While Vermont has seen great progress in creating stronger tobacco-free social norms – and reducing smoking prevalence, exposure to secondhand smoke, and health impact of tobacco – we have a long way to go. Groups of Vermonters who have higher rates of smoking and tobacco use experience greater impacts on their health and quality of life.
high priority populations
The Tobacco Control Program reviewed statewide tobacco use data and trends and identified groups with particularly high rates of smoking and tobacco use. We prioritize our efforts to extend services and supports to these two groups:
Low-income adult Vermonters (at or below 250% of the federal poverty level) are significantly more likely to use tobacco (29%) than adults of higher income (10%). Evidence shows that low-income smokers have a strong desire to quit, and are likely to need more help to succeed. Adult Vermonters insured by Medicaid have an especially high smoking rate (32%) compared to adults insured through an employer (10%). The Health Department and Department of Vermont Health Access (DVHA) work together to connect with Medicaid-insured adults and health care providers to increase quit support with patients.
The goals of the Medicaid Tobacco Benefit and Promotion Initiative are to:
- Identify and address barriers to using quit services through provider care and 802Quits
- Promote and reinforce quit support to community and clinical providers
Learn how Vermont’s providers are using clinical codes and receiving reimbursement for counseling: Medicaid Tobacco Benefit Expansion and Promotion Initiative: Summary Evaluation Report
According to the Centers for Disease Control & Prevention, people with mental health disorders who also use other substances smoke at a higher rate, smoke more heavily and die younger – on average five years younger for those with mental illness or substance abuse disorders.
In 2014, 27% of Vermont adults who reported having depression were also current smokers (Vermont Behavioral Risk Factor Surveillance System). Vermonters with mental health or substance abuse disorders are often overlooked for tobacco treatment. The general belief is that tobacco use is a coping tool that, if eliminated, will worsen mental health treatment outcomes. However, studies show that there are considerable health benefits to treating tobacco at the same time, helping to decrease anxiety and improve mental health. Tobacco can serve as a trigger for continuing or relapsing in use of other substances. A large study found that quitting tobacco helps to reduce the likelihood of relapse to alcohol use 1.
Since 2013, we have been working to provide training, technical assistance and improved access to quit resources in mental health and substance abuse treatment facilities. The goals of the Tobacco-Free Mental Health and Substance Abuse Initiative are to:
1. Address the burden of chronic disease and shortened life expectancy among those with mental health disorders who smoke. As a Health Department priority to reduce these disparities, we set grant expectations that create supportive tobacco-free grounds at treatment facilities. Resources, tool kits, templates, free facility signage, training and nicotine replacement therapy are available from 802Quits.org.
2. Support the health and wellness of staff and clients of mental health and substance use disorder treatment facilities. Visit the resources, toolkits, policy and communication templates available on our provider page at 802Quits.org.
- A Culture of Wellness work group has formed that includes leadership and staff from state government and designated agencies, with Dr. Batra, Medical Director of Department of Mental Health:
- Ana’s testimonial below provides an idea of what the successful quit journey can look like.
3. Improve methods for addressing tobacco use within treatment facilities. The Tobacco Control Program underwent an evaluation by its evaluator, JSI, that included key informant interviews with facility staff and directors. The findings have informed improvements in the program’s communications and planning of trainings.
1 Weinberger, A. H., Platt, J., Jiang, B. and Goodwin, R. D. (2015), Cigarette Smoking and Risk of Alcohol Use Relapse Among Adults in Recovery from Alcohol Use Disorders. Alcoholism: Clinical and Experimental Research, 39: 1989–1996. doi: 10.1111/acer.12840
Other Priority groups
We also work to provide services and supports to other groups who are especially vulnerable to the health impacts of smoking or tobacco use, or who have above-average rates of use:
Helping women of all ages, including those who are pregnant, is a state priority. We work with the Maternal and Child Health Division and other partners to support reducing smoking among women. We track our performance and progress using Vital Statistics and Quitline data. Visit the scorecard to see how we are doing.
802Quits offers a special phone-based program to support women who are pregnant and help them tailor their quit journey to meet their needs. Pregnant and new moms who want to quit tobacco use, including e-cigarettes or smokeless tobacco, can benefit from having their own dedicated coach, up to 10 coaching sessions and gift cards sent to them upon completing each one (up to $65). Women who are pregnant or breastfeeding also can use quit medications with approval from their doctor. All of these supports are free with 802Quits
By raising awareness of the dangers of smoking and secondhand smoke exposure while pregnant and with children present, in addition to providing group, online and incentivized phone coaching, women have a greater chance of success.
CounterBalance is a campaign directed towards the tobacco industry’s influence on youth and the damaging impact tobacco use has on community health. The goal of the CounterBalance campaign is to:
- Raise awareness and inspire engagement with reducing youth tobacco use
- Encourage local or state action to reduce the number and placement of tobacco licenses within a community
- Expose tobacco industry strategies to attract young smokers and new tobacco users, including price discounts, flavored products and selling tobacco close to schools.
- There are CounterBalance resources available to use in your community.
Vermonters with disabilities smoke at a higher rate and are less likely to be successful at quitting. It is important for community partners and providers to encourage and assist those with disabilities to quit smoking. We are collaborating with DAIL, the Department of Aging, Disabilities and Independent Living, to create tobacco-related policies that reduce exposure to secondhand smoke and triggers to smoke.
We have worked with the Vermont Refugee Resettlement Program. Together we produced fact sheets in multiple languages (Arabic, Bosnian, French, Nepali, Somali, Spanish, Swahili and Vietnamese) to raise awareness about dangers of smoking in the home, how smoking is harmful, and the risks of using betel nuts and tobacco. There are translated 802Quits postcards, highlighting our free services, available in 10 languages.
Our collaboration sought to increase access to 802Quits Resources among the refugee community. Interpreters are available locally for quit-in person classes and through the Quitline in order to increase access to these services.
From walking in the Pride Parade together to creating a “first” – a LGBTQ quit group that provides peer support with a trained Pride Center staff person, together we seek to raise awareness of tobacco’s harms and reduce over time the high use and chronic disease disparities seen among the LGBTQ community.