by Dr. Patrick Clements All parents want their children to grow up to be happy and healthy adults. Yet, too many young Hoosiers never get that chance. Seven out of every 1,000 babies born in Indiana die before their first birthday – about 600 infants each year. This rate of infant mortality is the 8th highest among the 50 states. As pediatricians, we have cared for the children and the families affected by these grim statistics. Governor Holcomb has recognized this is unacceptable. In his second State of the State address, he pledged that Indiana will have the lowest infant mortality rate in the Midwest by 2024. In the recent legislative session he took a great first step by signing a bill that ensures at-risk newborn babies receive care at a facility that is most appropriate for their needs. But there’s a lot more work to be done. Addressing the high rate of smoking in our state has to be part of the solution, or the Governor’s goal will not be met. Smoking while pregnant is a health crisis in our state. Approximately 15 percent of Indiana’s pregnant women smoke – almost double the national average of 7.8 percent. In 2015, more than 12,000 babies across our state were born to mothers who smoked. According to the Centers for Disease Control and Prevention, smoking is a contributing factor to some of the most common causes of infant death – premature birth, low birth weight, and sudden unexpected infant death. In fact, babies born to mothers who smoke during pregnancy are twice as likely to die before their first birthday as those born to mothers who do not smoke. For kids, the burden of tobacco smoke exposure doesn’t end there. Infants who are exposed to tobacco smoke are more likely to have pneumonia, viral illnesses, and ear infections than unexposed babies. As they grow up, smoke exposure will also increase the likelihood of long-term breathing problems such as asthma. We know the health and well-being of a child is directly linked to the health of their parents and other caregivers. For this reason, smoking is so problematic for anyone who spends time with children. Like ripples from a stone thrown into a pond, the impact of reducing smoking extends not only to children but to their entire family and our community as well. Pediatricians have the great privilege of caring for our state’s greatest commodity – our children. The life of a child is priceless. But we can put a price on what it costs to help save young lives: $1.50. According to the Indiana-based Raise It for Health campaign, that is the increase in the per-pack cigarette tax that would immediately help 50,000 Hoosier adults quit smoking.Significant tobacco price increases have an especially large impact on pregnant women.A cigarette tax increase that raises prices by 10 percent reduces smoking rates among expectant mothers by 7 percent. Not only would increasing the cigarette tax save lives directly, it would raise $315 million in its first year that could be dedicated to a wide range of public health investments, including smoking cessation and maternal health. Cigarettes and other tobacco delivery devices are designed to be extremely addictive, so we need equally strong public policy to help combat their damaging effects. Indiana ranks 49th of the 50 states in public health spending, and this tax could help correct this troubling trend. An increase in the cigarette tax passed the Indiana House in 2017, but stalled in the Senate. Further action is delayed until next year’s biannual budget debate. For every year we wait, thousands of more babies exposed to smoking will be born, and some will face death that could have been prevented. As pediatricians, we need action that will save the lives of our smallest patients. Addressing infant mortality is a complex problem, but we have a clear-cut policy in front of us that is proven to work. Hundreds of Indiana organizations – from the Indiana State Medical Association to the Indiana Chamber of Commerce –support reducing smoking and raising our cigarette tax to help save the lives of children and adults alike. The benefits squarely align with the Governor’s infant mortality goal, and it should be a top priority in next year’s budget. Join the cigarette tax campaign at Raise it for Health and attend an Alliance for a Healthier Indiana Road Show Town Hall this year to learn more and show your support. Dr. Patrick Clements is the Co-Chair of the Perinatal and Infant Mortality Committee of the Indiana Chapter of the American Academy of Pediatrics.