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Most US states have had laws to using these products is high."An Ethics Statement restrict the sale of cigarettes to additional gap in understanding the The stud approved b the minors for decades.'Because there effectiveness of youth tobacco access y was pp y University of Southern California was widespread violation of these restriction is during the transition laws by tobacco vendors,z Congress to the legal age of purchase.Most Institutional Review Board.Parental written informed consent and passed the Synar Amendment to the adult smokers historically have Public Health Service Act in 1993,3 initiated cigarette use by age 18,12 child assent were obtained for all which required that states enact laws which is the legal age of purchase <18 y Children's Health Study participants 18 y of age.Participants age 18 banning cigarette sales to minors in most states.There have been few and that they enforce such laws with prospective studies examining the or older provided written informed consent. compliance checks using undercover effect of tobacco licensing and youth "decoys"posing as underage access restriction on cigarette and Tobacco and Alternative Tobacco customers.4-5 alternative tobacco product use Product Use Enforcement of these youth access during this transition to adult life. At each survey,participants were regulations is a central feature of US Among participants in the Southern asked whether they had ever tried tobacco control programs.However, California Children's Health Study, e-cigarettes,cigarettes,cigars,or although compliance checks of we evaluated whether youth living hookah and the number of days vendors have been shown to reduce in jurisdictions with a strong tobacco each product was used in the past sales to minors,their effectiveness retail licensing(TRL)ordinance had 30 days.12 Participants who had in reducing youth smoking rates is reduced prevalence of cigarette and "never tried"a product(not"even 1 less certain,for example,because other tobacco use,compared with or 2 puffs")were classified as never they may obtain cigarettes legally participants in jurisdictions with users.Those reporting an age at first purchased by older friends.6,7 Key a poor TRL ordinance.In addition, use of each tobacco product were regulatory features that are reported using prospectively collected data, classified as ever(lifetime prevalent) to reduce both compliance violations we assessed the association of local users of that product at baseline. and youth cigarette use include a ordinances with the initiation of Rates of initiation were calculated on mandatory tobacco retailer licensing tobacco product use during a cohort the basis of a new report of use of a fee to provide sustainable funding of follow-up as youth reached 18 years tobacco product at follow-up among undercover decoys to make at least 1 of age,the age at which the sale participants not reporting use of that annual visit to each vendor and fines of tobacco products was legal in product at baseline.Both prevalent or penalties for violations.7,8 California at the time of the study. users and initiators of each tobacco Low rates of vendor compliance product were further characterized checks,which occur annually at only on the basis of past 30-day use. a small fraction of tobacco vendors under existingstate and federal METHODS Evaluation of Local Tobacco enforcement programs,9,10 and Regulatory Licensing to Reduce inadequate penalties may explain Study Population Youth Access why associations with youth smoking rates have not consistently been Between January and June of 2014, There were 14 political jurisdictions observed. Within states,compliance a total of 2097 11th-and 12th-grade with corresponding tobacco enforcement may vary markedly compliance participants in the Southern product ordinances across the 12 the basis of local ordinances that California Children's Health Study participating Children's Health provide funding to do so.riven the (mean age: 17.3;SD:0.6)completed Study communities.Four study expense involved in enforcement self-administered questionnaires jurisdictions were assigned an and the lack of expert consensus on collecting detailed information about A grade on the basis of the 2014 its benefits,additional studies are cigarette and alternative tobacco American Lung Association(ALA) warranted to assess the effectiveness product use.Follow-up online "Reducing Sales of Tobacco Products" in reducing youth cigarette use. questionnaire data were collected to youth scale,which is used to on 1553 participants(74%of the evaluate the strength of the local TRL The impact of youth access 2097 at baseline)as they reached ordinance across California.ls An restriction on the initiation of 18 years of age,between January A grade required adequate annual alternative tobacco products,such as 2015 and June 2016(mean age: 18.8; retail license fees,which were paid electronic cigarettes(e-cigarettes), SD:0.6).Additional characteristics by all tobacco retailers(including gas hookah,and cigars,has not been of the study sample have been stations,convenience stores,larger studied,although prevalence of ever described previously.13,14 grocery stores,and pharmacies), Downloaded from www.aappublications.org/news by guest on May 7,2019 2 ASTOR et al