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Prevent the harmful use of tobacco across the lifespan

% of middle school students in grades 6 through 8 who used cigarettes, electronic vapor products, cigars, or smokeless tobacco in the past month

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Story Behind the Curve

Updated: May 2024

Author: Tobacco Program, Vermont Department of Health

This indicator, or population measure, is part of our Healthy Vermonters 2030 data set. Read more about how this data helps us understand and improve the well-being of people in Vermont on the Healthy Vermonters 2030 webpage.

Because this data is meant to show how the health of our state changes during the decade from 2020-2030, some indicators may have very few data points for now. Keep checking back to see the progress our public health system and partners are making.

We would like to see the percent of middle school students using tobacco remain at 5% or lower through 2030 and beyond. Vermont has done well to succeed at meeting its target; we now want to join some other states where tobacco use among middle school students is even lower than 5%.

According to the Vermont Youth Risk Behavior Survey in 2021 5% of middle school students in grades 6 through 8 used cigarettes, electronic vapor products, cigars or smokeless tobacco in the past month. This is of particular concern due to the increased risk for lifelong nicotine addiction and adverse health consequences associated with use, in particular use before age 13. These individuals are more likely to become adult tobacco users who are more heavily addicted to nicotine.   

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Reducing tobacco use among youth is a Healthy People 2030 Leading Health Indicator. It is a high priority objective to drive action and results in improving overall health and well-being including healthy aging.

Why Is This Important?

Nicotine is harmful to developing brains, which keeps developing until the age of 25. Nicotine use during adolescence can disrupt the formation of brain circuits that control attention, learning, and susceptibility to addiction. In addition, nicotine use has been associated with mental health symptoms such as depression and anxiety. Tobacco use early in life is associated with increased risk for substance use and premature death. According to the American Heart Association, those who smoke, especially those who started young, are three times more likely to die prematurely. 

Equity and Impact

The Vermont Tobacco Program will continue to support, implement, and assess impact of evidence-based practices in reducing initiation and use of tobacco in addition to secondhand smoke exposure. Policy and mass reach media, in addition to tailored and culturally accessible cessation programs including clinicians' offering counseling and quit medications, are all effective. Policies that protect people from the impacts of tobacco play an important role in establishing greater health equity such as:

  • restrict marketing and sponsorships that target LGBTQ+ and Black, Indigenous and People of Color
  • reduce tobacco industry influence through strategies that ban price promotions and establish content neutral advertising
  • pass smoke-free and clean indoor air laws that protect all Vermonters from secondhand smoke
  • provide effective and culturally tailored, accessible cessation services.

Other strategies include sensitivity training of community and medical providers who can serve as trusted touch points for asking about and/or treating tobacco use.

How We Can Improve

The Vermont Tobacco Program currently implements population level approaches aimed at reducing the toll of tobacco use among youth. The program uses a third party evaluator, Professional Data Analysts, to assess its processes, progress and outcomes, and to receive recommendations for quality improvement.

Community Grantees: Tobacco-funded grantees create yearly work plans with population level approaches aimed at reducing the toll of tobacco use and the impact of tobacco advertising and marketing on youth.

Youth Groups: Our Voices Xposed (OVX) and Vermont Kids Against Tobacco (VKAT) are based on the Positive Youth Development framework that recognizes the individual strengths of Vermont youth and provides supports to prepare young leaders. Both these programs seek to empower youth around the state through focusing on the whole-person health impacts of commercial tobacco use and education on the industry's web of influence. This effort is in collaboration with the Agency of Education, Vermont Afterschool, Outright and other local and regional organizations. Together, youth work to educate their school peers, community members and local and state decision makers on the manipulative and deceptive marketing tactics tobacco and vape companies use to target youth.

Local Decision Makers: Select boards, boards of trustees, town officers, and town planners have the authority to enact, incorporate or include best practices and implement policies.

Offices of Local Health: Provide health services and promote wellness for all Vermonters.

Residents: Tobacco policy progress benefits from the participation of concerned residents who can help create the understanding, support and movement for protective policies. Often policy advancement is aided when there is a groundswell of support and demand from local residents. Community grantees educate residents and decision makers to create demand for change.

Notes on Methodology

The Youth Risk Behavior Survey (YRBS) is a national survey funded by the Centers for Disease Control and Prevention and many Vermont partners. It is administered every other year (odd years) through the public school system. The YRBS is a major source of information about youth health related behaviors that may contribute to leading causes of death and disability as adults.

Due to the COVID-19 pandemic and a delayed administration period, caution should be used when interpreting and comparing the 2021 results to other years. There are a couple of significant differences from previous years:

  • Survey data was collected during a period when schools and students were still significantly impacted by the ongoing challenges of the COVID-19 pandemic. This context has likely influenced the responses and behaviors captured in the survey.
  • Survey was conducted in the fall of 2021, deviating from its usual timing in the spring. As a result, the age of the surveyed students is approximately six months younger than in previous years. This age difference can potentially impact the trends and comparisons drawn from the data. 

Students who participated in the 2021 YRBS may have had a different educational and social experience compared to previous participants. Disruptions, including remote learning, lack of social interactions and extracurricular activities, are likely reflected in the survey results.


Caution should be used when interpreting and comparing the 2021 results to other years. For more information on the delayed administration and how it may have impacted the 2021 results, please see "YRBS Special Considerations for 2021".

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