Tobacco Prevention & Control State Plan 2025-2030

State Plan Goals, Objectives, Strategies, and Activities | July 1, 2025 – June 30, 2030

Burden Statement
Tobacco use is the single most preventable cause of death and disease in North Dakota and the United States, causing more deaths annually than alcohol, AIDS, car accidents, illegal drugs, murders, and suicides combined. Tobacco annually costs each North Dakota household $724 in taxes due to smoking-related expenses. The financial and human toll from tobacco use – either directly or from exposure to secondhand smoke – continues to be the most costly, preventable cause of death in the state. With the increase in availability of Electronic Nicotine Delivery Systems (ENDS), vaping nicotine and other substances has only escalated related health concerns.

In this plan, tobacco is any product or device that can deliver nicotine to the human brain, whether derived from tobacco or another source, except for safe and effective nicotine replacement therapies (NRT) approved by the U.S. Food and Drug Administration (FDA) for the treatment of nicotine dependence. Tobacco products include, but are not limited to, e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, heated tobacco products, and nicotine “tobacco-free” pouches. These are considered commercial tobacco products.

Commercial tobacco differs from traditional or sacred tobacco used by Indigenous people, including American Indians living in one of the five tribal nations in this geography. Commercial tobacco manufacturing includes adding harmful chemicals and manipulating nicotine levels to make these products more addictive. Traditional tobacco is used for medicinal or ceremonial purposes. Any references to tobacco in this report refer to commercial tobacco unless otherwise noted.

The current North Dakota Comprehensive Tobacco Prevention and Control State Plan (State Plan) is a state plan coordinated by the North Dakota Department of Health and Human Services (ND HHS), Tobacco Prevention and Control Program (TPCP). The TPCP seeks the input and collaboration of many partners, from state agencies to grassroots community organizations, working together in implementing this plan to reduce North Dakota’s burden from tobacco.

Mission
The mission of the TPCP is to improve and protect the health of North Dakotans by reducing the negative health and economic consequences of the state's number-one cause of preventable disease and death - tobacco use. North Dakota is addressing this by implementing innovative and evidence-based strategies to engage North Dakota communities in developing local solutions. These efforts work in tandem toward ensuring the program is fiscally responsible and prioritizing the state's health and economic interests.

Goal 
The goal of the TPCP is to reduce disease, disability, and death related to tobacco use by:

  • Preventing initiation among youth and young adults
  • Eliminating exposure to secondhand smoke
  • Promoting quitting among adults and youth
  • Sustaining a comprehensive, data-driven, evidence-based TPCP

Through this State Plan, the TPCP implements a process-based and outcomes-based evaluation of programs to keep state government officials, policymakers, and the public informed. The TPCP recognizes that monitoring and evaluating the planning activities and status of implementation is as important as identifying strategic issues and action steps. The State Plan is intended to be dynamic and will be updated as progress is made or change is indicated. Regularly scheduled meetings will occur so that the TPCP, its advisory teams, and partners can clarify and analyze progress, issues, challenges, and lessons learned. This will allow the TPCP the opportunity to change recommendations, plans, and resources as required and continuously evaluate progress and outcomes.

Goal 1: Prevent the Initiation of Tobacco Use Among Youth and Young Adults

5-Year Objective 1.1: By June 30, 2030, decrease the percentage of North Dakota high school students who use any tobacco or nicotine products to 10%. [Current 19.6%. Source 2023: Youth Risk Behavior Survey (YRBS)]. 

Objective 1.1: By June 30, 2027, decrease the percentage of North Dakota high school students who use tobacco or nicotine products to 15%. (Current 19.6%. Source 2023 YRBS).

  • Strategy 1.1.1: Maintain the number of Local Education Associations (LEAs) adopting the North Dakota Health and Human Services (ND HHS) and North Dakota School Board Association (NDSBA) comprehensive model tobacco-free school policy, including vaping devices or electronic nicotine delivery systems (ENDS) and nicotine pouches. (79% in 2025. Source: (ND HHS Tobacco Prevention and Control Program (TPCP) data).
    • Activity-State: Continue to engage the NDSBA policy director to coordinate comprehensive policy efforts.
    • Activity-Local: Disseminate updated ND HHS/NDSBA policies to local public health units (LPHU) tobacco prevention and control programs to compare with current school policies in their areas. 
    • Activity-Local: Engage local school boards, school administrators, and school staff to educate on the need for comprehensive tobacco and nicotine-free school policies to prevent youth initiation with tobacco products, including electronic nicotine delivery systems (ENDS) and nicotine pouches.
    • Activity-Local: Engage local schools to assist with monitoring the tobacco products youth are using.
  • Strategy 1.1.2: Maintain support for the Statewide Youth Action Summit. (Currently in two cities. Source: HHS TPCP data).
    • Activity-State: Provide technical and fiscal support to LPHUs and Tobacco Free North Dakota (TFND) for youth engagement efforts.    
    • Activity-Local: Work to expand the number of schools and communities that attend the Youth Action Summit. 
  • Strategy 1.1.3: Engage North Dakota youth, schools, and community groups to educate about youth advocacy and develop youth coalitions to address tobacco prevention and nicotine treatment issues.
    • Activity-State: Continue coordination to expand the Break Free North Dakota Statewide Youth Movement (Break Free) in communities in North Dakota.
    • Activity-State, Local: Support the Youth Action Summit to engage North Dakota students.
    • Activity-State: Provide technical and fiscal support for Break Free youth engagement efforts.
  • Strategy 1.1.4: Reduce the retailers selling tobacco products to minors as determined by the Synar tobacco compliance check program to 10% (16.8% in 2025. Source: ND HHS data).
    • Activity-State: Coordinate with ND HHS Behavioral Health Prevention Programs to provide guidance, resources, and training to implement compliance checks.
    • Activity-State: Provide funding for in-state development of the Responsible Tobacco Retailer Training Project (Valley City Police Department).
    • Activity-Local: Disseminate Responsible Tobacco Retailer Training Project information and provide support (if available) to local law enforcement agencies. 
    • Activity-State: Provide fiscal resources and guidance to support community leadership and law enforcement with local compliance check efforts. 
    • Activity-State: Gather data to report on the outcomes of compliance checks to measure success and the need for continued fiscal support. 
    • Activity-Local: Collaborate with law enforcement to perform community compliance checks.
    • Activity-Local: Provide communities with guidance to prevent youth access and resources for compliance checks.
    • Activity-Local: Educate local retailers on the importance of training staff to check purchaser identification for legal age compliance.
  • Strategy 1.1.5: Support local partners to increase the price of tobacco products as a means to effectively reduce youth tobacco and nicotine initiation and quit attempts.

Objective 1.2: By June 30, 2027, decrease the percentage of North Dakota 18–24-year-olds who report current tobacco use to 20%. (Current 22.7%. Source 2024 ND BRFSS).

  • Strategy 1.2.1: Engage North Dakota young adults (18-24-year-olds), schools, and community groups to educate about young adult-specific nicotine dependence treatment issues.
    • Activity-State: Engage the North Dakota University System (NDUS) prevention director in policy assessment efforts.
    • Activity-Local: Engage post-secondary education options to adopt and maintain a comprehensive tobacco-free campus policy.
       

Goal 2: Eliminate Exposure to Secondhand Smoke
 

5-Year Objective 2.1: By June 30, 2030, maintain efforts to address threats to the comprehensive 2012 North Dakota Smoke-Free Law.
 

5-Year Objective 2.2: By June 30, 2030, maintain the number of local smoke-free ordinances that meet or exceed the levels identified in the 2012 North Dakota Smoke-Free Law at 13 (from 13 in 2025. Source: HHS TPCP data). 
 

Objective 2.1: By June 30, 2027, eliminate/reduce exposure to secondhand smoke in North Dakota by addressing threats to the North Dakota Smoke-Free Law as passed in November 2012.

  • Strategy 2.1.1: Promote smoke-free law compliance and enforcement. 
    • Activity-State, Local: Provide smoke-free law signage to businesses required to comply with the law.
    • Activity-Local: Educate and respond to complaints of smoke-free law violations.
  • Strategy 2.1.2: Engage citizens and leadership on the importance of maintaining the North Dakota Smoke-Free Law to protect workers and the public in their communities. 
    • Activity-State: Partners work to develop strategies and tools to work in their communities to educate lawmakers on the importance of opposing exemptions to the North Dakota Smoke-Free Law.
    • Activity-Local: Use partner-developed resources to engage local communities and state representatives on the importance of opposing exemptions to the North Dakota Smoke-Free Law.

Objective 2.2: By June 30, 2027, maintain multi-level, multi-sector coalitions to plan and implement evidence-based tobacco prevention and control community interventions.

  • Strategy 2.2.1: Coordinate with and support TFND in statewide smoke-free/tobacco-free efforts.        
  • Strategy 2.2.2: Increase the number of smoke-free multi-unit residential housing properties in North Dakota. 
    • Activity-Local: Provide education and model smoke-free/tobacco-free policies to local multi-unit housing owners, managers, and tenants in North Dakota.
  • Strategy 2.2.3: Increase the number of tobacco-free public areas in North Dakota.
    • Activity-Local: Provide education and model tobacco-free policies to assist local efforts in addressing tobacco use in public areas not protected by the North Dakota Smoke-Free Law.

Goal 3: Promote Quitting Tobacco Use
 

5-Year Objective 3.1: By June 30, 2030, decrease the percentage of North Dakota adults who are current smokers to 10% (Current: 12.3%. Source: 2024 BRFSS).
 

5-Year Objective 3.2 (and Objective 1.1): By June 30, 2030, decrease the percentage of North Dakota high school students who are currently using any commercial tobacco/nicotine products to 10% (Current: 19.6%. Source: 2023 YRBS).
 

5-Year Objective 3.3: By June 30, 2030, expand access to youth-specific nicotine dependence treatment efforts, including counseling and medications, to youth under 18 years of age in all communities in North Dakota (from 0 communities in 2025). 
 

5-Year Objective 3.4: By June 30, 2030, decrease the percentage of North Dakota adults who are currently using any commercial tobacco/nicotine products to 15% (Current: 22.0%. Source: 2024 BRFSS).
 

Objective 3.1: By June 30, 2027, decrease the percentage of North Dakota adults who are current smokers to 11% (Current: 12.3%. Source: 2024 BRFSS).

  • Strategy 3.1.1: Promote North Dakota nicotine dependence treatment resources.
  • Strategy 3.1.2: Promote NDQuits nicotine dependence treatment services through media. 
    • Activity-State: Continue monitoring media evaluation and developing North Dakota-specific ads to reach priority populations identified through surveillance and evaluation data. 
    • Activity-State: Engage multiple statewide partners to administer Quit Week event activities annually.
  • Strategy 3.1.3: Promote American Indian-specific NDQuits media.

Objective 3.2: By June 30, 2027, decrease to 15% of North Dakota high school students who used ENDS products at least one day in the last thirty days. (33.1% in 2019 - 21.2% in 2021 - 18.2% in 2023. Source: YRBS).

  • Strategy 3.2.1: Expand access to youth-specific nicotine dependence treatment efforts, including counseling and medications, to youth under 18 years of age in four communities in North Dakota (from 0 communities in 2025).
  • Strategy 3.2.2: Provide support and promotion of My Life My Quit (MLMQ) youth treatment resources provided by the NDQuits contractor.

Objective 3.3: By June 30, 2027, expand access to youth-specific nicotine dependence treatment efforts, including counseling and medications, to youth under 18 years of age with four community partners in North Dakota (from 0 communities in 2025).

  • Strategy 3.3.1: Engage providers to expand NDQuits Youth Treatment (NDQYT) interventions.
    • Activity-State/Local: Promote the American Academy of Pediatrics (AAP) youth resources for youth nicotine dependence treatment with NRT.
    • Activity-State: Engage providers to utilize AAP and education resources developed by an education contractor.

Objective 3.4: By June 30, 2027, develop an assessment to determine the effectiveness of efforts to expand nicotine dependence treatment efforts through funding and training strategic partners working in multiple health systems in North Dakota (Currently not developed).    

  • Strategy 3.4.1: Expand NDQuits Cessation Grant (NDQC) Programs to providers representing a cross-section of the North Dakota population (including rural and urban health care settings, behavioral health and substance use treatment centers, pharmacies, and providers serving special populations, such as American Indians or low socioeconomic status (SES).
    • Activity-State: Engage providers to become NDQC Program grantees.
    • Activity-State, Local: Promote evidence-based treatment resources, such as counseling and NRT, in conjunction with NDQuits referrals and face-to-face treatment.
    • Activity-State, Local: Promote NDQuits quitline treatment services to providers.
  • Strategy 3.4.2: Expand the number of pharmacies providing nicotine dependence treatment services.
    • Activity-State: Promote approved trainings by the North Dakota Board of Pharmacy that are required for a pharmacist to have prescriptive authority for cessation treatment medications.
  • Strategy 3.4.3: Expand the behavioral health organizations offering medication-assisted treatment and counseling for nicotine dependence treatment.
    • Activity-State, Local: Promote NDQuits quitline treatment services and North Dakota Medicaid cessation treatment coverage.
    • Activity-State, Local: Educate organizations regarding co-treatment of nicotine dependence with other substances via nicotine dependence medications and counseling.
  • Strategy 3.4.4: Support North Dakota LPHUs providing on-site nicotine dependence treatment services. 

Objective 3.5: By June 30, 2027, increase to 500 the number of TPCP-trained Tobacco Treatment Specialists (TTS) in North Dakota (450 in 2025. Source: HHS TPCP data).

  • Strategy 3.5.1: Expand TTS training opportunities to providers representing a cross-section of the North Dakota population.
    • Activity-State: Provide access to and fiscal support for TTS training opportunities in North Dakota. 
    • Activity-State: Coordinate in-state education opportunities to obtain and maintain TTS continuing education and certification.
       


 

Goal 4: Maintain a Comprehensive Evidence-Based TPCP
 

5-Year Objective 4.1: By June 30, 2030, continue to maintain the ND HHS TPCP staffing and infrastructure that aligns with the five core components of the Component Model of Infrastructure, including contract management, providing technical assistance, and fiscal management.
 

5-Year Objective 4.2: By June 30, 2030, adjust media efforts reflective of evaluation results based on available funding.
 

5-Year Objective 4.3: By June 30, 2030, maintain comprehensive statewide tobacco prevention and control surveillance and evaluation activities.
 

5-Year Objective 4.4: By June 30, 2030, maintain programmatic efforts to support program sustainability by demonstrating program effectiveness, innovation, and value to the citizens of North Dakota.
 

5-Year Objective 4.5: By June 30, 2030, address tobacco-related disparities throughout all State Plan Goal areas.
 

Objective 4.1: By June 30, 2027, maintain the administrative structure to manage the comprehensive North Dakota TPCP in concurrence with CDC Best Practices for Tobacco Prevention and Control Programs. 

  • Strategy 4.1.1: Periodically update the ND HHS TPCP State Plan to adjust to program changes and emerging issues.
  • Strategy 4.1.2: Provide staffing for key strategically identified TPCP positions to prioritize work to support State Plan activities effectively.

Objective 4.2: By June 30, 2027, identify baseline for evaluation established as effective statewide mass-reach health communication interventions in North Dakota based on available funding levels.

  • Strategy 4.2.1: Promote NDQuits nicotine dependence treatment services through media. 
    • Activity-State: Continue monitoring media evaluation and promoting North Dakota-specific ads to reach priority populations identified through surveillance and evaluation data. 
    • Activity-State: Engage multiple statewide partners to administer Quit Week event activities annually.
    • Activity-Local: Participate in Quit Week promotions.

Objective 4.3: By June 30, 2027, maintain the North Dakota comprehensive statewide surveillance and evaluation plan.

  • Strategy 4.3.1: Maintain a contractor to update the Evaluation Plan.
  • Strategy 4.3.2: Continue evaluation of ND HHS TPCP programs and disseminate results.
    • Activity-State: Identify annual evaluation priorities and establish reporting processes to support these priorities.
    • Activity-State: Provide a biennial statewide TPCP effectiveness report (Synthesis Report) relating directly to the State Plan before each Legislative Assembly. The biennial evaluation will include community interventions, nicotine dependence interventions, and all areas relating to the State Plan. Disseminate to legislators, department leadership, and make it available to the public.
    • Activity-Local: Comprehensively report on local work that advances state plan goals and contributes to evaluation efforts. 
  • Strategy 4.3.3: Fund and implement tobacco-related surveillance.
    • Activity-State: Adult Tobacco Survey (ATS), Youth Tobacco Survey (YTS), BRFSS, YRBS, etc. 
  • Strategy 4.3.4: Coordinate with partners to continue data collection efforts with tobacco program involvement.
    • Activity-State: ATS, YTS, BRFSS, YRBS, North Dakota Vital Records, etc.
  • Strategy 4.3.5: Serve as a resource for tobacco-related data.
    • Activity-State: ATS, YTS, BRFSS, YRBS, etc.
    • Activity-State: Provide data to partners and the public through websites, surveillance tables, publications, etc.

Objective 4.4: By June 30, 2027, maintain programmatic efforts to support program sustainability by demonstrating program effectiveness, innovation, and value to the citizens of North Dakota.

  • Strategy 4.4.1: Engage key partners and stakeholders in planning update activities and strategic planning efforts.
  • Strategy 4.4.2: Provide partners and stakeholders with funding to implement plan activities.
  • Strategy 4.4.3: Utilize training resources demonstrated to be effective through evaluation in TPCP planning and community engagement activities.
  • Strategy 4.4.5: Coordinate and support the work of TFND, LPHU TPCPs, local coalitions, and other partners and stakeholders relating to the State Plan.
    • Activity-Local: Identify North Dakota-specific training needs for local communities.
  • Strategy 4.4.6: Utilize the Synthesis Report and media to promote the work and successes of the State Plan to stakeholders and decision-makers. 
  • Strategy 4.4.7: Identify partners able to provide innovative methods to expand tobacco prevention and nicotine dependence treatment efforts. 

Objective 4.5: By June 30, 2027, address tobacco-related disparities throughout specific populations in North Dakota disproportionally affected by commercial tobacco and nicotine addiction. 

  • Strategy 4.5.1: Low SES
  • Strategy 4.5.2: Behavioral Health
  • Strategy 4.5.3: Native Americans
  • Strategy 4.5.4: Other identified populations