Summary and Discussion

The adult smoking rate (adults who have smoked 100 cigarettes and currently smoke every day or some days) has shown a 24% decrease from a high of 21% in 2006 to 16% in 2017. Cigarettes are still the most popular form of tobacco use in Wyoming. Smokeless tobacco, (including chewing tobacco, snuff and dip) is the second most popular product type, and is especially popular among men.

Among Wyoming adults, current ENDS use is not as prominent as cigarette smoking or smokeless tobacco use, and most adults have never tried ENDS. Young adults (ages 18 to 29) are more likely to use ENDS than other adults (ages 30 or older). The majority of current ENDS users use products flavored like something other than tobacco. Curiosity was the most popular reason for trying ENDS. Two other common reasons are cutting back on or quitting cigarettes. Most Wyoming adults think that using ENDS is harmful to one’s health, but many are still unsure about whether using ENDS is harmful and whether ENDS use or cigarette smoking has greater health risk. As the marketplace for ENDS evolves, continued surveillance of ENDS use could help TPCPC efforts by better understanding ENDS prevalence.

Products flavored to taste like mint, candy, or other sweets are more popular among ENDS users and cigar smokers than among cigarette smokers. Young adults are more likely to use menthol cigarettes, flavored cigars, and flavored ENDS than other adults. Flavoring in cigarettes, cigars, and ENDS might be an important part of using those tobacco products, especially for younger adults.

The smoking habits of the vast majority of Wyoming adults begin when they are younger than 21, and especially before the age of 18. After age 21, very few adults begin to smoke or begin to smoke daily. A continued focus on preventing the initiation of smoking by youth and young adults and helping them quit using tobacco products could, over time, reduce the prevalence of smoking and associated health problems.

Wyoming adults almost unanimously agree that secondhand smoke is harmful to one’s health. However, opinions vary as to where and how smoking should be restricted. Wyoming adults have a high degree of agreement that indoor areas of restaurants and workplaces across the state should have smokefree indoor air and that all school grounds should be smokefree. There is less support for smokefree air in casinos, clubs, bars, and outdoor work areas. Most adults report working in places that have smokefree policies but outdoor areas rarely do. Most exposure to secondhand smoke occurs in outdoor areas, including at work and public places.

The majority of smokers have tried to quit and want to quit for good. When they had tried to quit or wanted to quit, most smokers faced obstacles such as loss of a way to handle stress, cravings for cigarette, and other people smoking around them. Thus, reducing exposure to secondhand smoke could help many smokers who are trying to quit. Also, the use of proven cessation aids is relatively low, and many tobacco users are not receiving screenings and assistance from healthcare providers to help them quit. Only half of current tobacco users who saw a healthcare professional in the previous year were advised to quit, but over half of those were offered assistance. Greater collaboration with health professionals could result in more tobacco users becoming aware of, and receptive to, proven cessation aids and services.

Awareness of tobacco quitlines is an area of potential improvement. About half of non-tobacco users were aware that a quitline (local or national) existed. Friends and family of tobacco users (which would include non-tobacco users) are key referral sources for many WQTP enrollees (WYSAC, 2017). If more nonsmokers knew about the existence of this proven cessation aid, then they could inform and encourage tobacco users who may not know about it.

American Indians, adults with mental health conditions, and those with annual household income less than $30,000 have relatively high smoking rates. Most current smokers have tried to quit cigarette smoking at some point in their lives, but young adult smokers are more likely to try smoking cessation than other adults. Promoting quitting and reducing initiation among these groups will, over time, reduce the disparities in tobacco use and its health consequences. American Indians, adults with mental health conditions, and young adults have a higher risk of being exposed to SHS at their workplace either indoors or outdoors.

The health consequences of smoking in Wyoming are similar to reports in the medical literature (e.g., USDHHS, 2014). Compared to nonsmokers, Wyoming smokers tend to be less healthy overall and report more chronic illness. Reducing the prevalence of smoking will, over time, reduce the health and economic burden of smoking-attributable chronic disease in Wyoming.

Recommendations

Many of the trends show continued, though slow, progress regarding the goals of the Wyoming and national tobacco prevention and control programs:

1. Preventing initiation of tobacco use (CDC, 2014b)
2. Eliminating nonsmokers’ exposure to secondhand smoke (CDC, 2017)
3. Promoting quitting among adults and young people (CDC, 2015)
4. Identifying and eliminating tobacco-related disparities (CDC, 2014b, 2015, 2017)

This progress is especially clear with the downward trend in cigarette smoking. Continued efforts will likely continue this progress. Breakthroughs in tobacco prevention and control, such as increased community mobilization or policy enforcement and regulatory action, could speed this progress (see https://www.thecommunityguide.org/topic/tobacco for empirically-based, specific suggestions). The Wyoming Department of Health is implementing a new approach to community mobilization for tobacco prevention. The next iteration of the ATS may be used as part of an evaluation of these efforts with the 2017 data serving as a baseline.

ENDS are an emerging tobacco product with a volatile market and regulatory environment (LaVito, 2018). Many adults are unsure about the safety of ENDS, both overall and relative to cigarettes. As part of a comprehensive approach to tobacco prevention, disseminating educational media about the risks of ENDS use may improve the public’s knowledge about these risks. Ideally, such a media campaign would be guided by the growing body of science and developing regulatory approaches to ENDS. For example, media about the regulations could highlight that no ENDS use, possession, or purchases are legal for minors.

Goal 1: Preventing Initiation of Tobacco Use

Because the smoking habits of the vast majority of Wyoming adults begin when they are younger than 21, and especially before the age of 18, a continued focus on preventing the initiation of smoking by youth and young adults could, over time, reduce the prevalence of smoking and associated health problems. Specific actions to consider for this goal include activities to reduce and counteract pro-tobacco messages, dissemination of pro-health messages, promoting tobacco-free policies, promoting anti-tobacco curricula in all levels of school (including higher education), implementing and enforcing restrictions on tobacco sales and availability, and increasing the price of tobacco (CDC, 2014b).

Goal 2: Eliminating Nonsmokers’ Exposure to Secondhand Smoke

Secondhand smoke is a health hazard in its own right (USDHHS, 2010, 2014). Educating the public and decision makers about the harms of SHS, such as through media campaigns, may provide people with motivation to avoid SHS. The Wyoming Department of Health is currently running and developing such media campaigns. The next iteration of the ATS may be used as part of an evaluation of these efforts with the 2017 data serving as a baseline. In 2017, men were less likely to support smokefree indoor air laws than women. Adults with an associate’s degree or less education were less likely to support smokefree indoor air laws than those with more education. Lesbian, gay, bisexual, and transgender (LGBT) individuals were less likely to support smokefree indoor air laws than straight individuals. The Wyoming Department of Health may especially benefit from focusing educational efforts on these groups. Support for smokefree indoor air in schools, workplaces, and restaurants is very high. Communities may be able to mobilize around this support.

Goal 3: Promoting Quitting Among Adults and Young People

The Wyoming Department of Health has invested substantially in the WQTP. ATS data indicate that promoting this program to young adults, who are more likely than other adults to try to quit smoking, might be especially useful in helping a distinct population quit using tobacco products and avoid the related diseases and death later in life. Health care professionals are an important referral source for the WQTP. Increased screening for tobacco use and encouraging tobacco-using patients to quit with help from the WQTP could be beneficial.

Goal 4: Identifying and Eliminating Tobacco-Related Disparities

The CDC recommends considering disparities in the use and burden of tobacco in all prevention work (CDC, 2014a, 2015, 2017). Recommendations are therefore included above (e.g., focusing WQTP promotion to young adults).