SAVI Community Trends Report: Unequal Access Tobacco Epidemic Report 2017 FINAL | Page 5

39th, with an adult smoking rate of 20.6%, [21]
while Marion County has a rate of 21.8%. [22]
Tobacco use has significant economic and tax
consequences for Indiana. The annual direct
cost of Indiana health care attributable to
smoking is estimated to be $2.93 billion dol-
lars. The state and federal tax burden from
smoking is $903 per household, as measured
by government expenditures. [23] The addi-
tional annual cost for lost productivity due to
tobacco use is estimated at $3.17 billion. [23]
Most Hoosiers who smoke want to quit. [1, 24]
Ready access to tobacco outlets and repeat-
ed exposure to tobacco advertising can make
quitting harder to accomplish. Easy retail ac-
cess to tobacco also makes it more likely that
people will begin to smoke. [25-36] In Indiana,
we have 8,593 licensed tobacco retailers and in
the Indianapolis metro area we have 1,952. [37]
As this report demonstrates, these outlets are
not evenly distributed.
Measuring Access
In order to understand tobacco access in the
Indianapolis metro area, first we collected
several datasets related to tobacco, popula-
tion, and transportation. We obtained a list of
tobacco retailer certificates from the Indiana
Alcohol and Tobacco Commission. These data
include the location of all valid certificates in
Indiana as of January 3, 2017. We used street
centerline information provided by the Indiana
Department of Transportation to map the
location of tobacco retailers. We retrieved
socioeconomic and demographic indicators
from the American Community Survey
(2010-2014 five year estimates) using the
SAVI Community Information System
(SAVI; http://www.savi.org). We also retrieved
the maternal smoking indicator, based on birth
certificate data from the Marion County Public
Health Department, again from SAVI. We used
risks scores for selected health conditions from
Center for Disease Control and Prevention’s
(CDC) 500 Cities small area estimate based
upon the 2014 Behavioral Risk Factor Surveil-
lance System (BRFSS) in January 2017. [47]
Density Matters
Tobacco retail density has become a measure
of environmental health risk. [9, 38, 39] In
addition to providing more opportunities to
purchase tobacco, higher density of retail
tobacco outlets increases exposure to POS
marketing, such as signs that display informa-
tion on available brands, and sales prices, and
prominent in-store product placement. [10, 31,
40-44] POS marketing is one of the few re-
maining means that tobacco retailers can use
to target potential users. [10, 45, 46] Retail den-
sity and POS marketing increase the usage of
tobacco and raise the health risks of residents.
Next, we calculated tobacco access based upon
both the density and accessibility of tobacco
retailers in a given census tract in 2017. As
Figure 1 below shows, we combined three
factors (two measures of density and one of
accessibility) to develop an access score for
each census tract.
HOW ACCESS TO TOBACCO RETAILERS WAS MEASURED
RETAILER DENSITY
NETWORK DENSITY
RETAILER ACCESSIBILITY
WEIGHT
10%
WEIGHT
50%
+
No. of tobacco retailers per
10 km of roadway.
WEIGHT
40%
+
Kilometers of road per square
kilometer of tract area.
Pct. of tract within walking
distance of retailer.
Figure 1. Methodology
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These factors were
combined to provide a
score for each census
tract, and were clustered
to find groups of tracts
with low, medium, and
high access.