Attachment C - 008 Changes - Marked Copy

ANNUAL SYNAR REPORT

42 U.S.C. 300x-26

OMB № 0930-0222

2008

FFY 2007

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Substance Abuse Prevention

www.samhsa.gov

Table of Contents

Introduction ii

Funding Agreements/Certifications 1

Section I: FFY 2004 (Compliance Progress) 2 5

Section II: FFY 2005 (Intended Use) 8 12

Appendix A: Forms 10 13

Appendix B: Synar Survey Sampling Methodology 18 22

Appendix C: Synar Survey Inspection Protocol 21 25

Appendix D: List Sampling Frame Coverage Study 23 27

INTRODUCTION

The Annual Synar Report (ASR) format provides the means for States to comply with the reporting provisions of the Public Health Service Act (42 U.S.C. 300x-26) and the Tobacco Regulation for the SAPT Block Grant (45 C.F.R. 96.130 (e)).

Public reporting burden for the collection of information is estimated to average 15 hours for Section I and 3 hours for Section II, including the time for reviewing instructions, completing and reviewing the collection of information, searching existing data sources, and gathering and maintaining the data needed. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to SAMHSA Reports Clearance Officer; Paperwork Reduction Project (0930-0222); 1 Choke Cherry Road, 7^th Floor Rockville, Maryland 20857

An agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-0222 with an expiration date of 08/31/2007.

How the Synar report helps the Center for Substance Abuse Prevention

In accordance with the tobacco regulations, States are required to provide detailed information on progress made in enforcing youth tobacco access laws (FFY xxxx Compliance Progress) and future plans to ensure compliance with the Synar requirements to reduce youth tobacco access rates (FFY xxxx Intended Use Plan). These data are required by 42 U.S.C. 300x-26 and will be used by the Secretary to evaluate State compliance with the statute. Part of the mission of the Center for Substance Abuse Prevention (CSAP) is to assist States¹ by supporting Synar activities and providing technical assistance helpful in determining the type of enforcement measures and control strategies that are most effective. This information is helpful to CSAP in improving technical assistance resources and expertise on enforcement efforts and tobacco control program support activities, including State Synar Program support services, through an enhanced technical assistance program involving conferences and workshops, development of training materials and guidance documents, and on-site technical assistance consultation.

How the Synar report can help States

The information gathered for the Synar report can help States describe and analyze sub-State needs for program enhancements. These data can also be used to report to the State legislature and other State and local organizations on progress made to date in enforcing youth tobacco access laws when aggregated statistical data from State Synar reports can demonstrate to the Secretary the national progress in reducing youth tobacco access problems. This information will also provide Congress with a better understanding of State progress in implementing Synar, including State difficulties and successes in enforcing retailer compliance with youth tobacco access laws.

Getting assistance in completing the Synar report

If you have questions about programmatic issues, you may call CSAP’s Division of State and Community Systems Development at (301) 443-0369 and ask for your respective State Project Officer, or contact your State Project Officer directly by telephone or e-mail using the directory provided. If you have questions about fiscal or grants management issues, you may call the Grants Management Officer, Office of Program Services, Division of Grants Management, at (301) 443-4456.

Where and when to submit the Synar report

The Annual Synar Report (ASR) must be received by SAMHSA no later than December 31, 2004 2007. The ASR must be submitted in the approved OMB report format. Use of the approved format will avoid delays in the review and approval process. The chief executive officer (or an authorized designee) of the applicant organization must sign page 1 of the ASR certifying that the State has complied with all reporting requirements.

Submit one signed original of the report, one additional copy, and an electronic version on either CD-ROM or 3.5” diskette to the Grants Management Officer at the address below:

Grants Management Officer

Office of Program Services, Division of Grants Management

Substance Abuse and Mental Health Services Administration

Regular Mail: Overnight Mail:

1 Choke Cherry Road, 7^th Floor 1 Choke Cherry Road, 7^th Floor

Rockville, Maryland 20857 Rockville, Maryland 20850

FFY 2005 2008: Funding Agreements/Certifications

The following form must be signed by the Chief Executive Officer or an authorized designee and submitted with this application. Documentation authorizing a designee must be attached to the application.

PUBLIC HEALTH SERVICES ACT AND SYNAR AMMENDMENT
42 U.S.C. 300x-26 requires each State to submit an annual report of its progress in meeting the requirements of the Synar Amendment and its implementing regulation (45 C.F.R. 96.130) to the Secretary of the Department of Health and Human Services. By signing below, the chief executive officer (or an authorized designee) of the applicant organization certifies that the State has complied with these reporting requirements and the certifications as set forth below.
SYNAR SURVEY SAMPLING METHODOLOGY
The State certifies that the Synar survey sampling methodology on file with the Center for Substance Abuse Prevention and submitted with the Annual Synar Report for FFY 2005 is up-to-date and approved by the Center for Substance Abuse Prevention.
SYNAR SURVEY INSPECTION PROTOCOL
The State certifies that the Synar Survey Inspection Protocol on file with the Center for Substance Abuse Prevention and submitted with the Annual Synar Report for FFY2005 is up-to-date and approved by the Center for Substance Abuse Prevention.
State:
Name of Chief Executive Officer or Designee:
Signature of CEO or Designee:
Title:			Date Signed:
If signed by a designee, a copy of the designation must be attached

SECTION I: FFY 2006 2007(Compliance Progress)

YOUTH ACCESS LAWS, ACTIVITIES, AND ENFORCEMENT

42 U.S.C. 300x-26 requires the States to report information regarding the sale/distribution of tobacco products to individuals under age 18.

1. Please indicate any changes or additions to the State tobacco statute(s) relating to youth access since the last reporting year. Please attach a photocopy of the change(s) in the State law(s) if any was made since the last reporting year. (See 42 U.S.C. 300x-26)

1. Has there been a change in the minimum sale age for tobacco products?

Yes No

If Yes, current minimum age: 19 20 21

b. Have there been any changes in State law that impact the State’s protocol for conducting Synar inspections? Yes No

If Yes, indicate change (check all that apply):

Changed to require that law enforcement conduct inspections of tobacco outlets

Changed to make it illegal for youth to possess, purchase or receive tobacco

Changed to require ID to purchase tobacco

Other change(s) (please describe):

c. Have there been any changes in the law concerning vending machines?

Yes No

If Yes, indicate change (check all that apply):

Total ban enacted

Banned from location(s) accessible to youth

Locking device or supervision required

Other change(s) (please describe):

4. Have there been any changes in State law that impact the following?

Licensing of tobacco vendors Yes No

Penalties for sales to minors Yes No

2. Describe how the Annual Synar Report (see 45 C.F.R. 96.130(e)) and the State Plan (see 42 U.S.C. 300x-51) were made public within the State prior to submission of the ASR. (Check all that apply)

Placed on file for public review

Posted on a State agency Web site (please provide exact web address)

Notice published in a newspaper or newsletter

Public hearing

Announced in a news release, a press conference, or discussed in a media interview

Distributed for review as part of the SAPT Block Grant application process

Distributed through the public library system

Published in an annual register

Other change(s) (please describe):

3. Identify the following agency or agencies. (See 42 U.S.C. 300x-26 and 45 C.F.R. 96.130)

a. The State agency(s) designated by the Governor for oversight of the Synar requirements:

Has this changed since last year’s Annual Synar Report? Yes No

b. The State agency(s) responsible for conducting random, unannounced Synar inspections:

Has this changed since last year’s Annual Synar Report? Yes No

c. The State agency(s) responsible for enforcing youth tobacco access law(s):

Has this changed since last year’s Annual Synar Report? Yes No

4. Identify the State agency(s) responsible for tobacco prevention control activities.

Has the responsible agency changed since last year’s Annual Synar Report?

Yes No

a. Describe the coordination and collaboration that occur between the agency responsible for tobacco control prevention and the agency responsible for oversight of the Synar requirements. The two agencies (check all that apply):

Are the same

Have a formal written memorandum of agreement

Have an informal partnership

Conduct joint planning activities

Combine resources

Have other collaborative arrangement(s) (please describe):

5. Please answer the following questions regarding the State’s activities to enforce the youth access to tobacco law(s) in FFY 2006. (See 42 U.S.C. 300x-26 and 45 C.F.R. 96.130(e))

a. Which one of the following describes the enforcement of youth access to tobacco laws carried out in your State? (Check one category only)

Enforcement is conducted exclusively by local law enforcement agencies.

Enforcement is conducted exclusively by State agency(s).

Enforcement is conducted by both local and State agencies.

b. The following items concern penalties imposed for violations of youth access to tobacco laws by LOCAL AND/OR STATE LAW ENFORCEMENT AGENCIES. Please fill in the number requested or indicate if these data are unavailable or the item is not applicable. If State law does not provide for tobacco retailer license/permit suspension or revocation, please mark “NA”.

	[DELETE COLUMN]		[DELETE COLUMN]	[DELETE COLUMN]	If Available
PENALTY	NOT APPLICABLE		NOT AVAILABLE	TOTAL	Owners	Clerks	TOTAL
Number of citations issued
Number of fines assessed
Number of permits/licenses suspended					[Shading Deleted]
Number of permits/licenses revoked					[Shading Deleted]
Other (please describe):

c. What additional activities are conducted in your State to support enforcement and compliance with State tobacco access law(s)? (Check all that apply)

Merchant education and/or training

Incentives for merchants who are in compliance (e.g., Reward and Reminder)

Community education regarding youth access laws

Media use to publicize compliance inspection results

Community mobilization to increase support for retailer compliance with youth access laws

Other activities (please list):

Briefly describe all checked activities:

4. Are citations or warnings issued to retailers or clerks who sell tobacco to minors for inspections that are part of the Synar survey?  Yes  No

4. If “Yes” to 5.d., please describe the State’s procedure for minimizing risk of bias to the survey results:

SYNAR SURVEY METHODS AND RESULTS

The following questions pertain to the survey methodology and results of the Synar survey used by the State to meet the requirements of the Synar Regulation in FFY 2006. (See 42 U.S.C. 300x-26 and 45 C.F.R. 96.130)

6. Has the sampling methodology changed from the previous year?

Yes No

The State is required to have an approved up-to-date description of the Synar sampling methodology on file with CSAP. Please submit a copy of your Synar Survey Sampling Methodology (Appendix B). If If the sampling methodology changed from the previous reporting year, these changes must be reflected in the methodology submitted.

7. Please answer the following questions regarding the State’s annual random, unannounced inspections of tobacco outlets. (See 45 C.F.R. 96.130(d)(2))

a. Did the State use the optional Synar Survey Estimation System (SSES) to analyze the Synar survey data?

Yes No

If Yes, attach SSES summary tables 1, 2, 3 and 4 and go to Question 8. If No, continue to Question 7b.

b. Report the weighted and unweighted Retailer Violation Rate (RVR) estimates, and the standard error.

Unweighted RVR

Weighted RVR

Standard error (s.e.) of the (weighted) RVR

Fill in the blanks to calculate the right limit of the right-sided 95% confidence interval.

	+	(1.645	×	)	=
RVR Estimate	Plus	(1.645	times	Standard Error)	equals	Right Limit

c. Fill out Form 1 in Appendix A (Forms). (Required regardless of the sample design)

d. How were the (weighted) RVR estimate and its standard error obtained? (Check the one that applies)

Form 2 (Optional) in Appendix A (Forms) (Attach completed Form 2)

Other (Please specify. Provide formulae and calculations or attach and explain the program code and output with description of all variable names.)

e. If stratification was used, did any strata in the sample contain only one outlet or cluster this year?

Yes No No stratification

If Yes, explain how this situation was dealt with in variance estimation.

f. Was a cluster sample design used?

Yes No

If No, go to Question 7g.

If Yes, fill out and attach Form 3 in Appendix A (Forms), and answer the following question:

Were any certainty primary sampling units selected this year?

Yes No

If Yes, explain how the certainty clusters were dealt with in variance estimation.

g. Report the following outlet sample sizes for the Synar survey.

	Sample Size
Effective sample size (sample size needed to meet the SAMHSA precision requirement assuming simple random sampling)
Target sample size (the product of the effective sample size and the design effect)
Original sample size (inflated sample size of the target sample to counter the sample attrition due to ineligibility and non-completion)
Eligible sample size (number of outlets found to be eligible in the sample)
Final sample size (number of eligible outlets in the sample for which an inspection was completed)

8. Fill out Form 4 in Appendix A (Forms).

8. Did the State’s Synar survey use a list frame?

Yes No

If Yes, answer the following questions about its coverage:

a. The calendar year of the latest frame coverage study:

b. Percent coverage from the latest frame coverage study:

c. Was a new study conducted in this reporting period? Yes No

If Yes, please complete Appendix D (List Sampling Frame Coverage Study) and submit it with the Annual Synar Report.

d. The calendar year of the next coverage study planned:

9. Has the Synar survey inspection protocol changed from the previous year?

Yes No

The State is required to have an approved up-to-date description of the Synar inspection protocol on file with CSAP. Please submit a copy of your Synar Survey Inspection Protocol (Appendix C). If the inspection protocol changed from the previous year, these changes must be reflected in the protocol submitted.

From:		To:
	MM/DD/YY		MM/DD/YY

a. Provide the inspection period:

b. Provide the number of youth inspectors used in the current inspection year:

NOTE: If the State uses SSES, please ensure that the number reported in 9.b. matches that reported in SSES Table 4, or explain any difference.

c. Fill out and attach Form 5 in Appendix A (Forms). (Not required if the State used the Synar Survey Estimation System (SSES) to analyze the Synar survey data)

SECTION II: FFY 2005 2008 (Intended Use):

Public law 42 U.S.C. 300x-26 of the Public Health Service Act and 45 C.F.R. 96.130 (e) (4, 5) require that the States provide information on future plans to ensure compliance with the Synar requirements to reduce youth tobacco access.

1. In the upcoming year, does the State anticipate any changes in the:

Synar sampling methodology Yes No

Synar inspection protocol Yes No

If changes are made in either the Synar sampling methodology or the Synar inspection protocol, the State is required to obtain approval from CSAP prior to implementation of the change and file an updated Synar Survey Sampling Methodology (Appendix B) or an updated Synar Survey Inspection Protocol (Appendix C), as appropriate.

2. Please describe the State’s plans to maintain and/or reduce the target rate for Synar inspections to be completed in FFY 20072008. Include a brief description of plans for law enforcement efforts to enforce youth tobacco access laws, activities that support law enforcement efforts to enforce youth tobacco access laws, and any anticipated changes in youth tobacco access legislation or regulation in the State.

3. Describe any challenges the State faces in complying with the Synar regulation. (Check all that apply)

Limited resources for law enforcement of youth access laws

Limited resources for activities to support enforcement and compliance with youth tobacco access laws

Limitations in the State youth tobacco access laws

Limited public support for enforcement of youth tobacco access laws

Limitations on completeness/accuracy of list of tobacco outlets

Limited expertise in survey methodology

Laws/regulations limiting the use of minors in tobacco inspections

Difficulties recruiting youth inspectors

Geographic, demographic, and logistical considerations in conducting inspections

Cultural factors (e.g., language barriers, young people purchasing for their elders)

Issues regarding sources of tobacco under tribal jurisdiction

Other challenges (please list):

Briefly describe all checked challenges and propose a plan for each, or indicate the State’s need for TA related to each relevant challenge:

APPENDIX A: FORMS

FORM 1 (Required for all States not using the Synar Survey Estimation System (SSES) to analyze the Synar Survey data)

Complete Form 1 to report sampling frame and sample information and to calculate the unweighted retailer violation rate using results from the current year’s Synar survey inspections.

Instructions for Completing Form 1: In the top right hand corner of the form, provide the State name and reporting Federal fiscal year (FFY 2007). Provide the remaining information by stratum if stratification was used. Make copies of the form if additional rows are needed to list all the strata.

Column 1: If stratification was used:

1(a) Sequentially number each row.

1(b) Write in the name of each stratum. All strata in the State must be listed.

If no stratification was used:

1(a) Leave blank.

1(b) Write “State” in the first row (indicates that the whole state is a single stratum).

Note for unstratified samples: for columns 2-5, wherever the instruction refers to “each stratum,” report the specified information for the State as a whole.

Column 2: 2(a) Report the number of over-the-counter (OTC) outlets in the sampling frame in each stratum.

2(b) Report the number of vending machine (VM) outlets in the sampling frame in each stratum.

2(c) Report the combined total of OTC and VM outlets in the sampling frame in each stratum.

Column 3: 3(a) Report the estimated number of eligible OTC outlets in the OTC outlet population in each stratum.

3(b) Report the estimated number of eligible VM outlets in the VM outlet population in each stratum.

3(c) Report the combined total estimated number of eligible OTC and VM outlets in the total outlet population in each stratum.

The estimates for Column 3 can be obtained from the Synar survey sample as the weighted sum of eligible outlets by outlet type.

Column 4: 4(a) Report the number of eligible OTC outlets for which an inspection was completed, for each stratum.

4(b) Report the numbers of eligible VM outlets for which an inspection was completed, for each stratum.

4(c) Report the combined total of eligible OTC and VM outlets for which an inspection was completed, for each stratum.

Column 5: 5(a) Report the number of OTC outlets found in violation of the law as a result of completed inspections, for each stratum.

5(b) Report the number of VM outlets found in violation of the law as a result of completed inspections, for each stratum.

5(c) Report the combined total of OTC and VM outlets found in violation of the law as a result of completed inspections, for each stratum.

Totals: For each sub-column (a-c) in Columns 2-5, provide totals for the State as a whole in the last row of the table. These numbers will be the sum of the numbers in each row for the respective column.

FORM 1 (Required for all States not using the Synar Survey Estimation System (SSES) to analyze the Synar Survey data)

Summary of Synar Inspection Results by Stratum State _______ FFY ________

(1)

(2)

(3)

(4)

(5)

STRATUM

NUMBER OF OUTLETS IN SAMPLING FRAME

ESTIMATED NUMBER OF ELIGIBLE OUTLETS IN POPULATION

NUMBER OF OUTLETS INSPECTED

NO. OF OUTLETS FOUND IN VIOLATION DURING INSPECTIONS

(a) Row #

(b) Stratum Name

(a) Over-the-Counter (OTC)

(b) Vending Machines (VM)

(c) Total Outlets (2a+2b)

(a) Over-the-Counter (OTC)

(b) Vending Machines (VM)

(c) Total Outlets (3a+3b)

(a) Over-the- Counter (OTC)

(b) Vending Machines (VM)

(c) Total Outlets (4a+4b)

(a) Over-the-Counter (OTC)

(b) Vending Machines (VM)

(c) Total Outlets (5a+5b)

RECORD COLUMN TOTALS ON LAST LINE (LAST PAGE ONLY IF MULTIPLE PAGES ARE NEEDED)

FORM 2 (Optional)

Appropriate for stratified simple or systematic random sampling designs.

Complete Form 2 to calculate the weighted RVR. This table (in Excel form) is designed to calculate the weighted RVR for stratified simple or systematic random sampling designs, accounting for ineligible outlets and non-complete inspections encountered during the annual Synar survey.

Instructions for Completing Form 2:

In the top right hand corner of the form, provide the State name and reporting Federal fiscal year (FFY2005).

Column 1: Write in the name of each stratum into which the sample was divided. These should match the strata reported in Column 1(b) of Form 1.

Column 2: Report the number of outlets in the sampling frame in each stratum. These numbers should match the numbers reported for the respective strata in Column 2(c) of Form 1.

Column 3: Report the original sample size (the number of outlets originally selected, including substitutes or replacements) for each stratum.

Column 4: Report the number of sample outlets in each stratum that were found to be eligible during the inspections. Note that this number must be less than or equal to the number reported in Column 3 for the respective strata.

Column 5: Report the number of eligible outlets in each stratum for which an inspection was completed. Note that this number must be less than or equal to the number reported in Column 4. These numbers should match the numbers reported in Column 4(c) of Form 1 for the respective strata.

Column 6: Report the number of eligible outlets inspected in each stratum that were found in violation. These numbers should match the numbers reported in Column 5(c) of Form 1 for the stratum.

Column 7: Form 2 (in Excel form) will automatically calculate the stratum RVR for each stratum in this column. This is calculated by dividing the number of inspected eligible outlets found in violation (Column 6) by the number of inspected eligible outlets (Column 5). The State unweighted RVR will be shown in the Total row of Column 7.

Column 8: Form 2 (in Excel form) will automatically calculate the estimated number of eligible outlets in the population for each stratum. This calculation is made by multiplying the number of outlets in the sampling frame (Column 2) times the number of eligible outlets (Column 4) divided by the original sample size (Column 3). Note that these numbers will be less than or equal to the numbers in Column 2.

Column 9: Form 2 (in Excel form) will automatically calculate the relative stratum weight by dividing the estimated number of eligible outlets in the population for each stratum in Column 8 by the Total of the values in Column 8.

Column 10: Form 2 (in Excel form) will automatically calculate each stratum’s contribution to the State weighted RVR by multiplying the stratum RVR (Column 7) by the relative stratum weight (Column 9). The weighted RVR for the State will be shown in the Total row of Column 10.

Column 11: Form 2 (in Excel form) automatically calculates the standard error of each stratum’s RVR (Column 7). The standard error for the State weighted RVR will be shown in the Total row of Column 11.

TOTAL: For Columns 2-6, Form 2 (in Excel form) provides totals for the State as a whole in the last row of the table. For Columns 7-11, it calculates the respective statistic for the State as a whole.

FORM 2 (Optional) Appropriate for stratified simple or systematic random sampling designs.

Calculation of Weighted Retailer Violation Rate
State:
FFY:
(1) Stratum Name	(2) N Number of Outlets in Sampling Frame	(3) n Original Sample Size	(4) n1 Number of Sample Outlets Found Eligible	(5) n2 Number of Outlets Inspected	(6) x Number of Outlets Found in Violation	(7) p=x/n2 Stratum Retailer Violation Rate	(8) N’=N(n1/n) Estimated Number of Eligible Outlets in Population	(9) w=N’/Total Column 8 Relative Stratum Weight	(10) pw Stratum Contribution to State Weighted RVR		(11) s.e. Standard Error of Stratum RVR
TOTAL

N - number of outlets in sampling frame

n - original sample size (number of outlets in the original sample)

n1 - number of sample outlets that were found to be eligible

n2 - number of eligible outlets that were inspected

x - number of inspected outlets that were found in violation

p - stratum retailer violation rate (p=x/n2)

N’ - estimated number of eligible outlets in population (N’=N*n1/n)

w - relative stratum weight (w=N’/Total Column 8)

pw - stratum contribution to the weighted retailer violation rate

s.e. - standard error of the stratum RVR

FORM 3 (Required when a cluster design is used for all States not using the Synar Survey Estimation System (SSES) to analyze the Synar survey data)

Complete Form 3 to report information about primary sampling units when a cluster design was used for the Synar survey.

Instructions for Completing Form 3:

In the top right hand corner of the form, provide the State name and reporting Federal fiscal year (FF2007).

Provide information by stratum if stratification was used. Make copies of the form if additional rows are needed to list all the strata.

Column 1: Sequentially number each row.

Column 2: If stratification was used: Write in the name of stratum. All strata in the State must be listed.

If no stratification was used: write “State” in the first row to indicate that the whole state constitutes a single stratum.

Column 3: Report the number of primary sampling units (PSUs) (i.e., first-stage clusters) created for each stratum.

Column 4: Report the number of PSUs selected in the original sample for each stratum.

Column 5: Report the number of PSUs in the final sample for each stratum.

TOTALS: For Columns 3-5, provide totals for the State as a whole in the last row of the table.

Summary of Clusters Created and Sampled
State:
FFY:
(1) Row #	(2) Stratum Name	(3) Number of PSUs Created	(4) Number of PSUs Selected	(5) Number of PSUs in the Final Sample
TOTAL

FORM 4 (Required for all States not using the Synar Survey Estimation System (SSES) to analyze the Synar Survey data)

Complete Form 4 to provide detailed tallies of ineligible sample outlets by reasons for ineligibility and detailed tallies of eligible sample outlets with noncomplete inspections by reasons for noncompletion.

Instructions for Completing Form 4:

In the top right hand corner of the form, provide the State name and reporting Federal fiscal year (FF2005).

Column 1(a): Enter the number of sample outlets found ineligible for inspection by reason for ineligibility. Provide the total number of ineligible outlets in the row marked “Total”.

Column 2(a): Enter the number of eligible sample outlets with noncomplete inspections by reason for noncompletion. Provide the total number of eligible outlets with noncomplete inspections in the row marked “Total”.

Inspection tallies by reason of ineligibility or noncompletion
State
FFY
(1) INELIGIBLE		(2) ELIGIBLE
Reason for ineligibility	(a) Counts	Reason for noncompletion		(a) Counts
Out of business		In operation but closed at time of visit
Does not sell tobacco products		Unsafe to access
Inaccessible by youth		Presence of police
Private club or private residence		Youth inspector knows salesperson
Temporary closure		Moved to new location
Unlocatable		Drive thru only/youth inspector has no driver’s license
Wholesale only/Carton sale only		Tobacco out of stock
Vending machine broken		Run out of time
Duplicate		Other noncompletion reason(s) (describe)
Other ineligibility reason(s) (describe)
Total		Total

FORM 5 (Required for all States not using the Synar Survey Estimation System (SSES) to analyze the Synar survey data)

Complete Form 5 to show the distribution of outlet inspection results by age and gender of the youth inspectors.

Instructions for Completing Form 5:

In the top right hand corner of the form, provide the State name and reporting Federal fiscal year (FFY2007).

Column 1: Enter the number of attempted buys by youth inspector age and gender.

Column 2: Enter the number of successful buys by youth inspector age and gender.

If the inspectors are age eligible but the gender of the inspector is unknown, include those inspections in the “OTHER” row. Calculate subtotals for males and females in rows marked SUBTOTALS. Sum SUBTOTALS for male, female, and OTHER and record in the bottom row marked TOTAL. Verify that that the TOTAL of attempted buys and successful buys equal the total for Column 4(c) and Column 5(c), respectively, on Form 1. If the totals do not match, please explain any discrepancies.

Synar Survey Inspector Characteristics		State
		FFY
	(1) Attempted Buys		(2) Successful Buys
Male
14 yrs [Delete Row]
15 yrs
16 yrs
17 yrs
18 yrs
MALE SUBTOTAL
Female
14 yrs [Delete Row]
15 yrs
16 yrs
17 yrs
18 yrs
FEMALE SUBTOTAL
OTHER
TOTAL

Appendices B & C: Forms

Instructions

Appendix B (Sampling Design) and Appendix C (Inspection Protocol) are to reflect the State’s CSAP-approved sampling design and inspection protocol. These appendices, therefore, should generally describe the design and protocol and are not to be modified with year-specific information. Please note that any changes to either appendix must receive CSAP’s advance written approval. To facilitate the State’s completion of this section, simply “cut and paste” the previously approved sampling design (Appendix B) and inspection protocol (Appendix C).

APPENDIX B

	STATE:
	FFY:

SYNAR SURVEY SAMPLING METHODOLOGY

1. What type of sampling frame is used?

List frame (Go to Question 2)

Area frame (Go to Question 3)

List-assisted area frame (Go to Question 2)

2. List all sources of the list frame. Indicate the type of source from the list below. Provide a brief description of the frame source. Explain how the lists are updated (method), including how new outlets are identified and added to the frame. In addition, explain how often the lists are updated (cycle). (After completing this question, go to Question 4)

Use the corresponding number to indicate Type of Source in the table below:

1 – Statewide commercial business list	4 – Statewide retail license/permit list
2 – Local commercial business list	5 – Statewide liquor license/permit list
3 – Statewide tobacco license/permit list	6 – Other

Name of Frame Source	Type of Source	Description	Updating Method and Cycle

3. If an area frame is used, describe how area sampling units are defined and formed.

a. Is any area left out in the formation of the area frame? Yes No

If Yes, what percentage of the State’s population is not covered by the area frame?

%

4. Federal regulation requires that vending machines be inspected as part of the Synar survey. Are vending machines included in the Synar survey?

Yes No

If No, please indicate the reason they are not included in the Synar survey.

State law bans vending machines

State law bans vending machines from locations accessible to youth

State has SAMHSA approval to exempt vending machines from the survey

Other (please describe):

5. Which category below best describes the sample design? (Check only one)

Census (STOP HERE: Appendix B is complete)

Unstratified State-wide sample:

Simple random sample (go to Question 9)

Systematic random sample (go to Question 6)

Single-stage cluster sample (go to Question 8)

Multi-stage cluster sample (go to Question 8)

Stratified sample:

Simple random sample (go to Question 7)

Systematic random sample (go to Question 6)

Single-stage cluster sample (go to Question 7)

Multi-stage cluster sample (go to Question 7)

Other (please describe and go to Question 9):

6. Describe the systematic sampling methods. (After completing Question 6, go to Question 7 if stratification is used. Otherwise go to Question 9.)

7. Provide the following information about stratification

a. Provide a full description of the strata that are created.

b. Is clustering used within the stratified sample?

Yes (go to Question 8)

No (go to Question 9)

8. Provide the following information about clustering

a. Provide a full description of how clusters are formed. (If multi-stage clusters are used, give definitions of clusters at each stage.)

b. Specify the sampling method (simple random, systematic, or probability proportional to size sampling) for each stage of sampling and describe how the method(s) is (are) implemented.

9. Provide the formulae for determining the effective, target, and original outlet sample sizes.

APPENDIX C

	STATE:
	FFY:

SYNAR SURVEY INSPECTION PROTOCOL

Note: Attach a copy of the inspection form and protocol used to record the inspection result.

1. How does the State Synar survey protocol address the following?

a. Consummated buy attempts?

Required Not Permitted

Permitted under specified circumstances Not specified in protocol

b. Youth inspectors to carry ID?

Required Not Permitted

Permitted under specified circumstances Not specified in protocol

c. Adult inspectors to enter the outlet?

Required Not Permitted

Permitted under specified circumstances Not specified in protocol

d. Youth inspectors to be compensated?

Required Not Permitted

Permitted under specified circumstances Not specified in protocol

2. Identify the agency(s) or entity(s) that actually conduct the random, unannounced Synar inspections of tobacco outlets. (Check all that apply)

Law enforcement agency(s)

State or local government agency(s) other than law enforcement

Private contractor(s)

Other

List the agency name(s):

3. Are Synar inspections combined with law enforcement efforts (i.e., do law enforcement issue warnings or citations to retailers found in violation of the law at the time of the inspection)?

Always Usually Sometimes Rarely Never

4. Describe the methods used to recruit, select, and train youth inspectors and adult supervisors.

5. Are there specific legal or procedural requirements instituted by the State to address the issue of youth inspectors’ immunity when conducting inspections?

a. Legal Yes No (If Yes, please describe):

b. Procedural Yes No (If Yes, please describe):

6. Are there specific legal or procedural requirements instituted by the State to address the issue of the safety of youth inspectors during all aspects of the Synar inspection process?

a. Legal Yes No (If Yes, please describe):

b. Procedural Yes No (If Yes, please describe):

7. Are there any other legal or procedural requirements the State has regarding how inspections are to be conducted (e.g., age of youth inspector, time of inspections, training that must occur)?

a. Legal Yes No (If Yes, please describe):

b. Procedural Yes No (If Yes, please describe):

APPENDIX D

	STATE:
	FFY:

List Sampling Frame Coverage Study

(LIST FRAME ONLY)

1. Calendar year of the coverage study:

2. Percent coverage found: %

(Provide calculation of the percent coverage)

3. Provide a description of the coverage study methods and results.

1 ^?The term State is used to refer to all the States and territories required to comply with Synar as part of the Substance Abuse Prevention and Treatment Block Grant Program requirements (42 U.S.C. 300x-64 and 45 C.F.R. 96.121).

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