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 5 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.