Vermont Experts Say Funding Tobacco Prevention and Evaluation Are Critical


The following guest editorial which appeared in Vermont Digger on February 28, 2016 by current and former chairs of the Vermont Tobacco Evaluation and Review Board stresses the importance of restoring funding to Vermont’s Tobacco Control Program.

Independent evaluation a worthwhile cost

This commentary is an open letter to Gov. Peter Shumlin and Vermont legislators from current and former Tobacco Evaluation and Review Board chairs, including current chair Amy Brewer, M.P.H., and former chairs John Hughes, M.D., 2003-2004; Martha Ide, R.N., 2005-2006; Ted Marcy, M.D., M.P.H., 2007-2008; and Brian Flynn, Sc.D., 2009-2014.

Dear Governor and Vermont Lawmakers;

We urge you to restore evaluation funding for Vermont’s Tobacco Evaluation and Review Board and Tobacco Control Program. The independent evaluation is an important basic contributor to the program’s success. The independent evaluator has provided evidence about the overall level of program effectiveness in reducing the burden of tobacco-related diseases and specific recommendations about how to allocate and focus resources within the tobacco control program.

The independent evaluator (RTI International) has shown that Vermont realized a total of $1.43 billion in savings that it otherwise would have spent on smoking-related health care costs – paid by Vermont citizens, health plans and the state of Vermont – had we not seen the decreases in smoking since the Tobacco Control Program began 15 years ago. Savings on tobacco-related health care spending in the past year alone were estimated to be $185 million less than the projected spending had smoking rates remained unchanged during this time.

The independent evaluation showed, further, that substantial proportions of these savings were due directly to the Vermont’s modest investment in tobacco control programs, such as quit programs and media messages, independent of the effects of tobacco tax increases and smoke-free laws. The independent evaluation has shown that Vermont’s Tobacco Control Program is an example of a small investment in government spending on prevention that is reducing the very high costs of chronic diseases in Vermont.

Independent evaluation of the Tobacco Control Program is a powerful way to ensure that decisions are made in the best interest of the overall program and the Vermonters it serves without regard to shorter term considerations. As we have seen in the past, when the independent evaluator makes recommendations based on program performance, changes have been made for the better. Examples included:

• Increasing the emphasis on policies and programs affecting lower income populations
• Redesigning the in-person cessation counseling service due to high costs and low fidelity
• Acting to prevent implementation of expensive, low reach programs that did not have evidence of effectiveness
• Reallocating funds among the three tobacco control program entities (Agency of Education, Department of Health, Department of Liquor Control).
• Recognizing the value and effectiveness of media campaigns such as the “8 out of 10” campaign that changed teens misperceptions regarding the social norms of smoking among their peers.

Vermont leaders realized the tremendous burden smoking was placing on state health care spending and wisely created Vermont’s comprehensive Tobacco Control Program in 2001 to provide resources for smokers to quit, educate youth about the dangers of smoking and change Vermont’s environment where smoking is no longer an accepted norm. Just as wise was the decision to provide the Vermont Tobacco Evaluation and Review Board with the resources to conduct an independent evaluation of the program each year to find out what works best about the program and what might need tweaking.

Without this important evaluation funding, the effectiveness of the program is at risk. Throwing money at a problem and hoping it works is never good. When it is state government that is doing the spending, evaluating state programs to ensure the best use of state funds should be critical. The current administration and Legislature have realized this notion by placing great emphasis in recent years on results based accountability. The evaluation of Vermont’s Tobacco Control Program is an example of results based accountability at its finest.

As we have seen in the past, when the independent evaluator makes recommendations based on program performance, changes have been made for the better.

The elimination of evaluation funds for the program included in the governor’s budget is a grave concern and will definitely negatively impact the program. The funding previously allocated to the Vermont Tobacco Evaluation was used by RTI to review how all the program components integrate and how effective, for instance, the community coalitions and media run through the Vermont Department of Health, integrated with the curriculum and work with youth through the Agency of Education and the enforcement provided by the Department of Liquor Control. Eliminating independent evaluation of the program and trying to realize savings by having a state agency evaluate the program internally will not adequately address the needs of the overall program and the interests of the state in further reducing tobacco related disease and health care costs.

State Sen. Dianne Snelling, a Senate Appropriations Committee member, stated the root of the issue quite well during discussion of the issue last year when she said, “You need someone outside state government to say if a program is working.” We agree.

Tobacco is still the No. 1 most preventable killer and driver of health care costs. Achieving sustainable health care funding goals will be even more challenging without addressing tobacco use as effectively as possible. Please restore the $291,127 allocation for independent evaluation of the tobacco control program to maintain an effective focus on this problem that has resulted in many diseases and deaths averted, and dollars saved.


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