APNA Position: Psychiatric-Mental Health Nursing’s Role in Nicotine and Tobacco Use Disorder Treatment

Introduction

Since the American Psychiatric Nurses Association’s (APNA) 2008 call for changes in practice and education for nurses providing care to patients who use recreational nicotine and tobacco products, many efforts have elevated the quality of nursing care for the treatment of nicotine and tobacco use disorders. For example, nurses now have more options to become informed and trained in evidence-based tobacco treatment interventions. Resources and education on the APNA website provide up-to-date information and resources on nicotine and tobacco use disorder treatment. Through participation in summits and conferences, APNA members have ensured that nurses are represented at multidisciplinary, national-level activities.

From a public health perspective, some progress in addressing nicotine and tobacco use disorders has been realized. Although the rate of overall cigarette consumption has dropped below 10% in the U.S., rates of novel product use, including those that are noncombustible, are on the rise (Agaku, 2026; Stone, Pierce, Dang et al., 2025; Pierce, Luo, McMenamin et al., 2025; Vahratian, Briones, Jamal et al., 2025). Recreational nicotine and tobacco product use can be addictive, and healthcare clinicians increasingly address this chronic, relapsing disease using recovery-oriented language. Terms such as “cessation” are being replaced with “treatment,” and “smoker” is being replaced with person-first language, such as “person who smokes” or “person who uses tobacco.”

There is now a need to review, revise, and re-engage with nursing-delivered, cost-effective interventions grounded in objective evidence. Because psychiatric-mental health nurses are leaders in translating evidence into effective tobacco treatment, and because nicotine and tobacco use disorders should receive care in every clinical setting, APNA developed Nursing Competencies for Treating Nicotine and Tobacco Use Disorders. APNA maintains that these competencies will enhance the practice of all nurses who provide care to persons impacted by nicotine and tobacco use disorders and that their dissemination will improve outcomes in the overall health of the population.

Discussion

The rate of cigarette smoking among U.S. adults continues to drop to historic levels (9.9%), but the use of novel products (e.g., e-cigarettes and vapes, oral nicotine pouches, and heated tobacco products) are on the rise; yet, the rate of deaths per year due to tobacco use remains approximately 480,000/year (Agaku, 2026; US Department of Health and Human Services, 2024). Additional data provide a more nuanced picture of the problem:

• 47.7 million US adults (18.8%) currently use any tobacco product, 31.8 million (12.6%) use any combustible tobacco (i.e., cigarettes/cigars), and 17.8 million (7.0%) use electronic nicotine delivery systems (i.e, e-cigarettes) (Agaku, 2026).
• 24.4% of US adults living in poverty use tobacco products (Agaku, 2026)
• Past year tobacco use or nicotine vaping among different ethno/racial groups is high among US adults: Non-Hispanic American Indian/Alaska native (47.5%); multiple race ethnicity (38.4%); non-Hispanic White (30.4%); non-Hispanic Black (30.1%) (SAMHSA, 2024)
• 39.9% of U.S. adults with any mental illness and 48.0% of those with serious mental illness reported past-year nicotine vaping and tobacco product use, compared to 25.1% without any mental illness (SAMHSA, 2024)
• 10.1% (1.58 million) of high school students reported that they used any tobacco products in the past month; electronic nicotine delivery systems (i.e., e-cigarettes) were the most commonly used product (7.8%) (Jamal et al., 2024)
• Among adults who currently use electronic nicotine delivery systems (i.e., e-cigarettes), 42.2% and 37.1% report former or current combustible cigarette use, respectively; e-cigarette use does not confer any health risk reduction over conventional cigarette use (Erhabor, Boakye, Obisesan, et al., 2023; Glantz, Nguyen, da Silva, 2024)
• Of growing concern are oral nicotine pouches of which 4% of those aged 13 to 27 years of age in the U.S. endorse ever use (CDC Foundation, 2025)

As efforts continue to treat the whole person, those who use recreational nicotine and tobacco products are increasingly seen in a wide variety of clinical and non-clinical settings. A recent scoping review of 53 studies identified six key roles for nurses regarding tobacco treatment delivery: educators, assessors, facilitators, coordinators of treatment collaboration, organizers, and supervisors (Jiang et al., 2024). Nurse-led tobacco treatment interventions can be effective and supporting their training in evidence-based tobacco treatment delivery can optimize success in intervening with individuals (McDaniel, Cooley, Andrews et al., 2024; Lee & Yu, 2025; Ramos-Morcillo, Ruzafa-Martinez, Granero-Moya et al., 2025).

Conclusion

Nurses are the largest sector of the healthcare workforce and are seen as the most trusted profession. Psychiatric-mental health nurses are ideally positioned to be nicotine and tobacco use disorder treatment leaders and champions in clinical practice, education, research, advocacy, policy and guideline development, and as innovators of new treatment methodologies. The American Psychiatric Nurses Association understands that nicotine and tobacco products are addictive, and persons with these disorders should receive care in every clinical setting. APNA also recognizes that many challenges remain in providing nursing education on effective nursing tobacco treatment and that the Nursing Competencies for Treating Nicotine and Tobacco Use Disorders are a first step towards addressing that issue (Essenmacher et al., 2022).

The American Psychiatric Nurses Association takes the position that psychiatric-mental health nurses are champions in the translation of evidence into effective tobacco treatment for every individual, at every visit, in every setting.

To support this position, the American Psychiatric Nurses Association calls for:

• Action to highlight and empower nurses to resolve implicit and explicit bias in thoughts, beliefs, and actions related to persons who use recreational nicotine and tobacco products.
• Creation of opportunities to increase the sense of urgency for care so that nicotine and tobacco use disorder treatment is no longer seen as a secondary psychiatric-mental health care need.
• Translation of the nursing competencies for treating nicotine and tobacco use disorders into additional continuing education opportunities.
• Positioning of psychiatric-mental health nurses as leaders, champions, and subject matter experts of effective nicotine and tobacco use disorder evidence-based practice and research, guideline development, and policy initiatives.

Approved by the APNA Board of Directors October 2008. Revised July 2020, February 2023, July 2026.

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