All Catawba County community members live in communities that support tobacco free lifestyles.

Why Is This Important?

Tobacco use is the leading cause of preventable disease, disability, and death in the United States. The use of tobacco harms nearly every organ in the body and causes cancer, heart disease, stroke, lung diseases, type 2 diabetes, and other chronic health conditions. The impacts of smoking extend past the smoker through secondhand smoke (CDC, 2020). Using e-cigarettes also causes health risks. E-cigarettes both contain and emit a number of potentially toxic substances (American Lung Association, 2020).

In Catawba County, chronic lung disease is the third leading cause of death. Chronic lung disease has led to 8,371 years of potential life lost by Catawba County residents. Mortality rates for lung cancer and chronic lower respiratory diseases for Catawba County are also higher than the North Carolina rates. In the 2019 Catawba County Community Health Opinion Survey, 15.5% of the respondents reported having smoked cigarettes or other nicotine products, including e-cigarettes, within the past twelve months; compared to 12.0% in 2015 (Catawba County Public Health, 2020).

If all Catawba County community members lived in communities that supported tobacco free and e-cigarette free lifestyles, Catawba County would potentially have:

  • Lower rates of lung cancer deaths,

  • Reduced hospital admissions related to lung cancer,

  • Increases in life expectancy,

  • Increases in community members receiving lung cancer screenings,

  • Decreases in the number of community members using tobacco, and

  • Increases in the number of tobacco free worksite policies.

  • Connection to COVID-19 complications?


American Lung Association. (2020). The Impact of E-Cigarettes on the Lung. Retrieved on November 30, 2020 from

Catawba County Public Health. (2020). 2019 Catawba County Community Health Assessment). Retrieved on November 30, 2020 from

Centers for Disease Control and Prevention. (2020). Tobacco Use. Retrieved on November 30, 2020 from


Story Behind the Curve

While Catawba County has seen a decrease in age-adjusted death rates for lung cancer since 2015, chronic lung disease remains one of the leading causes of death. Smoking tobacco is the leading risk factor for lung cancer. The risk of lung cancer for smokers is much higher than for non-smokers and the longer an individual smokes and the more packs a day smoked, the greater the risk. Secondhand smoke, breathing in the smoke of others, can also increase the risk of developing lung cancer (American Cancer Society, 2020). In Catawba County, there is an opportunity to push for tobacco policy adoption, enhancement, and implementation to support tobacco and e-cigarette free lifestyles to decrease lung cancer deaths in the long-term. Lung cancer screenings can increase detection before any symptoms appear. Implementing comprehensive policies is an evidence-based strategy used to reduce tobacco use.


American Cancer Society. (2020). Lung Cancer Risk Factors. Retrieved on December 2, 2020 from


In June 2020, Catawba County Public Health and LiveWell Catawba convened work groups for each of the 2020 to 2023 health priorities: chronic disease, behavioral health, and healthy foods & healthy weight. The Chronic Disease Work Group narrowed their focus from all chronic diseases to lung cancer specifically. As the work group moved through the results-based accountability process to develop the community health improvement plan (CHIP), they discussed on an ongoing basis who are partners and community members that are not involved that should be involved.

The Chronic Disease Work Group is continuously expanding to include a diverse group of community members, agencies, and sectors. A current list of Chronic Disease Work Group members is available here

What Works

The Chronic Disease Work Group through the strategy selection process discussed best practices that work to support tobacco and e-cigarette free lifestyles, potential low cost and no cost ideas, and data needed to better inform the work.  

Strategy Selection Process

In 2020, the Chronic Disease Work Group selected the overarching strategies of tobacco policy and lung cancer screening to support tobacco-free lifestyles. The strategy selection process included the work group members rating each strategy idea as high, medium, or low on the criteria of leverage (short-term: 3 years, intermediate: 3 to 5 years, and long-term: 10 years), feasibility, values, and specificity. The work group then reviewed the rating survey results, discussed each strategy, identified the overarching strategies based on related themes of the strategies selected, and determined, based on the criteria and rankings, which strategies should not be included in the community health improvement plan. The work group continued to update their strategies and action steps throughout 2021 and 2022. 

What are the programs and/or interventions recognized as best practices? 

  • Comprehensive tobacco-free policies

  • Leveraging health insurance for preventive screenings

  • Onsite screenings at worksites

What are potential low cost and/or no cost ideas for immediate improvements? 

  • Education for worksites

  • Media campaigns

  • Promoting available resources (American Cancer Society, NC Quitline, Tobacco Support Specialists)

What data is needed to better inform the work? 

The Chronic Disease Work Group has discussed the following data needs and/or additional data to consider if available.

  • Age-adjusted lung cancer rates at the census tract level (currently is available at the zip code level)

  • Hospital admission data related to lung cancer at the county level

  • Number of health professional referrals to tobacco treatment resources

  • Number of people receiving lung cancer screenings at the county level

  • Number of worksites currently with tobacco-free policies

  • Tobacco use (including e-cigarette use) data at the county level collected regularly for adults and children 

Action Plan

At the Chronic Disease Work Group meeting on January 24, 2022, work group members reviewed and updated their current strategies based on what was working well, what was not working well and/or could be removed or changed, and how these strategies impact health disparities in Catawba County. The work group’s action plan was updated to include the following strategies. Action steps related to the followling strategies are discussed and updated during monthly work group meetings. 

Strategies: Tobacco Policy

  • Workplaces adopt or enhance comprehensive tobacco-free policies.

  • Indoor and outdoor public places adopt or enhance tobacco policies. 

  • Media education campaign on tobacco policies to educate the public and have workplaces become more involved in setting tobacco policies. 

Strategies: Lung Cancer Screening

  • Screening education for the community and public about why lung cancer screening is a beneficial choice. 

  • Promotion and education of lung cancer screenings for providers.

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