Vermonters must be 21 to purchase and possess tobacco products starting Sept. 1

Law aims to protect youth from harms of e-cigarettes and reduce smoking rates

BURLINGTON, Vt – Starting September 1, [2019] Vermonters must be at least 21 years old to purchase and possess tobacco products or paraphernalia. The new law also includes tobacco-substitute products, such as e-cigarettes. Health officials say the increase in buying age will help protect youth from nicotine addiction and potentially toxic chemicals.
Commonly known as Tobacco 21, the new law is expected to reduce smoking rates over time and ultimately save lives. An estimated 95% of adults start smoking by age 21, so restricting access to these products will help prevent young Vermonters from ever taking it up.

“We’ve made great strides against tobacco use, but the popularity of e-cigarettes and vaping continues to skyrocket among our youth,” said Health Commissioner Mark Levine, MD. “We are also seeing evidence of increasing rates of health problems associated with vaping.”

According the Vermont Youth Risk Behavior Survey (YRBS) there was a significant increase in the percent of students who have ever tried e-cigarettes, from 30% in 2015 to 34% in 2017. Among high school students in Vermont, 12% said they used electronic vapor products in the past 30 days.

What’s in a “pod”?

A single 5% “pod” of liquid nicotine used in e-cigarettes can contain as much nicotine as an entire pack of cigarettes. Teens and young adults are uniquely vulnerable to the effects of nicotine, and more likely to get addicted. Exposure to nicotine in adolescence can impact attention, learning, mood and impulse control. The aerosol that users breathe from e-cigarettes can contain nicotine and other toxic chemicals, including formaldehyde and arsenic.

Dr. Levine said that while e-cigarettes are less harmful to adults than combustible cigarettes, they are never safe for teens and young adults, making this new law all the more necessary. “These cyber-cigarettes, with their thousands of flavors, represent a 21st Century version of big tobacco’s decades-long push to market and promote their products to youth,” said Dr. Levine. “Society always races to keep up with technology. This law helps to close the gap in favor of protecting public health.”

With the enactment of Act 27, Vermont joins 17 states, the District of Columbia, Guam and more than 480 municipalities with a Tobacco 21 law.

Two related laws went into effect in July that prohibit the online sales of e-cigarettes and liquid nicotine, and subjects e-cigarettes and liquid nicotine to the same 92% tax already assessed on tobacco-related products. These laws, in combination with Tobacco 21, help strengthen statewide tobacco prevention efforts to discourage teens and young adults from using these products.

Want to Learn More?

Health officials urge anyone looking for help to quit smoking or the use of any kind of tobacco product to visit

Read the Vermont Tobacco Prevention Laws fact sheet and find more information about tobacco, e-cigarettes, at

Schools can also find resources specific to their communities by using our new Electronic Vapor Product Education Toolkit.

Press Release from the Vermont Department of Health, August 29, 2019

Gaining Confianza: Cross-Cultural Lessons on Community Progress

Deb Kitzmiller with a community member in El Salvador in 1999.

Note: Trust is at the heart of the Public Health Council’s work. Are we representing our community partners fairly? Are we truly listening to them? Are we promoting work that addresses issues of concern to our community in a way that is meaningful and respectful? Every once in a while someone manages to describe the importance of trust in a way that makes it very real. This piece is one of these descriptions and we are lucky enough to have permission to share it. I hope you enjoy it. — Alice Ely

Article Written By Deb Kitzmiller, Brattleboro District’s Maternal and Child Health Coordinator for the Vermont Department of Health. Reposted with permission of Building Bright Futures, Williston, VT.

Cross-Cultural Lessons on Community Progress

Twenty years ago, in the Peace Corps in El Salvador, I was taught a life lesson that proved so valuable that I’m still reflecting on it within my work today. In 1999, Brattleboro based SIT/ World Learning taught me that in El Salvador the most important ingredient to a successful community development project is called confianza (in Spanish.)  The word means trust- the kind that you get by being in a close relationship.

Salvadorans frequently see foreigners who swoop in and try to “fix” their problems in ways that are unsustainable.  For that reason, they could be resistant to ideas brought in by foreigners, and confianza could be hard-won.  Because Peace Corps volunteers actually live in the communities that they work with, there is plenty of time to build relationships, and therefore, the confianza required for working well together. We were actually told during training to spend at least three months doing no work at all except for getting to know people.  This step of building confianza through relationship was that important– a critical step before proceeding together on project work. This concept has recently been popularized by Steven M.R. Covey who writes, “Change happens at the speed of trust.”

“Change happens at the speed of trust”

What surprised me most about this lesson is how much it applied to my work in public health, in my very own community, even now.  What I had previously thought was a truth specific to working within this Central American country is actually true here too.  It’s not about interacting with foreign cultures at all; it is about sustainability, which is universal.  In El Salvador the locals became used to foreigners “dropping in” and telling them how to change their lives for the better, and in many cases these projects did not succeed.  Similarly, in our own community we sometimes try to push through initiatives that weren’t formed with local input, and they have been the source of tension and lack of progress rather than achieving desired results.  In addition, many of the young families that we work with have been let down by the systems and structures that people in positions like mine have helped set up.  For that reason, I understand confianza as one of the most important parts of my job.

Taking the time to slow down and enjoy getting to know the people that I work with in my community is not just an added bonus to my job, it’s often what makes things work. For example, recently Brattleboro OB/GYN put together a postpartum planning packet with the help of the community.  It wasn’t enough that we recognized that the postpartum experience is hard, and that our culture over-emphasizes birth planning as opposed to preparing for what happens after the birth. It also wasn’t enough that UVM’s Sandy Wood’s team had already put together a postpartum planning packet that inspired us.

It was our conversations with local individuals that had recently had babies telling us about their postpartum lives, helping us realize that the time for this action is ripe right now.  It was the ease within which we were able to chat back and forth with Sandy Wood and the trust she had in our team to model our own version after UVM’s materials.  It was also the easy relationship between our Perinatal Wellness Initiative (PWI)’s team members and Meghan Arthur, the nurse-midwife which allowed for the chatting back and forth, tweaking and personalizing the end product to be right for our community.  Without the comfort and ease of frequent communications on all levels, a project like this one will become tedious have too many barriers to succeed. Our community created a beautiful product that will help our birthing families be better prepared for the postpartum period, and better able to access the resources they will need to do so.  This lays one of the first steppingstones for our families to become strong and resilient.

Sometimes it feels like progress is slow, and it is hard to measure our successes.  It is easy to get discouraged by this type of work for that reason. I would encourage anyone in this headspace to take a step back and stop worrying about progress for a bit.  Slow down, get to know people, and develop confianza with your community.   You never know, you might just be planting seeds for the future.

A Workshop Explores Racism

Jim Wuelfing, left, and Art Woodard lead a Racism of the Well-Intended workshop at Hypertherm in Lebanon, New Hampshire.

On May 20, 2019, The Public Health Council of the Upper Valley and the Hypertherm HOPE Foundation presented a free full-day public workshop, Racism of the Well-intended: Examining Privilege and Power.

“Racism of the Well-intended.” It’s a somewhat unusual title for a workshop, which is why presenters Art Woodard and Jim Wuelfing asked 100 participants in Hypertherm’s conference room to spend 15 minutes thinking about how to define the term. Many came up with a definition for racism similar to the presenters’: “any attitude, action or institutional structure which lessens or denies the power to be or do of a person or group because of their race.”

Participants seemed to struggle, though, with the term “well-intended” in this context. As the workshop progressed, we explored the meanings behind these words. We discussed microaggressions: verbal, nonverbal, or environmental communications that contain a hidden insult to the target group to which it is directed. We explored the concept of white privilege in an exercise that feminist and anti-racism activist Peggy McIntosh calls, “Unpacking the Invisible Knapsack.”

A Training Born of Friendship

Art and Jim, who have been friends for decades, offer Racism of the Unintended workshops to organizations throughout the United States. They hope the presentations serve as a model for changing relationships between people.

As part of their work, the two men conduct field studies together in which Jim, who is white, is attuned to the injustices Art, who is black, faces in daily life. In the same convenience store, Jim is not asked to show his driver’s license when he makes a credit card purchase, while Art carries a license with him at all times, as well as two other forms of ID.  Jim has witnessed Art get harassed by clerks in stores and followed by police in his car. I found it heartbreaking to hear about this inequality, but I would be naïve if I didn’t think it existed: I read about it every day in the news. And just because I don’t have the opportunity to interact with many people of color in our mostly white Upper Valley community, doesn’t mean that the scourge of racism doesn’t affect me, or that it doesn’t affect my community: Since we live in the United States, we live in a racist society.

Several people in the training wondered how best to explore the topic of racism in an area that isn’t racially diverse. Indeed, most of the participants at the workshop were white, and when we broke into smaller discussion groups throughout the day, I discussed heavy topics with others who, like me, were white. I felt I couldn’t fully explore some of the issues at hand because I couldn’t hear the perspective of someone who had experienced them first-hand. I also felt left off the hook for something I often fear when I’m in a diverse gathering: that I may hurt or offend somebody when we try to have an honest conversation.

We All Have Different Identities

The most powerful exercise of the day was when Art and Jim asked all participants to stand around the conference room in a circle. They told us they would name different identities, and if we claimed the identity they called, we were to walk to the center of room. Once there, we were to notice what we were feeling, notice who else was in the center of the room with us, and notice who was standing on the outside of our marginalized group. If we identified with one of the groups called and chose not to walk to the center, we were to take note of that, too, and consider why we kept our status hidden.

Jim began to call out marginalized identities: “If you are a woman, walk to the center of the room…”. He continued to read about 20 more identities. “If you have ever been treated for a mental illness, walk to the center of the room”; “if you were raised by a single parent…”; “if you or someone in your family identifies as LGBTQ+, walk to the center.”

I noticed I felt scared, at first, to publicly acknowledge my marginalized status in some of these categories—especially since we live in a small community. Many people in the room knew me personally but didn’t necessarily know these details about my life. Once I was in the center of the room with others in my group, though, I felt a sense of belonging within the minority.

It became easier, I felt stronger, to walk up each time to claim my marginalized status. While I was there, I noticed the people standing on the outside, and I felt somewhat exposed. I felt the others were lucky, in a sense, not to experience my particular hardship. But later, when I observed them walk to the room’s center under a category under which I didn’t fall, I was reminded of the feelings of my own marginalized status, and I felt connected to these people, even though I now stood on the outside.

The starkest examples were when Jim called for groups including African Americans, and Asian Americans, and only two or three participants stood alone in the center, surrounded by almost 100 people. I thought of how vulnerable those in the center looked: just a couple of people—surrounded by so many others. I also considered, since these were topics of race, these individuals could not choose to hide their identity: it is something that can be seen by all.

I was reminded of this image later that week when I read a column in the Valley News by Deb Beaupre about how a hateful object made her feel unsafe as an African American woman in our community. I recalled the sense of connection I felt that day in the training as participants walked back and forth, together in our very differences, united in our humanity. It was a feeling of compassion I will strive to carry with me.

Elizabeth Kelsey is a writer who specializes in mental health topics.

Mental Health Month is May

Upper Valley Stigma Stompers celebrate May Mental Health Month.For Mental Health Month, Donna Stamper, Public Health Council partner and volunteer with the NAMI Upper Valley Affiliate Support Group, submitted the following Letter to the Editor to the Valley News. It appeared in the Forum on Wednesday, May 08, 2019. We reprint here with permission of the writer.


Because May is Mental Health Month, and because 46.6 million adults in the United States experience a mental health condition in any given year, I want to share some local resources for families looking for support, information, education and advocacy opportunities for themselves and for their loved ones with schizophrenia, bipolar disorder, depression, anxiety or post-traumatic stress disorder.

These illnesses are treatable, but fewer than half get the help they need. Earlier efforts can save lives and reduce suffering.

Local Resources for Mental Health Help

Here are some ways to find help and hope.

The National Alliance on Mental Illness. NAMI-NH ( and NAMI Vermont (, are statewide organizations that provide information, classes, training and support groups.

Support Groups Around the Upper Valley

The NAMI Upper Valley Affiliate Support Group is for families and friends of adults who have or are coping with symptoms of mental illness and is led by NAMI-trained family member volunteers. Attending a support group is a form of self-care and a way to learn from others facing similar challenges. There are two meetings a month, on the second Monday and the last Wednesday, both from 5:45-7:45 p.m., at Dartmouth-Hitchcock Medical Center.

The NAMI Claremont Family Support Group meets on the first Thursday of each month, from 6-7:30 p.m., at Valley Regional Hospital, in the Buckley conference room.

The NAMI Connections Peer to Peer Support Group is for adults with a mental illness who support one another by sharing stories with a focus on wellness. This meeting is the second Monday of each month. from 5:45-7:15 p.m., also at DHMC.

Online Resource for the Upper Valley

See for contact information for these groups (click on “Support Groups”), as well as resources and events related to mental health topics.

Exploring Community Health Priorities in the Upper Valley

Improving community health is at the core of the mission of the Public Health Council of the Upper Valley. Most of our partners share this goal, but contribute in different ways to reaching that goal. Some partners are health care providers, some provide treatment for substance use disorders or mental illnesses, others support people in our communities who struggle with various social determinants of health.

Every three years, the Public Health Council works with our many partners to update a set of regional priorities that answers the questions: What are the health issues our community members are most concerned about? How can we make a difference, especially by using the strength of our collaboration? And every three years, nonprofit hospitals, like Dartmouth-Hitchcock and Alice Peck Day Memorial Hospital, are required to complete a community health needs assessment and a community health improvement plan. Over the course of 2018, the Public Health Council was able to work with these hospitals, and others in our region, to complete a joint community health needs assessment. As we move into 2019, we continue to work together to explore more deeply what the assessment results tell us and how we can share in the work of making a difference.

The Greater Upper Valley Works Together

All nonprofit hospitals in American must complete community health needs assessments and community health improvement plans. These plans identify priority needs in hospital service areas and direct the hospital’s community benefit investment in their communities. However, our region has taken this work to a new level, by combining the resources of six health care institutions in the region to complete a large scale assessment. These institutions include Dartmouth-Hitchcock, Alice Peck Day Memorial Hospital, Visiting Nurse and Hospice for VT, Mt. Ascutney Hospital and Health Center, Valley Regional Healthcare, New London Hospital. The purpose is to identify community health concerns, priorities and opportunities for community health and health care delivery systems improvement. By gathering the same data across a large region, we are able to see similarities across our many communities, identify differences (or disparities), and coordinate strategies to address concerns.

Upper Valley Community Health Needs Assessment

The Upper Valley Community Health Needs Assessment generated for the Dartmouth-Hitchcock and Alice Peck Day primary hospital service areas covers 19 municipalities in Vermont and New Hampshire, with a total resident population of 69,467 people. Data came from surveys of community residents; a direct email survey of key stakeholders and community leaders; a set of community discussion groups; a behavioral health needs assessment conducted in 2016; and a review of available demographics and health status indicators. The New Hampshire Community Health Institute conducted the survey, data analysis, and report generation. Throughout the process, they were careful to focus on vulnerable and disproportionately served populations in the region. We wanted to ensure all populations that could experience limited access to health-related services or resources due to income, age, disability, and social or physical isolation were seen in the results.

Taking It Back to the Community

Beginning in January 2019, the Public Health Council has been working with partners at Dartmouth-Hitchcock, Alice Peck Day Memorial Hospital, Visiting Nurse and Hospice for VT to share the results with members of our communities and get input into where we go from here. In January, we co-hosted two Community Health Improvement Summits open to all community residents to review the priorities emerging from the recent results and share thoughts about what the results tell us, what opportunities we have to address them, and what strategies we might help. In February, we took advantage of a training co-sponsored with the Special Needs Alliance, Cultural Competence with Disabilities, to address the priorities from the perspective of people living in our communities with disabilities.

Community Health Priorities from the 2019 Upper Valley Community Health Needs Assessment

Capturing Input from Our Communities

Notes from all the discussions held so far are available for review. You will find links to these notes below.

Community Summit Notes from January 18 @ 5:30 pm (Dwinell Room) and Public Health Council Partner Meeting (open to public), January 18 @ 9:00 am (Tracy Hall)

Mental Health Services
Substance Misuse
Child Abuse and Neglect
Primary Care Services
Domestic Violence
Health Care for Seniors

Discussing issues of child abuse and neglect with Nancy Bloomfield, of The Family Place, as a subject matter expert.

Forum at Cultural Competency with Disabilities Training, February 8 (Kilton Library)

Mental Health
Domestic Violence/Child Abuse and Neglect
Primary Care Services

Over the next several months, we will continue to present results to community groups, looking for insights into what work the results tell us to do. Each of the organizations collaborating on this work will develop their own Community Health Improvement Plan. Most of these plans will be completed by the end of 2019 or soon thereafter.

For more information about the community health improvement planning process or ways you can participate, please contact Alice Ely at the Public Health Council.