Johnston County Community Health Needs Assessment 2014

10 1PageTable of Contents Acknowledgements 3 Executive Summary 5 Background and Introduction 7 Johnston County A Brief Description 8 Geography 8 History 8 Demographics 9 Data Collection 11 Community Health Status 13 Mortality 14 Morbidity 15 Diseases 15 Health Care 18 Mental Health 19 Maternal and Child Health 20 Determinants of Health 24 Prevention and Health Promotion 30 Summary and Next Steps 32 References 33 Appendices , Itemized Listing 35 Appendix A - NNN Data Tables 38 Appendix OOO Community Resources 105 Appendix RRRR 2014 Community Health Assessment Survey 204 Appendix SSSS 2014 Community Health Assessment Survey Results 225 2PageAcknowledgements 2014 Community Health Assessment Committee Name Organization Role Abel Aguilar Vision of the Lamb Provided Latino faith community Ministries prospective , conducted a focus group and offered input Christine Allen Mt Zion Church of Provided faith community Deliverance opinions and input Christy Barfield Johnston County Health Lead Agency for the Community Department Health Assessment Connie Barnes Board of Health , Serving as a liaison between Campbell University public health and Campbell University Elaine Marshall Health Professional , Member of Community Health Smithfield Rotary Club Assessment Team , provided input Eugene Maynard Board of Health , Benson Provided data and input , Local Area Medical Medical Provider Kimetha Fulwood Johnston County Public Lead Agency for the Community Health Department Health Assessment Kyle McDermott Johnston UNC Health Provided data for Health Care Assessment and insight for the health assessment Lloyd Barnes Serve the Need in JC , Member of Community Health Wilson Mills Town Assessment Team Council Lori Anderson Board of Health , Johnston Member of Community Health Community College Assessment Team , provided input 3PageMaria Aguilar Vision of the Lamb Provided Latino faith community Ministries prospective , conducted a focus group and offered input Marilyn Pearson Johnston County Health Lead Agency for the Community Department Health Assessment Oliver Johnson Board of Health , Johnston Provided Johnston County Public County Schools School data sets , participated in the Community Health Assessment Survey Sterling Freeman First Missionary Baptist Provided faith community Church , Smithfield suggestions , distributed Community Health Assessment Surveys and input Steve Strickland Johnston County Health Lead Agency for the Community Department , Behavioral Health Assessment Health Division Tierra Taylor Johnston County Public Lead Agency for the Community Health Department Health Assessment Special thanks to the residents of Johnston County and all of those in the community and on the Community Health Assessment Committee who helped to make this process a success Everyone listed above had very specific but important responsibilities This process was made possible thanks to your survey distribution , community input , focus groups and data collection methods 4PagePage pageNumber5Executive Summary The Community Health Assessment CHA is based on primary and secondary statistics and involves collecting data from our community To make this an inclusive document , many of our partners and residents provided input As we worked to develop new priorities , we reviewed the areas of concern from our 2010 CHA and the progress made through action plans Those areas were obesity , diabetes , access to healthcare , cancer , and injury prevention with a focus on teen motor vehicle deaths Our partners worked together to develop programs and policies to target these areas of concern and had many successes For example , a Teen Driving Committee was formed that provided peer counselors and programs in our high schools leading to a significant decline in the teen motor vehicle death rate Based on the current data review , our CHA Committee , consisting of representatives from the Board of Health and 12 partner agencies , chose 3 top priority areas • access to health care — physical and behavioral health ; • obesity and overweight ; • nutrition and physical activity The other main areas of concern were access to • mental health , particularly substance abuse services ; • dental care Johnston County is a largely rural county Access to health care , which impacts quality of life , is affected by transportation as well as affordability Of 336 survey participants , 35 felt that low income , unemployment , and poverty were the main issue affecting quality of life in Johnston County The poverty rate in 2013 for Johnston County was 168 and almost 1 in 5 residents under 65 were uninsured So , although access to care was a priority area in 2010 , it continues to be an area of concern for our community Obesity , overweight and physical inactivity levels all contribute to the chronic disease rates In Johnston County in 2013 , heart disease was the leading cause of death with cancer being number two With a focus on risky health behaviors , the 28 of adults reporting physical inactivity and 33 obesity rate 2010 can be modified Many of our residents are concerned about the health of our children Thirty - five percent of adults participating in our survey acknowledged the need for education and programs focusing on obesity , exercise , and nutrition for their children By focusing on these two areas related to behavior and lifestyle changes , the risk for chronic disease can be decreased Limited mental health and dental providers contributes to residents reporting overall poor health The mental health provider ratio for Johnston County is 1,942 1 as compared to 715 1 for North 5PagePage pageNumber6Carolina 2010 and the dental provider ratio is 5,049 1 NC is 2,075 1 These provider shortages , residents reporting 42 poor mental health days over the past 30 days , and the expressed need for access to dental care shows the essential need to find ways to integrate all aspects of care Although it is difficult to make year to year comparisons with the county health rankings due to changes and data sources , Johnston County has improved from 2010 to 2014 Out of 100 counties , Johnston County is number 28 in health outcomes and has moved from number 50 in health factors to number 39 Although we achieved many positive outcomes , we continue to pursue avenues that will promote a healthier and safer environment for our community This Community Health Assessment will provide background information on our county , a data summary , and an overview of the health status of our community The report will be utilized for strategic health planning in and by our community In the future , the Johnston County Health Department and its partners will work to mobilize the community to develop Community Action Plans for the priority areas that will provide creative solutions and the opportunity for collaboration This document and action plans will be widely disseminated to the community 6PagePage pageNumber7Background and Introduction Every four years , the Johnston County Health Department and our partners are tasked with assessing the state of the health of our community through a Community Health Assessment CHA process The 2014 CHA utilized data provided from many data sources and the community and seeks to provide that information in a format that makes it useful for targeted community planning efforts The CHA process is a continual work in progress and we started collecting data in 2011 after the previous CHA was completed The primary data has been gathered over the past 4 years through community surveys , open forums , community festivals , listening sessions , and comments from our website The secondary data sources are listed at the end of the document To focus on health disparities , multiple outreach activities were conducted to gather information from traditionally hard to reach populations The process revealed differences in health status based on age , race and ethnicity , economic status , gender and income Throughout the document , a focus on these disparate groups is emphasized through the differences in morbidity and mortality rates The CHA is arranged by chapters and will provide an overview of Johnston County data in relation to Healthy North Carolina 2020 The CHA requires new ideas and input from the community in order to achieve the ultimate goal Healthy Johnstonians in All Communities If you would like to be involved in this process and contribute to the work groups developing action plans for our priority health concerns , please contact Kimetha Fulwood , Health Educator at 919 - 989 - 5200 7PagePage pageNumber8Johnston County A Brief Description Geography Considered the midpoint between New York and Florida on highway 95 , Johnston County is only a 2 hour drive from the splashing waves of the Atlantic coast and 4 short hours from the beautiful rolling mountains of the Blue Ridge Parkway 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 79185 square miles of land area in the Countys 506,377 acres Johnston County is known for barbecue and our many local seasonal festivals Interstates I - 40 and I - 95 and highways 70 , 301,701 run through the county Carolina Premium Outlets , located on the I - 95 corridor , provides shopping and eateries to travelers and a boost to our local economy nd Johnston County is ranked 2 in the production of flu - cured tobacco for 2012 However , the number of farmers in the county is steadily declining from 1,700 in 2000 to 1,245 in 2007 and 1175 in 2012 The average age of a Johnston County farmer was 576 years Farms operated by full time farmers totaled 548 Of annual sales reported , 50 percent of farmers reported less and 10,000 and 20 percent reported greater than 100,000 Reporting over 265 million in sales , th Johnston County ranks 10 in the state for total agricultural products sold Farmland in the County is primarily devoted to crops The average annual climate is 603 degrees Fahrenheit and the average rainfall is 4552 inches Average snow is 334 inches and the County elevation is 155 feet The gentle , rolling hills and inclines compose the topography of Johnston County References 1 , 2 , 3 , 4 History Johnston County was originally inhabited by Tuscarora Indians , most of whom migrated to New York to join the Iroquois , to whom they were related when their efforts to resist European settlement in the area ended with defeat in the Tuscarora War 1711 - 13 The county of Johnston was created in 1746 from Craven County and named in honor of Gabriel Johnston , North Carolinas royal governor at the time Johnston County originally contained most of what is now Wake , Wayne , Greene , Lenoir counties and part of Wilson County The countys first town , Smithfield , was established as an early trading post along the banks of the Neuse River at Smiths Ferry The courthouse was moved there in 1771 , and the town was incorporated in 1777 In 1770 the colonial assembly had attempted to boost North Carolinas tobacco trade by 8PagePage pageNumber9erecting a warehouse near Smiths Ferry for receiving and storing tobacco to be shipped down the Neuse River to the sea Nonetheless , it would be another century and a quarter before this product would gain the attention of Johnstons commercial farmers Later during the nineteenth century , cotton emerged as Johnston Countys chief product during the extension of the railroad This event facilitated the shipment of cotton for commercial purposes Located at the junction of the North Carolina and Atlantic Coast Line railroads , Selma became the countys second commercial center During the late nineteenth century , Fluctuating cotton prices paved the way for a rise in tobacco production , bringing the county a new prosperity Today , Johnston County continues to be a state leader in the production of flue - cured tobacco Various historical events bring travels to our state Most notably the Johnston Countys Bentonville Battleground State Historic Site , which commemorates the last major battle of the Civil War and celebrates its 150 year anniversary in 2015 This battle is remembered as the largest military engagement in North Carolinas history The county is also home to the Ava Gardner Museum in Smithfield , a tribute to the Johnston County native and screen legend The county is known for its many local festivals Annually , the town of Benson hosts one of the state’s largest festivals , Mule Days , which draws 40,000 - 50,000 attendees Additionally , exhibits on the history of tobacco farming in the state can be found at The Tobacco Farm Life Museum in Kenly References 5 , 6 , 7 , 8 , 9 , 10 Population Demographics The projected population for Johnston County in 2013 was 177,967 US Census Bureau Based on demographic profiles from 2010 - 2013 , there was a 54 9,089 increase in the th County’s population During 2013 , Johnston County was the 12 fastest growing county in the state The projected population for 2014 is 179,822 A 159 change of growth is expected from 2010 to 2020 References 11 , 12 Please refer to Appendix A 2013 Population Estimates by Race Ethnicity Population change is impacted by several components which include natural increase , vital events such as births and deaths and net migration The Countys population for 2013 is estimated at 805 White , 159 African - American , 09 American Indian or Alaska Native , 07 Asian , 18 two or more races Those of Hispanic or Latino Origin make up 132 of the th th total population Johnston County is ranked 13 in the state in total population size and 13 in 9Page0the state for total growth The Hispanic or Latino population has increased from 117 in 2009 to 132 estimated in 2013 Of the 132 total Hispanic population , the Mexican population represents the greatest percent at 87 15,501 individuals There are 5,008 individuals who identify with Hispanic or Latino but not Mexican , Puerto Rican or Cuban Reference 13 Please refer to Appendix A - C 2013 Population Estimates by Age and Gender In 2013 Johnston County population estimate for children between the ages 0 – 19 reflects an estimated 294 of the total population The population of children between the ages of 10 - 14 years old represents the majority of the child population with a total of 14,147 children The 35 - 44 year old age group represents the highest percentage of the population at 162 The two smallest age groups represented in Johnston County are the 75 - 84 year olds 34 and 85 and older age group at 10 The median age in Johnston County is 375 which is based on projected population data In Johnston County , 51 of the population is female while the males represent 49 The data correlates to health risk conditions for that age group For example , a high young adult population is at risk for injury while 234 of the population is over 55 and at risk for heart disease , cancer , disability , etc Please refer to Appendix D - F 10Page1Data Collection The Johnston County Public Health Department is the lead agency in the Community Health Assessment process Throughout the year of 2014 , the team took steps to collect a range of statistics which will be used as both primary and secondary data Johnston County Health Department and partners also joined community groups , working groups , and served on an assortment of boards and coalitions where statistical information and community input is shared The team also enlisted the help of community partners , non - profits and other state agencies in order to collect the most up to date and accurate information During a collaborative effort between Campbell University’s Masters level public health students and Johnston County Public Health , key informant interviews , focus groups and a community health forum were conducted in order to gather primary input from diverse groups of community members The summary of the key informant interviews included some discussion regarding key health concerns which included access to care , obesity , diabetes and cardiovascular disease There was praise of successful health programs such as human service agencies collaboration efforts , School Health Advisory Council , Childhood Immunization Program and prenatal program The programs that needed some improvement were collaborative efforts between programs with the same focus , programs to assist those in poverty , improving access to care with reduced unemployment and uninsured and county wide transportation The health priorities mentioned included focusing on prevention , reducing obesity and educating about healthy eating and exercise , admission to affordable health care , improving health outcomes related to cardiovascular disease and heart failure and education about nutrition and exercise to prevent diabetes and obesity The suggestions from the forum attendees focused on providing information to residents These included distribution of information by placing resource information at local medical provider offices and utilizing high traffic areas to provide information to residents such as town halls and utility offices The idea of attaching important information on to residents ’ electric or utility bills to disseminate information was brought up as well Our county also held a Latino Churches Community Forum During the forum the major health concerns discussed included the cost of health insurance , cost of health care for the uninsured , increasing fees for health services , options for undocumented adults for health insurance , assistance with hospital bills , Medicaid coverage for children , long wait times medical and transportation , low paying jobs and affordability of insurance There was also mention of services that needed to be offered in the county such as nutrition counseling and dental health services At a Johnston County Citizens Association Listening Session , some of the concerns and suggestions were increasing the number of medical providers , access to mental health services , 11Page2substance abuse treatment , prescription drug misuse and overdose , programs for the youth in the community , options for dental care for the uninsured and county transportation options An additional listening session held at a local African American church , the State of Our Children Conversation , included ideas for community focus areas The focus areas included partnering with families and children , venues for nurturing relationships between schools and families and workshops for skill building and adopt - a - family programs The conversation also included suggestions for improving the health of children and families The given suggestions were community development programs , parental development workshops , youth student development workshops and equity training for the community , schools and law enforcement At the Faith Food Pantry and Johnston County Industries listening sessions , concerns mentioned included difficulty paying the co - pay for health care , not enough jobs , hard for families to eat healthy due to cost of healthy foods , not enough food banks , the need for a central clearing house for all health information and equal treatment of all patients Their suggestions for improvement consisted of more jobs , Medicaid and Health Choice for young adults , affordable health insurance , equal access to health care for all with assistance if needed ex Deaf or hard of hearing , health care of low income people and access to programs for low income youth Lastly , the Johnston Health 2013 Community Health Needs Assessment meeting identified significant health needs that should be addressed These included affordability and accessibility to health care , coronary heart disease , diabetes , cancer , physician shortage , mental health suicide , obesity overweight and maternal and infant measures As mentioned earlier , the team also used a variety of sources to gather secondary data Sources will be referenced throughout and a list of resources will be given at the end of the assessment document For the purpose of this assessment , the following counties have been identified as Johnston County’s peer counties Craven , Davidson , Harnett , Randolph , Union , Wayne , and Wilson Please refer to Appendix SSSS - WWWW 12Page3Community Health Status Mortality The overall mortality rate for all causes in Johnston County has declined throughout the years However , Johnston County has had a higher mortality rate than North Carolina The mortality rate in Johnston County was 8361 compared to the North Carolina 7909 in the five year period of 2009 - 2013 The 2010 Community Health Assessment reports the morality rate was 8883 for the 2005 - 2009 period One rationale for such a decrease in the overall mortality rate may be the number of births or younger individuals migrating to Johnston County The top five leading causes of death in Johnston County are the following Heart disease , cancer , cerebrovascular disease , chronic lower respiratory and other unintentional injuries Currently , heart disease is the leading cause of death in Johnston County followed by cancer 246 Of the five leading causes of death , 258 of Johnston County residents died from heart disease in 2013 Johnston County had a slightly higher percent of deaths from heart disease than the state by 44 The leading causes of death include the following variables age between 0 - 99 years , all races , and both genders Johnston County had heart disease rate of 1854 per 100,000 population was slightly higher than the State in 2013 However , the respiratory 1764 and cancer rate 371 was lower than the state Please refer to Appendix G - K Reference 15 Age Specific Death Rate The leading causes of death is categorized by age groups based on a five year period from 2009 - 2013 The top five leading causes of death for all ages are heart disease , cancer , cerebrovascular disease , chronic lower respiratory disease , and all other unintentional injuries However , Johnston County has a lower cancer rate 1675 than the state 1881 and a higher heart disease rate 1862 compared to North Carolina 1789 For the population age group 0 - 19 82 and 20 - 39 247 , motor vehicle injuries is the second leading cause of death in Johnston County For these particular age groups , there are usually more motor vehicle related injuries , possibly due to limited driving experience and rural road architecture In addition , for the 20 - 39 age group , substance use , in particular alcohol may be a contributing factor for motor vehicle injuries For the population over the age of 40 , the top causes of death are cancer or heart 13Page4disease Many factors likely contribute to this increase in chronic disease conditions and deaths , including unhealthy food choices , inactivity and underutilized access to preventive services Please refer to Appendix L Race Sex Specific Death Rate The leading causes of death are categorized by race and sex based on a five year period from 2009 - 2013 The top leading cause of death for White non - Hispanic males 2839 , white non - Hispanic females 1884 , and African American non - Hispanic females 1935 is heart disease The heart disease rate is also higher among African American females 1935 compared to white females 1884 However , the leading cause of death for African American non - Hispanic males is cancer 3101 African American non - Hispanic males has a higher cancer rate compared to white males 2421 According the Centers for Disease Control and Prevention , African American men are at a higher risk of getting prostate cancer Despite higher rates of screening for African American men in North Carolina , the rate of cancer and death are higher compared to white males Please refer to Appendix M Infant and Fetal Mortality The 2010 Community Health Assessment last reported the infant mortality rate at 66 in 2009 Since that time , the infant mortality rate has fluctuated to a low of 57 in 2011 to as high as 77 in 2012 In comparison , the infant mortality rate for North Carolina has been higher than Johnston County’s rate except for the year 2012 In 2013 , Johnston County had a total of 13 infant deaths with the majority among the white non - Hispanic population A number of those deaths were due to sudden infant death syndrome In recent years , awareness regarding sudden infant death syndrome has increased As a way to continue to promote back to sleep and other measures in preventing SIDS , safe sleep education is provided to maternity patients receiving services at Johnston County Public Health Department and other maternity and pediatric practices The fetal mortality rate for Johnston County was 37 in 2009 The highest fetal mortality rate was 97 in 2010 and the lowest was 31 in 2012 Johnston County fetal mortality rate was lower than the state for all years with the exception of 2010 Some of the contributing factors for high fetal deaths are lack of prenatal care , smoking , and alcohol consumption In recent years , there have been social media campaigns and a focus on encouraging folic acid supplements which has been shown to decrease certain birth defects As part of the care it provides for women , Johnston County Public Health Department provides multivitamins which contains the recommended amount of folic acid for women of childbearing age 14Page5Please refer to Appendix N - O Morbidity Communicable Diseases Gonorrhea is a sexually transmitted disease STD that can infect both men and women It is a common infection especially among young people ages 15 - 24 years During the years of 2006 - 2010 , there were 784 cases of gonorrhea in Johnston County The African American , non - Hispanic population represented the majority at 534 cases The White , non - Hispanic population accounted for 209 cases while there were 34 cases of gonorrhea in the Hispanic population th When compared to our peer counties Johnston county ranks 4 in NC resident gonorrhea cases per 100,000 Union , Wayne and Wilson counties all had more gonorrhea cases than Johnston county from 2006 - 2010 Randolph reported the smallest number of cases at 337 during that time Wilson County had the majority of the cases from 2006 - 2010 with 1,771 cases and the highest rate of 4391 which is higher than North Carolina’s rate of 1689 Primary syphilis and secondary syphilis cases in Johnston County from 2006 - 2010 totaled 18 Again , the African American non - Hispanic population had the majority of the cases with 11 , while White non - Hispanic population had 6 cases The Hispanic population accounted for only 1 case of syphilis Genital sores caused by syphilis make it easier to transmit and acquire Human Immunodeficiency Virus HIV infection sexually In Johnston County , from 2009 - 2013 , 66 new HIV cases and 55 new AIDS cases were reported Forty - three individuals in Johnston County had been diagnosed in 2008 with AIDS , the highest number diagnosed in one year Eighteen new cases of HIV were diagnosed in 2013 , which is the highest number of confirmed cases in one year from 2009 - 2013 As of 12 13 13 there are 312 people living with HIV or AIDS in Johnston county Although , there is no cure for HIV or AIDS , early diagnosis is important in order to prevent the spread of the virus In comparison to our peer counties , Randolph County has continued to have the lowest HIV cases from 2009 - 2013 There was an increase in cases for Union County from 2012 11 to 2013 22 Wilson county is the only county whose HIV cases have decreased from 2012 20 to 2013 9 while Randolph County remained the same from 2012 to 2013 Chlamydia is a common STD that is spread by having vaginal , anal or oral sex with someone who has Chlamydia Chlamydia can infect both men and women Chlamydia can be cured with treatment with prescription medication In 2013 , 550 individuals were diagnosed with Chlamydia infection The infection rates of Chlamydia in Johnston County continue to rise The number of individuals infected has dropped once during 2009 - 2013 The decrease in infection was from 2011 - 2012 In 2011 , there were 545 people diagnosed with Chlamydia and a slight decrease was noted in 2012 with 464 people diagnosed 15Page6In comparing Johnston County’s peer counties , Wayne County has had the highest number of Chlamydia reports from January to December from 2009 - 2013 with the exception of 2010 In 2010 , Wilson County had the most Chlamydia cases at 1,122 Annually , Johnston County has seen 400 - 550 reports of Chlamydia Randolph County has had the least number of reports consistently between 2009 - 2013 Please refer to Appendix P - S Reference 16 , 17 , 18 Tuberculosis TB Tuberculosis TB is caused by a bacterium that usually attacks the lungs The bacterium can attack any part of the body such as the kidney , spine and brain If TB is not treated appropriately it can be deadly TB is spread through the air from one person to another When a person who has the TB disease of the lungs or throat coughs , sneezes , speaks or sings it is possible for people who are near by to inhale these bacteria and become infected TB bacteria can live in your body without making you sick which is called latent TB infection In this case , and in most cases , people who breathe in TB bacteria become infected but their body is able to stop the bacteria from growing If your immune system is compromised and cannot prevent the TB bacteria from growing and the bacteria becomes active thus creating TB disease The TB symptoms includes a bad cough that last 3 weeks or longer , pain in the chest , coughing up blood or sputum , weakness or fatigue , weight loss , no appetite chills fever and sweating at night Two tests are available to detect TB bacteria in the body The TB skin test TST and TB blood tests can be given by a medical provider or local health department The TB disease is treatable by taking medications for 6 - 9 months as prescribed If the medication is not taken correctly it is possible for the bacteria to become resistant to the drug which creates TB that is harder and more expensive to treat In North Carolina from 2009 - 2013 the Black African American had the majority of the cases over the years In Johnston County from , 2010 - 2014 there have been a total of 19 confirmed cases of TB During 2013 and 2014 , Johnston County has seen higher numbers of TB when compared to earlier years Generally speaking , people who are at high risk for developing TB are those who have been recently infected with the TB bacteria and those with medical conditions that weaken the immune system Please refer to Appendix T - U Reference 19 , 20 16Page7Pertussis Whooping Cough Pertussis is a respiratory illness commonly known as whooping cough and is extremely contagious The bacteria attach to the cilia tiny , hair - like extensions that line part of the upper respiratory system Once the bacteria have attached to the cilia they begin to release toxins , which leads to damage to the cilia , subsequently causing inflammation swelling Infants , children and adults can all be impacted by pertussis Pertussis can be life threatening for infants Typically the symptoms start with cold - like symptoms and a mild cough or fever , then after 1 to 2 weeks , severe coughing can begin Pertussis can evolve into a series of coughing fits that persist for weeks There are several formulations of the vaccine available to prevent pertussis The vaccination of pregnant women and families with Tdap is especially important to help protect infants Pertussis is generally treated with antibiotics , which are used to control the symptoms and to prevent infected people from spreading the disease In Johnston County from 2010 - 2014 , there have been a total of 59 cases of pertussis Please refer to Appendix V Reference 21 Cancer In 2014 it is projected that in North Carolina there will be 57,298 new cases of lung bronchus , female breast , prostate and colon rectum cancers Of those new cases 922 are projected for Johnston County The majority of the cancer cases in 2014 will be attributed to female breast 160 , lung bronchus 135 and prostate 134 It is projected that of our peer counties , Union County will have the most female breast cancer new cases during 2014 at 185 Wilson County is projected to have the least amount of new cancer cases overall at 508 in 2014 From 2006 - 2010 the cancer incident rates per 100,000 population which are age adjusted reflect that the highest number of cases were female breast cancer 612 The lowest number of incident cases from 2006 - 2010 for Johnston County is colon rectum cancer 329 The 2006 - 2010 female breast cancer incident rate of 147 for Johnston County as compared to NC rate of 1559 is highest when compared to prostate , lung brochus and colon rectum The all cancer rate for 2006 - 2010 in Johnston County was 496 NC rate 4981 and in 2007 - 2011 it was 4997 NC rate 4967 indicating a slight increase for Johnston County Please refer to Appendix W - AA Reference 2 17Page8Health Care Inpatient Hospital Utilization Discharges , Admissions and Charges Rising health care costs make it important to understand the reasons that people seek emergency room care rather than less expensive outpatient or office based care Community Health Assessment Surveys of 2014 show that most often when adults are sick they go to a doctor’s office or Health Department The majority of survey respondents 28 had other private health insurance purchased from an employer or workplace while 17 of respondents had no health plan of any kind Of the 17 of respondents with no health plan of any kind , 87 were Spanish speaking Twenty - two percent of the survey respondent adults had problems getting the health care they needed for themselves personally or for a family member from any type of health care provider , dentist , pharmacy or other facility The majority of the respondents also identified dental care as the type of facility or provider that they or a family member had trouble getting healthcare from Uninsured adults are more likely than those with private health insurance or a public health plan to visit the emergency room Although many residents use the emergency room for care , Johnston County’s inpatient hospital utilization total cases have remained almost steady over the past 3 years The cardiovascular and circulatory disease total cases declined from 3,114 in 2010 to 2,902 In 2012 , other diagnoses including those related to mental health also declined from 1,495 in 2010 to 1,233 There has been a constant increase in the total cases of injuries and poisoning in Johnston County In 2010 , there were 1,284 total cases of injuries and poisoning ; the number increased in 2011 1,291 , and was slightly higher in 2012 at 1,356 Johnston Health , the local hospital system , released data that speaks to the patient characteristics of the short term acute discharges In every year from 2008 - 2012 , the group who utilized the hospital the most was the 18 - 44 age group In 2012 , the Caucasian race accounted for 697 of the population seen while African Americans represented 217 The Hispanic ethnicity represented 74 718 in 2012 , 75 757 in 2011 and 75 727 in 2010 The general hospital discharges in 2008 17,130 continued to decrease over the years to 16,396 in 2012 Excluding normal newborns , average patient charges in 2012 was 21,726 down from 22,361 in 2011 In comparison , the charges were 16,730 in 2008 The average length of stay excluding normal newborns in 2012 was 39 days down from 46 days in 2008 Please refer to Appendix BB , SSSS Health Care Facilities and Providers The number of health care facilities and providers directly impacts access to care The Affordable Care Act is one resource that Johnston County residents can use in order to acquire health insurance In Johnston County in 2014 , approximately 5,500 people enrolled in health 18Page9care coverage via Healthcaregov Having health insurance can reduce the number of patients that skip or delay their care because of gaps in health insurance In addition to having the access to facilities , the number of health professionals affects access to care The overall number of primary care physicians has decreased slightly from 2009 to 2012 The number of internal medicine physicians has decreased by almost 50 from 2009 22 to 2012 12 The number of physicians per 10,000 population on average has been 745 for four years Although , the number of primary care physicians per 10,000 has declined from 2009 to 2012 , the number of dental hygienist has increased by 30 - 31 from 75 to 98 The number of nursing facility beds has also increased from 550 in 2009 to 555 in 2012 Safety net providers in the community are committed to filling the gaps for those with limited or no insurance coverage Project Access of Johnston and Harnett Counties , Benson Area Medical Center , CommWell Health , Johnston County Health Department and Johnston Health collaborate with other community providers to provide services to this population As part of this commitment , Johnston County Health Department expanded its staffing in 2013 to include a Behavioral Health Division Please refer to Appendix CC Mental Health The number of Johnston County residents served by psychiatric hospitals was at its all - time high at 93 in 2010 From that time the number of residents served in psychiatric hospitals has decreased to its lowest at 62 For North Carolina the number of those served is drastically higher than Johnston County In contrast , the number of persons served in alcohol and drug abuse treatment centers in Johnston County has greatly increased In 2010 , there were 26 Johnston County residents served in treatment centers which increased to 61 in 2013 The data suggests there is a great need to address substance abuse in Johnston County One major concern is the increase in meth labs in Johnston County According to the 2013 Johnston County State of the County Health Report , there were 15 meth labs in 2012 and 22 in 2013 Please refer to Appendix DD - EE Reference 23 19Page0Maternal and Child Health Teen pregnancy and childbearing bring substantial social and economic cost through immediate and long - term impacts on teen parents and their children Pregnancy and births are significant contributors to high school drop out rates among girls It’s important to educate the teens about sexual issues , HIV and STDs and pregnancy to include methods of prevention In Johnston County youth access to evidence - based and evidence - informed program to prevent teen pregnancy are available By offering linkages to teen pregnancy prevention programs and educating stakeholders about strategies to reduce teen pregnancy an impact on teen pregnancy can be made In 2007 - 2011 the rate per 1,000 population for girls 15 - 17 , in African American non - Hispanics was 337 and the rate of the Hispanic pregnancies was 664 white non - Hispanic rate was 194 There was a decrease in 2008 - 2012 , as the rate of pregnancy per 1,000 population for girls 15 - 17 who were African American non - Hispanic was 326 and the rate of Hispanic pregnancies was 585 The white non - Hispanic rate was 180 In Johnston County , pregnancy rates per 1,000 population in females 15 - 19 has decreased from 2010 - 2012 In 2010 the rate was 499 , while in 2011 the rate was 492 and then decreased to 414 in 2012 In comparison , Union County has repeatedly had the lowest pregnancy rates per 1,000 population of females 15 - 19 during 2010 - 2012 The total pregnancies per 1,000 population in females 15 - 19 averaged 279 from 2010 - 2011 with a decrease in 2012 to 234 In Johnston County , the total abortions per 1,000 population decreased from 2010 - 2012 A short interval birth is the amount of time between pregnancies Women with short birth intervals are at nutritional risk and more likely to experience adverse birth outcomes These risk factors , teen pregnancy and short interval births , can be modified with family planning education By providing family planning education , the number of unplanned or unintended pregnancies can be reduced Family planning education can include information regarding abstinence , consequences of not being abstinent , birth control options , natural methods and ineffective methods Offering family planning allows families to attain their desired number of children , determine the spacing of pregnancies and promotes informed choices about sexual and reproductive health Other benefits of family planning include preventing pregnancy - related health risks in women , reducing infant mortality , helping to prevent HIV AIDS , reducing adolescent pregnancies , slowing population growth Cesarean section or c - section is the surgical procedure where a baby is delivered through a surgical incision in the mother’s abdomen and uterus C - sections can be planned or unplanned surgical procedures In North Carolina from 2008 - 2012 , there were 192 , 712 31 births by c - section In Johnston County from 2008 - 2012 , 3,741 32 of births were by cesarean section During 2009 - 2013 , in Johnston County 3,575 births were by cesarean section which reflects 315 State efforts have focused on reducing the C - section deliveries among low risk pregnancies The Perinatal Quality Collaborative of North Carolina PQCNC ’ s , Eliminating Elective Deliveries Under 39 Weeks Gestation initiative aims to decrease C - Sections between 36 — 38 weeks gestation that are not medically necessary among first time mothers 20Page1When compared to peer counties , Union and Johnston Counties had the highest number of births delivered by c - section Wilson and Wayne Counties had the lowest number of NC resident births delivered by c - section Davidson County , with 35 of births delivered by c - section , was the highest Wayne County with 323 had the second highest percent of births delivered by c - section Wilson County 269 and Craven County 295 had the lowest percent of births delivered by c - section Based on five year adjusted rates 2005 - 2009 , the County’s fetal death rate was 61 vs the State’s rate of 83 2006 - 2010 Community Health Assessment p 21 Please refer to Appendix FF - MM Reference 23 , 24 , 25 , 26 Prenatal Care Patterns include smoking behavior Information regarding smoking during pregnancy and after pregnancy was gathered from the North Carolina Pregnancy Risk Assessment Monitoring System Survey Results Those results are reported either by all of North Carolina or by regions For this set of data Johnston County is a part of Region Four Smoking during pregnancy is a high risk behavior Smoking can increase a woman’s risk for a miscarriage and cause complications with the placenta After pregnancy smoking can increase the risk for Sudden Infant Death Syndrome SIDS Approximately , 86 of women in Region Four reported smoking during the last 3 months of pregnancy from 2006 - 2008 The highest percent of smokers were black 145 Throughout 2006 - 2008 , 119 of women reported smoking after the pregnancy From 2006 - 2008 , in the last three months of their pregnancy , 19 of women smoked 20 or more cigarettes per day , 3 of women smoked 10 to 19 cigarettes , 67 smoked 1 to 9 cigarettes and 911 of women smoked no cigarettes There are many benefits to quitting smoking These include more oxygen delivered to the baby , and decreased risk of developing heart disease , stroke , lung cancer , chronic lung disease and other smoke related diseases For support in quitting , including free quit coaching , a free quit plan , free educational material and referrals to local resources please call 1 - 800 - QUIT - NOW 1 - 800 - 784 - 8669 ; TTY 1 - 800 - 332 - 8615 Reference 27 Low Birth Weight Low birth weight is less than or equal to 2500 grams 5 pounds , 8 ounces and very low birth weight is less than or equal to 1500 grams 3 pounds , 5 ounces per the State Center for Health 21Page2Statistics Some low birth weight babies are healthy , even though they are small But being low birth weight can cause serious health problems for some babies There are two causes that account for the majority of low birth weight babies The causes are premature birth or birth before 37 weeks and fetal growth restriction Fetal growth restriction means the baby doesn’t gain the needed weight before birth Both premature birth and fetal growth restriction can be caused by numerous other conditions Conditions such as birth defects , infections , preterm labor , chronic health conditions , problems with the placenta , not gaining enough weight during pregnancy and having a low birth baby in a previous pregnancy are risk factors for a low birth weight baby Other risk factors that could cause a low birth weight baby are smoking , drinking alcohol , using street drugs and abusing prescription drugs Biological factors that are risk factors for a low birth weight baby are being younger than 17 or older than 35 years old When a baby is born with low birth weight there are some medical conditions that can be more common The medical conditions could include respiratory distress syndrome , bleeding of the brain , patent ductus arteriosus , necrotizing enterocolitis and retinopathy of prematurity A low birth weight baby is at a higher risk to develop diabetes , heart disease , high blood pressure , metabolic syndrome or obesity later in life It is important for parents of low birth weight children to work closely with their medical teams to ensure that their child is as healthy as possible , including providing proper nutrition and physical activity in order to promote healthy growth In North Carolina there were a total of 56,086 low and very low birth weight births from 2008 - 2012 while in 2009 - 2013 there were 54,666 In Johnston County from 2008 - 2012 , 894 low birth weight babies were born and 178 very low birth weight babies were born In 2009 - 2013 , 861 low birth weight and 169 very low birth weight babies were born Of those births in 2008 - 2012 , 141 were non - Hispanic black and from 2009 - 2013 , 137 of the births were non - Hispanic black This group had the highest percentage for both time periods , indicating a disparity for non - Hispanic blacks Reference 28 , 29 Infant care practices including breastfeeding rates Breast milk is the only food that is perfect for babies Breastfeeding gives babies a wide range of nutrients , vitamins , antibodies , fat and protection that can only come from breast milk Breastfed babies have a lower risk of asthma or allergies Babies who are exclusively breastfed for the first 6 months , without any formula , have fewer ear infections , respiratory illnesses , and bouts of diarrhea Breastfeeding has been linked to higher IQ scores and babies are more likely to gain the right amount of weight Breastfeeding also benefits the mom’s health by burning extra calories which can help mothers lose pregnancy weight faster and it reduces bleeding by helping the uterus return to pre - pregnancy size From 2005 - 2009 , the percent of North Carolina women who breastfed for any length of time continued to increase , from 657 to 715 In 2010 , there was a small decrease in the percent of North Carolina women who breastfed for any length of time to 711 North Carolina mothers were asked did his her doctors or health providers give you any help or encouragement for breastfeeding According to the survey , at least 70 or higher confirmed they received help from 22Page3medical providers The highest percentage of help was given in 2010 , at 757 by medical providers or doctors Please refer to Appendix NN Reference 30 , 31 , 32 Child Health Johnston County’s 0 - 19 year olds estimated 2013 population is 294 or 52,347 children In 2010 and 2011 , 61 of Johnston County’s Medicaid - eligible children received dental services Here in North Carolina 57 of Medicaid eligible children received services in 2010 and 58 in 2011 Statistics from 2006 - 2010 regarding asthma hospital discharges for children ages 0 - 14 years old , illustrate 2009 with the highest number of discharges in Johnston County at 64 children The rate of discharges from 2006 to 2009 rose slightly , while dropping in 2010 to 56 Poverty affects children’s health not only when they are young , but also later in their lives Family income is a key determinate of healthy child development In 2012 , 11,771 children were living at or below the poverty level in Johnston County There has been an increase in the percent of children who are enrolled in Medicaid receiving preventive care in Johnston County In 2011 , 595 of children in enrolled received preventive care while in 2012 , 629 received at least one health check screening Children are tested for lead poisoning at age starting at age one The effects of lead poisoning include learning and behavior problems , brain damage , hair loss , anemia , seizures , coma and death Lead can be found in lead paint , typically found in homes built before 1978 In addition , plastic or vinyl mini - blinds , water , soil , toys or workplaces may have lead In 2009 , of the 3,125 children tested , there were 2 confirmed cases in Johnston County The number of children tested represents 194 of children under the age of six Please refer to Appendix OO Tobacco Exposure Over the years , the number of tobacco farmers has decreased along with the number of residents who smoke In 2010 only 197 of Johnston County residents reported being a current smoker Of those who reported being current smokers , 224 of them were white while the other population groups represented only 118 The 2010 current smokers who had high school education or less represented 257 while those with some college represented 114 In 2010 , 984 of Johnston County residents reported not currently using chewing tobacco , snuff or snus which is slightly higher than the 96 of total respondents from North Carolina During the year of 2010 , 155 of the Johnston County population reported smoking everyday and 42 reported smoking some days The majority of the population reported being former smoker at 23Page421 and never smoked 592 in 2010 Due to changes in the weighting methodology and other factors , results from 2013 are not comparable to 2010 and earlier years The Behavioral Risk Factor Surveillance System BRFSS is a random telephone survey developed by the Centers for Disease Control and Prevention CDC in collaboration with state health departments and is currently conducted in all 50 states , the District of Columbia and several United States territories The 2014 Community Health Assessment survey conducted by the Johnston County Public Health Department and partnering agencies showed 223 respondents were not current smokers and 26 respondents were currently smoking The trend is that the majority of the population is composed of non smokers in Johnston County , NC The majority of the 26 smokers were English speaking representing 73 During the assessment 50 of respondents had been exposed to secondhand smoke The majority of the secondhand smoke exposures took place in homes or at workplaces Of those 26 survey participants who were currently smoking 23 were familiar with the North Carolina Quitline and 17 would depend on a doctor as a resource for getting help if they wanted to quit smoking North Carolina’s Smoke - Free Restaurants and Bars Law was passed by the NC General Assembly and signed by the Governor in May , 2009 , and became effective January 2 , 2010 The law prohibits smoking in enclosed restaurants , bars and most lodging facilities except for some designated guest smoking rooms Smoking is also banned in enclosed areas of hotels , motels and inns , if food and drink are prepared there Please refer to Appendix RRRR - SSSS Reference 33 Determinants of Health Social environment Education According to the US Census Bureau educational attainment data from 2009 - 2013 , Johnston County had a slightly higher percentage of students graduating high school compared to the state by 28 The percent of adults receiving some college with no degree 221 is higher than those who have an associates 109 or bachelor’s degree 153 in Johnston County Several factors can contributed to a higher percent of adults not completing college such as finances , transportation , and child care Over the past five years the dropout rate for both Johnston County and the State has gradually decreased However , Johnston County rate for the 2012 - 2013 academic year was lower than the state In 2012 - 2013 the dropout rate was 195 for Johnston County which is a drastic decrease 24Page5from the 2008 - 2009 rate of 458 In addition , Johnston County had a lower rate compared to the following surrounding peer counties for the 2012 - 2013 academic year Harnett 385 , Wayne 4 , and Wilson 34 For the 2012 - 2013 school year there was a total of 189 students who dropped out There were more male 121 than female 68 drop outs and a higher number of white students 93 than any other race or ethnicity Clayton High School had the highest number of students drop out for the 2012 - 2013 school year In 2010 , the average SAT score in Johnston County 1022 was higher than the State 1008 However , the average SAT score was the same for both Johnston County and North Carolina in 2013 One factor that may have contributed to the gradual decrease in the drop rate is the decrease in teen pregnancies in Johnston County Teen pregnancy can greatly affect the level of educational attainment due to factors such as finances and child care The Adolescent Parenting Program at the Department of Social Services in Johnston County has helped to address the drop out rate The program assists teen parents with improving child welfare and school readiness for their children and increasing graduation from high school Please refer to Appendix PP - SS Reference 30 , 31 , 32 Crime There are several offenses that are reported by law enforcement agencies such as murder , rape , robbery , aggravated assault , burglary , larceny , and motor vehicle theft In 2013 , Johnston County had a total 3,810 reportable offenses from law enforcement agencies There was a decrease in the number of offenses from 2012 to 2013 by 756 Of all the offenses reported , larceny 2,297 crimes were the highest in Johnston County followed by burglary 1,081 In comparison , North Carolina’s total of larceny offenses in 2013 was at 198,893 Although , North Carolina’s crime index is higher than Johnston County from 2009 to 2013 the rate has gradually decreased Johnston County Sheriff’s Department had the highest reported offenses from 2010 - 2013 as a result of servicing the entire county One contributing factor that may have influence on crime in Johnston County is the dropout rate According to the NC Department of Public Instruction , attendance is the top reason that many students dropout of school Therefore , students may not receive a high school diploma which may result in less employment opportunities and an increase in risky behaviors which may include criminal acts Please refer to Appendix TT - UU Financial and Economic Income and Poverty Levels 25Page6According to the US Census Bureau , the majority of Johnston County residents had a household income of 50,000 - 74,999 This percent is slightly higher than the state by 11 In 2013 , the percent of Johnston County residents estimated to be below poverty level over the previous twelve months was at 168 compared to the state 179 However , Johnston County poverty percent was not the highest or the lowest compared to the peer counties In 2013 , the poverty percent was the highest for Wayne County 214 and the lowest for Union County 97 Based on the 2010 Community Health Assessment there has been an increase in the percent of Johnston County residents with incomes below poverty level by 4 However , the percent is based on a 2000 estimate from the NC Rural Economic Development Center Please refer to Appendix VV - XX Financial Assistance The increase of residents living below the poverty level lead to the need for public assistance and increased Medicaid services The number of Johnston residents eligible for Medicaid increased by 1,136 in December from 2011 to 2013 There has been a major increase since the last Community Health Assessment which reports the number of Medicaid eligible was at 27,620 in 2009 Most often Medicaid recipients are also receiving some type of food and nutrition services The number of residents participating in the food and nutrition services programs in January 2011 was at 27,570 In January 2013 , those served increased to 34,235 Please refer to Appendix YY Reference 35 Unemployment Rates The 2010 Community Health Assessment reports the unemployment rate at 95 in September 2009 The unemployment rate has gradually decreased with the most current rate at 46 as of December 2014 Currently , Johnston County unemployment rate is less than the state by 06 In addition , the December 2014 preliminary data revealed that Johnston County labor force was at 82,941 Of the peer counties selected for comparison , Wilson County has the highest unemployment rate and the lowest is Union County Although , Johnston County’s top five employers are Johnston County Schools , Grifols , Johnston Memorial hospital , County of Johnston , and Asplundh Tree Expert Company there are many residents that seek employment in the triangle area which includes Raleigh , Durham , and Chapel Hill The unemployment rate may continue to decline with new employment opportunities such as those offered by pharmaceutical company Grifols Grifols recently opened a new facility in the town of Clayton that will have 200 employees 26Page7Please refer to Appendix DDD Reference 36 Transportation Transportation is a major concern in Johnston County particularly with accessing health care According to the US Census Bureau , 46 of households did not have a vehicle for transportation compared to the state 66 Many residents who qualify utilize Johnston County Area Transit System JCATS , the only public transportation available to assist them with access to health care and other services JCATS has 33 buses and vans that are accommodating to individuals with special needs Several human service agencies have contracts with Johnston County Area Transit System particularly for Johnston County residents with Medicaid or senior citizens over 60 years of age The general public can also utilize JCATS services ; however , availability is limited at this point due to funding Reference 37 Individual Behavior Obesity , Physical Activity , and Nutrition Obesity is still a major issue of concern in Johnston County According to the County Health Rankings , 33 of Johnston County residents are obese compared to the overall percent in North Carolina 29 In comparison the adult obesity percentage was highest in Wilson County 35 and lowest in Union County 27 for the peer counties Research has shown that physical activity and nutrition play an integral role in reducing adult obesity Johnston County had 28 of physical inactivity which is higher than the state 25 In comparing physical inactivity with the peer counties the highest percent was in Wilson County 31 and lowest Union County 21 It is evident that there is a correlation between physical inactivity and obesity based on the data According to the 2010 Community Health Assessment adult obesity was at 271 Adult obesity has increased by 59 in Johnston County Nutrition is another important factor that contributes to obesity According to the 2011 Behavior Risk Factor Surveillance System , the percent of residents that consumed five or more servings of fruits and vegetables or beans per day was 165 compared to North Carolina 137 Obesity can contribute to other chronic health conditions such as diabetes and heart disease Please refer to Appendix ZZ , AAA , BBB , and CCC 27Page8Health Screenings According to the 2010 Behavioral Risk Factor Surveillance System , 748 of Johnston County residents received mammogram screenings which is higher than North Carolina 674 Mammogram screenings are recommended beginning at the age of 40 ; however , if there is a family history of breast cancer the screening should be done earlier or at the discretion of a health care provider The percent of Johnston County population who had a sigmoidoscopy or colonoscopy screening was 676 which is slightly lower than the state at 696 Beginning at the age of 50 it is recommended that people should get colorectal screenings The percent of Johnston County male population that received a Prostate Specific Antigen Test to screen for prostate cancer was at 681 compared to the state 669 According to the CDC , the following men are at a higher risk of getting prostate cancer African American , 50 years old or older , or has a family history usually father , brother , or son Please refer to Appendix FFF - HHH Reference 38 Motor Vehicle Injuries From 2010 - 2013 , the total number of reportable crashes in Johnston County was at 14,141 Of those reported , 106 were fatal , 4,550 were non - fatal injuries , 9,485 were property damage only , and 862 involved alcohol There were 10,109 rural crashes reported ; however , of the towns reporting crashes Smithfield had the highest at 1,521 Johnston County residents reporting that they always used seat belts while driving or riding a car in the Wake AHEC area increased from 917 in 2011 to 947 in 2013 Wake AHEC services the following counties Durham , Franklin , Granville , Johnston , Lee , Person , Vance , Wake , and Warren Johnston County percent of seat belt use was higher than North Carolina 933 in 2013 The 2010 Community Health Assessment reported Johnston County ranking as fifteenth with 1,559 injury crashes and second with 33 fatalities from 2005 - 2009 Over the past few years there have been several efforts to address teen motor vehicle deaths The Teen Driving Committee has been integral in addressing and reducing the teen driving deaths in Johnston County Please refer to Appendix EEE , III , and JJJ 28Page9Family Planning The North Carolina “ Be Smart ” program has been an essential part of helping women and men in Johnston County receive family planning and reproductive health services as a way to reduce unplanned pregnancy The “ Be Smart ” program is especially important for people who are uninsured The “ Be Smart program has contributed to the decreasing the number of teen pregnancies since 2010 which reported 10 live births for the 10 - 14 age group and 215 for the 15 - 19 age group In 2013 , there were 2 live births among the 10 - 14 age group and 179 in the 15 - 19 age group The number of live births in Johnston County was drastically lower than the state which reported 128 births among the 10 - 14 and 9,017 amo