North Carolina Highlights
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Tobacco use remains the leading cause of preventable death and disease in the United States and in North Carolina. To address this enormous toll, the American Lung Association calls for the following actions to be taken by North Carolina’s elected officials:
- Raise the legal age to sell tobacco products to 21 to be in line with Federal law;
- Implement a comprehensive tobacco retail licensing system, including e-cigarette retailers; and
- Increase funding for the North Carolina tobacco prevention and control program.
The tobacco industry successfully added language to two pieces of legislation in their favor. House Bill 900 was originally intended to keep a school from closing, but after passing one chamber big tobacco companies successfully added language to create a directory of vapor products and consumable products based on U.S. Food and Drug Administration pre-market tobacco application status. The other chamber was forced to vote favorably to keep the school open. The Lung Association and partners spoke with the Governor’s office and legislators to share our concerns and educate staff on the bill. The bill was ultimately signed into law.
Senate Bill 527 included language removing the requirement for cigar bars to be located in a freestanding structure. This was an omnibus health-related bill that the tobacco industry again added language to after already passing one chamber. This bill also ultimately became law.
Thanks to the leadership of then Attorney General and now Governor Josh Stein, payments from the settlement with Juul he secured continued to be allocated to e-cigarette prevention and education activities through North Carolina’s tobacco prevention and control program in fiscal year 2025. Total state funding for the program, including the Juul settlement, stood at over $13.3 million.
In 2025, the American Lung Association in North Carolina will join our tobacco control partners, including the North Carolina Alliance for Health, to educate state legislators about the health and economic benefits of strong tobacco control policies. This includes the state policy goals highlighted above.
North Carolina Facts |
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|---|---|
| Healthcare Costs Due to Smoking: | $3,809,676,476 |
| Adult Smoking Rate: | 13.20% |
| Adult Tobacco Use Rate: | 21.60% |
| High School Smoking Rate: | 3.90% |
| High School Tobacco Use Rate: | 0.00% |
| Middle School Smoking Rate: | 2.40% |
| Smoking Attributable Deaths per Year: | 14,220 |
Adult smoking and tobacco use data come from CDC’s 2023 Behavioral Risk Factor Surveillance System; adult tobacco use includes cigarettes, smokeless tobacco and e-cigarettes. High school smoking rate comes from CDC's 2021 Youth Risk Behavioral Surveillance System. Middle school smoking rate comes from the 2019 North Carolina Youth Tobacco Survey. A current high school tobacco use rate is not available for this state.
Health impact information is taken from the Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking-attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable healthcare expenditures are based on 2004 smoking-attributable fractions and 2009 personal healthcare expenditure data. Deaths and expenditures should not be compared by state.
Health impact information is taken from the Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking-attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable healthcare expenditures are based on 2004 smoking-attributable fractions and 2009 personal healthcare expenditure data. Deaths and expenditures should not be compared by state.
North Carolina Information
Learn more about your state specific legislation regarding efforts towards effective Tobacco Control.