Smoking Statistics Reveal Troubling Trends in Indiana

INDIANAPOLIS – Indiana has the 2nd highest smoking rate in the nation—a habit that causes more deaths than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined. And researchers at IUPUI say that within that grim overall statistic, the numbers for some vulnerable subgroups in Indiana are especially troubling.

Indiana’s high smoking rates are among topics studied by a team of health policy researchers at the Center for Urban Policy and the Environment. Under the direction of Professor Eric Wright, director of health policy research, the team also keeps an eye on policies that can affect the health of Indiana citizens.

“Our health policy researchers are keenly interested in subgroups and issues that affect health disparities,” said Wright. “For example, blacks have one of the highest smoking rates in Indiana. Unfortunately, blacks may also have a higher genetic vulnerability to tobacco-related illnesses and death. Nationally, blacks have a 16 percent higher incidence of lung cancer mortality than whites, a rate that could decline by as much as two-thirds if they did not smoke.”

Wright said that the problem is compounded for blacks who are economically stressed, as this can mean less access to high quality healthcare and smoking cessation programs. Both nationwide and in Indiana, the poor and less educated have some of the highest smoking rates.

Blacks may also be more susceptible to tobacco addiction because of genetic factors. Cotinine—a major byproduct in the metabolism of nicotine—is broken down more slowly in the blood of black smokers, increasing the amount of nicotine absorbed in the body and the likelihood of tobacco dependence.

“In addition,” Wright said, “cultural preferences may be a factor, such as a preference among blacks for mentholated cigarettes, which contain more nicotine and are thus more addictive.”

“Each of these factors has a compounding effect,” said Wright, “with the result that blacks are more likely to smoke tobacco and, when they do smoke, they are both more likely to become dependent on tobacco and to develop a related illness.”

“Pregnant women are another group highly vulnerable to tobacco,” said Wright. Unfortunately, in 2004, Indiana had the sixth highest rate in the nation for pregnant women who smoke. Smoking increases the risk to their infants for preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome. Mothers who smoke during pregnancy are 2.4 times likely to have a child that is small for their gestational age and more than twice as likely to have an infant with low birth weight.

Although it appears that social marketing campaigns and perinatal physician consultations helped to cut the smoking rate among pregnant women in Indiana by 30 percent between 1990 and 2003, it continues to be a major problem in the state.

Wright said that Indiana launched a massive media and marketing campaign in 2000, and it appeared to be successful as the state’s smoking rates began to drop. Directed by the Indiana Tobacco Prevention and Cessation Agency, the campaign included TV ads and two websites, www.whiteLies.tv and www.voice.tv, that had more than five million hits combined. However, the ITPC’s budget has been cut by more than two-thirds since 2003—a decrease that may have been reflected in the state’s recent increase in smoking rates.

The Center’s health policy group published an issue brief about smoking rates in Indiana and public health initiatives that help combat the problem. The report, Troubling Trends in Indiana: Most Vulnerable Groups Have Highest Smoking Rates, is available on the Center website.

The Center for Urban Policy and the Environment is a nonpartisan applied research organization in the School of Public and Environmental Affairs at Indiana University–Purdue University Indianapolis. For more information, contact the Center at 261-3000, or visit the Center’s Web site (http://www.urbancenter.iupui.edu/).