By Jaymie Baxley and Rose Hoban
Sally Herndon has spent more than three decades working to get North Carolinians to quit smoking.
As head of the state Health Department’s Tobacco Prevention and Control branch, she oversaw various initiatives aimed at reducing tobacco and e-cigarette use among young people. She was instrumental in efforts to reduce residents’ exposure to second-hand smoke, helping to marshal support for a 2010 law that banned smoking in bars and restaurants across the state.
It was a mission that hit close to home for Herndon. Her mother was a smoker who died from complications of emphysema. Her younger sister didn’t smoke but died at age 50 from lung cancer, which Herndon suspects she developed after breathing in the chemicals in second-hand smoke.
At midnight last Saturday, Herndon’s work ground to an unceremonious halt. She and eight members of her 12-person team were furloughed after the federal Centers for Disease Control and Prevention discontinued a grant that funded the state’s anti-smoking programs.
“This is not the way I wanted to end my career,” she said in an emotional interview with NC Health News hours before her furlough was to begin.
Herndon led the Tobacco Prevention and Control branch for 34 years. She planned to retire this summer, but had hoped to close the door on her long career on her own terms. She was looking forward to “turning over the reins to a younger group of people” who could build on the strides made by her staff, she said.
Nearly 22 percent of adults in North Carolina regularly smoked tobacco in 2011, according to the CDC’s own Behavioral Risk Factor Surveillance System. After steadily declining for years, the state’s adult smoking rate fell to an all-time low of 13.2 percent in 2023, even as more adults — and kids — took up vaping.
With about $2.4 million in critical funding gone, Herndon fears their progress could be upended.
“I’ve cried more in meetings in the last three weeks than I’ve ever cried in my life,” she said. “It’s really hard.”
‘Cost effective, proven strategy’
The cuts are a consequence of the President Donald Trump administration’s decision to eliminate the CDC’s Office on Smoking and Health, which for the past 25 years had provided states with grants to support tobacco prevention initiatives.
Kelly Kimple, interim director of North Carolina’s Division of Public Health, said the termination of that support is likely to result in a reduction of services across the state.
She called tobacco prevention efforts a “cost-effective, proven strategy for prevention that keeps people healthy.”
“If we take that away, I am concerned for the health of North Carolinians moving forward,” she said. “I know there are also some outstanding questions that we still are waiting to learn from the overall strategy from the federal government.”
The furlough of Herndon and her colleagues, who had a combined 120 years of experience, is expected to have the most immediate impact. Their departure leaves the state’s Tobacco Prevention and Control branch with just three full-time staff members.
“These are passionate, dedicated state employees who have been doing this work for years and years,” Kimple said of the furloughed workers. “Not only are these federal terminations having an impact on public health as a whole, but also just on our workforce in general.”
Looking ahead, Kimple said local health departments have been instructed to narrow their prevention strategies to focus on youth vaping. That work will be funded using the remaining funds from a landmark settlement the state reached with e-cigarette manufacturer JUUL in 2021. Then-Attorney General Josh Stein’s office fashioned the settlement with language restricting the funds to be used on tobacco abatement only.
In their budgets, state lawmakers have earmarked $3.25 million from the JUUL settlement for tobacco cessation efforts in the coming year, leaving only $4.7 million until that pot of money, too, is extinguished.
The state is also looking at limiting nicotine replacement therapy provided to uninsured residents through its QuitlineNC service, which offers personalized support to help people quit smoking and vaping. More than 950 North Carolinians were enrolled in the service as of March.
A deep-rooted issue
North Carolina has a long relationship with tobacco.
The crop dominated the state’s economy for much of the 20th century, providing jobs, tax revenue and export income. Three of the nation’s four largest cigarette manufacturers — RJ Reynolds, Lorillard Tobacco Company and Liggett Group — are still headquartered in the state, which was also home to defunct industry giants like American Tobacco Company.
Tobacco was so central to North Carolina’s economy that the General Assembly was one of the last state legislatures that allowed for smoking on the floor of either chamber. Many bathrooms at the legislative building still have ashtrays.
Nonetheless, armed with funding from tobacco lawsuits, public health officials in the state chipped away at the smoking rate with successful anti-smoking campaigns in the early 2000s that helped reduce teen smoking, heighten awareness of how tobacco advertising targeted young people and gave kids a good reason not to smoke. In 2012, as funding for these programs was on the chopping block at the legislature, teens flooded the legislative building asking for the money to remain in the budget, to no avail.
It’s not that there isn’t any money that could be used for tobacco control and prevention flowing to North Carolina. Each year, the state receives close to $140 million in funding from the 1998 Tobacco Master Settlement Agreement reached with states’ attorneys general in the wake of major lawsuits against tobacco companies.
State lawmakers in the Senate and House of Representatives also estimate that North Carolina will collect more than $245 million in tobacco taxes, but none of this more than $380 million in accumulated revenue gets applied to tobacco cessation and prevention activities.
The federal funding eliminated for tobacco prevention could end up costing the state in the long run. According to an estimate shared by the N.C. Department of Health and Human Services, states save $55 in health care costs for every dollar invested in anti-smoking programs.
The cuts are the latest in a series of setbacks for NC DHHS, which has lost more than 80 jobs and tens of millions of dollars in federal funding since Trump took office. State health officials worry that proposed cuts to Medicaid, which provides health care coverage to one in every four North Carolinians, will exacerbate those losses.
“We’re not only looking at how we can maintain a comprehensive and strategic tobacco cessation and control program, but also our public health system as a whole,” Kimple said. “As we navigate some of the federal changes and look forward to the future, I am concerned about how we maintain a strong public health system.”
That system, she said, is held together by experienced professionals like Herndon.
During her long career with the state, Herndon and her team accomplished several things that had a lasting, positive effect on residents’ health. She’s especially proud of the role she played in passing the 2010 ban on smoking in bars and restaurants, which in its first year contributed to a 21 percent decrease in emergency department visits for patients experiencing heart attacks.
Still, Herndon said there is much more work to be done. Each year, smoking claims the lives of more than 14,200 adults in North Carolina, she said.
“The beautiful thing about working in tobacco prevention and control is we have many more years of research on what is really truly effective than many serious problems that we have today,” Herndon said. “What really works is policy, systems and environmental change, and the more immediate results of these cuts in federal funding is [eliminating] that kind of work.
“It takes time and people power, but the results really save lives and save dollars.”
The post Up in smoke: Federal cuts threaten to derail NC’s progress on tobacco prevention appeared first on North Carolina Health News.
