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More Than You Ever Wanted to Know About Conducting a Youth Tobacco

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									More Than You Ever Wanted to
Know About Conducting a Youth
  Tobacco Purchase Survey



                              Elizabeth A. Klonoff, Ph.D.
                              San Diego State University
 Supported by funds provided by the California Department of Health Services, Community Tobacco Control
Education Project, Grant nos. 96-26617, 94-20962, and 96-26617, and the Tobacco-Related Disease Research
                          Program, Grant nos. 6RT-0081, 4RT-0348, and 9RT-0043.
 Do Laboratory (YPS) Studies Match the
             Real World?

• Perhaps there is something wrong with how
  we have been measuring youth access
• Older youth say they can still buy cigarettes
  and we know that they are buying them and
  are supplying younger youth
• Perhaps the methodology of sending youth
  confederates into stores to buy cigarettes
  somehow differs from what 17 year old
  smokers do
  Summary of Results from Study of Youth
    found to be smoking in public places

• Preferred places to buy (because of
  perceived and reported easy access) were
  •   Liquor stores (70.7%)
  •   Gas stations (58.4%)
  •   Small grocery (51.2%) stores
  •   Convenience stores (48.8%)
• Preferred methods to acquire cigarettes were
  • Buying in their own neighborhood (77.2%)
  • Buying from a clerk who knows them (72.8%)
  • Lying about being underage (71.2%)
• Less common methods were
  •   Simultaneously buying non-tobacco items (59.9%)
  •   Saying that the cigarettes are for an adult (24.5%)
  •   Using fake ID (23.6%)
  •   Bringing a fake note from their parents (7.1%)
• All recommended going to clerks who knew
  them as the best method for a 16 year old
       What does this mean?
• Most common method is to buy it from clerks who
  know them as regular customers (e.g., to buy in their
  own neighborhoods)
   • Youth comments about this strategy (e.g., “If a
     clerk knows you, he’ll sell you anything”) indicated
     keen awareness of the familiarity effect entailed
• This youth-smoker method differs from the widely-
  used, standard method where
   • Youth attempt to purchase tobacco in stores where
     they are strangers to the clerks
   • And they are truthful about their age
 Clerk Compliance vs. Youth Behavior: Percentage of
Cigarette Sales to Youth (in press, Health Psychology)
                              CLERK COMPLIANCE:
                              Demanded Youth ID
                                                              2
       YOUTH BEHAVIOR:          NO      YES            Row  (df = 1)
  Normal
        Standard Protocol 1       36.1        1.0           61.927 *
        Standard Protocol 2       61.8        2.5          102.333 *
        Standard Protocol 3       49.0        0.0           96.952 *
        Standard Protocol 4       44.2        0.0           87.836 *
   Standard 1-4 Combined          47.6       0.9%           347.753*
  Manipulative
           Foot-in-the-Door      32.7 b       3.0           39.648 *
                                      c
             Note from Dad       17.5         1.4           11.230 *
                                      d
              Lie About Age      80.0         3.0          140.716 *
                       2      a
     Overall Column  (df = 3) = 62.327 *     6.776 (not significant)
   * p = .0005
   a
      Compares Standard Protocols 1-4 combined (Normal Behavior) to
  the three manipulative conditions.
   b                                             2
     Standard 1-4 combined vs. Foot in the Door  df 1 = 3.681, p = .055
   c                                           2
     Standard 1-4 combined vs. Note from Dad  df 1 = 33.247, p =.0005
   d                                           2
     Standard 1-4 combined vs. Lie about Age  df 1 = 12.193, p = .0005
  Interpretation of the above data

• Studies have found that some youth attempt to
  manipulate clerks into selling tobacco to them and
  that these manipulations are successful
• Here we found that such manipulations are effective
  only with clerks who fail to inspect youth ID as
  required by law
   • Youth access with these non-compliant merchants
     was far above 20% and was high (47.6%) even
     when youth behaved normally
   • It increased to 80% when youth lied about their
     age such that non-compliant merchants sold 89%
     of all of the cigarettes sold to the youth
• In contrast, with merchants who
  demanded youth ID, access was
  extremely low (0.9%) when youth
  behaved normally and did not increase
  significantly when youth lied or
  otherwise manipulated
  • Merchants who complied with the
    requirements rarely sold tobacco to youth
    irrespective of how youth behaved
          Things to remember
• Youth access to tobacco from commercial sources
  (stores) remains a problem because of merchant non-
  compliance
• Sales by men and Anglo clerks must be addressed
  through interventions
• Differential sales to Black and in particular Latino youth
  must be addressed through additional interventions
   • Smoking is increasing among these youth and they
     have the highest access as a result of merchant
     discrimination
• Youth do attempt to manipulate clerks into selling to
  them but it only works on clerks who are non-compliant
  with the law
            Why Do a YPS?

• Before you begin, need to know why you are
  doing YPS
• Three main reasons
   • To assess the efficacy of an intervention
   • To educate policymakers in an effort to
     promote policy development and
     implementation
   • To identify stores that consistently violate
     the law
  To Assess the Efficacy of an Intervention

• By definition, you will need to do at least two
  YPSs
  • One pre- and one post-intervention
  • Time frame must be considered because rates
    can be affected by many things
     • “Pre-” should be done immediately before
     • “Post-” should be done immediately after
     • Need to consider doing at least one “follow-up”
       assessment 3 months to one year after your
       intervention
    As Data for Policymakers

• A number of studies suggest the value of
  youth access policies at all levels
  • States with more extensive youth access policies
    have significantly lower youth smoking rates
  • 12-15 year olds living in towns with local
    ordinances at baseline were less likely to smoke
    than youth in towns without these ordinances
  • Communities that passed policies to reduce youth
    access showed less pronounced increases in
    youth smoking than communities that did not
   To motivate policymakers

• First, consider what outcome you desire
• Base the nature of your data collection
  on what you want to demonstrate
• The more restrictive the policy you
  desire is, the better your data need to be
  • For example, to encourage passage of a
    local licensing law, you better have sales
    rates far above the 8-15% currently being
    obtained in the statewide survey
      To aid law enforcement

• Many legal requirements to ensure that, if a
  store is caught selling tobacco illegally, the
  prosecution will be successful
  • Audio- or video-taping the sale
  • Specific requirements for how the tobacco that
    was illegally obtained needs to handled (“chain
    of evidence”)
  • Other procedures
• Unless working directly with law
  enforcement, it is unlikely that YPSs you
  do will result in prosecution
• Can use data obtained, however, to
  direct law enforcement to specific stores
  or types of stores that may be more or
  less likely to illegally sell tobacco to
  youth
      What types of stores?

• Need to decide in advance based on
  why you are doing YPS
• Different kids of stores have different
  sales rates
  • Lower than average in drug stores and
    major supermarket chains
  • Higher than average in small grocery,
    convenience, and liquor stores, as well as
    in “other” locations (e.g., donut shops)
 How many youth should be used?

• The more youth you use the better
  • Decreases the likelihood results are based on
    characteristics/skills of a specific youth
  • Each youth should probably visit no more than
    25 stores
  • For smaller counties and jurisdictions, no youth
    should do more than about 25% of the total
  • Cannot use the same youth both pre- and post-
• Consider “swapping” youth in smaller areas
How old should the youth be?

• Age is one of the strongest predictors of
  sales
• Unless there is good reason, should use
  youth who are at least 16 years old
  • Not only are sales rates higher, but this is
    consistent with what we know about how
    youth get tobacco
  • Younger children get tobacco from older
    ones, who tend to buy it
 Is ethnicity of the youth a factor?

• Numerous studies, using widely differing
  methods, have found that the ethnic group of
  the youth affects sales
   • In general, most have found that minority
     children have the highest access
• Also important is the ethnicity of the
  community you will be surveying
   • As much as possible it is best to have the
     ethnicity of the youth match the ethnicity of
     the community
    What about youth gender?
• Results for gender are mixed
• Many earlier studies found that girls were
  sold to more than boys
  • Theorized that this was because 1) girls look
    older and 2) men clerks were more likely to sell
    to them
     • We tested #2 and found that it did not hold
• More recent studies have found no gender
  differences
  • Safest to have equal numbers of boys and girls
    participate
Strategies for obtaining immunity

• Clearly articulate the purpose of the survey
  (i.e., the rationale, methods, use of the data)
• Work through contacts you already have
  established
• Involve community leaders to speak on your
  behalf (strong community support is essential)
• Use results from prior YPS as evidence that
  this would be valuable
        What if you are unable
         to obtain immunity?

• Think through what other options are
  available to you
• May want to only assess ID checking
  (i.e., stop sale after you see if ID is
  asked for)
• In any case, always want to make sure
  local law enforcement knows when you
  are going to be doing your survey
     Identifying survey sites

• Define geographic area
  • Region- or county-wide surveys
    • Most difficult because involves most planning
    • Does allow you to compare results with other
      Regions or with statewide survey
  • City-specific random sample survey
    • Easier to complete but only true for city where
      done
    • To compare sales rates among cities, may have
      to do more in each city to have sufficient sample
• Specialized studies of communities,
  products, or merchants
  • Particular neighborhoods (e.g., within ½
    mile of schools)
  • Products (e.g., chew tobacco or herbal
    cigarettes)
  • Types of stores (e.g., “mom and pop”
    markets or gas stations)
 How many stores need you do?

• Difficult question with no simple answer
• Goal is to get enough stores to conclude
  results are representative of region, type of
  store, county, etc.
• More you limit your survey, the more stores
  you may need to ensure it is representative
• Work with your evaluation consultant to arrive
  at the optimal number for your purposes
• It is not unusual for 10% of retailers to
  go out of business each year
• Means that 10% of your list will no
  longer be in operation, regardless of
  how you got the list
• Select 10-20% more retailers than the
  sample size determined by you and your
  evaluation consultant to ensure you
  reach your target
       Training Prior to the YPS
• For the youth
   • Memorize a so that they all behave the same way (“Can I
     have a pack of Marlboros?”)
   • Role play making PAs with the researchers
   • Youth should be paid for every PA, irrespective of its success
• For the adult accompanying them
   •   Assuring the child’s safety
   •   Providing the money for the PAs
   •   Confiscating all tobacco purchased
   •   Recording all data collected by youth
   •   Supervising the youth’s PAs
    Content of youth training

• Goals and planned use of survey
• Thorough review of exactly what the
  youth is being asked to do
• How to check for self-service displays
• Reminder that a “successful” PA is one
  that is completed, not necessarily one
  where they buy tobacco
• The importance of ensuring clerks do
  not suspect what they are doing
• Reminder that they will not be tricking or
  coercing clerks to sell
• Confidentiality as defined by your
  protocol (particularly with regard to
  friends who smoke)
• Review of safety considerations
    Role play of various youth scenarios

•   How to make buys
•   Types of tobacco to look for
•   What to do if clerk realizes this is a YPS
•   What to do if clerk gets angry
•   What to do if clerk says something racist
•   What to do if customers speak to the youth
•   What to do if the youth knows either the clerk
    or someone in the store
• Youth who participate must have written
  permission from parent or guardian
• It is best to include parent in training
  session
• Youth should also have a written
  description of what they will do
• Permission should include riding in car
  with adult associated with YPS
          Role play various scenarios
       accompanying adult may encounter

•   How to make buys (what youth will do)
•   What adult will do while youth is making PA
•   Types of tobacco to ask for
•   What to do if clerk realizes this is a PA
•   What to do if clerk gets angry
•   What to do if youth knows clerk or customer in
    store
• Familiarize adults with the retail environment
• Have example signs and products for them to
  view before doing actual YPS
• Conduct a practice session in an actual store
  so all aspects of what will be required can be
  experienced before adult goes out
  • We usually go to one large and one small store that
    will not be part of YPS
  • Discuss problems and possible questions during
    practice session
       Importance of safety

• Most important task for adult drivers is
  ensuring youth’s safety
• If either adult or youth feels
  uncomfortable at any time, terminate the
  PA
• Reschedule PA for that store at a later
  time
• Should remain on the lookout for
  • Small or large groups of teens or
    young adults loitering around the
    outside or inside a store
  • Anyone consuming alcohol around or
    near a store
  • Police activity (e.g., sirens, police
    cars) near or around a store
   Other things to think about

• How will money be distributed?
• What receipts are necessary and what
  should be done with leftover funds at the
  end of the day?
• If you go out for longer than 3 or 4
  hours, what provisions will you make for
  snacks, lunch, and so forth, and who will
  pay for this?
    “Actual” versus “Attempted”

• Although actual buys are more expensive and
  require immunity from prosecution, they are
  recommended for three reasons
  • Clear evidence a sale was completed
    • No way to say “I was going to ask for ID right before I
      took the money”
  • “Attempted” buys require too many judgments
  • Anger from clerks secondary to increased
    suspicion
 Should adult go in store or not?

• If present, you will get better data and can better
  assess safety issues
• However, increases suspicion, particularly in
  small or remote stores
• Also increases cost (adult has to buy something)
• If you do so, have adult count to 10 before
  entering store after youth
• Have adult stall so youth leaves first—entire sale
  should be witnessed
• Many do not have adult enter the store
• Decreases suspicion somewhat
• Slight increase in risk because adult
  does not assess
• Reduces data obtained because you
  rely only on youth
• Adult could enter after youth, but this
  also may increase suspicion
          Standard Protocol

• Youth enters store
• Goes to counter and asks for tobacco
  • “May I have a pack of Marlboro please?”
• Youth is truthful about age if asked
• ID should be left in car so youth can be
  truthful about not having it
• Only “lie” is if clerk asks if the cigarettes
  are for the youth
          Have ID Protocol (new
            recommendation)

• Some recent data support the following
  approach
• Youth enters store, goes to counter and asks
  for cigarettes
  • Waits for clerk to ask for ID
  • If clerk does, youth then displays own ID which
    indicates youth is too young to buy cigarettes
  • If clerk merely asks age, youth confirms that
    he/she is old enough to buy cigarettes
• Slightly more expensive as you need to
  provide Ids for youth who do not have them

								
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