North Carolina Highlights

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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. Raise the legal age to sell tobacco products to 21 to be in line with federal law and implement a comprehensive tobacco retail licensing system, including e-cigarette retailers;
  2. Increase the cigarette tax by $1.50 per pack or more and equalize taxes for all tobacco prodicts, including e-cigarettes; and
  3. Increase funding for the North Carolina tobacco prevention and control program.
During the 2025 legislative session in North Carolina policymakers did not prioritize strong tobacco prevention and control policies. A strong coalition was formed to pass legislation raising the age of sale for tobacco products to 21 years while codifying a comprehensive tobacco retail licensing system (TRL). The coalition is led by the North Carolina Public Health Association and has garnered support from many national and state health organizations. The American Lung Association serves on the steering committee of this coalition. The coalition was successful in getting Senate Bill 318 and House Bill 430, “Protect Youth from Harms of Vaping and Nicotine” introduced which would accomplish raising the age and strong TRL, but both bills failed to get a hearing.

Due to federal funding cuts in April 2025, a large portion of the North Carolina Tobacco Prevention and Control staff was furloughed. And despite federal funding eventually being allocated to the state in September 2025, the staff that were furloughed were ultimately lost. This makes state funding a top priority for 2026.

The American Lung Association in North Carolina will join our tobacco control partners during 2026 to educate state legislators about the health and economic benefits of strong tobacco control policies. This includes the state policy goals highlighted above.

North Carolina Facts
Healthcare Costs Due to Smoking: $3,809,676,476
Adult Smoking Rate: 13.20%
Adult Tobacco Use Rate: 21.60%
High School Smoking Rate: 3.90%
High School Tobacco Use Rate: N/A
Middle School Smoking Rate: 2.40%
Smoking Attributable Deaths per Year: 14,220
Adult smoking and tobacco use data come from CDC's 2023 Behavioral Risk Factor Surveillance System; adult tobacco use includes cigarettes, smokeless tobacco and e-cigarettes. High school smoking rate comes from CDC's 2023 Youth Risk Behavioral Surveillance System. Middle school smoking rate comes from the 2019 North Carolina Youth Tobacco Survey. A current high school tobacco use rate is not available for this state.

Health impact information is taken from the Smoking-Attributable Mortality, Morbidity and Economic Costs (SAMMEC) software. Smoking-attributable deaths reflect average annual estimates for the period 2005-2009 and are calculated for persons aged 35 years and older. Smoking-attributable healthcare expenditures are based on 2004 smoking-attributable fractions and 2009 personal healthcare expenditure data. Deaths and expenditures should not be compared by state.

North Carolina Information

Learn more about your state specific legislation regarding efforts toward effective Tobacco Control.

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