[A]fter years of declining funding, anti-smoking efforts in Vermont are getting a financial boost.
The state’s fiscal year 2019 budget statute allocates an additional $1 million for tobacco-control projects. It’s the first such increase in more than a decade, and officials are trying to make it last by spreading it among five programs over two years.
The two biggest priorities are attracting more adults to the state’s stop-smoking programs and educating young people about the risks associated with e-cigarettes. The latter effort is important, officials say, as a growing number of high school students say they’ve tried so-called “electronic vapor products.”
The state’s new campaign will address “the myth that e-cigarettes are harmless,” said Rhonda Williams, chronic disease prevention chief for the state Health Department. “They do contain harmful components, with a special emphasis on nicotine.”
Anti-smoking advocates have drawn a direct line between Vermont’s stagnating smoking rates and its dwindling tobacco-control funding.
The state’s adult smoking rate rose one percentage point between 2015 and 2016 and now stands at 18 percent. That’s higher than the 15.5 percent national average.
Among youths in grades nine through 12, the state’s latest risk behavior survey showed that smoking rates dropped from 11 percent in 2015 to 9 percent in 2017. But the number of high school youth who had ever tried an electronic-vapor product increased from 30 percent to 34 percent, and middle school students also were more likely to have tried such products than they previously had been.
State officials have not had much money at their disposal to address such issues. Vermont”s Tobacco Control Program – which includes prevention, enforcement and cessation efforts – has seen a steady decline in its budget.
The control program gets no money from the state’s tobacco product tax. And it receives only a small sliver of Vermont’s annual “master settlement agreement” funding from the tobacco industry.
In a January report, the Vermont Tobacco Evaluation and Review Board recommended that the Tobacco Control Program’s funding rise from $3.56 million to $5.65 million.
The Legislature’s subsequent allocation of an additional $1 million from a special, one-time tobacco settlement moves the program closer to that goal. Advocates were hoping for more, but they say they’ll take what they can get.
“The $2 million (increase) would have gotten us further, faster,” said Amy Brewer, former chair of the Tobacco Evaluation and Review Board. “But we’re trying to be very smart and strategic about it.”
The Legislature’s new allocation is to the Agency of Human Services, but the statute says “the use of these funds shall be pursuant to the plan specified by the Tobacco Evaluation and Review Board.” So the board met earlier this month to decide how to parcel out the money.
“The conversation was really around what can we do with one-time money … so we didn’t want to increase infrastructure or anything like that,” said Brewer, who still was serving as the board’s chair at that time.
Officials decided to allocate half of the $1 million to expanding smoking-cessation outreach to adults. The goal is to make more people aware of the free resources available via the state’s 802 Quits program.
“Nationwide – and we see this similarly in Vermont – even though a majority of smokers want to quit at any one time, there are fewer people using the quit line,” Williams said.
One challenge is the fact that more smokers are struggling with dependence on other substances or with depression, Williams said. “With those factors, it is harder for people to be able to quit tobacco use,” she said.
She also noted that cigarettes are still ubiquitous, making things more difficult for those who are trying to quit. There are nearly 1,000 cigarette retailers across Vermont, Williams said.
The Health Department will launch an ad campaign on television, digital, radio and print platforms promoting stop-smoking resources. Such campaigns have proven results, said Brewer, who works as a health educator at Northwestern Medical Center in St. Albans.
“What drives people to call the quit line or to make a quit attempt is generally television or other advertising,” she said.
Williams said the state also is targeting its educational campaign to the Medicaid population. Studies have shown that smoking rates are higher among Vermont adults on Medicaid, and the insurer offers stop-smoking benefits.
Another $180,000 from the newly allocated money will go toward an educational effort focused on young people and e-cigarette use. Health officials say the issue has been hard to get a handle on.
Under Vermont law, no one under 18 can buy tobacco or “tobacco substitutes,” which includes e-cigarettes. But direct purchases don’t seem to be the problem: In the 2017 Vermont Youth Risk Behavior Survey, half of current users who were under 18 said they borrowed or received electronic vapor devices from someone who was over 18, and only 8 percent said they’d bought a device in a store.
Officials also suspect that, with the expanding popularity of JUUL vapor devices, the risk behavior survey may not accurately reflect the extent of e-cigarette use among young people. So the state is looking to strike back with an educational campaign aimed at youth and parents.
“I think what’s very clear is that nicotine is not safe for an adolescent brain, and youth should not be using these products,” Brewer said.
As the educational effort rolls out, “we will be tracking the data to see whether we can, over two years, see a reduction (in e-cigarette use), especially in current use,” Williams said.
There are three other planned uses for the Tobacco Control Program’s new funding: Officials will allocate $150,000 to gather more information on tobacco use among youth; $100,000 for an adult tobacco survey in fiscal year 2020; and $70,000 to further address smoking during pregnancy.
The pregnancy issue is an ongoing concern, as officials have said Vermont has one of the highest smoking rates in the country for pregnant women. The Health Department wants to expand training for care providers on that topic.
“We are seeing a decrease (in the pregnancy smoking rate). And it’s encouraging,” Williams said. “While we’re making progress, we still have a lot more to do in order to bring it as far down as we’d like to see it.”
