Tobacco Facts. Center for Urban Population Health University of Wisconsin-Milwaukee

Transcription

1 Tobacco Facts Center for Urban Population Health University of Wisconsin-Milwaukee

2 ACKNOWLEDGEMENTS This report was prepared by Karen A. Palmersheim, Ph.D., and Sarah M. Luongo, B.A. Dr. Palmersheim is an epidemiologist and researcher with the University of Wisconsin-Milwaukee, Center for Urban Population Health (CUPH). Ms. Luongo is an associate researcher with CUPH. Support for this report was provided by the Wisconsin Department of Health Services, Division of Public Health, Bureau of Community Health Promotion, Tobacco Prevention and Control Program. The author wishes to thank Randall Glysch for his helpful review of the report. Suggested citation: Palmersheim KA, Luongo SM. Tobacco Facts Milwaukee, WI: University of Wisconsin-Milwaukee, Center for Urban Population Health; 2017.

3 TABLE OF CONTENTS Section A. Tobacco-Related Deaths and Economic Cost... A1 Figure A.1. Age-Adjusted Lung Cancer Mortality Rate, by Sex, Wisconsin, A1 Figure A.2. Age-Adjusted Chronic Obstructive Pulmonary Disease (COPD) Mortality Rate, by Sex, Wisconsin, A2 Section B. Cigarette Consumption and Prices... B1 Table B.1. Number of Cigarette Sales, Statewide and Per Capita, Wisconsin, B1 Figure B.1. Per Capita Cigarette Sales and Cigarette Price, Wisconsin, B1 Table B.2. Cigarette Tax Increases, Wisconsin, B2 Section C. Adult Cigarette and Smokeless Tobacco Use... C1 Figure C.1. Percent of Current Cigarette Smokers, Adults, Wisconsin and the United States, C1 Figure C.2. Cigarette Smoking Status, Overall and by Sex, Adults, Wisconsin, C1 Table C.1. Percent and Number of Current Cigarette Smokers, Adults, Wisconsin, C2 Table C.2. Prevalence of Current Cigarette Smoking, by County, Number of Smokers, and County Rank, Adults, Wisconsin, C3 Figure C.3. Percent of Smokeless Tobacco Users, Overall and by Sex, Adults, Wisconsin, C5 Section D. E-Cigarette Use and Related Attitudes Among Adults... D1 Figure D.1. Prevalence of E-Cigarette Use, by Current Cigarette Smoking Status, Adults, Wisconsin, D1 Table D.1. Reasons for E-Cigarette Use, Adults, Wisconsin, D1 Figure D.2. Perception of Whether E-Cigarettes are Less Harmful Than Regular Cigarettes, Adults, Wisconsin, D2 Section E. Tobacco Use During Pregnancy... E1 Figure E.1. Trends in the Prevalence of Smoking During Pregnancy, Wisconsin and the United States, E1 Figure E.2. Prevalence of Low Birthweight Babies Born to Smoking and Non-Smoking Mothers, Wisconsin, E2 Figure E.3. Low Birthweight Prevalences and Mortality Rates for Babies Born to Smoking and Non-Smoking Mothers, Wisconsin, E3 Section F. Tobacco-Related Disparities Among Adults... F1 Table F.1. Percent of Current Cigarette Smokers, by Select Characteristics, Adults, Wisconsin, F1 Figure F.1. Trends in Current Cigarette Smoking, by Race/Ethnicity, Adults, Wisconsin, , by 3-year Averages... F2 Figure F.2. Percent of Current Cigarette Smokers, by Educational Attainment, Adults, Wisconsin, , by 3-year Averages... F3

4 Section G. Secondhand Smoke Exposure, Rules and Policies on Smoking, and Related Attitudes Among Adults... G1 Figure G.1. Percent of Adults Exposed to Tobacco Smoke in the Home and in Vehicles, Wisconsin, G1 Figure G.2. Rules on Smoking in the Home, Adults, Wisconsin, G2 Table G.1. Policies on Smoking in Multi-Unit Housing, Adults, Wisconsin, G2 Figure G.3. Preferences on Allowing Smoking in Individual Units of Multi-Unit Housing Buildings, Adults, Wisconsin, G3 Table G.2. Public Opinion on the State Law That Prohibits Smoking in Public Places, Adults, Wisconsin, G3 Section H. Youth Tobacco Use... H1 Figure H.1. Current Tobacco Use, by Type of Tobacco Product, Middle School Youth, Wisconsin, H1 Figure H.2. Current Tobacco Use, by Type of Tobacco Product, High School Youth, Wisconsin, H2 Figure H.3. Ever Any Tobacco Use*, Overall, by Sex, by Grade, Middle School Youth, Wisconsin, 2016 H3 Figure H.4. Any Current Tobacco Use*, Overall, by Sex, by Grade, Middle School Youth, Wisconsin, H4 Figure H.5. Ever Any Tobacco Use*, Overall, by Sex, by Grade, High School Youth, Wisconsin, H5 Figure H.6. Any Current Tobacco Use*, Overall, by Sex, by Grade, High School Youth, Wisconsin, H6 Section I. E-Cigarette Use and Related Attitudes Among Youth... I1 Figure I.1. Prevalence of Ever and Current E-Cigarette Use, Middle and High School Youth, Wisconsin, I1 Table I.1. Reasons for E-Cigarette Use, High School Youth, Wisconsin, I1 Figure I.2. Likelihood of Trying E-Cigarettes If They Did Not Contain Flavoring Agents, High School Youth, Wisconsin, I2 Section J. Secondhand Smoke-Related Attitudes, Smoke Exposure, and Rules on Smoking Among Youth... J1 Figure J.1. Percent of Middle and High School Youth Exposed to Tobacco Smoke in the Home and in Vehicles, Wisconsin, J1 Figure J.2. Rules on Smoking in the Home, Middle and High School Youth, Wisconsin, J2 Figure J.3. Rules on Smoking in Vehicles, Middle and High School Youth, Wisconsin, J2 Section K. Mental Health, Adverse Events, and Smoking... K1 Figure K.1. Percent of Current Cigarette Smokers, by Depression Diagnosis, Adults, Wisconsin, K1 Figure K.2. Percent of Current Cigarette Smokers, by Number of Poor Mental Health Days, Adults, Wisconsin, K2

5 Figure K.3. Percent of Current Cigarette Smokers, by Number of Adverse Childhood Events (ACEs), Adults, Wisconsin, K3 Section L. Data Sources... L1

6 Age-Adjusted Mortality Rate (per 100,000) SECTION A. TOBACCO-RELATED DEATHS AND ECONOMIC COST The use of tobacco is the leading preventable cause of death in Wisconsin. Approximately 7,000 Wisconsin residents die annually from smoking related illnesses. The direct health care cost of smoking (e.g., physician visits, hospitalizations, medication, etc.) is estimated at $3.0 billion annually in Wisconsin, with an additional cost of $1.6 billion in lost productivity. Source: Palmersheim KA, Prosser EC. Burden of Tobacco in Wisconsin: 2015 Edition. Milwaukee, WI: University of Wisconsin-Milwaukee, Center for Urban Initiatives and Research; Figure A.1. Age-Adjusted Lung Cancer Mortality* Rate, by Sex, Wisconsin, Male Female * Lung cancer mortality is estimated using data for malignant neoplasm of the trachea, bronchus, and lung. Data: Wisconsin Interactive Statistics on Health A1

7 Age-Adjusted Mortality Rate (per 100,000) Figure A.2. Age-Adjusted Chronic Obstructive Pulmonary Disease (COPD) Mortality* Rate, by Sex, Wisconsin, Male Female * COPD mortality is estimated using data for bronchitis (chronic and unspecified), emphysema, and other chronic lower respiratory diseases. Data: Wisconsin Interactive Statistics on Health Note: Age-adjustment is a process by which the age composition is defined as constant so that differences in age composition can be eliminated from the analysis. This is needed because older populations have higher mortality rates, merely because death rates increase with age. Age-adjusted rates allow for more meaningful comparison of the risk of mortality over time and among groups. A2

8 Packs Per Capita Inflation Adjusted Price Per Pack SECTION B. CIGARETTE CONSUMPTION AND PRICES Table B.1. Number of Cigarette Sales, Statewide and Per Capita, Wisconsin, Year State Tax-Paid Cigarette Sales Annual Per Capita Cigarette Sales million packs 94.1 packs million packs 80.1 packs million packs 70.1 packs million packs 48.2 packs million packs 42.5 packs million packs 41.2 packs million packs 39.8 packs million packs 39.9 packs million packs 39.5 packs Source(s): Wisconsin Department of Revenue; Orzechowski and Walker. The Tax Burden on Tobacco: Historical Compilation. Volume 49. Arlington, VA: Orzechowski and Walker; Figure B.1. Per Capita Cigarette Sales and Cigarette Price, Wisconsin, * 140 Per Capita Sales Price Per Pack $ $8.00 $ $ $ $ $3.00 $ $ $ * Per capita cigarette sales data are available through 2015; Cigarette price data are available through Source(s): Wisconsin Department of Revenue; Orzechowski and Walker. The Tax Burden on Tobacco: Historical Compilation. Volume 49. Arlington, VA: Orzechowski and Walker; B1

9 Table B.2. Cigarette Tax Increases, Wisconsin, Date Amount Per Pack 1939 From $0.00 to 0.03 July 1, 1955 From $0.03 to 0.04 July 1, 1957 From $0.04 to 0.05 September 1, 1961 From $0.05 to 0.06 August 15, 1963 From $0.06 to 0.08 August 1, 1965 From $0.08 to 0.10 September 1, 1969 From $0.10 to 0.14 November 5, 1971 From $0.14 to 0.16 August 1, 1981 From $0.16 to 0.20 May 1, 1982 From $0.20 to 0.25 September 1, 1987 From $0.25 to 0.30 May 1, 1992 From $0.30 to 0.38 September 1, 1995 From $0.38 to 0.44 November 1, 1997 From $0.44 to 0.59 October 1, 2001 From $0.59 to 0.77 January 1, 2008 From $0.77 to 1.77 September 1, 2009 From $1.77 to 2.52 Source(s): Wisconsin Department of Revenue; Orzechowski and Walker. The Tax Burden on Tobacco: Historical Compilation. Volume 49. Arlington, VA: Orzechowski and Walker; B2

10 SECTION C. ADULT CIGARETTE AND SMOKELESS TOBACCO USE Figure C.1. Percent of Current Cigarette Smokers, Adults, Wisconsin and the United States, Wisconsin United States 35% 3 25% 2 15% 17.3% 16.7% 5% * Data collection methodology included the addition of cell phones beginning in 2011; Data from 2011 onward cannot be merged with previous years. Data: Behavioral Risk Factor Survey, Wisconsin and the United States Figure C.2. Cigarette Smoking Status, Overall and by Sex, Adults, Wisconsin, Current (every day) Current (some days) Former Never Overall 11.4% % 56.4% Males % 28.8% 51.4% Females 9.8% 5.1% 23.7% 61.4% Data: Wisconsin Behavioral Risk Factor Survey C1

11 Table C.1. Percent and Number of Current Cigarette Smokers, Adults, Wisconsin, Year Percent Number of Smokers % 899, % 946, % 843, % 850, % 859, % 828, % 954, % 887, % 896, % 945, % 958, % 976, % 948, % 914, % 929, % 897, % 900, , , % 828, % 826, * 21% 918, * 2 879, * 19% 840, * 17% 756, * 17% 759,779 * Data collection methodology included the addition of cell phones beginning in 2011; Data from 2011 onward cannot be merged with previous years. Note: All estimates were rounded to the nearest whole number. Data: Wisconsin Behavioral Risk Factor Survey; Wisconsin Interactive Statistics on Health C2

12 Table C.2. Prevalence of Current Cigarette Smoking, by County, Number of Smokers, and County Rank, Adults, Wisconsin, County Prevalence of 2015 Estimated Number of Rank Adult Smoking Adult Population Adult Smokers (1=lowest %) Adams 19.3% 17,703 3, Ashland ,478 2, Barron ,399 9, Bayfield 14.2% 12,651 1, Brown 16.3% 195,446 31, Buffalo 10.4% 10,734 1,114 2 Burnett ,643 3, Calumet 9.8% 37,918 3,707 1 Chippewa 20.2% 49,156 9, Clark 11.6% 24,706 2,856 3 Columbia 24.2% 44,489 10, Crawford 23.2% 13,282 3, Dane ,401 56, Dodge 22.4% 70,969 15, Door 15.1% 23,428 3, Douglas 22.4% 34,895 7, Dunn 16.5% 34,809 5, Eau Claire 19.3% 79,411 15, Florence 23.3% 3, Fond du Lac 15.4% 80,697 12, Forest 27.2% 7,346 1, Grant 20.5% 40,747 8, Green 12.2% 28,485 3,467 6 Green Lake 17.9% 14,895 2, Iowa ,205 2, Iron 19.6% 5, Jackson 21.9% 16,250 3, Jefferson 16.9% 64,863 10, Juneau 30.5% 21,575 6, Kenosha 22.3% 127,349 28, Kewaunee 13.9% 16,035 2,224 9 La Crosse 18.8% 92,114 17, Lafayette 13.2% 12,571 1,655 8 Langlade 18.1% 15,946 2, Lincoln 24.8% 23,120 5, Manitowoc 19.9% 64,099 12, Marathon 19.1% 103,703 19, Marinette 21.9% 33,442 7, Marquette 24.5% 12,569 3, Menominee 35. 3,104 1, C3

13 County Prevalence of 2015 Estimated Number of Rank Adult Smoking Adult Population Adult Smokers (1=lowest %) Milwaukee 23.6% 722, , Monroe 27.6% 34,282 9, Oconto 16.3% 30,121 4, Oneida 16.4% 29,942 4, Outagamie 16.6% 139,173 23, Ozaukee 11.7% 68,836 8,047 4 Pepin 12. 5, Pierce 14.7% 31,527 4, Polk 15.2% 34,323 5, Portage ,499 10, Price 24.4% 11,571 2, Racine 20.7% 149,904 31, Richland 15.8% 13,754 2, Rock 19.3% 122,528 23, Rusk 21.9% 11,643 2, Saint Croix 12.3% 64,523 7,958 7 Sauk 18.8% 48,708 9, Sawyer 25.4% 13,500 3, Shawano ,913 7, Sheboygan 16.3% 89,411 14, Taylor 19.9% 15,740 3, Trempealeau 24.2% 22,512 5, Vernon 20.7% 22,531 4, Vilas 21.1% 18,098 3, Walworth 20.5% 79,677 16, Washburn 20.9% 12,893 2, Washington 14.2% 103,283 14, Waukesha 15.3% 309,029 47, Waupaca 15.9% 41,747 6, Waushara 30.4% 19,914 6, Winnebago 20.1% 132,391 26, Wood 20.8% 58,650 12, Data: Wisconsin Behavioral Risk Factor Survey; Wisconsin Interactive Statistics on Health C4

14 Figure C.3. Percent of Smokeless Tobacco* Users, Overall and by Sex, Adults, Wisconsin, % 2 15% 5% Ever Use Smokeless Currently Use Smokeless Overall % Males 23.1% 7.2% Females % * Smokeless tobacco includes products such as chewing tobacco, snuff, snus, dip, orbs, sticks, and strips. Data: Wisconsin Behavioral Risk Factor Survey C5

15 SECTION D. E-CIGARETTE USE AND RELATED ATTITUDES AMONG ADULTS Figure D.1. Prevalence of E-Cigarette Use*, by Current Cigarette Smoking Status, Adults, Wisconsin, % 51.1% % 3.7% 12.3% All Respondents Never Smoker Former Smoker Current Smoker (some days) Current Smoker (every day) Data: Wisconsin Behavioral Risk Factor Survey Table D.1. Reasons for E-Cigarette Use, Adults, Wisconsin, 2015 Reason Used E-Cigarettes Percent They re fun 11.6% Like the flavors 35.4% You can use them indoors where you can t smoke other tobacco products 58.4% You can use them at outdoor events where you can t smoke other products 49.5% Help in trying to quit smoking regular tobacco products 64.2% They are less harmful to your health than regular tobacco products 48.9% The vapor is less harmful to the people around you than regular tobacco products 60.2% Data: Wisconsin Behavioral Risk Factor Survey D1

16 Figure D.2. Perception of Whether E-Cigarettes are Less Harmful Than Regular Cigarettes, Adults, Wisconsin, % % Yes No Don't Know Data: Wisconsin Behavioral Risk Factor Survey D2

17 SECTION E. TOBACCO USE DURING PREGNANCY Total Number of Live Births in Wisconsin in 2015: 67,004 Number (Percent) of Wisconsin Women Who Smoked During Pregnancy in 2015: 8,039 (12.1%) Data: Wisconsin Interactive Statistics on Health Figure E.1. Trends in the Prevalence of Smoking During Pregnancy, Wisconsin and the United States, % 22.9% WI US WI 2020 Goal 2 15% 18.4% 12.1% 5% 8.4% Note: Wisconsin data for 1990 through 2010, and U.S. data for 1990 through 2007, were collected using the 1989 U.S. Standard Certificate of Live Birth. Wisconsin and U.S. data for 2011 through 2014 were collected using the 2003 U.S. Standard Certificate of Live Birth. * Because available U.S. data for 2008 through 2010 were collected using the 2003 Standard Certificate of Live Birth, they are not comparable to the Wisconsin data for those years, and thus are not included in this figure. Data: Wisconsin Interactive Statistics on Health; CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) E1

18 Figure E.2. Prevalence of Low Birthweight* Babies Born to Smoking and Non-Smoking Mothers, Wisconsin, % Smoker Non-Smoker 12% 12.1% 8% 6% 6.6% 4% 2% * Low birthweight is defined as weighing less than 2,500 grams (approximately 5.5 pounds) at birth. Data: Wisconsin Interactive Statistics on Health E2

19 Figure E.3. Low Birthweight* Prevalences and Mortality Rates for Babies Born to Smoking and Non- Smoking Mothers, Wisconsin, % 12% 12.3% Low Birthweight Infant Mortality 9.5 8% 6.6% 6% 5.1 4% 2% Smoker Non-Smoker * Low birthweight is defined as weighing less than 2,500 grams (approximately 5.5 pounds) at birth. The infant mortality rate is per 100,000 live births. Data: Wisconsin Interactive Statistics on Health Additional information on factors associated with smoking during pregnancy is available in the following report: Palmersheim KA. Smoking During Pregnancy in Wisconsin: An Update on Trends and Patterns, Milwaukee, WI: University of Wisconsin-Milwaukee, Center for Urban Initiatives and Research; Available from: E3

20 SECTION F. TOBACCO-RELATED DISPARITIES AMONG ADULTS Table F.1. Percent of Current Cigarette Smokers, by Select Characteristics, Adults, Wisconsin, Wisconsin Average Adult Smoking Prevalence : 18.9% Age years 19.1% years 25.7% years 24.4% years 22.1% years 18.6% years 10.6% years 4.1% Gender Male 20.5% Female 17.4% Race/Ethnicity Non-Hispanic White Only 17.9% Non-Hispanic Black Only 33.7% Non-Hispanic American Indian Only 30.6% Non-Hispanic Asian/Pacific Islander Only 13.8% Non-Hispanic Multi-Racial 31.1% Hispanic/Latino 20.6% Educational Attainment (age 25 or older) Less Than High School 36.4% High School Graduate/GED 22.9% Some College 19.2% College Graduate + 7.2% Annual Household Income <$15, % $15,000-$24, % $25,000-$34, $35,000-$49, % $50,000-$74, % $75, % Urban/Rural County of Residence Urban 18.3% Rural 20.2% Sexual Orientation Heterosexual 18.7% Lesbian/Gay/Bisexual 27.4% Data: Wisconsin Behavioral Risk Factor Survey F1

21 Figure F.1. Trends* in Current Cigarette Smoking, by Race/Ethnicity, Adults, Wisconsin, , by 3-Year Averages AI/AN Black Hispanic White Asian/PI * Data are represented using a series of linear regression trendlines. Data: Wisconsin Behavioral Risk Factor Survey F2

22 Figure F.2. Percent of Current Cigarette Smokers, by Educational Attainment, Adults*, Wisconsin, , by 3-Year Averages 5 45% 4 35% 3 25% 2 15% Less than HS HS or GED Some post-hs 4-yr college grad or more 5% * Analysis was limited to adults aged 25 years or older to control for the confounding of age with level of educational attainment. Data collection methodology included the addition of cell phones beginning in 2011; Data from 2011 onward cannot be merged with previous years data were not available at the time of this analysis; sample sizes were sufficient for inclusion in this analysis. Data: Wisconsin Behavioral Risk Factor Survey F3

23 SECTION G. SECONDHAND SMOKE EXPOSURE, RULES AND POLICIES ON SMOKING, AND RELATED ATTITUDES AMONG ADULTS Figure G.1. Percent of Adults Exposed to Tobacco Smoke in the Home* and in Vehicles, Wisconsin, % % 15% 15.3% 9.1% 5% Home Vehicle Either * Smoke exposure in the home was assessed with the following question: Are you exposed to other people s tobacco smoke while you are in your home? Smoke exposure in vehicles was assessed with the following question: During the past seven days, on how many days did you ride in a car with someone who was smoking cigarettes? Data: Wisconsin Behavioral Risk Factor Survey G1

24 Figure G.2. Rules on Smoking in the Home*, Adults, Wisconsin, % % Allowed Anywhere 6.3% Allowed Some Times/Places Not Allowed Anywhere 11.2% No Rules * Rules on smoking in the home were assessed with the following question: Not counting decks, porches, or garages, which statement best describes the rules about smoking in your home: smoking is not allowed anywhere inside your home, smoking is allowed in some places or at some times, smoking is allowed anywhere inside your home, or there are no rules about smoking inside your home? Data: Wisconsin Behavioral Risk Factor Survey Table G.1. Policies on Smoking in Multi-Unit Housing, Adults, Wisconsin, 2015 Is Smoking Prohibited in Your Housing Unit? Prevalence Yes 48.3% No 51.7% Note: This question is only asked of survey respondents who say they live in multi-unit housing buildings. Data: Wisconsin Behavioral Risk Factor Survey G2

25 Figure G.3. Preferences on Allowing Smoking in Individual Units of Multi-Unit Housing Buildings, Adults, Wisconsin, % % 6.5% Allow No Preference Don't Allow Note: This question is only asked of survey respondents who say they live in multi-unit housing buildings. Data: Wisconsin Behavioral Risk Factor Survey Table G.2. Public Opinion on the State Law That Prohibits Smoking in Public Places, Adults, Wisconsin, 2015 Opinion on Law Prevalence Oppose 7.4% Neither Favor Nor Oppose 17.1% Favor 75.5% Data: Wisconsin Behavioral Risk Factor Survey G3

26 SECTION H. YOUTH TOBACCO USE Figure H.1. Current Tobacco Use*, by Type of Tobacco Product, Middle School Youth, Wisconsin, % 12% 8% 6% 4% 2% Cigarettes 12.2% 8.7% 7.7% 5.8% 4.3% 3.9% 2.5% 1.8% 1.3% Cigars 5.9% 4.9% 5.3% 3.7% 3.9% 2.6% 1.6% 1.2% 0.9% Pipes 3.9% 3.2% % 1.7% 1.6% 1.3% 1.4% 0.8% Smokeless Tobacco 3.6% 2.5% 2.2% 1.9% 1.8% 1.8% 1.2% 1.2% 0.6% E-Cigarettes 0.6% 1.4% 2.6% * Current tobacco use for youth was defined as having used the specified tobacco product during the past 30 days: (1) cigarettes (2) cigars, cigarillos, or little cigars (3) tobacco in a pipe (4) chewing tobacco, snuff, or dip (5) electronic cigarettes or e-cigarettes. Data: Wisconsin Youth Tobacco Survey H1

27 Figure H.2. Current Tobacco Use*, by Type of Tobacco Product, High School Youth, Wisconsin, % 3 25% 2 15% 5% Cigarettes 32.9% 27.1% 20.9% 19.9% 20.7% 14.6% % 8.1% Cigars 16.1% 11.5% 11.2% 12.4% 13.2% 14.8% 9.4% 8.9% 6. Pipes 4.7% 2.7% % 4.1% 3.6% 4.9% 5.3% 2.2% Smokeless Tobacco 7.6% 7.3% 7.1% 7.4% % 5.8% 9.7% 4.4% E-Cigarettes 1.9% 7.7% 13.3% * Current tobacco use for youth was defined as having used the specified tobacco product during the past 30 days: (1) cigarettes (2) cigars, cigarillos, or little cigars (3) tobacco in a pipe (4) chewing tobacco, snuff, or dip (5) electronic cigarettes or e-cigarettes. Data: Wisconsin Youth Tobacco Survey H2

28 Figure H.3. Ever Any Tobacco Use*, Overall, by Sex, by Grade, Middle School Youth, Wisconsin, % 16% 14% 13.8% 12% 9.9% 9.8% 9.8% 9.4% 8% 6% 6.3% 4% 2% Overall Females Males 6th 7th 8th * Ever any tobacco use for youth was defined as ever having used any of the following tobacco products: cigarettes, cigars, cigarillos, little cigars, pipes, chewing tobacco, snuff, dip, kreteks, or bidis. Data: Wisconsin Youth Tobacco Survey H3

29 Figure H.4. Any Current Tobacco Use*, Overall, by Sex, by Grade, Middle School Youth, Wisconsin, % 16% 14% 12% 8% 6% 4% 2% 2.1% 2.6% 1.5% 1.4% 1.4% 3.4% Overall Females Males 6th 7th 8th * Any current tobacco use for youth was defined as having used any of the following tobacco during the past 30 days: cigarettes, cigars, cigarillos, little cigars, pipes, chewing tobacco, snuff, dip, kreteks, or bidis. Data: Wisconsin Youth Tobacco Survey H4

30 Figure H.5. Ever Any Tobacco Use*, Overall, by Sex, by Grade, High School Youth, Wisconsin, % 45.9% 4 35% 31.6% % % 25% % 25.4% 15% 5% Overall Females Males 9th 10th 11th 12th * Ever any tobacco use for youth was defined as ever having used any of the following tobacco products: cigarettes, cigars, cigarillos, little cigars, pipes, chewing tobacco, snuff, dip, kreteks, or bidis. Data: Wisconsin Youth Tobacco Survey H5

31 Figure H.6. Any Current Tobacco Use*, Overall, by Sex, by Grade, High School Youth, Wisconsin, % 4 35% 3 25% % 12.5% 8.6% 15.3% 8.4% 8.2% 10.6% 5% Overall Females Males 9th 10th 11th 12th * Any current tobacco use for youth was defined as having used any of the following tobacco during the past 30 days: cigarettes, cigars, cigarillos, little cigars, pipes, chewing tobacco, snuff, dip, kreteks, or bidis. Data: Wisconsin Youth Tobacco Survey Additional information on youth tobacco use in Wisconsin can be found at the following site: H6

32 SECTION I. E-CIGARETTE USE AND RELATED ATTITUDES AMONG YOUTH Figure I.1. Prevalence of Ever* and Current E-Cigarette Use, Middle and High School Youth, Wisconsin, % 3 25% 2 15% 5% HS Ever Use 6.4% 16.3% 28.9% HS Current Use 1.9% 7.7% 13. MS Ever Use 1.6% 3.3% 9.3% MS Current Use 0.6% 1.4% 2.6% * Ever use is defined as ever having used e-cigarettes, even once or twice. Current use is defined as having used e-cigarettes on one or more days during the past the 30 days. Data: Wisconsin Youth Tobacco Survey Table I.1. Reasons for E-Cigarette Use, High School Youth, Wisconsin, 2016 Reason Used E-Cigarettes Percent Friend or family member used them 48.5% To try to quit using tobacco products, such as cigarettes 5.7% They cost less than other tobacco products, such as cigarettes 4.6% Famous people on TV or in movies use them 0.9% They are less harmful than other forms of tobacco, such as cigarettes 20.3% They are available in flavors, such as mint, candy, fruit, or chocolate 25.9% They can be used in areas where other tobacco products, such as cigarettes, are not allowed 4.9% I used them for some other reason 30.3% Data: Wisconsin Youth Tobacco Survey I1

33 Figure I.2. Likelihood of Trying E-Cigarettes If They Did Not Contain Flavoring Agents*, High School Youth, Wisconsin, % % 2 3.2% 8.9% Definitely Yes Probably Yes Probably Not Definitely Not * The impact of flavoring agents on youth s decision to use e-cigarettes was assessed with the following question, which was asked of all respondents, regardless of whether they had ever used e-cigarettes: Electronic cigarettes or e-cigarettes come in lots of flavors such as mint, candy, fruit, and chocolate. Do you think that you would try an electronic cigarette if it did not have any flavor? Data: Wisconsin Youth Tobacco Survey I2

34 SECTION J. SECONDHAND SMOKE-RELATED ATTITUDES, SMOKE EXPOSURE, AND RULES ON SMOKING AMONG YOUTH Ninety-four percent (94%) of middle school students think that breathing smoke from other people s cigarettes or other tobacco products is harmful to one s health. Among middle school students that report being current smokers, 59% think it is harmful. Ninety-two percent (92%) of high school students think that breathing smoke from other people s cigarettes or other tobacco products is harmful to one s health. Among high school students that report being current smokers, 63% think it is harmful. Data: Wisconsin Youth Tobacco Survey Figure J.1. Percent of Middle and High School Youth Exposed to Tobacco Smoke in the Home* and in Vehicles, Wisconsin, % 3 25% 2 15% 5% Home Vehicle Either Middle School 18.3% 19.7% 25.4% High School 20.8% 24.2% 31.3% * Someone smoked tobacco products in the youth s home while they were present during the past 7 days. The youth rode in a vehicle where someone was smoking a tobacco product during the past 7 days. Data: Wisconsin Youth Tobacco Survey J1

35 Figure J.2. Rules on Smoking in the Home*, Middle and High School Youth, Wisconsin, Always Allowed Allowed Some Times/Places Never Allowed Middle School 5.5% 9.5% 85. High School 8.5% 9.7% 81.8% * Rules on smoking in the home were assessed with the following question: Inside your home (not counting decks, garages, or porches), is smoking always allowed, allowed only at some times or in some places, or never allowed? Data: Wisconsin Youth Tobacco Survey Figure J.3. Rules on Smoking in Vehicles*, Middle and High School Youth, Wisconsin, Always Allowed Sometimes Allowed Never Allowed Middle School 9.7% 11.4% 78.9% High School 12.2% 14.8% 73. * Rules on smoking in vehicles were assessed with the following question: In the vehicles that you and family members who live with you own or lease, is smoking always allowed, sometimes allowed, or never allowed? Data: Wisconsin Youth Tobacco Survey J2

36 SECTION K. MENTAL HEALTH, ADVERSE EVENTS, AND SMOKING Figure K.1. Percent of Current Cigarette Smokers, by Depression Diagnosis*, Adults, Wisconsin, % 32.3% 3 25% 2 15% 16.2% 5% Ever Diagnosed With Depression Never Diagnosed With Depression * Ever diagnosed with depression was assessed with the following question: Has a doctor, nurse, or other health professional ever told you that you have a depressive disorder, including depression, major depression, dysthymia, or minor depression? Data: Wisconsin Behavioral Risk Factor Survey K1

37 Figure K.2. Percent of Current Cigarette Smokers, by Number of Poor Mental Health Days*, Adults, Wisconsin, % 35% 3 25% % 15% 5% 0-13 Poor Mental Health Days Poor Mental Health Days * The number of poor mental health days was assessed with the following question: Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good? Data: Wisconsin Behavioral Risk Factor Survey K2

38 Figure K.3. Percent of Current Cigarette Smokers, by Number of Adverse Childhood Events (ACEs)*, Adults, Wisconsin, % % 23.4% % 15% 11.3% 5% 0 ACEs 1 ACEs 2-3 ACEs 4-8 ACEs * The number of adverse childhood events (ACEs) was assessed with a series of 11 questions: All questions refer to the time period before you were 18 years of age. Now looking back, before you were 18 years of age (1) Did you live with anyone who was depressed, mentally ill or suicidal? (2) Did you live with anyone who was a problem drinker or alcoholic? (3) Did you live with anyone who used illegal street drugs or who abused prescription medications? (4) Did you live with anyone who served time or was sentenced to serve time in a prison, jail or other correctional facility? (5) Were your parents separated or divorced? (6) How often did your parents or adults in your home ever slap, hit, kick, punch or beat each other up? (7) How often did a parent or other adult in your home ever hit, beat, kick, or physically hurt you in any way? Do not include spanking. (8) How often did a parent or adult in your home ever swear at you, insult you or put you down? (9) How often did anyone at least 5 years older than you, or an adult, touch you sexually? (10) How often did anyone at least 5 years older than you, or an adult, try to make you touch them sexually? (11) How often did anyone at least 5 years older than you, or an adult, force you to have sex? Data: Wisconsin Behavioral Risk Factor Survey K3

39 SECTION L. DATA SOURCES Behavioral Risk Factor Surveillance System. U.S. adult smoking data are from the national Behavioral Risk Factor Surveillance System (BRFSS). The system is overseen by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Available from: Burden of Tobacco in Wisconsin. Tobacco-related deaths and economic cost data are from the following source: Palmersheim KA, Prosser EC. Burden of Tobacco in Wisconsin: 2015 Edition. Milwaukee, WI: University of Wisconsin-Milwaukee, Center for Urban Initiatives and Research; Available from: The Tax Burden on Tobacco. Per capita cigarette sales data from 1970 through 2014 are from the following source: Orzechowski and Walker. The Tax Burden on Tobacco: Historical Compilation. Volume 49. Arlington, VA: Orzechowski and Walker; Available from: Wisconsin Behavioral Risk Factor Survey. Wisconsin adult tobacco-related data are from the Wisconsin Behavioral Risk Factor Survey (BRFS). The survey is conducted by the Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics. Wisconsin Department of Revenue. The per capita cigarette sales datum from 2015 was calculated using the Wisconsin Department of Revenue s Cigarette and Tobacco Products Revenue Summary Report. Wisconsin Interactive Statistics on Health. Wisconsin population estimates, mortality data, and maternal smoking data are from Wisconsin Interactive Statistics on Health (WISH), which employs multiple sources from protected databases. WISH is developed and maintained by the Wisconsin Department of Health Services, Division of Public Health, Office of Health Informatics. Available from: Wisconsin Youth Tobacco Survey. Wisconsin youth tobacco-related data are from the Wisconsin Youth Tobacco Survey (YTS). The survey is administered by the Wisconsin Department of Health Services, Division of Public Health, Tobacco Prevention and Control Program. WONDER. U.S. maternal smoking data are from multiple published sources and the Centers for Disease Control and Prevention s online databases entitled Wide-Ranging Online Data for Epidemiologic Research (WONDER), available from: For more information on published national maternal data sources, please refer to the Technical Notes section in the following report: Palmersheim KA. Smoking During Pregnancy in Wisconsin: An Update on Trends and Patterns, Milwaukee, WI: University of Wisconsin-Milwaukee, Center for Urban Initiatives and Research; Available from: L1