Prevention and tobacco cessation challenges in behavioral health in the era of the affordable care act - aligning healthcare reform and primary prevention: Smoke-free multiunit housing policy and care coordination for low-income vermonters

Table 4: Prevention + Tobacco Cessation – This table will address the need for behavioral health prevention and tobacco cessation to be included in developing new models of care in numerous service settings. This is an opportunity to broaden the concept of population health to a broader population outside of public health.

Tobacco use and secondhand smoke exposure have declined in Vermont since 2000 yet continue to disproportionately affect the state's vulnerable populations, including elderly residents of affordable housing. More lower-income elderly Vermonters are current smokers (9% vs. 4%), have three or more chronic conditions (32% vs. 23%), and are exposed to secondhand smoke at home (20% vs. 9%) relative to higher-income. As a leader in comprehensive health reform while developing a single-payer healthcare system, the Vermont Department of Health (VDH) strives to decrease chronic disease burden and healthcare costs. VDH's comprehensive tobacco program is pairing an initiative to increase smoke-free multiunit housing stock with a specialized elderly residents tobacco cessation system. To reach the target population, VDH works with a statewide coordinated care partnership connecting healthcare systems with affordable housing communities. VDH agreements with several key partners serving lower income populations enabled tobacco control and prevention to be aligned with the National and Vermont initiatives to reduce the impact of tobacco use on chronic disease. Sustainable systems implemented in the first year resulted in 13 of 38 participating affordable housing communities (34%) adopting 100% smoke-free building policies.