After HB 1001 was signed on May 10, 2011, by Governor Mitch Daniels, the State Health Commissioner and former ITPC executive director jointly announced to state tobacco control advocates that the ITPC programs would move ISDH to the newly created TPCC (written communication, G.N. Larkin and K.S. Sneegas, May 2011).
Details of the structure and function of this tobacco control program await clarification. A potential positive effect of this new commission includes more emphasis on tobacco control interventions among all areas of health in ISDH. However, this new structure is more vulnerable to political interference and influence from the tobacco industry. In such an environment, with inevitable threats to its budget, the TPCC may find it increasingly difficult to sustain effective Best Practices in Indiana (18
For the TPCC to accomplish its current statewide tobacco use reduction goals using Best Practices, the following conditions need to be met: Indiana receives funding at the level recommended by CDC for all 5 components of the Best Practices model; Indiana's statewide cessation system, which includes the Indiana Tobacco Quitline, expands and is coupled with effective public education campaigns; Indiana enacts a comprehensive smoke-free workplace law that includes restaurants and bars; in the absence of a state law, local communities proceed with local ordinances to protect citizens from exposure to secondhand smoke; and taxes for cigarettes and other tobacco products increase to reflect national trends and reduce the state's tobacco-related disease burden and other economic costs.
The challenge of ISDH is to consolidate the support of the public and of policy makers in achieving short-term goals of a statewide smoke-free air law and an increase in the cigarette tax. Accomplishing these goals will increase the likelihood that Indiana's tobacco control program can address long-term goals of expanding its programs to achieve Healthy People 2020
tobacco use objectives (23
A further challenge for ISDH is to ensure stable and increased program funding over time for the expansion of Best Practices. Science has shown that investment in tobacco control produces major returns on investment. The more states spend on tobacco control programs, the larger the decrease in adult smoking, even when controlling for other factors such as high tobacco prices (24
). Such returns on investment would have a beneficial effect on Indiana's fiscal health. For example, if Indiana had been investing $35 million annually in tobacco use prevention since ITPC's inception, the state could have reduced tobacco-use-related costs by $479 million, $78 per capita, by reducing adult smoking (24
Many of the long-term objectives to decrease adult and youth smoking, established by the ITPC executive board in 2000, have been achieved. The test of the next decade will be to build on these successes, which requires continued strong program leadership and a focus on sustaining evidence-based tobacco control programs, as well as public support and political will of policy makers to make informed decisions that support the health and economic interests of Indiana citizens.