Updated: February 2023

Author: Tobacco Control Program, Department of Health

Due to increasing costs for fielding the Adult Tobacco Survey and the public health response to COVID-19, there has been a lack of data collection for this measure.

However, this is a key indicator for the performance dashboard because of the need to understand how many adult Vermonters are using one or more tobacco products. In 2022 the Tobacco Control Program's analyst fielded a request for proposals and received a successful bid. A new Adult Tobacco Survey Report will be published in 2023 which will be used to update this indicator.

In 2012, 12% of adults used smokeless or other tobacco products. In 2014 and again in 2016, the rate was 11% which was not a significant decrease from 2012. Our target was to reach 9% or lower by 2020. 

Examples of smokeless and other tobacco products include chewing tobacco, snuff, snus, cigar products and e-cigarettes, defined as tobacco substitutes in Vermont statute. Adult smokers are much more likely to use smokeless and other tobacco products than non-smokers. For example, in 2016 among adult smokers, 13% used e-cigarettes compared to 3% of non-smokers. In 2014, 15% of adult smokers reported using e-cigarettes compared to 1% of non-smokers.

In the 2016 Adult Tobacco Survey Report, among tobacco products other than cigarettes, cigar products (6%) and electronic cigarettes, commonly referred to as e-cigarettes (4%), are the most commonly used. Two percent of Vermont adults use smokeless tobacco or another form of tobacco product other than cigarettes. Overall, 11% of Vermont adults use at least one non-cigarette tobacco product. The prevalence of OTP use is significantly higher among current smokers than non-smokers. This is especially evident for cigar product and e-cigarette use.

There was a notable increase in the perceived harm of electronic cigarettes from 2014 to 2016. In 2016, 63% of Vermont adults believe that e-cigarettes are very or somewhat harmful to one's health. This is significantly more than the 52% who perceived e-cigarettes to be very or somewhat harmful in 2014. This change mostly occurred among Vermont adults who did not have an opinion or were not sure about the harm of e-cigarettes in 2014. There was no significant difference in the use of e-cigarettes from 2014 to 2016.

Vermont males are significantly more likely than females to report use of smokeless tobacco. Young adults in Vermont, those between 18 to 24-year-old, report significantly higher rates compared to their counterparts in the U.S. Adult use of smokeless tobacco in Vermont decreases with age, with those 45 and older less likely to report use than those 18-24 years old. Smokeless tobacco use is also lower among those with higher levels of education.

Smokeless tobacco is associated with gum disease, tooth decay and tooth loss and like cigarettes can lead to nicotine addiction. Use of smokeless tobacco can cause cancers of the mouth, esophagus, and the pancreas, increases the risk for early delivery and stillbirth when used during pregnancy, and may increase the risk for death from heart disease and stroke. See more from the CDC on Smokeless Tobacco Health Effects. Cigar smoke contains more cancer-causing chemicals, including tar, than cigarettes and is possibly more toxic. Read more from the National Cancer Institute. Given their larger size they can also cause overall higher exposure time to toxins. E-cigarettes are recognized as containing fewer toxic chemicals than cigarettes but they emit particulates, some of which may be harmful. Read more from the CDC about the health effects of multiple forms of tobacco. E-cigarettes often contain nicotine and are not recognized as a proven cessation device by the U.S. Food and Drug Administration (FDA).

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 CDC's Winnable Battles.

Reducing tobacco use is part of Healthy Vermonters 2020 which documents the health status of Vermonters at the start of the decade and the population health indicators and goals that will guide the work of public health through 2020. This indicator is also part of the State Health Improvement Plan (SHIP) that prioritizes broad Healthy Vermonters 2020 goals: reducing prevalence of chronic disease, reducing prevalence of substance abuse and mental illness, and improving childhood immunizations. The SHIP is a subset of HV2020 and details strategies and planned interventions. Read more about Department of Health Plans and Reports. 

The Agency of Human Services (AHS) operates in support of the Governor’s overall agenda for the State and his seven statewide priorities. Additionally, AHS’ mission and the work of its six Departments are targeted to achieve results in four strategic areas: the reduction of the lasting impacts of poverty; promotion of the health, wellbeing and safety of communities; enhancement of program effectiveness and accountability; and reform of the health system. Click here for more information.

Act 186 was passed by the Vermont Legislature in 2014 to quantify how well State government is working to achieve the population-level outcomes the Legislature sets for Vermonters’ quality of life. Act 186 assists the Legislature in determining how best to invest taxpayer dollars. The Vermont Department of Health and the Agency of Human Services report this information annually. Click here for more information.

• National Jewish Health- The program's Quitline contractor provides phone and online services to help Vermonters quit tobacco use including smokeless and other tobacco products.
• Department Vermont Health Access: The Vermont Medicaid office collaborates with the Tobacco Program on expanding and promoting the cessation benefit available through providers and 802Quits for Medicaid beneficiaries.
• CDC's Tips from Former Smokers: The Tobacco Program uses CDC’s broadcast and other resources in mass-reach health communications to educate on the dangers of tobacco use and to motivate users to seek cessation help.
• Vermont Substance Misuse Prevention Council: A governor appointed board that oversees and guides the state’s substance use prevention efforts and builds upon previous efforts of the Vermont Tobacco Evaluation and Review Board.
• Stakeholders instrumental in creating the Tobacco Control Plan 2015-2020.
• Coalition for Tobacco-free Vermont and VDH-funded tobacco community coalitions educate legislators and other stakeholders about the need for and value of tobacco control and prevention efforts.

CDC Best Practices for Comprehensive Tobacco Control Programs gives three specific recommendations for promoting quitting and addressing tobacco use among adults:

• promote health systems change,
• expand insurance coverage and utilization of insurance coverage, and,
• support state Quitline capacity.

Vermont’s Tobacco Control Program implements these strategies with the funding granted by the CDC and the State of Vermont. The program works to ensure that comprehensive and accessible benefits are available for Vermonters seeking to quit tobacco, including cigarettes, smokeless and e-cigarettes. Through engaging insurers, providers and systems of care on the importance of treating tobacco as an addiction and the efficacy of offering treatment and nicotine replacement therapies (NRT), Vermonters are supported in their quit journey.

The Tobacco Program seeks to expand and promote tobacco benefits in Medicaid given the higher tobacco use and chronic disease burden of its enrollees. VDH and Medicaid work closely together to make treatment even more accessible and effective in-clinic and through the state’s Quitline, Online and Quit Partners resources found through 802Quits. CPT codes were turned on in January 2014 allowing Medicaid providers to bill for reimbursement of tobacco treatment services. Two mailings have been sent to Medicaid beneficiaries as well to promote the free tobacco cessation resources available. The mailings resulted in increases of Quit Tool Kit orders that contain stress reliever tools to assist with quit success.

The health systems work of a CDC-funded tobacco program includes advocating for including comprehensive benefits including incentives. Tobacco is included as a payment measure in Vermont’s health care reform efforts, most recently in the All Payer Model. The Program has been working on supporting more accessible and mobile-friendly cessation resources on 802Quits for providers and care teams and individuals seeking help. Free text, peer support and free NRT are available. The program also offers additional support during and after pregnancy that includes gift cards for completion of counseling sessions. Moreover, airing mass reach media is an important component of the comprehensive program that effectively reaches tobacco users including smokeless and encourages them to contemplate and/or take action steps towards quitting.

The Tobacco Control Program is implementing initiatives and methodologies to reach, treat, and assess our progress in reducing tobacco use among adults, including those who use smokeless and other tobacco products.

• A multi-year initiative to create healthier environments in behavioral health centers that receive state funding. Research shows positive outcomes by including tobacco into treatment for mental health and co-occurring substance use disorders. Most state-funded mental health and substance use treatment facilities are tobacco-free or are working toward becoming one. In 2023 the Tobacco Control Program is supplying technical assistance, is granting with Clara Martin to build and implement capacity to treat tobacco onsite, is working with Vermont Care Partners on collecting screening and treatment data, and is hosting quarterly meetings to discuss community and state efforts to reduce the harm tobacco use causes to the mental health population. 

• The Tobacco Control Program's Tobacco Cessation Coordinator engages with clinics, dental hygienists, grantees and partners on health care systems referring their patients to our Quitline including fax and electronic methods. Referring sources receive feedback on their patients' status.

• The Program facilitates quarterly meetings with the Department of Liquor and Lottery, Attorney General's Office, Agency of Education and Health Department to discuss strategies and interventions aimed to reduce youth and young adult access and exposure to tobacco products, including electronic vaping products.

• The Tobacco Control Program publishes an annual report to share the challenges and successes for the fiscal year. To receive a copy of the report, email the program at tobaccovt@vermont.gov. 

Data is updated as it becomes available and timing may vary by data source. For more information about this indicator, click here.

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. 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 visit /www.cdc.gov/nchs/data/statnt/statnt20.pdf.

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.