{"id":1912,"date":"2017-02-23T08:55:55","date_gmt":"2017-02-23T15:55:55","guid":{"rendered":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/?p=1912"},"modified":"2021-03-30T15:53:39","modified_gmt":"2021-03-30T21:53:39","slug":"__trashed-31__trashed-2","status":"publish","type":"post","link":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/2017\/02\/23\/__trashed-31__trashed-2\/","title":{"rendered":"2016 Hospitality Survey"},"content":{"rendered":"<h1>Executive Summary<\/h1>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita1.png\" alt=\"\" width=\"328\" height=\"367\" \/>The Wyoming Tobacco Prevention and Control Program (TPCP) shares a goal with the federal tobacco prevention and control program: decrease exposure to secondhand smoke (Starr, et al., 2005). According to the Surgeon General (U.S. Department of Health and Human Services [USDHHS], 2014) and the Centers for Disease Control and Prevention (CDC, 2014), smoke-free air policies improve public health by reducing exposure to secondhand smoke. The National Institute for Occupational Safety and Health (NIOSH, 2015) recommends that all employers establish written policies that prohibit smoking and vaping (the use of electronic nicotine delivery systems [ENDS]) in all indoor areas of their businesses to protect the health of their employees.<\/p>\n<p>In 2016, the Wyoming Survey &amp; Analysis Center (WYSAC) at the University of Wyoming, under contract to the Wyoming Tobacco Prevention and Control Program (TPCP) in the Wyoming Department of Health, conducted a survey of hospitality businesses across Wyoming to learn about their policies related to smoking and vaping.<\/p>\n<p>Most dining businesses (all types of restaurants and bars) had written smoke-free indoor air policies that protect customers and employees from secondhand smoke in all indoor dining areas. Vape-free policies were less common. Policies in outdoor dining areas and other outdoor areas were even less common (Figure ES-1). Bars were less likely than other types of dining establishments to have written policies protecting their customers and employees from secondhand smoke and secondhand ENDS aerosol. It was rare for a dining business to have a vape-free air policy without also having a smoke-free air policy in place. Thus, vape-free policies were the limiting factor preventing businesses from having clean air (smoke-free and vape-free) policies. Overall, 55% of dining businesses (including bars) had policies protecting customers and employees from secondhand smoke.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita2.png\" alt=\"\" width=\"534\" height=\"368\" \/>When lodging businesses had smoke-free, vape-free, or clean indoor air policies, they were most likely to apply to indoor common areas (e.g., lobbies) or employee-only areas. Allowing smoking or vaping in at least some guest rooms was a relatively common practice in Wyoming, although this concession is becoming less popular nationally. In 2016, 85% of hotels nationwide were smoke-free, including all guest rooms (American Hotel &amp; Lodging Association, 2016).<\/p>\n<p>As with the dining businesses, smoke-free policies were more common than vape-free indoor air policies. Vape-free policies in the absence of smoke-free air policies were rare, meaning that vaping policies were the limiting factor for clean air policies (Figure ES-2).<\/p>\n<p><style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<p><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/p>\n<h1>Background<\/h1>\n<p>In 2011, the Wyoming Survey &amp; Analysis Center (WYSAC) at the University of Wyoming, under contract to the Wyoming TPCP in the Wyoming Department of Health, conducted a survey of businesses across Wyoming to learn about their smoke-free policies. In 2016, the Wyoming TPCP worked with WYSAC to follow up on that survey, but narrowed the focus to hospitality businesses: restaurants, bars, and lodging establishments (including businesses that fit in more than one of those categories). The 2016 survey also expanded the scope of the survey to include policies about vaping (the use of electronic nicotine delivery systems [ENDS], also known as e-cigarettes). This report details the results of the 2016 study and provides conclusions and recommendations based on the data collected.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita3.png\" alt=\"\" width=\"741\" height=\"603\" \/><\/p>\n<p>The Wyoming TPCP shares a goal with the federal tobacco prevention and control program: decrease exposure to secondhand smoke (Starr, et al., 2005). According to the Surgeon General (U.S. Department of Health and Human Services [USDHHS], 2014) and the Centers for Disease Control and Prevention (CDC, 2014) smoke-free air policies improve public health by reducing exposure to secondhand smoke. The preponderance (97%) of Wyoming adults agree with the statement, &#8220;Secondhand smoke is harmful to one&#8217;s health.&#8221; In 2012, 78% of Wyoming adults said the indoor areas of restaurants should be smoke-free, but only 47% said that indoor areas of bars, casinos, or clubs should be smoke-free (Wyoming Survey &amp; Analysis Center [WYSAC], 2014). By increasing the number of smoke-free policies and laws in Wyoming, more residents will live, dine, and work in smoke-free environments. In time, the associated decrease in their exposure to carcinogens and other toxins should lead to a decrease in tobacco-attributable mortality and morbidity (Figure 1; Starr, et al., 2005). Smoke-free indoor air laws also contribute to social norms against smoking and reduce cigarette consumption and related health problems (CDC, 2014; USDHHS, 2014).<\/p>\n<p>Wyoming has several local smoke-free laws of varying strengths, the first of which went into effect in 2005. Yet, 64% of Wyoming residents depend on voluntary business policies because they are not covered by any smoke-free indoor air law. An additional 8% of Wyomingites are not protected by a smoke-free indoor air law that includes bars. In places without comprehensive smoke-free indoor air laws, voluntary policies implemented by businesses can provide some protection to their employees and customers. Voluntary policies may also go beyond the scope of community laws by specifically incorporating ENDS, smokeless tobacco, or other tobacco products.<\/p>\n<p>The Community Preventive Services Task Force regularly reviews the scientific literature to identify effective interventions for communities and businesses to implement to improve public health. They collect their findings in the online Guide to Community Preventive Services (The Community Guide). In 2012, they concluded that smoke-free indoor air laws are effective in reducing exposure to secondhand smoke as indicated by self-report surveys, analysis of biological tests for chemicals that indicate exposure to secondhand smoke, and readings of air quality in covered businesses. They also found connections between smoke-free indoor air policies and reduced prevalence and consumption of cigarettes by adults, increased cessation activity, reduced cardiovascular events and mortality, and reduced asthma-related hospital admissions linked to exposure to secondhand smoke. Although the task force did not specifically review voluntary business policies, it is logical to conclude they could contribute to similar effects, though not necessarily at a population level.<\/p>\n<p>Some hospitality businesses (restaurants, bars, and lodging) offer smoking and non-smoking areas. In 2006, the Surgeon General concluded that such separation policies are not effective means to reduce exposure to secondhand smoke, even when adding ventilation to try to clear the smoke from the nonsmoking areas. Rather, ventilation may have the undesired effect of spreading smoke to nonsmoking areas (USDHHS, 2006). The National Institute for Occupational Safety and Health (NIOSH, 2015) recommends that all employers establish written policies that prohibit smoking and vaping in all indoor areas of their businesses to protect the health of their employees.<\/p>\n<p>In the most recent Surgeon General&#8217;s report (USDHHS, 2016), there is evidence that people exposed to secondhand ENDS aerosol later test positive for nicotine. Though the degree of nicotine appears to be lower than for secondhand smoke, it is still enough to warrant caution, especially for populations vulnerable to the negative effects of nicotine, such as pregnant women. As is often the case when researching the health effects of ENDS, the heterogeneity of the devices and their aerosols has hampered research into the effects of secondhand ENDS aerosol. Additionally, the difference between measuring airborne secondhand smoke and secondhand ENDS aerosol may require different tools or interpretations of measurements.<\/p>\n<h1>Methods<\/h1>\n<h2>Survey Administration<\/h2>\n<p>WYSAC and the Wyoming TPCP collaborated to develop two surveys of hospitality businesses: the Dining Survey (which included bars) and the Lodging Survey. The surveys were both developed to assess three types of business healthier air policies regarding smoke-free and vape-free indoor and outdoor air. WYSAC classified policies that provide smoke-free and vape-free air as clean air policies. Prior to distributing the surveys, WYSAC sent each business a letter from the TPCP asking for their participation. Both surveys were distributed between February 16, 2016, and May 4, 2016. Further details about the survey methods are reported in Appendix C.<\/p>\n<h3>Dining Survey<\/h3>\n<p>WYSAC invited 1,182 dining businesses across the state to complete the survey online or via mail. WYSAC invited a broad base of dining establishments to participate in the survey, including (but not limited to) bars, night clubs, cafes, full service restaurants, and fast food restaurants. A total of 277 businesses returned the survey, but some of these responses lacked sufficient data for analysis or indicated that the business was closed or ineligible. WYSAC used data from 264 dining businesses (22% of those invited to participate) to generate the findings discussed in this report.<\/p>\n<h3>Lodging Survey<\/h3>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita4.png\" alt=\"\" width=\"162\" height=\"276\" \/>As with the Dining Survey, WYSAC invited a broad base of lodging businesses to participate in the lodging survey including (but not limited to) hotels, motels, ski lodges, campgrounds, bed-and-breakfasts, and recreational vehicle (RV) parks. Short term rentals, such as those offered through Airbnb, were not invited to participate. WYSAC invited 684 lodging businesses from across the state to participate in the survey online or by mailing a hard copy to WYSAC; 179 businesses responded to the survey. As with the Dining Survey, some of these responses did not provide sufficient data for analysis or were from closed or ineligible businesses. WYSAC used data from 166 returned surveys (24% of those invited to participate) to generate the findings for this report.<\/p>\n<h2>Participating Businesses<\/h2>\n<p>Most people who completed and returned the Dining and Lodging Surveys identified their roles as owner or manager, including any combination of those roles with other options listed on the survey (Table 1). Therefore, they should be well-informed about the policies they described in their responses.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita5.png\" alt=\"\" width=\"319\" height=\"380\" \/>Standard Industrial Classification (SIC) codes are numeric codes that identify a type of business. WYSAC compared the primary SIC codes of the population invited to complete the surveys to the codes for the businesses that returned the survey. Some uncommon business types are not represented in the survey data. However, the percentages of business types represented in the sample are all similar to (less than a five-point difference) those calculated for the population. For example, 15% of the completed Dining Surveys came from businesses with the SIC code for &#8220;eating places;&#8221; 12% of the businesses invited to complete the survey had the same SIC code. Therefore, WYSAC treats the completed surveys as representative for each business type. Most respondents to the Dining Survey were completed by a combination of full service restaurants, fast food restaurants, and bars (Table 2).<\/p>\n<p>Most of the responding businesses for the Lodging Survey were motels or hotels. (Motels generally allow guest access directly from outside; hotels are generally defined as establishments with internal corridors that lead to guest rooms.) Several sites were multipurpose (e.g. a business that is both a motel and campground; Table 3). <\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita6.png\" alt=\"\" width=\"347\" height=\"251\" \/>WYSAC compared the town addresses of the completed surveys to the town addresses of the businesses invited to participate in the survey. Some small towns were not represented in the completed survey data. However, the percentages of Wyoming&#8217;s dining and lodging businesses in each town in the sample were all similar (less than a five-point difference) to those calculated for the population. For example, 2% of the completed Lodging Surveys were from businesses in Laramie; 3% of lodging businesses invited to complete the survey had Laramie addresses. Therefore, WYSAC treats the completed surveys as geographically representative.<\/p>\n<h2>Analysis<\/h2>\n<p>WYSAC analyzed the survey with SPSS version 23 by running frequencies and percentages for each survey question (see Appendix A) and cross-tabulations on core questions with variables of interest. Because the data come from an attempted census of all Wyoming dining and lodging establishments, there was no statistical sampling bias. Thus, statistical tests that use sample statistics to make inferences about a population are not appropriate.<\/p>\n<p>For the primary analysis, WYSAC identified a business as smoke-free indoors if (a) the business reported a written policy about smoking and (b) that policy prohibits smoking in all indoor areas of the business. WYSAC used equivalent standards to identify businesses as vape-free indoors. Businesses with written policies that prohibit smoking and vaping indoors qualified as having a clean air policy.<\/p>\n<p>Because some businesses were uncommon among the respondents (and the population), WYSAC provides the number of respondents by business type in many of the tables below. WYSAC interprets results by business type with caution by excluding small groups when discussing the relative prevalence of different policies.<\/p>\n<p><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/p>\n<h1><span style=\"background-color: white;\">Key Findings <\/span><\/h1>\n<h2><img loading=\"lazy\" decoding=\"async\" class=\"alignright fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita8.png\" alt=\"\" width=\"544\" height=\"368\" \/><span style=\"background-color: white;\">Dining Survey <\/span><\/h2>\n<p>About half (51%) of Wyoming dining businesses (including bars) had a written policy about smoking or vaping, though the prevalence of these policies varied by business type (Table 4). These policies were most common among fast food restaurants, when excluding business types with five or fewer respondents. Full service restaurants were more likely to have a written policy than full service restaurants with attached bars. Bars, taverns, and saloons (as a single category) were the least likely dining business type to have written policies.<\/p>\n<p><span style=\"background-color: white;\">Smaller businesses (as measured by the number of employees) were less likely to have a written policy than larger businesses (<\/span>Figure 2<span style=\"background-color: white;\">).<img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita9.png\" alt=\"\" width=\"218\" height=\"234\" \/> Policies specific to the respondents&#8217; locations accounted for 29% of smoking and\/or vaping policies, while parent company rules accounted for 7%. Multiple sources were indicated by 3% of respondents. Of those who indicated a smoking and\/or vaping policy, 75% said their policies were written and visible to employees.<\/span><\/p>\n<p><span style=\"background-color: white;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita10.png\" alt=\"\" width=\"322\" height=\"350\" \/><\/span><\/p>\n<p>Larger businesses were more likely to have healthier air policies for their indoor dining areas, followed closely by small businesses. Mid-sized businesses were the least likely to have clean air policies (Figure 3).<span style=\"background-color: white;\"> Most businesses had smoke-free indoor air policies, but fewer than half had vape-free or clean indoor air policies. Smoke-free, vape-free, and clean air policies were much less common for outdoor areas and uncommon for other outdoor areas (<\/span>Figure 4<span style=\"background-color: white;\">). The absence of a vape-free policy was the limiting factor for businesses to qualify as having clean air policies. For each coverage area (indoors, outdoor dining area, and other outdoor areas), dining businesses rarely had vape-free policies in the absence of smoke-free policies. <\/span><\/p>\n<p><span style=\"background-color: white;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita11.png\" alt=\"\" width=\"491\" height=\"336\" \/><\/span><\/p>\n<p><span style=\"background-color: white;\">The prevalence of smoke-free, vape-free, and clean air policies varied by business type. Policies covering indoor dining areas, outdoor dining areas, and other outdoor areas were most common among fast food restaurants and businesses that did not identify their type (after excluding business types with five or fewer respondents). Customers and employees at bars were the least often covered by smoke-free, vape-free, and clean indoor air policies (<\/span>Table 5<span style=\"background-color: white;\">). <img loading=\"lazy\" decoding=\"async\" class=\"alignright fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita12.png\" alt=\"\" width=\"530\" height=\"413\" \/> <\/span><\/p>\n<p>Fast food restaurants were also the most likely to have smoke-free, vape-free, and clean air policies covering their outdoor dining areas <span style=\"background-color: white;\">(after excluding business types with five or fewer respondents). Customers and employees at bars were the least often covered by smoke-free, vape-free, and clean indoor air policies (Table 6)<img loading=\"lazy\" decoding=\"async\" class=\"alignright fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita13.png\" alt=\"\" width=\"530\" height=\"441\" \/>. <\/span><\/p>\n<p>Fast food restaurants were also the most likely to have smoke-free, vape-free, and clean air policies covering their other outdoor areas <span style=\"background-color: white;\">(after excluding business types with five or fewer respondents). When focusing on full service restaurants without bars, bars, and full service restaurants with bars, customers and employees at limited service restaurants, bars, and businesses of unknown type were the least often covered by smoke-free, vape-free, and clean indoor air policies (<\/span>Table 7<span style=\"background-color: white;\">).  <\/span><\/p>\n<h2>Lodging Survey<\/h2>\n<p>Overall, 62% of lodging establishments had a written policy addressing smoking or vaping. The majority of tobacco policies (60%) in lodging establishments were local policies specific to the individual business location. Other sources for the policies included complying with local ordinances (17%; none of which prohibit smoking in all indoor guest areas), policies of a parent company (13%) and multiple sources (10%). Of the businesses with written policies about smoking or vaping, 83% said the written policy was posted and visible to employees. When looking across all areas, 52% of the respondents to the Lodging Survey were smoke-free in all indoor areas; 45% were vape-free across all indoor areas; and 43% had comprehensive clean indoor air policies.<\/p>\n<p>Smoke-free, vape-free, and clean indoor air policies were most common for indoor common areas (e.g., lobbies) and employee-only areas. Allowing smoking or vaping in at least some guest rooms was a relatively common practice in Wyoming. As with the Dining Survey results, smoke-free policies were more common than vape-free indoor air policies. Few businesses had vape-free policies in the absence of smoke-free policies, making vape-free policies the limiting factor on having clean air policies (Figure 5).<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita14.png\" alt=\"\" width=\"528\" height=\"520\" \/><\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita16.png\" alt=\"\" width=\"572\" height=\"372\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita17.png\" alt=\"\" width=\"539\" height=\"255\" \/>As with the Dining Survey, the prevalence of these policies differs across lodging business type. Each type of healthier indoor air policy was most common in multi-use businesses and bed-and-breakfast establishments, and 70% of hotels were smoke-free. Motels were the least likely to have any of these policies (Table 8). <\/p>\n<p>Outdoor smoke-free, vape-free, and clean air policies were uncommon. When they were in place, they were more likely to cover outdoor areas of guest rooms (e.g., balconies or patios; Figure 6).<img loading=\"lazy\" decoding=\"async\" class=\"alignleft fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2017\/05\/051917_1803_2016Hospita18.png\" alt=\"\" width=\"550\" height=\"222\" \/><\/p>\n<p>Because lodging establishments may offer their guests the convenience of an attached restaurant, which may or may not share indoor or outdoor air policies with the lodging business, it is important to examine how the policies of neighboring businesses relate to secondhand smoke exposure while at a lodging establishment. The majority of respondents (86%) reported they never smell smoke from neighboring businesses, while 11% said they &#8220;sometimes&#8221; smell smoke. No respondents stated that they &#8220;always&#8221; smell smoke.<\/p>\n<p><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/p>\n<h1>Conclusions and Recommendations<\/h1>\n<p>In the absence of a statewide smoke-free indoor air law covering hospitality businesses, customers and employees in Wyoming generally depend on the policies of individual businesses to protect their health. Partial exceptions to this general rule include the six Wyoming towns with smoke-free indoor air laws that cover customers and employees in bars and restaurants (Burlington, Casper, Cheyenne, Evanston, Laramie, and Mountain View) and the three towns with smoke-free indoor air laws that cover restaurants but not bars (Afton, Green River, and Rock Springs). None of these laws require all indoor areas of lodging businesses, including all guest rooms, to be smoke-free. Only Laramie&#8217;s law specifically addresses secondhand ENDS aerosol.<\/p>\n<p>Most Wyoming fast food and full service restaurants without bars have policies (including voluntary written policies and compliance with local smoke-free indoor air laws) that protect their customers and employees while in indoor areas. These policies are less common for restaurants with attached bars and less common still in stand-alone bars. When these written policies exist, they frequently allow smoking in outdoor dining areas and other outdoor areas. Written vape-free policies are less common than smoke-free policies, but they follow similar patterns. Few businesses have vape-free policies without also having smoke-free policies.<\/p>\n<p>Written smoke-free indoor air policies typically cover indoor common areas and indoor employee-only areas. Allowing smoking or vaping in at least some guest rooms is a relatively common practice in Wyoming, although this concession is becoming less popular nationally. In 2016, 85% of hotels nationwide were smoke-free, including all guest rooms (American Hotel &amp; Lodging Association, 2016). As with dining establishments, vape-free policies are less common, focus more on indoor areas, and rarely exist in the absence of smoke-free policies.<\/p>\n<p>Wyomingites and visitors would benefit most from increased smoke- and vape-free policies in lodging establishments, especially increases in the number of establishments that are completely smoke-free indoors, including all guest rooms. When considering dining and drinking establishments, Wyomingites and visitors would benefit most from an increase in the number of smoke-free bars and full service restaurants with attached bars.<\/p>\n<p><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/p>\n<h1>References<\/h1>\n<p style=\"margin-left: 36pt;\">American Hotel &amp; Lodging Association. (2016). The 2016 Lodging Survey hotel trends: An inside look at popular amenities and guest services. Retrieved December 7, 2016, from <a href=\"https:\/\/www.ahla.com\/sites\/default\/files\/1128_AHLA_GuestSvs.pdf\">https:\/\/www.ahla.com\/sites\/default\/files\/1128_AHLA_GuestSvs.pdf<\/a><\/p>\n<p style=\"margin-left: 36pt;\">Centers for Disease Control and Prevention. (2014). <em>Best practices for comprehensive tobacco control programs\u20132014. <\/em>Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health promotion, Office on Smoking and Health.<\/p>\n<p style=\"margin-left: 36pt;\">The Community Guide to Preventive Services. (2012). <em>Tobacco use and secondhand smoke exposure: Smoke-free policies<\/em>. Retrieved December 14, 2016, from <a href=\"https:\/\/www.thecommunityguide.org\/findings\/tobacco-use-and-secondhand-smoke-exposure-smoke-free-policies\">https:\/\/www.thecommunityguide.org\/findings\/tobacco-use-and-secondhand-smoke-exposure-smoke-free-policies<\/a><\/p>\n<p style=\"margin-left: 36pt;\">National Institute for Occupational Safety and Health. (2015). <em>Current intelligence bulletin 67: Promoting health and preventing disease and injury through workplace tobacco policies. <\/em>Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Retrieved November 18, 2016, from <a href=\"http:\/\/www.cdc.gov\/niosh\/docs\/2015-113\/pdfs\/cib-67_2015-113_v5.pdf\">http:\/\/www.cdc.gov\/niosh\/docs\/2015-113\/pdfs\/cib-67_2015-113_v5.pdf<\/a><\/p>\n<p style=\"margin-left: 36pt;\">Starr, G., Rogers, T., Schooley, M., Porter, S., Wiesen, E., &amp; Jamison, N. (2005). <em>Key outcome indicators for evaluating comprehensive tobacco control programs.<\/em> Atlanta, GA: Centers for Disease Control and Prevention.<\/p>\n<p style=\"margin-left: 36pt;\">U.S. Department of Health and Human Services. (2006). <em>The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General<\/em>. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved November 18, 2016, from <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK44324\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK44324\/<\/a><\/p>\n<p style=\"margin-left: 36pt;\">U.S. Department of Health and Human Services. (2014). <em>The health consequences of smoking \u2013 50 years of progress: A report of the Surgeon General. <\/em>Retrieved January 21, 2014, from <a href=\"http:\/\/www.cdc.gov\/tobacco\/data_statistics\/sgr\/50th-anniversary\/index.htm\">http:\/\/www.cdc.gov\/tobacco\/data_statistics\/sgr\/50th-anniversary\/index.htm<\/a><\/p>\n<p style=\"margin-left: 36pt;\">U.S. Department of Health and Human Services. (2016). <em>E-Cigarette use among youth and young adults. A report of the surgeon general<\/em>. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.<\/p>\n<p style=\"margin-left: 36pt;\">WYSAC. (2014). <em>Report on the 2012 Wyoming Adult Tobacco Survey<\/em>, by M. Kato, L. H. Despain, &amp; T. Comer Cook. (WYSAC Technical Report No. CHES-1408). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<h1>Appendices<\/h1>\n<p>To see the full appendices, please download the full report.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Wyoming Tobacco Prevention and Control Program (TPCP) shares a goal with the federal tobacco prevention and control program: decrease exposure to secondhand smoke (Starr, et al., 2005). 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