Communities support healthy living and healthy aging

% of Native American adults who currently smoke cigarettes


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Story Behind the Curve

September 2019

The rate of smoking among Native Americans in Vermont increased to 42% according to the 2017 Behavioral Risk Factor Surveillance Survey Report, after a four-year decline (from 41% in 2013). The rate of smoking in this population is significantly higher than the rate of 17% seen in the general Vermont population, and in the national rate of 24% (2017 CDC). In collaboration with other chronic disease programs and leadership among the American Indian communities in Vermont, our goal is to reduce smoking to 38% by 2023.

Tobacco use is the number one preventable cause of death. In Vermont, smoking costs approximately $348 million in medical expenses and results in about 1,000 smoking-related deaths each year. Smoking is a cause of premature death; on average a person who smokes dies 10 years earlier than a non-smoker. It isn’t known why those of Native American descent smoke at higher rates than other Vermonters. A study performed in California pointed to higher suicidal ideation, childhood trauma, current neglect, living with other smokers, and lower intention to quit.


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.

What Works

Traditional public health strategies have thus far not made the same level of change in these communities that have been seen in other populations. The CDC published a Health Equity guide for tobacco programs to provide approaches for achieving greater equity including among Native American or American Indian populations. Native American communities vary greatly in their beliefs, traditions and relationship to tobacco use, and because of this there is no single approach that will be successful in all communities. It has been found that strategies that come from within the community that respect the views and teachings of elders have the greatest impact. Some ideas to keep in mind when working with Native communities:

  • Value and support the cultivation of traditional tobacco practices

  • Fund long-term community-generated strategies

  • Place value on community outreach and relationship building

  • Hire representative staff from communities being served

Source: In a Good Way: Indigenous Commercial Tobacco Control Practices


Everybody, including Native Americans and others in groups with higher tobacco burden, needs to be supported in not starting to smoke commercial tobacco and quitting if they do smoke.  These strategies are part of CDC’s Comprehensive Best Practices for Tobacco Control Programs. Combined with recommendations from these best practices, the health equity guide and the Community Guide, prevention and treatment should be promoted, accessible and effective for everyone.

In 2018 the Vermont Tobacco Control Program (TCP) added a new protocol to its tobacco cessation Quitline tailored to Native Americans. A key part of this protocol is that it focuses on reduction in tobacco use instead of complete cessation in respect for the traditional or ceremonial use of tobacco in Native American culture.

In partnership with programs within the department, the TCP is engaging in relationship building with the state-recognized tribes in Vermont and will be promoting the Quitline protocol as advised by tribal members.

Why Is This Important?

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.

Historical injustice and discrimination, in part by the US government, has created a need for a thoughtful and culturally competent approach to working with those in the Native American community. Traditional public health approaches to tobacco control have not had the impact for these communities that has been seen in the general population for many reasons. One complication is the traditional use of tobacco and its cultural role, and the importance of differentiating between traditional and commercial tobacco. In Native American communities top-down programs that focus on evidence-based practice have not been successful. Evidenced base methods or implementation strategies have not been built using information, data and results gathered from these communities.  In working with these communities, valuing the wisdom and experience of our Native American partners and ensuring cultural appropriateness of our programming, will be crucial to helping improve health and wellness for Vermont's population.

Notes on Methodology

Data on smoking and depression are collected every year using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS) ( 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.

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