Our state of health: Indiana's smoking and obesity rankings are still poor. Increase the cigarette tax?

• Author: McKimmie, Kathy
• Position: HEALTH & FITNESS

THE ADVICE HASN'T changed over the years: eat right, exercise and shun tobacco. Do these things, we're told, and we'll live healthier and longer. Maybe the message is too subtle for us Hoosiers, or maybe we're just a contrary lot, but we consistently rank in the pitiful category among the states. Indiana is second in the percentage of smokers and 10th in the percentage of obese people, says Dr. Judith Monroe, state health commissioner: 27 percent of Hoosiers qualify in each category.

There's a simple way to improve our smoking ranking, she says. Raise the cigarette tax. "For every 10 percent increase, you decrease youth smoking by 7 percent, 4 percent for adults." Indiana's tax is the lowest in the Midwest. Michigan, for instance, charges $2 a pack in taxes, she says, while Indiana's tax is less than 56 cents. Simple, yes. Easy, no. Even with the governor's support, the proposed cigarette tax hike in the 2006 session died because "legislators opposed any tax increase," she says. Ninety percent of smokers start as teens, and they are particularly impacted by price.

Humorist Andy Rooney jabbed smoking recently in his "60 Minutes" segment, mulling what to do with out-of-use ashtrays and questioning who could afford the hefty $75 price tag on a carton of Marlboros. Hoosiers just can't relate--those cigs would cost only $33 here.

Local smoke-free ordinances help smokers quit, says Monroe, because the increase in smoke-free environments becomes an incentive to try. "Eighty percent of smokers would like to quit. They realize the toll it takes on their health." The couple dozen ordinances on the books is a great start, but Monroe says the tipping point for passage of a state law outlawing secondhand smoke will be 50 percent of the counties passing their own ordinances first.

Bottom line from a healthcare perspective: Monroe says Indiana smokers suffer heart problems, cancers, emphysema, amputations from peripheral vascular disease, are hospitalized twice as often as non-smokers with longer stays and cost $1.9 billion in related annual health costs, $448 million from taxpayer-funded Medicaid. "For every pack of cigarettes sold, Hoosiers spend $5.73."

Obesity has no quick fix like jacking up the cigarette tax, says Monroe. "We need to get the public health message out in force." Her department has been building relationships with Purdue extensions and local schools to encourage the development of healthy lifestyle habits, and has supported the...