Smoking and using tobacco accounts for up to one in three of all cancer-related deaths in the United States. MD Anderson is committed to ending tobacco use.
MD Anderson is a leader in tobacco control, nationwide. We provide services directly to smokers who want to quit, to schools so they can make sure children never start, and to health care providers who want to eliminate tobacco use in their communities. MD Anderson also collaborates with institutions and policy makers across the United States in a movement to end tobacco use, once and for all.
MD Anderson can help you quit smoking
Stopping smoking is the most important thing you can do for your health. Quitting at any age reduces your risk for health problems including cancer, heart disease and stroke. MD Anderson offers services proven to help you stop.
Get more information and resources to help you quit.
Tobacco Research and Treatment Program
If you are a cancer patient, quitting smoking improves your chances of surviving cancer. MD Anderson's Tobacco Research and Treatment Program (TRTP) offers free tobacco cessation services to patients and includes in-person, phone and video counseling. Patients also have access to several tobacco cessation medications.
Tobacco Research Program
MD Anderson has studies available for people who smoke and are interested in quitting, as well as for people who may not be ready to stop smoking yet. Our studies aim to learn more about why people smoke and the best ways to quit.
Visit the program website and complete the online questionnaire.
Tobacco resources for educators
MD Anderson offers several programs for school-age children, teens and young adults.
ASPIRE (A Smoking Prevention Interactive Experience)
ASPIRE is a free online program for teens that tackles the big issues about tobacco, including e-cigarettes, hookah, JUUL and synthetic marijuana.
EX Program
In collaboration with the nationally renowned Truth Initiative, MD Anderson offers a text message quit-vaping service to help anyone ages 13 or older quit tobacco products including vapes. EX Program provides a personalized experience based on age, tobacco product type, enrollment date or quit date. Text VAPEFREETX to 88709 to enroll. People using EX Program can also receive mental health support including mindfulness training and self-care prompts, breathing training, and access to a text-based mental health crisis intervention program called Crisis Text Line.
Tobacco education presentations
MD Anderson health educators visit schools, either in-person or virtually, to arm young people with the facts on tobacco and vaping and provide tools to resist peer pressure. A puppet show is available for younger audiences, which breaks down this complex subject in a fun and entertaining way for kids in kindergarten through 4th grade.
Did You Know?
To date, MD Anderson has provided tobacco education to 1,134 schools across the United States.
Protect your kids from tobacco
MD Anderson can help you keep your child away from tobacco. Find out what to know about vaping, e-cigarettes and other forms of tobacco, plus information on support services available to you and your children.
Learn more to help your family stay tobacco freeTobacco training programs and resources for health care providers
MD Anderson has training available to help you support your patients on their journey to becoming tobacco free.
Project ECHO TEACH is a telementoring service that provides tobacco education, consulting and cessation strategies to clinical providers across the United States.
Certified Tobacco Treatment Training Program. If you want to become a certified Tobacco Treatment Specialist, join MD Anderson’s five-day intensive training program, certified by the Council for Tobacco Treatment Training Programs.
Tobacco Outreach Education Program. MD Anderson offers free continuing medical education materials to help physicians counsel patients on the benefits of smoking prevention and cessation.
Quitline. If you are a Federally Qualified Health Center, collaborate with us to connect your patients to the MD Anderson Quitline. This enhanced service offers patients free access to one-on-one counseling and extended nicotine replacement therapy.
Tobacco Statistics
480K
Americans die from smoking each year
2M
teens report using e-cigarettes in the last 30 days
25%
non-smoking Americans exposed to secondhand smoke
Related News
10 years of EndTobacco
What’s in a name? For MD Anderson’s EndTobacco™ Program, it’s an ambitious commitment to tackling an issue that extends far beyond Texas.
Smoking is linked to up to 30% of all cancer deaths in the United States, according to the National Cancer Institute. This means that ending tobacco use is an integral part of MD Anderson’s mission to end cancer.
Since its launch in 2014, EndTobacco has not only dedicated itself to preventing tobacco-related cancer deaths, but also to improving lives. Its three main goals are to reduce youth tobacco use, lessen secondhand smoke exposure and promote evidence-based tobacco treatment.
Now, to mark EndTobacco’s tenth anniversary, the program’s leaders – Jennifer Cofer, Dr.P.H., Ernest Hawk, M.D., and Mark Moreno – are reflecting on the program’s progress and the challenges still ahead.
Planning for impact
EndTobacco was formed in response to the question ‘How can MD Anderson share information, take action against and limit the harms of tobacco for patients and the public?’
At the program’s inception, a group of experts came up with more than 100 pages of evidence-based recommendations based on findings from MD Anderson and other health entities.
“We thought very carefully about how to organize ourselves to be more impactful in trying to promote a tobacco-free culture at a population level well beyond the walls of MD Anderson,” says Hawk, head of Cancer Prevention and Population Sciences.
Combining tobacco control programming and policy
Since then, the program has taken those recommendations from the page to the public, making progress from the classroom to the Texas Capitol.
For students, MD Anderson offers the ASPIRE initiative, a five-part tobacco education program designed for adolescents and teens. To date, more than 160,000 students across 47 states have enrolled in the program.
At the college level, the Eliminate Tobacco Use Initiative aids universities in creating smoke- and tobacco-free campuses and providing prevention resources and smoking cessation support. Originally launched in Texas, the program expanded nationally in 2018; it has now reached more than 80 colleges.
Training initiatives for health care providers allow the program’s tobacco cessation efforts to reach broader audiences. In 2017, EndTobacco began Texas’ first accredited Tobacco Treatment Training Program, which has since graduated more than 1,300 Tobacco Treatment Specialists. Project TEACH ECHO provides resources for health care providers, while the Tobacco Cessation Clinic Enhancement Program helps clinics improve their existing programming.
EndTobacco also serves as an educational resource to the public and policymakers.
“The cancer and advocacy communities have had a lot of success at the local and state level adopting policies that have had a direct impact on tobacco use,” says Moreno, MD Anderson’s Chief Governmental Relations Officer.
Among these legislative wins are smoke-free workplace ordinances that now protect more than 60% of Texans, and the 2019 Tobacco 21 law, which made it illegal for Texas retailers to sell tobacco products to those under age 21. That policy became a federal law only three months later.
Big wins, new challenges for tobacco control
Between 2011 and 2021, the number of Texas high school students smoking cigarettes dropped from 17.4% to only 3.7%, according to the Centers for Disease Control and Prevention’s High School Youth Risk Behavior Survey.
Cofer, EndTobacco’s executive director, believes that decrease can be attributed to many factors, including EndTobacco. “We are one piece of the puzzle, but we're a strong partner in contributing to that reduction,” she says, noting the importance of both programs and policies in the decline of youth smoking rates.
Unfortunately, ending tobacco means taking aim at a moving target. Today, the EndTobacco team is facing the increasing popularity of products such as e-cigarettes and nicotine pouches. The program is now working to educate youth and young adults about the harms of these products while pushing for policy that drives sweeping change.
The program helped educate policymakers on the legislation that allows the state comptroller to track e-cigarette sales in Texas. Now, it is turning its attention to future policy that will allow the state to tax vape products at the same rate as other tobacco products. It also offers cessation resources that focus on emerging tobacco products, such as the Truth Initiative’s This Is Quitting program, which provides young Texans with free text message support to help them quit vaping.
While newer tobacco products take on different forms and flavors than their predecessors, “nicotine and tobacco are still nicotine and tobacco,” Cofer says. “Our big challenge is to counter what the industry may say and really get the public health and cancer prevention messages out there.”
As it responds to these new challenges, EndTobacco also hopes to continue scaling its initiatives like ASPIRE, the Eliminate Tobacco Use Initiative and the Tobacco Treatment Training Program. The plan is to expand them first throughout Texas, then nationally.
“Taking tobacco use to zero is our ultimate goal,” Hawk says. “We're not there yet, but we've come a long way over the last 10 years partly due to our program and partly due to the myriad of other efforts.”
While much work lies ahead, there is a decade of momentum to build on.
“When we dedicate resources and take intentional steps to identify ways we can address a problem, this is the incredible success that we can achieve,” Moreno says. “It's a wonderful example of teamwork and collaboration culminating in a pretty phenomenal outcome in a very short period of time.”
What to know about nicotine pouches
Nicotine pouches first became available in the U.S. almost a decade ago. Today, they are the second most used tobacco product among high school students, according to the 2024 National Youth Tobacco Survey, with 1.8% of respondents having used nicotine pouches in the past 30 days.
And recently, nicotine pouches have been in the headlines after the Food and Drug Administration (FDA) approved an application allowing some to be marketed in the United States.
So, what are these products, how do they affect health and why are they becoming so popular? To learn more, we spoke with Jennifer Cofer, Dr.P.H., who directs MD Anderson’s EndTobacco™ Program. Read on for six fast facts about nicotine pouches.
Nicotine pouches are a smokeless, spitless product
While nicotine pouches are considered a tobacco product, they don’t actually contain tobacco. Instead, these small white pouches are made of a type of plant fiber called cellulose. Inside each pouch is a blend of nicotine powder, sweetener, flavoring, pH stabilizers and other fillers. Users place nicotine pouches between their lip and gum allowing nicotine to enter the bloodstream. Unlike other tobacco products, there’s no smoking or spitting involved, Cofer explains.
“That's what this new product is touting: that it's a smoke-free alternative,” she says.
Nicotine pouches are linked to health issues
Since nicotine pouches don’t contain tobacco, does that mean they are healthier than other tobacco products? Not exactly. “We wouldn't use the word healthier,” Cofer says.
While nicotine pouches may have fewer ingredients than cigarettes and other smokeless tobacco products, studies have found hazardous substances and possible carcinogens in some nicotine pouches, Cofer says.
Here she shares more about how nicotine pouches impact health.
Nicotine is addictive
Nicotine is harmful and leads to nicotine addiction, Cofer says. This is why she encourages people who have never used tobacco not to start using any tobacco product, including nicotine pouches.
Nicotine disrupts brain development
The human brain develops until age 26. Nicotine use can disrupt this process.
Nicotine impacts the cardiovascular system
Nicotine may affect your heart health if you have or are predisposed to heart disease.
Nicotine may cause oral health issues
Right now, there isn’t data on how nicotine pouches impact oral health. However, Cofer notes that it is possible that nicotine pouches could cause the same types of oral health issues as other smokeless tobacco products, including cavities, gum recession and lesions that could become pre-cancer or cancer.
“Being a new product and not having the exact same ingredients, the verdict is still out. This will be studied for years to come,” she says.
It’s hard to know exactly how much nicotine these products contain
How much nicotine do nicotine pouches contain? The answer is less clear than you might expect.
In the U.S., common nicotine pouch dosages range from 1.5 milligrams per pouch to 12 milligrams per pouch. Internationally, however, studies have been done on pouches containing as much as 47.5 milligrams per pouch.
So, how does that stack up against other tobacco products?
One study found that smoking one cigarette resulted in 11.4 nanograms per milliliter of nicotine in the blood after 30 minutes, while using one 6 milligram nicotine pouch left 17.5 nanograms per milliliter of nicotine in the blood after 30 minutes.
Additionally, nicotine pouches that contain more than 6 milligrams of nicotine may provide users with more nicotine than other conventional tobacco products such as chewing tobacco, Cofer adds.
“Depending on the choice they use, they could have more nicotine than the traditional tobacco products sold currently,” she says.
They aren’t the best choice for tobacco cessation
Because nicotine pouches don’t contain tobacco, they may seem like a good option for people looking to cut down on or quit tobacco products.
In January 2025, the FDA approved a premarket tobacco product application which allows some types of nicotine pouches to be marketed in the United States.
This decision meant that the FDA found the approved nicotine pouches to be a less harmful alternative to cigarettes or smokeless tobacco for adults already using those products. What this approval doesn’t mean, however, is that nicotine pouches are safe for everyone. For young people or people who don’t already use tobacco products, using nicotine pouches could begin a nicotine addiction, Cofer says.
This sentiment is reflected in the FDA’s press release, which says the approval “does not mean these tobacco products are safe, nor are they “FDA approved.””
Another important note is that right now, these nicotine pouches are only approved by the FDA for marketing – not tobacco cessation. If you want to quit smoking or using tobacco products, Cofer recommends speaking to a physician and considering FDA-approved nicotine replacement therapies, such as gum, patches or lozenges.
“If your goal is to be free of the addiction, oral nicotine pouches are not the best way to go,” she says.
New products are designed to attract new tobacco users
While nicotine pouches seem like a relatively new tobacco product, they are far from an unknown one. In fact, Cofer says that many young people are likely already familiar with nicotine pouches.
“If they are between a 13- and a 30-year-old, they've already seen the white pouches in their friends or circles that they hang out with,” she says.
She believes that is due, in part, to the marketing strategies of the giant tobacco corporations. These marketing efforts draw on the same strategies used to market cigarettes and smokeless tobacco products and include social media, print and digital advertising, event sponsorships, incentive plans and giveaways.
So, while the product being sold may be newer, Cofer believes the end goal remains the same: to create a new generation of tobacco users.
“If we want to have a tobacco-free generation, we should also talk about a nicotine-free generation because nicotine is the addictive ingredient found in these tobacco products,” she says.
There’s still a lot we don’t know about their long-term use
In the coming years, researchers will continue to explore the health impact of nicotine pouches, Cofer says.
For now, she hopes that sharing what we do know about their health risks and the addictive properties of nicotine may be reason enough to avoid these products.
“These are not risk-free products,” she says.
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