Tobacco use in North Carolina 2021

• In 2020, 16.5% of adults smoked. Nationally, the rate was 15.5%.¹
• In 2019, 8.3% of high school students in North Carolina smoked cigarettes on at least one day in the past 30 days. Nationally, the rate was 6.0%.²

• In 2018, 5.1% of adults in North Carolina used e-cigarettes.³
• In 2020, 3.9% of adults in North Carolina used smokeless tobacco.³
• In 2019, 35.5% of high school students in North Carolina used electronic vapor products on at least one day in the past 30 days. Nationally, the rate was 32.7%.²

• North Carolina received $447.4 million (estimated) in revenue from tobacco settlement payments and taxes in fiscal year 2021.⁴
• Of this, the state allocated $1.9 million in state funds to tobacco prevention in fiscal year 2021, 1.9% of the Centers for Disease Control and Prevention’s annual spending target.⁴
• Smoking-caused health care costs: $3.81 billion per year.⁴
• Smoking-caused losses in productivity: $4.24 billion per year.⁵

Tobacco taxes

• North Carolina is ranked 48th in the U.S. for its cigarette tax of 45 cents per pack (enacted September 2009), compared to the national average of $1.91. (The District of Columbia has the highest tax at $4.50 and Missouri has the lowest at 17 cents.)^6-8
• E-cigarettes are taxed at 5 cents per fluid milliliter of consumable product. All other tobacco products are taxed at 12.8% of the cost price.^6,7,9

Clean indoor air ordinances

• Smoking is prohibited in schools (public schools only), restaurants and bars (cigar bars are exempt).^6,7
• Smoking restrictions are required in government workplaces (prohibited in state government buildings) and childcare facilities.^6,7
• There are no smoking restrictions for private workplaces, casinos/gaming establishments (tribal casinos only), retail stores and recreational/cultural facilities.^6,7
• The use of e-cigarettes is prohibited at child care centers, family child care homes, state correctional facilities, and on school property and at school sponsored events.¹⁰

Licensing laws

• Retailers are required to obtain a license to sell tobacco products, except cigarettes. Wholesalers are required to obtain a license to sell tobacco products.⁶
• A license is required to sell e-cigarette products.¹⁰

Youth access laws

• Effective December 2019, the United States adopted a law raising the federal minimum age of sale of all tobacco products to 21.  Some states have not yet raised their state minimum age of sale, however, the federal law takes precedence.
• While the federal law takes precedence, under the state law, the minimum sales age for North Carolina is 18.
• Establishments are required to post signs stating that sales to underage consumers are prohibited.^6,7
• Sales and distribution of vapor products to underage persons are prohibited.
• Vending machine sales of vapor products are restricted to locations inaccessible to underage persons or where controlled by the owner. ¹⁰
• Underage persons are prohibited from buying vapor products. ¹⁰
• Sample vapor products may only be distributed in a “qualified adult-only facility.” ¹⁰
• Internet distribution of vapor products requires third-party age verification. ¹⁰
• Delivery sales of vapor products require a license and require filing with the state a memo or copy of the invoice for each such sale each month. ¹⁰

• The CDC estimates 49.3% of daily adult smokers in North Carolina quit smoking for one or more days in 2019.³
• In 2014, the Affordable Care Act required that Medicaid programs cover all tobacco cessation medications.^7**
• North Carolina’s state quit line invests $1.39 per smoker, compared to the national average of $2.28.⁷
• North Carolina does not have a private insurance mandate provision for cessation.⁷

Updated August 2021

*National and state-level prevalence numbers reflect the most recent data available. This may differ across state fact sheets.

**The seven recommended cessation medications are NRT gum, NRT patch, NRT nasal spray, NRT inhaler, NRT lozenge, Varenicline (Chantix) and Bupropion (Zyban).

Fiore MC, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service: May 2008.

1. CDC, Behavioral Risk Factor Surveillance System, 2020.

2. CDC, Youth Risk Behavioral Surveillance System, 2019.

3. CDC, Behavioral Risk Factor Surveillance System, State Tobacco Activities Tracking and Evaluation System, 2021.

4. Campaign for Tobacco-Free Kids, Broken Promises to Our Children: a State-by-State Look at the 1998 State Tobacco Settlement 22 Years Later FY2021, 2020.

5. Campaign for Tobacco-Free Kids, Toll of Tobacco in the United States.

6. American Lung Association, State Legislated Actions on Tobacco Issues (SLATI).

7. American Lung Association, State of Tobacco Control, 2021.

8. Campaign for Tobacco-Free Kids. State Cigarette Excise Tax Rates & Rankings. https://www.tobaccofreekids.org/assets/factsheets/0097.pdf. Accessed.

9. Campaign for Tobacco-Free Kids. State Excise Tax Rates for Non-Cigarette Tobacco Products. https://www.tobaccofreekids.org/assets/factsheets/0169.pdf. Accessed.

10. Public Health Law Center. U.S. E-Cigarette Regulation: 50-State Review. http://www.publichealthlawcenter.org/resources/us-e-cigarette-regulations-50-state-review. Accessed.