The ads were jarring: a man with a hole in his throat where his larynx, or voice box, had once been. A woman whose teeth and jaw had been removed after oral cancer. Another woman speaking in a robotic voice, which was altered when her larynx was removed: “I wish I’d never seen a cigarette in my entire life.” A black screen followed, saying she died two days later.

The Centers for Disease Control and Prevention’s 14-year ad campaign, called Tips From Former Smokers, was highly memorable and, research shows, highly effective in motivating people to quit. Last year, though, as tobacco companies gave millions to political organizations related to the Trump administration, the campaign went dark.

There is no definitive evidence linking the donations to the lapse of the ad campaign. But the decision to terminate it was one of several steps the administration has taken to unravel federal government antismoking initiatives that had long had bipartisan support during a time when the administration has delivered significant policy wins to tobacco companies.

The C.D.C.’s Office on Smoking and Health, which managed the campaign and worked with states on smoking cessation measures, has been shut down for more than a year, after its staff was laid off as part of the administration’s government downsizing efforts. While hundreds of other federal health employees were eventually rehired, the smoking office staff members have not been.

Even after Congress restored the office’s funding late last summer, its employees have remained on paid leave as litigation challenging the firings plays out.

In recent weeks, under pressure from Congress, the C.D.C. has given states diminished funding to air ads from the campaign’s archive, but the federal government will not produce new ads or negotiate contracts for them to air nationwide. The ads had prompted millions of smokers to dial state quit lines for help on how to stop smoking. In interviews, people who ran quit lines in several states said that since the ads went off the air, calls have plummeted along with enrollment in programs that offered counseling and nicotine gum and patches.

The abandonment of an effort that was widely regarded as a public health triumph has puzzled antismoking activists who point out that Health Secretary Robert F. Kennedy Jr.’s platform was based on ending chronic diseases, which are a well-known consequence of smoking.

“We find it very ironic in an administration that wants to make America healthy again that we’re cutting all of these resources related to smoking and vaping,” said Nancy Brown, the chief executive of the American Heart Association.

Helping adults stop smoking is one of the most evidence-backed ways to improve the public’s health. Smoking rates in the United States have fallen significantly, to less than 10 percent of adults, compared with 42 percent of adults in the early 1960s. Still, smoking remains the leading cause of preventable death and disease in the country, causing about 490,000 premature deaths each year.

A national survey of adults who smoked from 2012 through 2018 found that the Tips from Former Smokers campaign was associated with more than 16 million people attempting to quit smoking and one million succeeding. During those years alone, the campaign was associated with saving an estimated $7.3 billion in health care costs.

“It’s crazy that they have cut this funding if they really want to save lives and save money,” said Sally Herndon, who ran North Carolina’s tobacco control program until her retirement last year.

Emily Hilliard, a spokeswoman for the Department of Health and Human Services, said in a statement that the C.D.C. “remains committed to tobacco prevention and control and continues to support this priority through outreach, education and surveillance.”

The cuts have come as tobacco companies have aggressively lobbied the administration for policy changes that would likely increase their market share of vaping and other nicotine products.

The New York Times recently reported that Reynolds American, which makes Newport and Camel cigarettes, saw a coveted new federal policy take shape that would allow an entire new class of flavored e-cigarettes onto the market. The initiative was announced just days after a $5 million donation and lunch with President Trump at his golf course in Florida. Executives from Altria, which makes Marlboro cigarettes, were also present.

The new policy was crafted over the objections of Dr. Marty Makary, then the F.D.A. commissioner, who cited it as the reason for his resignation in May. It stunned some public health experts, who say the F.D.A. set aside one of its central authorities: to approve or reject individual products based on their merits.

“It’s very clear this guidance is a gift to the tobacco industry on a silver platter with a side of public health malpractice,” said Brian King, a former leader of the F.D.A.’s tobacco division and executive vice president for U.S. programs of the Campaign for Tobacco-Free Kids.

Opponents of the policy say flavored vapes will introduce young people who have never smoked to nicotine products.

But Ms. Hilliard, the health department spokeswoman, said the F.D.A. was focused on protecting youth and a “science-based review process for tobacco products.”

She added: “Cigarette smoking remains the leading cause of preventable disease and death in the United States. And the agency supports the development of products that may provide less harmful alternatives for adults who smoke.”

The federal cuts to antismoking programs and what some view as lenient new policies represent a reversal of decades of setbacks for tobacco companies under both Democratic and Republican administrations.

The C.D.C.’s shuttered Office on Smoking and Health employed experts on effective tobacco interventions who worked with state health officials to advance antismoking policies such as bans on indoor smoking, higher tobacco taxes and education for parents about e-cigarettes.

The office sent most of its $240 million budget to states each year, but shortly after laying off the staff, in April 2025, the C.D.C. notified states that their annual funding for tobacco control would not be coming.

Many state tobacco control offices cut their own staff as a result, including in New York, Texas and North Carolina. Late last year, Congress reinstated some funding to states that had relied on the C.D.C. office for expertise.

“We know that we really save lives and save money with tobacco prevention and control,” said Ms. Herndon, who until recently led North Carolina’s tobacco control efforts. “But without the training and technical assistance and support from the Office on Smoking and Health, a lot of the newer staff coming along are struggling to know what to do.”

The Tips From Former Smokers campaign went off the air around September of last year, though some larger states such as New York and California continued to run some antismoking ads.

Since then, calls to 1-800-QUIT-NOW lines — which traditionally experience a 30 percent spike in the weeks after an ad campaign — have fallen off significantly.

National data on the quit line call volume was not compiled for the last year after the federal employee in charge was let go, said Thomas Ylioja, the president of the North American Quitline Consortium.

But at Quit for Life, an organization that operates quit lines in 19 states, Guam and Washington, D.C., calls fell by 25 percent in the first half of 2026 compared with the first half of 2025 when the ads were on the air, according to Nick Fradkin, the group’s director of public health strategy.

Officials in other states said calls had fallen off too — by about 45 percent in Texas, 25 percent in California and 18 percent in New York. In Virginia enrollment in the quit line counseling services fell by half from October 2025 through February 2026, said Logan Anderson, a spokesman for the Virginia Department of Health.

In recent weeks, the C.D.C. offered $40 million, down from the usual $65 million, for states to air archived antismoking ads. It is unclear whether new ads will be created.

In North Carolina, at least, “we don’t have the media machine that produced those fabulous ads,” Ms. Herndon said.

As nicotine pouches explode in popularity, tobacco companies are investing heavily in factories in the United States and creating new jobs from Florida to Colorado.

Along with vaping products, the Big Tobacco corporations have seized on the nicotine pouch market as a way to offset the steep decline in domestic sales of cigarettes. Pouch sales are projected to increase to more than $40 billion worldwide by 2033 from $6.9 billion in 2025, according to an analysis by Grand View Research, a market research firm.

Companies are racing to meet the demand, so far investing more than $1 billion in plant production to accommodate the growth. Several states have welcomed the industry’s forays into the latest twists on nicotine products, handing out millions of dollars in tax credits and grants.

But the marketing of nicotine-laden items like pouches, gums and lozenges as another safe alternative to traditional cigarettes has heightened public health concerns. Experts are accusing the tobacco industry of once again deliberately ignoring decades of science that proved the addictive nature of nicotine, and of stoking demand by producing more and more potent varieties.

Reminiscent of Juul and other flavored vaping products that caused a public uproar over teenage consumption, the pouches — tobacco-free “lip pillows” placed between the cheek and gum — have revived warnings that nicotine is highly addictive and can cause a host of conditions, like anxiety and heart arrhythmia. It also threatens a teenager’s still-developing brain, with the potential for affecting behavior and cognitive function, experts say.

Colorado’s governor, Jared Polis, a Democrat, defended his state’s decision to support a new $600 million plant in Aurora, built by Philip Morris International, which is getting $4.5 million in state tax credits.

“We were the first state to legalize marijuana, and now have over 650 dispensaries, have legalized natural medicine and have almost 50 regulated healing centers that offer psilocybin,” Governor Polis said. “Of course, we want safer alternatives to smoking, like Zyn, to be in our state.”

The expansions signal the tobacco industry’s influence in the widening debate over the safety of this new generation of products.

As a major donor to President Trump, the industry has enjoyed a friendlier reception from his administration than they did from other presidents.

In May, the Food and Drug Administration issued new guidance relaxing regulations on nicotine pouches and vapes, a week after the tobacco company Reynolds American donated $5 million to a Trump-backed super PAC.

In late June, the F.D.A. announced that it would allow some products from one brand, Zyn, to be marketed as having a lower risk for some cancers and diseases than cigarettes do.

The pouches also have a prominent booster in Robert F. Kennedy Jr., the U.S. health secretary, who has described pouches as “probably the safest way to consume nicotine” and has acknowledged using them.

Zyn is produced by Swedish Match, a Philip Morris International subsidiary. Its plant in Aurora employs more than 120 people, with plans to expand to 500 employees. In addition, the corporation spent $232 million to build a plant in Owensboro, Ky., and employs 340 workers there.

In the last two years, Reynolds added about 1,000 jobs in the United States, mainly through pouch-making expansion, according to Luis Pinto, a company spokesman.

Altria, which makes Marlboro cigarettes, is producing the brands called on! and on! PLUS in Richmond, Va. The company won F.D.A. approval in December for additional pouch products under a new streamlined program. (Altria was known as Philip Morris, which rebranded in 2008 and spun off international sales to Philip Morris International.)

In December, Swisher, known for Swisher Sweets cigars, announced a $135 million expansion to its Jacksonville, Fla., factory. The company said it expected to add at least 240 jobs to support production of nicotine and caffeine pouches.

And the Swedish firm WiJo is spending $13 million to open its first pouch plant in North America, in Lexington, S.C.

In South Carolina, a large Juul plant in Lexington County that had been awarded tax abatements and grants closed after a federal ban on most flavored vapes in 2020, and politicians said they were glad to see it go. But officials in the same county awarded tax incentives to WiJo for its pouch factory last year.

The American tobacco industry has imported the technology for nicotine pouches from Sweden, often by purchasing that country’s companies. Altria bought Helix Sweden in a series of deals starting in 2019. Philip Morris International bought Swedish Match for $16 billion in 2022.

Garrett Nelson, a senior equity analyst at CFRA, said smoke-free nicotine products like pouches and vapes were generating new revenue for a tobacco industry that had appeared moribund.

“They are now viewed as growth companies, and there is a lot of optimism surrounding products like Zyn and IQOS and other smoke-free products,” Mr. Nelson said in an interview.

Zyn dominates the pouch market.

“If you look at the first quarter, they have 61 percent retail market share in dollar terms of the nicotine pouch market in the U.S. and, on a volume basis, about 56 percent of the market share,” Mr. Nelson said.

While most of Philip Morris International’s revenue continues to come from cigarettes, Zyn has helped the company to nearly double its share price in two years.

But the supposedly safer alternatives to traditional smoking haven’t quelled concerns about nicotine dependence. Symptoms include irritability, restlessness, trouble concentrating, anxiety, and appetite and mood changes.

The American Lung Association has sounded the alarm about pouches becoming the latest avenue for young people to develop an addiction. Citing similar concerns, in May the World Health Organization urged stricter regulation of them. In April, France went further by outlawing nicotine pouches, causing trade tensions with Sweden.

Sam Dashiell, a spokesman for PMI, disputed claims that these products targeted young people, saying pouches were being marketed to the 25 million adult Americans who still smoked cigarettes.

“Smoke-free products are a better option for current legal-age nicotine consumers who would otherwise continue smoking or using other traditional tobacco products,” Mr. Dashiell said.

Pouch proponents often cite the success in Sweden, where smoking rates have dropped considerably, and where the switch from cigarettes to pouches is sometimes called “the Swedish model.”

These products use nicotine extracted from tobacco leaves or synthetic nicotine, which is becoming more common. The pouches contain a powdered mix of nicotine, flavors and other ingredients that dissolve in the mouth.

Pouches are often promoted as more than a cigarette replacement. Some MAHA-aligned health influencers (a.k.a. Zynfluencers) endorse them as a hack for energy and cognitive enhancement. The conservative media host Tucker Carlson, who co-owns a pouch brand, promotes pairing nicotine and caffeine products “for a perfect coffee break.”

Mr. Dashiell said Phillip Morris International does not pay social media influencers to market its pouches.

Dr. Gina Kruse, a professor of medicine at the University of Colorado Anschutz who researches tobacco cessation, said more research was needed to determine the effects of nicotine pouches.

“A lot of the studies that have looked at things like the cytotoxicity of pouches, or the constituents, have come from industry,” she said. “And there’s an urgent need for more independent research to understand what risks come with these.”

She added that a broad concern centers on the potential for pouches to become an “on-ramp” to nicotine dependence, and entice people to move to harmful products like cigarettes. “And there’s certainly concern about flavors appealing to youths,” Dr. Kruse said.

A growing worry is that companies are raising the levels of nicotine, making the pouches more potent and more addictive, said Sven Jordt, a distinguished professor at Duke University School of Medicine.

Dr. Jordt, who is a member of the F.D.A.’s advisory committee on tobacco products, said the highest levels of nicotine in some popular pouches had risen from six to eight milligrams of nicotine per pouch to nine to 15 milligrams. “That’s definitely a quantum jump.”

The stronger pouches include Reynolds American’s Grizzly and Velo Plus, and Philip Morris International’s Zyn Ultra, he said.

“We need to investigate what happens in long-term use, to the whole digestive system,” he said.

“It’s another source of artificial sweeteners, with their own issues,” Dr. Jordt added. “What happens to sleep behavior, what happens to fertility? There have to be studies about oral health — how does it affect gum health?”

Dr. Jordt said Sweden was a cautionary tale: “Now they have an epidemic of oral tobacco use, and I think that might, unfortunately, be the future in the United States.”

The expansion of factories “signals the strategies of these companies for the future,” he said.

Mr. Pinto of Reynolds American said the company planned to spend $3.2 billion by 2030 to make more nicotine products, with pouches driving most of the expansion.