August 2023

According to the 2021 VT YRBS, 20% of LGBTQ+ youth in grades 9-12 reported using any tobacco product, including cigarettes, vaping, cigars, or smokeless tobacco, in the past 30 days and are statistically more likely to currently use any of these products than heterosexual and cisgender youth.  In 2017, one-quarter (25%) of LGBT youth used any tobacco product, increasing to one-third (33%) in 2019.  However, making comparisons between 2021 and prior years should be made with caution due to changes in question wording and survey methodology.  The goal of the Tobacco Program, in partnership with grantees, community stakeholders, decisionmakers, and other Health Department programs, including the Division of Substance Use (DSU), is to reduce the rate of any tobacco use among LGBTQ+ youth to 24% by 2023.

For years, the tobacco industry has made efforts to target and market to LGBTQ+ consumers through targeted advertisements, giveaways, and free tobacco industry merchandise (Truth Initiative). Vermont has the highest per capita tobacco retailer to youth ratio in New England, which is a contributing factor to greater promotion of, access to, and risk for using tobacco products. Nationally, 22% of LGBQ+ youth use any tobacco product, significantly higher than their heterosexual and cisgender peers.  Of note, the national YRBS did not have a question asking about gender identity and as such, the T commonly used in the LGBTQ+ acronym is not included when referencing U.S. YRBS data.  Although the LGBTQ+ community is targeted by the tobacco industry, tobacco use is exacerbated by a number of factors. These include homophobia, transphobia, violence, harassment, bullying and discrimination (Truth Initiative).

LGBTQ+ youth experience significantly higher levels of poor mental health, anxiety and sadness compared to their peers.  According to the 2021 VT YRBS, 59% of LGBTQ+ experienced poor mental health, including stress, anxiety and depression, most or all of the time in the past 30 days, over twice the rate of their heterosexual and cisgender peers.   In addition, only 36% of LGBTQ+ youth felt they mattered to people in their community, significantly lower than the 58% of their heterosexual and cisgender peers.

Protective factors are effective at reducing youths’ risk of tobacco product use. Protective factors promote social and emotional competence and can include quality time with family; supportive and caring adults; positive peer groups; a strong sense of self, and access to and engagement in school and community activities. The more a community can do to increase protective factors, support youth voice and engagement and build cross-sector partnerships and collaboration, the more likely they are to succeed in prevention substance use among youth (Vermont Afterschool)

Vermont Tobacco Control has been working closely with Outright Vermont to address disparities among LGBTQ+ youth. Outright is dedicated to creating environments  and communities that decrease the stress, isolation, and use of maladaptive coping strategies like tobacco and substance use among LGBTQ+ youth. Outright also helps youth-serving organizations and school personnel focus on YRBS-identified resilience factors including creating communities where youth know they matter and creating at least one supportive adult in schools that youth can go to when they have a problem.

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 us prioritize goals and objectives for health, monitor trends, identify gaps and track progress.

In the state health assessment data inequities were identified that call for specific actions at multiple levels including programmatic and policy. Four broad strategies emerged during the 2017-2018 assessment and improvement planning process to improve outcomes in six priority health and social conditions including chronic disease.

The lack of protections for LGBTQ+ youth, for example, including being targeted by the tobacco industry and subjected to aggressions including bullying, will continue to contribute to the health inequities unless addressed. Therefore, it is the plan of the Vermont Tobacco Program, in coordination with partners, community organizations and other Health Department programs, to implement prevention strategies, build partnerships, expand inclusivity and continue to provide resources that will support healthy living and healthy aging for all Vermonters.

• Community Grantees: Tobacco-funded grantees create yearly work plans with local point of sale objectives, smoke- and tobacco-free objectives, earned media and several other activities.
• Youth Groups: Our Voices Xposed (OVX) and Vermont Kids Against Tobacco (VKAT) are based on the Positive Youth Development framework that recognizes the individual strengths of Vermont youth and provides supports to prepare young leaders. Together, youth work to educate their school peers, community members and local and state decision makers on the manipulative and deceptive marketing tactics tobacco and vape companies use to target youth.
• Local Decision Makers: Select boards, boards of trustees, town officers, and town planners have the authority to enact, incorporate or include best practices and implement policies.
• Local Residents: Tobacco policy progress benefits from the participation of concerned residents who can help create the understanding, support and movement for protective policies. Often policy advancement is aided when there is a groundswell of support and demand from local residents. Community grantees educate residents and decision makers to create demand for change.
• Outright Vermont: Working with an organization that focuses on building a safe, healthy and supportive environment for LGBTQ+ youth is an important part of the tobacco program’s plan.

The tobacco program will continue to support, implement, and adopt evidence-based practices such as ban on marketing and sponsorship targeted to LGBTQ+ and multicultural events, counter tobacco industry influence through point of sale strategies such as banning price promotions, content neutral advertising, promoting smoke-free and clean indoor air laws to protect all Vermonters from secondhand smoke, and providing accessible cessation services. Other strategies include sensitivity training of community and medical providers who can serve as trusted touch points for asking about and/or treating tobacco use.

The Tobacco Program will create a workplan with stakeholders for implementing starting July 2020. The program has begun implementing selected  best strategies as outlined by the Network For LGBTQ+ Health Equity, and provide support to community partners in achieving the goal of the target population identified. Strategies include:

1. Share and report on the data collected through YRBS. 
2. Develop a minimum of one partnership with youth organizations that serve LGBTQ+ youth in Vermont, e.g. Outright Vermont.
3. Maintain a LGBTQ+ friendly database for providers that includes those for youth to ensure they have access to welcoming physical and mental health services.
4. Host and promote smoke-free youth events.
5. Involve youth in the development of social media campaigns and messaging as seen with the This Free Life Campaign.

The Youth Risk Behavior Survey is administered every other year.

Any tobacco product use is defined as using at least one of the following tobacco products on one or more of the past 30 days: cigarettes; electronic vapor products; chewing tobacco, snuff, dip, snus, or dissolvable tobacco products; or cigars, cigarillos, or little cigars. LGBT adolescents are defined as those who identified as gay, lesbian, bisexual, or transgender. Respondents were excluded from the analysis if they gave an answer of don’t know or not sure. Electronic vapor products were added to the high school survey in 2015 and gender identity was added in 2017.

The Youth Risk Behavior Survey (YRBS) is a national program funded by the Centers for Disease Control and Prevention and measures the prevalence of behaviors that contribute to the leading causes of death, disease, and injury among youth. Vermont YRBS is administered every other year (odd years) and surveys over 30,000 students during each administration. Weighted data are compiled to generate a representative state sample. In 2019, the YRBS will be administered electronically, prior to this it was a paper survey. Please see the YRBS webpage for more information about this data source.