Tobacco use in North Dakota 2023

• In 2022, 15.1% of adults smoked. Nationally, the adult smoking prevalence was 14.0%.¹
• In 2021, 5.9% of high school students in North Dakota smoked cigarettes on at least one day in the past 30 days. Nationally, smoking prevalence among high school students was 3.8%.²

• In 202, 9.0% of adults in North Dakota used e-cigarettes.³ Nationally, adult e-cigarette use prevalence was 7.7%¹
• In 2022, 6.5% of adults in North Dakota used smokeless tobacco everyday or some days. ¹ Nationally, adult smokeless tobacco use prevalence was 3.4%.¹
• In 2021, 21.2% of high school students in North Dakota used electronic vapor products on at least one day in the past 30 days. Nationally, the e-cigarette use prevalence among high school students was 18%.²
• In 2021, 4.3% 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 smokeless tobacco use prevalence among high school students was 2.5%.²
• In 2021, 2.8% 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 cigar use prevalence among high school students was 3.1%.²

• North Dakota received $51 million (estimated) in revenue from tobacco settlement payments and taxes in fiscal year 2023.⁴
• Of this, the state allocated $5.7 million in state funds to tobacco prevention in fiscal year 2023, 58% of the Centers for Disease Control and Prevention’s annual spending target.⁴
• Smoking-caused health care costs: $379 million per year.⁴
• Smoking-caused losses in productivity: $715 million per year.⁵

Tobacco taxes

• North Dakota is ranked 49th in the U.S. for its cigarette tax of 44 cents per pack (enacted July 1993), compared to the national average of $1.93. (New York has the highest tax at $5.35 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

Licensing laws

• Retailers and wholesalers are required to obtain a license to sell tobacco products.⁶
• A license is required to sell e-cigarette products (effective Aug 1 2023).⁹

Youth access laws

• 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, e-liquid, and/or e-cigarettes.^6,9
• Self-service displays of electronic smoking devices is restricted to tobacco specialty stores and vending machines inaccessible to persons under 21 or controlled by the seller.⁹
• Retailers’ sale and shipment of electronic smoking devices through the mail is prohibited unless the retailer verifies the purchaser is at least 21 years of age and requires signature upon delivery of a person at least 21 years of age.⁹

Local tobacco laws

• Cando and Linton prohibit the sale of flavored tobacco products, except menthol cigarettes, cigars, and smokeless tobacco.¹⁰
• Valley City prohibits the sale of flavored e-cigarettes.¹⁰

• The CDC estimates 50.7% of daily adult smokers in North Dakota 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 Dakota’s state quit line invests $9.94 per smoker, compared to the national median of $2.37.⁷
• North Dakota has a private insurance mandate provision for cessation.⁷

Updated June 2023

* The datasets for both adults and youth prevalence were used to make direct comparisons at the state and national levels. National prevalence reported here may differ from what is reported in our national-level fact sheets. The numbers here also reflect the most recent data available. Dates of available data 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, 2022.

2.         CDC, Youth Risk Behavioral Surveillance System, 2021.

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 24 Years Later FY2023, 2023.

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, 2023.

8.         Campaign for Tobacco-Free Kids. State Cigarette Excise Tax Rates & Rankings. https://www.tobaccofreekids.org/assets/factsheets/0097.pdf. Accessed October 4th, 2023.

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. Accessed October 4th, 2023.

10.       Truth Initiative, Local restrictions on flavored tobacco and e-cigarette products. https://truthinitiative.org/research-resources/emerging-tobacco-products/local-restrictions-flavored-tobacco-and-e-cigarette. Accessed October 4th, 2023.