Background
Evidence of the ill effects of smoking has been growing since the 1950’s. In 1964, the U.S. Surgeon General issued the landmark report Smoking and Health: Report of the Advisory Committee to the Surgeon General, which stated unequivocally that a link between smoking and certain cancers exists. Cigarette smoking and breathing secondhand smoke has now been causally linked to an increased risk for multiple cancers and chronic diseases and is the leading preventable cause of death in the United States (U.S. Department of Health and Human Services [USDHHS], 2010, 2014). In Wyoming, this leads to approximately 800 deaths each year and nearly $258 million in annual healthcare costs that can be directly attributed to smoking (Centers for Disease Control and Prevention [CDC], 2014a).
The Wyoming Tobacco Prevention and Control Program (TPCP) works to reduce tobacco use in Wyoming by using a comprehensive, multi-strategy approach. The TPCP aligns its strategies around four goals that it shares with the CDC:
- Preventing initiation of tobacco use (CDC, 2014b)
- Eliminating nonsmokers’ exposure to secondhand smoke (Starr et al., 2005)
- Promoting quitting among adults and young people (CDC, 2015)
- Identifying and eliminating tobacco-related disparities (Starr et al., 2005)
As part of monitoring progress on these goals, the TPCP tracks the prevalence and consumption of tobacco products including cigarette smoking, use of electronic nicotine delivery systems (ENDS; also known as e-cigarettes), and use of other forms of tobacco.
The Wyoming Adult Tobacco Survey (ATS) is a standardized telephone survey administered by the Wyoming Survey & Analysis Center (WYSAC) at the University of Wyoming under contract to the Wyoming Department of Health, Public Health Division (PHD). Its purpose is to collect state and county level data pertaining to the prevalence of tobacco use, the four TPCP/CDC goals, and the broader goal of reducing tobacco-related disease and death. WYSAC merged data from the 2015 ATS with data from previous iterations of the survey to analyze trends.
Methods
Questionnaire Development and Survey Administration
WYSAC developed the 2015 Wyoming ATS items based on CDC’s core and supplemental ATS items. The TPCP and WYSAC selected some optional questions and created Wyoming-specific questions based on the indicators most directly related to Wyoming’s TPCP efforts.
The random digit dialing (RDD) for landlines and cell phones began on June 16, 2015, and ended on October 14, 2015. The final dataset contained a total of 4,948 completes, including 2,461 landline completes with a response rate of 31% and 2,487 cell phone completes with a response rate of 43%. The overall response rate was 37%.
Weighting and Analysis
After the completion of the data collection, the CDC weighted the 2015 ATS data to make the results more representative of the Wyoming adult population based on selection probability; non-response adjustment to landline records; and post-stratification demographic characteristics: county, age, gender, race/ethnicity, educational attainment, and phone type (cell phone only and all other types including landline only and dual phone use).
WYSAC analyzed the data using the complex sample survey methods feature of Stata version 12.1. Throughout this report, including the appendices, estimates and associated confidence intervals are calculated using weighted data. Reported sample sizes and group sizes are not weighted. WYSAC used logistic regression to test for trends for time periods longer than two years and to identify statistically significant associations between outcomes and other variables.
Throughout this report, WYSAC compares 2015 ATS data to the 2010 National Adult Tobacco Survey, previous iterations of the ATS (2002, 2004, 2006–2009, and 2012), and the 2013-14 County Tobacco Survey (CTS; reported as 2013 data). The protocols for these surveys were generally similar, allowing for analyses of trends for comparable questions on the surveys. Throughout the report, WYSAC identifies statistically significant differences, p < .05.
