SHERIDAN — Smoking killed 212 people with lung cancer in Wyoming in 2014. While the population of Wyoming smokers decreased significantly from 2003 to 2016, the state still recorded $258 million in 2017 annual health care costs in Wyoming directly caused by smoking.

Medicaid costs caused by smoking in Wyoming totaled $44.8 million in 2016, while tax revenues totaled almost $20 million in the state.

“That’s (around) $20 million that could be going to schools,” said Wendy Ongaro, executive director at the Sheridan Health Center.

Fifty-three percent of Sheridan Health Center patients smoke. That translates to about 265 people in Sheridan County. Most of the patients come to the Sheridan Health Center to receive treatment to end their addictions.

Ongaro provides cessation from smoking for her patients by switching long-term smokers to non-flavored e-cigarettes to help begin the process. Ongaro said switching long-term smokers to e-cigarettes helps reduce the amount of emphysema attacks a smoker suffers, but still might not be the best option available.

“The jury is out in terms of doing that,” Ongaro said. “It’s a common practice in the UK and Europe as a harm reduction move for people who are long-term smokers.”

Flavored e-cigarettes prove equally, if not more, harmful and may cause popcorn lung due to the presence of polypropylene.

Ongaro works with a medication donation program out of Cheyenne to provide patients looking to quit with tobacco gum, lozenges and patches and prescription medications like Chantix and Vyvance. Chantix is the most effective, but expensive, costing $300 per month versus Vyvance at $30 per month. Ongaro said Vyvance serves as a happy medium between Chantix and the other tobacco products.

Despite a wide array of options for those wishing to end their smoking addictions, Ongaro said it’s still really hard to quit.

“It’s one of the hardest things as a provider that I ask people to do,” Ongaro said.

The Sheridan Health Center works with clients 18 to 64 years of age. Ongaro said many of her clients’ parents started them on smoking at young ages, which proves the most vulnerable time for people to become addicted. She worries that tobacco companies, especially e-cigarette products, appeal to a younger demographic and become a gateway to lifelong cigarette use.

“Tobacco is addictive whether you smoke it in a cigarette or pipe or an e-cigarette,” she said. “It’s addictive. It’s just the nature of the beast.”

Smoking percentages have decreased in Wyoming over time, and health organizations continue to see a culture shift within the state’s communities. The Wyoming Department of Health reported smokers making up 18.9 percent of Wyoming’s population in 2016, according to Behavior Risk Factor Surveillance System results. That compares to 24.6 percent in 2003. Among adults, 24.3 percent had tried e-cigarettes while 5.5 percent use them currently.

Ongaro observed more Sheridan businesses becoming smoke-free establishments voluntarily.

“I think that’s a good thing because cigarette smoke doesn’t just affect smokers, it also has a significant impact on staff in restaurants, such as bartenders, waiters and waitresses,” Ongaro said.

While everyone maintains the option to continue smoking outdoors and in some establishments in Sheridan, a manager at the Wyoming Department of Health warns of smoking’s harmful links to detrimental health conditions.

“Smoking’s harmful link to health conditions such as cancer, chronic obstructive pulmonary disease, heart disease and dental issues is well established,” said Joe Grandpre, chronic disease and maternal and child health epidemiology unit manager with WDH.

After years of research linking smoking to deaths, Wyoming still loses people to the addiction for a petering revenue stream. Sheridan Health Center made more referrals than any other clinic in the state in 2016, and Ongaro will continue with her cessation efforts to help preserve Sheridan’s population.