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The 2023 Wyoming Adult Tobacco Survey (ATS) provides insights into Wyoming adults’ use and attitudes regarding commercial tobacco and nicotine products. The survey, conducted by the Wyoming Survey & Analysis Center (WYSAC), tracks progress toward commercial tobacco and nicotine prevention goals.<\/p>\n
ENDS (Electronic Nicotine Delivery Systems), cigarettes, and smokeless tobacco are the most commonly used products in Wyoming.<\/strong><\/p>\n The ATS reveals a decline in cigarette smoking rates but a rise in ENDS use among Wyoming adults. Public awareness of the harms of smoking is high, and there is considerable support for smokefree policies. Targeted efforts are needed to prevent new tobacco or nicotine use, particularly among youth, and to continue to monitor new and emerging tobacco and nicotine product use.<\/p>\n <\/p>\n In this report, we refer to the use of commercial tobacco, not ceremonial or traditional use of tobacco by Indigenous peoples such as the Eastern Shoshone or Northern Arapaho. Smoking refers to the use of commercial cigarettes. Smokeless tobacco refers to commercial products such as chew, moist snuff, and snus. Legally, the U.S. Food and Drug Administration has deemed electronic nicotine delivery systems (ENDS, also known as e-cigarettes or vaping devices) to be commercial tobacco products and subject to their regulation. Wyoming Statute (Wyo. Stat. \u00a7 14-3-301, 2013\/2020) also includes ENDS in the legal definition of commercial tobacco products.<\/p>\n Smoking is the leading preventable cause of death in the United States, annually causing more than 480,000 deaths. In Wyoming, smoking leads to approximately 800 deaths from smoking-related illnesses each year (Centers for Disease Control and Prevention [CDC], 2014a). In 2019, commercial tobacco use costs in Wyoming totaled $1.5 billion (State Epidemiological Outcomes Workgroup [SEOW], 2024). In addition, scientists have known since the 1950s that smoking can cause lung cancer. The Surgeon General widely publicized this link between smoking and cancer in the landmark 1964 report Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service (U.S. Department of Health, Education, and Welfare, 1964). Since then, further research has established that smoking cigarettes and breathing secondhand smoke causes multiple cancers and chronic diseases (U.S. Department of Health and Human Services [USDHHS], 2010, 2014).<\/p>\n The Surgeon General declared vaping (the use of ENDS) an epidemic among youth and young adults in 2018 (USDHHS, 2018). Research indicates that vaping can lead to cigarette smoking (Berry et al., 2019; Hair et al., 2021). However, the CDC also states that vaping could be better than smoking for non-pregnant adult smokers if they completely switch from smoked commercial tobacco products to ENDS (CDC, 2024e). More research is needed to learn about the long-term effects of vaping and breathing secondhand aerosol exhaled by someone who is using ENDS.<\/p>\n Certain groups of people are more at risk of suffering the impacts of commercial tobacco use than others. Research has repeatedly shown that commercial tobacco companies have targeted promotional efforts toward specific neighborhoods, people with lower incomes, people of color, Indigenous people, people experiencing behavioral health conditions, and other communities (D\u2019Silva et al., 2018; Farber & Folan, 2017; Lee et al., 2015; Prochaska et al., 2017). 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.<\/p>\n JUUL’s rapid rise in the ENDS market has raised significant concerns about its targeted marketing towards youth and young adults. JUUL uses approaches similar to traditional cigarette advertising, such as lower prices, price discounts, and attractive advertising. The Federal Trade Commission reported that e-cigarette companies, including JUUL, spent over $859 million on advertising and promotions in 2021, focusing on price discounts, promotional allowances, and point-of-sale advertising\u2014all strategies that appeal to youth by making e-cigarettes more accessible and affordable (Counter Tobacco, 2024). A large portion of JUUL\u2019s Twitter (now X) followers were underage, indicating exposure of minors to age-restricted content (Kim et al., 2019). JUUL’s marketing attracted high school and college students (Willis & Mindicino, 2020). As a result, increased exposure to ENDS marketing is linked to high usage among youth, suggesting effective targeting of this demographic and contributing to youth experimentation, sustained use, and difficulties in quitting (Willett et al., 2019). A significant portion of JUUL’s 2018 profits came from underage users, highlighting the need for stricter regulations to prevent youth e-cigarette use (Kaplan et al., 2021).<\/p>\n The Wyoming Substance Use and Tobacco Prevention Program (SUTPP) and the Centers for Disease Control and Prevention (CDC) share four goals:<\/p>\n The SUTPP uses various strategies to focus on reducing the impact of commercial tobacco and nicotine use in Wyoming by achieving these goals. The SUTPP monitors its progress on these goals by tracking the use and availability of commercial tobacco and nicotine products, including cigarettes, ENDS, and other forms of commercial tobacco.<\/p>\n The achievement of commercial tobacco prevention outcomes is the collective result of the work of many organizations over time. The efforts of state government programs, including the SUTPP, multiple federal agencies, county prevention specialists, and other groups, have all played a part in Wyoming\u2019s commercial tobacco prevention and control. 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 Nonsmokers\u2019 Rights Foundation, the American Cancer Society, and the American Lung Association. Changes also reflect the influences of the commercial tobacco and nicotine industry, such as changes in marketing practices or the release of new products such as ENDS.<\/p>\n The Wyoming Adult Tobacco Survey is 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 commercial tobacco and nicotine use, the aforementioned four specific goals, and the broader goal of reducing disease and death related to commercial tobacco and nicotine use. In addition to analyzing the 2023 data, WYSAC used data from previous survey versions to analyze trends.<\/p>\n <\/p>\n This report summarizes results from the 2023 Adult Tobacco Survey and trend analyses using previous versions of the Adult Tobacco Survey.<\/p>\n In this section, WYSAC provides a general summary of the methods used to collect and analyze the data for the 2023 Adult Tobacco Survey. For statistical analysis, WYSAC performed logistic regression and multinomial logistic regression to identify associations with time (difference since a reference year or other changes over time longer than two years). Relationships and linear trends noted as significant in the body of the report are statistically significant, p < .05.<\/p>\n Appendix A provides tables reporting Wyoming\u2019s state-level unweighted counts, weighted percentages, and 95% confidence intervals (CIs) for weighted percentages for every survey item and WYSAC-calculated variable.<\/p>\n Appendix B provides the technical details of the methods used to collect the data for the 2023 Adult Tobacco Survey as reported by WYSAC\u2019s Survey Research Center.<\/p>\n Appendix C provides details of statistical analyses summarized in the body of this report.<\/p>\n WYSAC purchased a random sample of telephone numbers in Wyoming and (new to 2023) requested that email and postal mail addresses be connected to the phone numbers. First, on May 2, 2023, WYSAC sent an email with an invitation to complete the survey online when emails were available for the numbers selected. On May 9, 2023, WYSAC sent an email reminder to those who had not responded to the initial email invite.<\/p>\n Second, on May 8, 2023, WYSAC mailed an invitation to complete the survey online to people who had postal addresses in the list and either did not have an email address or had undeliverable email addresses from the initial email invites. On May 23, 2023, WYSAC sent a second invitation letter to those who had not responded.<\/p>\n Finally, WYSAC called people who had not completed a survey online regardless of whether they had email or postal addresses in the sample list. Trained WYSAC telephone interviewers conducted the telephone interviews. Calling began on May 29, 2023, and ended on August 24, 2023. WYSAC completed a total of 2,733 surveys. Adult Tobacco Survey participants completed 1,144 surveys online. WYSAC callers completed 1,589 surveys (75% on cell phones; 25% on landlines).<\/p>\n This three-tier approach maintained the basic sampling process as in previous versions of the survey and sped up data collection by providing adults with options on how to respond.<\/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 Most Adult Tobacco Survey items have been tested and validated by the CDC and reused over time. However, the Adult Tobacco Survey 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 embarrassing or unpopular behaviors).<\/p>\n Unlike previous iterations of the Wyoming Adult Tobacco Survey, which were conducted exclusively via phone, the 2023 Adult Tobacco Survey introduced two response modes: online and phone. In 2023, 42% of respondents completed the survey online, while 58% responded via phone. WYSAC examined the demographic characteristics of respondents (unweighted frequencies) by mode:<\/p>\n The Adult Tobacco Survey has a complex skip pattern which means not all respondents are asked each question. For example, people who have never smoked are not asked about quitting smoking. In some cases, fewer than 50 people were asked a question. Estimates generated from such small groups are extremely imprecise, so WYSAC does not report them 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 In previous iterations of the Adult Tobacco Survey, ENDS use has been more common among young adults than other adults. A limitation of the Adult Tobacco Survey is the difficulty of getting young adults to respond. With a small subset of the respondents being young adults, reporting on the total adult population is necessary. That may hide some key findings that would be clearer in a survey of only young adults.<\/p>\n Most Wyoming adults (70%) have never tried ENDS, and few are current ENDS users (10%; Figure 1). For this report, current ENDS users are the respondents who said they use ENDS every day or some days.<\/p>\n However, current ENDS use has increased significantly from 7% in 2015 to 10% in 2023. ENDS use is now approaching the cigarette smoking rate (12% in 2023; Figure 2).<\/p>\n In 2023, the use of flavored ENDS was common for Wyoming adults:<\/p>\n Wyoming adults\u2019 use of flavored ENDS products has not significantly changed between 2017 and 2023, despite regulations implemented by the FDA in 2020 when the FDA partially banned ENDS flavors except menthol and tobacco. However, the ban has 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 Juice Head. According to the FDA, these exceptions avoided restricting all flavor options for adults who may be using ENDS to stop smoking (FDA, 2020). However, research shows that youth and young adults are using menthol instead of mint and are switching to the types of ENDS that can still have flavors (Truth Initiative, 2020).<\/p>\n For adults, the top three reasons for trying ENDS were for the flavoring (68%), to not disturb other people with smoke (65%), and to quit smoking cigarettes (64%; Figure 3). The pattern of these results has not changed significantly since these questions were first asked in 2015, except the \u201cfor the flavoring\u201d response, which was added in 2017.<\/p>\n However, comparisons using data between 2015 and 2023 may indicate some emerging trends among adults who currently use ENDS. There was a significant decrease in trying ENDS because they think ENDS might be less harmful than cigarettes, from 64% in 2015 to 51% 2023. Trying ENDS for a drug other than nicotine (such as marijuana) increased significantly from 5% in 2017 to 29% in 2023.<\/p>\n Some research suggests that use of ENDS with nicotine is associated with quitting smoking. The CDC has said that adults who smoke may see benefits from completely switching from smoking to ENDS (CDC, 2024e). However, there is not enough evidence to be sure (CDC, 2020, 2024e). More research is needed to learn if ENDS are a broadly successful tobacco-related harm reduction tool. The FDA has not approved ENDS as a cessation aid (FDA, 2023).<\/p>\n The Adult Tobacco Survey includes a question regarding how harmful people think ENDS use is to one\u2019s health. Perceived harmfulness of ENDS has significantly increased since 2017, with most adults saying it is very harmful (72%; Figure 4).<\/p>\n One reason for this change may be that the public health community, including the SUTPP and county partners, sponsored media messaging about the harms of ENDS use after 2017.<\/p>\n Findings about first using cigarettes or ENDS are somewhat limited because many people in the Adult Tobacco Survey sample would have started using commercial tobacco or nicotine before ENDS became popular in the US (roughly 2012). Adults who had ever tried smoking (see Table 1 for a summary of the four smoking status categories) and had also tried ENDS were asked whether they used cigarettes or ENDS first. In 2023, 18% of adults who currently smoke and had also tried ENDS used ENDS first, with no significant change from 2017 to 2023. Similarly, 20% of adults who used to smoke and had also tried ENDS used ENDS first, also with no significant change.<\/p>\n However, among adults who experimented with smoking and had also tried ENDS, the trend may be shifting: experimenting with ENDS before smoking increased from 18% in 2017 to 53% in 2023. The six percentage-point difference between ENDS first and cigarettes first in 2023 was not significant (Figure 5).<\/p>\n About one in four (24%) adults were exposed to secondhand aerosol from ENDS use in public places, indoors or outdoors (Figure 6). Fewer adults (15%) reported breathing someone else\u2019s secondhand aerosol in indoor public places. One in five (20%) adults were exposed to secondhand aerosol in outdoor public places. These may be underestimates if the short-lived cloud or smell from secondhand aerosol is not noticed.<\/p>\n In 2023, most adults (81%) agreed that breathing someone else\u2019s secondhand aerosol was very or somewhat harmful (Figure 7). Consistent with a lack of firm research findings, a few (10%) said they were unsure about the harmfulness.<\/p>\n In 2023, about two in three (63%) adults who currently used ENDS had tried to quit in the past year or in their lifetime (Figure 8). This is nearly double the estimate from 2021 (34%).<\/p>\n These findings reflect the total adult population of Wyoming. Surveys focused on young adults or youth may find different patterns.<\/p>\n Current ENDS use among adults has increased since 2015, now approaching the cigarette smoking rate (12% in 2023).<\/p>\n Many adults who currently use ENDS tried ENDS for the flavor, to not disturb other people with smoke, or to quit smoking cigarettes. Current research (CDC, 2020, 2024e) does not show a consistent benefit of using ENDS to quit smoking. The FDA has not approved ENDS as a cessation aid (FDA, 2023).<\/p>\n Perceived harm of ENDS has grown over time. Compared to 2017, more Wyoming adults said vaping is harmful.<\/p>\n Many adults who currently use ENDS want to quit. Nearly two in three current ENDS users had tried to quit ENDS in the past year or in their lifetime.<\/p>\n <\/p>\n Adult Tobacco Survey responses were divided into four key categories of smoking status, described in Table 2.<\/p>\n Most adults (88%) do not currently smoke\u00a0and nearly two in three adults (62%) have never smoked regularly. That is, they have not smoked at least 100 cigarettes in their lifetime. More than one in four (28%) adults had never tried smoking or (27%) used to smoke, and about one in three (34%) had experimented with smoking (Figure 9). Although current cigarette smoking has decreased from 21% in 2006 to 12% in 2023, nearly one in eight Wyoming adults currently smoke.<\/p>\n Sixty years ago (January 11, 1964), the U.S. Surgeon General first released an official report documenting links between smoking and two diseases: cancer and chronic bronchitis (U.S. Department of Health, Education, and Welfare, 1964). Since then, the list of smoking-related diseases has grown dramatically (USDHHS, 2014). Additionally, CDC, SUTPP, county, and other public health efforts have worked to educate the public about the potential harms of commercial tobacco use. Key components of these education efforts include warning labels on packaging and advertising, sharing research findings, and sharing educational content in various forms from print to social media (CDC, 2024a; USDHHS, 2014). These efforts have succeeded in Wyoming; in 2023, less than 1% of adults said smoking was \u201cnot at all harmful\u201d (Figure 10).<\/p>\n Cigarettes, ENDS, and smokeless tobacco were the most commonly used commercial tobacco and nicotine products among Wyoming adults. Cigarettes have remained the preferred product throughout the history of the Adult Tobacco Survey (Figure 11).<\/p>\n From 2015 to 2023, current ENDS use increased from 7% to 10% and is approaching the same level as cigarette use. The use of cigars and hookah have significantly decreased since 2010, while the use of smokeless tobacco and pipes have remained consistent.<\/p>\n The use of new and emerging commercial tobacco and nicotine products (e.g., heated tobacco, nicotine pouches, dissolvable nicotine, nicotine gel, and any other types) remains low among adults. The most common of these emerging products was nicotine pouches, such as ZYN; 5% of adults used these products. Surveys specific to youth or young adults, who might be more likely to try new and emerging products, could have different results.<\/p>\n The adult smoking rate, as measured by the Adult Tobacco Survey, has decreased significantly to 12% compared to 21% in 2006. Since 2010, the use of other commercial tobacco and nicotine products has remained fairly consistent or decreased, except for ENDS use approaching the same level as cigarette use.<\/p>\n Cigarettes, ENDS, and smokeless tobacco were the three most popular commercial tobacco and nicotine products for adults. ENDS are a subject of concern for youth and young adults because of national trends showing increased use (Gentzke et al., 2022) and the potential for them to lead to cigarette smoking (Berry et al., 2019; Hair et al., 2021). Their relative popularity is also increasing.<\/p>\n There is developing evidence that newer commercial tobacco and nicotine products (such as nicotine pouches) may become more popular than more established types (such as hookah or cigars).<\/p>\n <\/p>\n Preventing new cigarette smoking and decreasing the use of other commercial tobacco and nicotine products are key goals of the SUTPP and the CDC.<\/p>\n According to the CDC, increasing commercial tobacco product prices is an effective way to prevent youth from starting to smoke (CDC, 2014b). It also encourages adults to quit smoking (CDC, 2015).<\/p>\n Taxes are one way that federal and state governments can influence commercial tobacco prices. Nationally, every 10% increase in cigarette prices decreases cigarette use by 3\u20135%. Raising cigarette prices prevents youth and people with lower incomes from smoking and reduces the average number of cigarettes smoked (USDHHS, 2014).<\/p>\n In one study of adults aged 50 years and older, a $1 increase in the price of cigarettes was associated with a 6% higher quit rate (Stevens et al., 2017). Increasing cigarette taxes could encourage quitting among adults and could decrease the risk of smoking-related diseases.<\/p>\n <\/p>\n At the time of data collection, Wyoming\u2019s cigarette excise tax was $0.60 per pack, the second lowest among neighboring states (Figure 12). Wyoming ranks 44th out of the 50 states and the District of Columbia on cigarette taxes and 51st out of the 58 states and territories (CDC, 2023b). Wyoming\u2019s cigarette excise tax has not changed since 2003.<\/p>\n At the time of data collection, Wyoming\u2019s smokeless tobacco (chewing tobacco, dip, or snus) tax had a minimum tax of $0.60 per ounce, with an additional $0.60 per ounce for packaging larger than one ounce.<\/p>\n Since July 2020 and through the time of data collection, Wyoming has had a default ENDS tax at the rate of 15% of the wholesale purchase price. If the tax is not paid by the wholesaler, consumers pay 7.5% of the retail purchase price (Wyo. Stat. \u00a7 39-18-104[g], 2021).<\/p>\n More than half of adults support tax increases for each major class of commercial tobacco and nicotine products: cigarettes (56%), smokeless tobacco (chewing tobacco, moist snuff, dip, or snus; 56%), and ENDS (60%; Table 3).<\/p>\n Smoking is the leading preventable cause of illness and death in the United States. In 2018, the costs of smoking-related illness totaled more than $600 billion. These costs included more than $240 billion for direct medical care and more than $372 billion in lost productivity (CDC, 2022b).<\/p>\n <\/p>\n To provide additional context, the approximate size of Wyoming\u2019s economy in 2019 was $38.6 billion as measured by the gross domestic product (GDP). Total costs for commercial tobacco use were about 4% the size of Wyoming\u2019s economy. An alternative perspective is that smoking costs the Wyoming economy about $2,600 per person (regardless of smoking status) in 2019.<\/p>\n Wyoming\u2019s cigarette excise tax has remained at $0.60 per pack since 2003. Over half of Wyoming adults support increasing taxes on commercial tobacco or nicotine.<\/p>\n Higher commercial tobacco taxes are an evidence-based way to keep youth from starting to smoke (CDC, 2014b). Increasing commercial tobacco product pricing through taxation, minimum price laws, or other means is an evidence-based strategy for encouraging people to quit using commercial tobacco products (CDC, 2015). Wyoming could further reduce negative outcomes from smoking by raising its commercial tobacco or nicotine taxes.<\/p>\n <\/p>\n The SUTPP and the CDC share the goal of reducing the health burdens of commercial tobacco use by preventing new commercial tobacco use (CDC, 2014b). A success related to this goal was raising the legal age of purchase from 18 (or 19 in some areas) to 21 (see https:\/\/tobacco21.org\/<\/a>). Federal law implemented this change in 2019 (FDA, 2021), and Wyoming law followed in 2020 (Wyo. \u00a0Stat. \u00a7 14-3-305). Broad surveys, such as the Adult Tobacco Survey, with few young adults in the sample are not strong methods for showing short-term effects of Tobacco 21, though patterns in the data may change over time.<\/p>\n A key limitation of this section\u2019s findings is that many survey questions ask about events (such as when someone first smoked a whole cigarette) that happened years before data collection. Responses to such questions are especially subject to memory errors. However, precise recall is not critical to the conclusions in this report.<\/p>\n In 2023, almost all (90%) adults who had ever smoked an entire cigarette smoked their first one before the age of 21 (Figure 13). 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 similar questions were first asked in 2010.<\/p>\n The vast majority of adults who have ever smoked an entire cigarette first smoked when they were under the legal minimum age of 21, especially under the age of 18. Adult Tobacco Survey data are consistent with other research findings that the earlier someone starts smoking, the more likely they are to continue smoking (Dierker et al., 2012; Sharapova et al., 2020). Wyoming may benefit from continued commercial tobacco prevention efforts focusing on youth, though Adult Tobacco Survey data may not show results until years after success with youth happens.<\/p>\n <\/p>\n The Adult Tobacco Survey questions about smokefree indoor air policies asked adults if they think smoking should be allowed indoors at workplaces, restaurants, bars, and casinos and clubs. Casinos and clubs were combined in one item on the survey, so WYSAC treated them as a single venue type.<\/p>\n In 2023, most adults (88%; Figure 14) supported smokefree indoor air policies for restaurants. Most (83%) adults supported smokefree indoor air policies for workplaces. More than half (58%) of adults supported smokefree indoor air policies for casinos and clubs. More than half (57%) of adults supported smokefree indoor air policies for bars.<\/p>\n Support for indoor workplaces has remained stable since 2015. Support for smokefree indoor air policies for restaurants, casinos and clubs, and bars significantly increased between 2015 and 2023. For these venues, the increase in support from 2021 to 2023 was also significant.<\/p>\n <\/p>\n In 2023, most adults (86%; Figure 15) thought that commercial tobacco should be completely banned at schools. This support has been consistent since 2010.<\/p>\n In 2023, the majority of Wyoming adults (86%) thought smoking should be restricted at outdoor parks, at least in some manner. About one in three (36%; Figure 16) of adults thought that smoking should never be allowed, and half (50%) thought that smoking should be allowed only at some times or in some places. Support for any level of regulation has increased significantly since 2010 (76%).<\/p>\n Support for policies making outdoor workplaces smokefree was substantially lower than support for policies making indoor workplaces smokefree. In 2023, only 19% (Figure 16) of adults supported a smokefree air policy for outdoor workplaces, compared to 83% for indoor workplaces. The level of support for such a policy has not changed significantly since 2015.<\/p>\n In 2023, most employed adults (93%; Figure 17) reported that smoking was never allowed in indoor areas (including inside a vehicle) at their place of work. This is a significant increase from 87% in 2019.<\/p>\n About one in three (31%; Figure 17) adults reported that smoking was not allowed in outdoor areas. This has significantly increased since 2012 (25%). Workers are better protected by smoking regulations indoors than outdoors.<\/p>\n In 2023, most employed adults (83%) were not exposed to secondhand smoke at their workplace. Still, 17% of employed adults reported experiencing secondhand smoke indoors or outdoors at their workplace. There has been no significant change between 2010 and 2023.<\/p>\n In 2023, about one in three (34%; Figure 18) adults reported breathing someone else\u2019s secondhand smoke in public places, indoors, and outdoors. Most adults (66%) were not exposed to secondhand smoke. Almost one in three (30%) adults reported exposure to secondhand smoke in outdoor public places. Few (11%) adults reported exposure to secondhand smoke in indoor public places. Although still a cause for concern, exposure to secondhand smoke has significantly decreased in public places, indoors or outdoors, between 2012 and 2023.<\/p>\n In 2023, the chances of being exposed to secondhand smoke while in a public place were not significantly different between adults who currently smoke and those who do not smoke:<\/p>\n Over the years, nearly all adults have agreed that exposure to secondhand smoke is harmful to one\u2019s health. In 2023, 98% (Figure 19) believed secondhand smoke was very or somewhat harmful to one\u2019s health. Only 2% believed that it was not harmful. These levels of agreement have not changed significantly between 2010 and 2023.<\/p>\n However, opinions about the harmfulness of secondhand smoke have shifted in recent years. Adults who think breathing secondhand smoke is very harmful significantly decreased between 2019 and 2023.<\/p>\n Adults have consistently and strongly supported smokefree indoor air policies for workplaces and restaurants. In addition, support for smokefree indoor air policies for casinos and clubs and bars has increased. Wyoming adults continue to support a complete ban on commercial tobacco use at schools. Most adults thought that smoking should be restricted at parks, at least in some manner. Most employed adults are not exposed to secondhand smoke at work, indoors or outdoors.<\/p>\n Wyoming still has room for improvement. Smoking policies in outdoor areas, including at work and in public places, are less protective of adults. Adult support for outdoor policies at work and indoor air policies at adult-oriented establishments has shown improvement. Wyoming may benefit from focusing on prevention efforts in these areas. Recent decreases in reports of seeing secondhand smoke as \u201cvery harmful\u201d may indicate a need for revisiting education about the harms of secondhand smoke.<\/p>\n <\/p>\n The CDC says that quitting smoking is difficult because of the addictive nicotine that cigarettes rapidly deliver to the brain. Smoking leads to dependence, and quitting often leads to withdrawal. Smoking also becomes part of a person\u2019s daily routine, making it even harder to stop.<\/p>\n The SUTPP and the CDC share the goal of reducing the health burdens of commercial tobacco and nicotine use by promoting and supporting quitting among adults and youth.<\/p>\n In this section, WYSAC explores the desire to quit among adults who currently use commercial tobacco and their quit attempts. WYSAC looks at awareness of quitlines, use of quit aids, and barriers to quitting. This section also covers visits to healthcare providers and conclusions and recommendations based on the data and best practices in helping people quit.<\/p>\n More than half (66%) of adults who currently smoke want to quit smoking cigarettes. The nine percentage-point difference between 2021 and 2023 was not significant. There were no significant changes from 2015 to 2023 (Figure 20).<\/p>\n <\/p>\n <\/p>\n At some point in their lives, the majority of adults who currently smoke (87%) had stopped smoking for at least one day because they were trying to quit for good.<\/p>\n Nearly half (45%) of adults who currently smoke have tried to quit smoking at least once in the past year because they were trying to quit for good (Figure 21).<\/p>\n Smokers\u2019 quit attempts have not changed significantly between 2010 and 2023.<\/p>\n Most (77%) adults who use commercial tobacco or nicotine (including ENDS) were aware of telephone quitline services (Figure 22). About half (45%) of adults who do not use commercial tobacco or nicotine were aware of telephone quitline services.<\/p>\n This may demonstrate the success of media campaigns by SUTPP and their partners, including county-level efforts.<\/p>\n <\/p>\n In addition, 62% reported that other people smoking around them is an obstacle to quitting smoking. These adults could benefit from increased smokefree air policies in their environments.<\/p>\n <\/p>\n The 2023 Adult Tobacco Survey asked respondents if they had seen a health professional (a doctor, dentist, nurse, or another health professional) in the past year and, if so, if the health professional asked if they smoked cigarettes or used any other commercial tobacco or nicotine products, including ENDS.<\/p>\n In 2023, 28% of adults used commercial tobacco or nicotine while 72% did not. Most adults who use commercial tobacco or nicotine had seen a health professional in the past year (74%; Figure 25). Commercial tobacco or nicotine use was related to lower likelihood of seeing a health professional. This difference might be due, in part, to barriers to seeking care that might be linked to other related factors, such as lower income.<\/p>\n Adults are often asked about their commercial tobacco or nicotine use when visiting a health professional. In 2023, 78% of all adults were asked if they smoked cigarettes or used any other commercial tobacco or nicotine products. Adults who used commercial tobacco or nicotine (88%) were more likely to be asked if they smoked cigarettes or used any other commercial tobacco or nicotine products than adults who did not use commercial tobacco or nicotine (74%).<\/p>\n WYSAC does not know to what extent health professionals use medical records to screen for commercial tobacco or nicotine use during a visit. This may have been a limitation when health professionals did not ask about commercial tobacco or nicotine use because they already had records of it.<\/p>\n Less than half (26%) of commercial tobacco or nicotine users were offered assistance with quitting, even when focusing on those who say a professional asked them about their commercial tobacco or nicotine use (Figure 26).<\/p>\n Most 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, adults who use commercial tobacco or nicotine face obstacles such as cravings for a cigarette, loss of a way to handle stress, and others smoking around them. The WQT program is designed to assist with most of these obstacles.<\/p>\n Most adults who use commercial tobacco or nicotine are aware of quitline services. Nearly half of adults who had tried to quit in the last year used a quit aid the last time they tried to quit. However, only one in four (26%) reported using WQT the last time they tried to quit.<\/p>\n Education and media emphasizing how the WQT program addresses common barriers to quitting smoking may increase enrollment in the WQT program. Additionally, the use of WQT program offerings (such as NRT and medications) can then increase the chances of adults quitting.<\/p>\n Visits to health professionals are opportunities for connecting current commercial tobacco or nicotine users to available resources and addressing barriers to quitting. Most adults were asked by a health professional if they used commercial tobacco or nicotine products. Adults who use commercial tobacco or nicotine were less likely to report that health professionals followed up or offered help with quitting than being asked about their use. Greater collaboration with health professionals could result in more commercial tobacco or nicotine users becoming aware of, and receptive to, services that could increase their chances of quitting (CDC, 2015).<\/p>\n <\/p>\n Generations-long social, economic, and environmental disparities contribute to poor health outcomes. Breakdowns by race, ethnicity, socioeconomic status, or other demographic variables may reflect where a person lives, works, or plays rather than the individual\u2019s characteristics or personal choices (CDC, 2022c). These disparities have a greater impact on health outcomes than individual choices. The pressures of discrimination, poverty, and other social conditions can increase commercial tobacco use and increase health problems.<\/p>\n Addressing these health disparities is the fourth goal of the SUTPP and the CDC to reduce commercial tobacco or nicotine use and the related health burdens among populations disproportionately impacted by commercial tobacco-related disease and death.<\/p>\n Starting in 2019, the SUTPP identified four populations of focus in Wyoming that were unequally impacted by commercial nicotine use: people with low incomes, people who self-identify as American Indian, people reporting behavioral health conditions, and young adults (aged 18-29). The sampling methods described in 2023 Adult Tobacco Survey Methods section included extra effort to recruit people identified as American Indian in the sampling frame WYSAC purchased.<\/p>\n For ENDS within each population, WYSAC analyzed three key indicators: the prevalence of use, ENDS quit attempts, and exposure to secondhand ENDS aerosol in public places.<\/p>\n For commercial tobacco within each population, WYSAC analyzed three key indicators: the prevalence of smoking cigarettes, smoking quit attempts, and exposure to secondhand smoke at work.<\/p>\n Because the Adult Tobacco Survey is primarily designed to obtain state-level data for the full adult population, WYSAC does not recruit people from these populations of focus in a way that allows for all analyses in the main body of the report or for intersectionality (such as estimates for young adults with low incomes). Specifically, because of the small number of Adult Tobacco Survey respondents who currently use commercial tobacco or nicotine products within each population of focus, there is a high degree of uncertainty around the estimates for most of these groups. Therefore, WYSAC took a cautious approach and chose not to provide interpretations for statistical tests in which WYSAC had a low degree of confidence, including when fewer than 50 adults responded to a question. Because of this issue, WYSAC does not report ENDS quit attempts among all populations of focus (including adults with low annual household income, American Indian adults, adults who reported behavioral health conditions, and young adults) or cigarette quit attempts among these populations except for adults with behavioral conditions.<\/p>\n Proportion plots in the following sections are adapted from a template distributed by Stephanie Evergreen: https:\/\/stephanieevergreen.com\/proportion-plots\/<\/a><\/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 Adult Tobacco Survey. Based on practical considerations such as survey sample size, WYSAC and the SUTPP used a threshold of $30,000 in annual household income to identify adults with a low annual household income.<\/p>\n For context, the median household income for Wyoming adults is $65,304 (U.S. Census Bureau, 2021). By definition, half of the adults in the state have an annual income less than the median.<\/p>\n Evidence on ENDS marketing targeting people with low income is limited. Still, there is some indication that people with low socioeconomic status are more likely to see and be influenced by ENDS advertising (Addo Ntim et al., 2022). More research is needed to understand if the ENDS industry is using focused marketing toward people with low incomes.<\/p>\n In 2023, 14% of adults with annual household incomes less than $30,000 used ENDS every day or some days. Among adults with an annual household income of $30,000 or more, 10% reported using ENDS every day or some days. Partly because the Adult Tobacco Survey did not sample a large number of adults with an annual income of less than $30,000, the difference in ENDS use was not significant.<\/p>\n Partly because the Adult Tobacco Survey did not sample a large number of adults with an annual income of less than $30,000, the differences between reports of secondhand aerosol exposure in public places, indoors or outdoors, in the last seven days were not significant (Figure 28).<\/p>\n Commercial tobacco industry marketing has a documented history of targeting lower-income neighborhoods (Lee et al., 2015). This targeted marketing has included giving free cigarettes to children in low-income neighborhoods. Along with the increased marketing, low-income neighborhoods typically have a higher commercial tobacco outlet density than higher-income neighborhoods (CDC, 2024c; Truth Initiative, 2018). With the commercial tobacco industry\u2019s pointed strategies toward people with lower incomes, adults with lower incomes have a disproportionately high rate of commercial tobacco or nicotine use.<\/p>\n In 2023, adults with annual household incomes less than $30,000 were significantly more likely to smoke cigarettes every day or some days (24%) than those with higher incomes (10%; see Table 4 for a summary of the four smoking status categories).<\/p>\n Adults living in households making less than $30,000 per year were over-represented among adults who smoke.<\/p>\n While only 13% of survey respondents were living in households with an income of less than $30,000, they made up 27% of adults who currently smoke in the survey (Figure 29).<\/p>\n In 2023, 42% of adults with an annual household income less than $30,000 were exposed to someone else\u2019s secondhand smoke at work. Adults with an annual income less than $30,000 were significantly more likely to be exposed to secondhand smoke at work than adults with an annual income of $30,000 or more (Figure 30).<\/p>\n Occupational differences might explain this difference. For example, adults working in service industries are at a higher risk of exposure to secondhand smoke than those working in other industries (Holmes & Ling, 2017; Su et al., 2019), and they might have lower incomes. However, the 2023 Adult Tobacco Survey did not collect information about specific occupations.<\/p>\n The 2023 ATS data highlights the impact of the commercial tobacco industry\u2019s targeted efforts to engage already vulnerable populations in commercial tobacco use (Lee et al., 2015). People with an annual income of less than $30,000 are disproportionately affected by smoking.<\/p>\n Partly due to the low sample size of adults with an annual income of less than $30,000, differences in ENDS use and exposure to secondhand ENDS aerosol in public places were not significant.<\/p>\n Adults with an annual income of less than $30,000 are significantly more likely to smoke every day or some days than those with an annual income greater than $30,000. Commercial tobacco is marketed at a higher rate in low-income neighborhoods (Lee et al., 2015).<\/p>\n At workplaces, adults with an annual income of less than $30,000 were also more likely to be exposed to secondhand smoke than those with a higher income. Without details about where Adult Tobacco Survey respondents work, we cannot explore reasons for this relationship.<\/p>\n WYSAC acknowledges that different terms, such as Native American, refer to the Indigenous populations of the U.S. when not referring to specific tribes. In this report, use of the term American Indian mirrors the CDC-suggested survey item (which does not ask about tribal affiliation) used for the Adult Tobacco Survey.<\/p>\n WYSAC considered respondents as 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 In 2023, 33% of American Indian adults used ENDS every day or some days. American Indian adults (33%) were significantly more likely to use ENDS than non-American Indian adults (9%).<\/p>\n American Indian adults were over-represented among adults who use ENDS. While only 2% of survey respondents were American Indian, they made up 8% of adults who currently use ENDS in the survey (Figure 31).<\/p>\n Partly because the Adult Tobacco Survey did not sample a large number of American Indian adults, the differences between reports of secondhand aerosol exposure in public places, indoors or outdoors, in the last seven days was not statistically significant, though the estimates may look quite different (Figure 32).<\/p>\n Commercial tobacco companies have long used the ceremonial significance of tobacco to encourage American Indians to use their commercial tobacco products (D\u2019Silva et al., 2018). Commercial tobacco companies have a history of targeting this community, beginning with using American Indian imagery and symbols in marketing, often depicting negative stereotypes. The commercial tobacco industry misled these communities by providing financial support for their cultural events and providing highly discounted prices on commercial tobacco or nicotine products (Lempert & Glantz, 2019). The commercial tobacco industry\u2019s focused efforts have contributed to disproportionately high smoking rates for American Indians (D\u2019Silva et al., 2018).<\/p>\n In 2023, 19% of American Indian adults smoked cigarettes every day or some days. Among non-American Indian adults, 11% reported smoking every day or some days (see Table 5) for a summary of the four smoking status categories). Partly because the Adult Tobacco Survey did not sample a large number of American Indian adults, the difference in cigarette use between American Indian adults and non-American Indian adults was not significant.<\/p>\n <\/p>\n In 2023, 45% of American Indian adults were exposed to someone else\u2019s secondhand smoke at work. American Indian adults were more likely to be exposed to secondhand smoke at work than non-American Indian adults (Figure 33).<\/p>\n The 2023 Adult Tobacco Survey data highlighted the impact of the commercial tobacco industry\u2019s targeted efforts to engage already vulnerable populations in commercial tobacco or nicotine use. American Indian adults are disproportionately affected by ENDS use, though the 2023 sample did not show disproportionate effects of cigarette smoking. American Indian adults were also more likely to report secondhand smoke exposure at work. Without details about where Adult Tobacco Survey respondents work, we cannot explore reasons for this relationship.<\/p>\n Continuing to partner with representatives from the two main tribes in Wyoming (Northern Arapaho and Eastern Shoshone) will support sensitive approaches to reducing the burdens of commercial nicotine use and secondhand exposure for this population.<\/p>\n For this report, we use the term \u201cbehavioral health\u201d and recognize that subject matter experts may use, and distinguish between, terms such as behavioral or mental health, and these may have changed over time. The CDC-suggested item is as follows: \u201cDo you have any mental health conditions, such as an anxiety disorder, depression disorder, bipolar disorder, schizophrenia, attention-deficit\/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD) or substance use disorder?\u201d About 25% of adults reported having at least one behavioral health condition.<\/p>\n People experiencing behavioral health conditions have been harmed by unjust practices related to the sale of commercial tobacco and nicotine. These practices include promoting the false idea that tobacco and nicotine can be used to treat behavioral or mental health conditions and promoting unhealthy policies in behavioral healthcare facilities (CDC, 2024d). These misperceptions may affect healthcare providers\u2019 willingness to offer cessation treatments to adults with behavioral health conditions and increase smoking among people with behavioral health conditions (CDC, 2024b).<\/p>\n As with any self-report data, it is possible that people under-reported health conditions on the Adult Tobacco Survey, especially those conditions that may have stigma attached such as behavioral health conditions.<\/p>\n Historically, the commercial tobacco industry has targeted people experiencing behavioral health conditions (such as depressive disorder, bipolar disorder, substance use disorder, and psychotic disorder; Campbell et al., 2016; Prochaska et al., 2017). The ENDS industry might also be targeting those experiencing behavioral health conditions by claiming benefits of using ENDS (Spears et al., 2019). For example, an online ENDS store claimed that \u201ceCigs may help to cure depression\u201d (ePuffer Inc., 2018). Medical research, however, has shown that vaping is associated with more reports of depression for adults (Obisesan et al., 2019) and youth (Lechner et al., 2017). More research is needed to understand if the ENDS industry is also using focused marketing toward people experiencing behavioral health conditions.<\/p>\n In 2023, adults who said they had at least one behavioral health condition were significantly more likely to use ENDS every day or some days than adults who did not have at least one behavioral health condition: 27% of adults who reported having behavioral health conditions used ENDS every day or some days, compared to 5% of adults who did not report having behavioral health conditions.<\/p>\n Adults with behavioral health conditions were over-represented among adults who use ENDS. While only 25% of survey respondents said they had a behavioral health condition, they made up 64% of adults who currently use ENDS in the survey (Figure 34).<\/p>\n In 2023, 30% of adults who reported having behavioral health conditions reported being exposed to someone else\u2019s ENDS aerosol in public places, indoors or outdoors, in the past seven days. Overall, exposure to secondhand aerosol in public places was significantly more likely for adults who reported behavioral health conditions than those who did not report behavioral health conditions (Figure 35). In indoor public places, adults who reported behavioral health conditions (20%) were significantly more likely to report exposure to secondhand aerosol. The difference between secondhand aerosol exposure in outdoor public places was not statistically significantly different for adults with reported behavioral health conditions and those with no reported behavioral health conditions, though the estimates may look quite different.<\/p>\n Exposure to secondhand aerosol from ENDS is particularly concerning for adults who reported behavioral health conditions as it may be a barrier to their efforts to quit. The specific impact of ENDS aerosol exposure on individuals with behavioral health conditions requires further research.<\/p>\n Historically, the commercial tobacco industry has targeted people experiencing behavioral health conditions (such as depressive disorder, bipolar disorder, substance use disorder, and psychotic disorder; Campbell et al., 2016; Prochaska et al., 2017).<\/p>\n For this reason, studies (such as the Center for Behavioral Health Statistics and Quality, 2020, and Talati et al., 2016) have demonstrated an association between cigarette smoking and behavioral health conditions. People who report behavioral health conditions are more likely to smoke, and adults with these conditions who smoke tend to smoke more cigarettes than adults who do not report behavioral health conditions (Center for Behavioral Health Statistics and Quality, 2020).<\/p>\n In 2023, adults with behavioral health conditions (23%) were significantly more likely to smoke cigarettes than adults with no behavioral health conditions (7%).<\/p>\n Adults with behavioral health conditions were over-represented among adults who smoke while only 25% of adults who responded to the survey reported having behavioral health conditions, they made up 52% of adults in the survey who smoke (Figure 36; see Table 6 for a summary of the four smoking status categories).<\/p>\n Partly because the Adult Tobacco Survey did not sample a large number of adults with behavioral health conditions, the difference in quit attempts (including lifetime and past year) between adults who smoke and who reported behavioral health conditions and those who did not report such conditions was not statistically significant, though the estimates may look quite different.<\/p>\n Lifetime quit attempts:<\/p>\n Past year quit attempts:<\/p>\n Adults who smoke and who reported behavioral health conditions were more likely to report obstacles to quitting than those who did not report such conditions, particularly in managing cravings and handling stress. In 2023, cravings for a cigarette (99%) and loss of a way to handle stress (95%) were significantly more common among adults with behavioral health conditions than those without behavioral health conditions (Table 7). Partly because the Adult Tobacco Survey did not sample a large number of adults who reported having behavioral health conditions, the differences in the other obstacles between adults who reported behavioral health conditions and those who did not report such conditions were not significant based on statistical testing. When working to reduce barriers to healthy behaviors, connecting people to evidence-based resources to address those barriers can be justified regardless of the results of statistical tests. The Wyoming Quit Tobacco (WQT) is an evidence-based program designed to address the common barriers that adults face when quitting smoking, including adults with behavioral health conditions.<\/p>\n Adults who reported behavioral health conditions were more likely to be exposed to secondhand smoke at work (28%) than those who did not report such conditions (12%; Figure 37).<\/p>\n People experiencing behavioral health conditions are disproportionately affected by smoking and ENDS use. Particularly for cigarette smoking, this is likely related at least in part to the commercial tobacco industry\u2019s targeted marketing (Campbell et al., 2016; Prochaska et al., 2017). More research is needed to understand if the ENDS industry is also using focused marketing toward people experiencing behavioral health conditions.<\/p>\n Adults who reported behavioral health conditions were more likely to use ENDS than those who did not report a behavioral health condition. They are also more often exposed to someone else\u2019s ENDS aerosol in public places, particularly indoors.<\/p>\n Adults who report behavioral health conditions are more likely to smoke cigarettes than those who do not report such conditions. They are also more likely to be exposed to secondhand smoke at work than those who did not report such a condition. Without details about where Adult Tobacco Survey respondents work, we cannot explore reasons for this relationship.<\/p>\n In 2023, the Adult Tobacco Survey sampled too few adults who smoke and reported behavioral health conditions to detect a disparity in smoking quit attempts. Adults who smoke and reported behavioral health conditions were more likely to report obstacles to quitting smoking than those who did not report such conditions, particularly cravings for a cigarette and loss of a way to handle stress.<\/p>\n WYSAC considered respondents as young adults when they were between the ages of 18 and 29.<\/p>\n Young adults (aged 18-29) are a population of focus because young adulthood is an impressionable stage when people may begin a lifelong smoking or vaping habit (Biener & Albers, 2004; Lee et al., 2020). Additionally, nicotine use as the brain develops through the age of 25 (roughly) can change the brain to make it more vulnerable to additional addictions, cause difficulties in attention and thinking, and increase risk for behavioral health issues (USDHHS, 2016). Much like the commercial tobacco industry has targeted youth (Farber & Folan, 2017), the ENDS industry has targeted young adults with advertising and marketing that are attractive to them and has used social media as a pathway to reach young adults (Lee et al., 2020; Willis & Mindicino, 2020). The ENDS industry\u2019s focused efforts have contributed to disproportionately higher ENDS use rates for young adults (Willett et al., 2019).<\/p>\n Young adults (32%) were significantly more likely to use ENDS than other adults (5%). ENDS use may lead to later initiation of smoking, but more research is needed to investigate this potential pathway to smoking and, potentially, other commercial tobacco or nicotine products.<\/p>\n Young adults were over-represented among adults who used ENDS every day or some days. While only 20% of adults who responded to the survey reported being ages 18-29, they made up 61% of adults who currently used ENDS in the survey (Figure 38).<\/p>\n In 2023, young adults (40%) were nearly twice as likely to report being exposed to someone else\u2019s ENDS aerosol in public places, indoors or outdoors, in the past seven days, compared to other adults (19%; Figure 39). In indoor public places, young adults (29%) were significantly more likely to report exposure to secondhand aerosol. Secondhand aerosol exposure in outdoor public places was also significantly higher among young adults (32%).<\/p>\n Adult Tobacco Survey data (see Goal Area 1: Preventing Commercial Tobacco Use) show that most adults who smoke start smoking as youths or young adults. Young adulthood is an impressionable stage when people may begin a lifelong smoking habit, or a habit that had begun during adolescence could become set (Biener & Albers, 2004; Lee et al., 2020), making them a population of focus. The commercial 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 specifically for young adults (Lee et al., 2020). Commercial tobacco companies place these campaigns in places young adults frequent most, such as colleges, fraternities, and bars (Ling & Glantz, 2002). With such targeted industry efforts, young adults are a population of focus and require equally targeted efforts for control strategies aimed at commercial tobacco and nicotine prevention.<\/p>\n The smoking rate of young adults (16%) was similar to the smoking rate of other adults (10%; Figure 40).<\/p>\n Young adults were more likely to have never tried a cigarette: 38% of young adults have never tried a cigarette, compared to 25% of other adults. Because so few adults begin smoking after the age of 21 (see the Goal Area 1: Preventing Commercial Tobacco Use section), this difference between age cohorts may indicate that experimentation with cigarettes is becoming less common over time.<\/p>\n Young adults were significantly less likely to have smoked regularly and then quit (11%), compared to other adults (31%).<\/p>\n As shown in the ENDS Use section above, young adults are more likely to use ENDS (32%), which may lead to later initiation of smoking cigarettes. More research is needed to investigate this potential pathway to smoking or the use of new and emerging commercial nicotine products (such as nicotine pouches). Research about potentially complex relationships between the use of various commercial tobacco and nicotine products is currently lacking.<\/p>\n Table 8 details the four categories of smoking status used in Figure 40.<\/p>\n In 2023, 33% of young adults were exposed to someone else\u2019s secondhand smoke at work. Young adults were more likely to be exposed to secondhand smoke at work than other working adults (Figure 41).<\/p>\n 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 secondhand smoke than those working in other industries (Holmes & Ling, 2017). However, the 2023 Adult Tobacco Survey did not collect information about specific occupations.<\/p>\n The 2023 Adult Tobacco Survey data highlight the impact of the commercial tobacco industry\u2019s targeted efforts to engage already vulnerable populations in commercial tobacco or nicotine use.<\/p>\n Young adults were significantly more likely to use ENDS than other adults (age 30 and older).<\/p>\n Young adults were significantly more likely than other adults to have been exposed to secondhand ENDS aerosols in public places or secondhand smoke at work in the last week. Without details about where Adult Tobacco Survey respondents work, we cannot explore the reasons for this relationship.<\/p>\n Young adults were more likely to have never tried a cigarette compared to other adults.<\/p>\n <\/p>\n Addo Ntim, S., Martin, B., & Termeh-Zonoozi, Y. (2022). Review of use prevalence, susceptibility, advertisement exposure, and access to electronic nicotine delivery systems among minorities and low-income populations in the United States. International Journal of Environmental Research and Public Health<\/em>, 19<\/em>(20), 13585. https:\/\/doi.org\/10.3390\/ijerph192013585<\/a><\/p>\n Berry, K. M., Fetterman, J. L., Benjamin, E. J., Bhatnagar, A., Barrington-Trimis, J. L., Leventhal, A. M., & Stokes, A. (2019). Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths. JAMA Network Open, 2<\/em>(2), e187794\u2013e187794. https:\/\/doi.org\/10.1001\/jamanetworkopen.2018.7794<\/a><\/p>\n Biener, L., & Albers, A. B. (2004). Young adults: Vulnerable new targets of tobacco marketing. American Journal of Public Health (1971), 94<\/em>(2), 326\u2013330. https:\/\/doi.org\/10.2105\/AJPH.94.2.326<\/a><\/p>\n Campbell, B. K., Le, T., Andrews, K. B., Pramod, S., & Guydish, J. (2016). 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Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/guides\/pdfs\/2014\/comprehensive.pdf<\/a><\/p>\n Centers for Disease Control and Prevention. (2014b). 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. https:\/\/www.cdc.gov\/tobacco\/tobacco_control_programs\/surveillance_evaluation\/preventing_initiation\/pdfs\/preventing_initiation.pdf<\/a><\/p>\n Centers for Disease Control and Prevention. (2015). 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. https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/tobacco-control\/pdfs\/KOI_Goal3_Update_12_28_15.pdf<\/a><\/p>\n Centers for Disease Control and Prevention. (2017). 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. https:\/\/www.cdc.gov\/tobacco\/stateandcommunity\/tobacco-control\/pdfs\/eliminating-exposure-koi-goal2-508.pdf<\/a><\/p>\n Centers for Disease Control and Prevention. (2020). Adult smoking cessation-the use of e-cigarettes<\/em>. 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Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved December 6, 2022, from https:\/\/www.cdc.gov\/tobacco\/data_statistics\/fact_sheets\/economics\/econ_facts\/index.htm<\/a><\/p>\n Centers for Disease Control and Prevention. (2022c). What is health equity?<\/em> U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Minority Health & Equity. Retrieved November 30, 2022, from https:\/\/www.cdc.gov\/healthequity\/whatis\/index.html<\/a><\/p>\n Centers for Disease Control and Prevention. (2023b). Tax burden on tobacco. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Retrieved December 8, 2023, from https:\/\/www.cdc.gov\/statesystem\/factsheets\/excisetax\/ExciseTax.html<\/a><\/p>\n Centers for Disease Control and Prevention. (2024a, May 15). A history of the Surgeon General’s reports on smoking and health.<\/em> U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved January 16, 2025 from https:\/\/www.cdc.gov\/tobacco-surgeon-general-reports\/about\/history.html?CDC_AAref_Val=https:\/\/www.cdc.gov\/tobacco\/sgr\/history\/index.htm<\/a><\/p>\n Centers for Disease Control and Prevention. (2024b, May 15). People with behavioral health conditions encounter barriers to quitting successfully<\/em>. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Retrieved January 14, 2025, from https:\/\/www.cdc.gov\/tobacco-health-equity\/collection\/behavioral-health-quitting-tobacco.html<\/a><\/p>\n Centers for Disease Control and Prevention. (2024c, May 15). 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Retrieved June 4, 2024, from https:\/\/www.cdc.gov\/tobacco\/e-cigarettes\/quitting.html<\/a><\/p>\n CounterTobacco.Org. (2024, April 29). FTC report on e-cigarette advertising and sales in 2021<\/em>. https:\/\/countertobacco.org\/ftc-report-on-e-cigarette-advertising-and-sales-in-2021\/<\/a><\/p>\n D\u2019Silva, J., O\u2019Gara, E., & Villaluz, N. T. (2018). Tobacco industry misappropriation of American Indian culture and traditional tobacco. Tobacco Control, 27<\/em>(e1), e57\u2013e64. https:\/\/doi.org\/10.1136\/tobaccocontrol-2017-053950<\/a><\/p>\n Dierker, L., Swendsen, J., Rose, J., He, J., & Merikangas, K. (2012). Transitions to regular smoking and nicotine dependence in the adolescent national comorbidity survey (NCS-A). Annals of Behavioral Medicine, 43(3), 394. https:\/\/doi.org\/10.1007\/S12160-011-9330-9<\/a><\/p>\n ePuffer Inc. (2018, September 15). Ecigs may help cure depression. Retrieved June 5, 2024, from https:\/\/epuffer.com\/e-cigs-vaporizers\/ecig-nicotine-may-cure-depression\/<\/a><\/p>\n Farber, H. J., & Folan, P. (2017). The tobacco industry targets youth. American Journal of Respiratory and Critical Care Medicine, 196<\/em>(6), P11\u2013P12. https:\/\/doi.org\/10.1164\/rccm.1966P11<\/a><\/p>\n Gentzke, A. S., Wang, T. W., Cornelius, M., Park-Lee, E., Ren, C., Sawdey, M. D., Cullen, K. A., Loretan, C., Jamal, A., & Homa, D. M. (2022). Tobacco product use and associated factors among middle and high school students – National Youth Tobacco Survey, United States, 2021. MMWR. Surveillance Summaries, 71(5), 1\u201329. http:\/\/dx.doi.org\/10.15585\/mmwr.ss7105a1<\/a><\/p>\n Hair, E. C., Kreslake, J. M., Mowery, P., Pitzer, L., Schillo, B., & Vallone, D. M. (2021). A longitudinal analysis of e-cigarette use and cigar, little cigar or cigarillo initiation among youth and youth adults: 2017\u20132019. Drug and Alcohol Dependence<\/em>, 226<\/em>, 108821\u2013108821. https:\/\/doi.org\/10.1016\/j.drugalcdep.2021.108821<\/a><\/p>\n Holmes, L. M., & Ling, P. M. (2017). Workplace secondhand smoke exposure: A lingering hazard for young adults in California. Tobacco Control, 26<\/em>(e1), e79\u2013e84. https:\/\/doi.org\/10.1136\/tobaccocontrol-2016-052921<\/a><\/p>\n Kaplan, B., Cherukupalli, R., Welding, K., Kennedy, R. D., & Cohen, J. E. (2021). The youth e-cigarette epidemic: New estimates of JUUL Labs\u2019 revenue from youth users in the US. Tobacco Induced Diseases<\/em>, 19<\/em>(May), 33. https:\/\/doi.org\/10.18332%2Ftid%2F133874<\/a><\/p>\n Kim, A. E., Chew, R., Wenger, M., Cress, M., Bukowski, T., Farrelly, M., & Hair, E. (2019). Estimated ages of JUUL Twitter followers. JAMA Pediatrics<\/em>, 173<\/em>(7), 690-692. https:\/\/doi.org\/10.1001%2Fjamapediatrics.2019.0922<\/a><\/p>\n Lechner, W. V., Janssen, T., Kahler, C. W., Audrain-McGovern, J., & Leventhal, A. M. (2017). Bi-directional associations of electronic and combustible cigarette use onset patterns with depressive symptoms in adolescents. Preventive medicine<\/em>, 96<\/em>, 73\u201378. https:\/\/doi.org\/10.1016\/j.ypmed.2016.12.034<\/a><\/p>\n Lee, J. G. L., Henriksen, L., Rose, S. W., Moreland-Russell, S., & Ribisl, K. M. (2015). A systematic review of neighborhood disparities in point-of-sale tobacco marketing. American Journal of Public Health (1971), 105<\/em>(9), e8\u2013e18. https:\/\/doi.org\/10.2105\/AJPH.2015.302777<\/a><\/p>\n Lee, S. J., Rees, V. W., Yossefy, N., Emmons, K. M., & Tan, A. S. L. (2020). Youth and young adult use of pod-based electronic cigarettes from 2015 to 2019: A systematic review. JAMA Pediatrics, 174<\/em>(7), 714\u2013720. https:\/\/doi.org\/10.1001\/jamapediatrics.2020.0259<\/a><\/p>\n Lempert, L. K., & Glantz, S. A. (2019). Tobacco industry promotional strategies targeting American Indians\/Alaska natives and exploiting tribal sovereignty. Nicotine & Tobacco Research, 21<\/em>(7), 940\u2013948. https:\/\/doi.org\/10.1093\/ntr\/nty048<\/a><\/p>\n Ling, P. M., & Glantz, S. A. (2002). Why and how the tobacco industry sells cigarettes to young adults: Evidence from industry documents. American Journal of Public Health (1971), 92<\/em>(6), 908\u2013916. https:\/\/doi.org\/10.2105\/AJPH.92.6.908<\/a><\/p>\n Obisesan, O. H., Mirbolouk, M., Osei, A. D., Orimoloye, O. A., Uddin, S. M. I., Dzaye, O., El Shahawy, O., Al Rifai, M., Bhatnagar, A., Stokes, A., Benjamin, E. J., DeFilippis, A. P., & Blaha, M. J. (2019). Association Between E-Cigarette Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017. JAMA network open<\/em>, 2<\/em>(12), e1916800. https:\/\/doi.org\/10.1001\/jamanetworkopen.2019.16800<\/a><\/p>\n Prochaska, J. J., Das, S., & Young-Wolff, K. C. (2017). Smoking, mental illness, and public health. Annual Review of Public Health, 38<\/em>(1), 165\u2013185. https:\/\/doi.org\/10.1146\/annurev-publhealth-031816-044618<\/a><\/p>\n Sharapova, S., Reyes-Guzman, C., Singh, T., Phillips, E., Marynak, K. L., & Agaku, I. (2020). Age of tobacco use initiation and association with current use and nicotine dependence among US middle and high school students, 2014\u20132016. Tobacco Control, 29(1), 49\u201354. https:\/\/doi.org\/10.1136\/TOBACCOCONTROL-2018-054593<\/a><\/p>\n Spears, C. A., Jones, D. M., Weaver, S. R., Yang, B., Pechacek, T. F., & Eriksen, M. P. (2019). Electronic nicotine delivery system (ENDS) use in relation to mental health conditions, past-month serious psychological distress and cigarette smoking status, 2017. Addiction, 114<\/em>(2), 315\u2013325. https:\/\/doi.org\/10.1111\/add.14464<\/a><\/p>\n State Epidemiological Outcomes Workgroup. (2024). Cost of substance use in Wyoming: 2019<\/em>. Wyoming Department of Health, Public Health Division.<\/p>\n Stevens, V. L., Diver, W. R., Stoklosa, M., Flanders, W. D., Westmaas, J. L., Jemal, A., Drope, J. M., Gapstur, S. M., & Jacobs, E. J. (2017). A prospective cohort study of cigarette prices and smoking cessation in older smokers. Cancer Epidemiology, Biomarkers & Prevention, 26(7), 1071\u20131077. Retrieved May 14, 2023, from, https:\/\/pubmed.ncbi.nlm.nih.gov\/28264874\/<\/a><\/p>\n Su, C., Syamlal, G., Tamers, S., Li, J., & Luckhaupt, S. E. (2019). Workplace secondhand tobacco smoke exposure among U.S. nonsmoking workers, 2015. MMWR. Morbidity and Mortality Weekly Report, 68<\/em>(27), 604\u2013607. https:\/\/doi.org\/10.15585\/mmwr.mm6827a2<\/a><\/p>\n Talati, A., Keyes, K. M., & Hasin, D. S. (2016). Changing relationships between smoking and psychiatric disorders across twentieth century birth cohorts: Clinical and research implications. Molecular Psychiatry, 21<\/em>, 464\u2013471. https:\/\/doi:10.1038\/mp.2015.224<\/a><\/p>\n Truth Initiative. (2018, January 24). Why are 72% of smokers from lower-income communities?<\/em> Retrieved June 10, 2024, from https:\/\/truthinitiative.org\/research-resources\/targeted-communities\/why-are-72-smokers-lower-income-communities<\/a><\/p>\n Truth Initiative. (2020). Dangerous Loopholes: Young e-cigarette users report swapping products as vaping policies change<\/em>. Truth Initiative. <\/em>Retrieved June 4, 2024, from https:\/\/truthinitiative.org\/research-resources\/emerging-tobacco-products\/dangerous-loopholes-young-e-cigarette-users-report<\/a><\/p>\n U.S. Census Bureau. (2021). QuickFacts: Wyoming<\/em>. Retrieved November 30, 2022, from https:\/\/www.census.gov\/quickfacts\/fact\/table\/WY\/RHI325219#RHI325219<\/a><\/p>\n U.S. Department of Health and Human Services. (2010). How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease: A report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53017\/<\/a><\/p>\n U.S. Department of Health and Human Services. (2014). The health consequences of smoking \u2013 50 years of progress: A report of the Surgeon General<\/em>. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. http:\/\/www.cdc.gov\/tobacco\/data_statistics\/sgr\/50th-anniversary\/index.htm<\/a><\/p>\n U.S. Department of Health and Human Services. (2016). E-Cigarette use among youth and young adults: 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. https:\/\/www.cdc.gov\/tobacco\/data_statistics\/sgr\/e-cigarettes\/pdfs\/2016_sgr_entire_report_508.pdf<\/p>\n U.S. Department of Health and Human Services. (2018). Surgeon General\u2019s advisory on e-cigarette use among youth.<\/em> https:\/\/e-cigarettes.surgeongeneral.gov\/documents\/surgeon-generals-advisory-on-e-cigarette-use-among-youth-2018.pdf<\/a><\/p>\n U.S. Department of Health, Education, and Welfare. (1964). 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. https:\/\/www.govinfo.gov\/app\/details\/GPO-SMOKINGANDHEALTH\/summary<\/a><\/p>\n U.S. Food & Drug Administration. (2020, January 2). FDA finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint. Retrieved June 4, 2024, from https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-finalizes-enforcement-policy-unauthorized-flavored-cartridge-based-e-cigarettes-appeal-children<\/a><\/p>\n U.S. Food & Drug Administration. (2021, September 1). Tobacco 21. https:\/\/www.fda.gov\/tobacco-products\/retail-sales-tobacco-products\/tobacco-21<\/a><\/p>\n U.S. Food & Drug Administration. (2023, July 26). Facts about e-cigarettes<\/em>. Retrieved June 4, 2024, from https:\/\/www.fda.gov\/news-events\/rumor-control\/facts-about-e-cigarettes<\/a><\/p>\n Willett, J. G., Bennett, M., Hair, E. C., Xiao, H., Greenberg, M. S., Harvey, E. Cantrell, J., & Vallone, D. (2019). Recognition, use and perceptions of JUUL among youth and young adults. Tobacco Control<\/em>, 28<\/em>(1), 115-116. https:\/\/doi.org\/10.1136\/tobaccocontrol-2018-054273<\/a><\/p>\n Willis, N., & Mindicino, M. (2020). The role of advertisements in JUUL consumption: Analyzing the connections between different stimuli on advertisements and teenage vaping. Journal of Student Research, 9(2). https:\/\/doi.org\/10.47611\/jsrhs.v9i2.1069<\/a><\/p>\n Wyoming Statute \u00a7 14-3-305 (2013 & Rev 2020). https:\/\/wyoleg.gov\/NXT\/gateway.dll?f=templates&fn=default.htm<\/a><\/p>\n Wyoming Statute \u00a7 39-18-104[g] (2021) https:\/\/wyoleg.gov\/NXT\/gateway.dll?f=templates&fn=default.htm<\/a><\/p>\nKey Findings<\/h2>\n
\n
\n
\n
\n
\n
\n
Background<\/h1>\n
\n
2023 Adult Tobacco Survey Methods<\/h1>\n
Key Limitations<\/h2>\n
\n
Electronic Nicotine Delivery Systems (ENDS)<\/h1>\n
2023 ENDS Use in Wyoming<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_01-300x262.png\")
<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_02-300x268.png\")
<\/p>\nFlavored ENDS Use<\/h3>\n
\n
Reasons for Trying ENDS<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_03-196x300.png\")
<\/p>\nDo People Think ENDS Use Is Harmful?<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_04-279x300.png\")
<\/p>\nStarting ENDS Use<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Table_01-1024x480.png\")
<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_05-247x300.png\")
<\/p>\nEliminating Secondhand Exposure<\/h2>\n
Exposure to Secondhand ENDS Aerosol in Public Places<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_06-290x300.png\")
<\/p>\nOpinions about the Harms of Secondhand ENDS Aerosol<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_07-244x300.png\")
<\/p>\nQuitting ENDS Use<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_08-284x300.png\")
<\/p>\nConclusion<\/h2>\n
Cigarette Smoking and Use of Other Commercial Tobacco and Nicotine Products<\/h1>\n
Cigarette Smoking in 2023<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Table_02-1024x486.png\")
<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_09-300x225.png\")
<\/p>\nDo People Think Smoking Cigarettes Is Harmful?<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_10-300x295.png\")
<\/p>\nOther Commercial Tobacco and Nicotine Products (Including ENDS)<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_11-211x300.png\")
<\/p>\nConclusion<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Sidebar_02_Tob-Use-1-300x275.png\")
The public is very aware that smoking is harmful. Less than 1% of adults said that smoking is not at all harmful.<\/p>\nCommercial Tobacco and Nicotine Taxes<\/h1>\n
Commercial Tobacco and Nicotine Tax Rates<\/h2>\n
Cigarettes<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_12-242x300.png\")
<\/p>\nSmokeless Tobacco<\/h3>\n
Electronic Nicotine Delivery Systems (ENDS)<\/h3>\n
Support for Evidence-Based Policy<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Table_03-1024x435.png\")
<\/p>\nCosts of Smoking<\/h2>\n
\n
\n
Conclusion<\/h2>\n
Goal Area 1: Preventing New Commercial Tobacco Use<\/h1>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_13-281x300.png\")
<\/p>\nAge of Smoking a Whole Cigarette for the First Time<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Sidebar_03_Goal1-300x222.png\")
The age of first smoking a whole cigarette is related to long-term smoking habits. Those who start smoking at an early age are more likely to smoke as adults (CDC, 2014b).<\/p>\nConclusion<\/h2>\n
Goal Area 2: Eliminating Exposure to Secondhand Smoke for People Who Do Not Smoke<\/h1>\n
Support for Smokefree Indoor Air Policies at Restaurants, Workplaces, Casinos and Clubs, and Bars<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_14-298x300.png\")
<\/p>\nSupport for Other Smokefree Air Policies<\/h2>\n
Commercial Tobacco-Free School Policies<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_15-300x219.png\")
<\/p>\nSmokefree Park Policies<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_16-300x229.png\")
<\/p>\nSmokefree Outdoor Workplace Policies<\/h3>\n
Exposure to Secondhand Smoke<\/h2>\n
Smoking Policies at Work<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_17-300x275.png\")
<\/p>\nExposure to Secondhand Smoke at Work and in Public Places<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_18-1024x579.png\")
<\/p>\n\n
Opinions about the Harms of Secondhand Smoke<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_19-300x283.png\")
<\/p>\nConclusion<\/h2>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Sidebar_04_Goal2-187x300.png\")
Over the years, exposure to secondhand smoke has significantly decreased in public places, indoors and outdoors. Two-thirds of adults reported not being exposed to secondhand smoke in public places, indoors or outdoors.<\/p>\nGoal Area 3: Promoting Quitting<\/h1>\n
Efforts to Quit Smoking<\/h2>\n
Desire to Quit Among Adults Who Smoke<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_20-300x252.png\")
<\/p>\nQuit Attempts Among Adults Who Smoke<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_21-300x281.png\")
<\/p>\nAids to Quit Smoking<\/h2>\n
Awareness of Quitlines<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_22-300x268.png\")
<\/p>\nUse of Quit Aids Among Adults Who Currently Smoke<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Sidebar_06_Goal3-300x233.png\")
More than half (54%) of adults who currently smoke and tried to quit in the last year did not use any quit aids. Nicotine replacement therapy (NRT) was the most popular aid used by adults who smoke (Figure 23). This may have included people buying them over the counter themselves or getting them from the Wyoming Quit Tobacco (WQT) program.<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_23-193x300.png\")
<\/p>\nObstacles to Quitting Cigarettes Among Adults Who Smoke<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/WQT_PhoneNumber_ForLight-300x189.png\")
Cravings for a cigarette was the most common obstacle for adults who smoke and tried to quit in their lifetime or wanted to quit (84%; Figure 24). The second most common obstacle to quitting cigarettes was the loss of a way to handle stress (74%). The WQT program specifically targets the most common obstacle 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 obstacles, such as losing a way to handle stress.<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_24-1024x972.png\")
<\/p>\nHealth Professionals\u2019 Involvement in Quitting Commercial Tobacco or Nicotine Use<\/h2>\n
Visits with Health Professionals<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_25-234x300.png\")
<\/p>\nPatient Experiences with Health Professionals\u2019 Support for Quitting Commercial Tobacco and Nicotine Use<\/h3>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_26-1024x538.png\")
<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Sidebar_07_Goal3-300x292.png\")
When adults who use commercial tobacco or nicotine were offered assistance, health professionals provided WQT information (78%; Figure 27), recommended NRTs (50%), and prescribed medication (18%). These protocols align with best practices in support of quitting.<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_27-300x266.png\")
<\/p>\nConclusion<\/h2>\n
Goal Area 4: Identifying and Eliminating Commercial Tobacco and Nicotine-Related Disparities<\/h1>\n
Acknowledgement<\/h2>\n
Population of Focus: Adults with Low Annual Household Income<\/h2>\n
ENDS and Adults with Low Annual Household Income<\/h3>\n
ENDS Use<\/h4>\n
Exposure to Secondhand Aerosol in Public Places<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_28-1024x736.png\")
<\/p>\nCigarettes and Adults with Low Annual Household Income<\/h3>\n
Cigarette Use<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Table_04_Goal4-1024x485.png\")
<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_29-240x300.png\")
<\/p>\nExposure to Secondhand Smoke at Work<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_30-300x283.png\")
<\/p>\nConclusion<\/h3>\n
Population of Focus: American Indians<\/h2>\n
ENDS and American Indians<\/h3>\n
ENDS Use<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_31-268x300.png\")
<\/p>\nExposure to ENDS Aerosol in Public Places<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_32-1024x701.png\")
<\/p>\nCigarettes and American Indians<\/h3>\n
Cigarette Use<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Table_05_Goal4-1024x486.png\")
<\/p>\nExposure to Secondhand Smoke at Work<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_33_Goal4_AI-300x293.png\")
<\/p>\nConclusion<\/h3>\n
Population of Focus: Behavioral Health<\/h2>\n
ENDS and Behavioral Health<\/h3>\n
ENDS Use<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_34_Goal4_BH-255x300.png\")
<\/p>\nExposure to Secondhand Aerosol in Public Places<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_35_Goal4_BH-1024x742.png\")
<\/p>\nCigarettes and Behavioral Health<\/h3>\n
Cigarette Use<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_36_Goal4_BH-236x300.png\")
<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Table_06_Goal4-1024x487.png\")
<\/p>\nQuit Attempts: Lifetime and Past Year<\/h4>\n
\n
\n
Obstacles to Quitting Smoking Cigarettes<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Table_07_Goal4-1024x908.png\")
<\/p>\nExposure to Secondhand Smoke at Work<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_37_Goal4_BH-286x300.png\")
<\/p>\nConclusion<\/h3>\n
Population of Focus: Young Adults<\/h2>\n
ENDS and Young Adults<\/h3>\n
ENDS Use<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_38_Goal4_YA-266x300.png\")
<\/p>\nExposure to ENDS Aerosol in Public Places<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_39_Goal4_YA-1024x738.png\")
<\/p>\nCigarettes and Young Adults<\/h3>\n
Cigarette Use<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_40_Goal4_YA-251x300.png\")
<\/p>\n![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Table_08_Goal4_YA-1024x483.png\")
<\/p>\nExposure to Secondhand Smoke at Work<\/h4>\n
![\"\"](\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2025\/07\/ATS_2023_Figure_41_Goal4_YA-300x271.png\")
<\/p>\nConclusion<\/h3>\n
References<\/h1>\n
Appendices<\/h1>\n