Tobacco use in North Dakota 2019

• In 2017, 18.3% of adults smoked. Nationally, the rate was 17.1%.¹
• In 2017, 12.6% of high school students in North Dakota smoked cigarettes on at least one day in the past 30 days. Nationally, the rate was 8.8%.²

• In 2017, 4.3% of adults used e-cigarettes and 6.2% used smokeless tobacco.³
• In 2017, 20.6% of high school students in North Dakota used electronic vapor products on at least one day in the past 30 days. Nationally, the rate was 13.2%.²
• In 2017, 8.0% of high school students in North Dakota used chewing tobacco, snuff or dip on at least one day in the past 30 days. Nationally, the rate was 5.5%.²
• In 2017, 8.2% of high school students in North Dakota smoked cigars, cigarillos or little cigars on at least one day in the past 30 days. Nationally, the rate was 8.0%.²

• North Dakota received $53.6 million (estimated) in revenue from tobacco settlement payments and taxes in fiscal year 2019.⁴
• Of this, the state allocated $5.8 million in state funds to tobacco prevention in fiscal year 2019, 59.5% of the Centers for Disease Control and Prevention’s annual spending target.⁴
• Smoking-caused health care costs: $326 million per year.⁴
• Smoking-caused losses in productivity: $232.6 million per year.⁵

Tobacco taxes

• North Dakota is ranked 48th in the U.S. for its cigarette tax of 44 cents per pack (enacted September 2009), compared to the national average of $1.81. (The District of Columbia has the highest tax at $4.50 and Missouri has the lowest at 17 cents.)^6-8
• Cigars and pipe tobacco are taxed 28% of the wholesale price, chewing tobacco is taxed at 16 cents per ounce and snuff is taxed 60 cents per ounce.^6,7

Clean indoor air ordinances

• Smoking is prohibited in government workplaces, private workplaces, schools, childcare facilities, restaurants, bars, casinos/gaming establishments (tribal establishments exempt), retail stores and recreational/cultural facilities.^6,7
• E-cigarettes are included in the state’s definition of smoking.⁹

Youth access laws

• The minimum age to purchase tobacco products in North Dakota is 21. In December 2019, the United States adopted a law raising the federal minimum age of sale of all tobacco products to 21, effective immediately.
• Minors are prohibited from buying bidis and/or e-cigarettes.⁶

• The CDC estimates 45.3% of daily adult smokers in North Dakota quit smoking for one or more days in 2017.³
• In 2014, the Affordable Care Act required that Medicaid programs cover all tobacco cessation medications.^7**
• North Dakota’s state quit line invests $8.38 per smoker, compared to the national average of $2.21.⁷
• North Dakota has a private insurance mandate provision for cessation.⁷

Updated April 2019

*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, 2017.

2. CDC, Youth Risk Behavior Surveillance System, 2017.

3. CDC, Behavioral Risk Factor Surveillance System, State Tobacco Activities Tracking and Evaluation System, 2017.

4. Campaign for Tobacco-Free Kids, Broken Promises to Our Children: a State-by-State Look at the 1998 State Tobacco Settlement 20 Years Later FY2019, 2018.

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, 2019.

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

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