By Linda Carroll

(Reuters Health) – More retailers may be selling cigarettes to minors than government estimates have suggested, a new study finds.

Researchers determined that more than half of retail stores may be inadvertently, and illegally, selling cigarettes to underage buyers, according to the results published in JAMA Pediatrics.

Federal estimates are based on single visits to stores, the researchers note. The new study was based on six visits per store by teens too young to purchase cigarettes. Sometimes the teenage buyers were turned away, but sometimes a clerk at a store that refused one teen would allow another to purchase cigarettes.

“Policy makers need to understand that the way they are monitoring illegal sales from retail stores is pretty seriously flawed,” said the study’s lead author, Arnold Levinson, an associate professor of community and behavioral health at the Colorado School of Public Health in Aurora.

With the government underestimating illegal sales, it’s unlikely there will be stricter enforcement, Levinson added.

For the new study, Levinson and his colleagues rounded up 17 clean-cut teens between the ages of 15 and 16. The teens were sent into 201 convenience stores, liquor stores, groceries, gas stations and other tobacco retailers in Colorado’s Jefferson County to try to purchase cigarettes. The teens were told it was up to them whether to present an ID if asked for one. Most did. But in many cases the clerks gave the ID only a cursory glance and then handed over the cigarettes.

The researchers determined that 55 percent of retailers sold cigarettes during at least one of the six visits by the underage study volunteers. And 53 out of the 201 stores, or just over 24 percent, sold to the minor volunteers at least twice, while 24 out of 201, or about 12 percent sold to the volunteers three or more times.

Levinson points out that there is a move to raise the age at which tobacco can be purchased nationwide to 21. “That would make a huge difference,” he said. “But it would require consistent firm enforcement, which brings us back to this article. Which shows we’re not doing very well. So if we increase the age we’ve got to increase the monitoring and enforcement.”

The reason for raising the age to 21 is that it would “decrease rates of smoking among teens whose developing brains are particularly susceptible to addictive substances,” said Dr. Maria Rahmandar of Northwestern University’s Feinberg School of Medicine and the Ann & Robert Lurie Children’s Hospital of Chicago. “And nicotine is a very powerful drug. Even with once a month use, teens can show signs of dependence.”

While the brain isn’t finished developing until age 25, it’s much more vulnerable to addictive substances at 16 than at 21, said Rahmandar, who was not involved in the new research. “Putting tobacco in line with alcohol laws makes sense,” she said. “Then there’s more of a chance at having healthy brain development.”

States monitor compliance with tobacco age restrictions using a system of annual, random visits to stores, Levinson’s team notes. Since 2006, the “retailer violation rate” calculated with the results of these spot checks has been steadily around 10 percent. A violation rate of 20 percent or more would jeopardize a state’s federal block grants for substance abuse, the authors note.

The new study was limited to a single Colorado county and may not represent what happens elsewhere, or with youth who are not all “tattoo free” or more racially and ethnically diverse than the participants in this case, the study team adds.

The rate at which retailers were found to be breaking the law and selling cigarettes to minors, “is concerning because the easier it is for kids to get cigarettes in the first place, the more likely they are going to smoke and become established smokers,” said Joanna Cohen, director of the Institute for Global Tobacco Control and a professor in the department of health, behavior and society at the Johns Hopkins School of Public Health in Baltimore.

“These findings indicate that more needs to be done to ensure that retailers abide by the law and not sell tobacco products to minors,” Cohen said in an email. “One challenge is that a significant proportion of retailers are not properly checking IDs for proof of age. Requiring electronic age verification may help improve compliance rates.”

SOURCE: JAMA Pediatrics, online August 20, 2018.