Unsafe at Any Age

The legal product, that when used as directed, will kill you.

ID 156633320 (c) David Fowler| Dreamstime.com

On January 16, 2025, the Food and Drug Administration (FDA) published a press release announcing it had approved a new tobacco product (FDA, 2025). In the press release, it hastened to say,

While today’s actions permit these specific tobacco products to be legally marketed in the U.S. to adults 21 and older, it does not mean these tobacco products are safe, nor are they “FDA approved.” There is no safe tobacco product; youth should not use tobacco products and adults who do not use tobacco products should not start (para. 7).

The FDA also promised to “monitor youth use and company’s compliance with marketing restrictions” (FDA, 2025).

The tobacco companies promise to comply with restrictions? Seriously, does anyone else remember the 1994 congressional hearing where all seven of the CEOs of the existing tobacco corporations raised their hands and SWORE that they believed nicotine was not addictive?

Secret internal company documents later demonstrated all seven CEOs lied.

Why should we believe any tobacco company? Their sole job is to replace the over 1,300 people their products kill every day—just in the United States. They are going after our kids because they want them addicted to buy their lethal product. In fact, per the American Lung Association (ALA), “Each day, more than 1,200 kids under 18 try their first cigarette and 60 kids become new, regular smokers” (ALA, 2025, para. 26). In 2022, “The five largest cigarette companies spent over $21.9 million dollars per day marketing their products” (ALA, 2025, para. 28).

Do not tell me this is an individual choice that doesn’t harm other people. When I worked at the American Medical Association in the 1980’s, it was common practice for the tobacco companies to hire shills to sit in the audience of any anti-tobacco related program. These shills (one claimed to be a radiologist at an event I ran) asserted using tobacco was an individual choice and that we should not be legislating people’s right to choose. It was pure propaganda and still is. Tobacco impacts our families, our communities, our healthcare systems, and our country.

Tobacco kills more people than alcohol and opioids. So why do we ignore this killer addiction? Because it’s legal.

The CDC is no longer updating its tobacco-related mortality data. The page is archived and provided for “historical purposes”. However, in 2018, the Centers for Disease Control and Prevention (CDC) reported that, each year “Smoking-related illness in the United States costs more than $300 billion…with nearly $170 billion for direct medical care for adults, more than $156 billion in lost productivity, and $5.6 billion in lost productivity due to secondhand smoke exposure”. To put this in dollars closer to home, each smoking employee costs an employer approximately $6000 per year (Berman, Crane, Seiber, & Munur, 2014). More recently, the ALA (2025) doubled the cost of smoking and estimated that it costs the “US economy $600 billion in direct health care costs and lost productivity every year” (ALA, 2025, para. 27).

Each year in the U.S., almost half a million people die from the harmful effects of tobacco (ALA, 2025). These are 2021 COVID level mortality numbers—yet we aren’t panicking. But wait, there’s more! Tobacco causes more than just one disease; it is incontrovertibly and causally linked to:

• Cancer: lung cancer and cancers of the lip, pharynx and oral cavity, esophagus, stomach, pancreas, larynx, cervix uteri (women), kidney and renal pelvis, bladder, liver, colon, and rectum; also, acute myeloid leukemia;

• Cardiovascular and metabolic diseases: coronary heart disease, rheumatic heart disease, pulmonary heart disease, and other forms of heart disease PLUS diabetes, cerebrovascular diseases, atherosclerosis, aortic aneurysm, and other arterial diseases;

• Respiratory diseases: pneumonia, influenza, tuberculous, chronic obstructive pulmonary disease (COPD), emphysema, bronchitis, and chronic airways obstruction;

• Perinatal deaths: stillbirths, prenatal conditions, and sudden infant death syndrome (SIDS);

• Residential fires with deaths from smoke inhalation and burns; and,

• Secondhand smoke which can cause any of the above, including lung cancer in non-smokers (Buchbinder, Shanks, & Kite 2019, p. 436-437).

Who is still using tobacco products in 2025? With all the information available about the harm of smoking and using tobacco products, the warning labels, and the taxes on cigarettes¹ one might ask who is still using this toxic plant? The American Lung Association (2025) offers some insights:

Uninsured Americans smoke at a rate close to two times higher (16.8%) than people with private insurance (8.4%);

Nationwide, the Medicaid program spends more than $68.3 billion in healthcare costs for smoking-related diseases each year – more than 20.3% of total Medicaid spending;

Anxious and depressed people are more likely to smoke than those not diagnosed with either;

Kids are picking up tobacco; 5.4% of all middle-school kids have tried tobacco products;

One in ten (10.1%) high school students in the U.S. use at least one tobacco product;

Among youth e-cigarette users, flavored e-cigarette use was 87.6% among middle and high school users; and,

The prevalence of cigarette smoking and e-cigarette use among adults did not change from 2022 to 2023.

Analysis of data from the 2021 National Health Interview Survey (NHIS) of U.S. citizens 18 years old or older adds some additional insights (Cornelius et al., 2023). These researchers found: “tobacco product use was higher among… men; persons aged <65 years; persons of non-Hispanic other races; non-Hispanic White (White) persons; residents of rural (nonmetropolitan) areas; financially disadvantaged; lesbian, gay, or bisexual (LGB) persons; those uninsured or enrolled in Medicaid; those whose highest level of education was a general educational development (GED) certificate; who had a disability; and who had serious psychological distress” (Cornelius et al., 2023, para. 1-2).

To summarize, adult users of tobacco products are more likely to be male, rural residents, disabled, poor, uninsured or enrolled in Medicaid, LGB, anxious and/or depressed, and have a GED as their highest level of education. Kids who use tobacco products are picking up the habit in middle school and prefer flavored e-cigarettes.²

Tobacco use is the leading cause of preventable death in the U.S. As we watch cuts to healthcare funding, it is likely that programs developed to help people to quit smoking or to keep children from starting to use tobacco products will be jettisoned. These programs not only save lives, they save money. A study of California’s anti-smoking efforts found the state had a return on investment of 231 to 1 in direct CMS medical expenditures (Lightwood, Anderson, Glantz, 2023). If we cannot prevent these cuts on the importance of saving lives, perhaps we can get them to understand saving money.

Remember, big tobacco needs to keep making their profits by replacing the people their product kills with new consumers.

Make no mistake. They are going after our kids.

So what can you do? You can educate your kids and grandkids. Back in the day when smoking was still permitted in restaurants, a man was smoking at another table a bit away from us. My four year old son stood on the banquette, pointed at the man, and shouted, “Mommy! He’s going to die!” I said yes, he is, and urged my son to sit. You may not want your children to be this dramatic, but you can tell them about the dangers of smoking. As an RN, I also volunteered for health fairs in my son’s schools to talk about healthy behaviors.

In addition to talking to your kids and their friends, there are a number of organizations you can support and work with to work on youth anti-tobacco efforts. Herewith is a list of some. It is not exhaustive, but it will get you started.

The FDA has a plan. For now. The website is being “reorganized”, so grab it while you can. The page is current as of January 6, 2022.

The American Heart Association has an action list for individuals, including making your home smoke-free and quitting tobacco, if you use it. There are links to tips and resources for families.

The American Lung Association Youth & Young Adults in Action This has links to youth groups that are taking action to prevent youth smoking. Does your kid have a paper due on an important topic on, let’s say, tobacco? Check out this webpage for lots of resources.

The Campaign for Tobacco-Free Kids is a non-profit organization that has been around for over two decades. They work at local, state, and federal levels in the U.S. and in other countries that have been targeted by big tobacco for new customers.

Day of Action 2025|Take Down Tobacco Save the date: April 1. 2025 and share the news. There will be events you can help support or promote on social media.

There are lots of video PSAs (old ones) about not smoking that are terrifying. Just go on YouTube and search for Marlboro man anti-tobacco or CDC anti-smoking commercials if you want to see what I mean. I want to close with one that’s upbeat (pun intended).

References for this post along with other resources

Ahmad FB, Cisewski JA, Anderson RN. (2022). Provisional mortality data — United States, 2021. MMWR Morb Mortal Wkly Rep, 71:597-600. DOI: http://dx.doi.org/10.15585/mmwr.mm7117e1.

American Heart Association. (2025). How to keep kids and teens from smoking and vaping. https://www.heart.org/en/healthy-living/healthy-lifestyle/quit-smoking-tobacco/how-to-keep-kids-and-teens-from-smoking-and-vaping

American Lung Association (ALA). (2025, January 27). Tobacco facts|State of tobacco control. https://www.lung.org/research/sotc/facts#:~:text=Smoking%20is%20the%20number%20one,over%20490%2C000%20people%20per%20year.

American Lung Association (ALA). (2025). Youth & young adults in action. https://www.lung.org/get-involved/youth-empowerment

Berman, M., Crane, R., Seiber, E. & Munur, M. (2014). Estimating the cost of a smoking employee. Tobacco Control, 23(5),428-433.

Buchbinder, S.B., Shanks, N.H. & Kite, B. (2019). Introduction to health care management, 4th Ed. Jones & Bartlett. https://www.amazon.com/dp/1284156567

Buchbinder, S.B., Shanks, N. H., Buchbinder, D., & Kite, B. (Eds). (2022). Cases in health care management 2nd Ed. Jones & Bartlett. https://www.amazon.com/dp/1284180395

Buchbinder, S.B., Shanks, N.H., Rogers, R.K. (2026). Introduction to health care management, 5th Ed. Jones & Bartlett. https://www.amazon.com/Introduction-Health-Management-Sharon-Buchbinder-dp-1284276104/dp/1284276104

Campaign for Tobacco-Free Kids. (2025). About. https://www.tobaccofreekids.org/about/

Campaign for Tobacco-Free Kids. (2025). Day of action|Take down tobacco. National day of action. https://www.takedowntobacco.org/day-of-action

Centers for Disease Control and Prevention (CDC) (2018, January 17). Smoking & tobacco use: Tobacco-related mortality. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/index.htm

Cornelius, M.E., et al. (2023) Tobacco product use among adults – United States, 2021. MMWR Morb Mortal Wkly Rep. 72:475–483. DOI: http://dx.doi.org/10.15585/mmwr.mm7218a1

Food and Drug Administration (FDA). (2022, January 6). FDA's comprehensive plan for tobacco and nicotine regulation. https://www.fda.gov/tobacco-products/ctp-newsroom/fdas-comprehensive-plan-tobacco-and-nicotine-regulation

Food and Drug Administration (FDA). (16, January 2025). FDA authorizes marketing of 20 ZYN nicotine pouch products after extensive scientific review: Agency will closely monitor youth use and company’s compliance with marketing restrictions. https://www.fda.gov/news-events/press-announcements/fda-authorizes-marketing-20-zyn-nicotine-pouch-products-after-extensive-scientific-review

Lightwood, J.M., Anderson, S., Glantz, S.A. (2023) Smoking and healthcare expenditure reductions associated with the California Tobacco Control Program, 1989 to 2019: A predictive validation. PLOS ONE 18(3): e0263579. https://doi.org/10.1371/journal.pone.0263579

Tobacco Free Florida (2012, July 3). 1994 - Tobacco company CEOs testify before Congress.

1. Taxes on tobacco products work by raising prices and decreasing demand, especially among young people.

2. This is why tobacco companies use flavors their products like bubble gum. Nothing screams we’re coming for your kids like bubble gum!