In this Report, Roosevelt’s Emerging Fellow for Health Care Shauna Rust argues that in the 50 years since the landmark Surgeon General’s Report that revealed the health hazards of tobacco, U.S. adult smoking rates dramatically declined from 43 percent in 1965 to 18 percent in2014.However, tobacco use remains the leading preventable cause of death in the United States, with over 480,000 deaths per year. Furthermore, tobacco use contributes to over $3.81 billion inannual health care costs in North Carolina alone. Despite a decline in cigarette smoking, there hasbeen an uptick in the use of “other tobacco products” (OTPs) among youth in North Carolina andacross the U.S. These OTPs, including e-cigarettes, little cigars or cigarillos, smokeless tobacco, andhookah, are available in a wide array of flavors and have the potential to hook a new generation onnicotine. By restricting the sale of these fruity and candy-like flavored OTPs, which have a clearappeal to young people, North Carolina can reduce the deadly impact of tobacco and control risinghealth care costs.