Tobacco use in North Dakota 2021

• In 2020, 17.4% of adults smoked. Nationally, the rate was 15.5%.¹
• In 2019, 8.3% of high school students in North Dakota smoked cigarettes on at least one day in the past 30 days. Nationally, the rate was 6.0%.²

• In 2018, 6.4% of adults in North Dakota used e-cigarettes.³
• In 2020, 6.4% of adults in North Dakota used smokeless tobacco.³
• In 2019, 33.1% of high school students in North Dakota used electronic vapor products on at least one day in the past 30 days. Nationally, the rate was 32.7%.²
• In 2019, 4.5% of high school students in North Dakota used chewing tobacco, snuff or dip on at least one day in the past 30 days. Nationally, the rate was 3.8%.²
• In 2019, 5.2% of high school students in North Dakota smoked cigars, cigarillos or little cigars on at least one day in the past 30 days. Nationally, the rate was 5.7%.²

• North Dakota received $52.1 million (estimated) in revenue from tobacco settlement payments and taxes in fiscal year 2021.⁴
• Of this, the state allocated $5.4 million in state funds to tobacco prevention in fiscal year 2021, 55.5% of the Centers for Disease Control and Prevention’s annual spending target.⁴
• Smoking-caused health care costs: $326 million per year.⁴
• Smoking-caused losses in productivity: $232.6 million per year.⁵

Tobacco taxes

• North Dakota is ranked 49th in the U.S. for its cigarette tax of 44 cents per pack (enacted July 1993), compared to the national average of $1.91. (The District of Columbia has the highest tax at $4.50 and Missouri has the lowest at 17 cents.)^6-8
• Cigars and pipe tobacco are taxed 28% of the wholesale price, chewing tobacco is taxed at 16 cents per ounce and snuff is taxed 60 cents per ounce.^6,7

Clean indoor air ordinances

• Smoking is prohibited in government workplaces, private workplaces, schools, childcare facilities, restaurants, bars, casinos/gaming establishments (tribal establishments exempt), retail stores and recreational/cultural facilities.^6,7
• E-cigarettes are included in the state’s definition of smoking.⁹

Licensing laws

• Retailers and wholesalers are required to obtain a license to sell tobacco products.⁶
• A license is not required to sell e-cigarette products.⁹

Youth access laws

• Effective December 2019, the United States adopted a law raising the federal minimum age of sale of all tobacco products to 21.  Some states have not yet raised their state minimum age of sale, however, the federal law takes precedence.
• Underage persons are prohibited from buying bidis and/or buying and possessing e-cigarettes.⁶
• Sales and distribution of electronic smoking devices to underage persons are prohibited. ⁹
• Sales and distribution of flavored e-liquid or electronic smoking device containing flavored e-liquid to underage persons are prohibited. ⁹
• Self-service displays of electronic smoking devices are restricted to tobacco specialty stores and vending machines inaccessible to underage persons which are controlled by the seller. ⁹
• Retailers’ sale and shipment of electronic smoking devices through the mail is prohibited unless the retailer verifies the purchaser is at least 21 years old and requires signature upon delivery of a person at least 21 years old. ⁹

• The CDC estimates 50.7% of daily adult smokers in North Dakota 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 Dakota’s state quit line invests $8.85 per smoker, compared to the national average of $2.28.⁷
• North Dakota has a private insurance mandate provision for cessation.⁷

Updated August 2021

*National and state-level prevalence numbers reflect the most recent data available. This 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, 2020.

2. CDC, Youth Risk Behavioral Surveillance System, 2019.

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 22 Years Later FY2021, 2020.

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, 2021.

8. Campaign for Tobacco-Free Kids. State Cigarette Excise Tax Rates & Rankings. https://www.tobaccofreekids.org/assets/factsheets/0097.pdf. Accessed.

9. 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.