North Carolina, Tobacco, and

Health Reform
TOBACCO'S TOLL ON AMERICANS
In 2004, smoking caused $96 billion in annual public and private health care expenditures. 1 This includes
$67.9 billion spent by federal and state governments on tobacco-related health care expenses. 2
On average, 440,000 people die each year from their own cigarette use and 8.6 million Americans suffer from
a smoking related illness.3 Additionally, smokers lose an average of 13 to 14 years of their lives due to
smoking. 4
Many consider tobacco to be a way of life in North Carolina. North Carolina ranks first in the production of
tobacco with an approximate farm income of $745 million in 2009. 5 North Carolina's tobacco production
provides the state's economy over $7.0 billion from sales and increased jobs; tobacco provides jobs for
255,000 North Carolinians. 6
NORTH CAROLINA AND TOBACCO
In 2005, tobacco related diseases Adult Cigarette Use in 2008 13
accounted for approximately 21% 30%
of the deaths in North Carolina.7
25%
However, North Carolina's policy
20%
regulations against tobacco
products remain the weakest in the 15%
nation. 8 North Carolina has the 10%
44th lowest cigarette excise tax in 5%
the country at $0.45 per pack,
0%
compared to the national average
United States West Virginia North Carolina Utah
of $1.34.9
Furthermore, in a 2008 poll, 30.3% Over 1,450,000 North Carolinians smoke cigarettes. 14 The state had the
of North Carolinians were in favor thirteenth highest rate of adult smokers in 2008, with 20.9% of the adult
of a cigarette excise tax over $1.00, population smoking; nationally, 18.4% of Americans smoke cigarettes. 15
while 30.8% preferred no tax at
all. 10 Interestingly, only 24.6% of North Carolina's State Excise Tax, 1970-2010 16
18-24 year olds favored no tax
compared to 46.4% of residents $0.50
over 75 years old.11 This suggests $0.40
that tobacco has been a part of $0.30
North Carolina's history; but may
$0.20
change in the next generation.
Between 2005 and 2010, the $0.10
state's cigarette excise tax $0.00
increased from $0.05 to $0.45. 12 1970-1992 1993-2005 2006 2007-2009 2010

Issue Area, Tobacco: North Carolina Page 1 of 3

National Coalition on Health Care July 2010
 NORTH CAROLINA'S STUDENTS AND TOBACCO USE
In 2007, 10.8% of North Carolina's Tobacco Use Among North Carolina Students 2008-2009 20
youth, ages 12-17, smoked at least 80%
one cigarette per month, compared 70% Middle School
to the national average of 10.1%. 17 60% Students
50%
North Carolina had the 25th High School
40%
highest percentage of cigarette 30%
Students
smoking youths. 18 20%
In addition, in 2009, the North 10% * Used once in
0% the past 30
Carolina Department of Health and days
Tried Any Tried Any Tobacco Cigarette Live with
Human Services found that 67.7% Tobacco Cigarettes Product Use* ** Percent of
Current
of smoking middle school students Product Use* Smoker**Current
lived in a household with a current Smokers Only
smoker, while only 35.5% non-
smokers lived with a current The above chart demonstrates that the number of students using
smoker. 19 tobacco almost doubles between middle and high school.21
Furthermore, over 40% of all high school students have tried tobacco,
with nearly 20% trying cigarettes. 22
RECENT STATE AND FEDERAL LAWS REGULATING TOBACCO PRODUCTS
The Smoke-Free North Carolina's law bans smoking in all enclosed areas of most restaurants and bars,
Restaurants and Bars and in enclosed areas of lodging establishments if food and drink are prepared there.
Law 23 - North Carolina The law became effective January 2, 2010.
ACA creates a Prevention and Public Health Fund to fund preventive and public
health initiatives. On June 18, 2010 HHS Secretary Kathleen Sebelius announced that
"$126 million will support federal, state and community prevention initiatives; the
integration of primary care services into publicly funded community-based
The Patient behavioral health settings; obesity prevention and fitness; and tobacco cessation."25
Protection and
Affordable Care Act Additionally, ACA establishes the National Prevention, Health Promotion and Public
(ACA) 24 - Federal Health Council (“The Council”). The Council will coordinate prevention, wellness, and
health promotion practices at the federal level and among federal departments and
agencies. The Council will also be required to issue recommendations to the
President and Congress regarding their views on the most pressing obstacles to
reducing smoking, sedentary lifestyles, and poor nutrition.
The PACT Act focuses on decreasing the number of illegal online sales of cigarettes
The Prevent All and smokeless tobacco. To accomplish this goal, the PACT act requires additional
Cigarette Trafficking reporting requirements for sellers of tobacco products, mandates that sellers verify
Act of 2009 (PACT the age of purchasers at the time of payment and delivery, and forbids mailing
Act) 26 - Federal tobacco products though the U.S. Postal Service.

Issue Area, Tobacco: North Carolina Page 2 of 3

National Coalition on Health Care July 2010

The Family Smoking
Prevention and
Tobacco Control Act
(the 2009 FDA Law) 27
- Federal
The main accomplishment of the 2009 FDA Law was to allow the Food and Drug
Administration (FDA) to regulate tobacco products. Additionally, tobacco
manufacturers will have to disclose information including ingredients, marketing
research, and health research to the FDA. The 2009 FDA Law also requires larger
warning labels on tobacco products, forbids companies from promoting products as
"low-risk alternatives to traditional tobacco," unless the FDA allows it, and mandates
stricter marketing regulations on tobacco products. While companies may not
provide any sample of other tobacco products, they may provide samples of
smokeless tobacco products in restricted areas.

1
CTR. FOR DISEASE CONTROL & PREVENTION, TOBACCO CONTROL STATE HIGHLIGHTS 2010 144 (2010), available at
http://www.cdc.gov/tobacco/data_statistics/state_data/state_highlights/2010/pdfs/highlights2010.pdf (last accessed June 2010).
2
Ibid.
3
Ibid.
4
Ibid.
5
U.S. DEP'T OF AGRIC., NAT'L AGRIC. STATISTICS SERV. (2009), available at
http://www.nass.usda.gov/QuickStats/indexbysubject.jsp?Pass_name=&Pass_group=Crops+%26+Plants&Pass_subgroup=Field+Crops#
top (follow "Field Crops, Tobacco (All Classes), Search") (last accessed June 2010).
6
N.C. DEP'T OF AGRIC. AND CONSUMER SERVS., TOBACCO, available at www.ncagr.gov/markets/commodit/horticul/tobacco/index.htm (last
accessed June 2010).
7
N.C. DEP'T OF CRIME CONTROL & PUBLIC SAFETY, UNDERAGE SMOKING, HEALTH EFFECTS (2005) available at
http://www.nccrimecontrol.org/Index2.cfm?a=000003,000005,000996,000284 (last accessed July 2010).
8
See CTR. FOR DISEASE CONTROL & PREVENTION supra note 1.
9
Ibid.
10
N.C. STATE CTR. FOR HEALTH STATISTICS, TOBACCO USE PREVENTION (2008), available at www.schs.state.nc.us/SCHS/brfss/2008/nc/all/tax.html
(last accessed June 2010).
11
Ibid.
12
CTR. FOR DISEASE CONTROL & PREVENTION, STATE TOBACCO ACTIVITIES TRACKING AND EVALUATION (STATE) SYSTEM, Economics, Cigarette Sales,
Average Cost per pack, North Carolina, 1973-2009, available at http://apps.nccd.cdc.gov/statesystem/TrendReport/TrendReports.aspx
(last accessed July 2010); See CTR. FOR DISEASE CONTROL & PREVENTION supra note 1.
13
See CTR. FOR DISEASE CONTROL & PREVENTION supra note 1.
14
Ibid.
15
Ibid.
16
See CTR. FOR DISEASE CONTROL & PREVENTION, supra note 12; See CTR. FOR DISEASE CONTROL & PREVENTION supra note 1.
17
See CTR. FOR DISEASE CONTROL & PREVENTION supra note 1.
18
Ibid.
19
N.C. DEP'T OF HEALTH AND HUMAN SERVS., TOBACCO PREVENTION AND CONTROL BRANCH (2009), available at
www.tobaccopreventionandcontrol.ncdhhs.gov/data/yts/index.htm (last accessed June 2010).
20
Ibid.
21
Ibid.
22
Ibid.
23
N.C. DEP'T OF HEALTH & HUMAN SERVS., TOBACCO PREVENTION AND CONTROL BRANCH, THE LAW: AN ACT TO PROHIBIT SMOKING IN CERTAIN PUBLIC PLACES
AND CERTAIN PLACES OF EMPLOYMENT (2010), available at http://www.tobaccopreventionandcontrol.ncdhhs.gov/smokefreenc/sflaw.htm
(last accessed July 2010).
24
MERCEDES VARASTEH DORDESKI, AN OUNCE OF PREVENTION SAVES A POUND OF CURE: A SUMMARY OF PPACA’S WELLNESS AND PREVENTION REFORMS,
(2010), available at http://www.abanet.org/health/esource/Volume6/09/Dordeski.html (last accessed June 2010).
25
U.S. DEP'T OF HEALTH AND HUMAN RESOURCES, Sebelius Announces New $250 Million Investment to Lay Foundation for Prevention and
Public Health (June 18, 2010), available at http://www.hhs.gov/news/press/2010pres/06/20100618g.html (last accessed June 2010).
26
Prevent All Cigarette Trafficking Act of 2009, Pub. L. No. 111-154, 124 Stat 1087 (2010).
27
Family Smoking Prevention and Tobacco Control Act, Pub. L. No. 111-31, 123 Stat 1776 (2009).

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National Coalition on Health Care July 2010