SAVI Community Trends Report: Unequal Access Tobacco Epidemic Report 2017 FINAL - Page 7

Finally, we compared sociodemographic characteristics 3 and health behaviors across these three different access levels. To do this, we tested the results for significance to ensure the differences between the means for each indicator in each access group were not the result of random occurrence. In the Indy metropolitan area, tobacco retail outlets are concentrated where maternal smoking rates are the highest. We tested all three combinations of groups (low vs. high, medium vs. high, and medium vs. low) for significance using a two-tailed t-test. For low vs. high and low vs. medium, differenc- es in every indicator were significant with 95% confidence. For high vs. medium, differences were significant with 95% confidence for four of the seven indicators. See Appendix B for the p-values resulting from the significance testing. Tobacco Access and Vulnerable Populations In the Indianapolis metro area tobacco retail outlets are concentrated where vulnerable populations live. Poverty is more than three times greater in high tobacco access areas in the Indianapolis metro area than in low access areas. High ac- cess areas also have almost three times more adults without high school diplomas than low access areas. Or, nearly one in four adults in high access areas do not have a high school diploma. In low access areas, that rate is fewer than one in ten. The results demonstrate that in Indianapolis, as in other U.S. cities, tobacco retail outlets are concentrated where smoking rates are pre- dicted to be the highest. In medium and high access groups, the 2014 adult smoking rates, predicted by the 500 Cities Project using the Behavioral Risk Factor Surveillance System (BRFSS) and sociodemographic characteristics, exceed the rate for Indiana. Tobacco access is only part of the issue in Indianapolis, as even in the low access groups, the estimated smok- ing rate exceeds the rate for the United States (16.8%). [51] In Indianapolis, poverty is more than three times greater in high access areas than in low access areas. Individuals with poor mental health are also more vulnerable to tobacco. Nationally, people with psychiatric or addictive disorders consume about 40% of cigarettes purchased and are more likely to be regular and heavy smokers. [9, 54] In Indianapolis, residents with the highest access to tobacco also have the highest rate of self-reported poor mental health. This suggests that this vulnerable population could benefit from actions that decrease tobacco access. More significant, the measured rate of maternal smoking is nearly twice as high in high access areas than in low access areas and is also significantly higher in high access areas than in medium access areas. The maternal s moking rate in high access areas is 1.5 times higher than the 2015 maternal smoking rate in Indiana (14.3%). [52] Maternal smoking rates for all three access groups are higher than the U.S. rate (7.8%). [53] This illustrates that maternal smoking is a significant health issue in India- napolis regardless of level of tobacco access, but also that some geographic communities in Indianapolis are at greater risk than others. The percentage of households without access to a vehicle is more than four times higher in the high access group than the low access group, which may indicate that residents in The reported population characteristics of high, medium, and low access areas are based upon census tract level variables for 2010-2014, the latest available at the time of initial analysis. 3 7