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Truth Initiative
Truth Initiative
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Truth Initiative (formerly the American Legacy Foundation or Legacy)[1][2] is a nonprofit tobacco control organization "dedicated to achieving a culture where all youth and young adults reject tobacco".[3] It was established in March 1999 as a result of the Tobacco Master Settlement Agreement between the attorneys general of 46 states, the District of Columbia and five United States territories, and the tobacco industry.[4] Truth Initiative is best known for its youth smoking prevention campaign.[5][6][7] Its other primary aims include conducting tobacco control research and policy studies, organizing community and youth engagement programs and developing digital cessation and prevention products, including through revenue-generating models.[8] The organization changed its name from the American Legacy Foundation to Truth Initiative on September 8, 2015, to align its name with that of its Truth campaign.[9] As of 2016, the organization had more than $957 million in assets[10] and a staff of 133 based primarily in its Washington, D.C., office.

Key Information

History

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Truth Initiative was founded in 1999 as a result of the Tobacco Master Settlement Agreement (MSA). The MSA was announced in 1998, resolving the lawsuits brought by 46 U.S. states, the District of Columbia and five territories against the major U.S. cigarette companies, to recover state Medicaid and other costs from caring for sick smokers. The four other states settled separately. The tobacco industry agreed to pay the states billions of dollars in perpetuity, making the MSA the then-largest civil litigation settlement in U.S. history. The states directed that a portion of the money they received from the settlement should be used to establish a national public health foundation dedicated to prevent youth smoking and helping smokers quit: the American Legacy Foundation, now Truth Initiative.[11]

In 2018, the Truth Initiative partnered with Office of National Drug Control Policy and the Ad Council to combat opioid addiction.[12][13]

Activities

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Truth Campaign

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Main article: Truth (anti-tobacco campaign)

Truth Initiative's signature program is its Truth campaign, a youth smoking prevention mass media public education program that has been widely credited with contributing to a significant drop in teen smoking.[14] In 2000, 23% of American 8th, 10th and 12th graders smoked. As of 2016, that figure was 6%.[15] The campaign exposes tobacco industry practices as well as the health effects and social consequences of smoking.[16]

Truth Initiative Schroeder Institute

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Researchers in the Truth Initiative Schroeder Institute publish dozens of peer-reviewed research articles each year with the goal of identifying methods to minimize the harms of tobacco use, measure the effectiveness of interventions and identify best practices for tobacco control.[17] Research is also done to assess the Truth campaign's efforts, both pre-and post-market, including the use of the longitudinal Truth Longitudinal Cohort (TLC) survey of more than 10,000 young people and a continuous tracking study to assess campaign awareness and message receptivity.[18]

In the early 2000s the American Legacy Foundation (as the Truth Initiative was then known) gave around $10 million of the settlement funds it managed to the University of California San Francisco (UCSF) to help it formalize and expand the collection of internal tobacco industry documents that its library already hosted; the collection was then named the Legacy Tobacco Documents Library.[19][20] As of May 2017, the library contained 14.7 million internal documents (nearly 89 million pages) created by major tobacco companies related to their advertising, manufacturing, marketing, sales and scientific research activities.[21]

Community and Youth Engagement

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Truth Initiative provides individuals, coalitions, and organizations information and methods to reduce tobacco use in their communities. The organization trains and educates young people interested in tobacco control and partners with community-serving organizations to reduce tobacco use. This includes a grant program for community colleges and historically black colleges and universities to create tobacco-free campuses.[22]

Examples of youth activism programs include:

  • National Summit on Youth Activism: A training program for high school students that provides activism strategies, media training and approaches to community engagement
  • Youth Activism Fellowship: A year-long training program for young adults that prepares participants to carry out a tobacco control project in his or her community

These community engagement programs are often an "on the ground" extension of the Truth campaign's work. Supporters of the campaign are called upon to support other anti-tobacco issues, such as a 2017 rally outside a Walgreens shareholders meeting in New York that was organized to pressure the pharmacy's board of directors to stop selling tobacco in its stores.[23]

Innovations

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The innovations center within Truth Initiative designs, builds and markets digital smoking cessation and prevention products that are centered around online social networks, text messaging and web and mobile applications. Any revenue generated by the innovations programs helps support other work at the organization.[24]

Examples of these programs include:

  • BecomeAnEX: Created in 2008, BecomeAnEX is a free online resource for individuals who want to quit smoking.[25] Its website hosts a community forum and features blogs written by other smokers and ex-smokers that discuss quit strategies, challenges and successes. In addition to the online community, the site offers cessation tools, counseling, medication information and other cessation support services.[26]
  • EX Program: Launched in 2017 in collaboration with Mayo Clinic, the EX Program is a digital quit smoking program based on BecomeAnEx that health systems, health plans and employers can purchase and offer to their employees and members.[27] In April 2025, EX Program announced its exclusive partnership with Blip, an emerging FDA-approved nicotine replacement therapy (NRT) brand targeting young adults.[28]
  • This Is Quitting: Designed for young adults, This Is Quitting is a mobile app that relays evidence-based text messages and other user-generated content to assist users in the process of quitting smoking.[29]

Leadership

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Staff

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Truth Initiative is led by a senior leadership team with representatives from each of its functional program areas. Headed by CEO and President Kathy Crosby,[30] this team includes:[31]

  • Barbara Schillo, chief research officer, Truth Initiative Schroeder Institute
  • Liz Kenny, chief marketing officer
  • Amanda L. Graham, chief of innovations
  • Tricia Kenney, chief communications officer
  • Anthony O'Toole, chief financial and investment officer
  • Anna M. Spriggs, chief of human resources and administration
  • Amy Taylor, chief of community engagement
  • Robert Falk, general counsel[32]

Board of directors[33]

[edit]
Name Position Role Location
Kathy Crosby CEO and president Director ex officio Truth Initiative Washington, D.C.
Mike Moore Chair Principal, Mike Moor Law Firm, LLC Flowood, MS
Doug Peterson[34] Treasurer Nebraska Attorney General Lincoln, NE
Georges C. Benjamin, MD Director Executive Director, American Public Health Association Washington, D.C.
Nancy Brown[35][36] Vice Chair CEO, American Heart Association Dallas, TX
Herb Conaway, MD Director Member, New Jersey General Assembly Delran, NJ
Mike DeWine Director Governor of Ohio Columbus, OH
James (Jim) Dunnigan Director Representative, Utah State Legislature Salt Lake City, UT
Mary T. Bassett, MD, MPH Director Commissioner, New York City Department of Health and Mental Hygiene New York City, NY
Steve Oyer Director President, i[x] Investments New York City, NY
Josh Stein Director Attorney General of North Carolina Raleigh, NC
Gina Raimondo Director Secretary of Commerce Providence, RI
Giana Darville Youth Board Liaison Oakwood University Alum Memphis, TN
J'Pierre Bolling Youth Board Liaison Georgia State University Brooklyn, NY

Awards and recognition

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In addition to awards for its Truth campaign, including being named among the top 10 ad campaigns of the 21st century,[37] Truth Initiative has also been recognized with the following:

  • 2017 Alliance for Workplace Excellence Health & Wellness Seal of Approval[38]
  • 2017 honoree, Center for Positive Organizations' Positive Business Project[39]
  • 2017 Inc. magazine top 10 Washington, D.C. companies with the coolest perks[40]
  • 2016 North American Effie Index top five most effective marketer[41]
  • 2013 Telly Awards Online Video Silver Telly and Bronze Telly[42]
  • 2012 PRWeek Awards In-House PR Team of the Year honorable mention[43]
  • 2012 Nonprofit PR Awards Annual Publication or Brochure honorable mention[44]
  • 2012 PR Daily Awards Best Annual Report (Print) honorable mention[45]
  • 2012 Hermes Creative Awards Platinum Award - Publications/Annual Report and PR Campaign[46]
  • 2010 Communicator Awards Award of Excellence - Integrated Campaign[47]
  • 2005 Latino Marketing Awards - Public Relations Public Education Program[48]

See also

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References

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[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Truth Initiative

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Truth Initiative is a -based nonprofit organization founded in 1999 as the American Legacy Foundation to reduce youth use, established and initially funded through the 1998 (MSA) between major U.S. tobacco companies and state attorneys general. The MSA directed annual payments from tobacco manufacturers—totaling billions over time—to support anti- initiatives, with Truth Initiative receiving dedicated funding to operate as the first national entity focused on ending addiction among young people. Its mission centers on preventing nicotine addiction in youth and young adults while empowering quitting efforts across all ages through research-driven campaigns and programs. The organization's flagship truth® campaign, launched in 2000, employs aggressive advertising tactics targeting adolescents, emphasizing tobacco industry deception and peer empowerment, and has been associated with measurable reductions in youth smoking initiation and prevalence. Independent evaluations attribute approximately 22% of the decline in U.S. youth smoking rates from 2000 onward to the campaign, correlating higher exposure with lower intentions to smoke across diverse demographics. By 2021, teen smoking rates had fallen to under 2%, a stark contrast to nearly 23% in 2000, amid broader tobacco control measures including the campaign's influence. In response to rising e-cigarette use, Truth Initiative expanded to address vaping as a nicotine delivery threat, launching programs like "This is Quitting" text-based cessation for and anti-vaping media, which studies link to reduced e-cigarette intentions and use among young people. However, its staunch opposition to products including e-cigarettes—framing them as gateways to without endorsing for adult smokers transitioning from combustible —has sparked debate, with critics arguing it overlooks of vaping's lower risk profile relative to and potentially impedes adult cessation strategies. This absolutist approach, rooted in youth prevention priorities, aligns with its MSA origins but contrasts with perspectives in literature.

History

Founding via Master Settlement Agreement

The Master Settlement Agreement (MSA), signed on November 23, 1998, between the attorneys general of 46 U.S. states, the District of Columbia, and five territories and the four largest cigarette manufacturers—Philip Morris, , Tobacco Corporation, and —resolved state lawsuits alleging deception and harm from tobacco use. The agreement obligated the companies to pay states $206 billion over the first 25 years to compensate for costs associated with , while imposing marketing restrictions such as bans on youth-targeted , characters in promotions, and outdoor . A key provision mandated the creation of a national nonprofit foundation to counter influence and support youth prevention efforts. This foundation, initially named the American Legacy Foundation, was established in March 1999 directly as a result of the MSA, with the explicit purpose of fostering a culture in which young people reject use through research, education, and public campaigns. The MSA required participating manufacturers to fund the organization with $300 million annually for the first five years, providing an initial infusion to launch national anti- initiatives independent of state governments. This structure separated the foundation's operations from direct state control, allowing it to operate as a private entity while drawing exclusively from settlement funds derived from sales. The founding reflected a compromise in settlement negotiations, where attorneys general sought mechanisms to ensure long-term beyond immediate state reimbursements, amid concerns that settlement payments might otherwise be diverted to non-health priorities. By 2016, the American Legacy Foundation rebranded as Truth Initiative to emphasize its ongoing mission, though its core funding mechanism remained tied to MSA payments adjusted for inflation and volume. This arrangement has generated scrutiny over accountability, as foundation expenditures are not subject to the same public oversight as state budgets, despite originating from taxpayer-compensatory funds.

Early Anti-Smoking Campaigns (2000s)

The American Legacy Foundation, established in 1999 under the Master Settlement Agreement between U.S. states and tobacco manufacturers, initiated its primary anti-smoking efforts in the early 2000s through the launch of the "truth" campaign on February 4, 2000. This national countermarketing initiative targeted youth aged 12-17, employing provocative advertisements that emphasized tobacco industry deception and the health consequences of smoking, drawing inspiration from earlier state-level campaigns in Florida and Mississippi. The campaign's debut event featured a youth summit in Washington, D.C., attended by over 1,000 teenagers, marking it as the largest youth smoking prevention effort in the United States at the time. Key early advertisements included the "Body Bags" spot in 2000, which depicted teens unloading 1,200 body bags outside a company headquarters to symbolize annual youth smoking deaths, garnering significant media attention and high recall rates among adolescents. The campaign's strategy focused on techniques to foster anti- attitudes, achieving exposure to approximately 75% of U.S. aged 12-17 within its first year through television, print, and outdoor media. Between 2000 and 2002, "truth" messages contributed to an acceleration in the decline of prevalence, with peer-reviewed analyses attributing 22% of the overall drop in rates during that period to the campaign's influence. By 2004, evaluations indicated that the campaign had prevented an estimated 450,000 adolescents from initiating nationwide, based on dose-response models linking ad exposure to reduced initiation odds. Amid broader declines in from 23% in 2000 to around 8% by , the initiative's efforts were complemented by state programs and policy changes, though "truth" advertising demonstrated independent effects on attitudes and behaviors in longitudinal surveys of middle and high school students. Funding constraints emerged later in the decade, with tobacco companies challenging MSA payments earmarked for the foundation, prompting adjustments in campaign scale by 2007-2009 to sustain core .

Renaming and Shift to Broader Nicotine Focus (2010s–Present)

In 2014, the American Legacy Foundation re-launched its flagship truth campaign under the "FinishIt" banner, shifting emphasis toward empowering youth and young adults aged 15–24 to reject entirely and positioning their generation as the one to eradicate . This update responded to evolving tactics and the emergence of new delivery systems, moving beyond traditional cigarette-focused messaging to broader prevention efforts. On August 27, 2015, the American Legacy Foundation legally changed its name to Truth Initiative Foundation (doing business as ), reflecting a strategic pivot to encompass not only combustible but all forms of , with a core aim of fostering a culture where young people reject , vaping, and use. The , announced publicly in September 2015, built on the FinishIt relaunch and aligned the organization's identity with expanded anti- advocacy amid rising youth experimentation with electronic cigarettes. From the mid-2010s onward, Truth Initiative intensified focus on non-combustible products, particularly e-cigarettes, as youth vaping rates surged—reaching 19.6% among high school students by 2019 per national surveys. The organization launched targeted interventions, including the "Vaping: Know the truth" digital curriculum to educate students on e-cigarette risks and support quitting, and text-message-based programs that increased teens' likelihood of quitting vaping by 35% in randomized trials. Campaigns linking vaping to declines demonstrated effectiveness in lowering e-cigarette initiation and use odds among exposed youth. Truth Initiative advocated for federal regulations on all nicotine-containing products, supporting flavor bans and enforcement against unauthorized disposables while endorsing harm reduction for adult smokers unwilling to quit nicotine entirely—but rejecting vaping promotion as a cessation tool without youth safeguards. By 2023, its efforts included peer-to-peer resources and partnerships to address persistent youth e-cigarette use, which affected over 2 million middle and high school students annually. This broader nicotine orientation marked a departure from early 2000s cigarette-centric work, adapting to data showing e-cigarettes' high nicotine concentrations and appeal to non-smokers.

Funding and Governance

Sources of Revenue from Tobacco Settlements

Truth Initiative was established as part of the 1998 Master Settlement Agreement (MSA), a legal accord between major U.S. tobacco manufacturers—including Philip Morris, R.J. Reynolds Tobacco Company, and others—and 46 states, the District of Columbia, and five territories, resolving lawsuits over tobacco-related health costs. Under the MSA's terms, the tobacco industry was required to provide $25 million annually for 10 years (1999–2008) to capitalize a national foundation dedicated to youth smoking prevention, which became the American Legacy Foundation and later Truth Initiative. This totaled $250 million in direct payments from settlement funds, serving as the organization's primary initial revenue source tied to tobacco litigation. These MSA-designated funds were not part of the broader annual payments to states, which continue indefinitely based on cigarette sales volume and totalize over $100 billion to date but are allocated by states for various uses, often not prevention programs. Truth Initiative received no ongoing direct revenue stream from tobacco settlements beyond the initial decade-long endowment; subsequent operations rely on investment returns from that principal, which had grown to over $957 million in assets by 2016. No additional tobacco settlement revenues have been directed to the organization since 2008, distinguishing its funding model from state-level allocations where misuse of MSA payments for non-prevention purposes has been documented.

Financial Management and Expenditures

Truth Initiative Foundation, the primary nonprofit entity of Truth Initiative, derives its revenue predominantly from investment income generated by an endowment initially funded through the 1998 Master Settlement Agreement (MSA) with major tobacco companies, which established the organization with dedicated payments totaling approximately $250 million over the first decade. By fiscal year 2024 (ended June 30), the endowment supported investments valued at $600.76 million, yielding net investment income of $47.01 million, supplemented by $7.13 million from sponsored projects and other sources, for of $54.14 million. Total expenses for the same period reached $104.10 million, with 89% allocated to program services focused on initiatives. Management and general expenses accounted for $11.01 million, reflecting administrative costs including totaling $2.48 million across key officers.
CategoryAmount (millions)
Counter-marketing and public education$64.10
Truth Initiative Schroeder Institute (research)$8.41
Innovations$8.03
and youth engagement$6.39
Program grants$1.00
Other programs$1.07 (communications and miscellaneous)
Total Program Services$93.10
These expenditures prioritize campaigns and , consistent with the organization's mission, while maintaining net assets of $603.75 million as of , , down from historical peaks exceeding $1 billion due to sustained programmatic spending. Financial management is overseen by the Chief Financial and Investment Officer, with annual independent audits ensuring compliance and transparency; the organization holds a four-star rating from for accountability and finance metrics. No significant financial irregularities have been reported in public filings.

Organizational Structure and Oversight

Truth Initiative operates as a 501(c)(3) nonprofit organization governed by an independent board of directors comprising 11 voting members, all classified as independent with no material financial interests in the organization. The board's composition includes directors appointed by the National Association of Attorneys General (two), the National Governors Association (two), and the National Conference of State Legislatures (two), with the remaining five Class B directors elected by the Class A appointees to ensure representation from public health, policy, and legislative sectors. As of 2024, the board is chaired by Mike Moore, a former Mississippi Attorney General principal at Mike Moore Law Firm, LLC, with Nancy Brown, CEO of the American Heart Association, serving as vice chair; other members include state officials such as Utah Governor Spencer J. Cox, Maine Governor Janet Mills, South Dakota Attorney General Martin Jackley, and Indiana State Representative Carolyn B. Jackson (appointed September 2024), alongside academics like Harvard's Howard Koh and public health experts. The board provides strategic oversight, focusing on preventing youth nicotine addiction through behavior change initiatives and policy advocacy, while youth board liaisons, such as Vivian Nartey and Samuel Rose, offer input on young adult perspectives. Executive leadership reports to the board and manages day-to-day operations from headquarters in . Kathy Crosby assumed the role of CEO and President in October 2023, succeeding Robin Koval after board appointment in August 2023; Crosby previously directed the FDA's Center for Tobacco Products. Key executives include Anthony Thomas O'Toole as Executive Vice President and Chief Financial and Investment Officer, Anna M. Spriggs as (appointed February 2024), Elizabeth as Chief Marketing and Strategy Officer, and specialized roles such as Chief Research Officer Barbara Schillo and Chief Legal Officer Robert Falk. Oversight mechanisms include an that reviews annual IRS filings, alongside mandatory policies for (with annual disclosures monitored by general counsel), whistleblower protections, and document retention. These practices, detailed in public IRS disclosures, emphasize independence and accountability, with no reported material diversions of assets or excessive expenditures beyond permissible limits for a public charity.

Core Programs and Initiatives

Truth Campaign Advertising

The Truth Campaign, launched in February 2000 by the American Legacy Foundation (now ), represents the organization's primary mass media advertising effort aimed at reducing youth initiation of use through counter-marketing tactics. Funded initially by the Master Settlement Agreement with companies, the campaign allocated over $250 million in its first three years for nationwide television, print, and outdoor advertisements, supplemented by a "" of experiential events at music festivals and sports venues to engage teens directly. These efforts positioned the campaign as a youth-led rebellion against the , using branding techniques akin to commercial youth marketing (e.g., Nike or Sprite) to foster brand affinity among at-risk adolescents aged 12–17. Central to the campaign's advertising strategy is the dissemination of factual data on tobacco's impacts and industry manipulations, delivered via fast-paced, hard-edged ads designed to provoke outrage rather than . Early executions featured stark statistics, such as annual U.S. tobacco deaths exceeding 1,200 daily or the industry's targeting of with flavored products, often narrated by young spokespeople to emphasize corporate and personal agency. The approach eschewed traditional messaging in favor of anti-industry narratives, including exposés on tobacco expenditures—$12.49 billion by major manufacturers in 2006 alone—to highlight economic motivations behind targeting. Over time, the campaign adapted to digital platforms and emerging products, incorporating , animated shorts, and pop culture tie-ins, such as premiering ads during high-viewership televised events to extend reach and conversation. Post-2010s iterations expanded to address e-cigarettes and vaping, with examples including the 2023 "Toxic Therapy from Your Vape" animated series featuring actor , which linked to worsened and promoted cessation resources like text-based quit programs. Other recent ads, such as the "Big Tobacco Be Like" series, critique industry-driven vaping misconceptions by contrasting them with evidence-based risks, maintaining the core tactic of empowering youth to reject products through informed skepticism. Campaign evolution emphasizes audience to tailor content, with ongoing adaptations based on trends, such as shifting from cigarette-focused outrage to broader critiques amid declining rates (from 23% in 2000 to 2.3% in 2021 among U.S. high schoolers). Strategies prioritize measurable engagement metrics beyond mere ad recall, including brand favorability correlations with lower intentions, while leveraging partnerships like for credibility in cessation-linked messaging.

Research and Policy Analysis

Truth Initiative maintains dedicated research entities, including the Schroeder Institute for Tobacco Research and Policy Studies and its Innovations Center, which evaluate program effectiveness and generate evidence to support tobacco control policies. The organization publishes dozens of peer-reviewed articles annually in journals such as Tobacco Control, Nicotine & Tobacco Research, New England Journal of Medicine, and JAMA, aiming to fill knowledge gaps on nicotine addiction, youth initiation, cessation outcomes, and behavioral influences. These efforts emphasize empirical assessments of commercial tobacco products, including traditional cigarettes and emerging nicotine delivery systems like e-cigarettes and oral pouches, often highlighting youth vulnerability and industry marketing tactics. For instance, analyses document tobacco industry expenditures reaching $9.5 billion in 2021, with 95.6% allocated to retail promotions such as discounts and displays that disproportionately target youth and low-income communities. Key studies focus on youth nicotine use patterns and program impacts. A 2024 randomized published in demonstrated that Truth Initiative's text-message-based quit vaping intervention increased successful cessation rates by 35% among adolescent e-cigarette users compared to controls, marking the first such trial for teens. Another investigation found that exposure to the organization's anti-e-cigarette campaign correlated with significantly lower odds of e-cigarette use intentions and current use among and young adults, based on survey data linking messaging awareness to behavioral outcomes. on vaping's longitudinal effects reported in 2020 indicated that young people who had ever used e-cigarettes faced seven times higher odds of initiating smoking relative to non-users, attributing this to 's role in fostering dependence and gateway progression. Earlier work, including a 2016 review of 686 peer-reviewed e-cigarette studies, underscored risks and regulatory needs, though such syntheses have drawn scrutiny for potentially underweighting comparative data from adult smokers transitioning from combustibles. In , Truth Initiative leverages its research to advocate for measures reducing product access, appeal, and addictiveness, including bans on (which they link to uptake disparities) and caps on concentrations. The 2023 "" report outlined an "endgame" framework shifting beyond traditional control to eliminate industry influence, endorsing comprehensive flavor prohibitions, retail sales restrictions, and expanded cessation infrastructure like the EX Program, which evidence shows boosts quit odds by up to 40%. They track state-level policies and evidence-based prevention tools, such as excise taxes and smoke-free ordinances, arguing these yield geographic reductions in prevalence—e.g., nearly 50% higher rates in " Nation" regions lacking robust implementation. Analyses also critique interference in narratives, positioning flavored e-cigarettes as exacerbating epidemics despite regulatory gaps. While these positions align with settlement-funded mandates prioritizing protection, independent evaluations of similar policies reveal mixed causal impacts on overall adult cessation versus substitution effects.

Youth Prevention and Community Engagement

Truth Initiative operates several educational programs aimed at preventing use among youth and young adults. The "Vaping: Know the Truth" , a free digital resource launched for middle and high school students, addresses e-cigarette risks through peer-to-peer scenarios and includes modules on and misuse; since 2020, over 820,000 students have enrolled, with 96% of teachers and 91% of students reporting satisfaction. The organization also promotes the "This is Quitting" text-based cessation program, where users text DITCHVAPE to 88709 for tailored support; over 640,000 individuals have enrolled since 2019, and randomized trials indicate it increases quit rates among teens. These initiatives build on earlier efforts that correlate with a decline in teen from 23% in 2000 to under 2% currently, though attribution to specific programs remains debated amid broader cultural and shifts. For young adults aged 18-24, Truth Initiative's "Outsmart " campaign integrates the EX Program, a free digital quitting tool shown in studies to boost cessation odds by up to 40%. Complementing these are campus-focused efforts through the /Vape-Free Program, which engages over 230 institutions with peer leadership trainings to foster tobacco-free environments and educate on 's impacts. Such programs emphasize evidence-based strategies to restrict youth access and counter marketing influences, aligning with the organization's broader goal of reversing nicotine addiction trends. Community engagement occurs primarily through youth activism training, empowering participants as "truth" community leaders, college leaders, ambassadors, and digital "instigators" to lead local tobacco control projects, advocacy campaigns, and vape-free initiatives. Truth Initiative supports these via grants, scholarships, and summits that fund university-level prevention and cessation activities, while featured community projects highlight student-driven efforts like policy advocacy and awareness events. Through Truth Initiative Solutions, the organization partners with states and localities to customize programs such as curricula and quitlines, addressing the youth vaping epidemic via tailored interventions rather than one-size-fits-all approaches. These engagements prioritize grassroots action and policy influence, training young advocates to challenge nicotine industry tactics and promote healthier norms.

Cessation Tools and Digital Innovations

Truth Initiative has developed several digital platforms and mobile interventions aimed at supporting cessation, particularly among youth and young adults, leveraging , apps, and online communities to deliver personalized coaching, behavioral strategies, and . These tools emerged from partnerships with institutions like the and emphasize anonymity, accessibility, and evidence-based methods to address barriers such as low quit rates among tobacco users. The flagship youth-oriented program, This is Quitting, launched as a free, anonymous text-messaging service in , targets adolescents and young adults seeking to quit vaping or by sending tailored, age-appropriate messages with strategies, motivational content from peers, and quit tips. By November 2022, the program had enrolled over 500,000 young users, providing interactive support before, during, and after quit attempts. A randomized trial published in August 2024 in demonstrated its , finding that adolescents receiving the intervention via recruitment had higher self-reported vaping cessation rates at three months compared to controls ( 1.77). The program has since expanded to include e-cigarette-specific modules, integrating real-time advice on and alternatives to combustible . For broader adult cessation, Truth Initiative's EX Program (formerly BecomeAnEX), initiated in 2008 in collaboration with the Nicotine Dependence Center, offers a including web-based tools, mobile apps like EX Duo, live chat coaching, and moderated online communities. Participants receive customized quit plans, access to free shipped directly, and data-driven insights to track progress, with enterprise versions scaled for employer-sponsored wellness programs reaching 9.7 million individuals by 2022. In 2025, Truth Initiative introduced EX Program Go, a streamlined version for small to mid-sized organizations, incorporating advanced analytics to reduce healthcare costs associated with . These innovations prioritize user engagement through and social features, though long-term abstinence rates remain challenged by nicotine's addictive nature, as evidenced by general cessation literature. Additional digital efforts include social media-based interventions and live chat expansions, which a Truth Initiative study found effective in broadening treatment reach, particularly for underserved populations. These tools align with the organization's nicotine endgame by focusing on scalable, low-cost delivery over traditional clinic-based methods, though evaluations emphasize the need for ongoing refinement to sustain quit rates beyond initial engagement.

Policy Positions and Advocacy

Opposition to Traditional Tobacco Use

Truth Initiative has consistently advocated for stringent regulatory measures targeting combustible tobacco products, such as cigarettes, emphasizing their role as the primary driver of preventable disease and death. The organization supports policies that reduce the appeal, accessibility, and addictiveness of these products, including nationwide bans on menthol cigarettes, which it argues facilitate initiation and impede cessation due to menthol's cooling effect that masks harshness. In 2022, Truth Initiative endorsed the U.S. Food and Drug Administration's (FDA) proposed rule to cap nicotine levels in combustible cigarettes at non-addictive thresholds, projecting this could prevent 8 million premature deaths over 40 years by diminishing the reinforcing effects of nicotine delivery in smoked tobacco. Central to its opposition is the promotion of evidence-based tobacco control interventions, including higher excise taxes, comprehensive smoke-free indoor air laws, and restrictions on youth marketing and access. Truth Initiative's research underscores that such measures, when implemented robustly, correlate with significant declines in smoking prevalence; for instance, states with stronger policies saw youth smoking rates drop by up to 50% more than those with weaker frameworks between 1999 and 2019. The group also campaigns against tobacco industry tactics that sustain combustible product use, such as misleading claims about reduced-risk alternatives, which it views as efforts to undermine public health by diverting attention from quitting traditional smoking. In pursuit of an "endgame" for commercial , Truth Initiative calls for accelerating the phase-out of combustible products through combined strategies like flavor prohibitions and reduction, arguing these address the inherent addictiveness of traditional that fuels ongoing epidemics in vulnerable populations. A 2023 report by the organization highlighted geographic disparities in , advocating increased in cessation services and in high-burden areas to eliminate combustible use disparities. This stance aligns with its foundational mission, rooted in the 1998 Master Settlement Agreement, to prioritize prevention and cessation of cigarette as the most hazardous form of consumption.

Views on E-Cigarettes, Vaping, and Harm Reduction

Truth Initiative endorses as a strategy for adult smokers unable or unwilling to quit entirely, recognizing that e-cigarettes may offer lower-risk alternatives to combustible cigarettes when users completely switch. However, the organization rejects promoting or tolerating an expansive commercial market for addictive delivery systems, arguing that such markets prioritize industry growth and new user acquisition over . This position stems from concerns over youth initiation, with the group citing data showing 1.63 million U.S. middle and high school students using e-cigarettes in 2024, down from a peak of 27.5% high school usage in 2019. The organization highlights health risks of vaping, including exposure to toxins like and , nicotine's impact on adolescent development leading to , and associations with respiratory issues such as exacerbations. While acknowledging that e-cigarettes deliver fewer harmful chemicals than traditional cigarettes due to the absence of , Truth Initiative emphasizes insufficient long-term safety data and rejects vaping as a population-level solution, particularly amid flavored products' appeal—87.6% of youth users prefer non-tobacco flavors—which they link to sustained daily use rates of 26.3% among youth vapers in 2024. from clinical trials, however, indicates e-cigarettes outperform nicotine replacement therapies in achieving sustained , with biochemical verification showing higher quit rates among switchers, underscoring a causal distinction in harm primarily from avoiding tobacco smoke's byproducts rather than itself. In advocacy, Truth Initiative calls for stringent FDA oversight, including bans on flavored e-cigarettes, marketing restrictions, and expedited removal of unauthorized products, applauding actions like the FDA's denial of over 55,000 flavored applications in 2023. They operate anti-vaping campaigns, such as "Toxic Therapy from Your Vape" launched in October 2023, which portray vaping as exacerbating issues and cycles, and the "This is Quitting" text program, which supported over 780,000 youth quit attempts by 2024. This focus on youth prevention aligns with their broader endgame but has drawn criticism for potentially overstating vaping's absolute risks relative to , where epidemiological data affirm e-cigarettes' role in net for adult smokers without strong evidence of gateway effects to .

Broader Nicotine Endgame Strategies

Truth Initiative defines the "nicotine endgame" as a set of policies and strategies aimed at phasing out commercial and products, excluding FDA-approved used for , to achieve a future free from . This approach shifts focus from traditional measures, such as reducing prevalence through education and taxes, to proactively dismantling the tobacco industry's influence by limiting product appeal, access, and addictiveness. The organization argues that sustained reductions in use require addressing 's inherent addictiveness, drawing on evidence that current products are engineered to maximize dependency, with levels in cigarettes often exceeding 10-15 mg per cigarette, far above therapeutic NRT doses of 2-4 mg. Central to these strategies is advocacy for denicotinization, or capping concentrations in combustible and non-combustible products at minimally or non-addictive levels, such as below 0.4 mg per gram of filler. Truth Initiative endorsed the FDA's July 2022 proposed rule to enforce this standard for cigarettes and certain combusted products, citing modeling studies projecting up to 8 million fewer premature deaths by 2100 if implemented, based on reduced initiation and increased quitting rates among the 28 million U.S. adult smokers as of 2021. A 2019 Truth Initiative survey found 62% of adult smokers would attempt to quit under such a policy, supporting claims of feasibility without broad substitution to unregulated alternatives. Complementary measures include nationwide bans on products, which the group links to 80% of youth e-cigarette use involving flavors as of 2022, arguing flavors drive initiation more than alone. The organization promotes "nicotine-free generation" policies, modeled after international efforts like New Zealand's proposal to prohibit sales to those born after , as part of endgame escalation to prevent future cohorts from accessing any commercial . These are paired with supply-side restrictions, such as higher taxes—aiming for rates that raise prices by at least 50% to deter uptake, given showing a 4% price increase correlates with a 3% drop in prevalence—and limits on retail outlets to reduce and . Truth Initiative's 2023 "" report emphasizes integrating these with quitting infrastructure, like their EX Program, which has supported over 1 million quits since 2019 through digital tools and behavioral support, to mitigate transition harms during phase-out. Critics, including industry-aligned sources, contend such strategies overlook potential black-market growth or displacement to smokeless alternatives, but Truth Initiative counters with evidence from flavor restrictions in , where tobacco use fell 20% post-2019 ban without significant illicit trade spikes. Overall, these tactics prioritize causal reduction in exposure over harm minimization via alternatives, aligning with the group's empirical focus on addiction's root drivers rather than regulated substitution.

Impact and Effectiveness

Evidence of Reductions in Youth

Youth smoking prevalence among high school students declined from 28% in 2000 to 1.4% in 2024, marking a sustained downward trend monitored by the Centers for Disease Control and Prevention's National Youth Tobacco Survey. Similar data from the of Michigan's Monitoring the Future survey indicate a drop from nearly 23% in 2000 to 2.3% in 2021 for past-month use among 8th, 10th, and 12th graders. These reductions represent an approximately 90-95% decrease over two decades, with steeper declines observed after the national launch of the truth campaign in 2000, which built on an earlier pilot program initiated in 1998. Peer-reviewed analyses attribute part of these declines to the truth campaign's countermarketing efforts. A dose-response study published in the American Journal of Public Health found that higher exposure to truth advertisements correlated with greater reductions in youth smoking prevalence, estimating the campaign accelerated national declines beyond pre-existing trends, with attributable reductions of up to 22% in targeted outcomes like susceptibility to smoking. In , where the campaign originated, youth smoking rates fell rapidly from 25.3% in 1999 to 18.0% by 2002, with models isolating campaign effects after controlling for demographics and other factors, suggesting a causal contribution in the program's initial year. Further evidence from longitudinal studies supports reduced smoking initiation linked to campaign exposure. Research in the American Journal of Preventive Medicine reported that truth campaign exposure was associated with a 20% lower relative risk of smoking initiation (RR=0.80, p=0.001) among youth through 2004, based on analysis of national survey data. Youth affinity for the truth brand, measured via brand metrics, predicted larger drops in initiation rates compared to exposure alone, per a study in Health Education & Behavior. These findings, drawn from independent evaluations and national datasets, indicate the campaign's role in fostering anti-tobacco attitudes and behaviors, though broader contextual factors such as excise tax increases and smoke-free policies also contributed to the overall decline.
YearHigh School Past-Month Smoking Prevalence (%)Source
200028.0CDC NYTS
201019.3CDC NYTS (inferred from trends)
20212.3Monitoring the Future
20241.4CDC NYTS

Evaluations of Anti-Vaping and Cessation Programs

A published in on August 7, 2024, evaluated Truth Initiative's "This is Quitting" text-message program for adolescent e-cigarette users aged 15-24. The intervention, which delivered tailored, interactive messages over four weeks, resulted in 37.8% of participants reporting seven-month vaping abstinence, compared to 28% in the control group receiving minimal information—a 35% higher likelihood of quitting. Self-reported outcomes were biochemically verified in a subset, with the study noting higher engagement among those with greater dependence, though retention rates were moderate at around 60%. A 2023 study analyzing weekly survey data from over 5,000 youth and young adults linked higher exposure to Truth Initiative's anti-e-cigarette advertisements—specifically when 65-70% of respondents recalled seeing them—to 14% lower odds of current e-cigarette use in that week. The analysis controlled for demographics and prior use, suggesting a dose-response effect from campaign awareness, though causation was inferred from temporal associations rather than . Peer-reviewed on the "It's Messing with Our Heads" national vaping prevention campaign, launched in , indicated cost-effectiveness at approximately $36 per young person deterred from initiation, based on modeled reductions in susceptibility and modeled lifetime health benefits. For cessation support, Truth Initiative's EX Program—a digital platform combining coaching, community forums, and guidance—has been assessed in pragmatic randomized trials showing up to 40% increased odds of quitting compared to non-users. A 2025 outcome reported 30-day rates of 25-30% among enrollees, mirroring real-world deployment, with sustained linked to higher . An independent analysis of medical claims data from employer-sponsored implementations found a 4.75-fold in the first year, driven by reduced healthcare costs from fewer respiratory and cardiovascular events among quitters. Critiques of these programs highlight potential overemphasis on abstinence without addressing harm reduction alternatives. Harm reduction advocates, including groups like the Consumer Advocates for Smoke-free Alternatives Association (CASAA), argue that campaigns like "This is Quitting" discourage dual users from transitioning to lower-risk nicotine delivery, citing evidence that vaping aids more effectively than behavioral interventions alone in some meta-analyses, though Truth Initiative maintains vaping's youth appeal necessitates total prevention. Evaluations also note self-report biases in abstinence claims and limited generalizability to non-English speakers or severe addicts, with no large-scale trials isolating program effects from concurrent policy changes like flavor bans. Overall, while short-term in youth cohorts is supported by randomized data, long-term population impacts remain subject to factors such as regulatory environments.

Alternative Explanations and Attribution Challenges

While Truth Initiative attributes significant portions of the decline in U.S. youth —from 36.4% of high school students in 1997 to 9.3% in 2015, and further to 2.3% by 2021—directly to its campaigns, such as preventing over 300,000 initiations in 2015-2016 alone, causal attribution faces substantial methodological hurdles. Observational studies linking campaign exposure to reduced initiation risk (e.g., of 0.80) rely on self-reported data and cannot fully disentangle effects from concurrent societal shifts, as randomized controlled trials at national scale are infeasible. Alternative explanations emphasize multifaceted drivers beyond media campaigns. A primary factor is the evolution of social norms, where transitioned from culturally desirable to stigmatized, influenced by broader awareness predating intensified Truth efforts. interventions, including tax hikes, indoor bans, and Tobacco 21 laws raising the purchase age to 21 (implemented variably from 2015 onward), have demonstrably curbed access and use among adolescents sensitive to price and enforcement. The rise of e-cigarettes as a perceived lower-risk alternative may have accelerated declines by substituting rather than complementing use, with some analyses hypothesizing vaping's role in hastening the drop post-2010 despite Truth's opposition to such products. Attribution challenges are compounded by temporal overlaps and in evaluations. Declines began in the late 1990s amid the 1998 Master Settlement Agreement's restrictions on industry marketing, which funded Truth Initiative itself, making it difficult to isolate campaign effects from settlement-driven ecosystem changes. Critics note that while Truth's youth-focused ads contributed to norm shifts, overclaiming ignores generational factors like increased parental and reduced peer , which independently lower initiation odds through social learning dynamics. Comprehensive models, such as those from the CDC, attribute overall use reductions to synergistic evidence-based strategies rather than any single entity, underscoring the improbability of precise .

Criticisms and Controversies

Debates Over Vaping Opposition and Public Health Prioritization

Truth Initiative maintains that e-cigarettes do not constitute a reliable strategy due to the industry's profit-driven promotion, which has contributed to elevated use rates—such as 5.9% of middle and high students reporting past-30-day e-cigarette use in —and insufficient long-term evidence for safety or complete cessation among adults. The organization supports regulated alternatives like FDA-approved replacement therapies to assist smokers unable to quit but opposes lightly regulated e-cigarette markets, citing high concentrations (e.g., via salts) that heighten potential and a documented vaping surge, with high use reaching 27.5% in 2019 before regulatory interventions. Their campaigns emphasize e-cigarette risks, including 's impact on adolescent development, associations with exacerbation, and elevated odds (sevenfold) of progression to combustible cigarette . Critics from perspectives argue that this opposition overlooks empirical evidence positioning vaping as substantially less harmful than , with independent reviews documenting reduced exposure to toxicants linked to cancer, , and cardiovascular issues, alongside e-cigarettes' superior —twice that of nicotine patches or gum—for . Such critiques contend that Truth Initiative's youth-focused prevention efforts, while reducing vaping intentions among young people exposed to their messaging, may inadvertently sustain higher morbidity from combustible by deterring smokers from switching to lower-risk alternatives, prioritizing zero-tolerance nicotine policies over pragmatic mortality reductions. For example, population-level data indicate vaping serves as a viable long-term substitute, potentially displacing combustible use and yielding net gains if transitions are facilitated without youth initiation. These debates underscore tensions in prioritization, where Truth Initiative's absolutist emphasis on preventing all uptake—framed as countering industry tactics akin to historical —clashes with causal analyses favoring graded risk reduction, as e-cigarette lacks the byproducts responsible for most smoking-attributable deaths. proponents highlight that while protection remains critical, conflating e-cigarette risks with those of smoking distorts relative harms, potentially prolonging dependence on deadlier products among the 28 million U.S. smokers as of recent estimates. Truth Initiative counters that industry infiltration of scientific and targeted (e.g., flavors used by 87.6% of vapers) necessitates stringent measures like flavor bans and -only access to avert renormalization of use. Ongoing evaluations reveal unresolved questions on whether prevention-centric strategies maximize overall outcomes compared to hybrid approaches integrating regulated substitution.

Questions on Campaign Effectiveness and Resource Allocation

Critics have questioned the causal attribution of declines to Truth Initiative's truth® campaign, noting that while evaluations estimate it contributed to approximately 22% of the reduction in between 1999 and 2002, broader declines from 23% in 2000 to 2% in 2022 correlate with multiple factors including cigarette excise tax increases, shifts in social norms, and the rise of e-cigarettes as alternatives. These evaluations, such as analyses showing dose-response relationships between campaign exposure and reduced odds, rely on observational data from surveys like Monitoring the Future, which face challenges in isolating campaign effects from concurrent interventions like state-level policies or FDA regulations. Independent reviews, including those published in peer-reviewed journals, affirm associations with anti- attitudes but highlight limitations in establishing without randomized controlled trials at the national scale, prompting debates over whether self-reported exposure metrics overestimate impact amid declining baseline trends. Resource allocation has drawn scrutiny given Truth Initiative's substantial endowment and expenditures, with net assets exceeding $600 million and annual expenses around $107 million as of 2024, including over $2.4 million in and nearly $18 million in other salaries. While the organization directs most funds toward program services such as campaign production, research, and cessation programs like the EX text-based intervention—which a 2024 randomized trial linked to 35% higher quit rates among teen vapers—critics argue that high administrative and personnel costs, alongside a focus on prevention , may divert resources from scalable cessation efforts or partnerships with more cost-effective state programs. The initial $250 million endowment from the 1998 Master Settlement Agreement has grown through investments, yet questions persist about opportunity costs, particularly as similar federal campaigns like The Real Cost have demonstrated returns of up to $128 in societal savings per dollar spent, raising whether Truth Initiative's allocations optimize impact relative to alternatives like price-focused policies that empirical models show prevent initiation at lower per-person costs. Further debates center on the efficiency of digital and branding-heavy strategies, such as the FinishIt campaign, where cost analyses indicate conservative estimates of expenditures but lack direct comparisons to non-marketing interventions like replacement therapies, which meta-analyses suggest yield higher quit rates per dollar in clinical settings. With youth tobacco use now at historic lows, some analysts question the sustained emphasis on anti-vaping extensions of truth®, arguing that resource shifts toward could address adult smoking persistence more effectively, given vaping's role in displacing combustible cigarettes without clear of net gateway effects in longitudinal data. These concerns underscore broader challenges in nonprofit , where endowment-driven spending must balance prevention advocacy against measurable cessation outcomes amid evolving nicotine landscapes.

Influence of Settlement Funding on Objectivity

Truth Initiative, originally the American Legacy Foundation, received initial funding through the 1998 Master Settlement Agreement (MSA), including $25 million annually from manufacturers for 10 years to support national prevention efforts. This allocation, part of the broader $206 billion settlement resolving state lawsuits against cigarette makers for health costs and deception, endowed the organization with substantial resources—estimated at over $1 billion in total upfront and structured payments—to launch campaigns like the "truth" initiative aimed at prevention. The MSA's terms explicitly tasked the foundation with fostering a culture rejecting , embedding an advocacy mandate that prioritizes elimination over potentially less absolute strategies. This funding structure, derived from litigation portraying the tobacco industry as systematically harmful, inherently aligns Truth Initiative's mission with adversarial tobacco control, raising questions about neutrality in evaluating industry-linked innovations such as electronic cigarettes. While the endowment provides financial independence— with net assets exceeding $950 million as of 2016, sustained through investments rather than ongoing industry payments—critics contend it perpetuates a worldview skeptical of harm reduction approaches, as the organization's raison d'être depends on sustained opposition to nicotine products. For instance, tobacco control advocates favoring absolute abstinence argue that MSA-funded entities like Truth Initiative may undervalue evidence of vaping's relative safety compared to combustible cigarettes, potentially to preserve relevance amid declining traditional smoking rates. Independent analyses, including those from harm reduction perspectives, suggest this orientation can lead to selective emphasis on youth uptake risks over adult switching benefits, though peer-reviewed evaluations of Truth Initiative's core anti-smoking campaigns affirm their effectiveness without directly attributing bias to funding origins. Proponents of the model, including officials, assert that the MSA funding insulates Truth Initiative from commercial influences, enabling evidence-based advocacy untainted by profit motives, as evidenced by its role in reducing youth smoking prevalence by correlating campaign exposure with behavioral shifts. Nonetheless, the absence of diversified funding requirements post-endowment has not eliminated perceptions of mission lock-in, where positions on emerging technologies align more with foundational anti-industry litigation narratives than with evolving causal data on comparative harms, such as systematic reviews indicating e-cigarettes pose substantially lower risks than cigarettes. This dynamic underscores a broader tension in : settlement-derived resources empower sustained advocacy but may constrain adaptability to first-principles assessments of risk hierarchies in nicotine delivery.

Leadership

Executive Staff and Key Personnel

Kathy Crosby serves as CEO and President of Truth Initiative, having assumed the role in October 2023 following an announcement on August 15, 2023. Prior to joining, Crosby directed the Office of Health Communication and Education at the FDA's Center for Tobacco Products for 12 years, shaping tobacco policies, health warnings, and equity-focused research; she also held senior roles at the and , where she contributed to launching Truth Initiative's initial truth® campaign. Anna M. Spriggs has been Chief Operating Officer since 2024, overseeing daily business operations and human resources after serving over six years as Chief of Human Resources and Administration. Spriggs joined Truth Initiative in 1999 as its second employee and holds certifications including MSA, SPHR, and SHRM-SCP. Gary Tang was appointed Chief Financial and Investment Officer effective June 9, 2025, succeeding Anthony Thomas O'Toole, who retired after 25 years in the role. Tang brings over two decades of finance and operations experience from nonprofit and private sectors. Other key C-level executives include Elizabeth Kenny as Chief Marketing and Strategy Officer, with extensive experience in the organization's mission; Barbara Schillo as Chief Research Officer at the Schroeder Institute; Robert Falk as Chief Legal and Regulatory Affairs Officer; Amanda L. Graham as Chief Health Officer; Tricia Kenney as Chief Communications and Public Affairs Officer; Amy Taylor as Chief Development and Partnerships Officer; and .
ExecutiveTitleKey Background
Kathy CrosbyCEO and PresidentFormer FDA Director of Health Communication; 30+ years in public health communication.
Anna M. SpriggsChief Operating OfficerJoined in 1999; prior HR leadership; oversees operations and HR.
Gary TangChief Financial and Investment OfficerAppointed June 2025; 20+ years in nonprofit/private finance.
Elizabeth KennyChief Marketing and Strategy OfficerExtensive public health marketing experience.
Barbara SchilloChief Research OfficerLeads research at Schroeder Institute.

Board Composition and Decision-Making

The Board of Directors of Truth Initiative comprises an independent governing body responsible for overseeing the organization's efforts to prevent and and to promote cessation through change and policy advocacy. As of 2024, the board includes state governors, attorneys general, legislators, experts, and business leaders, reflecting the organization's origins in the 1998 Master Settlement Agreement between companies and U.S. states. It also features two board liaisons who provide input but cast non-binding votes.
NameRole/Affiliation
Mike MooreChair; Principal, Mike Moore Law Firm, LLC
Nancy BrownVice Chair; CEO, American Heart Association
Kathy CrosbyDirector Ex Officio; CEO and President, Truth Initiative
Mary T. Bassett, MD, MPHDirector; Director, FXB Center for Health and Human Rights, Harvard University
Ertharin CousinDirector; CEO, Food Systems for the Future Institute
Spencer J. CoxDirector; Governor of Utah
James (Jim) DunniganDirector; Representative, Utah State Legislature
Martin (Marty) JackleyDirector; Attorney General of South Dakota
Carolyn B. JacksonDirector; Representative, Indiana State Legislature (appointed August 2025)
Howard KohDirector; Professor, Harvard T.H. Chan School of Public Health
Janet MillsDirector; Governor of Maine
Steve OyerDirector; Private Investor (serves on Investment, Governance, and Audit committees)
Raúl TorrezDirector; Attorney General of New Mexico (joined 2024)
Vivian NarteyYouth Board Liaison; Student, Manhattan University
Samuel RoseYouth Board Liaison; Student, Spartanburg Community College
Decision-making authority rests with the board, which sets strategic direction, appoints the CEO and president—as demonstrated by its selection of Kathy Crosby in August 2023 following Robin Koval's retirement announcement in February 2023—and ensures fiduciary oversight of the organization's endowment derived from tobacco settlement funds. Specialized committees, including those for , , and , support these functions by addressing , policy compliance, and operational risks. The board's composition, dominated by and governmental figures with ties to litigation, shapes priorities toward stringent anti-nicotine policies, though youth liaisons introduce perspectives from affected demographics.

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