Synar Amendment Implementation:

Quality of State Data on Reducing Youth Access to Tobacco Could Be Improved

GAO-02-74: Published: Nov 7, 2001. Publicly Released: Dec 7, 2001.

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Every day, about 3,000 young people become regular smokers. It is estimated that one-third of them will die from smoking-related diseases. If children and adolescents can be prevented from using tobacco products they are likely to remain tobacco-free for the rest of their lives. In 1992, Congress enacted legislation, known as the Synar amendment, to reduce the sale and distribution of tobacco products to individuals under the age of 18. States are required to enforce laws that prohibit tobacco sales to minors, conduct random inspections of tobacco retail or distribution outlets to estimate the level of compliance with Synar requirements, and report the results of these efforts to the Department of Health and Human Services (HHS). The Synar amendment and regulation are the only federal requirements that seek to prohibit the sale and distribution of tobacco products to minors. GAO found that weaknesses in the states' implementation of Synar and in HHS oversight may be adversely affecting the quality and comparability of state-reported estimates of the percentage of retailers that violate laws prohibiting tobacco sales to minors. First, some states used inaccurate and incomplete lists of over-the-counter and vending machine tobacco outlets from which to select samples for inspection, which affect the estimated statewide violation rate. Second, states allowed the use of minors younger than 16 as inspectors, even though research suggests that using such minors can artificially lower violation rates. Third, HHS approved a few states' reported violation rates even though the rates included inspection results that were invalid because of the ages of the inspectors and the outcomes of the inspections were unknown. Fourth, HHS relied on states to validate their own inspection results with limited verification of the accuracy of state data even though the potential reduction in a state's block grant award for not meeting annual violation-rate goals could be an incentive for states to report artificially low rates. A little more than half the states reported for fiscal year 1999 that they used fines and suspension or revocation of retailers' licenses to penalize violators of youth tobacco access laws as part of their enforcement strategy. States also reported issuing warning letters and citations. HHS requires states to report evidence of actions taken to enforce state laws but does not require the use of penalties as an enforcement tool. Research shows that penalties reduce minors' access to tobacco products.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: SAMHSA official reported that several activities are being conducted by SAMHSA to help states improve the quality and comprehensiveness of states' lists of tobacco outlets. Examples of these activities include: (1) requiring states that use a list frame for sampling to annually report and justify the accuracy and completeness of their tobacco lists; (2) conducting site visits to help assess the accuracy and completeness of tobacco outlet lists; and (3) offering technical assistance on improving the quality and validity of list frames and reviewing state sampling frames. In addition, SAMHSA plans to publish a revised version of its sampling guidance document incorporating further guidance on assessing the quality and validity of sampling frames.

    Recommendation: To help ensure the quality of states' estimates of tobacco retailer violation rates under the Synar amendment and to make the rates more comparable across states, the Secretary of Health and Human Services should direct the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA) to help states improve the validity of their samples by working more closely with them in developing ways to increase the accuracy and completeness of the lists of tobacco outlets from which they draw random samples for inspections.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Implemented

    Comments: According to SAMHSA, limiting the age of inspectors in Synar compliance checks to 16 and 17 as the research suggest and a SAMHSA-convened recommended, does not provide the agency with a representative or valid measure of retailer compliance with youth access laws. SAMHSA believes that rigorous tests of youths' ability to purchase tobacco products rely on using youth inspectors that represent the demographic characteristics of underage purchasers in terms of age and gender, thus justifying the use of 14 through 17 year olds. However, SAMHSA will work with states to discontinue the use of 14 year olds by 2007. SAMHSA will also continue to work with state to improve standardization of inspection protocols and monitor changes in inspector characteristics over time.

    Recommendation: To help ensure the quality of states' estimates of tobacco retailer violation rates under the Synar amendment and to make the rates more comparable across states, the Secretary of Health and Human Services should direct the Administrator of SAMHSA to revise the inspection protocol guidance to better reflect research results, particularly regarding the ages of minor inspectors, and work with states to develop a more standardized inspection protocol consistent with state law, and more uniform implementation across states.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Implemented

    Comments: According to SAMHSA, the agency has instituted review protocols that require states to exclude inspections that do not include the age of minor and gender of minor inspectors and the outcome of inspections. To help states in estimating their retailer violation rates, SAMHSA has developed a Synar Survey Estimation System whereby the software will only operate if complete data sets that include the age and gender of inspectors and the outcome of the inspections are entered in the system. According to SAMHSA, since 2000, no invalid inspections are allowed in the calculation of retail violation rates.

    Recommendation: To help ensure the quality of states' estimates of tobacco retailer violation rates under the Synar amendment and to make the rates more comparable across states, the Secretary of Health and Human Services should direct the Administrator of SAMHSA to ensure that all states' retailer violation rates exclude invalid inspections, particularly those in which the ages of minors and outcomes of inspections are unknown.

    Agency Affected: Department of Health and Human Services

 

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