Guam's SYNAR Experience : Asking the Right Questions Department of Mental Health and Substance Abuse Annette M. David, MD, MPH Barbara Benavente, MPA Grace Lapid, MPA Remedios Malig J. Peter Roberto, ASCW

Learning Objective Recognize the importance of utilizing complementary surveillance data to evaluate the effectiveness of youth access restriction

Components Background and Objectives Methods Results Discussion Conclusion and Recommendations

Background

Introduction GUAM YOUTH ~ Half of all MS students have tried smoking ~ 75% of all HS students have tried smoking YRBS 2003 GUAM Highest adult smoking rate overall Adult female smoking rate ~ 4X Regional average 1 death/day due to tobacco

The Legal Background ‘91‘92‘98‘99‘00‘01‘02 Synar amendment Guam was ahead; In 1991, misdemeanor to sell or furnish tobacco to minors (PL ) Tobacco Control Act of 1998 Synar inspections begin on Guam

Objectives 1.To review the results of Guam's annual survey of tobacco vendors' compliance with the law restricting youth access to tobacco 2.To evaluate the law's impact on youth tobacco use using data from YRBS 3.To utilize the data to guide future tobacco control policy development

2004 Survey 492 total tobacco outlets on Guam – R & T list 371 outlets eligible for inspection 311 underwent actual inspections 57 successful buys by underage inspector

2004 Compliance Rate Non- compliance rate: 18.3% Over 80% of vendors who were inspected complied with the law.

Success…

…Or not? Synar Compliance Rates and Youth Tobacco Use Sources: Synar Data ; 1999, 2001 and 2003 YRBS as reported by DPHSS at Inspections start Prevalence Rate Compliance Rate

Where do they get it? Middle SchoolHigh School Store-bought 3.0%27.8% Vending machine 2.6%3.0% Gave money to someone to buy 20.1%25.7% Borrowed 19.5%17.8% Given by %3.0% Taken from store/family 16.4%4.5% Other 26.1%17.8% YTS 2002, DPHSS/Dept. of Education

Why are youth tobacco use rates still increasing despite SYNAR success? Vendors could be complying with the law only during inspections period Appearances of youth may be deceptive Commercial sales inside bases are not covered by the law Commercial sales are not the only means for youth to obtain tobacco products

What does this tell us? Reducing the supply of tobacco does not necessarily reduce the demand for these products – need to address both sides of equation Contradictory messages (Unspoken message: “But for adults it’s OK.”)

What is Needed Mechanisms to ensure compliance throughout the year: –timing of inspections – vary the timing –choice of inspectors – use “new faces” –vendor education and advocacy Standard protocols for verifying age –ask for ID on all occasions Mechanisms to address sales on bases Complementary approaches to address non- commercial sources of tobacco products

Needed Accurate message; Proven Interventions to address why youth smoke (based on WHO, World Bank and CDC data) –Raise prices of tobacco products –Enforce smoke-free public places –Limit tobacco advertising, marketing, promotions and sponsorships –Assist those who want to quit –De-normalize tobacco use – role models, messages, advocacy

Conclusions Guam compliance rates much improved over time Target compliance rate already achieved, and surpassed Inspections process a good means to raise advocacy among vendors and sales clerks Synar regulation may have directly contributed to the initial drop in youth smoking Youth tobacco use continues to rise

Conclusions Vendor inspections have a role in reducing access to tobacco products. Complementary approaches to reduce demand are needed to have a measurable impact on youth tobacco use.

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