Abstract
The following is a review of current policy and proposed legislation related to health behavior indicators in North Carolina. It is not an endorsement of any policy or bill; it is meant to serve as a resource for policy makers, health care stakeholders, and other readers of the NCMJ.
Healthy NC 2030
The North Carolina Department of Health and Human Services has released a set of health indicators and goals every 10 years since 1990. The latest iteration, Healthy North Carolina 2030 (Healthy NC 2030), draws attention to more non-medical factors than ever, aims to reduce inequities in outcomes for each indicator, and calls out institutional racism as a health indicator for the first time [1]. In this issue of the NCMJ, authors focus on rates of drug overdose deaths, tobacco use, excessive drinking, sugar-sweetened beverage consumption, HIV diagnosis, and teen birth rate in North Carolina (Figure 1). Suggested solutions include but are not limited to: increasing distribution of naloxone, implementing needle exchange programs, raising the price of tobacco products through a tax, increasing alcohol excise taxes, launching public awareness campaigns about sugary beverage consumption, increasing access to PrEP for those at high risk of HIV, and increasing access to longacting reversible contraception. See the Healthy NC 2030 report, pages 63–80, for more information on these indicators, desired results, potential levers for change, and developmental data needs [1]. See also the State Health Improvement Plan, a companion report to Healthy NC 2030 and the 2019 North Carolina State Health Assessment [2]. In addition to policy recommendations highlighted throughout this issue of the NCMJ, the State Health Improvement Plan also proposes expanding Medicaid eligibility, expanding peer support specialist programs, licensing tobacco retailers, restricting the sale of flavored tobacco products, promoting healthy restaurant meals, and requiring medically accurate sex education, among other proposals (Figure 2).
HEALTH INDICATORS AND DATA (TOTAL NC POPULATION, 2030 TARGET, AND DATA BY RACE/ETHNICITY, SEX, AND POVERTY LEVEL)
Source. Healthy NC 2030. NCIOM and NCDHHS; 2020.
Proposed Policy Changes in the2020 NC State Health Improvement Plan
Source. State Health Improvement Plan. NCDPH; 2020.
Tobacco, Alcohol, and Sugary Beverage Policies
Tobacco 21
In 2019, Congress passed a spending bill that raised the minimum age for legal tobacco sales from 18 to 21, enforced by the US Food and Drug Administration. More than 540 local jurisdictions and 19 states—not including North Carolina—have adopted their own Tobacco 21 laws [3].
Point of Service Regulations
Thirty-nine states, including North Carolina and the District of Columbia, have passed laws requiring tobacco retailers to post signs near the point of sale about age restrictions. At least two localities—Providence, Rhode Island and New York State—restrict point-of-sale marketing or discounts for tobacco products..
Menthol & Flavored Cigarette Bans
In April 2021 the Food and Drug Administration announced plans to ban the sale of menthol cigarettes and flavored cigars, proposing an official rule change in April 2022 [4]. Additionally, more than 145 localities and the state of Massachusetts restrict menthol cigarette sales [5]. North Carolina does not restrict the sale of flavored cigarettes, though flavored vape products are banned.
Tobacco Retail Licensing
Tobacco retail licenses allow policy-makers to require specific conditions of operation, such as not selling to those under the legal age or not selling fruit-flavored tobacco products. Retailers must pay for licensing, with fees providing funding for enforcement [6]. North Carolina does not currently require tobacco retail licensing, and state laws prohibit localities from implementing such policies.
Excise Taxes
Excise taxes are imposed on the sale of specific goods and services. In this issue of the NCMJ, the most relevant federal and state excise taxes include those on cigarettes, e-cigarettes, alcohol, and spirits. Authors in this issue highlight the potential impact of increasing cigarette and alcohol taxes, implementing a tax on sugary beverages, and allowing local governments to implement their own excise taxes on these products, which is currently preempted by state law.
Kids’ Meal Policies
As of 2021, 22 states and localities (not including North Carolina) have restaurant kids’ meal policies specifying that water, nonfat or low-fat milk, and 100% fruit or vegetable juice must be the default beverages for kids’ meals [7].
Sexual and Reproductive Health Policies
Pharmacy Practice Act
In 2021, as part of an update to the North Carolina Pharmacy Practice Act, the North Carolina General Assembly authorized immunizing pharmacists to also provide oral and transdermal hormonal contraceptives to people aged 18 and older while still requiring consent for patients under age 18 [8].
Minor’s Consent Law
Under the Minor’s Consent Law, North Carolina teens can obtain testing and treatment for sexually transmitted infections and HIV/AIDs [9].
Prohibition of Contraceptives on School Property
Under state statute, contraceptives, including condoms, cannot be distributed on school property, and information about where to obtain contraceptives and abortion can only be provided as part of a school’s sexual health curriculum depending upon the local school board’s parental consent policy [10].
Opioid Settlement and Harm Reduction Policies
Opioid Settlement Memorandum of Agreement
In July 2021, North Carolina Attorney General Josh Stein announced the state’s involvement in a $26 billion settlement agreement with opioid producers. The agreement was codified in a memorandum of agreement that allocates 15% of North Carolina’s settlement funds to the state and the rest to each of the state’s 100 counties, and 17 individual municipalities [11]. A multisector planning process for distributing these funds focused on supporting opioid treatment and prevention programs is currently underway. The settlement also involves the creation of an independent clearinghouse for data and analytics on pill distribution and requires opioid manufacturers to implement policies against promotion and marketing of these drugs [11].
Syringe Exchange Regulations
Under the philosophy of harm reduction, in 2016 the North Carolina General Assembly legalized syringe exchange programs. These programs distribute unused syringes, provide safe disposal of used syringes, and connect drug users to medication-assisted treatment, naloxone training, behavioral health care, and hepatitis prevention and treatment services [12]. NCMJ
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