Trump Budget Cuts Hobble Antismoking Programs

New York Times

15-05-2025

Students at Wyoming East High School in West Virginia's coal country had different reasons for joining Raze, a state program meant to raise awareness about the health risks of tobacco and e-cigarettes.
Cayden Oliver, 17, grew up around generations of people who smoked and vaped, and he wanted to make his own choice. Nathiah Brown, 18, was struggling to quit e-cigarettes and showed up for moral support. Kimberly Mills, 18, wanted to prove that even though she had been a foster child, she would defy the odds.
This high school's program cost West Virginia less than $3,000 a year and was meant to protect teenagers in the state that has the highest vaping rate in their age group. It fell prey to U.S. government health budget cuts that included hundreds of millions of dollars in tobacco control funds that reached far beyond Washington, D.C.
At the high school, students pack into stalls in the school restrooms, sneaking puffs between classes. 'It's bad now,' said Logan Stacy, 18, a member of the Raze group. 'Imagine what it will be like in two years.'
Experts on tobacco control said the Trump administration's funding cuts would set back a quarter-century of public health efforts that have driven the smoking rate to a record low and saved lives and billions of dollars in health care spending. Still, the Centers for Disease Control and Prevention estimates that nearly 29 million people in the United States continue to smoke.
The decimation of antismoking work follows a year of lavish campaign donations by tobacco and e-cigarette companies to President Trump and congressional Republicans.
During budget hearings on Wednesday, lawmakers expressed concerns about the cuts to Health Secretary Robert F. Kennedy Jr. At least one pending lawsuit could reverse them.
So far, though, the budget reductions have sliced across several federal agencies and every state, more than 20 former federal and current state tobacco control staff members said in interviews.
At the Food and Drug Administration, officials fired many staff members who levied fines on retailers that sold tobacco to minors or marketed illicit vapes. Some scientists who were experts in addiction and toxicology lost their jobs. The agency also fired the team that wrote proposals to ban menthol cigarettes and to reduce the amount of nicotine in cigarettes, efforts the Trump administration has abandoned. Most staff members who review new tobacco products for approval kept their jobs.
The National Institutes of Health canceled grants to researchers examining tobacco use among certain groups, including L.G.B.T.Q. youths, Black people and young people. One $14 million grant sought to determine the most effective messages to persuade teenagers not to vape.
The White House shuttered the Office on Smoking and Health at the C.D.C., a unit that traced its roots to a landmark report by the surgeon general in 1964 that first linked smoking to lung cancer. The office distributed nearly $100 million of its $260 million budget to the states.
It supported an antismoking ad campaign called Tips From Former Smokers, which featured people who were often visibly debilitated from tobacco-related disease. Those ads drove calls to a national network of help lines staffed with trained coaches. The C.D.C. also funded youth initiatives like the West Virginia Raze program across the United States.
State health departments have already received notices that no funding will come from the C.D.C. New York State's health officials had to lay off 13 tobacco control staff members, and in North Carolina, nine of 12 tobacco staff members were let go, according to a department spokeswoman.
The help lines for quitting smoking in Connecticut, New Jersey, Virginia, West Virginia, Washington and Tennessee relied on the C.D.C. for half or more of their funding, according to state officials and Thomas Ylioja, president of the North American Quitline Consortium, which is based in Phoenix.
Those dollars paid for staff members to counsel callers and provide free smoking cessation aids like nicotine patches, gums or, in some states, medications. States are now trying to figure out how to keep up with thousands of calls and pay for the supplies.
Mr. Kennedy has made chronic disease his top priority, taking aim at artificial colors in food and unproven theories about vaccines. Yet decades of data show that smoking is a top driver of cardiovascular disease, cancer and premature death.
'Ultimately, the casualties of these cuts are the American people and their wallets,' said Brian King, the executive vice president at the Campaign for Tobacco-Free Kids, who was forced out as the F.D.A. tobacco division chief on April 1. 'The math is very simple: Less tobacco control work equals more tobacco-related disease and death.'
The Department of Health and Human Services did not directly respond to questions about the elimination of the C.D.C.'s antismoking work, but said that the F.D.A. was continuing to enforce tobacco laws.
'H.H.S. remains committed to reducing tobacco use, preventing youth addiction and protecting public health,' Andrew Nixon, a department spokesman, said in an email. 'Functions are being streamlined — not abandoned — to ensure continued impact in a tighter fiscal environment.'
But some public health experts fear a reversal of progress: The rate of smoking cigarettes has reached a 75-year low among adults, and the rate of youth vaping has hit a 25-year low.
'We're at an inflection point,' said Mitch Zeller, a former director of the F.D.A.'s tobacco center. He likened the cutbacks to 'kneecapping' the agencies' mission.
The tobacco industry, meanwhile, has heavily supported Republican politicians and introduced new products. In 2024, Reynolds American, which makes Newport cigarettes and Vuse vapes, gave $10 million to PACs supporting President Trump and $4.6 million to support Republican leaders in Congress.
Altria, the maker of Marlboro cigarettes and NJOY vapes, contributed $6.4 million to congressional Republicans and $1 million to the Trump inaugural committee. Breeze Smoke, a vape company, and the Vapor Technology Association each contributed at least $1 million to the inauguration.
The F.D.A. has the authority to review new tobacco products, under a standard that's meant to help cigarette smokers make the transition to less harmful products and to avoid luring a new generation of tobacco users.
New offerings from the $50 billion U.S. tobacco industry include IQOS, a penlike heated tobacco device that was being introduced in Austin, Tex., and Fort Lauderdale, Fla., after reaching $11 billion in sales in 2024, so far mostly in Japan and the European Union. Oral nicotine pouches, like Zyn, are used by a small but rapidly growing percentage of teenagers.
The students in West Virginia knew they could go online or take a quick drive up the Coalfields Expressway to buy the illicit e-cigarettes that have flooded the country. Green apple, peach and strawberry slushy and jam flavors are popular, Mr. Brown said.
Teenagers also like vapes that can be easily hidden from teachers and passed off as a pen, a highlighter or a smartwatch. He said some students vape in class — and blow the vapor into their sleeve — to seem cool. Others, he said, are addicted.
'I wish we could make the kids understand this is not a 'gotcha' sort of thing,' said Christy Cardwell, the adult adviser of the Raze program and an English teacher at Wyoming East High School. Instead, she said, 'this is a 'we want to get it from you and stop you from doing this before you make such a destructive decision that you can never take it back.''
One recent study that followed people for four years found that those who used e-cigarettes exclusively were twice as likely as others to develop COPD, or chronic obstructive pulmonary disease.
'That was pretty shocking and was discussed quite widely,' said Sven Eric Jordt, a tobacco, cancer and physiology researcher at Duke University.
The strategies federal officials have used to identify smoking trends and, more recently, vaping behavior are among the many efforts eliminated by the Trump cutbacks.
The National Youth Tobacco Survey, an annual study by the F.D.A. and C.D.C., is expected to be conducted this year but not in following years, Mr. Zeller said. The survey has tracked the rise and fall of youth e-cigarette use, listing teenagers' favored brands and flavors.
The F.D.A. ran a campaign called the Real Cost, which featured award-winning anti-vaping ads that reached young people on YouTube and gaming platforms. Researchers estimated that the campaign prevented about 444,000 young people from taking up vaping in 2023 and 2024.
Most of the staff members who coordinated the campaign were fired recently, according to Mr. King.
The lack of survey data will limit the ability of experts to identify trends and rising popularity of the latest products, and to figure out how to combat the latest or most harmful. 'We will, as a country, basically be flying blind in terms of what nicotine and tobacco products people use very soon,' Dr. Jordt said.
The Trump administration also fired C.D.C. staff members who ran the long-running ad campaign featuring people who were weakened by smoking-related illnesses. The ads sent viewers to help lines that have been credited by C.D.C. researchers with helping one million people quit smoking.
The public service ads that have already been purchased are expected to end after September, former C.D.C. staff members said. Since 2012, the ads had concluded with a prompt for people to call a help line, but now direct people to a C.D.C. website.
Mr. Brown, one of the students at Wyoming East, was relying on the Raze program to help him quit vaping, and said he was frustrated by being unable to stop for good. 'Walking down the hall, I'm out of breath, ' he said.
Another student, Mr. Oliver, said he had helped a couple of friends quit e-cigarettes for good, and was disappointed that Raze was folding.
'This program means a lot to me,' he said. 'I try to help people see the big picture.'