A new study suggests it's all too easy for minors to buy cigarettes online, because most vendors don't take steps to verify the age of buyers. Researchers from the University of North Carolina at Chapel Hill found that children were able to buy cigarettes online 92% of the times they tried.

"We were surprised at how easy it was," said lead author Kurt Ribisl, PhD, of the university's School of Public Health and Lineberger Comprehensive Cancer Center.

His findings were published in the Journal of the American Medical Association (Vol. 290, No. 10: 1356-1359). The study is the first to formally examine Internet cigarette sales to minors, though there have been anecdotal reports in the past of children being able to make such purchases.

The study results trouble public health advocates, who fear Internet tobacco sales could undermine efforts to reduce teen smoking – efforts like increasing tobacco taxes, limiting access to cigarette vending machines, and restricting tobacco sales to minors in retail stores.

Previous research suggests that only about 2% to 3% of teens buy cigarettes online, Ribisl said. But as communities more carefully control cigarette sales in stores, advocates worry that the number online buyers could grow.

"We feel it's a great time – before we see teens flocking to the Internet to buy cigarettes – to put legislation in place to block it," Ribisl said. There is currently no federal legislation banning tobacco sales to minors over the Internet, he noted. And while retail sales to minors are illegal in all 50 states, only a handful ban online sales to children.

"Congress should pass a law that bans Internet cigarette sales to minors and requires age verification at the point of delivery," Ribisl said.

American Cancer Society CEO John Seffrin, PhD, agreed federal legislation is needed.

"Reducing youth initiation of smoking has proven to be one of the most effective ways of cutting future tobacco use, tobacco-related illnesses, and tobacco-related death, and should continue to be an important aspect of a comprehensive tobacco control campaign," he said. "The American Cancer Society has endorsed two pieces of legislation that address the increasing problem of remote cigarette sales." (Those bills are H.R. 2824, the "Internet Tobacco Sales Enforcement Act" and S. 1177, the "Prevent All Cigarette Trafficking Act" (PACT).)

The teen smoking rate has come down recently from a high of 36% in 1997, thanks in part to local tobacco control measures. It is estimated that nearly 30% of US high school students and about 15% of middle school students smoke, despite the serious health consequences. Smoking contributes to more than 400,000 deaths each year in the United States, and is a chief cause of lung cancer and several other cancers, as well as heart disease, emphysema, and stroke.

To examine the risk from Internet cigarette sales, Ribisl and his colleagues recruited four non-smoking young people (ages 11-15) to buy cigarettes from various online vendors. They had the consent of the children's parents and local authorities to conduct the experiment, since selling tobacco to minors or helping them buy tobacco is illegal in North Carolina.

The researchers identified 55 online tobacco vendors, and had the children attempt to purchase cigarettes using either a special credit card that is marketed specifically to minors, or a money order. Out of 83 attempts to buy cigarettes, 76 (92%) were successful, meaning cigarettes were delivered to the children's homes. In all, 50 of the 55 vendors sold a total of 1,650 packs of cigarettes to the children.

Although nearly all of the sites (91%) warned purchasers that they had to be at least 18 years old to buy cigarettes, age was not verified in any of the completed sales. About half the sites required buyers to check a box stating that they were old enough to buy cigarettes; another 15% of sites required buyers to fill in a birth date. In each case, the children in the study simply lied, checking the "yes" box or making up an appropriate birthday.

Nine sites required a copy of a photo identification to complete a sale, but no such proof was submitted. Only four of those sites refused to complete the sale because ID was not provided; the remaining five sites sent the cigarettes anyway.

"Clearly, we need the same standard that we have at retail outlets," Ribisl said. "You need to show photo ID when buying tobacco products (in a store) and we need the same standard to apply on the Internet."

Ribisl said he and his colleagues also were surprised by how easy it was for the children to receive the cigarettes once they had been ordered.

Only one package was clearly labeled as containing tobacco products, and only one required an adult signature for delivery. Just seven packages had return address labels indicating they came from a tobacco vendor.

Sixty-five of the 76 packages delivered were simply left on the doorstep. "That makes me think that these were not sent in a way that requires the delivery person to verify age," Ribisl said.

Vendors can require an adult signature or age verification before a package is delivered, he noted, but it costs extra. There's currently no incentive for vendors to spend that extra money, Ribisl said, "but if you had a law that required all vendors to do this, then it's just a cost of doing business."

That business expense could help prevent minors from getting cigarettes in the mail without a parent's knowledge. Many tobacco control efforts focus on adolescents because nearly all first use of tobacco takes place before people graduate from high school. Banning Internet cigarette sales to minors would support those efforts. Ribisl and colleagues also called for new methods for verifying the age of online buyers.