{"id":2325,"date":"2020-01-28T13:13:24","date_gmt":"2020-01-28T19:13:24","guid":{"rendered":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/?p=2325"},"modified":"2023-03-22T08:44:20","modified_gmt":"2023-03-22T14:44:20","slug":"2017-wyoming-adult-tobacco-survey","status":"publish","type":"post","link":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/2020\/01\/28\/2017-wyoming-adult-tobacco-survey\/","title":{"rendered":"2017 Wyoming Adult Tobacco Survey"},"content":{"rendered":"<h1>Executive Summary<\/h1>\n<h2>Background<\/h2>\n<p>The Wyoming Adult Tobacco Survey (ATS) is a key component in the evaluation of Wyoming&#8217;s Tobacco Prevention and Control Program (TPCP). Under contract to the Wyoming Department of Health (WDH), the Wyoming Survey &amp; Analysis Center (WYSAC) at the University of Wyoming called adults across the state (via cell phone and landline) to ask about their use of and attitudes about tobacco products and policies. Calling for the 2017 ATS began on April 30th, 2017, and ended on December 20th, 2017. The sample of 4,647 provides estimates for many of the state&#8217;s key evaluation questions and outcome performance measures that are part of the Centers for Disease Control and Prevention (CDC)-approved programming.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming3.png\" alt=\"\" width=\"356\" height=\"272\" \/><\/p>\n<p>Because tobacco prevention outcomes result from state government programs including the one implemented in Wyoming, the efforts of multiple federal agencies\u2014most prominently, the U.S. Food and Drug Administration [FDA], Substance Abuse and Mental Health Services Administration [SAMHSA], CDC, and other groups (e.g., the Robert Wood Johnson Foundation, Campaign for Tobacco-Free Kids, American Nonsmokers&#8217; Rights Foundation, American Cancer Society, and American Lung Association)\u2014changes over time reflect the cumulative impact of many sustained and new efforts to affect the key indicators. These indicators have not been revised drastically since at least 2005 (see CDC, 2007, 2014a, 2014b, 2015, 2017; Starr et al., 2005).<\/p>\n<h2>Key Evaluation Questions<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming1.png\" alt=\"\" width=\"247\" height=\"236\" \/><\/p>\n<h3>Is the WY TPCP impacting tobacco use rates?<\/h3>\n<p>Responses to the ATS lead to four key categories of smoking status, described in Table ES-1. In 2017, about one sixth (16%) of Wyoming adults were current smokers. About one quarter (26%) were former smokers. About one third (32%) were experimental smokers (Figure ES-1).<\/p>\n<p>The adult smoking rate (current smokers) has shown a 24% decrease since the peak in 2006 (Figure ES-2). It is likely that the evidence-based programming (e.g., media campaigns, providing the Wyoming Quit Tobacco Program) implemented by the WDH and community partners contributed to this decrease.<\/p>\n<p><img decoding=\"async\" class=\"alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming2.png\" alt=\"\" \/><\/p>\n<h3>Is the WY TPCP having an effect on preventing Wyomingites from initiating tobacco use?<\/h3>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming4.png\" alt=\"\" width=\"337\" height=\"317\" \/>The majority (69%) of adults who have ever smoked a whole cigarette smoked their first whole cigarette when they were younger than 18 (Figure ES-3). However, there was still a large group (22%) who smoked a whole cigarette for the first time between the ages of 18 and 20. In total, 91% of current, former, and experimental smokers (see Table ES-1 for a summary of the four smoking status categories) smoked their first whole cigarette before age 21; this pattern has not changed significantly since 2010.<\/p>\n<p>Among adults who had ever smoked at least one cigarette per day for at least 30 consecutive days (including current and former smokers), 85% said they started smoking daily when younger than 21. This pattern has been stable since 2010.<\/p>\n<p>The evidence-based programming (e.g., restricting youth access to tobacco products, media campaigns) implemented by the WDH and community partners has likely contributed to these favorable trends even though those efforts cannot completely prevent underage tobacco use.<\/p>\n<h3>Are local, business, school, and other tobacco prevention and control policies changing?<\/h3>\n<p>The ATS does not directly assess the policies of businesses, schools, and other places related to tobacco. An indirect measure from the ATS for business policies is the proportion of working adults who reported smokefree indoor air policies at their workplaces. Most Wyoming adults (93%) who worked indoors reported that smoking was never allowed in indoor areas (including inside a vehicle) at their place of work. This is a relatively small but significant increase from 89% in 2010. It is likely that the evidence-based programming (e.g., educational efforts) implemented by the WDH and community partners contributed to this increase.<\/p>\n<p>A key goal for changing policies regarding tobacco use is to reduce exposure to secondhand smoke (SHS). Relatively few Wyoming adults reported being exposed to SHS while at indoor or outdoor public places in the past seven days; 12% were exposed to SHS at indoor public places while 32% were exposed to SHS at outdoor public places. At both types of public places, significantly fewer adults have been exposed to SHS since 2012. It is likely that the evidence-based programming (e.g., educational efforts) implemented by the WDH and community partners and changes in smokefree indoor air polices across the state contributed to this decrease.<\/p>\n<h3>Are WY TPCP&#8217;s media and other educational efforts increasing public and decision-maker knowledge about tobacco prevention and control issues?<\/h3>\n<p>A key activity for the Wyoming TPCP program is to educate the public about the harms of secondhand smoke. Over the years, Wyoming adults have almost unanimously agreed that SHS is harmful to one&#8217;s health. In 2017, the majority (62%) believed SHS is very harmful to one&#8217;s health, 35% believed that SHS is somewhat harmful, while 4% believed that it is in no way harmful.<\/p>\n<p>According to the CDC (2017), awareness of the harms of SHS is likely to increase support for smokefree air. Support for tobacco-free schools has been consistently high since 2010. In 2017, 85% of Wyoming adults indicated that tobacco use should be completely banned for all students, staff, and visitors on all school grounds, fields, and parking lots and at all school events. Results from questions asking about whether specific venues should have smokefree indoor air revealed that the percentage of Wyomingites who agreed that smoking indoors should never be allowed in workplaces or restaurants significantly increased from 2002 to 2017. For bars, casinos, and clubs, support for smokefree policies remained relatively stable between 2015 and 2017 and remained lower than for other venues (Figure ES-4).<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming5.png\" alt=\"\" width=\"559\" height=\"441\" \/><\/p>\n<p>It is likely that the evidence-based programming (e.g., educational efforts) implemented by the WDH and community partners contributed to these favorable results and trends.<\/p>\n<h3>How are Wyoming&#8217;s social norms changing regarding tobacco use?<\/h3>\n<p>Increasing support for smokefree indoor air in restaurants, workplaces, and other venues (Figure ES-4) indicates strengthening anti-tobacco and pro-health social norms regarding tobacco use. Additionally, the percentage of Wyoming adults who reported they do not allow smoking inside their homes has been high and has increased significantly from 72% in 2002 to 89% in 2017.<\/p>\n<h2>Key Outcome Performance Measures<\/h2>\n<h3>Average age at which young people first smoked a whole cigarette<\/h3>\n<p>In 2017, the average age at which adults who have ever smoked a whole cigarette smoked their first whole cigarette was 16 (with the median of 16 and the responses ranging from 4 to 58).<\/p>\n<h3>Proportion of young people who report never having tried a cigarette<\/h3>\n<p>Young adults (aged 18 to 29) are more likely than other adults (30 or older) to have never tried a cigarette: 42% of young adults have never tried a cigarette as opposed to 23% of other adults.<\/p>\n<h3>Proportion of the population reporting exposure to SHS at the workplace<\/h3>\n<p>Consistently since 2010, most employed adults were not regularly exposed to SHS at their workplace either indoors or outdoors. In 2017, 20% reported that they had breathed someone else&#8217;s smoke at their workplace in the past seven days. Adults who worked outdoors most of the time were more likely to be exposed to SHS than those who worked indoors (including in vehicles): 28% of adults who work primarily outdoors experienced SHS exposure, compared to 16% of those who work primarily indoors.<\/p>\n<h3><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming6.png\" alt=\"\" width=\"261\" height=\"324\" \/>Proportion of adult smokers who have made a quit attempt<\/h3>\n<p>At some point in their lives, most current smokers (87%) had stopped smoking for at least one day because they were trying to quit for good. About half of current smokers (48%) had tried to quit smoking at least once in the past year (Figure ES-5), which has not changed significantly since 2010.<\/p>\n<h3>Proportion of young smokers who have made a quit attempt<\/h3>\n<p>Young adult current smokers (95%) were more likely than other current smokers (84%) to have stopped smoking, at some point in their lives, for at least one day because they were trying to quit for good. Also, young adult smokers (67%) were more likely to have tried to quit smoking at least once in the past year than other smokers (43%).<\/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>Evidence of the ill effects of smoking has been growing since the 1950&#8217;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 (U.S. Department of Health, Education, and Welfare, 1964). Cigarette smoking and breathing secondhand smoke (SHS) have 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).<\/p>\n<p>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 has shared with the CDC for many years:<\/p>\n<ol>\n<li>Preventing initiation of tobacco use (CDC, 2014b)<\/li>\n<li>Eliminating nonsmokers&#8217; exposure to secondhand smoke (CDC, 2017)<\/li>\n<li>Promoting quitting among adults and young people (CDC, 2015)<\/li>\n<li>Identifying and eliminating tobacco-related disparities (CDC, 2014b, 2015, 2017)<\/li>\n<\/ol>\n<p>As part of monitoring progress on these goals, the TPCP tracks the prevalence, consumption, and use of tobacco products including cigarettes, electronic nicotine delivery systems (ENDS; also known as e-cigarettes or vaping), and other forms of tobacco.<\/p>\n<p>A key issue in evaluating tobacco prevention and control is monitoring the same indicators of behaviors and attitudes related to tobacco over time. Because tobacco prevention outcomes result from state government programs including the one implemented in Wyoming, the efforts of multiple federal agencies\u2014most prominently, the U.S. Food and Drug Administration [FDA], Substance Abuse and Mental Health Services Administration [SAMHSA], CDC, and other groups (e.g., the Robert Wood Johnson Foundation, Campaign for Tobacco-Free Kids, American Nonsmokers&#8217; Rights Foundation, American Cancer Society, and American Lung Association)\u2014changes over time reflect the cumulative impact of many sustained and new efforts to affect the key indicators. These indicators have not been revised drastically since at least 2005 (see CDC, 2007, 2014a, 2014b, 2015, 2017; Starr et al., 2005).<\/p>\n<p>The Wyoming Adult Tobacco Survey (ATS) is a standardized telephone survey administered by the Wyoming Survey &amp; 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. In addition to conducting analyses on the 2017 data, WYSAC merged data from the 2017 ATS with data from previous iterations of the survey to analyze trends. WYSAC has formatted this report similarly to previous iterations of the report to facilitate readers&#8217; efforts to compare the current results to those in previous reports. The previous report is available here: <a href=\"https:\/\/wysac.uwyo.edu\/wysac\/reports\/View\/5553\">https:\/\/wysac.uwyo.edu\/wysac\/reports\/View\/5553<\/a>.<\/p>\n<h1>2017 ATS Methods<\/h1>\n<p>In this section, we provide a general summary of the methods used to collect and analyze the data for the 2017 ATS. Additional technical details are in Appendix B. The CDC protocols for the 2017 ATS, the 2010 National Adult Tobacco Survey, and the previous iterations of the ATS (2002, 2004, 2006\u20132009, 2012, 2015) were generally similar, which allowed WYSAC to perform analyses of trends for comparable questions on the surveys and reflecting the stability in key indicators related to tobacco prevention work.<\/p>\n<h2>Questionnaire Development<\/h2>\n<p>WYSAC developed the 2017 ATS items based on CDC&#8217;s core and supplemental ATS items. The Wyoming TPCP and WYSAC selected some optional questions and developed some Wyoming-specific questions based on the indicators most directly related to TPCP efforts in Wyoming. Because the national and Wyoming tobacco prevention programs have been stable since the 2015 iteration of the ATS, few changes to the survey questionnaire were required. Key changes for the 2017 ATS included adding questions about whether dual cigarette and ENDS users first used cigarettes or ENDS, adding questions about use of flavored ENDS and different ENDS brands, simplifying the questions about smoking cessation to focus on the Wyoming Quit Tobacco Program (WQTP), adding an item to assess barriers to quitting smoking, adding items to assess efforts to quit using ENDS, adding items to assess perceived harmfulness of ENDS use (overall and relative to smoking), adding an item to assess the perceived relative benefits of switching from smoking to ENDS use, adding an item to assess mental health as a key disparity in the burden of tobacco use, and shortening the survey (in an effort to improve the response rate) by eliminating questions about children in the adults&#8217; homes.<\/p>\n<h2>Survey Administration<\/h2>\n<p>The random digit dialing (RDD) landline and RDD cell phone samples for the 2017 ATS were disproportionately stratified to produce county-level data. The goal was to complete roughly 200 surveys in each county for a statewide total of 4,600 surveys. Both samples were pre-screened to avoid calling numbers that were known to be disconnected, businesses, or on WYSAC&#8217;s list of people who have asked not to be surveyed. WYSAC made 356,204 call attempts for the 75,755 numbers that were left after the pre-screening process. Some numbers were called up to 27 times before they were assigned a final disposition code, which resulted in an average of 4.7 call attempts per record. Calling began on April 30th, 2017, and ended on December 20th, 2017. The final dataset contained a total of 4,647 completions (meeting the goal of 4,600 completes statewide), including 2,152 landline completions and 2,495 cell phone completions. The response rate for the landline sample was 27%, the response rate for the cell phone sample was 38%, and the overall response rate was 33%. After the completion of the data collection, the CDC contractor weighted the 2017 ATS data to make the results more representative of the Wyoming adult population. Weighting variables included selection probability; nonresponse adjustment; gender by age, race\/ethnicity; educational attainment; county; and phone usage (cell phone only, landline only, and dual phone use). Weighting data does not change responses. It makes the dataset generally more reflective of the entire Wyoming adult population than the unweighted data. WYSAC received the 2017 ATS data file from the CDC contractor on February 26, 2018.<\/p>\n<h2>Analysis<\/h2>\n<p>WYSAC analyzed the data using Stata, version 12.1 with the complex sample survey methods available in that statistical package. In the tables and figures of this report, WYSAC used weighted data to calculate estimates and associated confidence intervals. WYSAC used logistic regressions to test for trends for time periods longer than two years. Generally, trends reported in this document are based on the earliest year a comparable question was asked through 2017. WYSAC also used logistic regression to identify statistically significant associations between outcomes and their correlates. The body of this report summarizes results for evaluation indicators for the Wyoming TPCP, including the estimates from 2017 and trend analyses (when possible). Results for each survey item are reported in Appendix A as a supplement to this summary. Relationships noted as significant in the body of the report are significant, <em>p<\/em>&lt; .05. Confidence intervals for estimates to responses for the 2018 survey are in Appendix A. Key statistical results are detailed in Appendix C.<\/p>\n<h2>Data Limitations<\/h2>\n<p>Most ATS survey items have been tested and validated by the CDC and reused over time. However, because ATS provides self\u2010reported data, respondents&#8217; recollection of events and interpretation of the survey items are estimates and might include respondent bias (e.g., underreporting undesirable behaviors). Also, not all estimates have the same level of precision due to survey skip pattern, analysis of subgroups, and the combination of both. For example, questions asked of smokers or other tobacco users tend to have sample sizes smaller than other questions asked of nonsmokers or non-tobacco users. Estimates for small subgroups, e.g., African Americans in Wyoming, would be also less precise than estimates for larger subgroups, e.g., White Americans.<\/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>Prevalence and Consumption<\/h1>\n<p>The Wyoming TPCP and the CDC track the prevalence rates and consumption of tobacco products as key indicators across their four shared goals.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming9.png\" alt=\"\" width=\"580\" height=\"251\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming7.png\" alt=\"\" width=\"349\" height=\"246\" \/><\/p>\n<h2>Cigarettes<\/h2>\n<p>Responses to the ATS lead to four key categories of smoking status, described in Table 1. In 2017, about one sixth (16%) of adults were current smokers. About one quarter (26%) were former smokers. About one third (32%) were experimental smokers (Figure 1).<\/p>\n<p>The adult smoking rate (current smokers) has shown a significant decrease since peaking in 2006 (Figure 2).<\/p>\n<h2><img loading=\"lazy\" decoding=\"async\" class=\"alignnone fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming10.png\" alt=\"\" width=\"546\" height=\"295\" \/><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming11.png\" alt=\"\" width=\"249\" height=\"265\" \/><\/p>\n<h2>Electronic Nicotine Delivery Systems (ENDS)<\/h2>\n<p>Although ENDS use is less popular than smoking cigarettes or using some other tobacco products, their relatively recent emergence on the market makes them a key tobacco prevention issue. About one in 20 adults (6%) currently use ENDS (e-cigarettes and vape pens) some days or every day (Figure 3). About three fourths (74%) have never tried ENDS. These estimates are similar to those from 2015, but may not reflect the increased popularity of ENDS that resulted from the recent commercial success of Juul&#8217;s new generation of ENDS products (LaVito, 2018). In addition, young adults (ages 18 to 29) are more likely to use ENDS than other adults (ages 30 or older): 11% of young adults currently use ENDS every day or some days, compared to 5% of other adults.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming12.png\" alt=\"\" width=\"247\" height=\"534\" \/><\/p>\n<p>Of those current ENDS users, 86% used ENDS flavored to taste like menthol, alcohol, candy, fruit, chocolate, or other sweets. A customized commercial juice or liquid from a vape shop was the most popular ENDS brand (83%). Juul was not specified as a brand because it was not a major market force at the time of drafting the 2017 ATS questionnaire.<\/p>\n<p>The most popular reason to try ENDS was curiosity (Figure 4). After that, the top results show an inclination by ENDS users toward cutting down or quitting cigarette smoking. These results are not significantly different from when the questions were first asked in 2015.<\/p>\n<p>What are adults&#8217; perceptions of harmfulness of ENDS use? The 2017 ATS asked respondents for their opinions about whether using ENDS is harmful to one&#8217;s health, how harmful using ENDS would be compared to cigarette smoking, and whether switching from cigarette smoking to using ENDS is healthy. All three questions had a relatively large percentage of adults answering &#8220;Don&#8217;t know \/ Not sure&#8221; (Figure 5; Figure 6; Figure 7). These adults are unsure about whether ENDS use is harmful to one&#8217;s health and whether ENDS use or cigarette smoking has greater health risk.<\/p>\n<p>Most adults (74%) think that using ENDS is harmful: 35% think it is very harmful and 39% think it is somewhat harmful (Figure 5). A relatively small percentage of adults (7%) think using ENDS is not at all harmful. The remaining 19% of adults were unsure about whether using ENDS is harmful to one&#8217;s health.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming13.png\" alt=\"\" width=\"247\" height=\"315\" \/> <img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming14.png\" alt=\"\" width=\"241\" height=\"321\" \/><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming15.png\" alt=\"\" width=\"351\" height=\"330\" \/>When compared to cigarette smoking, adults were more likely to think using ENDS is less harmful to a person&#8217;s health than to think it is more harmful: about 40% think using ENDS is less harmful than cigarette smoking while 11% think it is more harmful than cigarette smoking (Figure 6). Also, more adults think using ENDS is <em>somewhat<\/em> less harmful (31%) than those who think it is <em>much<\/em> less harmful (9%). Still, 35% think using ENDS is as harmful as smoking cigarettes, and 14% of adults were unsure about health risk of using ENDS, compared to smoking cigarettes.<\/p>\n<p>Opinions on the health benefits of switching <em>completely <\/em>from cigarette smoking to ENDS use are divided: 42% think switching from cigarette smoking to ENDS use is somewhat or very healthy while 41% think it is not healthy at all (Figure 7). The remaining 17% of adults were unsure.<\/p>\n<h2>Other Tobacco Products<\/h2>\n<p>Among adults, non-cigarette, non-ENDS tobacco products are less popular than cigarettes. Relatively few adults reported using other tobacco products (Figure 8). Prevalence rates of these tobacco products have not significantly changed since comparable question were first asked in 2010. Also, few women use chewing tobacco, compared to men: 18% of men used it in the past 30 days compared to 1% of women.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming16.png\" alt=\"\" width=\"320\" height=\"307\" \/>Among adults who had smoked at least 100 cigarettes and had also used chewing tobacco, snuff, dip, or snus in their lifetime, 37% of them had used some form of smokeless tobacco as a substitute for smoking when they were in a place where smoking was not allowed. This substitution rate has not significantly changed since 2012.<\/p>\n<h2>Flavor in Tobacco Products<\/h2>\n<p>About one fourth (23%) of adults who at least puffed on a cigarette in the past 30 days smoked menthol cigarettes. Young adults (ages 18 to 29) were significantly more likely to smoke menthol cigarettes than other adults (30 or older): 39% of young adults smoked menthol cigarettes while 18% of other adults did so.<\/p>\n<p>About half (49%) of adults who smoked cigars (including cigarillos and very small cigars) in the past 30 days smoked cigars flavored to taste like candy, fruit, chocolate, or other sweets. Young adults (ages 18 to 29) were significantly more likely to smoke flavored cigars than other adults: 70% of young adults smoked menthol cigarettes while 30% of other adults did so.<\/p>\n<p>About half (52%) of adults who had ever tried ENDS in their lifetime used ENDS for reasons related to flavor: (1) for the flavoring or (2) because they thought ENDS tasted better. Young adults (ages 18 to 29) were significantly more likely to list these flavor-related reasons than other adults: 70% of young adults listed the flavor-related reasons for trying ENDS, compared to 42% of other adults. Also, flavored ENDS use is common among current ENDS users: 86% of current ENDS users used ENDS that taste like menthol, alcohol, candy, fruit, chocolate, or other sweets in the past 30 days.<\/p>\n<h2>Conclusions<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming17.png\" alt=\"\" width=\"262\" height=\"110\" \/>Cigarettes are still the most popular form of tobacco for adults. ENDS use is not as prevalent as cigarette smoking or smokeless tobacco use in the overall adult population. Young adults (ages 18 to 29) are more likely to use ENDS than other adults (30 or older). The majority of current ENDS users used ENDS flavored to taste like something other than tobacco. Two of the top three reasons for using ENDS are cutting back or quitting cigarettes. While most adults would agree that ENDS use is harmful, many are unsure about whether ENDS use is harmful to one&#8217;s health and whether ENDS use or cigarette smoking has greater health risk. The prevalence rates of other tobacco products such as chewing tobacco, cigars, pipes, and hookahs remain relatively low, compared to cigarette smoking. Flavoring in cigarettes, cigars, and ENDS might be an important part of using those tobacco products, especially for young adults.<\/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><img decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming19-e1617138341928.png\" alt=\"\" width=\"351\" \/>Goal Area 1: Preventing Initiation of Tobacco Use<\/h1>\n<p>The Wyoming TPCP and the CDC share the goal of reducing the health burdens of tobacco use by preventing the initiation of tobacco use. A relatively recent effort in some local and state tobacco prevention programs outside of Wyoming has been to raise the legal age of purchase from 18 (or 19 in some jurisdictions) to 21 (see https:\/\/tobacco21.org\/). We deviated from previous analytical approaches to provide data relevant to this emerging issue in tobacco prevention.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming18.png\" alt=\"\" width=\"245\" height=\"309\" \/><\/p>\n<h2>Age of Smoking a Whole Cigarette for the First Time<\/h2>\n<p>The majority (69%) of adults who have ever smoked a whole cigarette smoked their first whole cigarette when they were younger than 18 (Figure 9). However, there was still a large group (22%) who smoked a whole cigarette for the first time between the ages of 18 and 20. In total, 91% of current, former, and experimental smokers (see Table 2 for a summary of the four smoking status categories) smoked their first whole cigarette before age 21; this pattern has not changed significantly since comparable questions were first asked in 2010. In 2017, the average age at which adults who have ever smoked a whole cigarette smoked their first whole cigarette was 16 (with the median of 16 and the responses ranging from 4 to 58).<\/p>\n<h2>Age of Initiating Daily Smoking<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming20.png\" alt=\"\" width=\"322\" height=\"265\" \/>Among adults who had ever smoked at least one cigarette per day for at least 30 consecutive days (including current and former smokers), 85% said they started smoking daily when younger than 21 (Figure 10). This pattern has been stable since comparable questions were first asked in 2010.<\/p>\n<h2>Role of ENDS in Initiation of Cigarette Smoking<\/h2>\n<p>The 2017 ATS asked current, former, and experimental smokers (see Table 2 for a summary of the four smoking status categories) who had also tried ENDS whether they had used cigarettes or ENDS first. For most of these smokers (72%), this question was not applicable because ENDS were not on the market (to their knowledge) when they started smoking. For those smokers who thought ENDS were on the market, 54% used ENDS first and 45% tried cigarettes first. These proportions are not significantly different.<\/p>\n<h2>Conclusions<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming21.png\" alt=\"\" width=\"157\" height=\"179\" \/>The smoking habits of the vast majority of smoking adults begin when they are under the age of 21, especially under the age of 18. Relatively few adults begin to smoke or begin to smoke daily after age 21. Although we cannot make causal inferences from these correlational data, the 2017 ATS provides some evidence in support of ENDS use as a potential gateway to smoking: 54% of current, former, and experimental smokers (see Table 2 for a summary of the four smoking status categories) who thought ENDS were available when they started smoking used ENDS before smoking a cigarette.<\/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>Goal Area 2: Eliminating Nonsmokers&#8217; Exposure to Secondhand Smoke<\/h1>\n<p>The Wyoming TPCP and the CDC share the goal of reducing the health burdens of tobacco use by eliminating nonsmokers&#8217; exposure to secondhand smoke.<\/p>\n<h2>Support for Indoor Smokefree Policies and Laws<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming22.png\" alt=\"\" width=\"552\" height=\"435\" \/>The 2017 ATS asked questions about both smokefree indoor air policies and smokefree indoor air laws. The <em>policy<\/em> questions asked respondents if they think smoking should be allowed indoors at workplaces, restaurants, bars, and casinos\/clubs. (Casinos and clubs were asked as a single survey item, so WYSAC treated them as a single venue type.) The survey questions about smokefree <em>laws<\/em> asked respondents if they support or oppose statewide smokefree indoor air laws in Wyoming for the same venues.<\/p>\n<p>Results from the policy questions revealed that the percentage of Wyomingites who agreed that smoking indoors should never be allowed in workplaces or restaurants significantly increased from when comparable questions were first asked in 2002 to 2017. For bars and for casinos\/clubs, support for smokefree policies remained relatively stable between 2015, when the comparable questions were first asked, and 2017, and remained lower than support for the other venues. The trend for related questions asked between 2004 and 2012 showed increasing support for smokefree indoor air in these venues (Figure 11).<\/p>\n<p>In 2017, the majority of adults supported statewide smokefree indoor air laws covering all workplaces, restaurants, or casinos and clubs. About half (50%) supported a statewide smokefree indoor air law covering all bars (Figure 12). These results are not significantly different from when comparable questions were first asked in 2015.<img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming23.png\" alt=\"\" width=\"321\" height=\"330\" \/><\/p>\n<p>WYSAC performed logistic regression analyses to identify associations between support for a state smokefree indoor air law for each venue and seven demographic variables: age, gender, annual household income, education, race, ethnicity, and sexual orientation. WYSAC modeled each of the four venues in Figure 12 separately, using these seven demographic variables as predictors. When controlling for the other demographic variables, gender, education, and sexual orientation were significantly associated with support for legally protected smokefree indoor air for workplaces, restaurants, bars, and casinos\/clubs. Men were less likely to support smokefree indoor air laws than women. Adults with an associate&#8217;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 (Table 3). See Appendix C for detailed results.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming24.png\" alt=\"\" width=\"553\" height=\"357\" \/><\/p>\n<h2>Support for Other Smokefree Air Policies and Laws<\/h2>\n<p>Most Wyomingites (81%) thought that smoking should be restricted at outdoor parks at least in some manner. This proportion has significantly increased from 76% in 2010. Complete restrictions are less popular than partial restrictions. In 2017, 37% of adults thought that smoking should never be allowed, and 44% of adults thought that smoking should be allowed only at some times or in some places.<\/p>\n<p>Support for laws making outdoor workplaces smokefree was substantially lower than support for laws making indoor workplaces smokefree: 66% of adults opposed a state smokefree air law for all outdoor workplaces while 27% would support such a law; 7% said they were unsure. The level of support for such a law in 2017 is not significantly different from when comparable questions were first asked in 2015.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming25.png\" alt=\"\" width=\"509\" height=\"235\" \/>The percentage of adults who reported they do not allow smoking inside their homes has been high and has increased significantly from 72% in 2002, when the question was first asked, to 89% in 2017 (Figure 13).<\/p>\n<h2>\u00a0<\/h2>\n<h2>Exposure to Secondhand Smoke<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming26.png\" alt=\"\" width=\"329\" height=\"328\" \/>Most adults (93%) who worked indoors reported that smoking was never allowed in indoor areas (including inside a vehicle) at their place of work (Figure 14). This is a relatively small but significant increase from 89% in 2010, when comparable questions were first asked. Conversely, relatively few (26%; including those who primarily worked outside) reported that smoking was not allowed in outdoor areas. This pattern has been consistent since 2012 after a drop from 36% in 2010, when comparable questions were first asked.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming27.png\" alt=\"\" width=\"254\" height=\"177\" \/>Consistently since 2010, most employed adults were not regularly exposed to secondhand smoke (SHS) at their workplace either indoors or outdoors. In 2017, 20% of working adults reported that they had breathed someone else&#8217;s smoke at their workplace in the past seven days. Adults who worked outdoors most of the time were more likely to be exposed to SHS than those who worked indoors (including in vehicles): 28% of adults who work primarily outdoors experienced SHS exposure, compared to 16% of those who work primarily indoors.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming28.png\" alt=\"\" width=\"306\" height=\"288\" \/>Relatively few adults reported being exposed to SHS while at indoor or outdoor public places in the past seven days (Figure 15). At both types of public places, significantly fewer adults have been exposed to SHS since 2012, when comparable questions were first asked. Also, smokers are more likely to be exposed to SHS at public places than non-smokers: 47% of smokers reported exposure to SHS while 35% of non-smokers reported exposure to SHS in 2017.<\/p>\n<h2>Conclusions<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming29.png\" alt=\"\" width=\"250\" height=\"219\" \/><\/p>\n<p>Adults almost unanimously agree that SHS is harmful to one&#8217;s health. However, opinions vary as to where and how smoking should be restricted. Adults have a high degree of support for the idea that indoor areas of restaurants and workplaces across the state should have smokefree indoor air. Similarly, support for smokefree indoor air laws covering those venues is common. Also, support for tobacco-free schools is high. There is less support for the idea that casinos, clubs, bars, and outdoor work areas should be smokefree or that there should be a law making them smokefree. As a reference point from a different survey in 2014, 71% of registered voters in Wyoming said they would support a smokefree indoor air law making all public buildings, such as government offices, stores, bars, and restaurants, smokefree indoors (WYSAC, 2015). Because that question was very different from the questions for the 2017 ATS, the difference in the estimates does <em>not<\/em> necessarily show a trend in support for smokefree air.<\/p>\n<p>Most adults report working in places that have smokefree indoor air policies, but outdoor smokefree air policies at workplaces are relatively rare. Exposure to secondhand smoke is more likely to occur in outdoor areas, including at work and public places, than at indoor areas.<\/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<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming30.png\" alt=\"\" width=\"254\" height=\"321\" \/><\/p>\n<h1>Goal Area 3: Promoting Cessation<\/h1>\n<p>The Wyoming TPCP and the CDC share the goal of reducing the health burdens of tobacco use by promoting quitting among adults and young people.<\/p>\n<h2>Smokers&#8217; Cessation Efforts<\/h2>\n<p>The majority (69%) of current smokers stated they wanted to quit, 26% said they did not, and 6% said they did not know or were not sure. At some point in their lives, most current smokers (87%) had stopped smoking for at least one day because they were trying to quit for good. About half of current smokers (48%) had tried to quit smoking at least once in the past year (Figure 16), which has not changed significantly since comparable questions were first asked in 2010.<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming31.png\" alt=\"\" width=\"255\" height=\"296\" \/><\/p>\n<p>Relatively few smokers who had tried to quit in the past year had used proven cessation aids (Figure 17). When they did use proven cessation aids, nicotine replacement therapy (NRT) was the most often used, consistently since 2012, when comparable questions were first asked.<\/p>\n<p>When they had tried to quit or wanted to quit, most smokers faced obstacles to quitting cigarette smoking. The most common barriers were loss of a way to handle stress and cravings for a cigarette, followed by other people smoking around them (Figure 18). Thus, smokefree indoor air policies and reducing exposure to secondhand smoke could help many smokers who are trying to quit.<\/p>\n<p>&nbsp;<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming32.png\" alt=\"\" width=\"345\" height=\"451\" \/><\/p>\n<h2>ENDS Users&#8217; Cessation Efforts<\/h2>\n<p>Although the adult population of current ENDS users is relatively small (6% of adults) and ENDS are a relatively new type of tobacco product, some of them still tried to quit using ENDS for good. At some point in their lives, about one quarter of current ENDS users (24%) had stopped using ENDS for at least one day because they were trying to quit for good. About one fifth of current ENDS users (19%) had tried to quit using ENDS at least once in the past year.<\/p>\n<h2>Involvement of Healthcare Providers in Tobacco Cessation<\/h2>\n<p>The ATS asked tobacco users if they had seen a healthcare professional in the past year and if so, if they received advice to quit from a healthcare professional. The majority (75%) of tobacco users had seen a healthcare professional in the past year. About half (55%) of these tobacco users were advised by a health professional to quit using tobacco. This result has remained stable since comparable questions were first asked in 2010. These respondents then answered more detailed questions about whether and how healthcare providers provided assistance. In 2017, 63% of tobacco users who were advised to quit were also offered assistance to quit from their healthcare providers. These tobacco users most often received information about the Wyoming Quit Tobacco Program (WQTP) from their healthcare providers (Figure 19).<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming33.png\" alt=\"\" width=\"255\" height=\"343\" \/> <img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming34.png\" alt=\"\" width=\"271\" height=\"343\" \/><\/p>\n<p>In a separate line of questioning, in the past year, 72% of tobacco users who were not advised to quit and non-tobacco-using adults reported that a health professional asked them whether they smoked cigarettes or used other forms of tobacco (Figure 20). This is a significant increase over time, going from 64% in 2010, when comparable questions were first asked, to 72% in 2017. Thus, healthcare professionals seem to be more frequently screening their patients for tobacco use. This increase coincides with changes related to the Patient Protection and Affordable Care Act of 2010, though we cannot make a causal attribution to the requirements of that law. Still, 13% of tobacco users were not advised to quit nor screened for tobacco use.<\/p>\n<h2><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming35.png\" alt=\"\" width=\"262\" height=\"304\" \/>Tobacco Cessation and Tobacco Tax<\/h2>\n<p>Increasing the price of tobacco products is one method of encouraging the cessation of tobacco use (CDC, 2015) and discouraging the initiation of tobacco use (CDC, 2014b). Since 2003, the state of Wyoming has taxed cigarettes with an excise tax of $0.60 per pack. When asked how much of an increase above $0.60 they would approve, over half (53%) of adults would approve an increase of some amount (Figure 21). The most popular amount was an increase of $1.50 or more, with 20% of adults supporting that change. For smokeless tobacco, over half (55%) of adults indicated that they were &#8220;for&#8221; an increase in the tax while 38% said they were &#8220;against,&#8221; and 7% said that they did not know or were not sure.<\/p>\n<p>Appendix A includes data on price smokers paid for a pack or carton of cigarettes and use of special promotions to buy cigarettes.<\/p>\n<h2>Conclusions<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming36.png\" alt=\"\" width=\"274\" height=\"138\" \/>The majority of smokers have tried to quit at some point in their lives and want to quit for good. However, the use of proven cessation aids is relatively low. 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 a cigarette, and other people smoking around them. Although it may be difficult for tobacco prevention efforts to help with the first two obstacles, reducing exposure to secondhand smoke could help many smokers who are trying to quit.<\/p>\n<p>Many tobacco users are not receiving screening and assistance from healthcare providers to help them quit. About half of tobacco users who saw a healthcare professional in the previous year were advised to quit, and about one third of those were not offered assistance. Greater collaboration with health professionals could result in more tobacco users becoming aware of, and receptive to, cessation services (CDC, 2015).<\/p>\n<p>Awareness of tobacco quitlines is another area for potential improvement. About half of non-tobacco users were aware that a quitline 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 non-tobacco users knew about the existence of this proven cessation aid, then they could inform and encourage tobacco users who may not know about it.<\/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>Goal Area 4: Identifying and Eliminating Tobacco-Related Disparities<\/h1>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming37.png\" alt=\"\" width=\"376\" height=\"187\" \/>The fourth goal of the Wyoming TPCP and the CDC is to reduce tobacco use and associated health burdens among populations that are disparately affected by tobacco and related disease and death. For each of Wyoming&#8217;s high-priority subpopulations, we report on the key indicators of smoking prevalence compared to the rest of the adult population, quit attempts, and exposure to SHS at work. As reference points, the overall estimates for each of these indicators are presented in Table 4. Because of the relatively small number of smokers within each subpopulation, there is a high degree of uncertainty around the estimates for most of the subgroups. Often, this makes interpretation of statistical tests problematic. Therefore, we took a conservative approach and chose not to provide interpretations for statistical tests in which we had a low degree of confidence.<\/p>\n<h2>American Indian<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming38.png\" alt=\"\" width=\"258\" height=\"227\" \/>To produce estimates for American Indians in Wyoming, WYSAC analyzed adults who considered themselves to be American Indian, including those who self-identified as multiracial including American Indian, regardless of whether they reported Hispanic ethnicity.<\/p>\n<p>In 2017, 36% of American Indians smoked cigarettes, about double the smoking rate of the rest of the population 15% (Figure 22).<\/p>\n<p>At some point in their lives, about nine out of every ten American Indian current smokers (89%) had stopped smoking for at least one day because they were trying to quit for good. About two thirds (63%) of American Indian current smokers had tried to quit smoking at least once in the past year.<\/p>\n<p>Most employed American Indian adults were not regularly exposed to SHS at their workplace either indoors or outdoors. In 2017, 34% reported they had breathed someone else&#8217;s smoke at their workplace in the past seven days. American Indian workers were significantly more likely to be exposed to SHS than other workers.<\/p>\n<h2>Mental Health<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming39.png\" alt=\"\" width=\"252\" height=\"260\" \/>The 2017 ATS asked respondents &#8220;Do you have any mental health conditions, such as anxiety disorder, depression disorder, bipolar disorder, alcohol abuse, drug abuse, or schizophrenia?&#8221; About one fifth (18%) of adults reported having at least one mental health condition.<\/p>\n<p>In 2017, 37% of adults with self-reported mental health conditions smoked cigarettes, more than double the smoking rate (12%) of those without self-reported mental health conditions (Figure 23).<\/p>\n<p>At some point in their lives, about eight out of ten (82%) current smokers with mental health conditions had stopped smoking for at least one day because they were trying to quit for good. About half (48%) of current smokers with mental health conditions had tried to quit smoking at least once in the past year.<\/p>\n<p>Most employed adults with mental health conditions were not regularly exposed to SHS at their workplace either indoors or outdoors. In 2017, 32% reported they had breathed someone else&#8217;s smoke at their workplace in the past seven days. Workers with mental health conditions were significantly more likely to be exposed to SHS than those with no mental health conditions.<\/p>\n<h2>Annual Household Income<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming40.png\" alt=\"\" width=\"236\" height=\"243\" \/><\/p>\n<p>In 2017, 28% of adults with annual household income less than $30,000 smoked cigarettes, about double the smoking rate (14%) of those with a higher income (Figure 24).<\/p>\n<p>At some point in their lives, about nine out of ten (89%) current smokers with income less than $30,000 had stopped smoking for at least one day because they were trying to quit for good; 44% had tried to quit smoking at least once in the past year.<\/p>\n<p>Most employed adults with income less than $30,000 were not regularly exposed to SHS at their workplace either indoors or outdoors. In 2017, 26% reported that they had breathed someone else&#8217;s smoke at their workplace in the past seven days. For employed adults with income of $30,000 or more, 19% reported that they were exposed to SHS at their workplace. The difference by income was not statistically significant.<\/p>\n<h2>Young Adults<\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming41.png\" alt=\"\" width=\"252\" height=\"305\" \/>In 2017, 15% of young adults (ages 18 to 29) smoked cigarettes, comparable to the smoking rate (17%) of other adults (ages 30 or older; Figure 25). Young adults are more likely to have never tried a cigarette: 42% of young adults have never tried a cigarette as opposed to 23% of other adults. Because so few adults begin smoking after the age of 21, this difference between age cohorts may indicate that experimentation with tobacco products is becoming less common over time. Or, it may reflect experimentation that occurs at a later age and does not develop into regular smoking. Young adults are also less likely to be former smokers than other adults: 14% of young adults are formers smokers, compared to 29% of other adults. This disparity between age cohorts may reflect greater motivation to quit, such as in response to more noticeable health effects of smoking as people age.<\/p>\n<p>At some point in their lives, young adult current smokers (95%) were more likely than other current smokers (84%) to have stopped smoking for at least one day because they were trying to quit for good. Also, young adult smokers (67%) were more likely than other smokers (43%) to have tried to quit smoking at least once in the past year.<\/p>\n<p>Significantly more young adults were exposed to SHS at their workplace (30%) than other working adults (17%).<\/p>\n<h2>Conclusions<\/h2>\n<p>American Indians, adults with mental health conditions, and those with annual household income less than $30,000 have relatively high smoking rates. Therefore, members of these populations are likely to suffer more from the health and economic burdens of tobacco use than are other adults. Many young adults (ages 18 to 29) have never tried a cigarette, but the smoking rate for young adults is comparable to the smoking rate for other adults (ages 30 or older). Preventing initiation and promoting cessation among young adults may reduce tobacco-related health risks later in their life.<\/p>\n<p>Most current smokers have tried to quit cigarette smoking at some point in their lives. Young adult smokers are more likely to try to quit smoking than other adults. Focused efforts to help them succeed may reduce the risk of them developing smoking-related diseases later in life.<\/p>\n<p>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. While efforts to reduce secondhand smoke exposure in the workplace would benefit all Wyoming residents, these populations could see the most benefit from instituting such 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>Health Consequences of Smoking<\/h1>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2020\/01\/012820_1827_2017Wyoming42.png\" alt=\"\" width=\"312\" height=\"569\" \/>The U.S. Surgeon General has concluded that smoking is harmful to nearly every organ in the body, causes disease, and worsens existing illnesses (USDHHS, 2014). The Wyoming TPCP collects data about the prevalence of several chronic diseases to demonstrate the burden and consequences of tobacco use for Wyoming adults.<\/p>\n<p>Adults who had smoked at least 100 cigarettes (current and former smokers) reported worse overall health than those who had not. One fifth (20%) of all adults who had smoked at least 100 cigarettes reported being in fair or poor health, about double the percentage (9%) of nonsmokers.<\/p>\n<p>WYSAC created seven logistic regression models based on data from the 2017 ATS (see Appendix C for detailed, technical results). When controlling for age, the models found that diabetes, chronic lung disease, and heart disease were significantly more common among people who had smoked at least 100 cigarettes (current and former smokers), compared to nonsmokers. The relative risk for diabetes was 1.7 times higher for current and former smokers than experimental smokers and those who never smoked. The relative risk for chronic lung disease was 5.5 times higher for current and former smokers than experimental smokers and those who never smoked. The relative risk for heart disease was 2.8 times higher for current and former smokers than experimental smokers and those who never smoked (Figure 26).<\/p>\n<h2>Conclusions<\/h2>\n<p>Smokers tend to feel less healthy overall and report more chronic illnesses than nonsmokers. Reducing the prevalence of smoking will, over time, reduce the burden of chronic disease in Wyoming and help Wyomingites feel healthier.<\/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>Summary and Discussion<\/h1>\n<p>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.<\/p>\n<p>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&#8217;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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>Wyoming adults almost unanimously agree that secondhand smoke is harmful to one&#8217;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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<p>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.<\/p>\n<h1>Recommendations<\/h1>\n<p>Many of the trends show continued, though slow, progress regarding the goals of the Wyoming and national tobacco prevention and control programs:<\/p>\n<ol>\n<li>Preventing initiation of tobacco use (CDC, 2014b)<\/li>\n<li>Eliminating nonsmokers&#8217; exposure to secondhand smoke (CDC, 2017)<\/li>\n<li>Promoting quitting among adults and young people (CDC, 2015)<\/li>\n<li>Identifying and eliminating tobacco-related disparities (CDC, 2014b, 2015, 2017)<\/li>\n<\/ol>\n<p>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 <a href=\"https:\/\/www.thecommunityguide.org\/topic\/tobacco\">https:\/\/www.thecommunityguide.org\/topic\/tobacco<\/a> 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.<\/p>\n<p>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&#8217;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.<\/p>\n<h2>Goal 1: Preventing Initiation of Tobacco Use<\/h2>\n<p>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).<\/p>\n<h2>Goal 2: Eliminating Nonsmokers&#8217; Exposure to Secondhand Smoke<\/h2>\n<p>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&#8217;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.<\/p>\n<h2>Goal 3: Promoting Quitting Among Adults and Young People<\/h2>\n<p>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.<\/p>\n<h2>Goal 4: Identifying and Eliminating Tobacco-Related Disparities<\/h2>\n<p>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).<\/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;\">Centers for Disease Control and Prevention. (2007). <em>Best practices for comprehensive tobacco control programs\u20132007<\/em>. Atlanta, GA: 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. Retrieved December 10, 2018, from ftp:\/\/ftp.cdc.gov\/pub\/fda\/fda\/BestPractices_Complete.pdf<\/p>\n<p style=\"margin-left: 36pt;\">Centers for Disease Control and Prevention. (2014a). <em>Best practices for comprehensive tobacco control programs\u20132014<\/em>. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved December 10, 2018, from <a href=\"https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/best_practices\/pdfs\/2014\/comprehensive.pdf\">https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/best_practices\/pdfs\/2014\/comprehensive.pdf<\/a><\/p>\n<p style=\"margin-left: 36pt;\">Centers for Disease Control and Prevention. (2014b). <em>Preventing initiation of tobacco use: Outcome indicators for comprehensive tobacco control programs\u20132014<\/em>. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved from <a href=\"https:\/\/www.cdc.gov\/tobacco\/tobacco_control_programs\/surveillance_evaluation\/preventing_initiation\/pdfs\/preventing_initiation.pdf\">https:\/\/www.cdc.gov\/tobacco\/tobacco_control_programs\/surveillance_evaluation\/preventing_initiation\/pdfs\/preventing_initiation.pdf<\/a><\/p>\n<p style=\"margin-left: 36pt;\">Centers for Disease Control and Prevention. (2015). <em>Promoting quitting among adults and young people: Outcome indicators for comprehensive tobacco control programs\u20142015<\/em>. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved from <a href=\"https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/tobacco_control_programs\/surveillance_evaluation\/key-outcome-2015\/pdfs\/KOI_Goal3_Update_12_28_15.pdf\">https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/tobacco_control_programs\/surveillance_evaluation\/key-outcome-2015\/pdfs\/KOI_Goal3_Update_12_28_15.pdf<\/a><\/p>\n<p style=\"margin-left: 36pt;\">Centers for Disease Control and Prevention. (2017). <em>Eliminating exposure to secondhand smoke: Outcome indicators for comprehensive tobacco control programs\u20132017<\/em>. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved from <a href=\"https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/tobacco_control_programs\/surveillance_evaluation\/eliminating-exposure\/pdfs\/eliminating-exposure-koi-goal2-508.pdf\">https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/tobacco_control_programs\/surveillance_evaluation\/eliminating-exposure\/pdfs\/eliminating-exposure-koi-goal2-508.pdf<\/a><\/p>\n<p style=\"margin-left: 36pt;\">LaVito, A. (2018, July 2). Popular e-cigarette Juul&#8217;s sales have surged almost 800 percent over the past year. <em>CNBS: Health and Science<\/em>. Retrieved December 10, 2018, from <a href=\"https:\/\/www.cnbc.com\/2018\/07\/02\/juul-e-cigarette-sales-have-surged-over-the-past-year.html\">https:\/\/www.cnbc.com\/2018\/07\/02\/juul-e-cigarette-sales-have-surged-over-the-past-year.html<\/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, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved December 10, 2018, from ftp:\/\/ftp.cdc.gov\/pub\/fda\/fda\/key_Indicators.pdf<\/p>\n<p style=\"margin-left: 36pt;\">U.S. Department of Health, Education, and Welfare. (1964). <em>Smoking and health: Report of the advisory committee to the Surgeon General of the Public Health Service<\/em>. Washington, DC: Department of Health, Education, and Welfare Public Health Service Publication No. 1103. Retrieved from <a href=\"https:\/\/profiles.nlm.nih.gov\/ps\/access\/NNBBMQ.pdf\">https:\/\/profiles.nlm.nih.gov\/ps\/access\/NNBBMQ.pdf<\/a><\/p>\n<p style=\"margin-left: 36pt;\">U.S. Department of Health and Human Services. (2010). <em>How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease: A report of the Surgeon General<\/em>. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved from <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53017\/\">http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53017\/<\/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 December 8, 2016, 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;\">WYSAC. (2015). <em>Fall 2014 Wyoming Election Survey fact sheet<\/em>. Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p style=\"margin-left: 36pt;\">WYSAC. (2017). <em>Impact of tobacco in Wyoming. 2016 Annual Summary<\/em>, by L. Despain, S. O&#8217;Donnell &amp; J. Simpson. Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<h1>Appendix<\/h1>\n<p>To see the appendix, please download the full report.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Wyoming Adult Tobacco Survey (ATS) is a key component in the evaluation of Wyoming&#8217;s Tobacco Prevention and Control Program (TPCP). Under contract to the Wyoming Department of Health (WDH), the Wyoming Survey &#038; Analysis Center (WYSAC) at the University of Wyoming called adults across the state (via cell phone and landline) to ask about their use of and attitudes about tobacco products and policies.<\/p>\n","protected":false},"author":4,"featured_media":1885,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[7,88,61,10,62,75,43,91,9,74,8,45],"coauthors":[21,22],"class_list":["post-2325","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-reports","tag-use-adults","tag-adults","tag-attitudes","tag-cessation","tag-cigarettes","tag-disparities","tag-electronic-cigarettes","tag-health","tag-health-econ","tag-secondhand-smoke","tag-laws","tag-wyoming"],"_links":{"self":[{"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/posts\/2325","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/comments?post=2325"}],"version-history":[{"count":56,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/posts\/2325\/revisions"}],"predecessor-version":[{"id":3354,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/posts\/2325\/revisions\/3354"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/media\/1885"}],"wp:attachment":[{"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/media?parent=2325"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/categories?post=2325"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/tags?post=2325"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/coauthors?post=2325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}