Introduction:
North Carolina has a high rate of smoking, yet legislators cut the state’s budget for tobacco control in 2011 from $18 million to $1 million. To inform legislators and others about effects of this cut, this ecological study uses county-level data to predict mortality rate reduction by reducing smoking prevalence in North Carolina’s 100 counties.

Methods:
County-level smoking data for 1996 were reported as percent of the county population who smoked. County level demographic data were taken from the 2010 US Census and the North Carolina Office of State Budget Management. Selected disease specific mortality rates for were reported per 100,000 county population. Linear regression analysis evaluated how a one-percent reduction in county smoking prevalence could reduce county mortality rates.

Results:
The 1996 percent county-level smokers correlated with 2010 rates for mortality from all-causes, total cancer, lung cancer, heart disease and diabetes (regression coefficients = 5.92; 4.84; 5.57; 4.12 and 1.80, respectively). The regression coefficient (5.93) for 1996 county level smoking rates was greatest for all-cause mortality. This coefficient implies that for each one percent change in county smoking rates in 1996, there would be a corresponding change in county all-cause mortality of 5.92 deaths per 100,000 population.

Conclusions:
This study found correlations between 1996 county-level smoking rates and disease-specific 2010 mortality in North Carolina’s 100 counties. Informing legislators and other stakeholders about these findings might influence an increase in tobacco control funding statewide as well as in legislators’ home counties. Other states could follow this approach.