Tackling Nicotine Addiction at Scale: How Strategic Partnerships and Support Expand What Works
Despite decades of progress, nicotine addiction remains a major, evolving public health challenge that requires more than isolated interventions to make large-scale impact.
More than 26 million people in the U.S. still smoke, with higher rates among military and veteran populations, certain racial and geographic communities, and LGBTQ+ individuals. Newer products like e-cigarettes and nicotine pouches are also reshaping how addiction takes hold, particularly among young people.
For more than two decades, Truth Initiative has partnered across public health, philanthropy, education, and the private sector to expand the scale of evidence-based strategies to reach people early, support them in quitting and reduce disparities.
“Issues like tobacco use that become societal challenges are so complex that no one entity can solve them. Ultimately, we're only as strong as the partnerships that we build,” says Kathy Crosby, CEO and president of Truth Initiative, the nation's largest nonprofit working to break the cycle of nicotine addiction.
The Stakes: Why Nicotine Addiction Demands Action
The impact of nicotine addiction shapes health, behavior, and community well-being in ways that affect multiple sectors. And at an individual level, it can affect skin and hair health, drain finances, strain relationships, and even influence things like dating, pet care, and overall quality of life.
Tobacco use, primarily smoking, is the leading cause of preventable disease and death in the U.S., killing nearly 500,000 Americans every year — more than gun violence, drug overdoses, and car accidents combined. It also costs the U.S. more than $300 billion annually from direct medical care and lost productivity.
Tobacco and nicotine products can pose numerous health risks, especially to those who don’t already use tobacco products, including young people.
Nicotine can harm the developing brain and nicotine addiction is linked to increased feelings of anxiety and depression, particularly among young people. Use of nicotine — often one of the first substances used by young people — may put them at higher risk for addiction to other substances like cannabis and could open them up to riskier behaviors in the future.
Concerningly, use of multiple nicotine products is increasing among those ages 15 to 24, raising the risk of dependence and making quitting more difficult. Data also show that 76% of teens who vape use their device within 30 minutes of waking — a key indicator of dependence.
Addiction risks also rarely occur in isolation. Behaviors like nicotine vaping, cannabis use, gaming, and gambling often overlap and reinforce one another, shaping how prevention and cessation strategies may need to be applied.
The consequences of nicotine use also show up where people live and work. More than 150 million disposable e-cigarettes end up in U.S. streets and landfills annually, and cigarette butts remain the most frequently littered item on beaches and waterways.
Turning Research into Real-World Impact
Translating evidence into measurable change requires interventions that reflect how and why people use nicotine and delivering them in ways that reach those most affected.
Truth Initiative’s work is grounded in ongoing research conducted through its Schroeder Institute that helps identify who is most at risk, what motivates use, and which approaches are most effective in shifting behavior.
"We closely follow the science of addiction, the tobacco landscape, and the policies that shape it," says Crosby. "Just as importantly, we understand the people we serve, their experiences, beliefs, and motivations, and use evidence to challenge misconceptions and drive meaningful behavior change.”
Public education campaigns, school-based prevention efforts, and cessation programs are delivered in partnership with health systems, educators, and community organizations. As patterns of use evolve, so do the interventions, including recent efforts to address nicotine pouches and the intersection of nicotine use and mental health.
Scaling Prevention and Cessation Through Partnership
Research informs programs that have reached millions of people nationwide.
Truth Initiative’s award-winning truth® public education campaign helped drive youth smoking from 23% in 2000 to under 2% today, while contributing to a decade low in youth e-cigarette use. Its Vaping: Know the truth curriculum that addresses both nicotine and cannabis has reached more than 1.5 million middle and high school students, often through partnerships with school districts and youth-serving organizations.
The same evidence underpins Truth Initiative’s EX Program, developed in collaboration with Mayo Clinic to support people trying to quit nicotine. It combines personalized quit plans, text-based support, and a large online community, offering free and confidential access to tools designed to help people manage cravings in real time.
Over the past 18 years, EX Program has supported more than 2 million people in their efforts to quit, including 1 million young people ages 13 to 24. In clinical trials with adolescents and young adults, it increased the odds of quitting by up to 40%, and has also shown effectiveness in helping reduce cannabis use among those who vape nicotine.
What makes it effective, Crosby says, is its focus on both motivation and practical skills. "We give people the will to try, and then we give them the skill to make it through the next five minutes when they're heading into a craving," she says.
Partnerships at the local, state, and national level have been critical to expanding these efforts into workplaces, schools, and communities. Collaborations with organizations and brands like CVS Health Foundation, Kaiser Permanente, Leidos, Vans, the NFL, and Petco to help extend reach and build trust with key audiences.
Policy and Partnerships Shape Health Outcomes
Sustained progress also depends on the broader systems that influence nicotine use. With that in mind, Truth Initiative also works to inform policy and institutional practices designed for population-level behavior change.
Its research has helped draw attention to the presence of illegal e-cigarettes in the marketplace, contributing to increased state-level enforcement. At the federal level, Truth Initiative regularly submits comments on regulatory actions, helping inform policy decisions.
Through its grant programs, Truth Initiative has also supported more than 250 colleges and universities in adopting 100% tobacco- and vape-free policies, reaching more than 2.7 million students, faculty, and staff.
Additionally, through its Culture + Cessation Collective, Truth Initiative works with organizations national and community-based partners like the NAACP and GLAAD to expand access to cessation resources in Black, LGBTQ+, and Hispanic/Latino communities.
Dr. Chris T. Pernell, Director of the NAACP Center of Health Equity, says the partnership “represents a powerful step toward dismantling systemic inequities and reframing quitting as both an act of healing and liberation for our communities.”
The Opportunity to Scale Impact
"People are trying to break away from what they see as stress in their life," Crosby says. "And they end up making their life even more stressful by an addiction that takes their money and their health."
Breaking the cycle of nicotine addiction requires aligning research, programs, and policy — and ensuring they reach people at the scale the problem demands.
While helping millions of people in the process, Truth Initiative has even received an “A” rating from Howard W. Buffett’s Global Impact for how its programs achieve positive public health outcomes.
Funders, community groups, corporate partners and other public health-minded organizations all have a role to play in expanding that impact and broadening access to prevention, cessation, and policy solutions.
With sustained collaboration and investment, these approaches can reach more communities and help reduce the burden of nicotine addiction over time.
This content was paid for and created by Truth Initiative. The editorial staff of The Chronicle had no role in its preparation. Find out more about paid content.
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