Preventing Underage Tobacco Access: A Cross-Sectional Study of Retailer Training in Southern Illinois.

Background. Stringent regulations restricting tobacco access to those under 21 are in place, yet young people continue accessing tobacco products. This study aimed to assess the knowledge, opinions, resource utilization, and training needs of tobacco retailers in terms of preventing underage tobacco sales. Methodology. This cross-sectional study analyzed anonymized responses from 467 licensed tobacco retailers in 16 southern counties of Illinois. The survey included 29 questions adapted from validated items, utilized a hybrid methodology (online and in-person), and targeted both retail store owners and managers. Results. Among 118 respondents, 98.3% were aware of the Tobacco-21 law, but 56.8% doubted its impact on reducing underage sales. Gaps in knowledge persisted, especially regarding policies and enforcement laws for Electronic Nicotine Delivery Systems (ENDS). Overall, there was a disparity in preventive measures and program utilization with a low engagement in rural areas and smaller stores. Approximately 48.3% encountered older youths attempting to purchase tobacco. Most respondents (72.9%) supported training for newly hired clerks, focusing on underage sales refusal (54.2%) and ID verification (62.7%). Nearly half (44.9%) felt the need for training in handling aggressive young buyers. The main barrier to training was time constraints for in-person sessions (28.0%), although 41.5% reported no barriers. While "We Card" was widely used (82.2%), only 38.5% displayed the FDA's "This is Our Watch." Conclusion. A discrepancy exists between awareness and effective practice among retailers, especially in rural areas and smaller establishments. Findings highlighted the need for targeted retailer training and resource utilization to combat underage tobacco access.