Methods: Data come from two cross-sectional random-digit dialed phone surveys of smokers in the WNY region conducted in 2005 (n=428) and 2006 (n=309). The 2005 sample was also reinterviewed a year later (n=185), which allows for looking at behavior change. Trends in the frequency of buying on Indian Reservations and correlates of this behavior are reported as well as the association between buying on an Indian Reservation and subsequent smoking behavior.

Results: Fifty-seven percent of 2006 smokers reported that they purchased cigarettes on an Indian Reservation all the time compared with 51% reporting ‘all of the time' in 2005. Nearly half of the 2006 smokers reported being less likely to purchase cigarettes on reservations if the state started taxing the tobacco products sold on reservations. No statistically significant differences in quitting or quit attempts was observed in this small sample, but Indian Reservation purchasers were less likely to reduce their cigarette consumption at follow-up.

Conclusions: Most of the cigarettes smoked in WNY are purchased free of state taxes on Indian Reservations. This reduces the beneficial health impact of high cigarette taxes and may undermine smoking cessation efforts. Tobacco price equity across different types of retail outlets should be a priority.