An NC task force suggests raising the age for legal tobacco purchases to 21

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A state task force that studies the reasons behind child and infant deaths is asking the legislature to address a wide ranging list of health and mental health issues from vaping to social media algorithms.

The state Child Fatality Task Force submits a report to the governor and the legislature each year that suggests new laws or a refinement of existing laws. 

In its 2025 report, the task force suggests raising the legal age for tobacco purchases from 18 to 21 to align with federal law and requiring licenses for tobacco retailers. The report notes that North Carolina is one of seven states to not have raised the age for purchases to 21, and is one of nine states to not require a license or permit for tobacco retailers. The lower legal age makes it easier for people younger than 18 to use e-cigarettes, the report said. And, without licensing, it’s harder to convince retailers to follow the law. 

Products containing CBD from hemp are legal in the state and carry no age restrictions. The task force recommends prohibiting the sale of intoxicating cannabis or hemp products to people younger than 21, requiring child-resistant packaging and package warnings, and requiring retailers to obtain permits.

According to state hospital data, emergency room visits for cannabis ingestion increased more than 600% from 2019 to 2023 for youth 17 and younger. For 15–17-year-olds alone, the increase was more than 1000%.

Last year, the legislature was close to passing a law that would have set a minimum age of 21 for buying edibles containing hemp CBD. The bill was derailed when the Senate added legalization of medical marijuana to it.  While the Senate passed the measure, it stalled in the House.

Other task force recommendations:

• Allow Medicaid reimbursement for doula care. North Carolina’s infant mortality rate is 10th highest in the country, and Black babies are three times more likely to die in infancy than white babies. Doulas offer non-clinical support during pregnancy, labor, and after babies are born. A 2022 study found that doula support decreases the likelihood of cesarean sections and postpartum depression among women who used Medicaid, NC Newsline has reported. A 2013 study found that mothers with low incomes were more likely to have healthy babies, less likely to have birth complications and more likely to initiate breastfeeding when they had doula assistance before giving birth. North Carolina has been thinking for years about making doula services available to people who use Medicaid. Former Gov. Roy Cooper included Medicaid reimbursement in his recommended 2022-23 budget, but the General Assembly did not fund it.  
• Pass a law making it easier for counties to set up Fetal and Infant Mortality Review teams that study infant deaths and ways to prevent them. 
• Fund education and outreach to prevent sleep-related infant deaths. More than 100 infants die each year from unsafe sleep environments, the report said. Babies die accidentally when they are smothered between couch cushions or when they share a bed with another person. Funding to prevent unsafe sleep runs out in June 2025. The task force wants an ongoing appropriation of $250,000 a year. 
• Address the state’s child care crisis. Between January and August of last year, 191 child care programs closed. The average yearly cost of infant care is $9,480. Child care teachers earn an average of $14 an hour. Low wages and lack of benefits contribute to a teacher shortage. The state’s child care subsidy only pays half what the service costs to deliver, the report says, and parents cannot afford to pay an amount that would allow teachers to make a living wage.
• Support student physical and mental health by paying for more school nurses, social workers, counselors, and psychologists. 
• Endorse an effort to limit social media companies’ use of minors’ data so it can’t be used in algorithms or targeted ads. A 2023 House bill addressing this issue had bipartisan support, but it did not get a vote in the full House. 
• Pay for the firearm safe-storage educational campaign and strengthen the law meant to prevent children from finding loaded guns. 
• Support changes to the child passenger safety law to reduce motor vehicle injuries and deaths.  

The report also includes data on child deaths from 2023.

The child mortality rate dipped slightly from 2022 to 2023. The 2023 rate is the second highest since 2009. Motor vehicle-related injuries are the leading cause of death.