Last Updated: October 2023

Authored by Tobacco Control Program

To aid monitoring use of e-cigarettes and electronic vapor products, several questions were added in 2015 to Vermont’s Youth Risk Behavior Surveillance System. The e-vapor products asked about included e-cigarettes, e-cigars, e-pipes and e-hookahs, vape pipes, vaping pens and popular brands like JUUL. While there had been a decrease reported from 2015 to 2017, there was a sharp increase from 12% to 26% from 2017 to 2019. This is attributed to the rise in market share of JUUL which is easy to use and conceal including in school environments.  In 2019, Vermont's vaping rates are similar to the national rate of 27% (National Youth Tobacco Survey). The 2021 VT YRBS was administered in fall 2021 rather than spring 2021, therefore students responding to the survey were younger than in prior years. Age can influence the prevalence estimates for risk behaviors. Caution should be used when interpreting and comparing 2021 to prior years

In addition to examining past 30 day use, the frequency of use is also important to analyze.  Among youth who currently vape, Over four in ten youth (42%) did so 20 or more days in the past 30 while 30% did so every day.  While current use decreased in 2021, ever use of vaping remains high with one-third (33%) of youth ever trying vaping in their lifetime. 

Several youth populations vape at higher rates.  Vaping increases with grade level, with 23% of 12^th grade students currently vaping compared to 9% of 9^th graders.  Female and LGBTQ+ youth vape at higher rates than male and non-LGBTQ+ students. 

E-vapor products are increasingly popular among youth given their wide array of flavors (mint, candy, fruit, alcohol and menthol), design and accessibility through social connections. Vaping among youth is shown to increase risk of smoking in the future. While e-vapor products are often promoted as a safer alternative to traditional cigarettes, which may be the case for adults who fully transition from combustible products, the Surgeon General cautions youth, young adults, those who are pregnant and non tobacco users not to vape. Although e-vapor products do not produce tobacco smoke, they still contain highly addictive nicotine and other potentially harmful chemicals. Testing of some e-cigarette products found the vapor to contain known carcinogens and toxic chemicals (such as formaldehyde and acetaldehyde), as well as potentially toxic metal nanoparticles from the vaporizing mechanism. The health consequences of repeated exposure to these chemicals are not yet clear (National Institute on Drug Abuse, 2016)

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 smoking and other tobacco product use is part of Healthy Vermonters 2020 (the State Health Assessment) that 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. Click here for more information. This indicator is also part of the State Health Improvement Plan (SHIP), a five-year plan 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. 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 Vermont’s quality of life. It will assist 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.

Vermont Agency of Education: The Vermont Agency of Education also funds school-based tobacco prevention activities, including OVX and VKAT, and is committed to raising awareness and reducing youth use of e-cigarettes.

Youth Groups: OVX and VKAT youth are instrumental for educating and engaging decision makers and local stakeholders on the harms of e-cigarettes.

Community Coalitions: Tobacco Prevention Coalitions support OVX and VKAT youth by connecting them to local and statewide policy initiatives, providing them with the resources they need to communicate to decision makers, and creating opportunities for education around the diverse issues surrounding tobacco prevalence in Vermont.

Prevention Works!: A network of community coalition leaders, prevention consultants, service providers and individuals with an interest in and a commitment to, substance misuse prevention across the state of Vermont.  

The CDC's framework for tobacco control includes infrastructure, surveillance, evaluation, youth and young adult education and engagement, media and tobacco treatment services. The CDC publishes best practice guides on youth engagement, tobacco treatment, health equity and strategic partnership. The tobacco control program follows and implements the CDC best practice with assistance from the CDC Office of Smoking or Health, national networks and researchers including at the University of Vermont and Rutgers.

The Vermont program has been acknowledged by the CDC for its youth engagement and empowerment programming, its strong media results, its strategic efforts with Medicaid to address and lower smoking prevalence among its members, and for its successful efforts in using financial incentives for counseling completion on its state Quitline. Vermont also promotes widely its generous and FDA-approved tobacco benefit available through Medicaid and the Quitline.

With one-time funding from the state legislature, the Division of Substance Use and the tobacco program are collaborating on vaping prevention of cannabis and nicotine among youth and young adults. The one-time contribution of $1 million is funding new community and state-level vaping prevention grants, Unhyped media to reach youth about the harms of vaping, surveillance and evaluation. Vaping products can contain high levels of nicotine. Nicotine use poses a serious risk to the developing adolescent brain and can impact attention, learning, and likelihood of addiction.

The Surgeon General Reports also states there are studies showing that non-smoking youth who use e-cigarettes are more likely to try conventional cigarettes in the future than non-smoking youth who do not use e-cigarettes. And among high school students and young adults who use tobacco, more use both e-cigarettes and combustible tobacco products than use e-cigarettes alone.

Preventing tobacco use among youth is critical to ending the tobacco epidemic, reducing likelihood of use of other addictive substances, and decreasing future health care costs.

• Hold annual Prevention Week and Youth Rally to support substance use prevention efforts and to increase awareness of how tobacco advertising, discounting and use in schools impacts youth, teachers and the community. 
• Support interested tobacco coalitions on using zoning, tobacco retail license process and ordinances to reduce youth access and exposure to flavored and other tobacco products including e-cigarettes.
• Continue CounterBalance messaging to educate and engage on flavors used by the industry in e-cigarettes and other tobacco products. Target audience includes parents. 
• Educate communities and stakeholders on the harms of e-cigarettes including exposure to dangerous particulates, toxins and nicotine.
• Limit access to e-cigarettes including online access through collaboration with the Department of Liquor and Lottery and the state Attorney General's Office. 
• Inform on how flavors are used to attract and appeal to youth and young adults. Flavors make the tobacco milder and appear less harmful.

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.