August 2023

After a few years of an increased smoking rate, the rate of smoking among Native Americans in Vermont decreased to a program-low of 28% according to the 2021 Behavioral Risk Factor Surveillance Survey data. The rate of smoking in this population, while lower, remains significantly higher than the rate of 16% seen in the general Vermont population. In collaboration with other chronic disease programs and leadership among the American Indian communities in Vermont, our goal is to reduce smoking to 25% by 2023.

Tobacco use is the number one preventable cause of death. In Vermont, smoking costs approximately $404 million annually 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 person who doesn't smoke. 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.

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.

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. 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. The Abenaki Equity Workgroup offers valuable input into strategies and next steps including the Vermont Tobacco Control and Sustainability Plan 2022-2027 which is equity-focused.

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.

Current smoking is defined as having smoked at least 100 cigarettes in a lifetime and now smokes every day or some days. 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).

Vermont tracks risk behaviors and chronic disease using a telephone survey of adults called the Behavioral Risk Factor Surveillance Survey (BRFSS). Vermont participates in the BRFSS with the Centers for Disease Control and Prevention (http://www.cdc.gov/brfss). Every year the Vermont Department of Health fields questions related to smoking and tobacco product use status, present and past use. The CDC recommends monitoring smoking and tobacco use and enacting policies and interventions to prevent use among all ages and populations.

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.