Problem: Increased addiction rate 2001 - 2002.

 

For the first time in the 12 years that the new version of the YRBS has been used, the trend of the addiction rate for one of the five grades sampled (12th grade) has moved in a different direction than the other four. For 1995 through 2001, smoking for all ages decreased significantly in approximately proportionate amounts. In 2003, smoking for 12th graders increased by 3% while decreases continued by 1% to 4% for all four of the lower grades. The 10% gap between 11th and 12th grades is 67% larger than it has been in any previous survey.

When discussing tobacco prevention, we often cite the addiction rate in terms of the number of new minor smokers per year in Vermont – which has been in the range of 1,500 to 1,800 per year. It is critically important to reduce this rate.

One of the clearest indicators of this addiction rate is the number of smokers in 12th grade because that is the age where the number of new smokers at each age comes together in one cumulative total for minors. If any part of our tobacco prevention programs succeeds only in delaying but not in preventing nicotine addiction for our young people, that part is failing in a significant way. An increase in smoking at the 12th grade level from 30% to 33%, regardless of whether smoking is going down at the lower grade levels, suggests that the addiction rate actually increased by 10% during the last two years. I think this is a problem that we should be very concerned about. We should try to find out why this significant increase happened and do something to turn it around.

As with many kinds of rational problem solving, and especially in the area of behavioral science, there may be more than one contributing cause, and it is not possible to determine precisely either what the causes are or their relative contributions. The best we can do is identify possible causes and rank them in order of probability. Higher probabilities should be assigned to those possible causes that best explain the observed facts that define the problem.

I want you to consider what I think is the most probable cause of this problem and what we can do to fix it.

Since one of the characteristics of 12th graders is they are about 17 years old, we need to consider what factors in our tobacco control program are different for that age level. One that is significantly different is buyers in compliance testing must be 17 years old. Section 13 of Act 58, 1997 says in part: “The Department of Liquor Control shall conduct or contract for compliance tests of tobacco licensees as frequently and as comprehensively as necessary to assure consistent statewide compliance with the prohibition on sales to minors of at least 90 percent for 17-year old buyers.”  In passing this law, the legislature understood that this exceeds federal requirements in both required compliance level and age of buyers. The Synar Amendment requires only 80% for 15- or 16-year-old buyers. There were two reasons for making our compliance testing law stronger than any other law in the country.

First, there is a “threshold effect” for compliance somewhere near the 90% level. Below this “threshold”, there is very little effect on the addiction rate and above it, there is a dramatic reduction in the addiction rate. Second, each year of age for buyers used in compliance testing is worth more than 6% in compliance test effectiveness when overall compliance is in the range of the 80s or higher. In other words, if 16-year-olds can buy cigarettes in 15% of attempts, 17-year-olds can buy them in about 21% of attempts. With consideration of these two critical factors, our law was designed to provide significant protection from addiction for every age under 18.

Why should we be particularly concerned about age 18? There are two very important reasons. First, there is a valid reason for laws that focus on this transition age, such as voting and entering into contracts – the ability to effectively consider the future consequences of today’s decisions develops very rapidly at this age. We see that in the fact that very few adult smokers became addicted after the age of 18. Vulnerability to drug addiction decreases rapidly near age 18. Second, if 17-year-olds (seniors) can still buy cigarettes easily while younger minors cannot, those 17-year-olds provide a conduit for the flow of cigarettes into the lower grades. We need to reduce that flow as much as possible.

Now, with this understanding of the age specificity and the threshold effect of compliance testing, we can see how our failure to assure consistent statewide compliance with the prohibition on sales to minors of at least 90 percent for 17-year old buyers”, even though we have maintained higher than 90% compliance for 8th through 11 graders, can explain what is reported in the 2003 YRBS for smoking on one or more days during the past 30 days. This is a clear indication that this is a possible cause with high probability and warrants consideration of immediate corrective action.

Corrective action is simple. All that is needed is for the DLC to do precisely what the law has required it to do since 1997. Fortunately, this can be done for far less than the current allocation of $319,000 to the DLC for enforcement.  In other words, even if we eliminate this possible cause and it turns out that this is not the primary cause of this problem, we will have spent no additional money and we will have stopped violating state law.

Whatever else we might do or not do to solve this problem, we should not risk the possible consequences of not doing this.

 

Analysis by Bruce Cunningham, 11/9/03

 

The charts below show Maine and Vermont compliance and 12th grade smoking. Maine uses 17-year-old buyers in its compliance testing and has been meeting the compliance requirements in the Vermont law (at least 90%) for the last five years. The addiction rate in Maine did not rise in 2001-2002 as it did in Vermont. In fact, it decreased by approximately the same amount as for smoking in the lower grades in Maine and in Vermont. The difference between the Maine results and the Vermont results represents about one new addict per day in Vermont.