Public Health in the Rockies 2026

In 2025, the Weld County Department of Public Health and Environment conducted its triennial Community Health Survey (CHS) to identify local health trends and inform public health programming. A random, mail-based survey was distributed across Weld County, and 2,802 completed responses were weighted to represent the county population.

Findings revealed an increase in smokeless tobacco/nicotine use and highlighted disparities in tobacco/nicotine use across Weld County. In 2025, 7.5% of residents reported using smokeless tobacco/nicotine products (chew, pouches), double the rate reported in the 2022 CHS. Higher rates of smokeless tobacco/nicotine use were reported among residents aged 18–34 (12.4%) compared to residents aged 35–54 (7.9%) and residents aged 55 and older (3.1%). Additionally, smokeless tobacco/nicotine use among young adults aged 18–34 nearly quadrupled from 3.4% in the 2022 CHS to 12.4% in 2025. Smokeless tobacco/nicotine use among men in Weld County was double the statewide rate reported in the 2024 BRFSS. The survey further identified significantly higher cigarette and e-cigarette use among Hispanic/Latino residents and residents living at or below 138% of the FPL.

These findings directly informed Weld County Tobacco Education and Prevention Program (WCTEPP) strategies and program planning. In response, WCTEPP expanded culturally responsive cessation outreach, increased in-school education efforts focused on emerging nicotine products for ages 9 and older, and developed new initiatives to address alternative-to-suspension needs in school and community settings in partnership with law enforcement, parents/trusted adults, and youth.

This presentation will explore how local survey data was translated into tobacco prevention and cessation programming in Weld County, a community that includes both rural and urban municipalities. Participants will have the opportunity to model an alternative-to-suspension approach in response to local county data trends.

Nicotine use is still the leading preventable contributor to disease and death in the United States. States in the Mountain West share many, but not all, patterns and trends in nicotine use.

This session presents findings from surveys on adult nicotine use conducted by WYSAC in the region, highlighting Colorado's neighbors to the north and south. WYSAC has conducted similar surveys in seven states. We will share how we develop survey instruments tailored to each state's needs, how we field surveys, and how we weight and analyze data to obtain accurate estimates of nicotine-related behaviors and opinions.

Our findings show broadly that:

* Smoking rates have declined while vaping rates have increased, so that vaping now matches or exceeds smoking among adults.
* Young adults, people experiencing poverty, and people with behavioral health challenges are disproportionately likely to vape.
* Poverty and behavioral health are significant predictors of cigarette smoking.
* In New Mexico, most smokers and vapers intend to quit within the next six months. In Wyoming, roughly a third of smokers tried to quit in the last year
* In New Mexico, people living in multi-unit housing are significantly more likely to be exposed to secondhand smoke in their homes.
* Substantial majorities of adults support cigarette tax increases and tax increases on other nicotine products.

We will present maps showing state- and county-level variations and graphs detailing variations across demographics and other population characteristics.

States in the Mountain West share in national trends in nicotine use and behaviors, but also differ in important ways. There are strong associations between social determinants of health and nicotine use and behaviors, but these determinants vary across our region. Placing local data in a regional context enables public health professionals to see both what we share and how we differ.

Background/Purpose: Tobacco use remains a leading preventable cause of disease and death, with persistent disparities among Black/African American individuals, LGBTQ+ individuals, individuals with behavioral or mental health conditions, and individuals receiving healthcare assistance. As Colorado's largest safety-net system, Denver Health serves nearly one in four Denver residents annually. With funding from the Colorado Department of Public Health and Environment's Amendment 35 program, Denver Health partnered with patients and providers to identify barriers and co-design strategies to reduce tobacco treatment disparities among these priority populations.

Methods: We used a participatory mixed-methods design across 12 clinical sites. Data included dot-voting with 275 clinical staff, surveys of 59 patients and 27 providers, four focus groups (n=28), and nine provider interviews. Qualitative data were thematically coded; quantitative data summarized descriptively. Findings were synthesized into candidate interventions, prioritized through clinic engagement, then piloted and integrated into workflows. Evaluation included website analytics, QR-code tracking, EHR-based outreach, and pre/post cessation indicators.

Results: Patients identified stress, withdrawal symptoms, social environments, and low motivation as primary barriers; providers added co-occurring mental health conditions, visit time constraints, and cost. Both groups identified nicotine replacement therapy, pharmacotherapy, and one-on-one counseling as most effective. Qualitative themes emphasized non-judgmental communication, follow-up, and clearer cost information. Over 20 interventions were implemented across five domains: provider and patient education (department lectures, patient stories, formulary tip sheet); patient-facing digital outreach (redesigned Tobacco Cessation website, MyChart campaign, banner, resource link, After-Visit Summary education); reducing stigmatizing language (Words Matter preference list, free-text tracking); clinic-based materials (bilingual posters, Gemba boards); and follow-up workflows (STC and TCC call lists). Monthly website views rose, scheduled cessation appointments increased, and smoking prevalence among priority populations declined.

Implications: Patient-centered, non-judgmental engagement supports cessation. Workflow integration determines uptake. Addressing the structural barriers of cost, access, navigation is essential for equitable outcomes.