Purpose: U.S. states annually estimate retailer propensity to sell adolescents cigarettes, which is a violation of law, by staging a single purchase attempt among a random sample of tobacco businesses. The accuracy of single-visit estimates is unknown. We examined this question using a novel test-retest protocol.
Method: Supervised minors attempted to purchase cigarettes at all retail tobacco businesses located in 3 Colorado counties. The attempts observed federal standards: Minors were aged 15-16 years, were nonsmokers, and were free of visible tattoos and piercings, and were allowed to enter stores alone or in pairs to purchase a small item while asking for cigarettes and to show or not show genuine identification (ID, e.g., driver's license). Unlike federal standards, stores received a second purchase attempt within a few days unless minors were firmly told not to return. Separate violation rates were calculated for first visits, second visits, and either visit.
Results: Eleven minors attempted to purchase cigarettes 1,079 times from 671 retail businesses. One sixth of first visits (16.8%) resulted in a violation; the rate was similar for second visits (15.7%). Considering either visit, 25.3% of businesses failed the test. Factors predictive of violation were whether clerks asked for ID, whether the clerks closely examined IDs, and whether minors included snacks or soft drinks in cigarette purchase attempts.
Conclusion: A test-retest protocol for estimating underage cigarette sales detected half again as many businesses in violation as the federally approved one-test protocol. Federal policy makers should consider using the test-retest protocol to increase accuracy and awareness of widespread adolescent access to cigarettes through retail businesses.