1. Tobacco Use Prevention Funding

2. Tobacco use, Heart Disease, & Stroke
Almost 1/3 of deaths from coronary heart disease are attributable to smoking and secondhand smoke.
Prolonged exposure to secondhand smoke increases the risk of a stroke by %
Source: US Department of Health and Human Services. 50 Years of Progress: A Report of the Surgeon General, Available at:
A few weeks ago, DHHS released some stunning news: tobacco use in the state had decreased to historic lows – 17.9%. It’s quite an achievement. But that decrease did not happen universally across the state: People w/less education, lower income, and the unemployed are more likely to smoke cigarettes than their peers with higher income and more education. This inequality exists across geographic areas: 1 in 5 people who live in rural communities smoke cigarettes. 1 in 4 people with disabilities smoke cigarettes.
We need to address the inequality. The best way to decrease the burden of disease and death that comes with tobacco use is to make sure people never start.

3. Preventing tobacco use among youth & young adults
Tobacco use is started and established primarily during adolescence.
Nearly 9 out of 10 individuals who smoke first tried smoking by age 18, and 99% first tried smoking by age 26.
Early cardiovascular damage is seen in most young people who smoke
Source: US Department of Health and Human Services. 50 Years of Progress: A Report of the Surgeon General, Available at:

4. Success of Youth Prevention Programs
North Carolina used to have a teen tobacco use prevention program that helped decrease tobacco use amongst middle school and high school students. It followed CDC best practices for youth tobacco prevention funding.
The funding came from the Tobacco Master Settlement Agreement, which, since 1999, has given $140 million to North Carolina every year. The Health and Wellness Trust Fund dedicated $17.3 million for prevention and cessation programs until 2011 and 2012, when the program was eliminated.
We still get that MSA money every year, but virtually none of it has been dedicated to tobacco prevention since While the MSA states that its primary purpose is to decrease youth tobacco use and promote public health, it does not contain any provisions requiring states to allocate settlement revenues to tobacco prevention and cessation

5. Increase in Youth Tobacco Use
After the MSA funding was decreased and then cut, combined with the emergence of new products, young people in North Carolina are starting to use more tobacco products again.
Between 2011 and 2015 use of electronic cigarettes among NC high school students jumped by 888%, from 1.7% to 16.8%. During the same time period, electronic cigarette use among middle school students increased 599%, from 1% to 6.99%.

6. Youth Tobacco use in North Carolina
Almost 3 in every 10 high school students (125,111) are current tobacco users, an increase from 2011 rates Use of electronic cigarettes by North Carolina high school students increased 888% between 2011 and 2015, from 1.7% to 16.8% There are currently 180,000 youth alive in North Carolina who will die prematurely from smoking
So where are we now?

7. Prevention is Critical
Successful multi-component programs prevent young people from starting to use tobacco in the first place and more than pay for themselves in lives and health care dollars saved.
Source: US Department of Health and Human Services. 50 Years of Progress: A Report of the Surgeon General, Available at:

8. Prevention Funding Proposal (at minimum)
Regional teen tobacco use prevention programs through local partners $6,200,000
Youth leadership training $200,000
Tobacco-free college campus initiative $150,000
1 FTE for smoke-free multi-unit housing coordinator $100,000
Education and enforcement of state youth access tobacco law $100,000
Initiative to increase awareness of tobacco-free schools law $150,000
Evaluation of tobacco use prevention program $100,000
We are asking for at LEAST $7 million annually for a teen tobacco use prevention program, which would include youth leadership training, staff to oversee efforts at the universities and in multi-unit housing, enforcement, and evaluation. This proposal aligns with CDC best practices for a robust youth tobacco prevention program.
In the most recent state budget, the Tobacco branch received $500,000 for each year of the biennium to start rebuilding the teen tobacco use prevention program. This is a great start, but it is not enough. There needs to be more resources and it needs to be recurring.

9. Questions?