Fact Sheet

Tobacco use in North Carolina 2026

Topic

Smoking by Region

Subtopic

State Facts

Cigarette use: North Carolina*

In 2024, 11.5% of adults in North Carolina smoked. Nationally, the adult cigarette smoking prevalence was 11.6%.
In 2018-2019, 46.7% of adults who smoked in North Carolina smoked menthol cigarettes. Nationally, 32.3% of adult smokers used menthol cigarettes during this period.
In 2023, 3.9% of high school students in North Carolina smoked cigarettes on at least one day in the past 30 days. Nationally, the prevalence of cigarette smoking among high school students was 3.5%.

Other tobacco product use: North Carolina*

In 2024, 7.3% of adults in North Carolina used e-cigarettes. Nationally, the adult e-cigarette use prevalence was 8.0%.
In 2024, 4.0% of adults in North Carolina used smokeless tobacco every day or some days. Nationally, the adult smokeless tobacco use prevalence was 3.4%.
In 2023, 21.4% of high school students in North Carolina 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 16.8%.

Economics of tobacco use and tobacco control

North Carolina received $385.9 million (estimated) in revenue from tobacco settlement payments and taxes in fiscal year 2026.
Of this, the state allocated $2.1 million in state funds to tobacco prevention in fiscal year 2026, 2.2% of the Centers for Disease Control and Prevention's annual spending target.
Smoking-caused health care costs: $4.42 billion per year.
Smoking-caused losses in productivity: $10.8 billion per year.

North Carolina tobacco laws

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 $2.05. (New York has the highest tax at $5.35 and Missouri has the lowest at 17 cents.)
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, although taxes on cigars cannot exceed 30 cents per cigar.

Clean indoor air ordinances

Smoking is prohibited in schools (public schools only), restaurants, and bars (cigar bars are exempt).
Smoking restrictions are required in government workplaces (and smoking is prohibited in state government buildings) and childcare facilities.
There are no smoking restrictions for private workplaces, casinos/gaming establishments (tribal casinos only), or retail stores.
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.
E-cigarettes are not included in the state's indoor air laws but are included in the state's definition of tobacco products.

E-cigarette Registry Laws

Effective May 1, 2025, only products from vapor product manufacturers and alternative nicotine product manufacturers listed in North Carolina's state directory, and that have provided certification of approval through the PMTA process, may be sold in the state.

Licensing laws

Retailers are required to obtain a license to sell tobacco products, except cigarettes. This requirement applies only to certain retailers, wholesalers, distributors, and delivery sellers that receive, store, or ship non-tax-paid cigarettes or tobacco products.
A license is required to sell e-cigarette products.

Youth access laws

In December 2019, the United States adopted a law raising the federal minimum age for the sale of all tobacco products to 21, effective immediately.
Establishments are required to post signs stating that sales to minors are prohibited.
People under 21 are prohibited from purchasing vapor products. Internet sales of vapor products require third-party age verification.
Vending machine sales of vapor products are restricted to locations inaccessible to minors or where access is controlled by the owner.

Quitting statistics and benefits

The CDC estimates that 49.3% of daily adult smokers in North Carolina quit smoking for one or more days in 2019.
In 2014, the Affordable Care Act required Medicaid programs to cover all tobacco cessation medications.**
North Carolina's state quitline invests $1.95 per smoker, compared to the national median of $2.62.
North Carolina does not have a private insurance mandate provision for tobacco cessation.

Notes and references (March 2026)

* 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 national-level fact sheets. The figures 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)
Bupropion (Zyban)

Fiore MC, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; May 2008.

References

CDC. (2024). Behavioral Risk Factor Surveillance System.
CDC. (2024). State Menthol Fact Sheets.
CDC. (2023). High School Youth Risk Behavioral Surveillance System.
Campaign for Tobacco-Free Kids. (2026). Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement 27 Years Later. Campaign for Tobacco-Free Kids. https://www.tobaccofreekids.org/what-we-do/us/statereport
Campaign for Tobacco-Free Kids. (2024). The Toll of Tobacco in the United States. Campaign for Tobacco-Free Kids.
American Lung Association. (2026). State of Tobacco Control. https://www.lung.org/research/sotc
American Lung Association. (2024). State Legislated Actions on Tobacco Issues (SLATI).
Campaign for Tobacco-Free Kids. (2024). State Cigarette Excise Tax Rates & Rankings. https://assets.tobaccofreekids.org/factsheets/0097.pdf
Public Health Law Center. (2024, June 15). U.S. E-Cigarette Regulations: 50 State Review. https://www.publichealthlawcenter.org/resources/us-e-cigarette-regulations-50-state-review
State E-Cigarette Registry Bill Map. Public Health Law Center. Retrieved October 23, 2025, from https://www.publichealthlawcenter.org/resources/state-e-cigarette-registry-bill-map
FDA. (2024). Tobacco 21. https://www.fda.gov/tobacco-products/retail-sales-tobacco-products/tobacco-21
CDC. (2024). Behavioral Risk Factor Surveillance System, State Tobacco Activities Tracking and Evaluation System.