The "Story Behind the Curve" helps us understand why the data on adult smokeless tobacco users is the way that it is in our community. When we understand the root causes of our community problems, we have a better chance of finding the right solutions, together.

What's Helping? These are the positive forces are work in our community and beyond that influence this issue in our community.

• Tobacco-free policies for schools and county parks
• Smoke-free (or perimeter) policies for many buildings
• Free tobacco cessation classes through the Health Department or Harris Regional Hospital
• Statewide media campaign through the Tobacco Prevention Control Network
• QuitlineNC
• Free nicotine replacement therapy available at various times throughout the year
• Proven ROI on substance abuse prevention programs

What's Hurting? These are the negative forces are work in our community and beyond that influence this issue in our community.

• Lack of access to resources (to include transportation)
• Lack of knowledge on available resources
• Overworked providers expected to do more (Ex. offer tobacco counseling)
• High maternal smoking rate
• Many residents in Pre-Contemplation or Contemplation (not yet Preparation) in terms of the Stages of Change

Stages of Change Public Health Model

Partners in our Community Health Improvement Process:

• Jackson County Department of Public Health
• Area Agency on Aging
• Good Samaritan Clinic
• Harris Regional Hospital
• Jackson County Department on Aging
• Jackson County Parks and Recreation Department
• Jackson County Public Schools
• Jackson County Department of Social Services
• Mountain Projects, Inc.
• Vaya Health
• Western Carolina University
• WNC Healthy Impact

Partners With a Role in Helping Our Community Do Better on This Issue:

• Behavioral and mental health providers (Ex. Meridian Behavioral Health Services)
• Clean Slate Coalition
• Community members with a vested interest
• Department on Aging
• Eastern Band of Cherokee Indians
• Faith-based community
• Local government (town & county commissioners)
• Law enforcement
• Medical professionals
• MountainWise
• Parents
• Tobacco Prevention Control Branch
• Those in recovery
• Western Carolina University

We are keeping an eye on tobacco use, alcohol use, overdose, and falls as a way of telling how we are doing as a community in addressing injury and substance abuse and build a community where all Jackson County residents are free from injury. We have also identified other data that is not currently available, but that we would like to develop to help us monitor progress on this result:

• Opioid overdose death rates
• Opioid use rates
• Less self-reported data and more clinically-gathered data on substance use

The following actions have been identified by the Injury and Substance Abuse Prevention Action Team and community members as ideas for what can work for our community to make a difference on adult smokeless tobacco prevalence.

(A) Actions and Approaches Identified by Our Partners These are actions and approaches that our partners think can make a difference on adult smokeless tobacco prevalence.

• Education in schools, communities, and churches
• Tobacco free policies
• Community involvement and buy-in
• Integrated care
• Media campaigns
• Access for those in the Medicaid gap
• Jail ministry

(B) What is Currently Working in Our Community These are actions and approaches that are currently in place in our community to make a difference on adult smokeless tobacco prevalence.

• Safe Kids Jackson County
• WNC Teen Institute
• Freshstart
• Media Detective
• Smart Teens
• Senior Seminar
  

(C)Evidence-Based Strategies These are actions and approaches that have been shown to make a difference on adult smokeless tobacco prevalence.

• QuitlineNC
• Tobacco-free college campuses
• Monitor tobacco use and prevention policies through BRFSS, Policy Tracking
• Work with state and local coalitions to build support for the state to adopt a comprehensive smoke-free law that protects workers in every workplace
• Warn about the dangers of tobacco through media campaigns
• Enforce bans on tobacco advertising, promotion, and sponsorship through enforcement of FDA regulations in NC and NCGS 14-313 Youth Tobacco Access Law

The Injury and Substance Abuse Prevention Action Team completed the "Whole Distance Exercise" to begin the prioritization process and select actions to take to address this health priority. The team answered the following questions:

• Result: What quality of life conditions do we want for Jackson County residents?
• Experience: How will we recognize this result in everyday life?
• Indicators: How can we measure these experiences?
• Partners: Who has a role to play in this?
• Current Actions: What are we currently doing to address this?
• What Works to Do Better: How can we make our numbers better?

The Action Team considered all options including those that were no/low cost and off the wall. After reviewing our "Current Actions" and pairing them with "What Works to Do Better," the Action Team selected strategies to implement based on feasiblity, impact, and resources.