Johnston County Community Health Needs Assessment 2002 through 2006

10 A Product of The Johnston County Public Health Department 2002 - 2006 Statistical DataPageTable of Contents Community Diagnosis and Comprehensive Plan Page Number Primary Data 2 Preface 3 Johnston County Health Concerns 2005 4 2006 Community Health Assessment Survey Summary 5 Top 5 Health Concerns 6 Pie Charts – Web - site Surveys 6 - 12 Secondary Data 13 Preface 14 15 Geographical Location 16 Demographic Characteristics 17 Johnston County Townships 18 - 19 2005 Population Estimates 20 - 21 Special Population Risk Group 22 Socio - Economic Influences on Health Care 22 Poverty 22 Labor Force and Unemployment 23 Johnston County 25 Largest Employers 23 Unemployment Rate 24 Education NC Drop Out Rates 24 Johnston County Rates 24 School Drop Out Totals 24 25 Colleges & Universities 26 - 27 Housing Johnston County Building Permits 28 Public Housing 28 Johnston County Housing Assistance 28 Income Assisted Housing Public Housing 29 Transportation JCAT 30 Important Public Health Program Statistical Data Maternal Health 30 Late or No Parental Care 31 Drop - Ins @ Johnston Memorial Hospital 31 Access to Prenatal Care 31 Deliveries - Hospital 32 Access to Contraceptive Services 32 Teen Pregnancies 32 Inter - conceptual Period 33 Nutritional Deficiencies 33 Other maternal Health Factors 33PageFamily Planning 34PageChild Health 34 Johnston County Children by Ages 35 Fetal Deaths Infant Deaths 36 Low Birth Weight Infants 37 Adult Health 2001 – 2005 Age Adjusted Death Rate Ranking 38 - 39 Healthy Carolinians 39 Living Well Partnership of Johnston County 39 - 40 Adult Morbidity Behavior Risk Factors 41 Communicable Diseases Morbidity Tuberculosis 42 TB Cases by Age 43 Sexually Transmitted Diseases 44 Salmonella , Shigellosis , Viral Meningitis , Hepatitis & Campylobacter 45 Epidemiology 46 Epidemiology Response Team 46 Johnston County Public Health Preparedness 47 Dental Health 48 Nutrition WIC 48 - 49 Environmental Health 49 - 50 Summary of Statistical Data 50 - 51PagePage pageNumber52PagePage pageNumber6Preface Primary Data is subjective data related to opinions and concerns regarding the health care system in Johnston County Throughout the years several community agencies , civic and church groups were surveyed to identify major health issues The following data is a summary of the results 3 JCPHPagePage pageNumber7Community Health Care Concerns 2005 In Johnston County ? Physician access increase number of doctors , PA ? s , FNP or other extended providers ? Affordable medical care ? Additional medical clinics and or Family Care Centers with improved facilities ? Improve quality time with patients particularly the elderly ? Children ? s Hospital ? Improve mental care facility ? High cost of medications ? Improve health insurance ? Preventive Health Care Programs for Heart Disease and Diabetes ? Nutrition and Physical Fitness programs ? Expanded transportation services ? Smoking related illnesses ? 24 - Hour urgent care services ? Free medical clinic ? Increase in nurses and educators ? Water and food safety ? Bioterrorism ? Environmental Pollutants ? Home and Fire Safety ? Infant Children Car Seat Safety In 2006 , the Health Education team of the Health Department developed and disseminated 283 community health surveys The surveys were completed by county residents through various functions that include Healthy Carolinians Forum , Human Service Council , Health Festivals , Council on Aging , Churches and Civic organizations In addition , the survey was placed on the County web site , wwwjohnstonnccom Health Assessment participants were asked to complete a written survey to which the question was , “ Is this a major concern for you ” Answer Yes or No 4PagePage pageNumber82006 Community Health Assessment Survey Summary 283 Respondents Summary of Yes of No Air Pollution 297 703 Communicable Disease 413 587 Child Care 251 749 Clean Water 403 597 Crime 530 470 Dental Health 424 576 Depression 431 569 Diabetes 484 516 Exercise 445 555 Food Assistance 261 739 Food Safety 389 611 Access to Health Care 445 555 Health Care for Seniors 534 466 Heart Disease 382 618 Higher Education 226 774 Homelessness 276 724 Immunizations 286 714 Hospital Care 318 682 Affordable Housing 357 643 Health Insurance Coverage 691 309 English Spanish Language 357 643 Job Opportunities 382 618 Literacy 318 682 Affordable Medicine 622 378 Mental Health Issues 396 604 Incompletion of High School 318 682 Nutrition 371 629 Obesity 473 527 Parenting Skills 311 689 Physical Fitness 456 544 Poverty 420 580 County - Wide Pre - K Education 163 837 Public Transportation 378 622 Recreational Facilities 272 728 Respiratory Illness 272 728 Stroke 353 647 Substance Abuse 481 519 Teen Pregnancy 385 615 Terrorism 261 739 Utilities 396 604 5PagePage pageNumber9Top 5 Health Concerns 1 Health Insurance Coverage 691 2 Affordable Medicine 629 3 Health Care for seniors 534 4 Crime 530 5 Diabetes 484 The following pie charts indicate a sample of the most significant data and concerns The demographic data is based on website surveys Data Significance The majority of the respondents to the survey were from Clayton , Selma and Smithfield 6Page0Data Significance The majority of the people answering the survey online had incomes of 35,000 or more Data Significance The majority of respondents had some college , undergraduate or graduate levels of education 7Page1Data Significance Obesity was a concern for almost 50 of the population Data Significance 622 Identified obtaining or paying for medications was problem 8Page2Data Significance A high percentage identified physical fitness or lack of exercise to be a concern Data Significance Nutrition was a concern 9Page3Data Significance Dental health was a concern Data Significance Depression was a concern 10Page4Data Significance A high percentage 691 identified health insurance coverage to be important Data Significance The ability to obtain a doctor or be treated by a heath care facility was an issue 11Page5Data Significance A high percentage of respondents were concerned about health care for seniors 12Page613Page7Preface The community diagnosis is the Health departments mechanism for assessing the Countys health status by utilizing the statistical data that is available to us , our knowledge of economic factors , and social influences within the County Statistical data sets were acquired from a variety of sources including , US Census , State Data Center , NC Employment Security Commission , N C Department of Commerce , Federal Statistics , Center for Disease Control , National Institutes of Health and numerous others The data from these various sources will be somewhat different based on the comparative analysis utilized However , a fairly close picture of the health needs and resources is developed herein A community assessment is a continuing work in progress 14 JCPHPage815Page9North Carolina Johnston County I INTRODUCTION Geographical Location The County is located in the east central section of North Carolina , situated on the fall zone between the Piedmont and Coastal Plain provinces The County seat , Smithfield , is located on North Carolinas central principal river , the Neuse , which is a major water source for the County The County border is located approximately 15 miles southeast of Raleigh , North Carolina and 45 miles north of Fayetteville , North Carolina There are 79198 square miles of land area in the Countys 506,867 acres According to 2005 Agriculture Stabilization Conservation Service ASCS state data , Johnston County ranks second in the state for the number of farms an estimated 4,810 However the number of farmers in the county is steadily declining from 1,700 in 2000 to 1,144 in 2002 Farmland in the County is primarily devoted to crops In 2005 , Johnston County ranked in the top ten for the following crops oats , sorghum , soybeans , corn , burley , wheat , hay , sweet potatoes and tobacco Johnston County is number one in the state for the production of sweet potatoes Johnston County competes with Wilson and Pitt County for top state production of Tobacco Cotton acreage is increasing significantly from 13,600 acres in the 2004 to 16,950 cotton acres in 2005 Horticulture nursery and greenhouses and livestock poultry turkey production continues to expand The Johnston County rankings for agriculture in 2005 are First in field crops income , first in pounds of Tobacco produced , first in Tobacco acreage , first in Tobacco income , second in Oats production , fourth in Greenhouse and Nursery income , sixth in Soybean income , seventh in Fruits , Vegetables and Nuts income , eight in Agricultural income and first in nation for Sweet Potato production Over 42 different soil types have been identified , which have a variety of uses Average annual climate is 608 degrees Fahrenheit , average rainfall is 4782 inches , average snow is 36 inches and the County elevation is 155 feet The gentle , rolling hills and inclines compose the topography of Johnston County Overall , Johnston County remains basically rural However , rural areas are turning into suburbs indicative of the county ? s expanded growth Based on 2005 State Demographics , 29 of the county ? s residents lived in incorporated towns or municipalities ; there were 103,836 residents in non - municipalities Population Density estimates that there are averages of 1837 people per square mile 16Page0II POPULATION AT RISK Demographic Characteristics The 2005 population estimates for the County indicated 146,437 individuals Based on demographic profiles from 1990 – 2000 there was a 50 increase in the county ? s population Johnston County is one of the fastest growing counties in the state A 156 change of growth is expected from 2005 to 2010 The calendar year projected population for 2006 is 151,031 and 170,237 for year 2010 There are more than 20 communities throughout the County with ten incorporated towns 2004 2005 Incorporated Towns Population Population Benson 3,320 3,380 Clayton 10,879 11,584 Four Oaks 1,424 1,822 Kenly 1,569 1,646 Micro 454 509 Pine Level 1,313 1,759 Princeton 1,066 1,201 Selma 5,914 6,841 Smithfield 11,510 12,172 Wilsons Mills 1,291 1,562 17 Johnston County , North Carolina Incorporated Towns Benson Clayton 14,000 Four opulationOaks 12,000 Kenly 10,000 8,000 Micro 6,000 Pine PLevel Total 4,000 Princeton 2,000 Selma 0 Smithfield 2004 Population 2005 Population Wilsons MillsPage1Townships in Johnston County that reflect significant growth are detailed in data below Johnston County Townships Banner Benson Bentonville Beulah Kenly Boon Hill Princeton Clayton Cleveland Elevation Ingrams Four Oaks Meadow Micro ONeals Pine Level Pleasant Grove Selma Wilders Wilson ? s Mills Johnston County continues significant growth due to its proximity to Research Triangle Park and to Raleigh , the States capital and major urban centers of the States Coastal Plains Region It is important to note that the fastest growing Johns Johnston County continues significant growth due to its proximity to Research Triangle Park and to Raleigh , the State ? s capital and major urban centers of the State ? s Coastal Plains Region It is important to note that the fastest growing townships are in the western part 18Page2of the county which is adjacent to Wake County Growth expanded to the Wilders ? township for 2005 According to the US Census Bureau estimates , the Clayton population grew 48 from 8,222 to 12,173 during 2000 – 2004 19Page31 2005 Population Estimates by Gender There are a total of 73,166 males and 72,972 females 2005 Totals Males 73,166 501 Females 72,972 499 2010 Estimate Males 85,060 503 Females 83,929 497 2 2005 Population Estimates by Race Ethnicity The Countys population is primarily 774 White , 155 African - American , 04 Indian or Alaska Native , 04 Asian , 52 Other Race , 12 two or more races and 103 Hispanic The Hispanic or Latino population has increased from being 3 of the population in 1990 to 103 in 2005 The dynamics of minority groups continues to change due to the increasing Hispanic or Latino population In 2000 , Hispanics accounted for 77 of the county ? s total population Based on a 2005 American Community survey the Hispanic Latino population will be the largest minority group in the US North Carolina has the fastest growing Latino population in the country , with an increase of over 400 in the past decade th The county ranks 8 out of 100 counties with a significant Latino increase Documenting race is becoming increasingly difficult due to the multi - ethnicity of individuals An estimated 9,329 individuals identified themselves as some other race or of two or more races 20 Indian Alaska Native 2005 Population Estimates by Race Asian Two or More Races Other Races Hispanic Ethnicity African - American WhitePage43 2005 Population Estimates by Age 2005 Years 2000 Census Estimate 0 to 4 9,573 79 11,081 76 5 to 14 17,573 144 21,745 149 15 to 19 7,322 60 9,332 64 20 to 24 7,287 60 9,107 62 25 to 34 20,969 172 22,493 154 35 to 44 20,789 170 24,632 169 45 to 54 15,939 131 19,434 133 55 to 64 10,540 86 14,017 96 65 to 74 6,700 55 8,019 55 75 to 84 4,122 34 4,586 31 85 + 1,151 09 1,692 12 The above data is significant for the following reasons 1 Depicts the population subgroups that require health care 2 The largest population age group is between 35 and 44 years of age 3 The data will relate to health risk conditions that place these groups at risk For example a high , young adult population at risk for injury , HIV , etc ; 193 of the population is over 55 and at risk for heart disease , cancer disability , etc 4 The median age based on 2005 data for the County is 347 Special Population Risk Group 21 Johnston County - Population by Age 85 + es 65 to 74 Ag 45 to ation54 25 to 34 2005 pulEstimate 2000 Census o 15 to 19 P 0 to 4 0 5,000 10,000 15,000 20,000 25,000 Population TotalsPage5Johnston County is in the states largest catchment area for migrant and seasonal farm workers The three counties in the catchments area include Johnston , Harnett and Sampson , which employ up to 35,900 workers annually Based on the totals , 12,500 are migrants and 25,400 are seasonal farm workers In addition , many workers bring their families , young and old , who require medical services with no previous medical records The demand to provide health care for these special populations continues to increase In 2007 , Tri - County Community Health Center is proposing to open a clinic in the Johnston County community of Four Oaks to serve a primarily growing Latino workforce Tri - County Community Health Center located in Newton Grove is in Sampson County and provides medical care in conjunction with the Johnston County Health Department for migrants and seasonal farm workers in Johnston County The Johnston County Health Department has increased its bilingual staff from 5 in 2004 to 16 in 2005 to accommodate the health care language barriers Several migrant and seasonal farm workers reside 45 miles from the nearest heath care facilities Telamon is an agency in Johnston County , located at the Job Link center in Clayton that assists migrant and seasonal farm workers in employment and legalization In recent years the St Martins Episcopal Migrant Ministry located in Dunn , NC serves numerous farm workers with legalization , resources and referral services Socio - Economic Influences on Health Care 1 Poverty According to the NC Rural Economic Development Center , 128 of Johnston County residents had incomes below the poverty level The median family household was 45,208 Per capital income for Johnston County residents was 26,907 as compared to the State at 29,322 Statewide , the white per median family income of 52,991 is higher than that of non - white at 30,463 The poverty rate of 75 for whites in comparison to a 252 rate for non - white depicts a greater disparity There were approximately 4,059 families in poverty Families include a household of one or more related persons living in the same household Female households with children and no husband present comprise 1,011 poverty families During 2006 , 683 persons received aid to families with dependent children AFDC , representing 389 households , 6,155 households received Food Stamps , representing 12,762 individuals Recipients of AFDC are generally Medicaid eligible In Johnston County 22,100 individuals were Medicaid eligible One out of every ten Johnstonians is potentially eligible for Medicaid annually Poverty among specific age and racial groups deserves attention Children under five years of age living below poverty comprise 328 with 109 white children in poverty compared to 219 African - American children Children and adolescents under the age of 18 represent 182 of the poverty population The elderly constitute 187 of the poverty - stricken It is estimated there are 2,965 Medicaid eligible children with 32 not enrolled An estimated 38 of public school students receive free or reduced lunch 22Page62 Labor Force and Unemployment The county work force as of November , 2006 was 76,442 In 2005 , industry , manufacturing , retail trade , health care , social assistance , educational services , construction and food services reflect highest employment in the county Johnston County Twenty - Five Largest Employers Quarter Ending December 31 , 2005 Company Name Industry Description Employment 1 Johnston County Schools Education & Health Services 1,000 + 2 Talecris Biotherapeutics Inc Bayer Manufacturing 1,000 + 3 Johnston Memorial Hospital Education & Health Services 1,000 + 4 County of Johnston Public Administration 500 - 999 5 Asplundh Tree Expert Company Professional and Business Services 500 - 999 6 Caterpillar Inc Manufacturing 500 - 999 7 Bayer Manufacturing 500 - 999 8 Precisionaire of North Carolina Manufacturing 500 - 999 9 Johnston Technical Institute Education & Health Services 250 - 499 10 Wal - Mart Associates Inc Trade , Transportation & Utilities 250 - 499 11 Novo Nordisk Pharmaceutical Manufacturing 250 - 499 12 State of North Carolina Public Administration 250 - 499 13 Polymer Group Inc Manufacturing 250 - 499 14 Food Lion LLC Trade , Transportation & Utilities 250 - 499 15 Andrew Corporation Manufacturing 250 - 499 16 JR Tobacco of North Carolina Inc Trade , Transportation & Utilities 250 - 499 17 Eaton Corporation Manufacturing 100 - 249 18 Doubletree Personnel A Corp Professional and Business Services 100 - 249 19 Bowman Enterprises Inc Information 100 - 249 20 F & D Huebner LLC T A McDonalds Leisure and Hospitality 100 - 249 21 Jerry G Williams & Sons Inc Manufacturing 100 - 249 22 Corestaff Services LP Professional and Business Services 100 - 249 23 Town of Clayton Public Administration 100 - 249 24 Britthaven Inc Education & Health Services 100 - 249 25 Thyssenkrupp Precision Forge Inc Manufacturing 100 - 249 Source Quarterly Census of Employment and Wages ES - 202 Unit , ESC LMI Division Unemployment Rates Annual unemployment rate is 35 Latest unemployment rate as of September 2006 was 34 2003 45 2004 44 2005 43 Industrial employment in the county has increased Manufacturing jobs have declined representing 107 of the workforce 23Page73 Education The Johnston County Public School system consists of 38 schools and one Academically Intellectually Gifted AIG center which serves 29,193 th students , from kindergarten through 12 grade , as of October 2006 Employment in Johnston County School system is estimated to represent 1,525 certified professionals and 1,196 classified personnel Overall , 759 of all Johnstonians possess a high school education A Bachelor ? s degree or higher educational training is held by 1539 of the County ? s population North Carolina Drop - Out Johnston County Drop - Out Rates per Fiscal Year Rates per Fiscal Year th th th th 9 – 12 Grade 9 – 12 Grade 2004 – 2005 474 2004 – 2005 446 2003 – 2004 486 2003 – 2004 501 2002 – 2005 478 2002 – 2003 534 2001 – 2002 525 2001 – 2002 584 School Drop - Out Totals th th 7 – 12 Grade 2004 – 2005 357 2003 – 2004 375 2002 – 2003 375 2001 – 2002 389 24 School Drop Out Totals 7th - 12th Grade Outs400 390 389 Drop 380 375 375 of 370 Number 360 357 350 340 2002 2003 2004 2005 – – – – 2001 2002 2003 2004Page8Johnston Community College aids Johnstonians in higher education , enrolling an estimated 5,766 curriculum and 8,997 continuing education students annually There are 21 schools of higher education within a two - hour drive Colleges and Universities Two Hours Drive from Johnston County NC Wesleyan College East Carolina University University of NC at Greensboro University of NC at Wilmington University of NC at Chapel Hill North Carolina Central University NC State University Duke University Shaw University Peace College St Augustines College NC A & T University Gilford College Louisburg College St Andrews Presbyterian College Campbell University Meredith College Barton College Fayetteville State University 25Page94 Housing The existing major highways and the expansion of I - 40 through Johnston County to Wilmington continue to have a major impact on the housing market in Johnston County Also Johnston County is one of the fastest growing residential areas in the state Building permits reflect the rising demand for residential accommodations In 2005 , 249 well and 1543 septic tank permits were issued particularly in the areas best serviced by I - 40 , Benson , Clayton and Cleveland County areas In comparison to previous years the housing demand continues to increase Johnston County Building Permits Year New Residential 2005 1550 2004 1421 The availability of rental housing is increasing ; however , home ownership is dominant , excluding public housing Numerous mobile home parks exist for purchase or rent and further expanded housing possibilities Public Housing The Housing Authorities have constructed public housing with Federal funds Numerous units are equipped for the elderly and handicapped Council on Aging has 126 housing units for elderly and disabled adults over the age of 62 years Johnston County Housing Assistance It is the mission of this program to assist eligible families in securing housing offering good living conditions in safe , low poverty neighborhoods , at affordable costs and which adequately meets the needs of all family members including those with specific needs USDA Rural Development is a government agency that assists applicants from very low , low and moderate income levels They are able to help applicants with new or existing housing , and repair loans as well You can find USDA Rural Development on the web at http wwwrurdevusdagov nc 26Page0Income Assisted Housing Public Housing Smithfield Smithfield Housing Authority Pine Knoll Apts Fieldale Apts 5th Street 202 Skyland Dr Hwy 301 Smithfield , NC Smithfield , NC Smithfield , NC 919 - 934 - 9491 919 - 934 - 6036 919 - 989 - 6015 Johnston Court Landmark Apts Austin Manor Apts Hwy 301 118 Landmark Dr Seniors & Disabled rd Smithfield , NC Smithfield , NC 129 S 3 Street 919 - 934 - 6546 919 - 934 - 4437 Smithfield , NC 919 - 934 - 9600 Windsor Place Homewood Apts JC Housing Asst 116 NC Hwy 210 Towbridge Road HAPP Housing Payment Program Smithfield , NC Smithfield , NC 107 East Johnston St 919 - 934 - 1773 919 - 934 - 9822 Smithfield , NC 919 - 989 - 5070 Selma Selma Housing Authority Meadows Meadowview Lizzie Street 1000 Ricks Rd 700 Primose St Selma , NC Selma , NC Selma , NC 919 - 965 - 3755 919 - 965 - 9492 919 - 965 - 8607 Benson Benson Housing Authority Hedge Apts Ridgecrest Apts 413 Williams Dr Ryals St 290 Adams St Benson , NC 27504 Benson , NC Benson , NC 919 - 894 - 4710 919 - 894 - 5854 919 - 894 - 7344 Four Oaks Princeton Clayton Twin Oaks Delwood Apts Austin Acers 312 Surles Dr Pearl Street 525 N Church St Four Oaks , NC 27524 Princeton , NC Clayton , NC 27530 919 - 963 - 3756 919 - 936 - 2541 919 - 553 - 7710 Kenly Kenly Court Apts Kenly Village 6022 N Whitley Dr 657 W 1st St Kenly , NC Kenly , NC 919 - 284 - 5978 919 - 284 - 2337 27Page15 Transportation One of the Countys greatest assets is its proximity to two major highways , 301 and US 70 , and to two interstates , I - 95 and I - 40 Transportation is available in the County through Johnston County Area Transportation System JCATS The system offers adult transportation to all Medicaid recipients , including children , as well as private paying citizens and organizations In - county clients are transported to Health and Human Services Agencies such as the Health Department , DSS , Mental Health , Council on Aging , Johnston County Industries , Vocational Rehab , and more The transport system allows necessary trips to the pharmacy , grocery store , shopping center and other places for personal needs JCATS business hours are 6 30 am till 5 30 pm , Monday through Friday The seating capacity for the JCATS passenger vehicles is 16 - 26 seats A phone call 24 to 48 hours in advance is recommended to reserve a JCATS ride In addition JCATS offers an out of County service The van seats 11 and transports clients to tertiary medical centers such as Chapel Hill , Wake Medical , Duke and the Veteran ? s Administration Hospital from 8 am till 5 pm on Mondays , Wednesdays and Fridays JCATS expanded its services to the general public , for a nominal fee of 200 one way The routes operate from the Smithfield county seat to Clayton , Princeton , Selma and Benson Approximately 62 of the households in Johnston County are without a car The majority of Johnstonians without a car must pay 5 to 25 to a private provider for transformation within the County Council on Aging reports more than 40 of the older adult population is without a transportation resource III Important Public Health Program Statistical Data A Maternal Health The 2000 - 2004 State Center for Health Statistics indicated that live birth rates were higher than the state The 2005 pregnancy rate for Johnston County was 840 vs 822 for the state County data for 2005 revealed the following facts ? Women in childbearing years comprise 218 the Countys total female population ? A total of 2,685 pregnancies occurred with 355 abortions and 13 fetal deaths ? Johnston County has a higher fertility rate than the state 669 vs 725 28Page2? The rate of childbearing women with less than nine years education is 28 higher than the States five - year adjusted rate Pregnancy involves the optimal care of the mother and fetus Several negative indicators that include physical , social - financial , emotional and environmental concerns place both at risk In Johnston County , the following indicators exist 1 Late or No Parental Care Based on adequate prenatal care data for 2003 - 2005 , the percent of woman receiving prenatal care in the first trimester in Johnston County was 743 compared to the state percentage of 812 , reflecting a need for improvement The non - white percentage indicates a need for improvement at 676 In addition , the Hispanic rate for adequate care is 510 The County continues to strive and improve the rate of women receiving prenatal care through a state - wide effort to expand Medicaid services Drop - ins are pregnant women receiving no prenatal care The birth percentage of mothers in the county receiving no prenatal care was 11 compared to 08 for the state Drop - Ins at Johnston Memorial Hospital 2005 – 34 Drop - Ins 2004 – 44 Drop - Ins 2003 – 40 Drop - Ins 2 Access to Prenatal Care Johnston County has two licensed OB - GYN practices Johnston OB - Gyn Associates Dr Marzbani , Dr Perez , Dr Parmar and Southeast Women ? s Center Dr Turlington , Dr Evans , and Dr Kramer In addition , several Family Physicians , including Dr R Davis , Dr JT Liverman , Dr J Pittard , Dr S Watson , Dr Charles Williams , and Dr Harris , provide prenatal services at Johnston Memorial Hospital 29 Johnston Memorial Hospital Drop - Ins 60 44 40 34 2003 40 2004 20 2005 0 Drop - In Rates Per YearPage3Johnston Memorial Hospital ? s Delivery Book reflects access to care resources In 2002 , Johnston Memorial Hospital opened a Women ? s Health Pavilion The Women ? s Pavilion improved delivery and post - partum care with four birthing rooms , two observation rooms , 14 post - partum rooms and a expanded nursery Deliveries – Johnston Memorial Hospital Year Private JCHD Tri - County Drop - Ins Total 2005 872 372 34 1278 2004 780 355 44 1179 2003 562 329 40 931 Facts related to the above data ? There were 2317 total births in the county for 2005 , of which 1278 were in county births and 1,039 449 births delivered out of the county ? The County ? s Drop - In rate decreased in women delivering at the Johnston Memorial hospital with no medical prenatal history ? 60 - 70 of hospital deliveries are Medicaid Emergency Medicaid clients ? 379 births were to women of Hispanic descent , representing 296 3 Access to Contraceptive Services See the Family Planning Section 4 Teen Pregnancies 30 Johnston Memorial Hospital Deliveries 872 900 780 800 700 600 562 Private Patients 500 JCHD Tri - County 372 400 355 329 Drop - Ins 300 200 100 44 40 34 0 2003 2004 2005Page4The teenage mothers health risk factors are twice that of the adult child bearer Teenage mothers risk factors include maternal mortality , complications ie ; hemorrhage , pre - eclampsia , toxemia , etc , pre - term birth and socio - economic changes In Johnston County , there were 300 teen pregnancies in 2005 and 276 in 2004 th Johnston County ranks 50 in 100 counties related to teen pregnancies Disturbingly , the teenage pregnancy rate in Johnston County is not experiencing the decline identified by the state A true picture of the adolescent at highest risk reflects the school age teens 18 years or younger Thirteen pregnancies were reported in 2005 between ages 10 - 14 ; an increase In addition , girls 18 years old and younger had 184 pregnancies with one fetal death The Health Departments maternity data revealed that 10 of the maternity caseload was teens 17 years or younger Twelve unmarried teenagers under 18 were having their second or higher pregnancy 5 Interconceptual Period , High Parity , Short Birth Interval See Family Planning Section 6 Nutritional Deficiencies See WIC Section Pregnant women are a group constantly at nutritional risk due to their increased need for nutrients to provide for their rapidly growing unborn child Pregnant teenagers are at even greater risk due to social pressures , erratic eating habits , and the high nutrient demands of adolescent growth 7 Other Maternal Health Factors The Health Department ? s Maternity Program during 2005 medically assessed , monitored or treated five percent of the case load for hypertension and five percent for diabetes All diabetic patients are referred to a private physician ? s office following diagnosis for continued care or for follow - up care In recent years there were 18 patients diagnosed with gestational diabetes In 2005 , 56 patients were diagnosed with abnormal glucose tolerance test A common and prevalent diagnosis is anemia representing 131 patients pre - and post - natal The Maternity Program case load averages 300 to 400 clients annually In 2004 – 2005 the Maternity clinic serviced 448 clients A significant and evolving change in the Maternity clinic is that 252 or 56 of maternity patients were non - English - speaking in 2005 The identification and rate of substance abuse use increased among 31Page5women of childbearing age Based on maternal health histories , 20 to 30 of the Health Department maternity caseload abused or used drugs , including tobacco In 18 of all live births , the mother reported smoking B Family Planning There are an estimated 31,948 women of child - bearing age in Johnston County Based on Medicaid data , 10 percent of the childbearing population is potentially Medicaid eligible The Health Department ? s Family Planning program for calendar year 2004 – 2005 served 1,254 women Eighty seven percent 1,091 of women in the program were 18 years or older The other 13 percent 163 of the caseload included women 17 years or less Overall the department ? s program serves an estimated one third of the population in need The limited access to transportation , inadequate finances and social misconceptions prevent one - third from obtaining care The remaining one - third receives contraceptives from the private sector or out of the county The Family Planning Waiver program has expanded income guidelines that offer services to working women and men Several private physicians provide contraceptive methods with increased Medicaid acceptance Private physicians often refer patients without funding to the Health Department ? s program All Family Planning patients are on a sliding fee scale The need for Family Planning services is indicative of high parity births five or more pregnancies to mothers less than 30 years of age The high parity rate of 171 is slightly lower than the state ? s 185 , for the adjusted years of 2000 - th 2004 Johnston County ranked 67 in high parity pregnancies The county ? s rate of 119 for short birth intervals of less than 6 months indicates the need for Family Planning services in Johnston County 32Page6C Child Health Johnston County children between the ages 0 – 19 comprise 29 of the total population Children 0 – 4 years 12,019 5 – 9 years 11,681 Adolescents 10 – 14 years 10,705 15 – 19 years 9,649 Adolescent Males 10 – 19 years 10,565 Adolescent Females 10 – 19 years 9,789 Based on five year adjusted rates 2001 – 2005 , the County ? s fetal death rate was 61 vs the State ? s rate of 71 The County infant death rate was 69 which is lower than the State rate of 85 North Carolina infant mortality rate is one of the highest in the nation A total of 18 perinatal deaths registered fetal 33 48 52 Adolescent Males 10 - 19 years Adolescent Females 10 - 19 years Johnston County Children By Ages 14,000 12,019 11,681 12,000 10,705 9,649 10,000 8,000 6,000 4,000 2,000 0 0 - 4 years 5 - 9 years 10 - 14 years 15 - 19 years Children AdolescentsPage7and neonatal deaths occurred in the County during 2005 Although the County ? s fetal and infant mortality rates were lower than the State ? s , the numbers continue to fluctuate The fetal death rate for white children was 46 compared to 136 for minority children The infant death rate for white children was 59 compared to 121 for minority children Year Fetal Deaths Infant Deaths 2005 13 7 2004 10 18 2003 18 20 Low birth weight infants weighing less than 5 lbs 8 oz are decreasing in the th County The County ranks 29 in the State for low birth rate babies Low Birth Weight Infants 2005 187 2004 200 2003 167 Note Overall , adolescent and non - white rates are substantially higher in relationship to the above total data The Child Service Coordination Program within the department maintains a caseload of 250 at risk children 0 – 5 years of age The children are identified as primarily high risk based on birth genetics , weights , gestational age , congenital abnormalities and maternal risk factors , ie ; age of mother , history of substance abuse , parental mental status , perinatal infections , etc It is 34 Fetal Deaths Infant Deaths 20 20 18 18 15 13 10 10 7 5 0 2005 2004 2003 Low Birth Weight - Infants 2005 200 2004 187 2003 200 167 180 160 140Page8estimated that out of the 187 low birth rate babies in 2005 , 20 or more were related to drug abuse by the mother The major cause of death for all children still relates to injury External injury and motor vehicle accidents accounted for the majority of deaths According to 2005 Detail Mortality Data , 91 deaths were caused by external injury in the county Specifically , 32 deaths were transport accidents , 29 deaths related to drowning , falls , fire , poisoning and suffocation Reportable SIDS deaths are decreasing in the County Year Total Deaths 2005 1 2004 3 2003 1 Children of all ages are a nutritionally vulnerable group due to the demands of rapid physical growth and because the diet itself is constantly changing throughout childhood to parallel physical and social changes during this period The highest prevalence and frequently documented nutrition related problems for children include obesity , anemia , small stature and dental caries Morbidity or disease management is a major concern for children In the last two years , three health focus areas have emerged Recent data notes that 25 of all children are obese The number of Asthmatic Medicaid claims represented 1,081 children age 10 – 14 years Type II diabetes is being more frequently diagnosed in adolescence D Adult Health – Mortality Adult Health accounts for the largest numbers of disease and death in the County The leading causes of death in comparison with the State are shown on the table below 35Page92001 – 2005 Age Adjusted Death Rate Ranking Johnston Johnston NC NC County County Diseases Rate Ranking Rate Ranking st st Heart Disease 2268 1 2418 1 nd nd Cancer 1977 2 1999 2 rd rd Cerebrovascular Disease 647 3 607 3 th th Chronic Lower Respiratory Disease 469 4 482 5 th th Accidents 453 5 502 4 th th Diabetes 276 6 263 6 th th Alzheimer 271 7 204 8 th th Pneumonia 233 8 204 7 th th Kidney Disease 179 9 153 9 th th Septicemia 145 10 136 10 th th Suicide 116 11 130 11 th th Chronic Liver Disease & Cirrhosis 88 12 75 12 th th Homicide 72 13 59 13 th th HIV AIDS 52 14 55 14 Categorical types resulting in death for Johnston County residents based on the five leading causes of death Cause Types Heart Disease Myocardial Infarction Hypertension Arteriosclerosis Cancer Lung Digestive Breast , Skin and Bone Cerebro - vascular Occlusion of Arteries Accidents Motor Vehicle Fire and Flames Submersion and Suffocation Respiratory Disease Chronic Obstructive Pulmonary Disease , Pneumonia Chronic Airway Obstruction In 2005 , there were 1,055 deaths in Johnston County with a five - year adjusted rate of 9460 versus State at 8955 , meaning Johnstonians are at a slightly higher risk for dying compared to North Carolinians Death rates for minorities , males , especially minority males and the elderly over 65 are substantially high A comparison of Johnston County ? s mortality rate to North Carolina with regard 36Page0to specific age groups indicates that all of the following rates are higher than the State 25 – 44 year olds for cancer , motor vehicle injuries , heart disease and suicides ; and 44 – 64 year olds for cancer , CVA , respiratory diseases , diabetes and chronic liver disease In an effort to more efficiently address chronic diseases , the county applied for and received state certification in 2005 as a Healthy Carolinians county A partnership was formed entitled the “ Living Well Partnership of Johnston County ” In October 2005 , The Living Well Partnership of Johnston County was recognized as a certified Healthy Carolinians Partnership Year after year , the Johnston County Health Department and various community organizations help our needy citizens with existing programs , but this partnership is special as it draws on existing resources and acts as an umbrella of true collaboration No one entity can address health and human service needs alone ; therefore , the Living Well Partnership of Johnston County was formed In early 2006 , the Partnership held its first Community Health Forum Attendance was high and three sub - committees were successfully formed The partnership ? s subcommittees focus areas are Diabetes Prevention and Management , Adult and Childhood Obesity and Smoking Cessation The Partnership ? s Mission “ To serve as a multidisciplinary partnership which enhances community well being by assessing , planning , promoting , implementing and evaluating programs to improve the health status of the citizens of Johnston County ” The Diabetes Subcommittee of the “ Living Well Partnership ” developed a plan to address diabetes prevention and self management In the area of prevention it is important that our citizens understand a clear definition of diabetes and the cause A portable banner display will be developed and purchased for exhibition throughout the county Banner display locations will include health and human service agencies , local businesses , government agencies and medical facilities Fifty banner locations will be identified and expanded to local community events , ie town festivals , church and civic conferences and other public events The Diabetes self - management program will be titled “ Diabetics Taking Control ” The target audience will be Diabetics and their family members A collaborative partnership has been established between Cooperative Extension and the Health Department to offer a four part educational series The educational series will focus on the physiology of diabetes to prevent related complication ; the usage of insulin and oral medication ; diabetic nutrition , cooking and the benefits of exercise The classes are an hour and a half in length and will be offered in April , July , September and November with a 1000 fee The partnership will provide a 37Page1free glucometer to those who need one , free refreshments and door prizes Scholarships will be acquired through private and public donations to participants with no health care insurance Class enrollment will accommodate 25 to 30 participants In order to evaluate the effectiveness of the program , participants will record their BMI , blood pressure and blood sugars An information pretest and post test will be given on diabetes The location sites for the classes include Cooperative Extension , Health Department , the community college , faith organizations and other public facilities We also plan to help participants determine if they are eligible for any state for federally supported medical benefits We will implement train the trainer programs to continue the good work and disseminate media materials The Adult and Childhood Obesity Subcommittee will implement “ The Families Eating Smart and Moving More ” program in one African - American church and one Latino church Four programs will be offered at each church - one program per quarter January , April , July and October and each program will consist of four two - hour evening sessions The goal is to have 20 families participate at the African - American church and 20 families at the Latino church during each program This program is designed to continue for three years Marketing and advertisement will be disseminated to recruit community members to the selected churches Plans for a mobile playground or “ PlayMobile ” are underway and will be implemented in 2007 The “ PlayMobile ” is a traveling playground of sorts that will be featured at health fairs and local events through out the county The Smoking Cessation Subcommittee is currently surveying restaurants in Johnston County to assess the climate in regards to smoke - free and or healthy menu policies In spring 2006 , the Smoking Cessation Subcommittee played an integral part in a significant smoking policy change within the Johnston County School System E Adult Morbidity Behavioral Risk Factors The North Carolina State Center for Health Statistics polled 300 to 400 residents by phone randomly in Johnston County concerning the following health risk factor and these were the results ? 177 stated they were in poor health ? 188 had no current health insurance ? 233 had no personal doctor ? 118 could not see a doctor due to cost ? 650 were not getting recommended physical activity ? 284 reported having High Blood Pressure 38Page2? 228 not taking medications regularly ? 348 reported being diagnosed for High Blood Cholesterol ? 61 diagnosed with Asthma ? 256 diagnosed with arthritis ? 21 of Johnstonians smoke ? 248 live in a household where smoking is allowed ? 262 are disabled ? 87 diabetes prevalence ? 414 never had blood sugar tested for diabetes ? 29 of men never tested for specific prostate antigen ? 206 provided care in past month to family friend with long term illness ? 518 provided care to a person with Alzheimer or similar condition ? 905 did not recognize all heart attack symptoms ? 852 did not recognize all stroke symptoms F Communicable Diseases – Morbidity 1 Tuberculosis In 2005 , the state of North Carolina had 15 counties with greater than 4 cases of tuberculosis There were a total of 6 counties with 4 cases , one of which was Johnston County In 2006 , Johnston County experienced the lowest case rate of 26 per population In past years , Johnston County averaged 83 cases of TB per year In North Carolina , there were 329 cases of TB identified to be pulmonary North Carolina ranks th 25 in overall US case rates for tuberculosis The county and the state during 2001 – 2004 noted a rise in drug resistant TB The cases of drug resistant tuberculosis were lowered from 29 cases in 2004 to 17 cases in 2005 The other types of TB include bone , genito - urinary , pleural , miliary , meningeal , peritoneal , and lymphatic and multiple causes constitute 348 TB is a bacterium that places people at high risk ; in correctional facilities with a rate of 147 per 100,000 in year 2005 There was a 50 increase in long term care facilities from 2004 – 2005 In addition there is high mortality rate with co - morbidity of HIV and TB infection based on total TB cases , 103 of individuals are HIV - infected 39Page3Cases of Tuberculosis in Johnston County Reported TB Cases Cases of Tuberculosis in Johnston County Total TB White White Minority Minority Total Total Cases Male Female White Male Female Minority 2005 4 1 0 1 3 0 3 2004 8 3 0 3 2 3 5 2003 7 0 0 0 3 4 7 TB Cases By Age 2005 Age Group Male Female Totals 25 - 44 2 0 2 45 - 64 2 0 2 gt; 65 0 0 0 Totals 4 40Page42004 Age Group Male Female Totals lt; 24 0 0 0 25 - 44 0 3 3 45 - 64 4 0 4 gt; 65 1 0 1 8 Totals 2003 Age Group Male Female Totals 20 Month old 0 1 1 22 Year old 0 1 1 25 - 44 1 1 2 45 - 64 1 1 2 gt; 65 0 1 1 7 Totals Note Minority Americans accounted for 75 of the fatalities due to TB 2 Sexually Transmitted Diseases The cumulative HIV AIDS cases as of 2005 totaled 243 cases A quarterly report for January thru September 2006 revealed 22 cases of HIV Disease and th 18 diagnosed AIDS Cases Currently , Johnston County ranks 35 out of 100 st counties in total number of AIDS cases , a decrease compared to 31 in 2004 In Johnston County the number of Syphilis , Gonorrhea and Chlamydia cases was as shown in the following table 41Page5Gonorrhea Syphilis Chlamydia HIV AIDS Year 2005 68 3 135 15 9 2004 93 4 165 7 4 2003 158 4 169 24 20 3 Salmonella , Shigellosis , Viral Meningitis , Hepatitis and Campylobacter The following is Epidemiological data Cases 2005 2004 2003 2002 2001 2000 Campylobacter 6 5 4 9 8 4 E Coli 5HTOX 7 2 Hemophilus Inf 1 0 0 0 0 0 Hep A 0 8 0 3 3 6 Hep B 3 0 1 7 9 6 Hep B Carrier 5 9 4 6 8 6 Hep C 0 0 0 2 1 1 Lyme Disease 2 0 1 4 4 1 Pneum 0 1 0 0 1 0 Meningitis Rocky Mount 36 23 17 10 5 3 Spotted Fever Salmonella 22 24 21 24 13 10 Shigellosis 5 1 2 4 0 3 Strep A 4 6 0 1 0 0 Vancomycin Resistant 0 11 8 16 12 13 Enteroccus Whooping Cough 3 1 6 0 0 1 G Epidemiology The emergence of periodic outbreaks of E Coli , Hepatitis , Whooping Cough , Meningitis and other diseases created a detailed infrastructure in the Health 42Page6Department to address these problems In addition the risk of Pandemic and Avian Flu due to their global nature is identified to be a significant threat to Public Health Johnston County has created a Public Health Preparedness Plan and teams to implement crisis management Epidemiology is the scientific study of factors affecting the heath and illness of individuals and populations , and serves as the foundation for interventions made in the interest of public health and preventive medicine It is considered a cornerstone methodology of public health research , and is highly regarded in evidence - base medicine for identifying risk factors for disease and determining optimal treatment approaches to clinical practice The acting epidemiologist works on issues ranging from the practical , such as outbreak investigation , environmental exposure , and health promotion , to the theoretical , including the development of statistical , mathematical , philosophical and biological theory To this end , epidemiologist employ a range of study designs from the observational to experimental , with the purpose of revealing unbiased relationships between exposures such as nutrition , biological agents , stress , or chemicals to outcomes such as disease , wellness and health indicators Epidemiologic studies are generally categorized as descriptive , analytic aiming to examine associations , commonly hypothesized causal relationships , and experimental a term often equated with clinical or community trials of treatments and other interventions Epidemiologists work in a variety of settings Some epidemiologists work „ in the field ? , that is , in the community , commonly in a public health service These individuals are often at the forefront of investigating and combating disease outbreaks The term „ epidemiologic triangle ? is used to describe the intersection of Host , Agent and Environment in analyzing an outbreak Epidemiology Response Team The Johnston County Health Department has a deployable EPI - Response Team on call 24 7 The team members consist of the health director , communicable disease nurses , environmental health specialists , health educators and administrative support Other health care professionals within the Health Department act as an additional pool of resource personnel , including the preparedness coordinators and registered dieticians Also , outside county agencies , such as animal control , law enforcement and emergency services serve as additional resources for the EPI - Response Team The team responds to public health disease outbreaks by investigating and putting interventions into place in an effort to quell or stop the spread of disease For example , the EPI - Response team will respond to a suspected E Coli or Legionella outbreak The Johnston County EPI - Response team recently acquired geographic information system software and handheld global positioning systems devices for field and disease investigation 43Page7Johnston County Public Health Preparedness The first steps toward establishing a state office specifically designed to address biological attacks began in November 2001 when more than 3 million from the state ? s “ Rainy Day Fund ” was made available to public health officials In addition to Bioterrorism Preparedness , the Division of Public Health was tasked with revitalizing the department ? s disease prevention and detection infrastructure At this time , the North Carolina State Office of Public Health Preparedness and Response PHP & R was created To make efficient and effective use of the funds , the PHP & R office created seven Public Health Regional Surveillance Teams PHRSTs to provide support to local health agencies serving all 100 counties The host counties for these regional offices are Buncombe , Mecklenburg , Guilford , Durham , Cumberland , Pitt and New Hanover Johnston County Public Health Preparedness is supported by Public Health Regional Surveillance Team Three This elite team of specialists consists of a Physician Epidemiologist , an Industrial Hygiene Consultant , Pharm D and an Administrative Specialist The Team Three region includes Bladen , Cumberland , Harnett , Hoke , Johnston , Lee , Moore , Richmond , Robeson , Sampson , Scotland and Wayne counties The regional surveillance team is on call 24 7 to aid Region Three in the event of an actual or suspected biological , chemical or radiological emergency The team also holds regional monthly preparedness coordinator meetings , aids in county training , training exercise design and leadership , holds informative seminars and is nationally deployable for rapid needs assessment in the wake of hurricane activity In order to uniformly spread preparedness planning , training and exercises throughout the state , the Office of Public Health Preparedness and Response created a Preparedness Coordinator Position within each county The Preparedness Coordinator is responsible for planning and preparing for an actual or suspected event At this time , Pandemic Influenza Planning is at the forefront of Johnston County preparedness activities Several government agencies , civic organizations , private businesses and community members are involved in this complex planning H Dental Health Dental disease is the most prevalent disease in the nation According to School level oral health status data 2005 - 2006 , the State average for children in kindergarten with untreated tooth decay was 21 compared to Johnston County ? s 17 44Page8Oral cancer accounts for 2 of all malignant tumors More than 250 North Carolinians die each year as a result of oral cancer The County is served by 43 general dentists , which is a ratio of one dentist to 3,811 people and one public health hygienist However there has been a slight increase in low income children receiving dental care In 2005 , only five dentists accepted Medicaid ; currently , 10 local general dentists bill Medicaid An additional dental care benefit for children 0 to 3 years of age with Medicaid is the application of Dental Varnishing In 2002 , a total of 170 Medicaid clients children received dental varnishing at the Johnston County Health Department Two local pediatricians , Dr Bliss and Dr Carpenter , estimated 50 clients received dental varnish The national average is one dentist for 2,100 people One - Third of the nation ? s population is under - insured for dental care Hopefully with increasing education , improved economic conditions and insurance programs , more people will seek care If more people in Johnston County would seek regular care , the shortage of dentist would be more evident Results of NC Oral Health Survey of school children 2003 – 2004 states two - thirds of 7,500 parents of students identified the importance of oral health with primary teeth as a low priority A major dental health concern for county residents is untreated tooth decay in primary teeth of children ages 0 to 5 years Dental care for fixed income senior citizens is an increasing problem I Nutrition WIC Nutrition and or dietary interventions are an integral part of the prevention and treatment program design to reduce deaths from heart disease , cancer , cerebral - vascular disease , diabetes and numerous other chronic diseases Overall , the major adult nutritional health problems relate to poor dietary habits resulting initially in obesity problems In addition , anemia among adults continues to be a health concern The WIC Program services are limited to pregnant , postpartum , and nursing women and to children up to five years of age A participants household income must be below the 185 of the Office of Management and Budget Poverty Guidelines The participant must be medically certified to be a nutritional risk , for example , they must show evidence of abnormal weight gain during pregnancy ; growth problems such as stunting , underweight or obesity ; iron - deficiency anemia ; or inadequate dietary pattern WIC is a preventive program , providing supplemental foods , nutrition education and improved access to health care in order to reduce and prevent the incidence of nutrition - related health problems in pregnancy , infancy and early childhood The 2006 WIC caseload was 3,127 Health surveillance data from the Health Departments WIC program during the 2004 fiscal year revealed the following significant public health problems ? 178 of the women had a history of substance abuse , including 45Page9cigarette usage ? 506 of the women had a BMI 26 or greater ? 98 of the infants were low birth weight rd ? 135 of the infants were premature , in 3 trimester and 456 post - partum ? 293 of the children were anemic ? 27 of prenatal received no prenatal care ? 88 of WIC participants are 15 – 17 years of age ? 389 had breastfed in the past ? Significant Ethnic groups receiving WIC – 2,782 clients 448 Caucasian , 244 African American and 295 Hispanic J Environmental Health The Environmental Health Division has enforcement responsibility for a variety of County , Local and State Programs The environmental division employs16 people including support staff In Johnston County there are several significant environmental health issues affecting the County Major issues include 1 Subdivisions and mobile home parks are rapidly increasing which place a tremendous threat on the quality of ground water and the high amount of waste water being disposed of in concentrated areas , including pesticide petroleum products and inorganic chemicals and nitrates Note A significant percentage of Johnston County residents still obtain water from a private well source Johnston County is only one of about 35 counties that enforce local well rules These rules required sampling before the well is placed in use The Environmental Health Division samples wells for a variety of contaminants 2 Enforcement of standards for lead abatement to day care facilities , migrant housing , regulations governing food , lodging and institutional standards , public swimming pools , tattoo parlors , special food events Ham and Yam , Mule Days , etc have placed significant burdens on resources 3 Johnston County is typically one of the leading counties in the state with the amount of onsite waste water permits and inspections 4 The Environmental Health Division is responsible for enforcing a portion of the Johnston County Minimum Housing Code as it pertains to maintaining certain standards for rental properties to help promote safe and healthy places to live 5 Emerging public health and environmental issues in the areas of West Nile Virus , In - Door Air Quality molds and mildews Out Door Air Quality for Carbon Monoxide from Automobiles and Neuse River Basin regulations will place additional responsibilities on the Environmental Division The Environmental Health Division has regulatory responsibility in the decontamination of methamphetamine labs 46PagePage pageNumber50Summary of Statistical Data The consensus among Johnston County residents is to seek health care only if you need it ; therefore , prevention is not their first priority Also , there are an estimated 1,573 persons per primary care physician plus extender in contrast to 749 people per physician for the State of North Carolina ; the ratio for physician extenders , nurses and hospital beds is equally high The lack of medical care providers , along with poverty , educational handicaps and transportation difficulties for anyone living outside the towns increases the health problems Poverty , more than any one socio - economic factor accounts for poor health status and a high incidence of chronic health problems Johnston County is one of the fastest growing counties in the state Rapid growth has a tremendous impact on the infrastructure of the county Farmland is a major asset in the county However , today it is competing with residential housing An increase in family housing affects roadways , water and sewer , utilities , environmental pollutants , schools , etc According to data from “ Demographics Now ” a web - based site ; from 1990 to 2000 the percent change of growth in the county was 50 The growth rate from 2005 until 2010 is expected to be 156 The most notable population data is the increase in the Hispanic population In 2005 , 284 of births in the county were to women of Hispanic descent The actual number is difficult to quantify due to reporting mechanisms A higher rate of death and disease exists for county adults 45 years and older See leading causes of deaths for adults According to the estimates based on the 2000 race sex adjusted death rates , the following populations were at risk ? White males - heart disease , CVA and respiratory illness ; ? White females - heart disease , CVA and cancer ; ? Non - white males - heart disease , CVA and diabetes ; ? Non - white females - heart disease and CVA Also , unintentional injuries , suicide and homicide rates were higher than the State for all age , sex , and race groups Significant sentinel events for Adult Health included three deaths of cervical cancer , two unspecified genital cancer deaths and three cases of primary liver cancer less than 45 years of age 47PagePage pageNumber51Based on the Behavioral Risk Factor Data for 2005 , 188 percent of the adults surveyed had no health insurance In an effort to provide comprehensive medical care to adults , a Primary Care Clinic at the Health Department opened in 1998 The clinic averages a caseload of 1500 with 60 uninsured clients and 40 Medicaid or Medicare The clinic relies heavily on the indigent medicine program to provide treatment The major medical conditions diagnosed and treated in the primary care clinic coincide with the chronic conditions that are a major cause of death - - heart disease , hypertension , diabetes , respiratory illnesses , asthma and COPD Several clients are affected by mental illness Johnston County continues to have some significant problems as it relates to th child and maternal health The County is 19 in the state for inadequate prenatal care to teens 15 - 19 years Also , the number of births to teens 18 years or less has remained relatively high at 184 The infant death rate has declined although low birth weight babies are a concern Tuberculosis cases were reduced However , the rates of HIV AIDS and Chlamydia have increased The case rates for Campylobacter , Shigellosis , Strep A and Whooping Cough Pertussis increased Rocky Mountain Spotted fever cases increased from 23 cases in 2004 to 36 cases in 2005 Salmonella cases continue to be a concern as well as Hepatitis B carriers Overall , the health status of Johnstonians needs to be improved greatly Behavior risk factors such as smoking , 14,746 individuals ; sedentary lifestyles 34,169 along with chronic and communicable diseases add to poor health 48Page