The purpose of this assignment is to have students investigate a current health issue and serve as an advocate of this health issue within their community. This assignment will include 3

Teen Smoking Cessation Political Advocacy in Forsyth County

Juliette E. Navoa, RN

Minnesota State University Mankato

NURS-482W-01

Population Focused Care for RNs

Professor Kelly Krumwiede, PhD, RN, PHN

November 15, 2020

Teen Smoking Cessation Political Advocacy in Forsyth County

Dear Forsyth County School Board Members,

My name is Juliette Navoa and I am a registered nurse that has worked in both inpatient

and ambulatory care settings Forsyth County, North Carolina. I graduated from nursing school in

Bloomington, MN and I now reside in downtown Winston-Salem with my husband where we

have lived for almost four years. I currently work for Wake Forest Baptist Medical Center in

their Clemmons Urgent Care clinic and I am also enrolled online in a BSN completion program

through the Minnesota State University Mankato.

The public health concern I am writing in regards to is the high tobacco use rate in the

Forsyth County area. During my time as a nurse, I have worked with many different people of

different backgrounds. The issue of tobacco abuse is of concern to me due to my experience with

many individuals and families that use tobacco products in the ambulatory care setting. My

husband and I are both in the healthcare field and we are passionate about preventing health

problems for individuals, families, and communities.

When working in the Wake Forest Baptist Hospital Cancer Center, I observed young

patients take their IV poles down to the ground floor of the hospital to smoke cigarettes right

outside of the Cancer Center entrance. I have seen teen patients checking into the Clemmons

Urgent Care Respiratory Clinic with their cell phone in one hand and their vape in the other.

When asked about tobacco use, many teens in the urgent care setting seem to view vaping as a

less serious form of tobacco use than cigarettes, dip, or chew. They will easily admit to cigarette

use like it’s a casual hobby without significant health consequences for themselves and others.

There are currently 40 million cigarette smoking adults in the United States (CDC,

2020b) while 12.9% of North Carolina adults report smoking daily in 2019 (CDC, 2020a). Youth

tobacco use continues to be a major health issue in the state of North Carolina as well as Forsyth

County. In 2017, 31.7% of high schoolers living in Forsyth Country admitted to using some sort

of tobacco product, which is higher than the 28.8% state average for high school tobacco users

listed for the same year (North Carolina Institute of Medicine, 2019). The FDA reports that over

3.6 million youth members currently use vapes and e-cigarettes (FDA, 2020). Savage (2020)

states that heart disease, cancer, COPD, oral disease, and birth defects can all be linked to

tobacco use. Savage (2020) also states that health problems can occur for those exposed to

secondhand smoke such as ear infections, respiratory tract inflammation and infection, and

sudden infant mortality.

Though there seems to be several established programs to combat adult tobacco use in the

area, there is very little information to aid in teen smoking cessation. I am writing with the

request to establish a local teen tobacco cessation support group for high school students in

Forsyth County. Though not all high schools in the county are currently in session due to the

current COVID-19 pandemic, tobacco use is still a health risk affecting many local teens. Schoon

et al. (2019) recommend that registered nurses get involved in tobacco policy change by taking a

comprehensive approach to community beliefs, awareness, and initiatives.

Community support is needed from the school district, local youth organizations, and

adult tobacco cessation groups. Local tobacco retailers may think that there is a youth market for

tobacco products and thus oppose the group. Parents might show resistance toward having a

youth group focused on tobacco cessation. Easy access to free community smoking cessation

resources and youth focused support groups are something I would like to continue to pursue in

order to assist this generation of teens and those in the future. I believe together we can make a

difference and cut down on youth tobacco use in the state of North Carolina.

Please contact me at the telephone or email address listed below with questions or to

request additional information as needed. Thank you for your time commitment and detailed

attention to this community public health issue.

Sincerely,

Juliette Navoa, RN

615-364-4302

[email protected]

Teen Tobacco Use Fact Sheet

(Image courtesy of CDC, 2020c) (Image courtesy of CDC, 2020c)

*Teens that are exposed to tobacco advertising through retailers, the internet, and the media are more likely to use vapes and cigarettes (CDC, 2020c) *Recognizing personal reasons for tobacco use helps teens to quit using tobacco products (American Lung Association, 2020) *After participating in a teen smoking cessation program, students earn better grades, have better school attendance, and respect educators (American Lung Association, 2020) ***I am proposing the establishment of a teen smoking cessation group to help teens

in Forsyth County quit smoking and vaping. Thank you for your time and consideration! (Image courtesy of Tobacco Twenty-One, n.d.)

Juliette Navoa. 615-364-4302. [email protected]

Reflection

It took time to organize my thoughts on youth smoking habits and smoking cessation in a

format that I believed to be appropriate to submit to the Forsyth County School Board. I wanted

to be sure to make my position known and eloquently explain the need for action in my own

words. Though I do not currently have children enrolled in this school district, my theoretical

children might attend these schools in the near future, thus linking me personally to this cause.

The area I live in now has strong ties and history with tobacco use, being a central location for

cigarette production. There are still large smokestack towers all over the town of Winston-Salem

from the tobacco factories that used to be located here. I wanted to respect this rich history while

advocating for the health of the youth in the community with credible sources and plenty of

evidence-based research. I believe I provided scholarly evidence to support my claims and

hopefully the county school district recognizes the data as relevant.

I have had strong ideas regarding political advocacy in the past, but I have not acted on

them. I have not heard back from the decision making body quite yet, but I expect to hear back

from them this week. I expect to have some sort of positive response, at least thanking me for

reaching out to serve as an advocate for the teens in the community. Some pushback is to be

expected, due to the complicated relationship the city of Winston-Salem has with the local

tobacco industry. I hope to appear more confident in my requests when I decide to advocate for

policy change in the future and I believe this assignment helped to prepare me for this. I want to

use my position as a registered nurse to make a political impact on individuals and families in the

community where I live. In the future, I would like to organize a group of nurses to attend a local

school board meeting and present a similar proposal in person, making more of an immediate

impact.

References

American Lung Association. (2020). N-O-T: Not on tobacco-Proven teen smoking and vaping

cessation program. Retrieved from: https://www.lung.org/quit-smoking/helping-teens-

quit/not-on-tobacco

Centers for Disease Control and Prevention (CDC). (2020a). ​BRFSS prevalence & trends

data​. Retrieved from: https://www.cdc.gov/brfss/brfssprevalence.

Centers for Disease Control and Prevention (CDC). (2020b). ​Data and statistics​. Retrieved

from: https://www.cdc.gov/tobacco/data_statistics/index.htm.

Centers for Disease Control and Prevention (CDC). (2020c). ​Youth tobacco use infographics​.

Retrieved from: https://www.cdc.gov/tobacco/infographics/youth/index.htm#youth

-tobacco

North Carolina Institute of Medicine. (2019). ​North Carolina health profile. ​Retrieved from:

https://nciom.org/counties/forsyth-county/

Savage, C. L. (2020). ​Public/community health science and nursing practice: Caring for

populations​(2nd ed.). Philadelphia, PA: F.A. Davis.

Schoon, P. M., Porta, C. M., & Schaffer, M. A. (2019).​ Population-based public health

clinical manual: The henry street model for nurses ​(3rd ed.). Indianapolis, IN: Sigma

Theta Tau International.

Tobacco Twenty-One. (n.d.). ​The Juul epidemic. ​Retrieved from: https://tobacco21.org/the-

juul-epidemic/

U.S. Food & Drug Administration (FDA). (2020). ​Youth tobacco use: Results from the

national youth tobacco survey.​ Retrieved from: https://www.fda.gov/tobacco-products

/youth-and-tobacco/youth-tobacco-use-results-national-youth-tobacco-survey

Running head: POLITICAL ADVOCACY 1

Political Advocacy: Child Abuse and Neglect Prevention

Student Name

School of Nursing, Minnesota State University, Mankato

NURS 482: Population Focused Care for RNs

Dr. XXX (faculty name)

Date

DISCLAIMER: This sample paper is intended to be a resource to better understand how key

content may be addressed in a paper for this assignment. The sample paper is not intended to be

used as a guide for formatting, as the assignment grading criteria and/or APA format

requirements may differ from current requirements; or used to obtain content for your individual

paper. This sample paper may not reflect a paper that received a 100% grade.

POLITICAL ADVOCACY 2

Dear Mr. XXXX and Glencoe-Silver Lake School Board,

My name is XXXX. I graduated from Glencoe-Silver Lake (GSL) in 2016 and I currently live in the community. I am a newly graduated registered nurse (RN) and I recently accepted a position at the Glencoe Regional Health hospital as a medical-surgical nurse. I am also finishing my bachelor’s degree in nursing from Minnesota State University, Mankato. Growing up and now working as an RN in the community has made me aware of growing concerns that may not be addressed as often as it should. I have been working closely with the Mcleod Alliance for Victims of Domestic Violence (MAVDV), and this organization has opened my eyes to the growing issue of child abuse and neglect that is present within our community. As a public health nursing student, I have been able to research and study this topic more in-depth in the community, state-wide, and nationally. It is no secret that due to the COVID-19 pandemic children are more vulnerable to abuse and neglect, as many children are forced to stay home with their abusers. The incidence and prevalence of child abuse and neglect in the community puts children at risk for learning deficits, depression, anxiety, and defiant behaviors towards peers and educators. In 2018, the Minnesota Department of Human Resources (MDHS) received 86,060 reports of child abuse and neglect within the state of Minnesota (MDHS, 2018). When comparing data to previous years, the incidence of child abuse and neglect continues to rise. After speaking with Rhonda Buerkle, the executive director of the MAVDV, she states that since the beginning of the COVID-19 pandemic, more and more children have been calling in to their office or physically coming in to seek help (personal communication, September 2, 2020). She explains that the children’s’ safe place was school, in which they could escape their abusers, but now they are forced to stay home and deal with the consequences of their abuser(s). I have noticed an increase need to spread awareness of this issue and provide proper education to school-age children on this sensitive topic as many children are unaware of how they can seek help or what to do if they are experiencing abuse or neglect. The MAVDV website (2020) shows that they gave 21 school, community, and professional training and education presentations within the community, but GSL was not one of the districts that accepted one of these trainings. These presentations are crucial because it provides a resource for children who may need help and allows staff members to become educated on the warning signs of possible abuse or neglect in children and how to properly report these suspicions. Since most children are distance-learning, educators are unable to physically be with the children. I am proposing to implement a child abuse and neglect virtual self-paced training for all staff members and an educational presentation to be shown to all students. Although child abuse and neglect may not be occurring at school, there is a direct correlation between the child’s ability to learn and the exposure of abuse and neglect. An article written by Esteban Ortiz-Ospina (2017) states, “The interaction between violence and education operates in both directions, which means education can be used as an instrument to reduce the prevalence of violence” (para. 16). Children are more likely to succeed in school if their primary health needs are being addressed and cared for. Prevention is key to this issue because long-term stress in children’s bodies can lead to an increase in cortisol levels, which impairs neural connections in the brain that are crucial for learning (Ortiz-Ospina, 2017).

POLITICAL ADVOCACY 3

GSL’s district school nurse would be a great partner in implementing this program, along with community organizations, such as the MAVDV, United Way, and the Healthy Communities Health Coalition. All of these organizations have funds that are available in assisting school districts with educational trainings for staff and students. After speaking with the MAVDV, they would gladly be a partner and supply the needed presentations and education for this program to be successful.

Through the use of MAVDV’s child abuse and neglect prevention presentation and training, staff members will receive the proper education needed to ensure the safety of their students, along with the proper resources to contact in the case of suspected abuse or neglect occurrence. The children would also benefit as they will be able to have the contact information of agencies and also develop an awareness of the warning signs of abuse and neglect to become more vigilant and attentive to the issue. As distance-learning continues, it is important to understand the detrimental effects of abuse and neglect in children, as these effects have the potential to affect their educational success and abilities. I ask that you consider this information and implement this needed training into your school district.

Sincerely, NAME & CONTACT INFORMATION

POLITICAL ADVOCACY 4

Fact Sheet

• In 2018, Minnesota had a reported 86,060 reports of child abuse and neglect state-wide (MDHS, 2018)

• Disruption in a child’s brain due to abuse or neglect can cause impairments in the child’s learning abilities and contribute to learning deficits, memory impairment, and decreased self-control (Children’s Bureau, 2019)

• Children of parents who are experiencing additional stress from the COVID-19 pandemic are five times more likely to mistreated and neglected (Lawson, et al., 2020)

• Negative effects from abuse and neglect can last a lifetime, so awareness and prevention can reduce the risk of children experiencing adverse health concerns, such as anxiety, depression, and post-traumatic stress disorder (Children’s Bureau, 2019)

I propose that an implementation of the McLeod Alliance for Victims of Domestic Violence child abuse and prevention program be taught to staff members in the Glencoe-Silver Lake school district and presented to all students in the format of a virtual PowerPoint to assist in prevention and awareness of this critical issue occurring in our community. In you have additional questions or concerns, please do not hesitate to contact me. Thank you for your time and consideration for bringing awareness to such an important health concern. NAME & CONTACT INFORMATION

POLITICAL ADVOCACY 5

Reflection

This assignment was very beneficial because I was able to get out of my comfort zone

and propose a community change implementation within a local school district. I was nervous to

propose the idea at first because I knew the GSL school district has denied the opportunity to

conduct a child abuse and neglect prevention program in the past, so I was fearful they would

reject it again. After gathering evidence-based research and obtaining information from

community members pertaining to the topic, I was able to build my confidence and send the

proposed idea to the GSL school district’s superintendent. As a future public health nurse, this

assignment was extremely beneficial as I was able to step outside my comfort zone and be an

advocate for children in the community.

After contacting the superintendent, Mr. XXX, he was receptive to the idea of

implementing this prevention and awareness program into the school district but stated that his

only concern was getting the teachers involved as they are already stressed with virtual teaching.

I then emailed him the PowerPoint presentation and training module in the case that the teachers

are willing to participate in the program. I was enthused that he was interested in the program, as

he was asking many questions about community programs that are also involved in prevention

and awareness of child abuse and neglect. He then added that he is seeing an increase in phone

calls from the child protective services, so he explained that this program would be very

beneficial for all students and staff.

I was very pleased that he accepted my proposal and further contacted me for more

information, but one thing I would do different in the future is provide him with more

community statistics and data prevalence, as this directly pertains to the school district. He was

POLITICAL ADVOCACY 6

very eager to learn about the statistics of child abuse and neglect in school-age children, so

gathering more information from public health and social workers could have strengthened the

presented information and made it more personal to the school district.

Overall, this assignment was much more beneficial than I originally thought it would be.

I learned to become a public health advocate for those in need in my community and truly strive

to provide evidence-based information and skills to back-up my propositions. I have gained more

confidence in myself and my nursing abilities, as I feel that my proposed implementation was

well-received and respected by school officials.

POLITICAL ADVOCACY 7

References

Children’s Bureau. (2019, April). Long-term consequences of child abuse and neglect. Retrieved

from https://www.childwelfare.gov/pubPDFs/long_term_consequences.pdf

Lawson, M., Peil, M. H., & Simon, M. (2020). Child maltreatment during the COVID-19

pandemic: Consequences of parental job loss on psychological and physical abuse

towards children. Child Abuse and Neglect, 104709.

https://doi.org/10,1016/j.chiabu.2020.104709

Mcleod Alliance for Victims of Domestic Violence. (2020). About. Retrieved from

About

Minnesota Department of Human Resources. (2018). Minnesota annual child maltreatment

report, 2018. Retrieved from https://www.leg.mn.gov/docs/2020/mandated/200126.pdf

Ortiz-Ospina, E. (2017, December 17). Child maltreatment and educational outcomes. Retrieved

from https://ourworldindata.org/child-maltreatment-and-educational-outcomes

Public/Community Health and Nursing Practice

CARING FOR POPULATIONS

SECOND EDITION

7711_FM_i-xviii 21/08/19 11:08 AM Page i

Public/Community Health and Nursing Practice

CARING FOR POPULATIONS

SECOND EDITION

Christine L. Savage, PhD, RN, FAAN Professor Emerita

Johns Hopkins University School of Nursing Baltimore, Maryland

7711_FM_i-xviii 21/08/19 11:08 AM Page iii

F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com

Copyright © 2020 by F. A. Davis Company

Copyright © 2020, 2016 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.

Printed in the United States of America

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

Publisher, Nursing: Terri Wood Allen Senior Content Project Manager: Elizabeth Hart Digital Project Manager: Kate Crowley Design and Illustration Manager: Carolyn O’Brien

As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is ad- vised always to check product information (package inserts) for changes and new information regarding dose and contraindi- cations before administering any drug. Caution is especially urged when using new or infrequently ordered drugs.

Library of Congress Cataloging-in-Publication Data

Names: Savage, Christine L., author. Title: Public/community health and nursing practice : caring for populations

/ Christine L. Savage. Other titles: Public health science and nursing practice Description: 2nd edition. | Philadelphia : F.A. Davis Company, [2020] |

Preceded by: Public health science and nursing practice / Christine L. Savage, Joan E. Kub, Sara L. Groves, 2016. | Includes bibliographical references and index.

Identifiers: LCCN 2019007149 (print) | LCCN 2019008721 (ebook) | ISBN 9780803699878 (ebook) | ISBN 9780803677111 (pbk.)

Subjects: | MESH: Public Health Nursing | Community Health Nursing | Health Planning | Population Characteristics

Classification: LCC RT97 (ebook) | LCC RT97 (print) | NLM WY 108 | DDC 610.73/4—dc23

LC record available at https://lccn.loc.gov/2019007149

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organi- zations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-7711-1/19 0 + $.25.

7711_FM_i-xviii 21/08/19 11:08 AM Page iv

To my husband, Joe, for all his love and support.

7711_FM_i-xviii 21/08/19 11:08 AM Page v

Preface

The World Health Organization (WHO) partnered with the International Council of Nursing and began the Nursing Now campaign that “… aims to improve health by raising the profile and status of nursing worldwide” (WHO, 2018). They recognized that nurses provide care essential to the optimizing of health for individuals, fam- ilies and communities. Health occurs from the cellular to the global level; thus nurses must have knowledge re- lated to health across this continuum. Nursing education often begins with understanding health at the cellular level through courses related to pathophysiology and physical assessment. Building on this knowledge, this text covers health, disease, and injury within the context of the world we live in. No matter what settings nurses work in, they apply public health science on a daily basis to prevent disease, reduce mortality and morbidity in those who are ill, and contribute to the health of the com- munities we serve. Our goal with this book is to lead you on the journey of discovering how the public health sci- ences are an integral part of nursing practice and how nurses implement effective public health interventions.

About This Book This book presents public health in a way that captures the adventure of tackling health from a community- and population-based perspective. Public health helps us to answer the question, “Why is this happening?” and to im- plement interventions that improve the health of popu- lations. Public health issues are usually messy real-world problems that

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