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:

  1. Implement a comprehensive tobacco retail licensing system, including e-cigarette retailers;
  2. Increase the cigarette tax to the current average cigarette tax and equalize taxes for all tobacco products, including e-cigarettes; and
  3. Rollback preemption of stronger local laws in North Carolina regarding tobacco use and prevention.
In 2023, the North Carolina General Assembly had a heavy focus on Medicaid expansion, which ended up being tied to a controversial state budget. Ultimately, the budget passed with expansion along with a few other provisions related to commercial tobacco use prevention and cessation. This included $11,250,000 in nonrecurring funds in each year of the biennium from the state’s settlement with Juul Labs, Inc. for evidence-based electronic cigarette and nicotine dependence prevention and cessation activities targeting students in grades 4 through 12. Additionally, the method of taxing snuff changed from cost-based to weight-based. Also added was a base tax for “alternative nicotine products” of 10 cents per container containing up to 20 units and ½ cent per unit for every unit over 20.

Partners continue discussions about the importance of implementing a comprehensive evidence-based tobacco retail licensing system, which would include policy changes to raise the sale of age of tobacco products to 21 years old in alignment with federal law.

In 2024, 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
Healthcare Costs Due to Smoking: $3,809,676,476
Adult Smoking Rate: 14.50%
High School Smoking Rate: 3.90%
High School Tobacco Use Rate: N/A
Middle School Smoking Rate: 2.40%
Smoking Attributable Deaths per Year: 14,220
Adult smoking data come from CDC's 2022 Behavioral Risk Factor Surveillance System. 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.

North Carolina Information

Learn more about your state specific legislation regarding efforts towards effective Tobacco Control.

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