Communities support healthy living and healthy aging

% of LGBT adolescents in grades 9-12 who used any tobacco product in the past 30 days


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Story Behind the Curve

June 2019

A quarter (25%) of LGBT adolescents in grades 9-12 reported using any form of tobacco in the past 30 days (VT YRBS, 2017). This is significantly higher than the non-LGBT adolescent rate of 18%. We cannot report a trend because Vermont first asked about gender identity in the high school YRBS in 2017 and first asked about e-cigs in 2015. Once trends are available, we will share in this story behind the curve. The goal of the Tobacco Program, in partnership with grantees, community stakeholders, decisionmakers, and other Health Department programs including Alcohol and Drug Abuse Prevention (ADAP), is to reduce the rate of  any form of tobacco use by LGBT youth to 24% by 2023.


For years, the tobacco industry has made efforts to target and market to LGBT consumers through targeted advertisements, giveaways, and free tobacco industry merchandise ( 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, 19% of LGBT high school students smoke cigarettes, which is nearly double the rate of heterosexual students, while 31% of transgender youth smoke cigarettes. Although the LGBT community is targeted by the tobacco industry, any form of tobacco use is even more exacerbated through a number of factors such as discrimination, lack of supportive communities, and lack of LGBT friendly policies and student groups (Willoughby, Doty, Malick, 2010). LGBTQ youth are identified by the CDC as a targeted group for bullying (


Over the long term for improving the physical and mental health of Vermont youth including LGBT, in addition to community partners, the Health Department and its prevention grantees seek to support efforts contributing to greater youth resiliency. Protective factors make up resiliency and include individual or environmental characteristics, conditions, or behaviors that reduce the effects of stressful life events. These factors promote social and emotional competence and can include family support and monitoring; caring adults; positive peer groups; strong sense of self, self-esteem, and future aspirations; and engagement in school and community activities.[5] More specifically to address disparities with the adult LGBT population, the program works closely with the Pride Center of Vermont to provide cessation and provider resources. The program also utilizes resources from the CDC’s Health Link in its work.

 Although the tobacco program currently does not have strategies that are specific to LGBT youth, it will be expanding its partnerships and making a workplan over the next year to include selected best practices outlined in the MPOWERED report authored by the Health Link.



[5] Measures of Resilience Among Vermont High School Students Data Summary: 2017 Vermont Youth Risk Behavior Survey, Vermont Department of Health.


  • 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: OVX and VKAT members often support tobacco coalition initiatives through youth activism, educating school and community members, and becoming the face of tobacco prevention.
  • 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 a goal the tobacco program should incorporate in its plan.
What Works

The tobacco program will continue to support, implement, and adopt evidence-based practices such as ban on marketing and sponsorship targeted to LGBT 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 LGBT Health Link, 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 LGBT youth in Vermont, e.g. Outright Vermont.
  3. Maintain a LGBT 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.
Why Is This Important?

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 LGBT 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.

Notes on Methodology

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.

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