NEW YORK (Reuters Health) - As little as one penny per pack of cigarettes sold in the United States could fund an enforcement program that would reduce the amount of tobacco products sold to minors, a new study reports.

Such a program could save 10 times as many lives as the same amount of money spent on mammograms or screening for colorectal cancer, according to Dr. Joseph R. DiFranza of the University of Massachusetts Medical Center in Worcester and colleagues. DiFranza and his team of researchers reviewed states' progress reports and found there was wide variation in the enforcement of laws prohibiting the sale of tobacco to minors. Their results are published in the journal Preventive Medicine. ``Some states, like Wyoming, have never enforced laws that penalize merchants for selling tobacco to minors,'' DiFranza said in an interview with Reuters Health. ``Florida, Vermont and Maine on the other hand, have been able to achieve compliance with the prohibition of tobacco to minors about 90% of the time. This means that when underage kids are sent in to a store to buy cigarettes by law enforcement groups, 90% of the time they are turned down,'' he explained. ``It wasn't that long ago that people thought it would be impossible to attain such a high compliance,'' DiFranza added. Currently, the vast majority of states are not spending nearly enough money to do a good job, DiFranza noted. It is also difficult to know exactly how much money, if any, a particular state is spending on tobacco enforcement because it is combined with alcohol enforcement. In the study, the researchers calculated several variables including the number of retailers that sell tobacco products, the cost of enforcement, smoking rates among minors and years of potential life saved. All these factors helped build a mathematical model. Inspecting an estimated 543,000 stores that sell tobacco products four times a year would cost about $190 million annually. ``Just the state and federal taxes paid on cigarettes consumed by minors generate revenues more than double this amount ($513 million in 1997) and states could use some of the $206 billion they will receive from the tobacco settlement to fund enforcement,'' DiFranza and colleagues write. In the tobacco settlement reached in 1998, the nation's biggest tobacco companies agreed to pay 46 states $206 billion. Some states plan to use the money to help pay for health issues related to smoking. By spending the money in a cost-effective manner on enforcement, millions of lives could be saved. The potential is also great for states to save on future healthcare costs due to smoking-related illness including lung cancer, according to DiFranza. A tax of about one-cent per pack of cigarettes would fully fund the most expensive enforcement program considered in the study, DiFranza noted. According to the study, implementing a smoking enforcement program would cost about $41,000 per year of life saved. This puts it right on par with mammography, which costs about $35,000 per year of life saved, and colorectal cancer screening, which costs about $47,000 per year of life saved. The legal age to buy cigarettes is 18 in the majority of states. The federal government requires that all states enforce their laws pertaining to the illegal sale of tobacco products to minors in order to qualify for full federal funding for substance abuse programs.

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