Tobacco use in North Carolina 2023

• In 2022, 14.5% of adults smoked. Nationally, adult smoking prevalence was 14.0%.¹
• In 2021, 3.9% of high school students in North Carolina smoked cigarettes on at least one day in the past 30 days. Nationally, the rate was 3.8%.²

• In 2022, 8.0% of adults in North Carolina used e-cigarettes. Nationally, adult e-cigarette prevalence was 7.7%¹
• In 2022, 3.5% of adults in North Carolina used smokeless tobacco every day or some days. Nationally, adult smokeless tobacco use was 3.4% ¹
• In 2021, 23.8% of high school students in North Carolina used electronic vapor products on at least one day in the past 30 days. Nationally, e-cigarette use prevalence among high school students was 18%.²

• North Carolina received $458.6 million (estimated) in revenue from tobacco settlement payments and taxes in fiscal year 2023.⁴
• Of this, the state allocated $13.4 million in state funds to tobacco prevention in fiscal year 2023 13.5% of the Centers for Disease Control and Prevention’s annual spending target.⁴
• Smoking-caused health care costs: $4.42 billion per year.⁴
• Smoking-caused losses in productivity: $10.8 billion per year.⁵

Tobacco taxes

• North Carolina is ranked 48th in the U.S. for its cigarette tax of 45 cents per pack (enacted September 2009), 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
• E-cigarettes are taxed at 5 cents per fluid milliliter of consumable product. All other tobacco products are taxed at 12.8% of the cost price.^6,7,9

Clean indoor air ordinances

• Smoking is prohibited in schools (public schools only), restaurants and bars (cigar bars are exempt).^6,7
• Smoking restrictions are required in government workplaces (prohibited in state government buildings) and childcare facilities.^6,7
• There are no smoking restrictions for private workplaces, casinos/gaming establishments (tribal casinos only), retail stores and recreational/cultural facilities.^6,7
• The use of e-cigarettes is prohibited at child care centers, family child care homes, state correctional facilities, and on school property and at school sponsored events.¹⁰

Licensing laws

• Retailers are required to obtain a license to sell tobacco products, except cigarettes. Wholesalers are required to obtain a license to sell tobacco products.⁶
• A license is required to sell e-cigarette products.¹⁰

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.
• Establishments are required to post signs stating that sales to minors are prohibited.^6,7
• Minors are prohibited from buying vapor products. The internet distribution of vapor products requires third-party age verification.¹⁰
• Vending machine sales of vapor products is restricted to locations inaccessible to minors or where it is controlled by the owner.¹⁰

• The CDC estimates 49.3% of daily adult smokers in North Carolina 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 Carolina’s state quit line invests $1.97 per smoker, compared to the national median of $2.37.⁷
• North Carolina does not have 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.         Campaign for Tobacco-Free Kids. State Excise Tax Rates for Non-Cigarette Tobacco Products. https://www.tobaccofreekids.org/assets/factsheets/0169.pdf. Accessed October 4th, 2023.

10.       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.