The SHIP Tobacco Committee recognizes that effective tobacco control includes tobacco price increases, smoke-free policies, targeted media campaigns, and access to cessation services. Addressing availability, pricing and promotion, advertising and display bans, age of sale, and retail licensure are strategies for boosting tobacco control efforts.

The term tobacco use refers to commercial tobacco use, which includes all tobacco products offered for sale, not tobacco used for sacred and traditional ceremonies by many American Indian tribes and communities.

Point of Sale

• Explore policy strategies to prohibit the sale of tobacco products in pharmacies
• Remove state preemption of local government regulations on the sale, promotion, distribution, and display of tobacco products
• Revise zoning ordinances to control placement of shops that sell tobacco, limiting the number of these shops per area and ensuring they are placed a safe distance from children’s areas

Price and Funding

• Fund comprehensive state tobacco control programs to levels recommended by Centers for Disease Control and Prevention (CDC)
• Increase number of paid staff at the state/local level to conduct comprehensive tobacco control programs
• Increase the price of tobacco products by raising the current state tax on cigarettes and increase other tobacco products taxes to parallel levels

Providing Barrier Free Access to Tobacco Treatment

• Ensure Medicaid reimbursement for provision of tobacco cessation counseling and treatment for parents in any pediatric setting, not just during a tobacco-related sick visits
• Expand Medicaid eligibility to include coverage for all tobacco cessation treatment without barriers; this includes Medicaid coverage of group counseling for tobacco treatment
• Expand the accessibility of tobacco use treatment for Medicaid beneficiaries into more settings and modalities, with a broader array of providers
• Explore seeking reimbursements for Certified Tobacco Treatment Specialists (CTTS) for their work in providing standard of care tobacco treatment- counseling and tobacco treatment medications under the supervision of a prescriber
• Increase access to treatment based on the N.C. Tobacco Treatment Standard of Care, to include counseling and FDA-approved medications
• Provide nicotine replacement options and services to the uninsured and underinsured
• Support Tobacco Treatment Specialist Training for historically marginalized communities

Raise State Minimum Sales Age/ Retailer Permitting System

• Raise state minimum sales age from 18 to 21 and establish a tobacco retailer permitting system to protect NC youth; this includes taking action to:
  • Increase compliance of retailers to ask purchasers for a photo ID to buy tobacco products to prevent sales to anyone under the age of 21;
  • Educate NC merchants and the NC public that the minimum sales age for tobacco is 21 is federal law.
  • Adopt change in state law that allows for full implementation of the federal Tobacco 21 law, including changing the minimum legal sales age from 18 to 21; an amended definition of tobacco products to include nicotine from any source, including synthetic nicotine; prohibits the sale of loose cigars and cigarettes; prohibits free samples of all tobacco products; requires ID to be shown for delivery of most internet sales, and that tobacco products be sold from behind the counter.
  • Repeal preemption to allow NC and communities in NC to restrict the sale of flavored tobacco products

Smoke-Free and Tobacco-Free Environments

• Enforce the federal law that calls for smoke-free multi-unit public housing and promote smoke-free multi-unit affordable housing
• Implement state and local tobacco-free and smoke-free air policies that include electronic cigarettes
• Increase the number of tobacco-free public parks
• Recommend an electronic cigarette policy for restaurants and bars

June 15, 2023, Hybrid Work Group Meeting (In-Person at Poe Center for Health Education)

Attendees: Kim Bayha, Teresa Beardsley, Ronny Bell, Catherine Bonniot, Anna Brown, Heather Burkhardt, Kim Canady, Megan Canady, Lisa Dalton, Kaycee Deen, Evangeline Eure, Stephanie Gans, Krysta Gougler-Reeves, Sanquis Graham, Morgan Wittman Gramann, Courtney Heck, Sally Herndon, Mona Hood, Kearston Ingraham, Virginia Johnson, Camaryn Jones, Susan Kansagra, Rita Krosner, Noxxie Malinga, Jim Martin, Viviana Martinez, Erin McClain, Keith McCoy, Lu McCraw, Beth McDermott, Kimberly McDonald, Mallory Moran, Michelle Mulvihill, Tiffany Munday, Sharon Nelson, Sherry Nethercutt, Dana Painter, Sherrie Parish, Susan Peebles, Amy Perry, Richard Peters, Leah Ranney, Ashley Rink, Ray Riordan, Ann Rollins, Delton Russell, Charlene Sampson, Lou Simmons, Kyle Smith, Anna Stein, Deidre Sully, Joyce Swetlick, Tiffany Thigpen, Natalie Thompson, Elizabeth Tilson, D’Asia Thompson, Tenika Walker, Mary Ward, Ernest Watts, Tori Whitley, David Willard, Juliana Wilson, Rachel Yip, Emily Yost, Christine Zazzaro

Topics: Refer to the presentation slides for information shared during the panel discussions on the following topics.

• Leadership Panel: How far we have come in 5 Years and Why this is a Great Step in North Carolina
• Level Setting: What is the Medicaid Policy? To Whom does it Apply/Not Apply?
• The Road Ahead to April 1, 2024: Training, Technical Assistance, and Change for Life: A Successful Peer Support Coalition Model

Below are the links shared during the panel discussions.

• BreatheEasyNC
  • FAQs for medical, behavioral, and IDD/TBI providers
  • Training calendar
  • Evidence-based treatment and policy information with citations and links to resources
  • Sample policies, sample signage
  • Regional tobacco control staff map
• Tobacco Treatment Standard of Care
• North Carolina Standard Plan, Tailored Plan and LME/MCO Tobacco-Free Policy Requirement (NC Medicaid’s Bulletin)
• QuitlineNC

April 14, 2023, 1:00 to 2:30 pm, Work Group Meeting

Co-Leads: Ronny Bell, Sally Herndon, and Delton Russell

Attendees: Joshua Batten, Kim Bayha, Teresa Beardsley, Anna Bess Brown, Kimberly Canady, Carleen Crawford, Ashley Curtice, Lisa Dalton, Kaycee Deen, Krysta Gougler-Reeves, Sanquis Graham, Morgan Wittman Gramann, Cierra Hamlet, Eric Harbour, Courtney Heck, Mona Hood, Kearston Ingraham, Jaimie Lea, Noxxie Malinga, Viviana Martinez, Molly Monath, Tamra Morris, Michelle Mulvihill, Tiffany Munday, Sharon Nelson, Dana Painter, Sherrie Parish, Leah M. Ranney, Vera Reinstein, Hope Rife, Ray Riordan, Ann Rollins, Faith L. Samples, Charlene Sampson, Jasmine Simmons, Lou Ann Simmons, Ann Staples, Gregg Stave, Antoinette Stein, Joyce Swetlick, Tiffany Thigpen, Natalie Thompson, Steph Trilling, Mary Ward, Ernest Watts, Cathy Weedman, David Willard, Larissa Williams

New QuitlineNC Services

• Joyce Swetlick, Director of Tobacco Cessation, North Carolina Tobacco Prevention and Control Branch, provided an overview of QuitlineNC and new services available.
• Participants can enroll by calling 1-800-QUIT-NOW (1-800-784-8669), going to the website www.quitlinenc.com, or texting 234191, which will send a link to the web enrollment. Spanish speakers can call 1-855-DÉJELO-YA (1-855-335-3569) or text LISTO to 34191. The website is also available in Spanish.

Progress on Rescue Agency “Behind the Haze” Campaign

• Ann Staples, Senior Media Consultant, NC Tobacco Prevention and Control Branch, shared updates from “Behind the Haze,” one of the campaigns purchased from the Rescue Agency.
• “Behind the Haze” targets teenagers ages 13 to 18, who are either using vapes or are susceptible to vapes. The first message package, the Great Manipulator, ran between January 10 to March 8, 2023, on Instagram, Snapchat, and TikTok. Due to the state ban, the next package will not be on TikTok.
• Down & Dirty, another message package purchased from Rescue, will target teenagers ages 13 to 18. A cessation program from Rescue, Quit the Hit, will include small, adult-facilitated Instagram Groups.

North Carolina Alliance for Health (NCAH) Legislative Updates

• Morgan Wittman Gramann, Executive Director, North Carolina Alliance for Health, shared there has been a lot of discussion around Tobacco 21 that would increase the age from 18 to 21 to purchase tobacco products and would also implement a retail permitting system for retailers that sell tobacco products.
• Mogan shared during this legislative session the Alliance is focusing on strategic education with specific lawmakers and continuing to build coalition support. Also, continuing to focus on funding for commercial tobacco use prevention and cessation programs like the QuitlineNC that Joyce shared, the Rescue campaign that Ann shared, and some youth focused activities.
• For additional information about Senate Bill 116, 2023 Youth END (End Nicotine Dependence) Act, refer to https://www.ncleg.gov/BillLookUp/2023/s116.

Unity Conference and Tobacco Survey of NC Tribes

• Dr. Ronny Bell shared the North Carolina American Indian Unity Conference happens the second Thursday, Friday, and Saturday of March each year. This year’s conference was very well attended.
• The Southeastern American Indian Cancer Health Equity Partnership, which includes the community outreach and engagement programs for the three NCI-Designated Cancer Centers at Wake Forest, Duke, and UNC, did a workshop on their partnership and the work they are doing with the V Foundation to engage with the tribal communities across the state.
• They had a wonderful session with representatives from the North Carolina Native American Youth Organization where they trained them to do photovoice in three of the tribal communities.
• Through partnership with the North Carolina Tobacco Prevention and Control Branch a survey to gain a better understanding of the use of commercial tobacco and alternative tobacco products in tribal communities in North Carolina will be conducted. The North Carolina Commission on Indian Affairs will organize and administer the survey. Their goal is to have about 2,000 surveys completed.

Medicaid Bulletin

• Sally Herndon shared the Medicaid Bulletin released recently clarifies and articulates the work done over the past five years in North Carolina to move all behavioral health facilities tobacco free and to offer tobacco treatment concurrently with substance use treatment and mental health disorder treatment.
• The bulletin is available at https://medicaid.ncdhhs.gov/blog/2023/03/15/north-carolina-standard-plan-tailored-plan-and-lmemco-tobacco-free-policy-requirement.

Next Steps on SHIP

• The next meeting will be in-person on Thursday, June 15, 2023, from 12:30 to 3:00 pm at the Poe Center in Raleigh. This will be a kickoff to the Medicaid Tobacco-Free policy that goes into effect in 2024. Dr. Betsey Tilson will be leading a panel discussion. There will be a question-and-answer session on the policy and implementation, including who this policy will and will not affect, and planned training and technical assistance. Another presentation will be on a peer-based model to help organizations that want to go tobacco free.

February 10, 2023, 1:00 to 2:30 pm, Work Group Meeting

Co-Leads: Ronny Bell, Sally Herndon, and Delton Russell

Work Group Members & Attendees Present: Ami McGarity, Ann Staples, Anna Bess Brown, Beverly Gray, Carleen Crawford, Charlene Sampson, Cierra Hamlet, Courtney Heck, Dana Painter, Danna Thompson, David Willard, Eric Donny, Erin McLain, Ernest Watts, Faith Samples, Heather Burkhardt, Jim Martin, Joyce Swetlick, Juliana Wilson, Kathy Dail, Kearston Ingraham, Kim Bayha, Kimberly McDonald, Krysta Gougler-Reeves, Larissa Williams, Lisa Dalton, Lou Ann Simmons, Lu McCraw, Mary Ward, Megan Williams, Michelle Mulvihill, Mona Hood, Natalie Thompson, Ray Riordan, Richard Peters, Ronda Doward, Sanquis Graham, Sarah Arthur, Shamika Howell, Sheryl Parish, Stacy Thiedeman, Stella Blankenship, Steph Gans, Tenika Walker, Teresa Beardsley, Thomas Carr, Tiffany Munday, Tiffany Thigpen, Vera Reinstein, Viviana Martinez

Tobacco 21 Updates

• Jim Martin provided an update on providing educational presentations about the benefits of Tobacco 21 and aligning North Carolina’s law with the federal law. Organizations that have voiced their support for Tobacco 21 include:
  • The Justus-Warren Heart Disease and Stroke Prevention Task Force, a legislatively appointed task force, unanimously voted to have this as part of their policy agenda for this year.
  • The North Carolina Association of Local Health Directors voted in December to have this as part of their legislative priorities for 2023.
  • The North County Public Health Association, the North Carolina Association of School Nurses, and the North Carolina Association of School Resource Officers have also voiced their strong support.
  • Other key organizations wanting to lend their support were the Alcohol and Drug Council of North Carolina, the North Carolina Psychiatric Association, Community Impact of North Carolina, Addiction Professionals of North Carolina, North Carolina Substance Use Disorder Federation, and Poe Center for Health Education.
  • Population Sciences at UNC, Duke, Atrium Health, and Wake Forest Baptist have also voiced lending their strong support.
  • The North Carolina Alliance for Health has this as their strongest policy priority for this year and are moving this forward as it relates to the legislature with strong support from multiple organizations.
• Ray Riordan shared the regional tobacco control managers have been speaking with and providing education on Tobacco 21 (T21) to County Commissioners, Boards of Education, and Boards of Health. As a result of the conversations, ten Boards of Health, three Boards of Education, some school health advisory councils (SHACs), and other regional groups have signed onto the T21 resolution.

American Lung Association: State of Tobacco Control, North Carolina

• Thomas Carr, National Director for Policy with the American Lung Association, provided a presentation on the “State of Tobacco Control.”
  • The 2023 “State of Tobacco Control” report is available at https://www.lung.org/research/sotc. The report is intended to be used as a tool to advance policy change at the federal, state, and local levels.
  • North Carolina’s state highlights are available at https://www.lung.org/research/sotc/state-grades/highlights/north-carolina. North Carolina had Fs in all five grade categories, https://www.lung.org/research/sotc/state-grades/north-carolina.

LGBTQ Tobacco Engagement and Data

• Juliana Wilson, MSW, Sexual and Gender Minority Tobacco Treatment Coordinator with the North Carolina Tobacco Prevention and Control Branch, provided a presentation on LGBTQ+ tobacco/nicotine product use and preferences for quitting.
  • The goal of this work was to begin to understand how and how much North Carolinians with minoritized gender identities and sexual orientations used tobacco and nicotine products, and how can begin to work toward improving access to use of an awareness of quitting services.
  • The NC LGBTQ+ Tobacco Assessment data was collected in-person by predominantly LGBTQ survey takers. Surveys were collected between June to November 2022. Data was collected at 20 pride events, 2 regional conferences, and a health fair across the state from over 1300 current and former tobacco and nicotine product users. The survey was for adults over eighteen.

December 9, 2022, 1:00 to 2:30 pm, Work Group Meeting

Co-Leads: Sally Herndon and Delton Russell; Absent: Ronny Bell

Work Group Members Present: Ami McGarity, Anna Bess Brown, Carleen Crawford, Charlene Sampson, Courtney Heck, Dana Painter, Erin Sutfin, Georgia Childs, Heather Burkhardt, Jaimie Lea, Jim Martin, Joyce Swetlick, Juliana Wilson, Kearston Ingraham, Kim Bayha, Kimberly McDonald, Kimberly Sumrell, Kyle Smith, Leah M Ranney, Lu McCraw, Mary Ward, Megan Canady, Megan Williams, Meghan Kissell, Michelle Mulvihill, Mona Hood, Natalie Thompson, Noxxie Malinga, Peg O'Connell, Richard Peters, Rita Krosner, Sanquis Graham, Shamika Howell, Sharon L. Greer, Steph Gans, Tiffany Munday, Trina Fullard, Vera Reinstein, Viviana Martinez

Announcements:

• Jim Martin provided an update on support from partner organizations for establishing a tobacco retailer permitting system and raising the sales age from 18 to 21.
• Peg O’Connell, Chair of the Stroke Advisory Council, shared that the Stroke Advisory Council is part of the Justus-Warren Heart Disease and Stroke Prevention Task Force. The Council’s focus is to reduce the incidence and revert heart disease and stroke in North Carolina. The Task Force is composed of both legislators and civilians, including heart disease and stroke survivors. Anna Bess Brown shared a link to the Justus-Warren Task Force’s action agenda, https://www.startwithyourheart.com/justus-warren-heart-disease-and-stroke-prevention-task-force/action-agenda/.    
• Shamika Howell introduced Michelle Mulvihill, Wake County’s new Tobacco Prevention and Control Coordinator. Michelle is the former Region 7 Tobacco Control Manager. Michelle Mulvihill shared Wake County’s tobacco-free policy ordinance includes tobacco-free areas in the unincorporated areas of the county. Wake County now has the most comprehensive tobacco-free policy in the state. They are now working with municipalities to pass their own ordinance/ resolution and/or opt-in.

Data Updates:

• Courtney Heck, Director of Surveillance and Evaluation with the North Carolina Tobacco Prevention and Control Branch, provided an update on adult and youth commercial tobacco use in North Carolina.

Success Stories:

• Delton Russell shared his personal story and why prevention work is so important to him.
• Trina Fullard shared the story of Charlotte Rescue Mission in becoming a tobacco-free campus. Charlotte Rescue Mission is a recovery related program that is spiritual based. Their mission to provide food, clothing, and shelter for those facing the intersection of homelessness and addiction. Their program is not connected to insurance, LMEs, or treatment plans and are solely funded by private donations and grants.

Next Steps: 

• Workgroup members were asked to share suggestions for future agendas. Suggestions for meeting topics included:
  • Data collection from NC Pride events
  • Work being done to replicate rapid data collection at tribal events/ tribal survey
  • How Tobacco 21 will impact NRT sales
  • Asking any of the tobacco-free behavioral health facilities talked to this group about how they implemented the policy, outcomes and lessons learned

October 14, 2022, 1:00 to 2:30 pm, Work Group Meeting

Co-Leads: Ronny Bell, Sally Herndon, and Delton Russell

Work Group Members Present: Ann Staples, Anna Bess Brown, Antoinette Stein, Ashley Curtice, Beverly Gray, Carla Alston Daye, Carleen Crawford, Dana Painter, David Willard, Ellen Essick, Erin McLain, Ernest Watts, Faith Samples, Heather Burkhardt, Jim Martin, Joyce Swetlick, Juliana Wilson, Julie Kokocha, Kearston Ingraham, Kim Bayha, Kim Caldwell, Kim Canady, Kimberly McDonald, Kyle Smith, Leah M Ranney, Les Spell, Mary Ward, Meghan Kissell, Morgan Wittman Gramann, Natalie Thompson, Ray Riordan, Richard Peters, Rita Krosner, Sanquis Graham, Sarah Arthur, Sarah Jacobson, Steph Gans, Steph Trilling, Susanne Schmal, Tenika Walker, Tiffany Munday, Vera Reinstein, Viviana Martinez

Discussion:

• Reviewed results of policy prioritization survey. All the policies, including the ones added at the August work group meeting, will be prioritized as the work group recognized that all are intertwined. All the policies will be added to the NC SHIP Policy Scorecard and included in the 2023 NC SHIP. None of the policies will be deferred.
  • Raise state minimum sales age from 18 to 21 and establish a tobacco retailer permitting system to protect NC youth. (19 votes)
  • Increase the price of tobacco products by raising the current state tax on cigarettes and increase other tobacco products taxes to parallel levels (17 votes)
  • Expand Medicaid eligibility to include coverage for all tobacco cessation treatment without barriers. This includes Medicaid coverage of group counseling for tobacco treatment. (11 votes)
  • Fund comprehensive state tobacco control programs to levels recommended by Centers for Disease Control and Prevention (CDC). (10 votes)
  • Remove state preemption of local government regulations on the sale, promotion, distribution, and display of tobacco products. (10 votes)
  • Implement state and local tobacco-free and smoke-free air policies that include electronic cigarettes (8 votes)
  • Expand the accessibility of tobacco use treatment for Medicaid beneficiaries into more settings and modalities, with a broader array of providers. (6 votes)
  • Increase number of paid staff at the state/local level to conduct comprehensive tobacco control programs (4 votes)
  • Support Tobacco Treatment Specialist Training for historically marginalized communities (4 votes)
  • Increase access to treatment based on the N.C. Tobacco Treatment Standard of Care, to include counseling and FDA-approved medications (3 votes)
  • Enforce the federal law that calls for smoke-free multi-unit public housing and promote smoke-free multi-unit affordable housing. (3 votes)
  • Revise zoning ordinances to control placement of shops that sell tobacco, limiting the number of these shops per area and ensuring they are placed a safe distance from children’s areas. (3 votes)
  • Provide nicotine replacement options and services to the uninsured and underinsured (2 votes)
  • Explore seeking reimbursements for Certified Tobacco Treatment Specialists (CTTS) for their work in providing standard of care tobacco treatment - counseling and tobacco treatment medications under the supervision of a prescriber (2 votes)
  • Recommend an electronic cigarette policy for restaurants and bars (2 votes)
  • Ensure Medicaid reimbursement for provision of tobacco cessation counseling and treatment for parents in any pediatric setting, not just during a tobacco-related sick visits. (2 votes)
  • Increase the number of tobacco-free public parks (1 vote)
  • Explore policy strategies to prohibit the sale of tobacco products in pharmacies. (1 vote)
• Received updates from workgroup members on relevant work they were doing, successes, and challenges.
• Jim Martin, Director of Policy and Programs with the Tobacco Prevention and Control Branch, provided a presentation on protecting our kids from vaping and nicotine addiction by establishing a tobacco retailer permitting system and raising the minimum legal age to purchase tobacco from 18 to 21.
• Discussed next steps and input for future meetings.

August 26, 2022, 1:00 to 2:30 pm, Work Group Meeting

Co-Leads: Ronny Bell and Sally Herndon; Absent: Delton Russell

Work Group Members Present: Ami McGarity, Ann Staples, Anna Bess Brown, Antoinette Stein, Aubrey Cuthbertson, Beverly Gray, Carleen Crawford, Charlene Sampson, Courtney Heck, David Willard, Elizabeth Brewington, Ellen Essick, Erin McLain, Erin Sutfin, Ernie Watts, Faith Samples, Jarret Stone, Jim Martin, Joshua Batten, Joyce Swetlick, Juliana Wilson, Julie Kokocha, Kearston Ingraham, Kim Bayha, Kim Caldwell, Kim Sumrell, Kimbery Canady, Kyle Smith, Larissa Williams, Leah Ranney, Lu McCraw, Mary Ward, Molly Monath, Morgan Wittman Gramann, Natalie Thompson, Nicole Johnson, Ray Riordan, Richard Peters, Rita Krosner, Ronda Doward, Sanquis Graham, Sarah Jacobson, Steph Gans, Steph Trilling, Susanne Schmal, Tenika Walker, Teresa Beardsley, Terri Bell, Tiffany Thigpen, Tobin Lee, Vera Reinstein, Viviana Martinez

Discussion: 

• Built connections with work group members present. Everyone asked to share their name, organization, their work with tobacco control, where they were from, and their favorite restaurant from their early days.
• Reviewed result statement, targets and baselines for youth and adult tobacco use, and proposed policy initiatives for Indicator 11: Tobacco Use. 
• Discussed recommendations for additional policies and questions from work group members. Two additional policy initiatives were added: 
  • Ensure Medicaid reimbursement for provision of tobacco cessation counseling and treatment for parents in any pediatric setting, not just during a tobacco-related sick visits.
  • Expand the accessibility of tobacco use treatment for Medicaid beneficiaries into more settings and modalities, with a broader array of providers.
• Asked work group members to submit their top three policy priorities by end of day on Friday, September 9, 2022. 
• Set schedule for meetings. The work group will meet every other month on the second Friday from 1:00 to 2:30 pm. 

August 12, 2022, 8:00 to 8:45 am, Co-Lead Planning Meeting

Co-Leads: Ronny Bell, Sally Herndon, and Delton Russell

Discussion:

• Discussed potential revisions to the proposed policy initiatives from the NC SHIP for Indicator 11: Tobacco Use.
• Reviewed list for gaps in potential work group members.
• Planned agenda for first work group meeting on August 26, 2022.
• Identified process for prioritizing the proposed policy initiatives.