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state and local partners created and updated the Opioid Tobacco Action Plan 2.0. Tobacco use and smoking remains the leading cause of In 2013, the OCHD became the first in the state to preventable death in the U.S., NC, and Orange County. pursue a standing order to allow public health nurses to Smoking and tobacco use can cause cardiovascular dis- dispense the drug naloxone to its clinic patients. Nalox- ease, cancer, stroke and upper respiratory infections32. one, also known as Narcan, is an antidote that reverses Tobacco products include cigarettes, cigars, chew opiate overdoses within minutes of being administered tobacco, hookah, and electronic cigarettes. via intramuscular injection or intranasal spray. OCHD's naloxone kit distribution is one innovative and replicable Over the past 60 years, tobacco companies have been way to help tackle NC's opioid-related deaths. In 2019, known to spend billions of dollars each year in market- the Orange County Board of County Commissioners ing that disproportionately impacts low-income and supported the formation of the Orange County Opioid people of color communities. Targeting has been seen Taskforce. This group will work together to address through distributing free cigarettes to children in hous- education around opioids, reducing the oversupply of ing projects, dispensing tobacco coupons with food prescription opioids by prescribers, and expand treat- stamps, discounting tobacco products, and increasing ment and recovery oriented systems of care. the number of retailers selling tobacco products in cer- tain communities33 Below is a non-inclusive list of local and state programs and initiatives to help address and combat the opioid Here's how tobacco impacts different segments of the epidemic. population: COORE (Coordinated Opioid Overdose Reduction • Tobacco use varies among racial, income, geographic Effort) and other demographic groups. Drug Treatment Courts • Low-income persons, those with lower levels of education, persons with mental illness and substance NC Safe Syringe Initiative disorders, and those who are unemployed smoke at Orange County Health Department Syringe Exchange higher rates than other groups. • American Indians have a higher prevalence of smok- ing than any other racial or ethnic group. Prescription Drug Drop Boxes • African American tobacco users die from tobac- co-related causes at higher rates than any other racial or ethnic group. • LGBTQ+ individuals are more likely to be smokers than their heterosexual counterparts. • Infants and children exposed to second-hand smoke are more likely to experience asthma attacks, ear in- fections, and sudden infant death syndrome (SIDS). • Adolescents who use nicotine become addicted more quickly than adults. • Educational level and household income are key indicators of smoking status. In 2018, cigarette smoking among Orange County adults holds steady at approximately 14.2%, compared to NC (17.6%) and the Region 5 (combined) surrounding counties (17.4%). Alamance, Wake, Durham, Chatham, Orange, Rockingham, Guilford and Caswell counties all make up Region 5. Of the current smokers with- in Region 5, 18.2% are non-Hispanic Whites, 17.2% are non-Hispanic other, 12.2% are non-Hispanic African 14 2019 COMMUNITY HEALTH ASSESSMENT