Smoking is the leading preventable cause of death in the United States. In Wyoming, smoking leads to approximately 800 deaths from smoking-related illnesses each year and nearly $258 million in annual healthcare costs (Centers for Disease Control and Prevention [CDC], 2014a).<\/p>\n
The impact of tobacco has been greater for specific groups. For example, research shows the tobacco industry has targeted promotional efforts toward certain neighborhoods and groups such as the LGBTQ+ community, people of color, people with lower incomes, indigenous people, and people experiencing behavioral health conditions (D\u2019Silva et al., 2018; Farber & Folan, 2017; Lee et al., 2015; Williams et al., 2013). As a result, people in these groups are more likely to smoke. That puts these populations at a disproportionate risk of smoking-related disease and death. These inequities have a greater impact on health outcomes than individual choices.<\/p>\n
The Wyoming Tobacco Prevention and Control Program (TPCP) works to reduce tobacco use in Wyoming by using a variety of strategies to achieve the following four goals that it shares with the CDC:<\/p>\n
- \n
- Preventing initiation of tobacco use (CDC, 2014b)<\/li>\n
- Eliminating nonsmokers\u2019 exposure to secondhand smoke (CDC, 2017a)<\/li>\n
- Promoting quitting among adults and young people (CDC, 2015b)<\/li>\n
- Identifying and eliminating tobacco-related disparities (CDC, 2014b, 2015b, 2017a)<\/li>\n<\/ol>\n
As part of monitoring progress on these goals, the TPCP tracks the use and availability of tobacco products including cigarettes, electronic nicotine delivery systems (ENDS; also known as e-cigarettes or vaping devices), and other forms of tobacco.<\/p>\n
The achievement of tobacco prevention outcomes is the collective result of the work of many organizations over time. The efforts of state government programs including the TPCP, multiple federal agencies, and other groups such as county tobacco prevention coalitions have all played a part in tobacco prevention and control in Wyoming. Key federal agencies include the U.S. Food and Drug Administration (FDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the CDC. Non-governmental groups include the Robert Wood Johnson Foundation, the Campaign for Tobacco-Free Kids, the American Non-smokers\u2019 Rights Foundation, the American Cancer Society, and the American Lung Association. Changes also reflect influences of the tobacco industry, such as changes in marketing practices or the release of new products such as ENDS.<\/p>\n
The Wyoming Adult Tobacco Survey (ATS) is a telephone survey administered by the Wyoming Survey & Analysis Center (WYSAC) at the University of Wyoming under contract to the Wyoming Department of Health (WDH), Public Health Division (PHD). Its purpose is to collect state- and county-level data about tobacco use, the four TPCP\/CDC goals, and the broader goal of reducing tobacco-related disease and death. In addition to analyzing the 2019 data, data from previous versions of the survey were used to analyze trends.<\/p>\n
2019 ATS Methods<\/h2>\n
This section provides a general summary of the methods used to collect and analyze the data for the 2019 ATS. Additional technical details, including criteria for determining statistical significance, are in Appendix A.<\/p>\n
WYSAC telephone interviewers conducted the telephone interviews. Most callers have significant experience on previous ATSs conducted by WYSAC for other states in recent years. Calling began on February 21, 2019 and ended on June 9, 2019. WYSAC callers completed 2,306 surveys (49% on cellphones; 51% on landlines).<\/p>\n
In some figures and tables, percentages may not total 100% because respondents could choose more than one response. Occasionally, rounding of the actual percentages may result in reporting percentages that do not total 100.<\/p>\n
Key Limitations<\/h3>\n
Most ATS survey items have been tested and validated by the CDC and reused over time. However, the ATS relies on self\u2010reported data, respondents\u2019 memory of events, and their interpretation of the survey items. Therefore, the results presented here might include recall errors or respondent bias (such as not reporting on behaviors perceived to be unhealthy or unpopular).<\/p>\n
In some cases, fewer than 50 people were asked an item. Estimates generated from such small groups are extremely imprecise and are not included in the body of the report. This follows the example set by the CDC in reporting Behavioral Risk Factor Surveillance System (BRFSS) statistics (https:\/\/www.cdc.gov\/brfss\/brfssprevalence\/<\/a>).<\/p>\n
<\/p>\n
Electronic Nicotine Delivery Systems (ENDS)<\/h1>\n
ENDS Use in Wyoming<\/h2>\n
ENDS Usage<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.55.21-PM-1024x1016.png\")
ENDS are electronic nicotine delivery systems, also known as e-cigarettes or vapes. When people use ENDS, they are vaping. In 2018, the Surgeon General officially called youth and young adult vaping an epidemic (USDHHS, 2018). Studies show that young adults who have never smoked start using nicotine products by using ENDS (Bandi et al., 2020). They are then more likely to begin smoking combustible cigarettes (Berry et al., 2019; Hair et al., 2021).<\/p>\nAlthough ENDS use is less common among adults than smoking cigarettes or chewing tobacco, their recent emergence on the market and surging use among youth and young adults make them a key tobacco prevention issue.<\/p>\n
Most Wyoming adults (72%) have never tried ENDS and few are current ENDS users (Figure 1). For this report, current ENDS users are the respondents who said they use ENDS every day or some days.<\/p>\n
ENDS use was about as common in 2019 as it was in 2015, the first time this question was asked on the ATS (Figure 2).<\/p>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/02\/Figure2.png\")
<\/p>\nFlavored ENDS Use<\/h3>\n
The Wyoming 2019 ATS was completed before new FDA flavor restrictions went into effect. In 2020, the FDA banned ENDS flavors except menthol and tobacco. However, the ban has large loopholes. It only applies to the cartridge ENDS style, like JUUL. These products have closed, pre-filled e-liquid cartridges that the user replaces when empty. The ban does not include ENDS with refillable e-liquid tanks or single-use or disposable products, like Puff Bar. According to the FDA, these exceptions avoided restricting all ENDS flavor options for adults who may be using e-cigarettes to stop smoking (FDA, 2020). However, data from Truth Initiative\u2019s vaping cessation program, This is Quitting, showed that many youth and young adult ENDS users enrolled in the program were switching to the types of ENDS that can still have flavors (Truth Initiative, 2020).<\/p>\n
In 2019, the use of flavored ENDS was common for Wyoming adults:<\/p>\n
- \n
- 83% of current ENDS users had used products flavored to taste like menthol, alcohol, candy, fruit, chocolate, or other sweets in the past 30 days.<\/li>\n
- 45% of adults who had ever tried ENDS in their lifetime did so for reasons related to flavor.<\/li>\n<\/ul>\n
Because the use of flavored ENDS is common among Wyoming adult ENDS users, it will be important to monitor how the use of ENDS among Wyoming adults changes in response to the FDA ban.<\/p>\n
Preferred ENDS Types<\/h3>\n
Most adult ENDS users (82%) preferred a customized commercial juice or liquid from a vape shop to prefilled cartridges or mixing their own e-liquid. The FDA\u2019s 2020 flavor ban did not cover this type of ENDS.<\/p>\n
The 2019 ATS questionnaire added Juul as a brand option. It was by far the most preferred cartridge-style ENDS brand; 22% of ENDS users reported using Juul most often in the previous 30 days. The next most often used brand was Blu at 9% of users.<\/p>\n
Reason for Trying ENDS<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.57.04-PM-450x1024.png\")
The top three reasons for trying ENDS were curiosity (60%), cutting back on smoking without necessarily trying to quit (55%), and to quit smoking\u00a0cigarettes (54%; Figure 3). These results have not changed significantly since these questions were first asked in 2015. The U.S. Food and Drug Administration (FDA) has not approved ENDS as a cessation aid (FDA, 2019).<\/p>\n<\/p>\n
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Do People Think ENDS Use Is Harmful?<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.57.52-PM-686x1024.png\")
The 2019 ATS included a series of questions regarding how harmful people think ENDS use is. In 2019, more people thought ENDS use was very harmful than in 2017 (Figure 4).<\/p>\nThere are two likely reasons for this change. First, the public health community, including the TPCP, sponsored media messaging about the harms of ENDS use after 2017.<\/p>\n
Second, an outbreak of lung injury associated with vaping was occurring as some people were answering the ATS questions. The early news headlines and public health communication about the outbreak may have influenced respondents\u2019 answers to these items. Data has since shown the majority of cases in the outbreak were linked to THC or marijuana-containing products (CDC, 2020b).\u00a0<\/p>\n
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![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-11.48.31-AM-589x1024.png\")
Three detailed findings stand out from the 2019 data. All relate to adults feeling more informed about the harms of vaping: (a) fewer adults said they did not know how harmful vaping was, (b) fewer adults think vaping is not at all harmful, and (c) more adults say that vaping is very harmful.<\/p>\nIn 2019, compared to 2017, more adults said that vaping was about as harmful as, or even much more harmful than, smoking (Figure 5).<\/p>\n
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![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/02\/Figure6-1.png\")
<\/p>\nMost adults (55%) now believe that switching from cigarette smoking to using ENDS is not at all healthy, a significant increase since 2017 (41%; Figure 6). Those who said that switching is somewhat healthy decreased from 37% in 2017 to 29% in 2019. However, the number of people who said that making the switch was very healthy stayed about the same (4% vs 5% in 2017). Adults were less likely to report they did not know if making the switch was healthy or not (11% vs 17%). This change is part of a pattern in the data that suggests adults were more informed about the harms of vaping than in 2017.<\/p>\n
<\/p>\n
While more research is needed, the CDC has stated that smokers may see benefits from a complete switchover, with the caution that smokers are actually more likely to add a vaping habit to their smoking rather than completely switch (CDC, 2020a).<\/p>\n
Initiation of ENDS Use<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-11.52.58-AM-820x1024.png\")
Current, former, and experimental smokers (see Table 1 below for a summary of the four smoking status categories) who had also tried ENDS were asked whether they used cigarettes or ENDS first. For most of these smokers (64%), this question was not applicable because ENDS were not on the market (to their knowledge) when they started smoking. However, more of the remaining smokers reported using ENDS before cigarettes in 2019 than in 2017 (Figure 7). Younger people turning 18 and becoming eligible for the ATS may be contributing to this change. Although a different research approach would provide stronger evidence, the 2019 ATS data support emerging research (such as Berry et al., 2019; Hair et al., 2021) that vaping may lead people to smoke, including some people who would not otherwise have started smoking.<\/p>\n<\/p>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-11.54.47-AM-1024x437.png\")
<\/p>\nPromoting Cessation<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-11.58.51-AM-596x1024.png\")
As noted above, 21% of adults had tried ENDS but were not current users. This group could include former regular users and people who experimented with ENDS but never became regular users. The 2019 ATS questions do not allow a breakdown of those groups.<\/p>\nAlthough ENDS are a relatively new type of tobacco product, many current ENDS users have already tried to quit using them for good. At some point in their lives, about one third of current ENDS users (38% overall) had stopped using ENDS for at least one day because they were trying to quit for good (Figure 8).<\/p>\n
Many Wyoming smokers vape as part of their strategy to quit smoking (Figure 3). According to the CDC, current research regarding ENDS use and quitting smoking is uncertain. There is some evidence suggesting that increased use of ENDS containing nicotine is associated with an increase in smoking cessation when compared to ENDS with no nicotine. However, there is not enough evidence to make any definitive claims (CDC, 2020c). In Wyoming, 72% of regular smokers (current and former; see Table 1) who had tried ENDS reported quitting smoking as one of their reasons for trying them.<\/p>\n
ENDS-Related Disparities<\/h2>\n
Generations-long inequities in social, economic, and environmental conditions contribute to adverse health outcomes. Breakdowns by race, ethnicity, or socioeconomic status may reflect where a person lives, works, or plays rather than the individual\u2019s characteristics or personal choices. These inequities have a greater impact on health outcomes than individual choices.<\/p>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.00.04-PM-754x1024.png\")
The TPCP has identified four priority populations, primarily based on disparities in the use and burden of traditional tobacco products: people with low incomes, American Indians, people experiencing behavioral health conditions, and young adults (18-29). As the ENDS market develops, WYSAC and the TPCP are monitoring ENDS use to identify and eliminate disparities of ENDS use among the selected priority populations (Figure 9).<\/p>\nThree groups in Wyoming are disproportionately impacted by ENDS use: American Indians, young adults, and adults who reported having behavioral health conditions. This may be because the ENDS industry has focused marketing toward young adults (Lee, 2020) and American Indians (Field, 2020). WYSAC\u2019s literature review did not find conclusive evidence that the ENDS industry is also using targeted marketing toward people experiencing behavioral health conditions and lower incomes. In Wyoming, income does not appear related to adults\u2019 ENDS use.<\/p>\n
The 2019 ATS included follow-up questions about quitting ENDS use. Fewer than 50 ENDS users within each priority population answered those questions. That is insufficient data for a precise estimate of lifetime and past year quit attempts in this report. WYSAC is available to discuss the data and associated limitations with interested parties.<\/p>\n
American Indian<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.01.11-PM-861x1024.png\")
We acknowledge that different terms refer to the Indigenous population of the U.S. when unable to refer to specific tribes. In this report, use of the term American Indian mirrors the CDC-suggested survey item used for the ATS.<\/p>\nRespondents were considered American Indian when they self-identified as American Indian or multiracial including American Indian, regardless of whether they reported Hispanic ethnicity. This approach allowed for a larger sample from which to draw conclusions.<\/p>\n
Focused efforts from tobacco companies have contributed to high smoking rates for American Indians (D\u2019Silva et al., 2018). There is evidence that the ENDS industry is using this focused marketing of their products toward American Indians. A congressional investigation found ENDS manufacturer Juul targeted American Indian tribes with price discounts and programs (Field, 2020; Subcommittee on Economic and Consumer Policy, 2020). In Wyoming, ENDS use is more than double for American Indians (15%) than the overall population.<\/p>\n
American Indians are over-represented among ENDS users (Figure 10). Only 4% of adults who responded to the survey identified as American Indian (including people who were multiracial including American Indian), yet they made up 10% of ENDS users in the survey.<\/p>\n
Young Adults<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.02.39-PM-1-867x1024.png\")
Respondents were considered young adults when they were between ages 18 and 29 years.<\/p>\nMuch like the tobacco industry has targeted youth in the past (Farber & Folan, 2017), the ENDS industry has targeted young adults with advertising and marketing (Lee, 2020). The ENDS industry uses social media as a pathway to reach young adults (Lee, 2020).<\/p>\n
With the ENDS industry\u2019s focused marketing, ENDS use is more than double for young adults (ages 18 to 29; 12%), compared to older adults (ages 30 and older; 5%).<\/p>\n
Young adults are over-represented among ENDS users. Only 22% of adults who responded to the survey were young adults, yet they made up 42% of current ENDS users in the survey (Figure 11).<\/p>\n
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Behavioral Health<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.03.58-PM-877x1024.png\")
Historically, the tobacco industry has targeted people experiencing behavioral health conditions (such as depressive disorder, bipolar disorder, substance use disorder, and psychotic disorder; Williams et al., 2013). More research is needed to understand if the ENDS industry is also using focused marketing toward people experiencing behavioral health conditions.<\/p>\nFor the ATS, respondents were considered to have a behavioral health condition if they reported one or more of the following conditions: anxiety disorder, depression disorder, bipolar disorder, alcohol abuse, drug abuse, or schizophrenia.<\/p>\n
ENDS use is more than double for adults experiencing behavioral health conditions (12%), compared to those experiencing no behavioral conditions (5%).<\/p>\n
Adults with behavioral health conditions are over-represented among ENDS users (Figure 12). Although 18% of adults who responded to the survey had behavioral health conditions, they made up 34% of ENDS users in the survey.<\/p>\n
As with any self-report data, it is possible that people under-reported behavioral health conditions on the ATS. This limitation is especially relevant because of the stigma associated with having a behavioral health condition.<\/p>\n
Adults With Low Annual Household Income<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.05.04-PM-939x1024.png\")
Lower-income neighborhoods have been targeted by tobacco industry marketing (Lee et al., 2015). With the tobacco industry\u2019s focused strategies, adults with lower incomes have a disproportionately high rate of smoking (see the Goal Area 4: Identifying and Eliminating Tobacco-Related Disparities section for more information). More research is needed to understand if the ENDS industry is also using focused marketing toward people with lower incomes.<\/p>\nIn Wyoming, income may not affect adults\u2019 ENDS use. About the same percentage of adults with annual household incomes less than $30,000 used ENDS (7%).<\/p>\n
Adults with low annual incomes were similarly represented among ENDS users. Fifteen percent of adults who responded to the survey had annual household incomes less than $30,000, and they made up 17% of ENDS users in the survey (Figure 13).<\/p>\n
Although ENDS use does not differ for adults with lower incomes, saving money is a motivation for ENDS users. About 18% of adults who had tried vaping did so to save money, most likely compared to the cost of cigarettes (Figure 3). ENDS products and cigarettes are packaged and sold very differently. These differences make direct cost comparisons challenging for consumers. The 2019 ATS did not include any items about the cost of ENDS products.<\/p>\n
Conclusions<\/h2>\n
Certain populations are more vulnerable to ENDS use. Three out of four of the TPCP\u2019s priority populations (American Indians, young adults, and adults experiencing behavioral health conditions) have much higher ENDS use than those not in these priority groups. This may be because the ENDS industry has focused marketing toward young adults (Lee, 2020) and American Indians (Field, 2020). WYSAC\u2019s literature review did not find conclusive evidence that the ENDS industry is also using targeted marketing toward people experiencing behavioral health conditions and lower incomes. Income does not appear related to adults\u2019 ENDS use in Wyoming.<\/p>\n
Using focused strategies to reach priority populations may help counter the ENDS industries\u2019 targeted measures. Prevention messaging directed toward the TPCP priority populations is an important part of work to reduce disparities. Messaging for these new products could include educational material about potential harms and risks. Messaging may also include ensuring these populations are aware of cessation resources for quitting ENDS use, especially among young people.<\/p>\n
<\/p>\n
Use and Consumption of Cigarettes<\/h1>\n
Use and Consumption<\/h2>\n
Smoking Status<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/02\/Figure14.png\")
Most adults (60%) have never been regular smokers. That is, they have not smoked at least 100 cigarettes in their lifetime. Adult Tobacco Survey (ATS) responses are divided into four key categories of smoking status, described in Table 2. In 2019, 13% of adults were current smokers. About one quarter (27%) of adults were former smokers and about one third (34%) were experimental smokers. About one quarter (26%) of all adults have never smoked or even tried smoking (Figure 14).<\/p>\n\u00a0<\/h3>\n
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<\/p>\nCigarette Use Over Time<\/h3>\n
Cigarette smoking was less common in 2019 than it had been recently in Wyoming. In 2006, 21% of Wyoming adults smoked\u2014a recent peak. Since then, the smoking rate has dropped significantly to 13% (Figure 15).<\/p>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/02\/Figure15.png\")
<\/p>\nAll Tobacco Products (Including ENDS)<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.13.32-PM-938x1024.png\")
Despite the decline in smoking, cigarettes remain the preferred tobacco product for adults in Wyoming (Figure 16).<\/p>\nThe use of ENDS and chewing tobacco were about the same in 2019 as they were in 2017. ENDS use stayed at 6% and chewing tobacco use increased slightly to 10% of adults reporting current use. Use of these products has not changed significantly since 2010 when comparable questions were first asked.<\/p>\n
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Conclusions<\/h2>\n
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Cigarettes and chewing tobacco remain the most commonly used types of tobacco for adults. ENDS are not as frequently used as cigarettes or smokeless tobacco in the adult population but are still a subject of concern for youth and young adults.<\/p>\n<\/p>\n
Goal Area 1: Preventing Initiation of Tobacco Use<\/h1>\n
The TPCP and the CDC share the goal of reducing the health burdens of tobacco use by preventing the initiation of tobacco use. A related effort in some local and state tobacco prevention programs has been to raise the legal age of purchase from 18 (or 19 in some jurisdictions) to 21 (see https:\/\/tobacco21.org\/<\/a>). On December 20, 2019, President Trump signed a bipartisan bill that raised the minimum legal sales age for all tobacco products in the U.S. (including ENDS) to 21 (Carlisle, 2020). On March 13, 2020, Governor Gordon signed a similar law specific to Wyoming (Angell, 2020). This report provides data relevant to this developing issue in tobacco prevention, but all ATS data were collected before these laws took effect.<\/p>\n
A key limitation for findings in this section is that many of the relevant survey questions ask about events (such as when someone first smoked a whole cigarette) that happened years before data collection. Therefore, these data are especially subject to memory errors. However, precise recall is not critical to the conclusions in this report.<\/p>\n
Age of Smoking a Whole Cigarette for the First Time<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.17.01-PM-792x1024.png\")
Almost all (92%) of the adults who had ever smoked an entire cigarette smoked their first one before the age of 21 (Figure 17). Moreover, the vast majority of them smoked their first cigarette before they were 18, with an average age of 16. This pattern has remained consistent since comparable questions were first asked in 2010.<\/p>\n<\/p>\n
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Age of Initiating Daily Smoking<\/h2>\n
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When people start smoking at a younger age, they are more likely to keep the habit long term (CDC, 2014b). These ATS data show that this holds true for Wyomingites: 88% of regular smokers (current and former smokers; see Table 3) began smoking daily before the age of 21 (Figure 18). Regular smokers are those who had smoked at least 100 cigarettes in their lifetime (Table 3).<\/p>\nA growing public health concern is the link between ENDS use and the initiation of cigarette smoking. Emerging research (such as Berry et al., 2019; Hair et al., 2021) shows that vaping may lead people to smoke. In Wyoming, 73% of regular smokers who reported that ENDS were on the market when they began smoking said that they used ENDS first. This finding is consistent with concerns that vaping may lead to smoking, though it does not directly assess the transition. For a detailed examination of vaping in Wyoming see the ATS Electronic Nicotine Delivery Systems (ENDS) module.<\/p>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.18.43-PM-1024x674.png\")
<\/p>\nConclusions<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2022\/10\/ATS_2019_Sidebar_02.jpg\")
The smoking habits of the vast majority of smokers begin when they are under the age of 21, especially under the age of 18. Relatively few adults begin to smoke after age 21. ATS data on the subject clearly point toward youth being a key factor in the initiation of long-term smoking habits. Further, ATS data are consistent with new research showing that vaping may lead nonsmokers to smoke cigarettes.<\/p>\n<\/p>\n
Goal Area 2: Eliminating Nonsmokers\u2019 Exposure to Secondhand Smoke<\/h1>\n
The TPCP and the CDC share the goal of reducing the health burdens of tobacco use by eliminating nonsmokers\u2019 exposure to secondhand smoke.<\/p>\n
Support for Smokefree Indoor Air Policies and Laws<\/h2>\n
The ATS gathered information regarding Wyoming adults\u2019 opinions on smokefree indoor air policies and laws. Different ATS questions asked about support for policies, rules put in place by individual businesses, and statewide laws.<\/p>\n
The ATS items about smokefree indoor air policies <\/em>asked adults if they think smoking should be allowed indoors at workplaces, restaurants, bars, and casinos\/clubs. (Casinos and clubs were combined on the survey, so were treated as a single venue type.)<\/p>\n
The survey questions about smokefree laws<\/em> asked respondents if they support or oppose statewide smokefree indoor air laws in Wyoming for the same venues.<\/p>\n
Support for smokefree air policies continued to grow in 2019. That support is the highest for indoor workplaces; however, support has basically leveled out since 2015. Support is weakest for venues considered adult only (Figure 19). Between 2004 and 2012, the ATS included a single item about support for smokefree bars, casinos, and clubs. After 2012, that was split into two items: one for bars and one for casinos and clubs. Although these older estimates are not directly comparable to estimates from the related items on the 2015 and later surveys, Figure 19 includes them as a historical reference.<\/p>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.20.08-PM-1024x775.png\")
<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.22.13-PM-1024x990.png\")
<\/p>\nSupport for smokefree indoor air laws has increased since 2015. The levels of support for smokefree indoor air laws are very similar to those for smokefree indoor policies (Figure 20).<\/p>\n
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Demographic Differences in Support for Statewide Indoor Smokefree Air Laws<\/h3>\n
Potential associations were examined between support for state smokefree indoor air laws and seven demographic variables: gender, education, annual household income, sexual orientation, age, race, and ethnicity. Each of the four venues in Figure 20 were looked at separately to see which demographic variables were associated with more or less support for statewide smokefree air laws.<\/p>\n
Age, race (White or non-White), and ethnicity (Hispanic or non-Hispanic) were not significantly associated with support for legally protected smokefree indoor air for any of the four venues.<\/p>\n
When accounting for the other demographic variables, gender was the only variable significantly associated with support for smokefree indoor air laws across all venues. For each venue, men were less likely to support smokefree indoor air laws than women.<\/p>\n
Additional demographic variables were related to smokefree indoor air laws covering specific venues. These relationships are summarized in this section, with full results in Appendix C: Statistical Analysis Methods and Detailed Results.<\/p>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.22.56-PM-675x1024.png\")
<\/p>\nMost people (80%) support smokefree air laws for workplaces (Figure 20). Gender and education were significantly associated with support for smokefree air laws (Table 4). Women and those with at least a bachelor\u2019s degree were more likely to support the laws. Income and sexual orientation did not have significant differences in support. Overall, support for smokefree workplaces is very high for all demographic groups.<\/p>\n
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Most people (81%) support smokefree air laws for restaurants (Figure 20). However, there were significant differences in support for gender, income, and sexual orientation (Table 5). Women, those making over $30,000 per year, and those who identify as straight were more likely to support smokefree air laws in restaurants. Overall, support for smokefree air laws in restaurants is very high for all demographic groups.<\/p>\n<\/p>\n
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Overall, a slim majority (55%) of people support smokefree air laws in bars (Figure 20). As in workplaces, women and those with at least a bachelor\u2019s degree were more likely to support legal protections (Table 6). For most demographic groups, a majority of adults support smokefree laws covering bars.<\/p>\n<\/p>\n
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In casinos and clubs, like bars, a slim majority, 58%, of adults support legal protections for smokefree air (Figure 20). Gender was the only demographic variable that showed a significant difference, with women being more likely to support laws (Table 7). For most demographic groups, a majority of adults support smokefree laws covering casinos and clubs.<\/p>\nAdult venues (bars, casinos, and clubs) had much lower support for smokefree air laws from all demographics, but most adults support legal protection.<\/p>\n
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Support for Other Smokefree Air Policies and Laws<\/h2>\n
Outdoor Parks Policy<\/h3>\n
Most Wyomingites (83%) 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 2019, 36% of adults thought that smoking should never be allowed, and 47% of adults thought that smoking should be allowed only at some times or in some places.<\/p>\n
Outdoor Workplaces Law<\/h3>\n
Support for laws making outdoor workplaces smokefree was substantially lower than support for laws making indoor workplaces smokefree: Only 30% of adults support a statewide smokefree air law for all outdoor workplaces. The level of support for such a law in 2019 has not changed significantly since comparable questions were first asked in 2015.<\/p>\n
Tobacco-Free School Policy<\/h3>\n
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Support for tobacco-free schools has been consistently high since 2010. In 2019, 85% of adults indicated that all school events should be tobacco-free for all students, staff, and visitors on all school grounds, fields, and parking lots (Figure 21). There was no significant difference between adults who had a child living with them and those who did not.<\/p>\n<\/p>\n
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Exposure to Secondhand Smoke<\/h2>\n
Smoking Prohibited Indoors\/Outdoors at Work<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.30.29-PM-1024x856.png\")
Most employed adults (87%) reported that smoking was never allowed in indoor areas (including inside a vehicle) at their place of work. The question asked in 2019 does not allow direct comparisons to earlier data, but does not show a dramatic change over time. However, relatively few adults (27%) reported that smoking was not allowed in outdoor areas, which has been consistent since 2012 after a drop from 36% in 2010, when comparable questions were first asked (Figure 22).<\/p>\n<\/p>\n
Exposure to Secondhand Smoke at Work or in Public<\/h3>\n
Consistently since 2010, most employed adults did not regularly experience secondhand smoke (SHS) exposure at their workplace, either indoors or outdoors. However, in 2019, about 1 in 5 (21%) working adults still reported that they had breathed someone else\u2019s smoke at their workplace in the past seven days.<\/p>\n
In public places, indoors and outdoors, 1 in 3 people reported breathing someone else\u2019s smoke in the past seven days (Figure 23). Although still a cause for concern, this is significantly less than the 2012 rate (45%), when comparable questions were first asked. Further, the chances of being exposed to SHS while in a public place is not significantly different between current smokers and nonsmokers: 38% of current smokers reported exposure to SHS while 34% of nonsmokers reported exposure to SHS in 2019. This lack of a difference could indicate that nonsmokers are unable to choose to avoid SHS exposure or often choose not to.<\/p>\n
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<\/p>\nOpinions About Harmfulness of SHS<\/h3>\n
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Over the years, adults have almost unanimously agreed that SHS is harmful to one\u2019s health (Figure 24). In 2019, the majority (63%) believed SHS is very harmful to one\u2019s health, and 34% believed that SHS is somewhat harmful. Only 2% believed that it is not harmful. These levels of agreement have not changed significantly since a comparable question was first asked in 2010.<\/p>\n\u00a0<\/h2>\n
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Conclusions<\/h2>\n
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Wyoming has seen improvement in both the number of people exposed to secondhand smoke and the number of people who support smokefree air laws and policies. Adults exposed to SHS in public places decreased 24% since 2012. Between 2015 and 2019, support for smokefree indoor air laws increased significantly to 81% for restaurants and 55% for bars.<\/p>\nHowever, Wyoming still has room for improvement. In public places, 1 in 3 adults still report SHS exposure in the last week. A slight majority of adults think that smoking should not be allowed in bars, and men are generally less likely to support smokefree air laws and policies in all venues. Wyoming can still improve by increasing support for smokefree air in adult-oriented businesses and further protecting people at work and in public.<\/p>\n
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Goal Area 3: Promoting Cessation<\/h1>\n
The TPCP and the CDC share the goal of reducing the health burdens of tobacco use by promoting and supporting quitting among adults and young people.<\/p>\n
In this section, we explore smoker\u2019s cessation efforts, including their desire to quit and quit attempts. We look at respondents\u2019 awareness of quitlines, use of cessation aids, and barriers to quitting. The Wyoming Quit Tobacco (WQT) program is designed to assist with common barriers to quitting. This section also covers smokers\u2019 visits to healthcare providers, respondents\u2019 support of tobacco tax increases, and conclusions and recommendations based on the data and best practices in cessation efforts.<\/p>\n
Smokers\u2019 Cessation Efforts<\/h2>\n
Smokers\u2019 Desire to Quit and Quit Attempts<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/02\/Figure25.png\")
Most smokers (68%) wanted to quit smoking cigarettes. Some (28%) said they did not want to quit. Few (4%) were unsure if they wanted to quit smoking.<\/p>\nAt some point in their lives, about four out of five current smokers (81%) had stopped smoking for at least one day because they were trying to quit for good.<\/p>\n
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Two out of five (40%) current smokers have tried to quit smoking at least once in the past year because they were trying to quit for good (Figure 25).<\/p>\nThe percentage of smokers who have tried to quit has remained consistent over the years (Figure 26).<\/p>\n
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Awareness of Quitlines<\/h3>\n
About half (48%) of non-tobacco users were aware of telephone quitline services. Non-tobacco users\u2019 awareness has significantly grown over the years (Table 8).<\/p>\n
Three-fourths (75%) of tobacco users were aware of telephone quitline services. Tobacco users\u2019 awareness of quitlines has remained consistent over the years.<\/p>\n
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<\/p>\nSmokers\u2019 Use of Cessation Aids<\/h3>\n
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Three out of five (60%) smokers who tried to quit in the last year did not use any cessation aids. Nicotine replacement therapy (NRT) is the most popular cessation aid used by smokers trying to quit (Figure 27). This may include people buying them over-the-counter themselves or by getting them from the WQT program.<\/p>\n\u00a0<\/h3>\n
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Smokers\u2019 Obstacles to Quitting Smoking Cigarettes<\/h3>\n
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Cravings for a cigarette was the most common obstacle for current smokers the last time they tried to quit (77%; Figure 28). Current smokers said other obstacles to quitting cigarettes included the loss of a way to handle stress (68%) and other people smoking around them (56%).<\/p>\nThe WQT program specifically targets the most common barriers to quitting smoking (https:\/\/www.quitwyo.org<\/a>). In particular, the medications provided are designed to reduce cravings. Coaching can include strategies to deal with other barriers.<\/p>\n
Many of these obstacles differ significantly for smokers experiencing behavioral health conditions. For details, see the Goal Area 4: Identifying and Eliminating Tobacco-Related Disparities section.<\/p>\n
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Smokers\u2019 Visits with Healthcare Providers<\/h3>\n
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Most smokers had seen a healthcare professional in the past year (Figure 29). There was no significant relationship between seeing a healthcare professional and smoking status. For definitions of smoking status, see Table 9.<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.42.21-PM-1024x425.png\")
<\/p>\nTobacco Cessation and Tobacco Tax<\/h2>\n
Cigarette Tax Increase<\/h3>\n
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Increasing tobacco product prices is an effective way to increase tobacco cessation (CDC, 2015b). It also discourages the initiation of tobacco use (CDC, 2014b). In Wyoming, the state\u2019s cigarette excise tax has remained at $0.60 per pack since 2003. Just over half (52%) of Wyoming adults would support an increase in the tax on cigarettes (Figure 30).<\/p>\nWyoming adults\u2019 support for a cigarette tax increase has grown significantly since 2015 (Table 10). The Wyoming House of Representatives, Senate, and governor would have to approve a change to the cigarette tax.<\/p>\n
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<\/p>\nAppendix B: Wyoming 2019 ATS Frequency Tables includes data on the price smokers paid for a pack or carton of cigarettes and use of special promotions to buy cigarettes.<\/p>\n
Smokeless Tobacco Tax Increase<\/h3>\n
Wyoming state legislation currently taxes smokeless tobacco (chewing tobacco, snuff, dip, or snus) at $0.60 per ounce. A minimum tax of $0.60 is required even if the amount sold is less than one ounce. Over half (54%) of Wyoming adults said they would support an increase in the smokeless tobacco tax. A little over one third (36%) said they would not support an increase. Some respondents (10%) were not sure if they would support this tax increase. These findings have not changed significantly since 2015.<\/p>\n
Conclusions<\/h2>\n
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The majority of smokers want to quit smoking cigarettes and have tried to quit at some point in their lives. When they try to quit or want to quit, smokers face obstacles such as cravings for a cigarette, loss of a way to handle stress, and other people smoking around them. The WQT program is designed to assist with these obstacles.<\/p>\nMost tobacco users are aware of quitline services, yet most smokers did not use any cessation aids. This choice probably made it less likely they would quit. Media emphasizing how the WQT program addresses common barriers to quitting smoking may increase enrollment in the WQT program and use of program services such as free medications.<\/p>\n
Being around other people who are smoking was the third most commonly reported barrier to quitting smoking. Smokefree indoor air policies and laws may help many smokers who are trying to quit. They would also protect people who chose not to smoke from exposure to the harmful chemicals in secondhand smoke (CDC, 2015b).<\/p>\n
Just under half of non-tobacco users were aware of telephone quitline services. Media campaigns can reach non-tobacco users who may encourage their family members who use tobacco to contact the WQT program.<\/p>\n
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Since 2010, about three-fourths of tobacco users were aware of telephone quitline services. Market research may be able to identify ways to reach the remaining fourth.<\/p>\nMost adults (including current smokers) had seen a healthcare provider in the past year. This is an opportunity for healthcare providers to connect current smokers to available cessation resources and address barriers to quitting. Greater collaboration with healthcare providers could result in more tobacco users becoming aware of, and receptive to, cessation services (CDC, 2015b).<\/p>\n
Public support for increasing the cigarette excise tax in Wyoming has grown significantly since 2015. Still, the cigarette excise tax has remained at $0.60 per pack since 2003. Increasing tobacco product pricing through taxation, minimum price laws, and other means is an evidence-based strategy for promoting cessation (CDC, 2015b).<\/p>\n
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Goal Area 4: Identifying and Eliminating Tobacco-Related Disparities<\/h1>\n
Generations-long inequities in social, economic, and environmental conditions contribute to adverse health outcomes. Breakdowns by race, ethnicity, or socioeconomic status may reflect where a person lives, works, or plays rather than the individual\u2019s characteristics or personal choices. These inequities have a greater impact on health outcomes than individual choices. For example, research shows the tobacco industry has targeted promotional efforts toward certain sociodemographic neighborhoods (D\u2019Silva et al., 2018; Farber & Folan, 2017; Lee et al., 2015; Williams et al., 2013).<\/p>\n
Addressing these health inequities is the fourth goal of the TPCP and the CDC with the aim to reduce tobacco use and the related health burdens among populations disproportionately impacted by tobacco-related disease and death.<\/p>\n
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The TPCP focuses on people with low incomes, American Indians, people experiencing behavioral health conditions, and young adults (age 18-29) as priority populations (Figure 31). The tobacco industry has targeted each of these populations (D\u2019Silva et al., 2018; Farber & Folan, 2017; Lee et al., 2015; Williams et al., 2013).<\/p>\nFor each population, we analyzed three key indicators: the prevalence of smoking compared to the rest of the adult population, quit attempts, and exposure to secondhand smoke (SHS) at work.<\/p>\n
Because of the relatively small number of ATS respondents who are smokers within each priority population, there is a high degree of uncertainty around the estimates for most of these groups. This makes interpretation of statistical tests problematic. Therefore, we took a cautious approach and chose not to provide interpretations for statistical tests in which we had a low degree of confidence, including when fewer than 50 adults responded to a question regardless of their answers to that question. This follows the example set by the CDC in reporting Behavioral Risk Factor Surveillance System (BRFSS) statistics (https:\/\/www.cdc.gov\/brfss\/brfssprevalence\/<\/a>).<\/p>\n
These low numbers and cautious approach make it difficult to explore the possible overlap of different factors that may be affecting these groups and contributing to inequalities. For example, when looking at people with self-reported behavioral health conditions and people in lower income households, there may be some overlap of these two groups. Because there are so few respondents in each category, we do not explore these intersections, limiting the conclusions.<\/p>\n
Adults with Low Annual Household Income<\/h2>\n
Tobacco industry marketing has traditionally targeted lower-income neighborhoods (Lee et al., 2015). Tobacco retailers are also more common in lower income neighborhoods (Young-Wolff et al., 2014). With the tobacco industry\u2019s pointed strategies toward people with lower incomes, adults with lower incomes have a disproportionately high rate of tobacco use.<\/p>\n
An ideal measure for identifying people with low incomes would be the poverty level. However, this varies by size of household and other factors not included in the ATS. Based on practical considerations such as survey sample size, WYSAC and the TPCP partners use a threshold of $30,000 in annual household income to identify adults with low incomes.<\/p>\n
For context, the median household income for Wyoming adults is $64,049 (U.S. Census Bureau, 2019). By definition, median means that half of the adults in the state have an annual income less than the median.<\/p>\n
Smoking<\/h3>\n
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About twice the percentage of adults with annual household incomes less than $30,000 smoked cigarettes (26%).<\/p>\nAdults living in households making less than $30,000 per year are over-represented among smokers (Figure 32). Only 15% of adults who responded to the survey were living in households with an income of less than $30,000, yet they made up 30% of current smokers in the survey.<\/p>\n
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Current Smokers\u2019 Quit Attempts: Lifetime and Past Year<\/h3>\n
Fewer than 50 current smokers said they live in households making less than $30,000 annually. That is insufficient data for a precise estimate of lifetime and past year quit attempts in this report. WYSAC is available to discuss the data and associated limitations with interested parties.<\/p>\n
Exposure to SHS at Work<\/h3>\n
Due in part to the small sample size of adults with low incomes, the difference between reports of SHS exposure based on income was not statistically significant.<\/p>\n
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- 19% of adults with an annual income less than $30,000 reported that they were exposed to SHS at their workplace.<\/li>\n
- 22% of adults with an annual income of $30,000 or more reported that they were exposed to SHS at their workplace.<\/li>\n<\/ul>\n
American Indians<\/h2>\n
WYSAC acknowledges that different terms refer to the Indigenous population of the U.S. when unable to refer to specific tribes. In this report, use of the term American Indian mirrors the CDC-suggested survey item used for the ATS.<\/p>\n
Tobacco companies have long used the ceremonial significance of tobacco to entice American Indians to use their commercial tobacco products (D\u2019Silva et al., 2018). Tobacco companies have a history of targeting this community, beginning with using American Indian imagery and symbols in marketing, often depicting negative stereotypes. Changing their approach, tobacco companies began to shift their branding appearing to uphold the spiritual use of ceremonial tobacco by American Indians and began to introduce their products as all natural (D\u2019Silva et al., 2018). With tobacco industries using the misrepresentation of American Indian culture and tradition to market their commercial tobacco products, the smoking rate for American Indians is much higher than the non-American Indian population.<\/p>\n
WYSAC considered respondents American Indian when they self-identified as American Indian or multiracial including American Indian, regardless of whether they reported Hispanic ethnicity. This approach allowed for a larger sample from which to draw conclusions.
For context, American Indian and Alaska Native people make up 2.7% of the Wyoming population, although that number excludes American Indian and Alaska Natives who identify as more than one race or ethnicity including Hispanic or Latinx (U.S. Census Bureau, 2019).<\/p>\nA key limitation of the ATS is that it does not specifically account for ceremonial use of tobacco products. Asking about specific commercial products may lead respondents to exclude ceremonial use on their own.<\/p>\n
Smoking<\/h3>\n
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About twice the percentage of adults who identified as American Indian smoked cigarettes (24%).<\/p>\nAdults who identified as American Indian are over-represented among smokers (Figure 33). Only 4% of adults who responded to the survey were American Indian, yet they made up 8% of current smokers in the survey.<\/p>\n
Current Smokers\u2019 Quit Attempts: Lifetime and Past Year<\/h3>\n
Even after expanding the population analyzed as American Indians, fewer than 50 current smokers said they were American Indians. That is insufficient data for a precise estimate of lifetime and past year quit attempts in this report. WYSAC is available to discuss the data and associated limitations with interested parties.<\/p>\n
Exposure to SHS at Work<\/h3>\n
Due in part to the small sample size for the American Indian population, the difference between reports of SHS exposure was not statistically significant.<\/p>\n
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- 31% of American Indian adults reported that they were exposed to SHS at their workplace.<\/li>\n
- 21% of non-American Indian adults reported that they were exposed to SHS at their workplace.<\/li>\n<\/ul>\n
Behavioral Health<\/h2>\n
Historically, the tobacco industry has targeted people experiencing behavioral health conditions (such as depressive disorder, bipolar disorder, substance use disorder, and psychotic disorder; Williams et al., 2013). Tobacco retailers are also more common in neighborhoods where people with behavioral health conditions live (Young-Wolff et al., 2014). This may be due in part to the overlap between people with behavioral health conditions and lower incomes.<\/p>\n
Further, people experiencing behavioral health issues often have fewer resources to help them quit using tobacco (Williams et al., 2013). Research has shown that in a behavioral health setting, patients who are addicted to nicotine are less likely to be treated for a tobacco addiction than for addictions to alcohol or other substances (Petersen, 2003).<\/p>\n
For all these reasons, studies (such as CDC, 2013; Talati et al., 2016) have demonstrated an association between cigarette smoking and behavioral health conditions. People with behavioral health conditions are more likely to smoke, and smokers with these conditions tend to smoke more cigarettes than smokers without behavioral health conditions (CDC, 2013). The 2019 ATS asked respondents \u201cDo you have any mental [behavioral] health conditions, such as anxiety disorder, depression disorder, bipolar disorder, alcohol abuse, drug abuse, or schizophrenia?\u201d About one fifth (18%) of adults reported having at least one behavioral health condition.<\/p>\n
For context, the National Survey on Drug Use and Health showed that about 23% of adults in Wyoming have behavioral health conditions (SAMHSA, 2021).<\/p>\n
As with any self-report data, it is possible that people under-reported health conditions on the ATS, especially those conditions that may have stigma attached such as behavioral health conditions.<\/p>\n
Smoking<\/h3>\n
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About twice the percentage of adults who said they had at least one behavioral health condition smoked cigarettes (21%).<\/p>\nAdults with behavioral health conditions are over-represented among smokers (Figure 34). Only 18% of adults who responded to the survey reported having behavioral health conditions, yet they made up 30% of current smokers in the survey.<\/p>\n
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Current Smokers\u2019 Quit Attempts: Lifetime and Past Year<\/h3>\n
Due in part to the small sample size for people with behavioral health conditions, the differences between lifetime quit attempts for smokers with behavioral health conditions and those without behavioral health conditions were not statistically significant.<\/p>\n
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- 82% of current smokers with behavioral health conditions had stopped smoking for at least one day because they were trying to quit for good, and<\/li>\n
- 81% of current smokers without behavioral health conditions had stopped smoking for at least one day because they were trying to quit for good.<\/li>\n<\/ul>\n
Due in part to the small sample size for people with behavioral health conditions, the differences between recent quit attempts for smokers with behavioral health conditions and those without behavioral health conditions were not statistically significant.<\/p>\n
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- 48% of current smokers with behavioral health conditions had tried to quit smoking at least once in the past year, and<\/li>\n
- 36% of current smokers without behavioral health conditions had tried to quit smoking at least once in the past year.<\/li>\n<\/ul>\n
Smokers\u2019 Obstacles to Quitting Smoking Cigarettes<\/h3>\n
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Four obstacles to quitting were statistically significantly more common among people with behavioral health conditions (Table 11). The Wyoming Quit Tobacco (WQT) program is designed to address the common barriers that adults face when quitting smoking, including these four obstacles.<\/p>\nCraving cigarettes was the greatest obstacle for the majority of current smokers who had tried to quit. It was a more common obstacle for current smokers with behavioral health conditions (94%) than it was for those without behavioral health conditions (72%).<\/p>\n
Current smokers with behavioral health conditions said other obstacles to quitting cigarettes included the loss of a way to handle stress (89%) and worsening anxiety (82%). Just under half (47%) of current smokers with behavioral health conditions said the cost of medicines or products was an obstacle to quitting, but 17% of current smokers without behavioral health conditions said this was a barrier to quitting. It is possible that an intersection exists between behavioral health conditions and lower incomes, but too few people in these groups were in the ATS sample to do any analyses.<\/p>\n
Exposure to SHS at Work<\/h3>\n
Due in part to the small sample size of people who reported behavioral health conditions, the difference between reports of SHS exposure was not statistically significant.<\/p>\n
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- 24% of adults with behavioral health conditions reported that they were exposed to SHS at their workplace.<\/li>\n
- 21% of adults without behavioral health conditions reported that they were exposed to SHS at their workplace.<\/li>\n<\/ul>\n
Young Adults<\/h2>\n
ATS data (see the Goal Area 1: Preventing Initiation of Tobacco Use<\/a> section) shows that most smokers start smoking as youths or young adults. Young adulthood is an impressionable stage when people may begin a lifelong smoking habit or a habit begun during adolescence could become set (Biener & Albers, 2004; Lee et al., 2020), making them a priority population. The tobacco industry has targeted young adults with advertising and marketing that promises to help them create the attractive, successful, and popular personas they seek (Farber & Folan, 2017). Industry campaigns promote messages, values, and product features designed specific to young adults (Lee et al., 2020). Tobacco companies place these campaigns in places young adults frequent most, such as colleges, fraternities, and bars (Ling & Glantz, 2002). With such targeted efforts, young adults are a priority population and require equally targeted efforts for tobacco prevention and control strategies.<\/p>\n
WYSAC considered respondents young adults when they were between ages 18 and 29 to increase the sample size and improve the reliability of estimates for this group. The U.S. Census Bureau\u2019s public reports do not estimate the proportion of Wyoming\u2019s population within this specific age range. The closest match is people 20 to 29 years old. As such, about 13% of Wyoming adults are between the ages of 20 and 29 (U.S. Census Bureau, 2020).<\/p>\n
Smoking<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/02\/Figure35.png\")
The smoking rate of young adults (13%) was similar to the smoking rate of other adults (13%; Figure 35).<\/p>\nYoung adults are more likely to have never tried a cigarette: 39% of young adults have never tried a cigarette as compared to 22% of other adults. Because so few adults begin smoking after the age of 21 (see the Goal Area 1: Preventing Initiation of Tobacco Use<\/a> section), this difference between age cohorts may indicate that experimentation with tobacco products is becoming less common over time. It may also demonstrate the success of TPCP efforts to curb youth cigarette initiation and use.<\/p>\n
Young adults are more likely to use ENDS (12%), which may lead to later initiation of smoking cigarettes. More research is needed to investigate this potential pathway to smoking.<\/p>\n
Table 12 details the four categories of smoking status used in Figure 35.<\/p>\n
<\/p>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2023\/01\/Screenshot-2023-01-25-at-12.53.53-PM-1024x438.png\")
<\/p>\nCurrent Smokers\u2019 Quit Attempts: Lifetime and Past Year<\/h3>\n
Fewer than 50 current smokers said they were between 18 and 29 years old. That is insufficient data for a precise estimate in this report. WYSAC is available to discuss the data and associated limitations with interested parties.<\/p>\n
Exposure to SHS at Work<\/h3>\n
Significantly, more young adults were exposed to SHS at their workplace (29%) than other working adults (19%). A possible explanation for this is an occupational disparity, as young adults who work in the service, maintenance, and transportation industries are at a higher risk of exposure to SHS than those working in other industries (Holmes & Ling, 2017). However, the ATS does not collect information about specific occupations.<\/p>\n
Conclusions<\/h2>\n
The 2019 ATS data highlights the impact of the tobacco industry\u2019s targeted efforts to engage already vulnerable populations in tobacco use. The 2019 ATS data shows that people from households who make less than $30,000, who identify as American Indian, or who report having behavioral health conditions are disproportionately affected by tobacco use.<\/p>\n
Current smokers with behavioral health conditions are more likely to face four obstacles to quitting than smokers without such conditions: craving cigarettes, the loss of a way to handle stress, worsening anxiety, and the cost of medicines or products. Free coaching and free cessation aids from the WQT program address these obstacles.<\/p>\n
Young adults were more likely to have never tried a cigarette compared to other adults. This difference between age cohorts may indicate that experimentation with tobacco products is becoming less common over time, possibly due to the concerted efforts of the TPCP and other organizations to prevent youth use and initiation of cigarettes.<\/p>\n
These priority populations are already vulnerable and most demonstrate higher smoking rates. These communities carry disproportionate burdens of smoking. Work related to Goal 4 of the TPCP is essential to combat targeted efforts from the tobacco industry to eliminate these tobacco-related disparities and work toward health equity.<\/p>\n
Acknowledgement<\/h2>\n
Proportion plots adapted from a template distributed by Stephanie Evergreen: https:\/\/stephanieevergreen.com\/proportion-plots\/<\/a><\/p>\n
<\/p>\n
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