2017 Swain County SOTCH

What We Do

Why Is This Important?

Heart disease, stroke, and diabetes are three health concerns in Swain County that have preventable risk factors. Chronic diseases such as these can decrease individual’s functionality, quality of life, and life expectancy.

Healthy People 2020 includes the following information about community factors which can be modified to enhance health outcomes.

Understanding Heart Disease and Stroke

Disease does not occur in isolation, and cardiovascular disease is no exception. Cardiovascular health is significantly influenced by the physical, social, and political environment, including:

• Maternal and child health
• Access to educational opportunities
• Availability of healthy foods, physical education, and extracurricular activities in schools
• Opportunities for physical activity, including access to safe and walkable communities
• Access to healthy foods
• Quality of working conditions and worksite health
• Availability of community support and resources
• Access to affordable, quality health care

The following conditions are implicated in the development of heart disease and stroke. These ideas are the parameters for educational prevention programs in Swain County:

• High blood pressure
• High cholesterol
• Cigarette smoking
• Diabetes
• Unhealthy diet and physical inactivity
• Overweight and obesity

Healthy People 2020 addresses the following health disparities:

• Minority groups constitute 25 percent of all adult patients with diabetes in the United States and represent the majority of children and adolescents with type 2 diabetes.
• African Americans, Hispanic/Latino Americans, American Indians, and some Asian Americans and Native Hawaiians and other Pacific Islanders are at particularly high risk for the development of type 2 diabetes.
• Diabetes prevalence rates among American Indians are 2 to 5 times those of whites. On average, African American adults are 1.7 times as likely and Mexican Americans and Puerto Ricans are twice as likely to have the disease as non-Hispanic whites of similar age.

Prevention strategies include: screenings and education, and can help save Swain County the financial burden of chronic disease treatment with each individual reached

Healthy NC 2020 has outlined the following strategies in the prevention of chronic diseases.

Progress Made in 2017

The following progress was made in 2017 on our action plan interventions for Heart Disease, Stroke, Diabetes Prevention (Focus: Nutrition, Obesity, Physical Activity)

• Action Plan Intervention: Results-based Accountability (RBA) approach to collaborative action planning process
  • Public Health Educator/Dietitian attended a "Getting to Results" training
  • Public Health Educator/Dietitian attended four performance measure workshop study halls
  • Public Health Educator/Dietitian was introduced to RBA basic ideas 
  • Public Health Educator/Dietitian created survey for past Lifestyle Change Program feedback which included RBA language
  • Swain County Health Department utilized Results Scorecard to develop a publicly available e-CHIP

• Action Plan Intervention: National Diabetes Prevention Program
  • February 2017 MDPP Class:  This year-long class will graduate in February 2018.  Thus far five participants will be graduating giving this class 100% retention rate.  This class was in partnership with the Mariana Black Library
  • September 2017 DPP Class:  This year-long class is the fourth pre-diabetes class to start in Swain County.  Their are five participants and currently has 100% retention rate. This class is in partnership with United Community Bank
  • Two graduating participants from the February Lifestyle Change Program became Lifestyle Change Program coaches
  • Swain County registered with CDC to become a nationally recognized CDC Diabetes Prevention Program (DPP), Swain County is currently pending recognition due to data (January 2018 Swain County became; Interim Preliminary Recognized).  
  • October 2016 DPP Class: This year-long class ended in October 2017.  Three participants graduated giving the class 100% retention rate.

• Additionally, the following progress was made in 2017 on Heart Disease, Stroke, Diabetes Prevention in Swain.
  • Four CDC Worksite Wellness Scorecards were completed by end of January 2017
  • Employee Wellness Program Pilot Program -  The pilot program began in January 2017 with screenings/registration for the 62 employees.  The Pilot program ended in June with a potluck awards banquet
  • Heart Health Event February 1, 2017 
  • Heart Health Lecture Series (four lectures, starting the first Monday evening in February) February 2017
  • Swain County Health Department partnered with the Restoration House and Whole Life Challenge to create a Swain County Team and provide nutrition education along with grocery store tours and food prep demonstrations throughout the challenge held three times a year
  • Swain County Health Department partnered with Mariana Black Library to create an updated healthy book list for Nutrition Month, March 2017, as well as created and implemented and educational display section in the library for Nutrition Month
  • Swain Safe Multi-use Pathways and Greenways Committee was officially formed from the Community Wellness Action Team (the committee moved under Parks and Recreation in October 2017) meeting once a month
  • Swain Safe Multi-use Pathways and Greenways Committee hosted an open forum to gauge the communities view of safe multi-use pathways and greenways June 15th 
  • Swain County Health Department attended a Racial Equity Workshop in May 2017
  • Blood Pressure Awareness Month (May)-Community Blood Pressure Checks once a week, checking blood pressure of community members (Bo Jangles, IGA, Ingles, Marianna Black Library)
  • May 2017 held the Swain County Health Department held a six week Cooking Matters course for those community members who have children in the home. Cooking Matters awarded the Swain County Health Department with a $200. grant to implement the course
  • May 2017 the Swain County Health Department conducted a Fruit and Vegetable Outlet Inventory of Swain County
  • May 2017 kicked off the Produce Nutrition Voucher Program for WIC and CHORE participants at the Swain County Health Department
  • Employee Wellness Program - a year long program kicked off in July 2017 to coincide with Open-Enrollment, currently 47 employees participate
  • Multiple lunch and learns were conducted through the year in partnership with the Swain County Cooperative Extension Office
  • Growing Minds; Farm - to - School Campaign, an Appalachian Sustainable Agriculture Program (ASAP), was initiated August 2017. Bulletin Boards change quarterly in the cafeteria's of Swain East and West Elementary Schools, along with Swain County Middle School. This effort was a partnership between the Swain County Health Department, Swain Schools Nutrition Program and Western Carolina University Service Learning Program.
  • Clinical Director of the Health Department along with the Public Health Educator attend monthly meeting with the local SHAC
  • Chronic disease and nutritional educational booths were developed and displayed during the Smoky Mountain Medical IRT August 2017
  • August 2017 an Employee Wellness Peer-to-Peer Committee was formed meeting monthly
  • Public Health Educator joined a Regional Public Health/Mountain Wise group along with becoming the chair of two action teams
  • Swain County Health Department partnered with WCU nutrition service learning students and Caring Corners to develop a meal voucher program at a local restaurant for Caring Corners Chronic Disease patients
  • Swain County Health Department partnered with WCU with an intern to develop and implemented a Heart Health Lecture Series every Monday for four week in October 2017
  • Swain County Health Department provided multiple Grocery Store Tours for the public, Swain School Employee Wellness Program and Swain County Employee Wellness Program
  • Public Health Educator attended Know It! Control It! (a blood pressure program)training in October 2017, the first class is scheduled to start in January 2018 at the Senior Center for community members over 65 years of age
  • Swain County Health Department provided apples for the community "Trick-or-Treat" on the street in October 2017
  • Swain County Health Department provided nutrition education at the community "Baby Shower" in November 2017

Progress Made in 2016

The following progress was made in 2016 on Preventing Heart Disease, Stroke, and Diabetes in Swain County.

• Lifestyle Change Program marketing campaign began in January of 2016 to gain community involvement. Program provides educational classes addressing subjects such as: healthy eating, healthy strategies, physical activity, stress management, motivation and goal-setting.
• Swain County Health Department's Public Health Educator participated in three training sessions, beginning April 12, for Results Based Collaborative Action Planning using Results Based Accountability.
• Cooking Matters at the Store(grocery store tours) was initiated May 2016. Four tours have been completed.
• Produce Nutrition Voucher Program Continues, giving vouchers to all Women, Infant and Child Program (WIC) and CHORE participants.
• Conducted MyPlate education and taste test at West Elementary School on May 20, 2016 reaching 64 students.
• Created a Community Wellness Action Team, in July 2016 meetings held every month through 2016.
• On June 2, Results-based Accountability was incorporated into Coalition For a Drug Free Swain County meetings. RBA language utilized in 3 meetings.
• Nutrition Educational Sign Grant planning committee initiated July 7, 2016. Three meetings were conducted in 2016.
• Growing Minds; Farm - to - School Campaign, an Appalachian Sustainable Agriculture Program (ASAP), initiated August 2016. Bulletin Boards change quarterly in the cafeteria's of Swain East and West Elementary Schools, along with Swain County Middle School.
• Education provided on Fruits, Vegetables and MyPlate at all Swain County Schools August 18th and 19th, 2016 reaching 183 students.
• Provided assistance to Swain Community Hospital for Swain County School staff wellness screenings, September 6th and 7th, 2016.
• Cooking Matters Cooking Class for students and adults initiated November 3, 2016. Three cooking classes have been completed.
• Created Swain County Employee Wellness Action Team in November 2016 meetings held every month through 2016.
• First Lifestyle Change Program class initiated February 25, 2016 at the Swain County Health Department. Class Statistics show progress toward meeting 2017 goals - 9 of the 12 participants lost an average weight loss of 7.88 lbs. A total of 23 classes held in 2016.
• Second Lifestyle Change Program class initiated October 27, 2016.

What Is It?

The audience for this action is the Lifestyle Change Program Committee, and the committee aims to make a difference at the organizational/policy level. Implementation will take place in the Swain County Health Department.

African Americans, Hispanic/Latino Americans, American Indians, Asian Americans, Native Hawaiians and other Pacific Islanders being at higher risk for developing Type II Diabetes than other members of Swain County, this program directly address health disparities in a strategic way.

Healthy People 2020 cites "Systems Problems" as a barrier to optimal health, mentioning the healthcare system design flaws in relation to this issue. Because diabetes cases are on the rise, less resources are available per person. Classes such as the Lifestyle Change Program, offered at the community level strive to address this gap in traditional healthcare.

Partners

The partners for this committee include:

• WNC Healthy Impact
• Swain County Health Department
• MountainWise

What Is It?

The National Diabetes Prevention Program is a research- based strategy, offered by the Centers for Disease Control and Prevention (CDC). This program is rooted in the fact that prediabetes can be reversed and we can assist Swain County residents in avoiding a Type II Diabetes. Western North Carolina has a diabetes rate nearly twice the national average. As stated by the CDC, the Lifestyle Change Program can offer participants more energy, better health, and also risk avoidance in relation to stroke and heart disease. The National Diabetes Prevention Program's Lifestyle Change Program was identified by the Swain County Health Department as an action, when combined with other actions in our community, that has a reasonable chance of making a difference in our county at the organizational and environmental level.

Swain County goals which correlated with the National Diabetes Prevention Program include:

• 80% of program participants will lose an average of 5-7% of their body weight
• 80% of participants will be physically active for 150 minutes per week
• 75% of Swain County's Wellness Program members will register for the Lifestyle Change Program using the Prevention T2 Curriculum

Swain County Health Department will continue marketing the program year-round and work in conjunction with local physicians. This approach aims to avoid participation and referral barriers and ensure that Swain County employees and residents working to avoid chronic disease have access to the program. An annual evaluation is planned for spring 2018 and will explore further tactics which aim to encourage resident involvement.

 Goals include:

• Participate in regional network meetings
• Increase the number of referrals made to Diabetes Prevention Program (DPP)
• Increase the number of participants enrolled in DPP
• Register with the CDC as a nationally recognized CDC DPP
• Maintain two qualified and trained lifestyle coaches in Swain County
• Keep a DPP retention rate of 90%

Implementation takes place in a group setting.

Partners

The partners for this evidence-based prevention program include:

• Swain County Health Department
  • Leads classes
• Swain County Department of Social Services
  • Co-leads classes
• Swain County Public Schools
  • Provides access to participants, assists with promotion
• Mountain Wise
  • Provides funding for necessary tools and class materials, provides assists with promotion
• Mariana Black Library
  • Provides access to participants, venue for classes, assists with promotion
• United Community Bank
  • Provides access to participants, venue for classes, assists with promotion
• Centers for Disease Control and Prevention
  • Endorses programs utilizing curricula with high standards. Programs must submit outcomes annually to prove impact on preventing or delaying Type II Diabetes Mellitus. Research on the effectiveness of this program was conducted by the National Institute of Health.

Why Is This Important?

Sexually Transmitted Diseases are currently on the rise in Swain County. Healthy People 2020 details that there are "more than 25 infectious organisms that are transmitted primarily through sexual activity. STD prevention is an essential primary care strategy for improving reproductive health.... Untreated STDs can lead to serious long-term health consequences, especially for adolescent girls and young women. The CDC estimates that undiagnosed and untreated STDs cause at least 24,000 women in the United States each year to become infertile." Other complications could include:

• Reproductive health problems
• Fetal and perinatal health problems
• Cancer
• Facilitation of the sexual transmission of HIV infection

The cost of ignorance surrounding STDs can be as bad as increased fatality rates or as infertility. Lack of education leads to increased spread of these disease when cases are not diagnosed.

Because of the delicate nature of these health issues and "despite their burdens, costs, and complications, and the fact that they are largely preventable, STDs remain a significant public health problem in the United States. This problem is largely unrecognized by the public, policymakers, and health care professionals."

Women and those age 15-24 tend to have higher rates of these diseases. According to Healthy People 2020, behavioral factors affecting the spread of Sexually Transmitted Diseases can include:

• Racial and ethnic disparities. Certain racial and ethnic groups (mainly African American, Hispanic, and American Indian/Alaska Native populations) have high rates of STDs, compared with rates for whites. Race and ethnicity in the United States are correlated with other determinants of health status, such as poverty, limited access to health care, fewer attempts to get medical treatment, and living in communities with high rates of STDs.
• Poverty and marginalization. STDs disproportionately affect disadvantaged people and people in social networks where high-risk sexual behavior is common, and either access to care or health-seeking behavior is compromised.
• Access to health care. Access to high-quality health care is essential for early detection, treatment, and behavior-change counseling for STDs. Groups with the highest rates of STDs are often the same groups for whom access to or use of health services is most limited.
• Substance abuse. Many studies document the association of substance abuse with STDs. The introduction of new illicit substances into communities often can alter sexual behavior drastically in high-risk sexual networks, leading to the epidemic spread of STDs.
• Sexuality and secrecy. Perhaps the most important social factors contributing to the spread of STDs in the United States are the stigma associated with STDs and the general discomfort of discussing intimate aspects of life, especially those related to sex. These social factors separate the United States from industrialized countries with low rates of STDs.
• Sexual networks. Sexual networks refer to groups of people who can be considered “linked” by sequential or concurrent sexual partners. A person may have only 1 sex partner, but if that partner is a member of a risky sexual network, then the person is at higher risk for STDs than a similar individual from a lower-risk network.

Healthy NC 2020 details evasion strategies in effort to reduce population risk:

Eradicating the spread of other infectious diseases such as food born illness and those largely avoidable through vaccination is a similar process because it is principally controllable through prevention.

Healthy People 2020 details the frustration that "people in the United States continue to get diseases that are vaccine preventable. Viral hepatitis, influenza, and tuberculosis (TB) remain among the leading causes of illness and death in the United States and account for substantial spending on the related consequences of infection.

The infectious disease public health infrastructure, which carries out disease surveillance at the Federal, State, and local levels, is an essential tool in the fight against newly emerging and re-emerging infectious diseases. Other important defenses against infectious diseases include:

• Proper use of vaccines
• Antibiotics
• Screening and testing guidelines
• Scientific improvements in the diagnosis of infectious disease-related health concerns"

Immunization is an evidence-based practice that is vital in avoiding the over use of antibiotics. Healthy NC 2020 states these strategies for stopping the spread of infectious diseases:

Progress Made in 2017

The following progress was made in 2017 on our action plan interventions for Reduce Substance Abuse in our community in Swain County.

• Action Plan Intervention 1
  • Coalition Vice Chair attended a training on RBA 
  • Coalition Vice Chair attended four performance measure workshop study halls
  • Coalition Vice Chair introduced RBA basic ideas to its meetings
  • 25% (Amber, Mark, Tobin, Myself out of 15 members) of Coalition for a Safe and Drug Free Swain County and Swain County Health Department members can talk about their program performance and how it contributes to population indicators 
  • A survey was developed using RBA language for Coalition members to show effectiveness of Coalition
  • Swain County Health Department was unable to complete a Whole Distance Exercise; however, Coalition leadership has introduced RBA basic ideas to its meetings
  • Swain County Health Department utilize Results Scorecard to develop a publicly available e-CHIP 

• Action Plan Intervention 2
  • Coalition for a Safe and Drug Free completed an environmental scan of Swain County - an Environmental scan is utilized to survey external factors (syringes & paraphernalia) that inform about a particular subject (IV drug use)
  • Coalition hosted a Discussion Platform and presentation by Full Circle Recovery Center on Harm Reduction/Needle Exchange January 23, 2018
  • Swain County Health Department provided education and material on drugs and drug use for the triennial Civil-Military Innovative Readiness Training Program August 2-10
  • Swain County Health Department provided education and material on drugs and drug use for the 1st annual NC Med-Assist on September 30th

• Additionally, the following progress was made in 2017 on Reducing  Substance Abuse in Swain County
  • Syringe Exchange – The coalition has been in support of this initiative since attending the stakeholder meeting 1/23/17Supplied over 15,000 Prescription Medication Disposal Stickers at Healthmart, Bryson City Pharmacy for use on Rx bag
    
  • Coalition supplied Prescription Medication Disposal Flyers for Crisp Funeral Home - for inclusion in family planning packets
  • Coalition completed an environmental scan of Swain County to determine where people are discarding needles and other paraphernalia
  • The Health Department has Prescription Medication Lock Boxes available free of charge from a Project Lazarus Grant and Mountain Projects, thus far we have supplied over 86 Lock Boxes or Bags to community members
  • Coalition and Swain County Health Department attended a Racial Equity Workshop May 2017
  • Coalition received a $2000. Grant from Project Lazarus this year to install a new Prescription Medication Drop Box at Healthmart, Bryson City Pharmacy; to provide a Prescription Medication Drop Event to support the new Drop Box, which we Conducted in October; to provide an educational campaign on the two locations of Drop Boxes in Swain County; and to purchase a new scale for the Sheriff's Department (they have been using a personal scale and/or the Health Department scale, but needs one that will go down to grams.
  • Coalition participated in Red Ribbon Week/Month which is a National Drug Prevention Awareness Campaign providing education throughout the community and schools as well as hosting a poster competition for the 5^th grade 
  • Coalition attempted to set up meetings between Bryson City Police Department, Sheriff's Department, Stephanie Almeida and Mountain Projects to help with funding for replacement of Naloxone Kits.
  • Swain County Health Department attended a series of Opioid poisoning strategies conference calls starting in April
  • Coalition held a fundraiser to help with Bryson City Police Department’s purchase of K—9 training kits, we are also working with connecting with Haywood Dog Fanciers Club to help support our K-9 units with other needs
  • Swain County Health Department attended an Opioid Round Table hosted by Cherokee Reservation on September 26th (Swain County completed their own Opioid Summit February 2018)
  • Medicine Abuse Project –planned for March 2018

Progress Made in 2016

The following progress was made in 2016 on infectious disease and STD prevention in Swain County.

• Coalition for a Safe and Drug Free Swain County created in December 2016 a planning committee for a county wide Environmental scan
• Increased education among health department nurses to be aware of and look for STD symptoms
• Updated educational information has been passed on to community partners, including: Appalachian Community Services, Swain Family Care, Swain Urgent Care, Swain County Detention Center
• Free hepatitis C tests are now available, as of 2016, in Swain County for at risk populations
• Needle Exchange dialoge was started with Commissioners and Advisory Board during the September 20, 2016 meeting.
• STD presentation/talks were implemented at Swain County Middle School and High School October 2016.
• Swain County Law Enforcement attended the December 2016 Coalition for a Safe and Drug Free Swain County meeting, participating in a discussion concerning the necessity of a Needle Exchange program and also optimal locations for sharps dispensers.
• Swain Health Department held a meeting with the Swain County Caring Corner, a local free clinic, on needle exchange and the need for STD screenings in Swain County.
• Project Lazarus STD prevention training held on November 8, 2016. Using this grant money, Swain Health Department in partnership with the Coalition for a Safe and Drug Free Swain County also distributed 46 lock boxes to the public. The purpose of the lock boxes is to contain prescription medications to ensure only those for whom the meds are intended partake.

What Is It?

The Coalition for a Safe and Drug Free Swain County was identified by the Swain County Health Department as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in programs in our community.

The audience for this action is the Coalition for a Safe and Drug Free Swain County members, and the coalition aims to make a difference at the organizational/policy and environmental change level. Implementation will take place in the Swain County Health Department.

Community Health Assessment action teams will understand and articulate the difference between population accountability and performance accountability; they can talk about their program performance and how it contributes to population indicators; and they will use Clear Impact Scorecard™ to track their program performance.

Partners

The partner for this coalition include:

• WNC Healthy Impact
• Swain County Health Deparatment

What Is It?

The Swain County Health Department, in accordance with the Coalition for a Safe and Drug Free Swain County, has resolved to implement community-wide environmental scans and early screenings for sexually transmitted infections and disease. Swain has increased education among health department nurses to be aware of and look for STD symptoms. Updated educational information has been passed on to community partners, including: Appalachian Community Services, Swain Family Care, Swain Urgent Care, Swain County Detention Center. Swain County Health Department patient's "Self History Forms" obtain information concerning sexual history, partners, needle sharing, and prior STD testing. Condom and disease prevention material dispensers are dispersed in local bars. Health disparity issues include: racial and ethnic, poverty and marginalization, access to healthcare, substance abuse, sexuality and secrecy, and sexual networks. Early Screenings and Environmental System Changes was identified as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in avoiding the spread of infectious disease as well as the sexual and mental health of our community. The aim of the program is to make Swain County safer for residents and visitors alike. Free hepatitis C tests are now available, as of 2016, in Swain County for at risk populations

Swain County Law Enforcement continues to attend meetings where communities needs are discussed. These needs included Naloxone kits, employment of a needle exchange program and also optimal locations for sharps dispensers.

Conversations continue with all local entities concerning needle exchange issues. New programs are still in planning phases, particularly concerning needle exchange as a result of the recent legislation changes. Actions are yet to be defined and evaluation practices, feedback, and performance measures also need to be established.

Expected Outcomes include:

• Increased screenings of target population
• Increased facilities that offer screenings
• Increased education to partners and community on best screening practices
• A completed environmental scan of high drug use areas in Swain County by the Coalition for a Safe and Drug Free Swain County members

In order to facilitate screenings and education, trusting relationships will need to be established with priority populations. This will involve open communication and dialogue between partners. Local physician's offices will require education. The Swain County Health Department aims to increase knowledge and awareness of hospital and other healthcare providers regarding appropriate screening and referral protocols. Intervention teams will need training in implementation of best practices during screening and environmental scans. Training will also necessary to carry out environmental scan processes once procedures are defined.

Specific goals include:

• Provide outreach and engagement within community to reach priority population
• Provide education to medical practices and partners in Swain County to increase their knowledge and awareness that screenings need to be completed either in their facilities or provide contacts of those facilities that do offer screenings
• Create educational speaking engagements to partners on where, when, and how screenings are implemented
• Health department will provide screening services to facilities, such as the Swain County Jail and Appalachian Behavioral Health on an as needed basis
• Environmental Scan will be conducted in areas known by law enforcement and other community partners to be problematic with drug use paraphernalia and are hazardous to the community
• Start dialogue on potential interventions with community members and partners on the needs for the community from the results of the Environmental Scan, such as sharps dispensers or needle exchanges

Swain County aims to make a difference at the organizational/policy and environmental change level.

Partners

The partners for this include:

• Coalition for a Safe and Drug Free Swain County
  • This is a newly established partner, assisting in collaboration, support, planning, and implementation.
• Swain County Law Enforcement
  • Assisting with information and support
• Swain County Health Department
• Environmental Scan Committee members as of December 1st, 2016.
• Wayne Dickert, Senior Pastor Bryson City United Methodist Church
  • Environmental Scan Committee member as of December 1st, 2016

Why Is This Important?

According to Healthy People 2020, “Tobacco use is the largest preventable cause of death and disease in the United States.” We know that tobacco definitely causes:

• Cancer (oropharynx, larynx, esophagus, trachea, bronchus, lung, acute myeloid leukemia, stomach, liver, pancreas, kidney and ureter, cervix, bladder, and colorectal)
• Heart disease and stroke
• Lung diseases (emphysema, bronchitis, chronic airway obstruction, chronic obstructive pulmonary disease, and pneumonia)
• Reproductive effects (ectopic pregnancy, premature birth, low birth weight, stillbirth, reduced fertility in women, and erectile dysfunction; and birth defects, including cleft-lip and/or cleft palate)
• Other effects (Type 2 diabetes, age-related macular degeneration, rheumatoid arthritis, blindness, cataracts, hip fractures, impaired immune function, periodontitis, and overall diminished health

Secondhand smoke can cause many of these health conditions. Children can also experience the following as a result of secondhand smoke exposure:

• More severe asthma attacks
• Respiratory infections
• Ear infections
• Sudden infant death syndrome (SIDS)

“Smokeless tobacco causes a number of serious oral health problems, including cancer of the mouth and gums, periodontitis, and tooth loss.”

Over half of Swain County residents choose to use tobacco products. It is vital to discourage tobacco use in order to promote health in our community. “Each year, approximately 480,000 Americans die from tobacco-related illnesses. Further, more than 16 million Americans suffer from at least one disease caused by smoking.”

It is our goal to specifically target pregnant mothers and youth in this endeavor. Pregnant moms that use tobacco are harming not only themselves, but another life. These children deserve to make their own decisions concerning future health.

Adolescents may not be able to make responsible decisions concerning something with such far- reaching consequences. Peer- pressure may encourage unhealthy behaviors and these youth need a voice urging positive choices. They also need regular reminders about these issues. Once adolescents begin using tobacco, they may be users for life.

It is worth exploring that the Centers for Disease Control list Native American Indians and those of Low Socioeconomic Status as bearing the highest risk for tobacco use. This health disparity may be the result of focused advertising and lack of education, respectively.

Healthy NC 2020 details evidence-based strategies which can be used towards maternal/infant health and smoking cessation efforts and education in Swain County.

Progress Made in 2017

The following progress was made in 2017 on our action plan interventions for Promote a health environment in Swain County.

• Action Plan Intervention 1
  • Coalition Vice Chair attended a training on RBA 
  • Coalition Vice Chair attended four performance measure workshop study halls
  • 25% (Amber, Mark, Tobin, Myself out of 15 members) of Coalition for a Safe and Drug Free Swain County and Swain County Health Department members can talk about their program performance and how it contributes to population indicators
  •  A survey was developed using RBA language for Coalition members to show effectiveness of Coalition
  • Swain County Health Department was unable to complete a Whole Distance Exercise; however, Coalition leadership has introduced RBA basic ideas to its meetings
  • Swain County Health Department utilized a Results Scorecard to develop a publicly available e-CHIP 

• Action Plan Intervention 2
  • Coalition Vice Chair attended "You Quit, Two Quit", January 2017
  • Coalition provided educational booth on tobacco use (specific information on pregnancy and teen smoking was provided) at the Swain County Heart Health Event February 1st
  • Coalition attended Mountain Projects Initiative regarding tobacco, underage drinking and suicide meeting March 6, 2017
  • Coalition initiated a government building Tobacco Free Sign Scan in Swain County, March 2017 - currently still in progress
  • Coalition provided educational booth on tobacco and pregnancy at the Swain County Community Baby Shower April 18th
  • Swain County Health Department attended the five day Mission Health & Duke-UNC Tobacco Treatment Specialist Training Certification
  • Swain County Health Department provided education and material on tobacco for the triennial the Civil-Military Innovative Readiness Training Program August 2-10
  • Swain County Health Department attended the Tobacco Media Spokesperson Training August 25th
  • Swain County Health Department initiated the process of a Tobacco Cessation Policy at the Swain County Health Department - still in progress
  • Swain County Health Department and Coalition attended a Swain County Tobacco Free Parks strategy meeting September 22nd
  • Coalition provided education and material on tobacco for the 1st annual NC Med-Assist on September 30th
  • Coalition provided educational booth on tobacco and pregnancy at the Swain County Community Baby Shower October 14th
  • Swain County Health Department negotiated with the Swain County Manager to add a Tobacco Free Parks question to the Parks and Recreation's Master Plan Survey September 13th
  • Coalition presented Tobacco Free Parks strategies to the Swain County Commissioners October 26th - Policy change is still in progress and waiting for results of Parks and Recreation Master Plan survey

• Additionally, the following progress was made in 2017 on Promote a health environment in Swain County.
  • Swain County Health Department and Coalition attended a Racial Equity Workshop May 2017

Progress Made in 2016

The following progress was made in 2016 in pursuing Freedom from Tobacco in Swain County.

• Swain County Health Department's: Nurse supervisor, Director of the Health Department, and Public Heath Educator trained in 5 A's tobacco cessation counseling methods March 7th, 2016.
• Swain County Health Department's Public Health Educator participated in three training sessions, beginning April 12, for Results Based Collaborative Action Planning using Results Based Accountability.
• On June 2, Results-based Accountability was incorporated into Coalition For a Drug Free Swain County meetings. RBA language utilized in 3 meetings.
• An E-cigarette class was taught by WCU Nursing Professor Susan Hester on June 20, targeting pregnant mothers. This class was held at the Swain County Health Department.
• Swain County Health Department held a Quitline campaign at 4th of July Festival offering tobacco cessation materials to the community.
• Held county-wide Baby Shower, sharing education on tobacco and pregnancy with 15 pregnant mothers October 20 from 4:30-6:30 at the Swain County Health Department. Education included information concerning: Quitline, tobacco free education.
• Red Ribbon Week October 23-31: The Coalition for a Drug Free Swain County held a Red Ribbon Poster Contest available to 5th graders in 4 schools. Posters were judged by Commissioners and prizes were offered to winners.
• Quitline campaign presence at Trick-or-Treat on the Street, October 31st. Tobacco-free educational materials were distributed to older teens and adults, reaching over 300 families.

What Is It?

The Coalition for a Safe and Drug Free Swain County was identified by the Swain County Health Department as an action, that when combined with other actions in our community, has a reasonable chance of making a difference in programs in our community. This is a new coalition in our community as of July 12, 2016.

The audience for this action is the Coalition for a Safe and Drug Free Swain County members, and the coalition aims to make a difference at the organizational/policy and environmental change level. Implementation will take place in the Swain County Health Department.

Community Health Assessment action teams will understand and articulate the difference between population accountability and performance accountability; they can talk about their program performance and how it contributes to population indicators; and they will use Clear Impact Scorecard™ to track their program performance.

Partners

The partners for this coalition include:

• WNC Healthy Impact
• Swain County Health Department

Updates

What Is It?

The 5 A's Training (Ask, Advise, Assess, Assist & Arrange) was identified by the Swain County Health Department as an action, that when combined with other actions in our community, that has a reasonable chance of making a difference in promoting a healthy environment in our community. This is an ongoing program in our community.

The audience for this training is the Swain County Health Department Staff, and the training aims to make a difference at the organizational/policy & environmental change level. All staff will be trained, with continuing education occurring annually. Implementation will take place in Swain County by the Swain County Health Department and goals include:

• Clinical staff will be able to talk about their 5 A's program performance and how it contributes to population indicators
• Clinical staff can use 5 A's in their own work (programs, agencies, etc.)
• Clinical staff can use 5 A's to screen and educate their clients

The Swain County Health Department will:

• Host 5 A's training for all new clinical staff yearly
• Host 5 A's continuing education training for all trained staff yearly
• New staff will implement 5 A's screenings and education once trained

Residents of Native American descent and those with a low socioeconomic status typically use tobacco at higher rates than other community members.

Evaluation will be implemented by the Clinical Services Director and feedback will be gathered from staff via annual continuing education trainings.

Partners

The partners for this program include:

• Swain County Health Department
  • Role: Convener/Facilitator
  • Established Partner
• North Carolina Department of Health and Human Services
  • Role: Support
  • Established Partner
• Amber Frost
  • Role: Clinical Services Director; Target Population Representative
  • Established Partner
• Mountain Wise
  • Offers and funding for necessary tools and class materials, making it possible for Swain County to offer this program.
• Swain Hospital
  • Offered marketing efforts and training support
• Cherokee Community Wellness Team
  • Assisted in planning and implementing 5 A's training sessions.

Updates

Progress Made in 2017

These are the new or emerging issues in our community in 2017 that were not identified as priorities in our CHA.

• Heroin use has increased by 60% in recent years. Heroin and opioid use among persons who inject drugs may lead to an outbreak of HIV/Hepatitis B and C. According to  a report from CDC there are 220 counties in the United States who are at increased risk for an outbreak of HIV and Hepatitis B and C. Counties in WNC are among those most at risk. https://www.wsj.com/articles/c... . Swain County has also seen the increase in cases of Hepatitis B and C over the last few years. According to the CDC, Syringe Exchange Programs are "an effective component of a comprehensive, integrated approach to HIV prevention among PWID (persons who inject drugs). These programs have also been associated with reduced risk for infection with hepatitis C virus (CDC.gov, 2018).  Syringe exchange programs offer prevention materials such as clean needles, alcohol swabs, and condoms but they also provide education, referral to mental health and substance abuse counseling, vaccinations, screening for communicable diseases and STD's, and referrals to other needed services https://www.cdc.gov/hiv/risk/s... . Swain County leadership is focused on the opioid epidemic and its effect on our community. Syringe exchange programs are another avenue that may be considered to improve health outcomes for our population.

• Swain Safe Multi-use Pathways and Greenways Initiative has been gaining momentum to help create  safe, vehicle-free pathways and greenways improving the health and well-being of Swain Countyresidents. Greenway Inc. states; improving health through active living, a county trail network will contribute to the overall health of residents by offering people attractive, safe, accessible places to bike, walk, hike, jog, skate, and possibly places to enjoy water-based trails. In short, trail networks create better opportunities for active lifestyles. The design of our county—including transportation systems, parks, trails and other public recreational facilities—affects people’s ability to reach the recommended 30 minutes each day of moderately intense physical activity (60 minutes for youth). According to the Centers for Disease Control and Prevention (CDC), “Physical inactivity causes numerous physical and mental health problems, is responsible for an estimated 200,000 deaths per year, and contributes to the obesity epidemic”. In identifying a solution, the CDC determined that by creating and improving places in our communities to be physically active, there could be a 25 percent increase in the percentage of people who exercise at least three times a week. This is significant considering that for people who are inactive, even small increases in physical activity can bring measurable health benefits. Additionally, as people become more physically active outdoors, they make connections with their neighbors that contribute to the health of their community. Many public agencies are teaming up with foundations, universities, and private companies to launch a new kind of health campaign that focuses on improving people’s options instead of reforming their behavior. A 2005 Newsweek Magazine feature, Designing Heart-Healthy Communities, cites the goals of such programs. “The goals range from updating restaurant menus to restoring mass transit, but the most visible efforts focus on making the built environment more conducive to walking and cycling.”Clearly, the connection between health and trails is becoming common knowledge. The Rails-to-Trails Conservancy puts it simply: “Individuals must choose to exercise, but communities can make that choice easier.” http://www.greenways.com/benef...

Progress Made in 2017

The following are new initiatives or changes in our community in 2017:

• NC Med-Assist - FREE Over the Counter (OTC) Medicine Give Away Day on Saturday, September 30^th. The event was open to all Swain County residents and their families needing OTC medication. 667 Swain County residents were served.

The following are recurring initiatives in our community in 2017:

• 1st annual Heart Health Event and Lecture Series (2nd annual to be held February 2018) funded by a Great Smokies Foundation Grant
• Diabetes Prevention Program is on-going 
• Swain County Health Department's Outreach Committee was re-formed April 2017 
• Swain County Health Department's Outreach Committee designated and area in the waiting room for education and outreach, to be changed monthly
• Triennial Civil-Military Innovative Readiness Training (IRT) Program - Swain County Health Department hosted a Civil-Military Innovative Readiness Training (IRT) Program, administered by the United States Department of Defense (DOD) in our county.  This consisted of free medical, optometry, dentistry and veterinary services to any person.  An ARC grant was approved to provide resources and supplies for the IRT.  The Smoky Mountain Medical started on August 2 and ended on August 10, 2017.  The two week event treated more than 5,800 patients and conducted more than 14,500 medical and dental procedures and exams. 
•  Restoration Community Garden is on-going