The Cost of Federal Funding Cuts Part 2
The Cost of Federal Funding Cuts: Public Health, Tobacco Prevention, and the Future
On April 1, the U.S. Department of Health and Human Services (HHS) announced massive cuts that had a profound impact on public health programs, including tobacco use prevention, cessation, research, and public education programs. Included in the eliminated departments was the Office on Smoking and Health at the Center for Disease Control and Prevention (CDC), and a scaling back of the Center for Tobacco Products at the Food and Drug Administration (FDA). Among other things, the Office on Smoking and Health (OSH) at the CDC funded much of Truth Initiative’s work around tobacco, including SacBreathe’s long-standing annual project that focused on screening popular tv and streaming shows every spring, as part of our Tobacco-Free Screens program.
Example of “Tips From a Former Smoker”
In addition to impacts on our work, other tobacco use prevention programs, education, and research have been eliminated or reduced. Mechanisms such as surveys to measure tobacco use by various demographics, such as the National Youth Tobacco Survey, National Survey on Drug Use and Health, Population Assessment of Tobacco Health, and Behavioral Risk Factor Surveillance System are at risk without continued funding[1]. These tobacco use surveillance systems allow public health organizations to track trends in tobacco use by age and other demographics, track trends in product use and variance, design more effective prevention campaigns, and allow us here at SacBreathe to create educational content for the community on use in our area. Funding for scientific research has been deeply impacted, with grants on health disparities or health equity being terminated and analysis around gender identity and sexual orientation being terminated. Future research funding is in question and academic institutions have had their funding threatened. There have also been financial and staffing impacts to cessation (quitting support) infrastructure, severely impacting the resources available to smokers who want to quit.
The CDC’s OSH department plays a critical role in preventing youth tobacco use and helping adult users quit. The “Tips from Former Smokers” public education campaign features real people sharing their stories of living with long-term health effects from smoking and secondhand smoke exposure. From 2012-2018, the Tips campaign helped over one million people quit and saved an estimated $7.3 billion in smoking-related health costs[2].
OSH is also the only federal agency providing funding and technical assistance for state health departments for tobacco control efforts. All states rely on OSH for some funding, but over 23 states rely on OSH for over a quarter of their funding. Extended furloughs, administrative leave for large numbers of staff, and uncertainty with the future of funding leaves states relying heavily on this funding scrambling. For example, as of May 21, the loss of federal funding from OSH has led to the furlough of the only nine staff working at North Carolina’s tobacco prevention and control program, leaving only three state-level employees to continue prevention efforts for the entire state[3]. The Raze program in West Virginia and the Tobacco Free Rhode Island Network in Rhode Island that worked with youth in schools to help prevent peers from starting to use tobacco products will end[4]. Since OSH’s program began providing tobacco control support and funding in 1999, the percentage of American adults who smoke has fallen from nearly a quarter to just 10.8%, while smoking among high school students fell from 28% in 2000 to 1.4% last year[5] and is extremely effective.
Truth Initiative Infographic visually detailing the impacts to tobacco control infrastructure
The HHS layoffs also placed dozens of staff at the FDA’s Center for Tobacco Products (CTP) on leave. CTP is responsible for overseeing the marketing restrictions and warning labels on tobacco and nicotine products as well as educating the public on the dangers of such products. FDA CTP is fully funded by tobacco user fees collected from domestic manufacturers and importers of cigarettes, snuff, chewing tobacco, roll-your-own tobacco, cigar, and pipe tobacco, and as such, these layoffs do not save taxpayer money[6]. At the CTP, Director Brian King was placed on administrative leave, the leadership of the Office of Science (responsible to the review of tobacco products) was removed, and the office responsible for public education, outreach, and regulatory communications programs experienced layoffs, halting the progress made on the FDA’s The Real Cost campaign, which had prevented an estimated 444,252 youth from starting to use e-cigarettes from 2022-2023[7]. Also at the CTP, staff responsible for issuing warning letters and penalties to retailers selling tobacco products to underage people were laid off (they have been temporarily asked to return)[8], the regulations division was eliminated, the management division was cut, and has paused compliance checks to ensure tobacco products are not sold to minors, and paused review of premarket applications of tobacco products. While it is still unclear what the long-term impact of this reduction in staffing and resources will be, it is clear that the agency has less staff to enforce current regulations and will likely result in more tobacco products entering the market, more youth starting to use tobacco products, and a lack of regulations to manage new products. As Tim McAffee, head of OSH from 2010 to 2017 stated, these staffing and funding cuts are “the greatest gift to the tobacco industry in the last half century.”[9]
Locally, these funding cuts may look a little different. California has long led the charge for smoke-free workplaces, restaurants, and housing. Starting in 1989, California was the first state to establish a statewide tobacco prevention program, authorizing education programs to combat tobacco use, requiring application of current funding and research, and prioritizing programs that demonstrate an understanding of the role of community norms play in influencing behavior change regarding tobacco use[10]. Through this funding, SacBreathe has been able to conduct our Smoke-Free Sacramento Project over the last five years. However, California does receive CDC funding, totaling over $3.5 million for tobacco prevention and control activities in 2024, including funding to the “Tips From Former Smokers” quit line [11]. Incoming calls to the California state quit line increased by an average of 105% during the Tips campaign[12]. California has a long history of prioritizing public health, tobacco prevention, and youth tobacco use education but will be strained to continue to provide high quality services with reduced funding.
Example of CA Quit Line through KickItCA
At SacBreathe, the elimination of the OSH department unfortunately led to an indefinite pause in our Tobacco-Free Screens work, particularly the tv and streaming portion. This program was fully funded through Truth Initiative to review and code all movies that made the Top 10 highest grossing each week, as well as tv and streaming shows popular with youth 15-24 year olds annually, as portions of the work were directly funded through the CDC’s OSH department. On April 1, 2025, no one at OSH was there to answer the phone, continue to execute contracts, or pay invoices. Our work came to an immediate pause, requiring us to let seasonal interns who had just started the hiring process go as well as a long-time staff member. At this time, our work is still indefinitely paused. From 2022 to 2023, there was a 6% increase in tobacco imagery in movies, with the number of tobacco incidents rising by 70%. 23% of movies rated appropriate for youth (G, PG, PG-13) contained tobacco, continuing a concerning trend of exposure among young audiences[13].
Example of “no-smoking” sign data collected from Law & Order: SVU
Through this work, our organization was responsible for reporting violations of the Master Settlement Agreement, which, among other restrictions, prohibited payments to promote tobacco products in media, such as movies[14]. Without our organization screening media through this program, there is no regulatory body overseeing violations. We know through the data we collect and through the experiences that our youth volunteers and staff share with us that the problem is far from over. Youth are being exposed to tobacco imagery more frequently and in more ways than ever before with the rise of tobacco companies marketing their products through social media, YouTube, and other digital platforms. The education component of all tobacco research and prevention programs remains incredibly vital to protecting public health, especially the health of our youth.
We are experiencing the impacts of major cuts to public health funding more indirectly as well – local school districts have scaled back their Tobacco Use Prevention and Education (TUPE) staffing due to funding reductions and numerous partner organizations are also facing serious funding reductions and are laying off staff as a result. These staff and funding cuts at other organizations impact our ability to partner with them, further the reach of our services in the community, and provide the public with education. Particularly, staffing and funding cuts at school districts prevent us from partnering with those districts to provide vital tobacco use prevention lessons to students and families.
The long-term and trickle-down impacts of the massive cuts to HHS may take years to fully reveal themselves. But the trends are not promising if history has taught us anything. These use and prevention programs work at keeping our youth from beginning an addictive habit as well as helping adults quit.
Authors: Ellen Brickey and Micaela Pearson
[1] https://truthinitiative.org/FederalCuts
[2] https://www.cdc.gov/tobacco/campaign/tips/about/impact/campaign-impact-results.html
[3] https://www.newsobserver.com/news/politics-government/article306502121.html
[4] https://www.wvnews.com/news/wvnews/west-virginia-s-raze-youth-tobacco-prevention-program-to-end-july-1/article_dfa155fd-b693-4f3b-a971-db18c346ca15.html
[5] https://www.statnews.com/2025/04/14/cdc-closing-office-smoking-health-called-gift-to-big-tobacco-by-former-osh-director/
[6] https://truthinitiative.org/FederalCuts
[7] https://www.ajpmonline.org/article/S0749-3797(25)00071-6/fulltext
[8] https://www.politico.com/news/2025/04/14/fda-fired-tobacco-enforcers-asked-return-00289985
[9] https://theweek.com/health/tobacco-industry-health-agency-cuts
[10] https://tcfor.catcp.org/index.cfm?fuseaction=opportunities.background
https://www.cdc.gov/tobacco/php/tobacco-control-programs/program-funding.html
[12] https://www.cdc.gov/tobacco/stateandcommunity/state-fact-sheets/index.htm#CA
[13] https://truthinitiative.org/research-resources/tobacco-pop-culture/tobacco-films-2023
[14] https://www.naag.org/our-work/naag-center-for-tobacco-and-public-health/the-master-settlement-agreement/