Wisconsin Department of Health Services January 2014 P-00522O Healthiest Wisconsin 2020 Baseline and Health Disparities Report Tobacco Use and Exposure

TOBACCO Background Overview of Healthiest Wisconsin 2020 Baseline and Health Disparities Report Healthiest Wisconsin 2020 objectives and indicators Rationale Key points Data Tobacco use among youth Tobacco use and exposure among adults Tobacco cessation among adults References Links to additional reports and resources Contacts Chapter Outline 2 Chapter outline

TOBACCO Report Overview This chapter is part of a larger report created by the Wisconsin Department of Health Services to track progress on the objectives of Healthiest Wisconsin 2020 (HW2020) and identify health disparities in the state. The full report is available at: The report is designed to address the Health Focus Areas in HW2020. Where direct measures exist, data are presented; where direct measures are not available, related information may be included. Information about populations experiencing health disparities is provided in the Health Focus Area chapters and is summarized in separate chapters devoted to specific populations. Technical notes are available at: Report overview 3

TOBACCO Report Format Full Report Format: PDF Intended use: reference document Chapters Format: Annotated PowerPoint slide set Intended uses: presentations to –Decision-makers –Service providers –Community leaders –The public Sample annotated slide Report overview 4

TOBACCO Report Outline Executive Summary Section 1: Introduction Section 2: Demographic overview Section 3: Health focus areas Section 4: Infrastructure focus areas Section 5: Data summaries by population Section 6: Technical notes Report overview 5

TOBACCO Report Outline: Detail Section 3: Health focus areas Alcohol and other drug use Chronic disease prevention and management Communicable diseases Environmental and occupational health Healthy growth and development Injury and violence Mental health Nutrition and healthy foods Oral health Physical activity Reproductive and sexual health Tobacco use and exposure Section 4: Infrastructure focus areas Access to health care Report overview 6

TOBACCO Report Outline: Detail Section 5: Data summaries by population  Racial/ethnic minority populations o American Indians o Asians o Blacks o Hispanics  People of lower socioeconomic status  People with disabilities  Lesbian, gay, bisexual, and transgender populations  Geography Report overview 7

TOBACCO Data notes Please refer to the Technical Notes chapter for a more detailed description of limitations and methods: The 95% confidence intervals are denoted by error bars. Where confidence intervals do not overlap, as shown in the example on the right, differences are statistically significant. Larger confidence intervals may indicate less reliable estimates that should be interpreted with caution. Population estimates that are considered unreliable are excluded. Misclassification of racial/ethnic groups may affect the accuracy of rates. Unless otherwise indicated, the Hispanic population may include people of various races; Whites, Blacks, Asians, and American Indians are non- Hispanic. Report overview 8

TOBACCO Factors that influence health Social determinants of health Source: University of Wisconsin Population Health Institute. County Health Rankings 2013, Report overview 9

TOBACCO Healthiest Wisconsin 2020 objectives and indicators Objective 1 By 2020, reduce tobacco use and exposure among youth and young adults by 50%. Objective 1 Indicators Proportion of youth and young adults using tobacco. Proportion of smoke-free homes. Percent of Wisconsin children in smoke-free homes. Source: Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Tobacco Use Focus Area Profile. 10 HW2020 objectives

TOBACCO Healthiest Wisconsin 2020 objectives and indicators Objective 2 By 2020, reduce tobacco use and exposure among the adult population by 25%. Objective 2 Indicators Proportion of adults using tobacco products. Proportion of smoke-free workplaces. Proportion of smoke-free homes. Source: Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Tobacco Use Focus Area Profile. 11 HW2020 objectives

TOBACCO Objective 3 By 2020, decrease the disparity ratio by 50% in tobacco use and exposure among diverse populations Objective 3 Indicators Proportion of adults and youth using tobacco and exposed to tobacco in diverse populations Source: Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Tobacco Use Focus Area Profile, Healthiest Wisconsin 2020 objectives and indicators 12 HW2020 objectives

TOBACCO Rationale Tobacco use continues to create a devastating health and economic burden in Wisconsin. Individuals, families and communities across Wisconsin suffer from the effects of tobacco use and addiction. Smoking causes cancer, heart disease, stroke, and lung diseases. For every person who dies from a smoking-related disease, 20 more people experience at least one serious illness from smoking. On average, smokers die 10 years earlier than nonsmokers. Tobacco use leads to disease and disability and is the leading cause of preventable death. 6 Smoking prevalence and exposure to secondhand smoke remain high among youth and young adults, and among people in low socioeconomic groups (defined by income, education, and type of occupation). By adopting and building on policies and programs that have been proven to work, societal norms, systems, and networks can change and play a significant role in improving health across the life span. Source: Source: Wisconsin Department of Health Services, Healthiest Wisconsin 2020, Tobacco Use Focus Area Profile. 13 Rationale

TOBACCO Key points Youth According to the 2012 Youth Tobacco Survey, smoking rates among high school students in Wisconsin have continued to decline. 11 American Indian youth have the highest rates of current smoking among all racial and ethnic groups. Sexual minority youth, defined as those who have had same-sex sexual contact, have higher rates of tobacco use and exposure. This puts them at risk of tobacco-related health disparities. 14 Key points

TOBACCO Key points Adults Each year, approximately 15% of all deaths in Wisconsin are from illnesses directly related to smoking. Cigarette smoking causes an estimated 79% of all lung cancer deaths and 14% of deaths from cardiovascular disease in Wisconsin. 16 Rates of tobacco use were estimated to be significantly higher among: o Males compared to females; o Adults ages 25-44, compared to those age 45 and older; o American Indians, Blacks, and Hispanics, compared to Whites; o Populations with less formal education and lower incomes; o People with a disability. 15 Key points

TOBACCO Indicator, yearWisconsin rateWisconsin rank Adult cigarette use, %21 st highest of 50 states, Range: 10.6%-28.3% Youth cigarette use, %31 st highest of 44 participating states Range: 5.9% % Per cigarette pack excise tax, 2012 $2.528 th highest of 50 states Range: $ $4.35 Legislation: In 2010, Wisconsin enacted smoke-free workplace legislation One of 33 states with a smoking ban in restaurants, as of 2012 Wisconsin in the National Context Source: CDC State Tobacco Activities Tracking and Evaluation (STATE) System. 16 Context

TOBACCO Tobacco use among youth 17

TOBACCO Initiation of tobacco use among Wisconsin high school students, by race/ethnicity, Tobacco use among youth Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. 18

TOBACCO Tobacco use among Wisconsin high school students, by sexual minority status, Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Tobacco use among youth 19

TOBACCO Use of chewing tobacco and cigars among Wisconsin high school students, by race/ethnicity, Source: Wisconsin Department of Public Instruction, Youth Risk Behavior Survey (YRBS); 2007, 2009, 2011 combined dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Tobacco use among youth 20

TOBACCO Tobacco use and exposure among Wisconsin middle school students, % of middle school students currently use a tobacco product. 17% of middle school students have used a tobacco product in their lifetime: o 6 th grade = 11% o 7 th grade = 19% o 8 th grade = 21% 35% of middle school students live in homes where others smoke. 88% of middle school students believe that smoking tobacco products should never be allowed inside the home. Source: Wisconsin Department of Health Services, Tobacco Prevention and Control Program, Youth Tobacco Survey Tobacco use among youth 21

TOBACCO Tobacco use and exposure among adults 22

TOBACCO Smoking rates among Wisconsin adults, by sex, Tobacco use and exposure among adults Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); combined landline-cell dataset. 23

TOBACCO Smoking rates among Wisconsin adults, by age, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); combined landline-cell dataset. Tobacco use and exposure among adults 24

TOBACCO Age-adjusted rates of smoking among Wisconsin adults, by race/ethnicity, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Tobacco use and exposure among adults 25

TOBACCO Age-adjusted rates of smoking among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Tobacco use and exposure among adults 26

TOBACCO Age-adjusted rates of smoking among Wisconsin adults, by education level, Question asked in years 2009 and Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline only dataset Tobacco use and exposure among adults 27

TOBACCO Smoking among Wisconsin adults, ages 18-64, by disability status, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Tobacco use and exposure among adults 28

TOBACCO Smoking among Wisconsin adults, by sexual orientation, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. 29 Tobacco use and exposure among adults

TOBACCO Rates of secondhand smoke exposure among Wisconsin adults, by race/ethnicity, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: The smoking at work question was only asked in years 2009 and Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Tobacco use and exposure among adults 30

TOBACCO Rates of secondhand smoke exposure among Wisconsin adults, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: The smoking at work question was only asked in 2009 and Tobacco use and exposure among adults 31

TOBACCO Rates of secondhand smoke exposure among Wisconsin adults, by level of urbanization, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: The smoking at work was only asked in 2009 and Tobacco use and exposure among adults 32

TOBACCO Rates of secondhand smoke exposure among Wisconsin adults ages 18-64, by disability status, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Note: The smoking at work was only asked in 2009 and Tobacco use and exposure among adults 33

TOBACCO Rates of secondhand smoke exposure among Wisconsin adults by sexual orientation, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline only dataset Note: The smoking at work was only asked in 2009 and Tobacco use and exposure among adults 34

TOBACCO Estimated prevalence of smoking among Wisconsin adults, by county, Source: Wisconsin Department of Health Services, Division of Public Health, Tobacco Prevention and Control Program, The Burden of Tobacco in Wisconsin, Tobacco use and exposure among adults 35

TOBACCO Tobacco cessation among adults 36

TOBACCO Attempts to quit smoking among adult smokers in Wisconsin, by sex, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); combined landline-cell dataset. Tobacco cessation among adults 37

TOBACCO Attempts to quit smoking among adult smokers in Wisconsin, by age, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); combined landline-cell dataset. Note: Estimates that are unreliable (based on Relative Standard Error or small sample size) are not shown; this means an estimate may not be presented for every population group. Tobacco cessation among adults 38

TOBACCO Attempts to quit smoking among adult smokers in Wisconsin, by household income, Source: Wisconsin Department of Health Services, Behavioral Risk Factor Survey (BRFS); landline-only dataset. Tobacco cessation among adults 39

TOBACCO 1.University of Wisconsin Population Health Institute. County Health Rankings, Center for Urban Population Health. Milwaukee Health Report, LaVeist TA, Gaskin DA, Richard P (2009). The Economic Burden of Health Inequalities in the United States. Joint Center for Political and Economic Studies. Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf Burden%20of%20Health%20Inequalities%20in%20the%20United%20States.pdf 4.Thomas JC, Sage M, Dillenberg J, Guillory VJ (2002). A Code of Ethics for Public Health. Am Journal of Public Health. 92(7):1057– Wisconsin Department of Health Services (DHS). Healthiest Wisconsin CDC. Smoking and Tobacco Use: Fast Facts Centers for Disease Control and Prevention (CDC). State Cigarette Excise Taxes — United States, 2010– CDC. Smoking and Tobacco Use: Smoke-Free Policies Improve Air Quality. r_quality/index.htm r_quality/index.htm References 40 References

TOBACCO 9.CDC. Smoking and Tobacco Use: Youth and Tobacco Use CDC. Current Tobacco Use Among Middle and High School Students, United States, DHS, Tobacco Prevention and Control Program. Middle School Fact Sheet 2012: Wisconsin Youth Tobacco Survey (YTS) National Cancer Institute: Menthol and Tobacco Lee JGL, Griffin GK, Melvin CL (2009). Tobacco use among sexual minorities in the USA, 1987 to May 2007: A systematic review. Tobacco Control, 18, CDC. Smoking and Tobacco Use: Secondhand Smoke Facts. index.htm index.htm 15.DHS, Bringing Everyone Along: A Strategic Plan to Eliminate Tobacco Related Disparities in Wisconsin 16.DHS, Burden of Tobacco in Wisconsin, f%20Tobacco%20Report% pdf f%20Tobacco%20Report% pdf 41 References

TOBACCO Links to additional reports and resources Wisconsin Department of Health Services, Wisconsin Tobacco Prevention and Control Program. The Burden of Tobacco in Wisconsin, 2010 Edition. 20Burden%20of%20Tobacco%20Report% pdf 20Burden%20of%20Tobacco%20Report% pdf Tobacco Related Disparities in Wisconsin. University of Wisconsin Center of Tobacco Research and Intervention. Centers for Disease Control and Prevention (CDC). Smoking and Tobacco Use Links

TOBACCO Contact Randy Glysch Research Scientist Tobacco Prevention and Control Program Bureau of Community Health Promotion Division of Public Health Wisconsin Department of Health Services 43 Contacts