August 2023

Tobacco use is the number one preventable cause of death, and in Vermont, results in about 1,000 smoking-related deaths each year, totaling approximately $404 million in annual healthcare costs.  The rate of smoking in the LGBTQ+ community has declined from 27% in 2016 to 17% in 2021 according to the 2021 Behavioral Risk Factor Surveillance Survey Report (LGBT was previously only asked, but has no been expanded to LGBTQ+). The Vermont Tobacco Program has set a goal of maintaining the reduced rate of 17% through 2023.

After many years of higher smoking rates in the LGBT community, previous work has paid off, and the smoking rate is similar to the smoking rate of the general population in Vermont (16%, 2021). While there are many factors cited for higher tobacco use include bullying, social isolation and aggressive marketing tactics used by the tobacco industry (www.truthinitiative.org), the smoking rate in the LGBT community in Vermont is not significantly above average. This is due to the Tobacco Program’s collaboration with the Pride Center over many years to offer culturally appropriate cessation support and provide trainings to providers and organizations to increase inclusivity. This success is due to the strategies selected for this work which was done by the Pride Center.  

The Vermont State Health Assessment 2018 is our five-year update on what we know about the health status of Vermonters. It provides vital data for examining health inequities by race and ethnicity, gender, age, sexual orientation, disability, socioeconomic status and geography. This assessment served as the basis for developing the State Health Improvement Plan 2019-2023, helping to prioritize goals, objectives for health, monitor trends, identify gaps and track progress.

This indicator is part of the State Health Improvement Plan for 2019-2023. The Plan documents the health status of Vermonters, the disparities between different populations, and goals that will guide public health work through 2023.

Engaging authentically with people who identify as LGBTQ about their health and behavior choices, as well as ensuring that they can see themselves in public health is important. Not only does this counteract the historical targeting of their community by tobacco companies, but it can help to create a feeling that their community matters to those working in health and public health positions. Ensuring the LGBTQ community is prominent in our workplace, messaging, and vision creates visibility and a sense of belonging for those who are not always treated equitably. 

The Pride Center Vermont - Pride Center of Vermont (PCVT) is New England’s most comprehensive community center dedicated to advancing community and the health and safety of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) Vermonters.

National Jewish Health (NJH)- The Tobacco Program's contractor provides the phone, web, and text messaging support for those trying to quit tobacco known as 802Quits. The services on the phone are offered in over 200 languages. Services on the web are offered in English and Spanish. NJH is committed to providing cultural competence trainings to its coaching staff.

Blueprint for Health- The Blueprint for Health designs community-led strategies for improving health and well-being. This work includes designing and improving health care delivery. The Blueprint for Health collaborates with the Tobacco Program offering the Vermont Quit Partner program, an in-person branch of 802Quits.

National LGBT Cancer Network: Funded by the CDC to provide resources and technical assistance to tobacco control programs to address and reduce the higher tobacco use rates among LGBT communities.

The Vermont Tobacco Program (TCP) has had a grant partnership with The Pride Center Vermont (PCVT) since 2015 through 2021. TCP supported PCVT in offering tobacco cessation classes and training providers across the state in LGBT cultural competence and tobacco use in the LGBT community. PCVT revamped the Vermont Diversity Health Project, a database of healthcare providers who are safe, affirming providers for those who identify as LGBT. TCP also involves the LGBT community in ad testing and research to include their perspective in decision making on media campaigns. In addition, the TCP has been the driving force behind adding sexual orientation and gender identity questions to population health surveys in Vermont, such as the Behavioral Risk Factor Surveillance Survey, and in the Health Department’s involvement in the annual Pride Parade.

These activities represent strategies that are identified by the National LGBT Cancer Network. The tobacco program has been invited to share its work on national CDC webinars. In collaboration with colleagues in Health Promotion and Disease Prevention, the work and direction of the Pride Center and meet with other organizations including Green Mountain Crossroads to learn, engage and expand our work to address disparity and increase inclusivity.

• Collect and monitor data on sexual orientation and gender identity minorities thorough validated survey questions
• Create culturally competent cessation services and messaging
• Include LGBT-specific representation in media campaigns
• Engage LGBT stakeholder groups in policymaking decisions

Source: MPOWERED: Best and Promising Practices for LGBT Tobacco Prevention and Control

Current smoking is defined as having smoked at least 100 cigarettes in a lifetime and now smokes every day or some days. LGBT adults are defined as those who identify as gay, lesbian, bisexual, or transgender. Respondents were excluded from the analysis if they gave an answer of don’t know or not sure.

Data on smoking is collected every year using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS) (http://www.healthvermont.gov/health-statistics-vital-records/population-health-surveys-data/brfss). Sexual orientation and gender identity (SOGI) were first collected on BRFSS in 2014. SOGI was not collected in 2015. Two years of data are combined for this measure (most recent year is noted in graph) and results are weighted to represent the Vermont adult population (18 or older).

In order to remain consistent with the methods of comparison at a national level, this measure is age-adjusted. In other words, 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 http://www.cdc.gov/nchs/data/statnt/statnt20.pdf.