The regulation requires all 50 states, the District of Columbia, and eight insular areas to (1) have in effect and enforce laws that prohibit the sale and distribution of tobacco products to people under 18 years of age, (2) conduct annual random, unannounced inspections, using a valid probability sample of outlets that are accessible to youth, of all tobacco outlets within the state to estimate the percentage of retailers who do not comply with the laws, and (3) report the retailer violation rates to the Secretary of HHS in their annual SAPT block grant applications. Although SAMHSA approved states’ sample designs, inspection protocols, and inspection results, the quality of the estimated statewide violation rates reported for fiscal years 1998 and 1999 is undermined because of several factors: First, some states used inaccurate and incomplete lists from which to select samples of tobacco outlets to inspect. As a result, using minors younger than 16 could bias the outcome of state inspections by lowering the violation rate. However, SAMHSA relied on the states to assess the quality of the data they used to develop their rates, even though the potential 40-percent reduction in a state’s block grant for not meeting annual violation rate goals could provide an incentive for some states to report artificially low violation rates. Penalties Have Been Used By States as an Enforcement Tool

A little more than half the states reported in their fiscal year 1999 block grant applications that violators of youth tobacco access laws were penalized as part of the state’s enforcement strategy. Research shows that enforcement strategies that include the assessment of penalties are successful at reducing minors’ access to tobacco products. These penalties included fines against retailers and sales clerks and the suspension or revocation of retailers’ licenses. Seven states reported that they took other law enforcement actions against violators, such as issuing warning letters or citations. Conclusions

The goal of the Synar amendment is to help reduce the sale of tobacco products to minors through state laws that make it illegal for retailers to sell them tobacco products. Recommendations for Executive Action

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, we recommend that the Secretary of HHS direct the Administrator of 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; 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; and   ensure that all states’ retailer violation rates exclude invalid inspections, particularly those in which the ages of minors and outcomes of inspections are unknown.
Why GAO Did This Study

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.

What GAO Found

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.