{"id":980,"date":"2015-08-05T08:00:45","date_gmt":"2015-08-05T15:00:45","guid":{"rendered":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/?p=980"},"modified":"2021-04-21T15:11:49","modified_gmt":"2021-04-21T21:11:49","slug":"impact-of-tobacco-in-wyoming","status":"publish","type":"post","link":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/2015\/08\/05\/impact-of-tobacco-in-wyoming\/","title":{"rendered":"Impact of Tobacco in Wyoming"},"content":{"rendered":"<h1><span style=\"font-family: Montserrat; font-size: 28pt;\"><strong>Introduction <\/strong><\/span><\/h1>\n<p><span style=\"font-family: Palatino Linotype;\"><em>The Impact of Tobacco in Wyoming: 2015 Annual Summary<\/em> provides data on the prevalence of tobacco use and data associated with the four goals of the Wyoming Tobacco Prevention and Control Program: <\/span><\/p>\n<ul>\n<li style=\"margin-left: 18pt;\"><span style=\"font-family: Palatino Linotype;\">Reduce youth initiation <\/span><\/li>\n<li style=\"margin-left: 18pt;\"><span style=\"font-family: Palatino Linotype;\">Reduce exposure to secondhand smoke <\/span><\/li>\n<li style=\"margin-left: 18pt;\"><span style=\"font-family: Palatino Linotype;\">Promote tobacco cessation <\/span><\/li>\n<li style=\"margin-left: 18pt;\"><span style=\"font-family: Palatino Linotype;\">Minimize disparities in the burden of tobacco use. <\/span><\/li>\n<\/ul>\n<p><span style=\"font-family: Palatino Linotype;\">This <em>Annual Summary<\/em> also includes a discussion about the health and economic burdens of tobacco use in Wyoming. In reporting the data, the Wyoming Survey &amp; Analysis Center (WYSAC) uses the data sources&#8217; conventions for ascertaining statistical significance and for reporting confidence intervals. Using those criteria (generally an alpha of .05 for statistical tests or 95% confidence intervals), WYSAC identifies as significant only differences or relationships that have been identified by the data sources as statistically significant or where confidence intervals do not overlap. The references list at the end includes information for materials cited in this document. <\/span><\/p>\n<h1><span style=\"font-family: Montserrat; font-size: 28pt;\"><strong>Prevalence of Tobacco Use <\/strong><\/span><\/h1>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Adult Cigarette Smoking<img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob1.png\" alt=\"\" width=\"231\" height=\"336\" \/> <\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">Current smokers are those who reported smoking at least 100 cigarettes in their lifetime and currently smoke every day or some days. According to the 2013 Behavioral Risk Factor Surveillance System (BRFSS), 21% of Wyoming adults smoke, slightly higher than the national median of 19%. Wyoming, South Dakota, Montana, and Nebraska are in a statistical tie for the highest smoking rate in the region defined by Wyoming and the six bordering states (Figure 1). The smoking rate in Wyoming has declined since 2011, when the smoking rate was 23%. <\/span><\/p>\n<p><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Adult Use of Other Tobacco and Electronic Nicotine Delivery Systems (ENDS) <\/em><\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Compared to the national median, a greater proportion of Wyoming adults use chewing tobacco, snuff, or snus. In 2013, 9% of Wyoming adults reported using chewing tobacco, snuff, or snus every day or some days, compared to 4% of U.S. adults. A greater proportion of Wyoming men, 16%, than women, 1%, use smokeless tobacco (BRFSS, 2013). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Electronic cigarettes (e-cigarettes, e-cigs, vape-pens) are battery powered devices that produce a vapor by heating a liquid instead of producing smoke from burning tobacco. Contents of the liquid vary across products, and some models allow for customized liquids. Many electronic cigarette liquids contain nicotine. In 2014, 20% of Wyoming adults had tried electronic cigarettes at least once. Of those who had tried them at least once, 36% used electronic cigarettes every day or some days. The majority (66%) of Wyoming adults who reported ever trying electronic cigarettes said they tried them out of curiosity. Other common reasons for trying electronic cigarettes included using them in places where tobacco is not allowed and to replace, cut down, or quit other tobacco products (WYSAC, 2014b). The U.S. Food and Drug Administration (FDA) has not approved any e-cigarette as a cessation aid. Using results from a web survey of adults in the United States, King, Patel, Nguyen, and Dube (2015) found that, in 2013, about 9% of U.S. adults had used electronic cigarettes at least once and nearly 3% reported use in the past 30 days. They also reported rapid growth in electronic cigarette use between 2010 and 2013.<\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">In 2012, 48% of Wyoming adults and 34% of U.S. adults had tried cigars or cigarillos at least once. Of those who had tried cigars or cigarillos, 8% of <em>Wyoming<\/em> adults and 0.1% of <em>U.S.<\/em> adults had smoked them at least once in the past 30 days (U.S. Department of Health and Human Services [USDHHS], Substance Abuse and Mental Health Services Administration [SAMHSA], Center for Behavioral Health Statistics and Quality, 2014; WYSAC, 2014a). <\/span><\/p>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Youth Cigarette Smoking <\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">In Wyoming and in th<img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob2.png\" alt=\"\" width=\"232\" height=\"275\" \/>e United States, the cigarette smoking rate among high school students declined since 2001, based on smoking on one or more of the 30 days prior to being surveyed. In each year, the Wyoming and national smoking rates have been similar (Figure 2; Youth Risk Behavior Surveillance System [YRBSS], 2013). <\/span><\/p>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Youth Use of Other Tobacco and Electronic Nicotine Delivery Systems (ENDS) <\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">In 2013, 14% of Wyoming high school students reported that they used smokeless tobacco on at least one of the last 30 days, much higher than the U.S. average of 9%. More Wyoming young men used smokeless tobacco (22%) than young women (6%; YRBSS, 2013). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Wyoming high school students reported using cigars, cigarillos, and little cigars (15% of students) similarly to the U.S. average (13% of students) based on smoking them on at least one of the 30 days prior to being surveyed (YRBSS, 2013). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Wyoming data for youth electronic cigarette use is not currently available. In the United States, in 2014, 9% of 8th graders, 16% of 10th graders, and 17% of 12th graders had used electronic cigarettes at least once in the 30 days prior to being surveyed (Monitoring the Future, 2014). <\/span><\/p>\n<p>&nbsp;<\/p>\n<p><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/p>\n<h1><span style=\"font-family: Montserrat; font-size: 28pt;\"><strong>Youth Initiation<br \/><\/strong><\/span><\/h1>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Initiation as Reported by Adult Smokers <\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob3.png\" alt=\"\" width=\"284\" height=\"264\" \/><\/span><span style=\"font-family: Palatino Linotype;\">Overall, it is clear that most Wyoming adults who are or have been smokers began smoking before the legal age of 18. Few reported starting smoking after the age of 24 (Figure 3). Among current smokers, the age of smoking initiation appears to be increasing. Between 2010 and 2012, the percentage of current smokers who reported first smoking a whole cigarette before turning 18 decreased by 14 percentage points. In the same timeframe, the percentage of smokers who reported first smoking a cigarette between the ages of 18 and 24 increased by 13 percentage points. Among former smokers, the changes between 2010 and 2012 were relatively small and not statistically significant (WYSAC, 2014a). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Smoking experimenters are those who have smoked fewer than 100 cigarettes in their lifetime. Like current and former smokers, few experimental smokers first smoked a whole cigarette after the age of 24. However, similar percentages of experimental smokers first smoked a cigarette before the legal age of 18 and between the ages of 18 and 24. As with former smokers, changes in initiation age between 2010 and 2012 were relatively small and not statistically significant (WYSAC, 2014a). <\/span><\/p>\n<h2><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob4.png\" alt=\"\" width=\"227\" height=\"307\" \/><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Preventing Youth Access <\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">One approach for preventing youth initiation of tobacco use is to limit access to tobacco products (Centers for Disease Control and Prevention, Office on Smoking and Health [CDC-OSH], 2014; Starr et al., 2005). SAMHSA requires states to complete annual, random, unannounced inspections of tobacco retailers, known as Synar inspections. SAMHSA requires the noncompliance rate for Synar inspections to be below 20%. <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">During Wyoming&#8217;s Synar inspections, trained 16- and 17-year old inspectors use standardized protocols to attempt to purchase cigarettes or smokeless tobacco from a sample of Wyoming tobacco retailers accessible to minors. Violations during Synar inspections do not result in actual sales, so citations are not issued. <\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob5.png\" alt=\"\" width=\"208\" height=\"339\" \/><span style=\"font-family: Palatino Linotype;\">Wyoming&#8217;s Synar results are usually similar to the national violation rates (Figure 4). In 2012, Wyoming&#8217;s Synar noncompliance rate was unusually high at 14% because one geographic area had a high violation rate. Since 2007, clerks not asking inspectors for identification has been the strongest predictor of retailer violations in Synar inspections (WYSAC, 2014d). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Each year, the Wyoming Association of Sheriffs and Chiefs of Police (WASCOP) conducts additional inspections of tobacco retailers. During WASCOP inspections, trained adolescent inspectors attempt to purchase cigarettes from Wyoming tobacco retailers. Unlike Synar inspections, these compliance checks allow law enforcement officers to issue citations to merchants who sell to minors. WASCOP partners with WYSAC to compile and analyze the results of these inspections. Violation rates are generally slightly higher for WASCOP inspections (Figure 5) than Synar inspections. <\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob6.png\" alt=\"\" width=\"225\" height=\"284\" \/><span style=\"font-family: Palatino Linotype;\">Even though retailers are generally compliant with laws restricting youth access to tobacco products (WYSAC, 2014d, 2014e), data show that underage youth can access tobacco despite legal restrictions. They obtain tobacco from relatives, unrelated adults or minors, buying it themselves, taking it, and other non-specified sources (Prevention Needs Assessment [PNA], 2014; Wyoming Youth Risk Behavior Survey [WY YRBS], 2013; YRBSS, 2013). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">In 2014, 27% of Wyoming middle school students and 65% of Wyoming high school students under the age of 18 said it would be easy (either sort of easy or very easy) to get some cigarettes. The perceived ease of access to cigarettes varied by students&#8217; grade level: Students in higher grades perceived access to cigarettes as easier than students in lower grades (Figure 6; PNA, 2014). In general, Synar compliance checks in Wyoming have shown that clerks are more likely to attempt to sell tobacco to older minors (WYSAC, 2014d). Together, these findings suggest that it may be easier for youth to purchase or otherwise access cigarettes as they approach the age of 18. <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob7.png\" alt=\"\" width=\"540\" height=\"320\" \/><\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Increasing the price of tobacco products, usually by increasing taxes, is another strategy to reduce youth initiation of tobacco use (CDC-OSH, 2014; Chaloupka, Yurekli, &amp; Fong, 2012; Guide to Community Preventive Services, 2015; Starr et al., 2005). Excise taxes are levied at different levels of government. The federal cigarette excise tax has been $1.01 per pack since April 1, 2009. Wyoming last raised the state cigarette excise tax on July 1, 2003, when the rate increased from $0.12 to $0.60 per pack. For comparison, Wyoming&#8217;s average weighted (by market share) price of a pack of cigarettes, not including taxes, went up from $3.56 in 2003 to $5.02 in 2014 (Orzechowski &amp; Walker, 2014). With state and federal excise taxes, the current average weighted (by market share) price of a pack of cigarettes is $6.63. State tax rates vary considerably with a low of $0.17 per pack in Missouri to a high of $4.35 per pack in New York (Figure 7). <\/span><span style=\"font-family: Palatino Linotype;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob8.png\" alt=\"\" width=\"332\" height=\"243\" \/><\/span><span style=\"font-family: Palatino Linotype;\">The average state tax rate is $1.48 (not including the federal tax). Wyoming is tied with Kentucky for the 11th lowest excise tax in the nation (Figure 8; CDC, 2015). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Consistent with every state that has implemented a significant cigarette tax increase (Farrelly et al., 2013), Wyoming experienced a significant increase in tax revenue when it last raised its cigarette excise tax. In fiscal year 2003, before the tax increase took effect, excise tax revenue from cigarette sales equaled $5.1 million (equivalent to $6.6 million today, adjusting for inflation). For fiscal year 2014, excise tax revenue from cigarette sales was $19.1 million (Wyoming Department of Revenue [WYDOR], ca. 2014). WYSAC generated a statistical model based on data from 1996 through 2014 that predicts that Wyoming would see $48.3 million in total revenue during the first year after a $1 tax increase (WYSAC, 2014c). <\/span><\/p>\n<h1><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/h1>\n<h1><span style=\"font-family: Montserrat; font-size: 28pt;\"><strong>Exposure to Secondhand Smoke <img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob9.png\" alt=\"\" width=\"171\" height=\"260\" \/><\/strong><\/span><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em><br \/>Smokefree Indoor Air <\/em><\/span><\/h1>\n<p><span style=\"font-family: Palatino Linotype;\">Smokefree indoor air policies and laws have demonstrated effectiveness in reducing youth initiation, reducing exposure to secondhand smoke, and increasing cessation of tobacco use (Guide to Community Preventive Services, 2015). Since the city of Laramie enacted Wyoming&#8217;s first smokefree indoor air law in 2005, the coverage and number of Wyoming&#8217;s smokefree indoor air laws have increased (Figure 9). A law in Lyman includes a clause that allows business owners to opt out by prominently displaying signs identifying the business as a s<br \/>moking establishment (Lyman Municipal Code, 2011). Because WYSAC does not have data about the decisions of all individual business owners in Lyman, WYSAC does not include Lyman residents as covered by a smokefree indoor air law. Five cities in Wyoming have comprehensive smokefree indoor air laws. Comprehensive smokefree indoor air laws cover workplaces, restaurants, and bars. All other smokefree indoor air laws in Wyoming cover workplaces and restaurants.<br \/><\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"fullWidth alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob10.png\" alt=\"\" width=\"500\" height=\"377\" \/><\/p>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Smokefree Indoor Air Laws: Wyoming and the Nation <\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">Wyoming does not have a statewide smokefree indoor air law. However, every one of the states bordering Wyoming has some sort of statewide smokefree indoor air law. Five of the six bordering states have comprehensive smokefree indoor air laws (Figure 10). Utah implemented a non-comprehensive law in 1995 (CDC, 2011); the law became comprehensive in 2009. South Dakota implemented a non-comprehensive law in 2002; the law became comprehensive in 2010. Idaho implemented a non-comprehensive law in 2004. Montana implemented a non-comprehensive law in 2005; the law became comprehensive in 2009. Colorado implemented a comprehensive law in 2006. Nebraska implemented a comprehensive law in 2009 (CDC, 2015). <\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob11.png\" alt=\"\" width=\"544\" height=\"308\" \/><\/p>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Smokefree Policies <\/em><\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob12.png\" alt=\"\" width=\"230\" height=\"261\" \/><span style=\"font-family: Palatino Linotype;\">Voluntary smokefree policies in workplaces, restaurants, bars, and homes also provide some protection from secondhand smoke (Guide to Community Preventive Services, 2015). Wyoming adults generally believe that such policies should be strictly enforced (Table 1; WYSAC, 2014a). <\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob13.png\" alt=\"\" width=\"222\" height=\"337\" \/><span style=\"font-family: Palatino Linotype;\">The 2011 Wyoming Workplace Tobacco Survey documented the existence and implementation of smokefree air policies in Wyoming workplaces with more than 25 employees. Smokefree air policies are most common in the field of education\/government. Of the 640 surveyed workplaces, 13% had a written policy that prohibited smoking by anyone, at any time, both indoors and outdoors; 24% had a policy prohibiting smoking by anyone at any time indoors (Table 2; WYSAC, 2011). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Support for smokefree indoor areas of workplaces; restaurants; and bars, casinos, or clubs has significantly increased since 2004 (Figure 11). In 2012, the majority of Wyoming adults (79%) said that smoking should never be allowed in indoor workplaces, an increase from 70% (WYSAC, 2014a). For comparison, in 2010, 82% of U.S. adults reported that smoking should never be allowed in indoor workplaces (King, Dube, &amp; Tynan, 2013). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Support for eliminating secondhand smoke from indoor dining areas of restaurants grew from 57% of Wyoming adults in 2004 to 78% <img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob14.png\" alt=\"\" width=\"300\" height=\"321\" \/>in 2012 (WYSAC, 2014a). For comparison, in 2010, 75% of U.S. adults reported that smoking should never be allowed in indoor dining areas of restaurants (King et al., 2013). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Support for eliminating secondhand smoke from indoor areas in bars, casinos, or clubs grew from 29% of Wyoming adults in 2004 to 47% in 2012 (WYSAC, 2014a). For comparison, in 2010, 50% of U.S. adults reported that smoking should never be allowed in indoor areas of bars, casinos, or clubs (King et al., 2013). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob15.png\" alt=\"\" width=\"318\" height=\"231\" \/><\/span><span style=\"font-family: Palatino Linotype;\">In 2013, 79% of Wyoming adults reported that they would support a law making indoor workplaces smokefree, 78% would support a law making indoor areas of restaurants smokefree, 57% would support a law making indoor areas of bars smokefree, and 58% would support a law making indoor areas of casinos\/clubs smokefree (WYSAC, 2014b). In 2014, 71% of Wyoming <em>registered voters<\/em> said they would support a comprehensive statewide smokefree indoor air law (WYSAC, 2015). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Most Wyoming adults who work primarily indoors are covered by policies prohibiting smoking in the indoor areas of their workplaces, but these policies do not completely protect Wyoming workers from secondhand smoke (Table 3). Few Wyoming adults allow smoking in their homes (Table 4; WYSAC, 2014b).<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob16.png\" alt=\"\" width=\"241\" height=\"199\" \/><span style=\"font-family: Palatino Linotype;\">According to the Wyoming 2014 School Health Profiles Report: Trend Analysis Report (2015), schools qualify as tobacco-free when there is a policy that specifically prohibits the use of <em>all types of tobacco<\/em> (including cigarettes, smokeless tobacco, cigars, and pipes, but not necessarily e-cigarettes) <em>by all people<\/em> (all students, faculty\/staff, and visitors) <em>at all times<\/em> (including during non-school hours) <em>and in all places<\/em> (including school-sponsored events held off campus). In 2014, 50% of Wyoming schools had tobacco-free policies, a statistically significant increase from 44% in 2008. <\/span><\/p>\n<p><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/p>\n<h1><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em><img loading=\"lazy\" decoding=\"async\" class=\"alignright fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob17.png\" alt=\"\" width=\"473\" height=\"435\" \/><\/em><\/span><span style=\"font-family: Montserrat; font-size: 28pt;\"><strong>Tobacco Cessation <\/strong><\/span><\/h1>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Benefits of Cessation<\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">Smoking cessation has various short- and long-term health benefits (Table 5). Some health effects of smoking cessation (e.g., increased lung functioning) are evident within a few weeks or months of quitting, suggesting that relatively brief periods of abstinence have health benefits. Others (e.g., reduced risk of stroke) are not fully evident for five years or longer, reflecting the long-term benefits of successful smoking cessation (American Cancer Society [ACS], 2012). Additional research suggests that smoking cessation stops pathogenic processes which lead to cancer (CDC, 2010).<\/span><\/p>\n<h1><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Cessation among Wyoming Smokers <\/em><\/span><\/h1>\n<p><span style=\"font-family: Palatino Linotype;\">In 2012, 86% of current smokers had made a quit attempt during their lifetime; 55% of those smokers had tried to quit within the previous year (<img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob18.png\" alt=\"\" width=\"260\" height=\"215\" \/>WYSAC, 2014a). <\/span><span style=\"font-family: 'Palatino Linotype'; line-height: 1.5;\">Among current smokers who tried to quit in the previous year, 62% did not use the Wyoming Quit Tobacco Program (WQTP) or proven medications (nicotine replacement therapy [NRT] or prescription medications such as Chantix) during their most recent quit attempt. The most popular cessation aid was NRT: 28% of current smokers who had made a quit attempt within the previous year <\/span><span style=\"font-family: Palatino Linotype;\">used NRT (WYSAC, 2014a). Most Wyoming adults said they were aware of cessation quitlines and advertisements for cessation services (Table 6; WYSAC, 2014b). <\/span><\/p>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>The Wyoming Quit Tobacco Program (WQTP)<br \/><\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob19.png\" alt=\"\" width=\"243\" height=\"277\" \/>The Wyoming Quit Tobacco Program (WQTP) assists Wyoming residents who want to quit using tobacco by providing them with over-the-counter NRTs, coupons for prescription medication, and by offering them free cessation coaching services over the phone or online. WYSAC conducts a follow-up survey of WQTP enrollees seven months after their enrollment. The data in this section include information on WQTP participants who enrolled between July 2013 and April 2015. During this period, National Jewish Health provided WQTP services. WYSAC surveyed those participants seven months after they enrolled in the WQTP. Therefore, this section contains results from follow-up surveys conducted between February 2014 and December 2014 (WYSAC, 2014f). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">In 2015, 67% of Wyoming adults reported having heard of the &#8220;Wyoming Quit Tobacco Program or WQTP.&#8221; The most well-known WQTP services were telephone coaching and NRTs (Table 7; Tobacco Media Evaluation, 2015). <\/span><\/p>\n<h3><span style=\"color: #404040; font-family: Montserrat; font-size: 13pt;\">Enrollment and Referral Sources <\/span><\/h3>\n<p><span style=\"font-family: Palatino Linotype;\">Enrollment in the WQTP varies by month. Enrollment was at its lowest in November of 2013 and 2014. There were spikes in enrollment in January 2014 and 2015 (Figure 12; National Jewish Health, 2015). <\/span><\/p>\n<h3><img loading=\"lazy\" decoding=\"async\" class=\"alignnone fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob20.png\" alt=\"\" width=\"507\" height=\"248\" \/><\/h3>\n<p><span style=\"font-family: Palatino Linotype;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob21.png\" alt=\"\" width=\"228\" height=\"313\" \/><\/span><span style=\"font-family: Palatino Linotype;\">A plurality (26%) of WQTP enrollees heard about the program primarily from healthcare professionals. Many others learned of the program primarily from friends and family (20%) or on television (15%, Table 8).<br \/><\/span><\/p>\n<h3><span style=\"color: #404040; font-family: Montserrat; font-size: 13pt;\">Use of WQTP Program Components <\/span><\/h3>\n<p><span style=\"font-family: Palatino Linotype;\">The majority (83%) of WQTP enrollees used at least one medication, alone or with coaching. About seven out of 10 (72%) WQTP enrollees used at least one form of coaching offered through the program, alone or in combination with medication. About three out of five (61%) enrollees used both coaching and medication (WYSAC, 2014f; Figure 13).<\/span><\/p>\n<h3><span style=\"color: #404040; font-family: Montserrat; font-size: 13pt;\">Success in <img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob22.png\" alt=\"\" width=\"223\" height=\"259\" \/>WQTP <\/span><\/h3>\n<p><span style=\"font-family: Palatino Linotype;\">Seven months after enrollment, 30% of WQTP survey respondents had not used tobacco in the past 30 days. Quit rates varied by the program components enrollees used (WYSAC, 2014f): <\/span><\/p>\n<ul>\n<li style=\"margin-left: 18pt;\"><span style=\"font-family: Palatino Linotype;\">33% of those who used both medication and coaching. <\/span><\/li>\n<li style=\"margin-left: 18pt;\"><span style=\"font-family: Palatino Linotype;\">34% of those who used only medication. <\/span><\/li>\n<li style=\"margin-left: 18pt;\"><span style=\"font-family: Palatino Linotype;\">15% of those who used only coaching. <\/span><\/li>\n<li style=\"margin-left: 18pt;\"><span style=\"font-family: Palatino Linotype;\">11% of those who used neither coaching nor medication. <\/span><\/li>\n<\/ul>\n<p><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/p>\n<h1><span style=\"font-family: Palatino Linotype;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob23.png\" alt=\"\" width=\"241\" height=\"267\" \/><\/span><span style=\"font-family: Montserrat; font-size: 28pt;\"><strong>Tobacco-Related Disparities<br \/><\/strong><\/span><\/h1>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Smoking<br \/><\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">Within age and education, two demographic groups stand out as having low smoking rates: adults 65 years of age and older (Figure 14) and adults with a college degree (Figure 15; BRFSS, 2013). Wyomingites who are American Indian or multiracial are more likely to smoke than Wyomingites who are White or another race, which includes Black or African American, Asian, Pacific Islander, and other races (Figure 16). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob24.png\" alt=\"\" width=\"245\" height=\"271\" \/> <img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob25.png\" alt=\"\" width=\"226\" height=\"286\" \/><br \/><\/span><\/p>\n<p>&nbsp;<\/p>\n<h2><em><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob26.png\" alt=\"\" width=\"228\" height=\"251\" \/><\/em><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">Within ethnicity, the smoking rate among Wyomingites who have a Hispanic, Latino\/a, or Spanish origin is 25%, compared to 20% for non-Hispanic Wyomingites (BRFSS, 2013).<\/span><\/p>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Smokeless Tobacco<br \/><\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">Unlike smoking (which does not <\/span><span style=\"font-family: Palatino Linotype;\">show a statistically significant gender difference), men are more likely than women to use smok<\/span><span style=\"font-family: Palatino Linotype;\">eless tobacco (Figure 17; BRFSS, 2013). <\/span><\/p>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Disparities among Youth<br \/><\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">In Wyoming, older students are more likely to smoke, with the largest jump in prevalence occurring between 8th and 9th grades (Figure 18; WY YRBS, 2013). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">In each iteration of the YRBSS (2013), high school boys in Wyoming have used smokeless tobacco at a significantly higher rate than high school girls. For young men and young women, the use of smokeless tobacco has significantly declined since 1995 (Figure 19).<\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob28.png\" alt=\"\" width=\"237\" height=\"264\" \/><img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob27.png\" alt=\"\" width=\"291\" height=\"269\" \/> <\/span><\/p>\n<h1><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/h1>\n<h1><span style=\"font-family: Montserrat; font-size: 28pt;\"><strong>Burdens of Tobacco Use <\/strong><\/span><\/h1>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Health B<img loading=\"lazy\" decoding=\"async\" class=\"alignright fullWidth\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob29.png\" alt=\"\" width=\"513\" height=\"359\" \/>urdens <\/em><\/span><\/h2>\n<p><span style=\"font-family: Palatino Linotype;\">Although there is no safe level of exposure to tobacco smoke, greater exposure increases the risk for and severity of chronic disease. Cigarette smoke contains cancer-causing agents and chemicals linked to biological mechanisms that cause cardiovascular diseases, pulmonary diseases, respiratory diseases, and contribute to poor reproductive and dental health. More than 7,000 toxic chemicals comprise cigarette smoke, including ammonia, tar, and carbon monoxide. These chemicals increase the risk for developing several preventable chronic diseases for smokers and those who breathe secondhand smoke (Figure 20; USDHHS, 2014). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Electronic cigarettes are a new tobacco-related product, so research on the contents of their liquid, vapor, and health effects is limited. Currently, the FDA does not have any regulations on the liquids used in electronic <img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob30.png\" alt=\"\" width=\"277\" height=\"325\" \/>cigarettes or the devices and components. Early studies about the contents of the liquid and vapor show the presence of varying levels of nicotine as well as cancer-causing chemicals such as formaldehyde (American Lung Association, 2015). Overdoses have been reported, including among children, from drinking the nicotine liquid or spilling the liquid on their skin (CDC, 2014). Many of the liquids also contain other chemicals for flavoring, which could be harmful when vaporized and inhaled. Research shows that the use of electronic cigarettes negatively affects lung function (Cressey, 2014). <\/span><\/p>\n<p><span style=\"font-family: Palatino Linotype;\">Chronic diseases are the leading causes of death and sickness in the United States and Wyoming (Kochanek et al., 2011). Smoking is the leading preventable cause of chronic disease and dea<br \/>th in the United States (USDHHS, 2010). Compared to Wyoming nonsmokers (adults who had smoked fewer than 100 cigarettes in their lifetime), current and former smokers (adults who had smoked at least 100 cigarettes in their lifetime) were significantly more likely to have been diagnosed with high blood pressure, high cholesterol, asthma, heart disease, chronic lung disease, diabetes, and\/or cancer (the survey item excluded skin cancer, but did not specify any other cancers; Figure 21; WYSAC, 2014a). <\/span><\/p>\n<h2><span style=\"color: #595959; font-family: Palatino Linotype; font-size: 20pt;\"><em>Economic Burdens <\/em><\/span><\/h2>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob31.png\" alt=\"\" width=\"299\" height=\"285\" \/><span style=\"font-family: Palatino Linotype;\">In 2010, tobacco-related healthcare cost Wyoming nearly $240 million, including private and public costs, more than alcohol and other drugs (Figure 22; WYSAC, 2012).<\/span><\/p>\n<p><span style=\"font-family: 'Palatino Linotype'; line-height: 1.5;\">Smoking is associated with lost productivity nationally (USDHHS, 2015) and in Wyoming. Tobacco cost the state of Wyoming<\/span><span style=\"font-family: Palatino Linotype;\"> nearly $450 million in total productivity losses in 2010 (Table 9; WYSAC, 2012). <\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" src=\"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-content\/uploads\/2016\/09\/090616_2140_ImpactofTob32.png\" alt=\"\" width=\"325\" height=\"235\" \/><span style=\"font-family: Palatino Linotype;\">Smoking workers are generally less healthy and more costly for employers (USDHHS, 2015). When considering aggregate cost and productivity impacts, Berman et al. (2013) estimated that, on average, a U.S. smoker costs $5,816 more annually than a nonsmoker to employ. Employing smokers is also associated with increased property loss and occupational disease (USDHHS, 2015). Smokers are more likely to be injured at work than nonsmokers (Craig et al. 2006; USDHHS, 2015). <\/span><\/p>\n<h1><!--nextpage--><\/p>\n<style>@media only screen and (max-width: 1200px){.fullWidth {width: 100% !important; height: auto;}}@media only screen and (max-width: 700px){.alignright, .alignleft, .alignnone {display: inline;float: none;margin: 20px 0;width: 100%;height: auto;}}<\/style>\n<\/h1>\n<h1><span style=\"font-family: Montserrat; font-size: 28pt;\"><strong>References <\/strong><\/span><\/h1>\n<p>Afton, Wyoming, Municipal Code \u00a76-8-04 (2008).<\/p>\n<p>American Cancer Society. (2012). <em>Guide to quitting smoking<\/em>. Retrieved May 18, 2012, from <a href=\"http:\/\/www.cancer.org\/docroot\/PED\/content\/PED_10_13X_Guide_for_Quitting_Smoking.asp\">http:\/\/www.cancer.org\/docroot\/PED\/content\/PED_10_13X_Guide_for_Quitting_Smoking.asp<\/a><\/p>\n<p>American Lung Association. 2015. <em>E-cigarettes and lung health<\/em>. Retrieved April 29, 2015, from <a href=\"http:\/\/www.lung.org\/stop-smoking\/about-smoking\/health-effects\/e-cigarettes-and-lung-health.html\">http:\/\/www.lung.org\/stop-smoking\/about-smoking\/health-effects\/e-cigarettes-and-lung-health.html<\/a><\/p>\n<p><em>Behavioral Risk Factor Surveillance System <\/em>[Datafile 1994-2013]. (2013). Atlanta, GA: Centers for Disease Control and Prevention. Retrieved March 3, 2015, from <a href=\"http:\/\/www.cdc.gov\/brfss\">http:\/\/www.cdc.gov\/brfss<\/a><\/p>\n<p>Berman, M., Crane, R., Seiber, E., &amp; Munur, M. (2013). Estimating the cost of a smoking employee. <em>Tobacco Control<\/em>, 23, 428-433. doi 10.1136\/tobaccocontrol-2012-050888<\/p>\n<p>Burlington, Wyoming, Municipal Code \u00a78-64-40 (2008).<\/p>\n<p>Casper, Wyoming, Municipal Code \u00a78-16 (2013).<\/p>\n<p>Centers for Disease Control and Prevention. (2010). <em>How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease\u20132010<\/em>. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health promotion, Office on Smoking and Health. Retrieved May 15, 2015, from <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53017\/\">http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53017\/<\/a><\/p>\n<p>Centers for Disease Control and Prevention. (2011). State smoke-free laws for worksites, restaurants, and bars\u2014United States, 2000 \u2013 2010. <em>MMWR<\/em>, 60(15), 472-475.<\/p>\n<p>Centers for Disease Control and Prevention. (2014). Notes from the field: Calls to poison centers for exposures to electronic cigarettes\u2014United States, September 2010\u2013February 2014. <em>MMWR<\/em>, 63, 292\u2013293.<\/p>\n<p>Centers for Disease Control and Prevention, Office on Smoking and Health (2014). <em>Preventing initiation of tobacco use: Outcome indicators for comprehensive tobacco control programs\u20132014<\/em>. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.<\/p>\n<p>Centers for Disease Control and Prevention. (2015). <em>State tobacco activities tracking and evaluation (STATE) system<\/em>. Retrieved March 3, 2015, from <a href=\"http:\/\/www.cdc.gov\/tobacco\/statesystem\">http:\/\/www.cdc.gov\/tobacco\/statesystem<\/a><\/p>\n<p>Chaloupka, F. J., Yurekli, A., Fong, G. T. (2012). Tobacco taxes as a tobacco control strategy. <em>Tobacco Control<\/em>, 21(2), 172-180. doi:10.1136\/tobaccocontrol-2011-050417<\/p>\n<p>Cheyenne, Wyoming, Municipal Code \u00a78-64-040 (2006).<\/p>\n<p>Craig, C. N., Congleton, J. J., Kerk, C.J., Amendola, A.A., &amp; Gaines, W. G. (2006). Personal and non-occupational risk factors and occupational injury\/illness. <em>American Journal of Industrial Medicine<\/em>, 49(4), 249-206. doi: 10.1002\/ajim.20290<\/p>\n<p>Cressey, D. (2014). E-cigarettes: The lingering questions. <em>Nature<\/em>. Retrieved from <a href=\"http:\/\/www.nature.com\/news\/e-cigarettes-the-lingering-questions-1.15762\">http:\/\/www.nature.com\/news\/e-cigarettes-the-lingering-questions-1.15762<\/a><\/p>\n<p>Evanston, Wyoming, Municipal Code \u00a710-4 (2007).<\/p>\n<p>Farrelly, M. C., Loomis, B. R., Han, B., Gfroerer, J., Kuiper, N., Couzens, G. L., \u2026 Caraballo, S. (2013). A comprehensive examination of the influence of state tobacco control programs and policies on youth smoking. <em>American Journal of Public Health, <\/em>103<em>(3)<\/em>, 549-555. doi:10.2105\/AJPH.2012.300948<\/p>\n<p>Green River, Wyoming, Municipal Code \u00a718-93 (2007).<\/p>\n<p>Guide to Community Preventive Services. (2015). Reducing tobacco use and secondhand smoke exposure. Retrieved March 11, 2015, from <a href=\"http:\/\/www.thecommunityguide.org\/tobacco\/index.html\">http:\/\/www.thecommunityguide.org\/tobacco\/index.html<\/a><\/p>\n<p>Huelsmann, K. (2011, February 11). Judge Day kills smoking ban. <em>Jackson Hole News and Guide<\/em>. Retrieved June 21, 2011, from <a href=\"http:\/\/www.jhnewsandguide.com\/article.php?art_id=6978\">http:\/\/www.jhnewsandguide.com\/article.php?art_id=6978<\/a><\/p>\n<p>King, B.A., Dube, S.R., Tynan, M.A. (2013). Attitudes towards smoke-free workplaces, restaurants, and bars, casinos, and clubs among U.S. adults: Findings from the 2009-2010 National Adult Tobacco Survey. <em>Nicotine &amp; Tobacco Research<\/em>, 15(8), 1464-1470. doi: 10.1093\/ntr\/nts342<\/p>\n<p>King, B.A., Patel, R., Nguyen, K., &amp; Dube, S.R. (2015). Trends in awareness and use of electronic cigarettes among U.S. adults, 2010-2013. <em>Nicotine &amp; Tobacco Research<\/em>, 17, 219-227. doi: 10.1093\/ntr\/ntu191<\/p>\n<p>Kochanek, K. D., Xu, J. Q., Murphy, S. L., Mini\u00f1o, A. M., &amp; Kung, H. C. (2011). <em>National vital statistics reports<\/em>, 60(3). Retrieved December 7, 2012, from <a href=\"http:\/\/www.cdc.gov\/nchs\/data\/nvsr\/nvsr60\/nvsr60_03.pdf\">http:\/\/www.cdc.gov\/nchs\/data\/nvsr\/nvsr60\/nvsr60_03.pdf<\/a><\/p>\n<p>Laramie, Wyoming, Municipal Code \u00a78-56-030 (2005).<\/p>\n<p>Lyman, Wyoming, Municipal Code \u00a73-2-4-2 (2011).<\/p>\n<p>Mountain View, Uinta County, Wyoming, Municipal Code \u00a7 2011-1 (2011).<\/p>\n<p>Monitoring the Future. (2014). <em>Trends in 30-day prevalence of use of other tobacco products for grades 8, 10, and 12.<\/em> Retrieved July 1, 2015, from <a href=\"http:\/\/www.monitoringthefuture.org\/data\/14data\/14tobtbl13.pdf\">http:\/\/www.monitoringthefuture.org\/data\/14data\/14tobtbl13.pdf<\/a><\/p>\n<p>National Jewish Health. (2015). <em>Wyoming Quit Tobacco Program monthly intake data<\/em> [Data File 2013-2015] (2015). Denver, CO: Author.<\/p>\n<p>Orzechowski, &amp; Walker. (2014). <em>The tax burden on tobacco: Historical compilation volume 48<\/em>, 2013. Arlington, VA: Authors.<\/p>\n<p><em>Prevention Needs Assessment<\/em> [Data File 2001-2014]. (2014). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>Rock Springs, Wyoming, Municipal Code \u00a74-1604 (2008).<\/p>\n<p>Substance Abuse and Mental Health Services Administration. (2014). FFY 2013 Annual Synar Reports: Tobacco sales to youth. Retrieved August 29, 2014, from <a href=\"http:\/\/beta.samhsa.gov\/sites\/default\/files\/synar-annual-report-2013.pdf\">http:\/\/beta.samhsa.gov\/sites\/default\/files\/synar-annual-report-2013.pdf<\/a><\/p>\n<p>Starr, G., Rogers, T., Schooley, M., Porter, S., Wiesen, E., &amp; Jamison, N. (2005). <em>Key outcome indicators for evaluating comprehensive tobacco control programs.<\/em> Atlanta, GA: Centers for Disease Control and Prevention.<\/p>\n<p><em>Tobacco media evaluation<\/em> [Data File]. (2015). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>U.S. Census Bureau. [ca. 2012]. <em>Population finder<\/em> [user interface tool]. Retrieved March 7, 2011, from <a href=\"http:\/\/www.census.gov\/popfinder\/\">http:\/\/www.census.gov\/popfinder\/<\/a><\/p>\n<p>U.S. Department of Health and Human Services. (2010). <em>How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease: A report of the Surgeon General<\/em>. Atlanta, GA: 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 from <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53017\/\">http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53017\/<\/a><\/p>\n<p>U.S. Department of Health and Human Services. (2014). <em>The health consequences of smoking \u2013 50 years of progress: A report of the Surgeon General<\/em>. Retrieved January 21, 2014, from <a href=\"http:\/\/www.cdc.gov\/tobacco\/data_statistics\/sgr\/50th-anniversary\/index.htm\">http:\/\/www.cdc.gov\/tobacco\/data_statistics\/sgr\/50th-anniversary\/index.htm<\/a><\/p>\n<p>U.S. Department of Health and Human Services. (2015). <em>Promoting health and preventing disease and injury through workplace tobacco policies<\/em>. Atlanta, GA. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Retrieved from <a href=\"http:\/\/www.cdc.gov\/niosh\/docs\/2015-113\/pdfs\/cib-67_2015-113_v5.pdf\">http:\/\/www.cdc.gov\/niosh\/docs\/2015-113\/pdfs\/cib-67_2015-113_v5.pdf<\/a><\/p>\n<p>U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2014). <em>National Survey on Drug Use and Health, 2013 <\/em>[Datafile]. ICPSR35509-v1. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2014-11-18. http:\/\/doi.org\/10.3886\/ICPSR35509.v1<\/p>\n<p>Wyoming Department of Revenue. [ca. 2014]. <em>Cigarette tax distribution, by year.<\/em> Retrieved April 7, 2014, from <a href=\"http:\/\/revenue.wyo.gov\/tax-distribution-reports\/cigarette-tax-distribution-by-uear\">http:\/\/revenue.wyo.gov\/tax-distribution-reports\/cigarette-tax-distribution-by-uear<\/a><\/p>\n<p><em>Wyoming Youth Risk Behavior Survey<\/em> [Data File 2001\u20132013]. (2013). Cheyenne, WY: Wyoming Department of Education. Retrieved July 1, 2014, from <a href=\"http:\/\/edu.wyoming.gov\/data\/yrbs\">http:\/\/edu.wyoming.gov\/data\/yrbs<\/a><\/p>\n<p><em>Wyoming 2014 School Health Profiles report: Trend analysis report.<\/em> (2015). Retrieved July 1, 2015, from <a href=\"http:\/\/edu.wyoming.gov\/downloads\/data\/2014wy_profiles_trend_report.pdf\">http:\/\/edu.wyoming.gov\/downloads\/data\/2014wy_profiles_trend_report.pdf<\/a><\/p>\n<p>WYSAC (2011). <em>Results of the 2011 Wyoming Workplace Tobacco Survey (WWTS)<\/em>, by R. Jenniges &amp; L. Feldman. (WYSAC Technical Report No. CHES-1106). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>WYSAC. (2012). <em>Cost of substance abuse in Wyoming 2010<\/em>, by N. M. Nelson, M. Kato, &amp; H. Costello. (WYSAC Technical Report No. DER-1250). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>WYSAC. (2014a). <em>Report on the 2012 Wyoming Adult Tobacco Survey<\/em>, by M. Kato, L. H. Despain &amp; T. Comer Cook. (WYSAC Technical Report No. CHES-1408). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>WYSAC. (2014b). <em>Report on the 2013-2014 Wyoming County Tobacco Survey<\/em>, by M. Kato &amp; T. Comer Cook. (WYSAC Technical Report No. CHES-1443). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>WYSAC. (2014c). <em>Tax revenue and cigarette consumption in Wyoming: May 1996 \u2013 April 2014<\/em>, by N. M. Nelson &amp; M. Kato. (WYSAC Technical Report No. DER-1211). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>WYSAC. (2014d). <em>Wyoming&#8217;s 2014 (FFY 2015) Synar tobacco compliance inspection report<\/em>, by L. H. Despain &amp; S. Neufer. (WYSAC Technical Report No. CHES-1437). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>WYSAC. (2014e). <em>Wyoming alcohol and tobacco sales compliance checks, 2014<\/em>, by W. T. Holder. (WYSAC Technical Report No. SRC-1412). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>WYSAC (2014f). <em>Wyoming Quit Tobacco Program Follow-Up Survey<\/em> [Data File 2014]. Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p>WYSAC (2015). <em>WYSAC fact sheet: 2014 election survey<\/em>. (WYSAC Fact Sheet No. CHES-1503). Laramie, WY: Wyoming Survey &amp; Analysis Center, University of Wyoming.<\/p>\n<p><em>Youth Risk Behavior Surveillance System<\/em> [Data File 1991\u20132013]. (2013). Atlanta, GA: Centers for Disease Control and Prevention. Retrieved July 1, 2014, from <a href=\"http:\/\/www.cdc.gov\/healthyyouth\/yrbs\/index.htm\">http:\/\/www.cdc.gov\/healthyyouth\/yrbs\/index.htm<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Impact of Tobacco in Wyoming: 2015 Annual Summary provides data on the prevalence of tobacco use and data associated with the four goals of the Wyoming Tobacco Prevention and Control Program:<\/p>\n<p>Reduce youth initiation<br \/>\nReduce exposure to secondhand smoke<br \/>\nPromote tobacco cessation<br \/>\nMinimize disparities in the burden of tobacco use.<\/p>\n","protected":false},"author":5,"featured_media":907,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[3],"tags":[7,10,62,75,43,9,74,8,76,73,45,39,72,6],"coauthors":[25,22],"class_list":["post-980","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-reports","tag-use-adults","tag-cessation","tag-cigarettes","tag-disparities","tag-electronic-cigarettes","tag-health-econ","tag-secondhand-smoke","tag-laws","tag-smokeless-tobacco","tag-tax","tag-wyoming","tag-access-youth","tag-youth-initiation","tag-use-youth"],"_links":{"self":[{"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/posts\/980","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/comments?post=980"}],"version-history":[{"count":86,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/posts\/980\/revisions"}],"predecessor-version":[{"id":3315,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/posts\/980\/revisions\/3315"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/media\/907"}],"wp:attachment":[{"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/media?parent=980"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/categories?post=980"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/tags?post=980"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/wysac.uwyo.edu\/wyomingtobacco\/wp-json\/wp\/v2\/coauthors?post=980"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}