Last Updated: September 2022

Author: Tobacco Control Program, Vermont Department of Health

Annual investment in comprehensive tobacco control is instrumental for reducing the deaths and disease burden caused by tobacco: 1,000 smoking attributable deaths in Vermont each year. A well-funded tobacco control program is cited in CDC's 2014 Best Practices for Comprehensive Tobacco Control Programs as a strategy to reduce the state's smoking prevalence. State Tobacco Control Programs have documented return on investments of between 2:1 (cardiovascular hospital admissions among Medicaid population in Massachusetts over a three-year period) and 50:1 (health care costs in California over a 10-year period).

The Centers for Disease Control and Prevention (CDC) published in the 2014 Guide both minimum and recommended funding levels for each of the fifty states it funds to reduce and prevent tobacco use and burden. For Vermont, the minimum level for a comprehensive program is $6.1 million while the recommended amount is $8.4 million. Vermont is funded at 45% of recommended level. Through the efforts of the Vermont Legislature, the state's leadership, the former Vermont Tobacco Evaluation and Review Board and the Coalition for a Tobacco-free Vermont, Vermont's program has been awarded funds from several sources including the Tobacco Master Settlement Agreement (MSA) and Global Commitment which helps achieve a funding level and impact that is higher than if solely reliant on federal funds.

The Vermont Tobacco Control Program’s funding has remained steady over the past several years at approximately $3.6 million and increased in July of 2020 to $3.8 million through a new CDC award for 2020-2025. In 2018 the state legislature temporarily boosted the Tobacco Control Program's capacity to address the emerging issue of e-cigarettes use and flavors by allocating $1 million of the 2004-2012 MSA settlement fund to the program. These funds have been instrumental in starting a youth campaign, "Unhyped", to increase perception of harm of e-cigarettes, enhance services to adults seeking to quit smoking, and support online youth enforcement checks performed by the Department of Liquor and Lottery. 

The state has continued its investment in tobacco control and prevention at a maintenance level, which the Department's tobacco program uses to tackle the vaping epidemic among youth, serve thousands of Vermonters with free cessation information and assistance, equip partners and 12 community grantees to reach vulnerable populations with tobacco education and resources, and strive for reducing exposure to dangerous secondhand smoke. However, the Tobacco Program is not as impactful as it could be if it were funded at the recommended minimum level by the CDC.

Coalition for Tobacco-Free Vermont: Through advocacy and engagement, promotes and assists in the implementation of policies and programs at the state and local levels to reduce tobacco use and its impact on the health and economic wellbeing of Vermonters.

Department of Liquor and Lottery: The Vermont Department of Liquor & Lottery provides a regulatory framework for the responsible sale and consumption of alcohol, tobacco, and gaming entertainment, ensuring public safety and contributing 100% of profits to Vermont communities through the General and Education funds. The DLL conducts annual youth enforcement checks and retail audits.

Vermont Department of Health Access: As the department that oversees the benefits provided to Vermonters served by Medicaid insurance, DVHA partners with the VTCP on the tobacco benefit and its utilization by providers and beneficiaries.

Centers for Disease Control and Prevention Office of Smoking and Health (OSH): is the lead federal agency for comprehensive tobacco prevention and control. OSH is a division within the National Center for Chronic Disease Prevention and Health Promotion, and funds each state and US territories for tobacco control and prevention activities.

As stated by the CDC in the 2014 Best Practices Guide, the primary objectives of the recommended statewide comprehensive tobacco control program are to reduce tobacco use and the individual and societal burden of tobacco-related disease and death. Research indicates that the more a state spends on comprehensive tobacco programs, the greater the reductions in smoking. It is also found that the longer a States invests, the greater the impact and the more quickly it can be seen. Over the past ten years, the program and partners, with the commitment of leadership and the legislature, has reduced adult smoking from 20 percent to 14 percent (BRFSS 2020) and youth smoking from 18 percent to 7 percent (YRBS 2019). Unfortunately, during this same time period we have seen the rate of youth vaping increase dramatically from 15 percent to 26 percent (YRBS 2019). 

In FY2023 the Tobacco Program will:

• Implement several financial incentives for completion of counseling sessions available through the 802Quits program. Incentives and tailored protocols are offered for Medicaid members, those who are pregnant, Vermonters with mental health conditions and those that use menthol products.
• Fund and promote the youth tobacco cessation text-based program, My Life My Quit. 
• Complete and disseminate the Retail Audit report and dashboard that highlights disparities seen in tobacco access and retailer density around schools using the 2014, 2017-2018, and the new 2022 audit data compiled by the Department of Liquor and Lottery.
• Coordinate strategies including mass reach and digital media, public education and policy to address the vaping epidemic among middle and high school youth.
• Field the Adult Tobacco Survey to understand attitudes and behaviors of Vermonters and use the results to inform tobacco control strategies.
• Fund 12 community coalitions who work at the local level to support policy efforts and school wellness; educate on emerging tobacco control issues; advance smoke- and tobacco-free spaces (parks, downtowns, around municipal buildings), link clinics with 802Quits and promote cessation services.
• Coordinate middle and high school youth groups, VKAT and OVX, across the state. Fund partners working to increase youth and young adult assets and inclusivity including with Vermont Afterschool and Outright Vermont. 
• Disseminate data on trends seen in youth and adult tobacco use and the best strategies to improve Vermonter’s health and cost savings. Discuss with partners and at meetings how a well-funded program contributes to desired economic and public health outcomes including community education and engagement, clinic-based tobacco treatment, clinician and community referrals to Vermont’s suite of free services at 802Quits, and mass reach media to educate and encourage quitting.