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Table 2 Should the licensing of tobacco retailers be conditional on not selling tobacco to minors?

From: SUPPORT Tools for evidence-informed health Policymaking (STP) 16: Using research evidence in balancing the pros and cons of policies

Population: Minors (as defined by a legal age limit)
Setting: Europe
Interventions: Licensing of tobacco retailers + compliance checks*
Comparison: No licensing or compliance checks
  Pessimistic Best guess Optimistic Number of studies Quality of the Evidence (GRADE)
Reduced number of smokers per year 0 ? 1,650 in the country
(population 4.5 million)
4 Very low
Life years saved per year 0 ? 9,240 in the country
(population 4.5 million)
4 Very low§
Cost per year €10,5 million
(3 controls per year)
? €2 million
(1 control per year + internal control)
0 Very low**
  1. *The proposed licensing law in the European country in question would require retailers to have a licence to sell tobacco. The policy options that were considered included three compliance checks per year, and one per year together with internal control. Compliance checks (by a teenager attempting to purchase tobacco) are done to ensure that tobacco is not being sold to minors. The penalty for non-compliance is the loss of a retail licence. Internal control requires the retailers themselves to have routines for controlling the sale of tobacco to minors
  2. See Table 8
  3. The systematic review used as a basis for this summary (which was not used in the expert report to which we refer in subsequent tables) included one relevant randomised trial and three controlled before-after studies with important limitations. There was a high risk of bias for the estimated impacts on smoking prevalence. Important inconsistencies in the results lacked a compelling explanation. The studies in the review were based in the United States (2), the United Kingdom (1) and Australia (1), with differences in the interventions and uncertainty about whether similar results would be expected in the country where this policy was being considered. Two studies found an effect in lower age groups that was not sustained in one study; two studies did not find a change in smoking behaviour. It is difficult to estimate, based on these studies, what the best estimate would be of the impact of licensing of tobacco retailers with compliance checks on reducing the number of people who smoke. A lower estimate would be that there would be no impact from this intervention. The upper estimate is taken from an expert report (see Tables 3 5)
  4. §The upper estimate of life years saved, which is taken from the same expert report, has the same limitations as the estimate of the impact on smoking behaviour, since it is based on that estimate. In addition, it is based on assumptions about what would happen long beyond the length of the studies that had evaluated impacts on smoking behaviour as well, and assumptions about the impact of the changes in smoking behaviour on mortality
  5. **The estimates of the cost of the policy are taken from the expert report (described in subsequent tables in this article). These are based on an estimate of how many retailers sold tobacco, an assumption about what it would cost to process each licence, and an assumption about the costs of each compliance check