For decades, the United States made real progress against the leading cause of preventable death: smoking. Strong public policies, sustained investment in prevention and clear public health messaging helped drive smoking rates down from 42.6% in 1965 to 9.1% in 2025, saving millions of lives in the process.
But that progress is at risk. The war against Big Tobacco is not over – and in many ways, it is becoming more complicated and more difficult to win.
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Today, we are seeing warning signs of a retreat in tobacco control efforts and a resurgence of cultural acceptance that demand attention. At a time when more flavored products and products with higher nicotine concentrations are hitting the market, federal agencies tasked with monitoring tobacco usage are being gutted. At the same time, these deadly products are finding their way back into the hands of celebrities and young influencers who are promoting them to their millions of followers. When prevention weakens and accountability slips, dire consequences follow.
The stakes could not be higher. Tobacco is responsible for more than 490,000 deaths annually in the U.S. It causes at least 12 types of cancer and costs our nation more than $600 billion annually in healthcare expenses and lost productivity. Meanwhile, the tobacco industry continues to attract and addict young people via ever more guileful efforts, especially many-colored and many-flavored e-cigarettes.
The science is clear. Government data shows that nearly all youth who use e-cigarettes are using flavored products. At a Senate hearing this spring, both National Institutes of Health Director Jay Bhattacharya and National Institute on Drug Abuse Director Nora Volkow agreed that e-cigarettes are dangerous for children. While youth e-cigarette use has been declining since its peak in 2019, now is not the time to reverse course by authorizing products with flavors like mango and blueberry that clearly appeal to kids.
The public health community has spent decades undoing the consequences of one of the most successful marketing campaigns in history: the glamorization of tobacco. Cigarettes were woven into television, movies and popular culture, portrayed as symbols of rebellion and success. Smoking rates rose – and so did cancer deaths.
A legal settlement in 1998 ended paid tobacco product placement, and when health consequences became undeniable, those images began to disappear from our screens, alongside a growing focus on prevention and cessation. As tobacco products got more expensive and smoke-free laws expanded, smoking rates declined, youth tobacco use dropped, cancer death rates went down, and tobacco products lost much of their cultural status.
Today, however, we are witnessing a troubling reversal.
Television shows, movies, music videos and social media increasingly feature tobacco products. Last year, the Truth Initiative reported that tobacco incidents in movies increased by 70% between 2022 and 2023. Magazines have also welcomed tobacco back into their pages. In May of this year, Vanity Fair published a cover featuring Kylie Jenner lighting a cigarette, while Interview magazine featured images of Hailey Bieber smoking that same month. And it doesn’t stop there.
The playbook is even more dangerous as the tobacco industry can now market to young people through algorithm-driven channels that barely existed a decade ago. These images send a clear message: Tobacco use is once again tied to status and celebrity. Research consistently shows that exposure to tobacco makes young people more likely to initiate smoking. The tobacco industry understands this. It always has.
This reglamorization isn’t exclusive to cigarettes. Big Tobacco has expanded into a new generation of products. Social media is filled with influencers promoting nicotine pouches and other products to millions of followers. A new category of influencers, often called “zynfluencers,” help normalize nicotine addiction via these pouches for a new generation. Unlike the tobacco advertising of the past, these messages are embedded within entertainment and lifestyle content that is easily accessible to young people.
The tobacco product may be different, but the strategy remains the same.
None of this is occurring in a vacuum. Tobacco control efforts that drove real progress are increasingly taking a back seat. For more than 40 years, the Office on Smoking and Health at the Centers for Disease Control and Prevention provided leadership on tobacco prevention and cessation. Today, the office largely exists in name only, with its staff dismissed. While this office is no longer functioning, Big Tobacco is becoming more aggressive.
Congress can’t afford to ignore these warning signs. Lawmakers must provide sustained funding for evidence-based tobacco prevention and cessation programs and ensure that those funds are used as intended.
Public health progress is not self-sustaining. When prevention efforts are weakened, Big Tobacco fills the void. The reglamorization of tobacco is not an accident. It is the predictable result of a cultural and policy environment in which prevention work has been undermined and tobacco industry marketing has expanded. If we are serious about protecting the next generation from addiction and disease, all of us must recommit to the proven tobacco control strategies that have saved lives for decades.
Shane Jacobson is the CEO of the American Cancer Society and the American Cancer Society Cancer Action Network.
