A long way come, a long way to go Photo courtesy of WhyQuit.com health issues want to quit, but for some of them it’s a coping mechanism, or strategy, that helps them reduce their stress.” There are good reasons to quantify tobacco retailing in relationship to high smoking rates in Indiana and the Indianapolis metro area. The stakes are high on multiple levels, beginning with economics. Each year, healthcare expenses related to smoking cost Indiana an estimated $3 billion. The state and federal tax bill for treating smoking-related diseases, per household, is about $900. And, the annual cost for lost productivity due to smoking is another estimated $3 billion. Smoking also imposes profound human costs across all age ranges. Nearly 20 percent of deaths in the state are attributable to it, according to Caine, while in Utah, which has the lowest percent of smoking-related deaths, the figure is less than 10 percent. 10 The “common sense” about smoking, which blames it on a weakness of individual will, underplays the addictive power of tobacco and the power of marketing that targets vulnerable populations. Tobacco is “aggressively and skillfully marketed by the tobacco companies,” Caine says, and smoking is “often perceived as a bad habit that’s easily broken. Too often, it’s not seen as a public health issue” that can be dramatically influenced—for good or bad—by public policy. Caine notes that Indiana has had some notable recent success in this arena. Over the past five years, the smoking rate has dropped by several points, from the mid-20s to the low-20s, and there are some small but important signs of progress. For example, the Indianapolis Motor Speedway recently announced that it would ban smoking in grandstand seats beginning in late 2017. “We’ve come a long way,” Caine says. “I don’t think, even 10 to 15 years ago, people realized the extent of the harm done by smoking.” For all the progress, though, much more could be done. Indiana should invest about $74 million per year in tobacco control, according to the Centers for Disease Control’s recommendation. Yet the state’s tobacco control programs receive only $7 million annually in state and federal funding. Tobacco companies, meantime, spend nearly $285 million on marketing their products in the state each year.