SAVI Community Trends Report: Unequal Access Tobacco Epidemic Report 2017 FINAL - Page 8

SAVI community trends » unequal access: tobacco retail in the indianapolis metro area Action Toward Tobacco Control Tobacco control interventions are among the most thoroughly researched strategies to im- prove public health, and we know a lot about which are most effective, in large measure because of funding provided through the 1998 Master Tobacco Settlement. 4 One result of this research are the recommendations from the Institute of Medicine’s (IOM) Ending the Tobacco Problem: A Blueprint for the Nation. [55, 56]. Listed in the table on page 9 are the recom- mended actions that are appropriate at state and local levels. They can serve as a framework for discussing current and potential action. Increasing the price of tobacco products (IOM Recommendation 2) is the single most powerful tool available for curtailing tobacco consumption. [15] Several peer-reviewed economic evaluations have reached the same conclusion—the demand for cigarettes, like other consumer products, is responsive to price. As the price of cigarettes increases, the sale of cigarettes decreases. [57] For every 10% rise in the price of cigarettes, overall cigarette consumption goes down 3 to 5% and smoking among pregnant women goes down 7%. [15, 58] [59] [60-63] Responsiveness to price is most pronounced among males, Blacks, Hispanics, and lower-income smokers. [58, 62, 64, 65] Raising the price of cigarettes is also the most cost-effective tobacco control intervention, because tax increases have consistently increased state revenues after they were enacted. [66] Photo courtesy of these areas have limited mobility – that is, residents in high access areas may more often find themselves in close proximity to higher concentrations of tobacco retailers than residents in low access areas. Demographic disparities in tobacco access in Indianapolis also reflect those found elsewhere. The high tobacco access group had the highest percentage of people of color. Tobacco access in the Indianapolis metro area is similar to what has been found in other parts of the country, with poor and minority areas having a higher density of tobacco outlets. In disadvantaged communities, higher tobacco retail density has been shown to have an even greater negative association with cessation efforts and an even greater positive association with smoking initiation. [3, 25] Because of the previously noted economic burden to Indiana, these disparities impact us all. As such, we have additional incentive to explore how local tobacco control policy and practice can respond to disparities in tobacco access. Indiana currently levies a $0.995 tax on a pack of cigarettes, placing the State of Indiana 37th among states. [58] The average state tax nationally is $1.69 per pack. A broad coalition of business, health care, not-for-profit and academic groups have joined forces to advocate for legislation to raise the tax by $1.50. This increase will not elevate Indiana’s cigarette tax into the top quintile of states as The Master Settlement resulted from a class action suit filed by several states, including Indiana, against the tobacco companies for excess health care costs due to smoking. 4 8