily smokers
2002 YLS
% (95% CI)

I bought them from a shop
I got them from friends
Someone else bought them for me
I got them from my parents
I stole them
I bought them from another student
I got them from my brother / sister
Other

44.3
29.2
10.4
3.2
3.3
7.1
2.4
–

35.3 (30.7–40.3)
24.7 (21.3–28.4)
12.1 (10.0–14.6)
6.7 (4.9–9.0)
5.7 (3.8–8.5)
4.2 (2.2–7.8)
2.4 (1.5–3.8)
9.0 (7.0–11.5)

47.5 (41.3–53.9)
13.1 (9.5–17.8)
14.3 (11.2–18.1)
10.0 (7.4–13.4)
3.4 (2.0–5.9)
3.6 (1.6–8.1)
2.8 (1.4–5.3)
5.2 (3.1–8.6)

YLS= Youth Lifestyle Study; CI=confidence interval.

Table 2. YLS 2002 proportions (95% CI) purchasing from selected outlets, all smokers, 14–16 years

Retail outlet	Never	Once	2–3 times	4 or more times
Dairy Liquor store / hotel Service station Supermarket Takeaway shop Vending machine Other shop	37.3 (32.2–42.6) 80.5 (75.9–84.5) 58.1 (52.8–63.2) 77.3 (72.4–81.5) 85.1 (80.9–88.4) 82.4 (79.4–85.0) 87.8 (84.4–90.5)	21.8 (18.5–25.5) 9.0 (6.9–11.7) 15.4 (12.5–18.8) 8.8 (6.2–12.4) 6.3 (4.6–8.6) 7.8 (5.9–10.2) 4.1 (2.4–7.1)	17.3 (14.3–20.8) 5.8 (4.1–8.2) 14.7 (11.9–18.0) 6.5 (4.8–8.8) 3.0 (2.0–4.5) 3.6 (2.3–5.6) 2.8 (1.8–4.4)	23.6 (18.9–29.1) 4.7 (2.6–8.1) 11.8 (8.5–16.1) 7.4 (5.0–10.8) 5.6 (3.7–8.2) 6.3 (4.5–8.8) 5.3 (3.3–8.4)

Results

Eligible schools (n=141) were invited to participate in the 2002 YLS; 82 schools agreed to participate (response rate 58.2%). Higher socioeconomic decile schools were slightly over-represented: 43.1% of participants attended schools of decile 7 or higher. The remainder of participants attended decile 1–3 (24.3%) or decile 4–6 (32.5%) schools. The absentee rate in participating school classes was relatively low (median 13.3% absent). Overall, 3434 young people completed the YLS; 51.7% were boys, 59.6% were from Year 10, and the mean age was 15.0 years. Maori students were under-represented in the sample: 15.4% self-identified as NZ Maori compared with 20% in the general population of equivalent age.17

Nearly one-quarter of participants smoked at least monthly (22.7%). Smoking increased incrementally with increasing age from 21.1% that smoked at least monthly at 14 years to 22.4% (15 year olds); and, 24.9% (16 years). Commercial outlets were the most common sources of cigarettes for all smokers (35.3%), and more so for daily smokers (47.5%). Sources of cigarettes for all smokers and daily smokers are presented in Table 1 along with the sources of cigarettes reported for all smokers in the 2000 YLS. The 2000 YLS used comparable measures to the 2002 YLS and was administered in 53 NZ secondary schools.14

More than one-third of the smokers (38.0%) had not been asked to show proof of age when purchasing cigarettes in the month preceding the survey. Similarly, more than one-third of participants had not been refused cigarette purchases on the basis of their age (35.7%). Logistic regression was used to investigate the association between smokers who were refused cigarettes (binary variable) and age. There was a significant positive association between increasing age and not being refused sales of tobacco products (OR 1.33; 95% CI 1.17–1.52); that is, older students were more likely to be able to buy cigarettes.

The total number of packs of cigarettes purchased by NZ youth in a 12-month period was estimated using data about purchasing from selected outlets (see Table 2). Participants’ responses were totalled conservatively, so that for the response category 2-3 times the mid-point was used; and for 4 times or more, 4 times was assumed. It was assumed that a single pack was purchased on each occasion: the total number of occasions was divided by 751 (the number of students 14–16 years who had smoked in the previous month), and then multiplied by 12 (months).

Based on this calculation, student smokers smoked approximately 54.7 packets per year, or 1.05 packets per week. Data were obtained from Statistics New Zealand for the 2001 Census usual resident population, 14–16 years.18 Extrapolating from the YLS monthly smoking prevalence rates for 14, 15, and 16-year-olds to the usual resident population of the same age, 37,067 young people 14–16 years were likely to be monthly smokers, at least.

Based upon this calculation, it was estimated that approximately 2,029,048 packets of cigarettes were consumed by those less than 18 years of age.

This estimate is based on three assumptions:

The mid-point of categories for purchasing cigarettes was used;
Only one packet of cigarettes was purchased on each occasion; and
The smoking prevalence within the population of NZ youth 14–16 years was extrapolated from sample prevalence rates for each year of age.

The average cost per pack of the brand most commonly used by youth in 2002, was $8.95. The total estimated value of purchases by youth 14–16 years, therefore, amounted to $18,159,976 of which approximately $2,272,533 was GST; $10,449,595 tobacco tax; and $5,437,848 was retained by retailers, but from which wholesale costs were deducted.19

Discussion

Data were obtained from a school-based cross-sectional survey; lower-decile schools and young people who self-identified as NZ Maori were under-represented in the sample.

Low socioeconomic status has been widely identified as a risk factor for cigarette smoking;20 for this reason, it is likely that this study presents a conservative estimate of the purchasing of tobacco products by under-age youth (14–16 years) in NZ. Furthermore, the assumption (that underpinned the estimation of cigarette packages purchased) errs on the side of caution, as it is possible that more than one pack of cigarettes was purchased on each occasion.

Among the students surveyed, more than two-thirds of all smokers and nearly one-half of the daily smokers usually purchased their cigarettes from commercial sources. This finding is consistent with the model proposed by DiFranza (2001)21 that daily smokers require regular, reliable sources of cigarettes. Further investigation, using longitudinal data, might usefully examine the relations between smoking stages and sources of cigarettes.

When compared to the results of the 2000 YLS,14 greater proportions of young people reported getting cigarettes from parents, getting someone else to purchase cigarettes for them, and stealing cigarettes. A smaller proportion of students purchased cigarettes from commercial sources in 2002 (35.3%) compared with students purchasing in 2000 (44.3%). Although the difference between the surveys was statistically significant, this should be interpreted cautiously because the survey procedures were not identical.

Compliance with youth access laws is measured in NZ using controlled purchasing operations; however collated national information is not available to allow comparison between levels of compliance and the proportions of under-age youth purchasing cigarettes. Nevertheless, over one-third of youth who purchased cigarettes in the month prior to the study did so on at least one occasion without being asked for proof of age.

The apparent ease with which under-age youth are able to purchase tobacco products would suggest a need for a review of compliance enforcement. The review by DiFranza (2001)21 clearly identified a high level of compliance was required before youth access laws would decrease youth prevalence. It is clear that to achieve the intention of NZ legislation, greater resources are required to ensure its successful implementation. Youth access programmes, alone, are unlikely to achieve a decrease in youth smoking prevalence; however, they are critical in maintaining the consistent message that tobacco smoking is a serious health issue.

The apparent lack of consensus among tobacco control researchers on the effects of youth access restrictions should be interpreted cautiously. It is possible that poorly enforced legislation may be at least as harmful as having no legislation. Indeed, youth tobacco use is a complex problem that requires many levels of intervention, including youth access restrictions, with adequate enforcement, as part of a comprehensive prevention programme to further denormalise tobacco use.

The value of revenue generated from under-age tobacco sales was estimated by extrapolating from the smoking prevalence of students 14–16 years among a nationally representative sample of NZ adolescents, and from Census 2001 data. In the absence of data on actual retailer revenue obtained from youth, this is considered a valid measure of revenue. It is similar to the method of revenue calculation used by Laugesen and Scragg (1999),13 but differs in that we were able to estimate the number of packs of cigarettes bought per week from responses to the question—which places did you buy cigarettes from in the last 30 days?, which elicited the frequency of purchases from each category of commercial outlet.

We found that tobacco products were most often obtained from commercial sources. Extrapolation from the estimated revenue generated from under-age sales of tobacco suggests that considerable retailer and government revenue is obtained from illegal sales to youth. Furthermore, the estimate of revenue is conservative as it is based on under-age purchases by youth 14 -16 years, alone, assumes purchase of a single pack per occasion and excludes purchases made on their behalf.

The amended Smoke-free Environments Act 19907 prohibits the sale or supply of tobacco products to youth less than 18 years. It is likely that the revenue generated from under-age sales to aged 17 years and less than 14 years is also considerable. Crude extrapolation from the survey data (to obtain estimates of total sales to all those under 18 years) suggests that total sales greatly exceed the conservative level reported and would probably exceed $35 million per year, of which $24 million would be in taxes.

This raises several issues, perhaps the most serious of which concerns the ethical implications of Government and retailer revenue generated from the development of addiction during adolescence. We have estimated that the NZ Government receives over $12.5 million in taxes from youth 14–16 years and considerably more that this for all under-age smokers.

Therefore, it would be appropriate for at least some of this money to be used to support a comprehensive youth tobacco control programme that included (but was not limited to) increased resources to ensure improved retailer compliance. In addition, there is a need for regular, timely, collated national data on visits, prosecutions, and fines so that the access programme can be properly evaluated.

Author information: Helen Darling, PhD Candidate; Anthony I Reeder, Senior Research Fellow; Rob McGee, Associate Professor; Social and Behavioural Research in Cancer Group; Sheila Williams, Senior Research Fellow (Biostatistician), Department of Preventive and Social Medicine, University of Otago, Dunedin.

Acknowledgements: The Health Sponsorship Council was the primary contributor to the 2002 YLS, with additional support from the Ministry of Health, Cancer Society of New Zealand, The Quit Group, and the Social and Behavioural Research in Cancer Group at the University of Otago. Dr Reeder and the Social and Behavioural Research in Cancer Group receive support from the Cancer Society of New Zealand and the University of Otago. The research was completed while Helen Darling was the recipient of post-graduate scholarships from the Health Sponsorship Council and the University of Otago.

Correspondence: Ms Helen Darling, Social and Behavioural Research in Cancer Group, Department of Preventive and Social Medicine, University of Otago, PO Box 913, Dunedin. Fax: (03) 479 7298; helen.darling@stonebow.otago.ac.nz

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