Teen Smoking Cessation Political Advocacy in Forsyth County

Juliette E. Navoa, RN

Minnesota State University Mankato


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.


Juliette Navoa, RN




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. jnavoa1@gmail.com



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



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-


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


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

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-


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