Breanna Cutright was getting her nails painted purple for junior prom when the email arrived on her phone with bad news. Raze, an anti-tobacco program focused on young people across West Virginia, was shutting down because of federal funding cuts.
“I was trying not to cry,” said Cutright, now an 18-year-old high school senior in the historic coal mining town of Clarksburg, W.Va. She felt panicked — Raze had opened up her world ever since she first got involved in middle school, giving her access to scholarship opportunities, trips to the West Virginia State Capitol in Charleston each fall to bond with other young people involved with Raze, and even the chance to meet with senators on Capitol Hill to talk about tobacco use in schools. Her first thought, she said, was: “What am I going to do from here on out?”
She also felt angry. Starting in eighth grade, she’d seen vaping explode among her classmates. “Suddenly, all your friends are hanging out in the bathrooms and skipping class,” she said. “And then you go into the bathroom and it smells like cotton candy.” In West Virginia, 27% of high school students use tobacco products — the highest rate in the nation, compared to 10% across the U.S. Almost everyone she knew had a family member who’d been affected by lung disease or other health problems tied to tobacco. In the face of those problems, she thought, getting rid of Raze didn’t make any sense: “Why does no one see how important this is?”
Cutright, and the Raze program that meant so much to her, had been caught up in the fallout from last spring’s sweeping cuts at the Centers for Disease Control and Prevention. Health secretary Robert F. Kennedy Jr. justified the changes as necessary to bring the CDC back to its “core mission” of fighting infectious disease.
Many Americans may not have yet felt the impact of those cuts — including the effective shuttering of the Office on Smoking and Health (OSH), a division of the CDC responsible for everything from the National Youth Tobacco Survey to the Tips from Former Smokers television ad campaign. Helping people quit tobacco, or avoid using in the first place, has clear health benefits, but these tend to show up in public health data only in the longer term as disease rates fall. This story traces how the upheaval at the CDC is already filtering down to the lives of everyday people far removed from politics — including teens like Cutright.
The end of OSH created turmoil in the states that relied heavily on the agency for tobacco use prevention funding. West Virginia received 73% of funding for its anti-tobacco efforts from OSH, higher than any other state in the U.S.
Often, people outside the public health field have no idea that OSH was decimated this year, said Thomas Ylioja, head of the North American Quitline Consortium, or “how that’s impacted the ability to plan and implement tobacco control across the nation.” The funding from OSH “was not just sitting in Washington, D.C.,” he said. “It really had impacts at the state level.”
Raze, founded in 2001, was supported by OSH as well as state funding, and administered by the American Lung Association via a state grant. Last year, about 1,558 middle and high school students participated in the program’s more than 50 “crews” — groups run out of schools and other community organizations like 4-H and Boy and Girl Scouts. Each crew led activities that spread the word about the health effects of smoking, e-cigarettes, and other tobacco products. One activity simulated the effects of emphysema by having young people run in place while holding their noses and breathing through a straw. Another invited people to contribute to a paper chain of hospital bracelets, scrawled with the names of friends and family members who had died from tobacco-related disease.
The end of Raze is “devastating for the state,” said Laura Williams, a coordinator for the program at the American Lung Association. The tobacco industry, which says it does not advertise its products to kids and teens, spends an estimated $106 million each year on marketing in West Virginia.
The state has the highest rate of new lung cancer cases in the nation. West Virginia also has the highest rate of adult tobacco use of any state, at 33%, which means that a lot of young people grow up seeing their parents and older siblings using cigarettes, vapes, dip, and chew at home.
That’s what made the peer-to-peer education and events offered by Raze so important, Williams said — they provided teenagers with consistent warnings about the harmful consequences of habits that might otherwise seem natural.
“I hate that it’s probably going to get worse before it gets better,” said Williams. “Because that’s a whole new generation of youth who will be trapped by that tobacco addiction.”
The power of a persistent voice
On a recent November evening, Cutright was at home in Clarksburg, where she lives with her parents, younger brother, and two black cats named Obi and Emmy. On the yellow accent wall of her bedroom hung the guitar she’s learning to play and a psychedelic poster of Billy Strings, the bluegrass artist her dad took her to see for her recent birthday. Above her bed was a vintage illustration of a woman holding a flute along with the phrase, “Practice makes perfect.”
Cutright, who plays the flute and piccolo and spends most of her weekends at band practices and competitions, plans to study music therapy when she goes to college next fall. “I want to help people,” she said, “but I couldn’t be a nurse because I’m too squeamish.”
Helping people has been a part of her life ever since she got involved with Raze. She joined the program in middle school because her favorite teacher, who taught science, was the club’s adviser. But as she saw vaping become more popular among the kids she went to school with each passing year, she realized the seriousness of Raze’s mission. Elf Bar vapes were particularly popular, with their confectionary color palette of pinks and yellows and flavors like “Tropical Rainbow Blast.” On TikTok, she said, “every major influencer had some kind of vape in their hand.”
By high school, “everyone was in the bathrooms 24/7,” Cutright said. Her classmates tucked vapes in the sleeves of their hoodies. A lot of them didn’t know that e-cigarettes were addictive because they contained nicotine, or how they could affect their lungs.
Cigarettes are everywhere in Clarksburg, too. At the local ice cream shop where Cutright has worked since she was a freshman, she often ducks out to the patio to tell customers they can’t smoke there.
Raze wasn’t exactly cool in the minds of some teenagers at her school: A few would make fun of her for giving presentations during assemblies or setting up tables in the cafeteria with information about the harmful effects of tobacco use. She remembers one time when a boy grabbed some Smarties candies from her table and crumbled them, pretending to smoke them like a cigarette. That didn’t faze her much: “I’ve dealt with mean girls and bullies,” she said. She figured there were other people out there she could reach.
Case in point: The same day, one girl lingered behind at the table after her friends had moved on. She didn’t like the way vaping made her feel, she told Cutright, but she was finding it hard to kick the habit. Cutright had a sheet ready with resources that could offer her classmate support. Quitting was hard, she told the girl; it was totally normal if she wasn’t able to do it cold turkey. These things took time.
Cutright’s work with Raze had a ripple effect on her family, too. Her grandfather had been a daily smoker since he was 15. When she was in seventh grade, she handed him a pencil she’d gotten from Raze, with “Tear Down Tobacco” printed on its side, and told him he should really try to quit. He knew how bad smoking was for his health; he’d even had strokes in the past.
Her grandfather agreed to give it a shot, with the goal of kicking the habit by his wife’s birthday in a few months. Now he’s been tobacco-free for years.
“That was a huge thing for me,” Cutright said. She thought, “Well, if he can do it, there’s so many people that I know who can do it.”
Cuts in federal prevention ripple to rural areas
Even with the loss of federal support, there was hope that more state funding could save Raze. Instead, West Virginia’s state legislature reduced the amount of money that went to countering tobacco use. What was left went toward preserving the state quitline — a toll-free hotline that provides counseling to people who want to give up tobacco, and which had also depended heavily on OSH funds.
West Virginia wasn’t the only state with anti-tobacco initiatives that suffered after OSH closed down. New York state’s tobacco control bureau lost 13 staff members, slowing down the local programs that relied on those staff for support, said Vonetta Dudley, director of the nonprofit Public Health Solutions’ program NYC Smoke Free.
Georgia, which got half its tobacco prevention funding from OSH, shut down its tobacco use prevention program in May. Courtlandt Fouche, who led the Georgia department until his role was eliminated this spring, said that tobacco use prevalence among adults in Georgia had dropped from 15% to 12% during his tenure. Now he expects that number will go back up.
“What’s most concerning is how these changes ripple through communities,” said Fouche. “Fewer outreach activities mean less visibility for cessation resources and fewer prevention messages reaching young people, especially in rural areas.”
Those concerns are shared by Sally Herndon, who led North Carolina’s Tobacco Prevention and Control Branch until she retired this summer. North Carolina got 23% of its tobacco cessation budget from OSH, around $2.3 million in 2024. With the agency gone, the state quitline is now North Carolina’s only anti-tobacco initiative that serves adults, Herndon said. The rest of the department’s efforts are focused on youth, which are funded with money from a $40 million settlement with e-cigarette maker Juul.
But just over 13% of adults smoke cigarettes in North Carolina, the top tobacco-producing state in the nation and the home of Camel cigarette maker R.J. Reynolds. Each year, 14,200 residents die from tobacco use. Focusing on youth alone is not enough.
The issue is personal for Herndon. Her mother was addicted to cigarettes and died from COPD, or chronic obstructive pulmonary disease. She remembers that at a family meeting when she was 6 years old, her mother told her and her sister that if they promised not to take up smoking, they would each get a car when they turned 21. That moment sent Herndon on the path to a career dedicated to helping people be free of tobacco.
More recently, she lost her younger sister, who was exposed to a lot of secondhand smoke as an adult, to lung cancer — three weeks shy of her 51st birthday. “Many of my staff had the same experience; they were really mission-driven and dedicated,” Herndon said. Nine lost their jobs in the aftermath of OSH’s closure. “They could have made a lot more money in the private sector,” she said. “They really wanted to do this work.”
Some state quitlines, five of which relied on OSH for at least 75% of their funding, have had to drastically reduce their services this year, said Ylioja of the North American Quitline Consortium. That means scaling back their phone counseling services to a single call for people who want to quit, rather than offering multiple sessions to people seeking help. A number have also had to stop offering free cessation medications like nicotine patches and gum. “We know that when we offer these together with telephone counseling, the chances of somebody quitting is much higher,” he said.
Ylioja and others are holding out hope for the future of OSH and the programs that depend on it. The Senate Appropriations Committee approved funding for OSH in its budget for next year, though the equivalent House committee did not.
OSH’s work supporting local and state tobacco use prevention programs is vital because change “percolates from the bottom up,” said Brian King, the former director of the Food and Drug Administration’s Center for Tobacco Products, who joined the nonprofit advocacy group Campaign for Tobacco-Free Kids after he was removed from his post in April.
“By removing those programs that really have their pulse on what’s happening at the community level, that removes the ability to continue the important declines we’ve seen in tobacco use among kids, and tobacco related disease and death more broadly across the country,” King said.
When politics get personal
Cutright doesn’t consider herself to be particularly political, though she said her town certainly is. Nearly 70% of people in the county voted for Trump in the 2024 presidential election.
But because of her work with Raze, which also led her to become an ambassador for the Campaign for Tobacco-Free Kids, she’s had a lot of exposure to legislators at the state and federal level. This summer, she even spoke at a congressional briefing on the importance of federal funding for tobacco prevention and cessation efforts. “I was a shy, timid person, and I spoke on a panel in Washington, D.C.,” Cutwright marveled. There were a lot of Republican staffers there, according to Herndon, who was also on the panel, taking furious notes.
Now that she’s old enough to vote, Cutright said she’s starting to think about politics more. She’s seen the apparent carelessness with which budgets can be slashed for programs like Raze that were clearly doing good.
“The youth voice is always going to cut [through] more than a teacher or a parent,” she said. She knows that people are dying because of tobacco use every day. “If we know that these things are having a negative effect on our nation, our state, our community, our family, why wouldn’t we take steps to correct it?” she asked. “With youth voices, why would we not encourage you to get involved and have a say?”
In the absence of Raze, Cutright hopes to start a new version of the club at her school. It won’t be the same. But she wants to pass on everything she’s learned about tobacco to younger students who could keep carrying out the work once she leaves. The people she went to school with might not have liked what they were hearing, she said, “but they were hearing it nonetheless … a persistent voice telling them that this is bad and you should not do this.”
Every so often, she’d see proof that the message was getting through. Sitting cross-legged atop her bed in a red American Eagle sweatshirt, Cutright remembered the sense of victory she felt watching another girl in her class interrupt a boy who’d been boasting about vaping to tell him it was bad for his health. “I was like, ‘yes,’” Cutright said, pumping her fists. “It’s working.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
