Cracking down on youth tobacco may influence drug use.

29 de dezembro de 201210min16

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In Illinois in the USA, randomly allocating towns to enforce laws against youth smoking in public led not just to fewer youth smoking but also fewer drinking or using and being offered illegal drugs – did anti-tobacco policing spill-over to create an environment unfriendly to drinking and illegal drug use?

Summary The featured report drew its data from a study which randomly assigned 24 towns in the US state of in Illinois to either more vigorously enforce laws prohibiting under-age possession and use of tobacco, or to continue with existing low-level enforcement practices, a study which showed the intended effects on youth smoking. The issue addressed by the featured report was whether this spilled over to affect other forms of substance use and availability.

The towns selected for and which (via their officials) agreed to participate in the study were also all engaged in a state-sponsored programme intensifying enforcement of the ban on commercial tobacco sales to youngsters under the age of 18. The difference in the 12 towns allocated to enhanced enforcement was that this was supplemented by intensified enforcement of laws against young people having or using tobacco, in particular by levying civic fines against minors caught using or possessing tobacco in public. By design, at the start of the study all the towns only infrequently enforced these laws, a situation continued in the 12 control towns not allocated to enhanced enforcement.

Assignment had the intended effect; over the four years of the study, the average yearly number of anti-tobacco citations issued to minors was significantly higher (17 v. 6) in towns assigned to enhanced enforcement than in control towns.

Earlier reports on the study also showed the intended impact on youth smoking, which increased at a significantly slower rate for adolescents in towns where enforcement was extended. The researcher-administered, confidential surveys of school pupils which established this also asked about current (past 30 days) and ever use of substances other than tobacco. The key statistics for the study were the total number of different types of drugs the student had recently or ever used, averaged over pupils in the same town to assess the impacts on youth in the town as a whole. Pupils were also asked how many times over the past year someone had tried to give or sell them illegal drugs. These surveys were administered in four succeeding years to students from grade seven (age 12–13) up to grade ten in 2002, 11 in 2003, and 12 in 2004 and 2005, meaning that in each year some of the same pupils but also many new ones were sampled.

Across the four waves of data collection 52,550 pupils were eligible to be surveyed of whom 29,851 (57%) completed at least one survey. From these were selected only the 25,404 pupils (who completed 50,725 surveys) living in the 24 towns in the study.

Main findings

At the start of the study towns in the two sets of 12 did not differ in the number of substances currently or ever used by their pupils. As the different tobacco enforcement policies were implemented, over the succeeding three years the number of different drugs that a pupil currently or had ever used increased significantly less steeply in towns assigned to enhanced tobacco enforcement. There was a similar and also statistically significant result for offers of illicit drugs.

Use of substances other than tobacco was dominated by alcohol, so a further analysis focused on this substance alone. Again, increases in the average proportions of pupils who had recently or ever drank alcohol were significantly less steep in towns assigned to enhanced tobacco enforcement.

Though differences between the two sets of towns were statistically significant they were modest, and in both sets most substances had or were being used by few pupils.

The authors’ conclusions

In this study, towns allocated to heightened enforcement of laws prohibiting youth possession and use of tobacco experienced relatively lower increases in the probability that their young people had or were using a number of different substances or had been exposed to an offer of illicit drugs, providing preliminary evidence that police efforts to reduce specific substance use behaviours might have a positive spill-over effect on other high-risk activities. Given the co-occurrence of different forms of substance use, strategies that strengthen community norms against youth tobacco use might work synergistically to help reduce youth drug use and illicit drug offers.

How did an enforcement effort focused exclusively on tobacco affect use and availability of other substances? There are several possible explanations. Being punished for tobacco-related crimes might deter individual children from possessing and using other drugs, and the knowledge that police in enforcement towns approach youngsters to enforce anti-tobacco laws may deter young people and even adults from selling drugs in these communities. Possibly relevant too is the ‘broken window’ approach to enforcement, supported by studies which have shown that enforcement of laws against lower-level crimes can deter more serious offences. According to this theory, creating an environment where youth cigarette use is not tolerated might create an unfavourable environment for drug use. More directly, greater contact between young people and police enforcing underage tobacco laws might give police more chances to search for and confiscate illegal drugs.

Police believe that publicly smoking cigarettes acts as a signal to drug dealers that a young person might also be in the market for drugs. If so, making youth smoking less visible in a town may also make that town less attractive to dealers. Reduced visibility may also minimise the perception that illegal behaviour is normal and acceptable in that community. The effect could be to reduce sales attempts by make potential young customers less obvious and by making the entire town seem an undesirable dealing location. Alternatively, the findings might reflect reduced offers of alcohol or other drugs from friends rather than drug dealers, because reductions in use of tobacco spread to other substances, especially alcohol.

However, alcohol not illegal drugs might account for the bulk of the findings. Use of tobacco and alcohol tend to go together, so if police crack down on tobacco, they might also discourage drinking.

It should be acknowledged that these findings derive from only about half the young people who could have been surveyed, possibly the lower risk half whose parents were prepared to give their consent, and are limited to young people living in towns. Also many pupils could not be resurveyed and their reports of their substance use were not biologically confirmed. Perhaps young people in the enhanced enforcement towns were less willing to admit to substance use. Finally, it is unclear what the longer-term impact on substance use might be after the end of high school.

Thanks for their comments on this entry in draft to Leonard A. Jason of DePaul University in Chicago, USA. Commentators bear no responsibility for the text including the interpretations and any remaining errors.

Last revised 28 December 2012. First uploaded 28 December 2012

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A Unidade de Pesquisa em álcool e Drogas (UNIAD) foi fundada em 1994 pelo Prof. Dr. Ronaldo Laranjeira e John Dunn, recém-chegados da Inglaterra. A criação contou, na época, com o apoio do Departamento de Psiquiatria da UNIFESP. Inicialmente (1994-1996) funcionou dentro do Complexo Hospital São Paulo, com o objetivo de atender funcionários dependentes.


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