American Lung Association Report Aims to Reduce Tobacco Use in Vermont’s Rural Communities

Today, the American Lung Association released its latest lung health disparity report, “Cutting Tobacco’s Rural Roots:  Tobacco Use in Rural Communities,” which examines tobacco addiction and exposure to secondhand smoke in rural America, particularly among rural youth. Sixty percent of Vermont’s population lives in rural areas, the second highest percentage in the country, behind only Maine. Eighty-eight percent of adult smokers report starting prior to the age of 18, according to the Centers for Disease Control and Prevention (CDC).

Tobacco use is higher in rural communities than in suburban and urban communities, and smokeless tobacco use is shockingly twice as common.  Rural youth are more likely to use tobacco and to start earlier than urban youth, perpetuating the cycle of tobacco addiction and death and disease.   This trend is evident in Vermont where the smoking rate in urban Chittenden County is 13 percent compared with counties like Franklin and Essex where the rates are 21 percent and 29 percent respectively.

“Tobacco use is often more socially acceptable in rural areas, making it more likely that kids living in these communities will also start to use tobacco,” said Jeff Seyler, President and CEO of the American Lung Association of the Northeast.  “We hope this report will make community leaders and the public more aware of this health disparity and encourage them to take a stand against the culture of tobacco.  We need to empower future generations to lead healthy, tobacco-free lives so that we can prevent tobacco-caused disease and save lives.  This report stresses how important it is that people living in rural areas have access to ample quit smoking resources.”

Changing the culture of tobacco use requires a multi-pronged approach and is reliant on the support and persistence of local community members.  One example of a successful approach to reversing the culture of tobacco use occurred at Northwestern Medical Center in St. Albans, Vermont.  Here, one employee collaborated with hospital administration to vigorously enforce the hospital’s existing smokefree air policy which was sometimes being overlooked. A narrative about the hospital’s efforts is highlighted in “Cutting Tobacco’s Rural Roots:  Tobacco Use in Rural Communities.”

“In 2006, our organization evaluated our more than decade-old policy and re-committed ourselves to communicating it to all visitors, patients and staff,” said Amy Brewer, Northwestern Medical Center Health Educator and Coordinator, Franklin Grand Isle Tobacco Prevention Coalition.  “Our employee smoking rate is extremely low and our patients all receive bedside assistance in remaining smoke-free while they are on campus and hopefully even when they go home.  Although work with visitors continues daily, we remain confident that when this policy is communicated to all by all staff, we will reduce secondhand smoke-exposure campus-wide.”

There are a number of environmental and social factors that contribute to the generational cycle of tobacco use among youth and adults in rural America. 

Increased tobacco use is associated with lower education levels and lower income, which are both common in rural areas where there may be fewer opportunities for educational and economic advancement.  Exposure to secondhand smoke is also higher as rural communities are less likely to have smokefree air laws in place and residents are less likely to refuse to allow smoking in their homes or other indoor places. 

For decades, the tobacco industry has used rural imagery, such as the Marlboro Man, to promote its products and appeal to rural audiences.  Over the past several years, the tobacco industry’s marketing of smokeless tobacco products has skyrocketed. Sadly as the tobacco industry spends millions of dollars targeting rural youth, these youth are less likely to be exposed to tobacco counter-marketing campaigns.  Rural tobacco users are also less likely to have access to tobacco cessation programs and services to get the help they need to quit.

Many rural states have low tobacco taxes.  Increasing the price of tobacco products is one of the most effective ways to prevent youth from starting to smoke. In Vermont, the cigarette tax is $2.62, which is higher than the current average state cigarette tax of $1.46 per pack, but much less than neighboring New York where the tax is $4.35.  Unfortunately, most cigars are taxed differently than cigarettes, and are available at kid-friendly prices and flavors. While the youth cigarette smoking rate has been cut in half in Vermont in the last decade, cigar smoking, especially among boys, is on the rise.

“We know that communities working together to change policy and cultural norms is an effective way to reduce tobacco use at the local level,” said Barbara Cimaglio, Deputy Commissioner, Vermont Department of Health. “Vermont Department of Health will continue to lead in this effort –we cannot afford to risk the progress that we've made over the years.”

The American Lung Association in Vermont is calling on government agencies, the research and funding community, health systems and insurers, community leaders, schools and families to take steps now to cut tobacco’s rural roots.  “Rural communities here in Vermont and across the country need special attention if we’re going to make a major dent in tobacco prevalence,” said Rebecca Ryan, Director of Health Promotion and Public Policy in the American Lung Association of the Northeast’s Williston office.  “If residents, community leaders, organizations and decision-makers all work together, we can make progress in reducing the health disparity caused by tobacco use in rural communities.”   

 The state and the American Lung Association offer smoking cessation resources to help people quit smoking for good.


·         The Vermont Quitnetwork: the state provides a comprehensive tobacco treatment program including quit in person, quit by phone or quit online, along with free nicotine replacement therapy while supplies last. Visit or call 1-800-QUIT-NOW.


·         The American Lung Association’s Not-On-Tobacco® (N-O-T) is a group program designed to help 14 to 19 year old smokers end their addiction to nicotine. The curriculum consists of ten 50-minute sessions that typically occur once a week for 10 weeks.


·         The Lung HelpLine, 1-800-LUNG-USA, offers one-on-one support from registered nurses and respiratory therapists.  Individuals have the opportunity to seek guidance on lung health and find out how to participate in and join the Lung Association smoking cessation programs. 

 In addition to expanding the Lung Association’s capability to provide its programs and services to the rural community, there are also several other action steps to reduce rural tobacco use.  These steps are detailed in the full report, and include that state and federal tobacco control programs must make a concerted effort and dedicate funding to reach rural communities; the research community should focus attention and resources on identifying effective cessation treatments for smokeless tobacco use; and school, health and employment systems in rural areas must all implement effective tobacco control strategies including smokefree air policies and access to cessation services.

 This report is part of the Lung Association’s Disparities in Lung Health Series.  To download a copy of the report, visit: