American Lung Association Report: North Dakota Earns Failing Grade for Tobacco Taxes and Restricting Flavored Tobacco Products

American Lung Association “State of Tobacco Control” report releases North Dakota grades for tobacco control policies, outlines steps to reduce burden of tobacco

The American Lung Association’s 2024 “State of Tobacco Control” report, released today, reveals that North Dakota earned a failing grade for taxing tobacco products and for its restrictions on flavored tobacco products, and found that more work needs to be done to prevent tobacco use and save lives. The 22nd annual report evaluates state and federal policies on actions taken to eliminate tobacco use and recommends proven-effective tobacco control laws and policies to save lives.

“Tobacco use is the leading cause of death in North Dakota and across the country and takes the lives of 980 state residents each year. The tobacco industry will do anything to protect their profits at the expense of North Dakota lives, so we must push forward in our efforts to prevent and reduce tobacco use,” said Pat McKone, Director of Advocacy at the American Lung Association in North Dakota. “This year, we are working with state policymakers to focus on restricting flavored tobacco products and increasing the tobacco tax.

“One of the most effective ways to reduce tobacco use, not only among low-income individuals but also for youth, is to significantly increase the tax on all tobacco products, including e-cigarettes. Multiple studies have shown that every 10% increase in the price of cigarettes reduces consumption by about 4% among adults and about 7% among youth. North Dakota should increase its tax on cigarettes by $2.00 per pack.”  North Dakota ranks 49th in the country for lowest tobacco tax and hasn’t raised it since 1993.

North Dakota’s Grades
The “State of Tobacco Control” report grades states and the District of Columbia in five areas that have been proven to prevent and reduce tobacco use and save lives. In the 2024 report, North Dakota received the following grades:

  1. Funding for State Tobacco Prevention Programs – Grade B
  2. Strength of Smokefree Workplace Laws – Grade A
  3. Level of State Tobacco Taxes – Grade F
  4. Coverage and Access to Services to Quit Tobacco – Grade A
  5. Ending the Sale of All Flavored Tobacco Products – Grade F

Federal Grades Overview
This year’s report focuses on recent federal actions, including President Biden’s failure to finalize rules to end the sale of menthol cigarettes and flavored cigars, as well as FDA’s overdue review of all applications for e-cigarette products, including flavors that are popular among youth. Because of the delay on the federal rules to end the sale of menthol cigarettes and flavored cigars, it is even more important for states to enact laws to end the sale of all flavored tobacco products.

The 2024 “State of Tobacco Control” report grades the federal government in five areas:

  • Federal Government Regulation of Tobacco Products – Grade C
  • Federal Coverage of Quit Smoking Treatments – Grade D
  • Level of Federal Tobacco Taxes – Grade F
  • Federal Mass Media Campaigns to Prevent and Reduce Tobacco Use – Grade: A
  • Federal Minimum Age of Sale for Tobacco Products to 21 – Incomplete*

*FDA remains grossly overdue in publishing the final Tobacco 21 regulations as required by statute, which is why it earns an “incomplete.” 

The Lung Association calls on the White House to urgently finalize rules to end the sales of menthol cigarettes and flavored cigars in the U.S. to save lives now. Send an email to President Biden at to insist these rules be finalized urgently. To learn more about this year’s “State of Tobacco Control” grades and take action, visit

*State Funding for Tobacco Prevention Programs grades in “State of Tobacco Control” reflect actions taken by elected officials and do not reflect on the hard work of state tobacco control programs or advocates.

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For more information, contact:

Janye Killelea
[email protected]

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