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Joseph R. DiFranza, MD

Arch Pediatr Adolesc Med. 1999;153:1089-1097.

Background  In 1992, Congress enacted the Synar Amendment, requiring states and territories to enact a law prohibiting the sale of tobacco to minors and to enforce that law in a manner that could reasonably be expected to decrease the availability of tobacco to minors. The Department of Health and Human Services (DHHS) was mandated to withhold block grant funding from noncompliant states.

Objective  To determine if DHHS and applicant states and territories are complying with the Synar Amendment.

Data Sources  Fiscal year 1997 substance abuse block grant applications from 59 states and territories.

Main Outcome Measures  Whether applicants had enacted a tobacco sales law, conducted enforcement inspections, penalized violators, and conducted a statewide survey, and whether DHHS regulations and actions were consistent with the statutory requirements of the Synar Amendment.

Results  Two applicants failed to enact appropriate laws, 15 failed to conduct enforcement inspections, 18 failed to provide a single example of a violator being penalized, and 1 failed to conduct a survey. Nineteen applicants failed to meet the statutory requirements, but none were sanctioned by DHHS as required by the Synar Amendment. The DHHS regulations, as implemented, do not require states to enforce their laws or to achieve illegal tobacco sales rates low enough to reduce the availability of tobacco to minors.

Conclusions  The states and DHHS are violating the statutory requirements of the Synar Amendment, rendering it ineffective. Few states have implemented effective enforcement programs, and national surveys confirm that there has been no measurable reduction in the availability of tobacco to youths.

From the Department of Family Medicine and Community Health, University of Massachusetts Medical Center, Worcester.

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