Updated: September 2023

Author: Tobacco Control Program, Vermont Department of Health

The smoking rate in Vermont increased during the pandemic response. Adult smoking prevalence in Vermont had significantly decreased from 18% in 2016 to 14% in 2020, which had been the lowest rate in the past decade. The increase in smoking is concerning for Vermonter's health and the costs to healthcare.

In the last 20 years in Vermont, there has been a gradual decline in smoking from a high of 24% in 1996. Historically, compared to national rates, Vermont shows a significantly higher smoking rate among racial/ethnic minorities; Vermonters who make less than $25,000 in annual income; and those who have less than a high school degree (Tobacco Use Among Adults and Youth in Vermont and United States). Vermont is one of the most rural states in the nation; research shows that tobacco use is higher among rural populations along with youth and pregnant women. 

Vermont has a robust and long history in tobacco control and prevention and offers a comprehensive suite of cessation services through the 802Quits program. In 1987 Vermont was the first state to implement a smoke-free workplace law, and in 1995 Vermont public schools became smoke-free. In 2001 Vermont established a comprehensive Tobacco Control Program and the Vermont Tobacco Evaluation and Review Board, both funded by the Master Settlement Agreement dollars. The State also began offering an evidence-based state Quitline that is accessible and staffed by trained counselors. The program also implemented counter marketing to raise awareness about the dangers of tobacco and resources to quit. The comprehensive approach of the program expanded to include collaboration with Medicaid and the Blueprint for Health, Quit Online and text services, and mass reach media to provide motivation to quit.   

Vermont has made significant progress in passing policies that protect from hazardous secondhand smoke, reduce youth access and contribute to people quitting. For many years the Vermont Tobacco Evaluation and Review Board (VTERB) guided policymaking to strengthen protections for Vermonters from the morbidity and mortality caused by tobacco. VTERB was disbanded in 2019 and in its place is the Substance Misuse Prevention Council which operates as an advisory body to VDH. In 2012 VTERB worked on establishing price parity among cigarettes and other tobacco products which helps to prevent consumers switching to another harmful product when the price of cigarettes is increased, and updated to include tobacco substitutes now considered tobacco products and taxed at 92% wholesale price as of July 1, 2019. Other protective policies passed in the past several years include restricting smoking in cars when children under the age of 8 are present; restricting use of e-cigarettes where lit tobacco products are not allowed; requiring all tobacco products be safely stored behind the counter or in a locked case, and increasing the legal age to purchase tobacco products to 21 in addition to restricting online purchase of vaping products to only those with a wholesale license.  

Tobacco use is the #1 preventable cause of death. In Vermont, smoking costs approximately $348 million in medical expenses and results in an estimated 1,000 smoking-related deaths each year. 10,000 kids now under 18 and alive in Vermont will ultimately die prematurely from smoking. Countless other lives, including those of friends and family members, are impacted by the negative effects of tobacco use and secondhand smoke exposure. Reducing tobacco use and the chronic disease and mortality it causes is one of Center for Disease Control and Prevention (CDC) Winnable Battles.

Partners include:

• National Jewish Health: The program's contractor which provides the state's Quitline and Quit Online in English, Spanish and other languages per translation services, financial incentives to reward completion of counseling sessions, and text messaging support.
• Department Vermont Health Access: The Vermont Medicaid office collaborates with the program on expanding and promoting the tobacco treatment benefits. The Medicaid tobacco benefit includes brief or intermediate one-on-one and group counseling and approved nicotine replacement therapies that when combined with counseling greatly increases the likelihood of a successful quit.
• Blueprint for Health: In collaboration with VDH's My Healthy Vermont, group cessation classes are offered in person and online through a network of regional coordinators and tobacco treatment specialists. Group cessation offers peer support and lifestyle modifications that can help with staying quit and improving overall health. To enroll in a class visit Home - MyHealthyVT. 
• Substance Misuse Prevention Council (SMPC): A Governor appointed board dedicated to a statewide comprehensive and coordinated approach to prevention of all substances to improve the health and well-being of Vermonters.
• Coalition for Tobacco-free Vermont: A statewide coalition comprised of members of health voluntary organizations (Lung, Cancer, Heart) and community tobacco coalitions. The Coalition works to advance strong tobacco control and prevention policies to create a Tobacco-free Vermont.

Population-wide interventions that change societal environments and norms related to tobacco use - including increases in the unit price of tobacco products, comprehensive smoke-free policies, restrictions on flavors, and hard-hitting media campaigns - increase tobacco cessation by motivating tobacco users to quit and making it easier for them to do so. Center for Disease Control and Prevention (CDC) Best Practices for Tobacco Control Programs delivers four specific recommendations for promoting quitting, addressing tobacco use among adults and shifting to tobacco-free social norms:

• promote health systems change
• expand insurance coverage and utilization of insurance coverage
• support state Quitline capacity
• pass state and local policies that influence and support behavior change.

Vermont’s Tobacco Control Program implements these strategies within the current funding granted by the CDC and the State of Vermont. The program is working to expand its efforts and efficacy in its health systems engagement with other insurers to complement the accomplishments it has realized for expanding and promoting tobacco benefits in Medicaid. In working with Medicaid, CPT codes were turned on in January 2014 allowing medical practitioners and other providers to bill for reimbursement of cessation counseling services. Through this effort that contributed to reducing smoking prevalence among Medicaid members, an estimated $12 million was saved in the state's Medicaid budget in 2019. 

In the recent past the tobacco program has been working to expand the use of financial incentives to support priority populations in quitting. In collaboration with Office of Local Health and Rutland Regional Medical Center a pilot was completed using incentives that assisted 20 women in reducing or quitting smoking. The tobacco program now offers a financial incentives and protocols that are tailored to meet Vermonters' needs including those who use menthol, are Medicaid members, are uninsured, have depression or other mental health diagnoses in addition to being pregnant. For more information visit: SUPPORT FOR ME - 802Quits. 

Airing mass reach media is also an important component of the comprehensive program that effectively reaches smokers and encourages them to contemplate and/or take action steps towards quitting.

The Tobacco Control Program implements CDC's comprehensive framework for prevention and control of all tobacco products. In collaboration with prevention coalitions and partners, evidence based initiatives and methodologies are implemented to prevent initiation and use of tobacco and reduce the harmful effects of secondhand smoke exposure. The program uses strategies from the CDC Best Practice Guides including for health equity. Additionally, the program is collaborating with the VDH health equity leads and its chronic disease partners. The program funds third-party evaluation to assess its progress and make recommendations for improvement and relies on surveillance data to inform decisionmaking.

Lastly, funding of community grantees is key. Community tobacco coalitions are knowledgeable in educating on tobacco harms and engaging stakeholders and decisionmakers on why it is important to restrict access to tobacco and to increase the number and type of tobacco-free environments. Successes include smoke and tobacco-free college and hospital campuses, parks, beaches, and community gathering spots across Vermont.

Similar to statewide efforts, local partners are using data to drive local strategy. For regional data on Tobacco indicators, check out our Public Health Data Explorer.

The Behavioral Risk Factor Surveillance Survey (BRFSS) data is collected annually and is updated as it becomes available (timing may vary).

This data comes from adults who have smoked more than 100 lifetime cigarettes and responded either 'everyday' or 'some days' to the question: "Do you now smoke cigarettes everyday, some days, or not at all?" 

This indicator is age-adjusted to the 2000 U.S. standard population. In U.S. data, age adjustment is used for comparison of regions with varying age breakdowns. In order to remain consistent with the methods of comparison at a national level, some statistics in Vermont were age adjusted. In cases where age adjustment was noted as being part of the statistical analysis, the estimates were adjusted based on the proportional age breakdowns of the U.S. population in 2000. For more detailed information on age adjustment see the CDC Statistical Notes on age adjustment.

Due to BRFSS weighting methodology changes beginning in 2011, comparisons between data collected in 2011 and later and that from 2010 and earlier should be made with caution. Differences between data from 2011 forward and earlier years may be due to methodological changes, rather than changes in opinion or behavior.

For more information on the BRFSS survey, visit the Vermont Department of Health's BRFSS page.