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. Increase state funding to $17 million for tobacco control programs, including prevention, education and cessation;
2. Establish licensing for all tobacco retailers, including electronic cigarette retailers; and
3. Support a tobacco tax increase of $1.37 to reach the national state average as of October 2020 of $1.82 and equalize the tax for all tobacco products including e-cigarettes to the cigarette tax.

The 2020 North Carolina Legislative Session began on April 28. It was the second year of the biennium commonly called the "Short Session." The American Lung Association and other advocates under the banner of the North Carolina Alliance for Health planned support for an increase in funding for the state Tobacco Prevention and Control Branch, and for measures to stem the youth vaping epidemic such as licensing for all retail sellers of tobacco products, including electronic cigarettes. However, COVID-19 took center stage as the state grappled with dropping revenues and funding cuts. While legislators were not amenable to increasing funds for tobacco cessation programs and services, current recurring funding levels of $1,850,000 were maintained while tobacco use prevention funding was not increased. Legislators returned in September but addressed only COVID-19 relief funding.

The American Lung Association has long identified restoration of funding for the state's tobacco use prevention and cessation programs as a prerequisite to improving the health of North Carolinians. In North Carolina, 35.5% of high school students used e-cigarettes in 2019, according to the Centers for Disease Control and Prevention (CDC)'s 2019 Youth Risk Behavior Survey. While the North Carolina General Assembly has added incremental amounts of funding for the Tobacco Prevention and Control Branch in recent years, funding levels remain far from the $17.3 million the program received in 2011. Increased funding for state tobacco use prevention programs could provide more support for schools and communities battling the youth vaping epidemic and provide greater support to help smokers quit.

As North Carolina continues to face the impact of COVID-19, an increase in tobacco excise taxes offers health and fiscal benefits that should be considered. Not only have significant increases in the price of cigarettes been shown to reduce the percentage of kids starting to smoke and the prevalence of adult smoking, but a tobacco tax increase would provide an infusion of needed state funds.

The American Lung Association will continue to work with the North Carolina Alliance for Health and other partners to press for increased funding for the state tobacco prevention program to protect young lungs from the vaping epidemic and provide resources to help smokers quit and reduce their risk from COVID-19.
  • North Carolina Facts
  • Economic Cost Due to Smoking: $3,809,676,476

  • Adult Smoking Rate: 18.5%

  • High School Smoking Rate: 8.3%

  • High School Tobacco Use Rate: 28.8%

  • Middle School Smoking Rate: 2.5%

  • Smoking Attributable Deaths per Year: 14,220

Adult smoking data come from CDC's 2019 Behavioral Risk Factor Surveillance System. High school smoking rate is taken from the 2019 Youth Risk Behavior Surveillance System. High school tobacco use and middle school smoking rates are taken from the 2017 Youth Tobacco Survey. High school tobacco use includes cigarettes, cigars, smokeless tobacco, and electronic vapor products, as well as pipes, bidis, roll-your-own cigarettes, hookah, snus, dissolvable tobacco products, and clove cigars, making it incomparable to other states.

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