2013 State of the County Health Report

10 2 0 13 Johnston County State of the County Health Report Table of Contents Demographics 2 This annual report provides an overview of the health and wellbeing of Johnston County residents It highlights the most current data Health and Medical 3 which includes demographics , leading causes of death , and the Obesity 4 county’s top health priorities In addition , this report serves as a Diabetes 6 resource for grant application , policy development , financial planning , and program implementation Access to Healthcare 7 Cancer 10 Priority Health Issues Injury Prevention 11 Identified from the 2010 Sexually Transmitted Community Health Assessment Infections 13 Disability and Mental • Obesity Health 14 • Diabetes New Initiatives and Emerging Issues 15 • Access to Healthcare • Cancer Data Sources 16 • Injury Prevention Electronic copies of this Teen Motor Vehicle Deaths document and other Johnston County health reports are available on our website wwwjohnstonnccom Johnston County Public Health Department 517 N Bright Leaf Blvd Smithfield , NC 27577 Phone 919 989 - 5200 JCPH Marilyn Pearson , MD Health DirectorPage2 Every four years the state of North Carolina requires each local county health department and Healthy Carolinians Partnership to conduct a community health assessment CHA Completion of the CHA is a process that allows community members and stakeholders to gain a better understanding of the health needs and concerns of the community During the three interim years , the health department is responsible for submitting the state of the county health SOTCH report to the North Carolina Division of Public Health and Office of Healthy Carolinians Johnston County Public Health Department completed the Community Health Assessment CHA in 2010 To access the 2010 CHA visit wwwjoconchealthcom The submission of the 2013 SOTCH addresses the most current data related to each priority health issue along with a summary of the progress to date Although this report is a reflection of years 2012 - 2013 , there are some categories where the most current data available is from 2009 - 2011 Johnston’s Demographic and Economic Summary 1 2012 Johnston County Demographics 2,13 , 24 Sex Estimate Percent Economic Glimpse Male 86,793 496 ? The unemployment Female 88 , 145 504 rate has steadily Race Estimate Percent decreased from 85 White 139,428 797 in 2012 to 71 as of Black or African American 26,034 149 August 2013 American Indian or Alaska 609 03 ? As of September 2013 Native 36,684 individuals Asian 879 05 received SNAP Native Hawaiian or Other 0 0 benefits and 33,881 Pacific Islander individuals received Other Race 1,947 11 Medicaid Two or more races 6,041 35 ? 173 of residents Ethnicity Estimate Percent were below the Hispanic any race 22,948 131 poverty level in 2012 Non Hispanic or Latino 151,990 869 1 2012 Estimated Age Population 2012 Johnston County 1 Population by Age 60 and over 0 - 19 16 Age Estimate 301 Population 0 - 19 52,727 Population 20 - 34 29,498 Population 35 - 59 64,755 35 - 59 20 - 34 Population 60 and 27,958 37 169 overPage3 Health and Medical Care Overview of Leading Causes of Death In 2011 , the rate for the leading cause of death for Johnston County , diseases of the heart was higher than North Carolinas rate The rate for diseases of the heart in Johnston County was 1912 while 3 North Carolina had a rate of 1756 There was a higher number of heart disease deaths in Johnston County among non - Hispanic Whites 273 compared to African Americans 54 in 2011 For all 3 cancer deaths , the rate for Johnston County was 1686 compared to North Carolina’s rate of 1885 Contributing to most of these deaths are lifestyle behaviors such as tobacco use , alcohol consumption , lack of physical activity , poor nutrition , and substance abuse Of all the leading causes of death , Johnston County had higher rates than the state for motor vehicle injuries Many of the chronic diseases identified as the leading causes of death in Johnston County are also major 4 contributors of disabilities in the United States 3 Leading Causes of Death 2011 Rate per 100,000 Heart Disease 1912 Cancer 1686 Cerebrovascular 319 Chronic Lower Respiratory Diseases 278 All Other Unintentional Injuries 226 Motor Vehicle 191 Diabetes Mellutis 151 Nephritis 151 Alzheimers 145 139 Septicemia 0 50 100 150 200 250 2011 Health Professionals 2011 Number of Heart Disease Deaths 5 per 10,000 population in Johnston County 3 Aged 0 - 99 yrs Physicians 2 Registered White Nurses 74 1 23 Dentists 12 African American 54 409 Pharmacists 273 Hispanic all 65 race Nurse American 21 Practitioners Indian Physician AssistantsPage4 Obesity Healthy North Carolina 2020 Objective Increase the percentage of adults who consumed five or more servings of fruits and vegetables Objective Increase the percentage of adults getting the recommended amount of physical activity 25 In 2011 , 716 of adults were overweight or obese while North Carolina had a rate of 651 This 6 was a increase from 708 in 2010 A few of the factors associated with overweight or obesity are poor eating habits , consumption of high sugar foods and beverages , minimal fruit and vegetable consumption and physical inactivity The tables below reveal that Johnston County had a higher percentage of people who had a body mass index greater than twenty - five compared to North Carolina However , according to the 2011 Behavioral Risk Factor Surveillance System , 768 of Johnston County residents compared to 733 of state residents participated in some type of 7 physical activity or exercise in the past month that was not related to work The rate of Johnston County residents who did not eat more than five fruits and vegetables 835 is lower than the rate 8 for North Carolina 863 in 2011 6 , 25 , 26 Body Mass Index gt; 25 Overweight or Obese 708 716 704 698 80 72 667 638 573 591 60 Percentage 2009 2010 40 2011 20 0 Johnston Wayne Union Harnett Wilson County Note - No data in Behavior Risk Factor Surveillance System BRFSS for Harnett and Wilson Counties Due to changes in weighting methodology the data for 2011 is not comparable to previous years for the above chart See BRFSS Technical Notes for methodology changes 7,32 Body Mass Index gt; 25 Overweight or Physical Activity in the Past Year 6,25 Obese 78 768 76 80 708 716 651 Percentage743 733 653 74 Percentage 60 2010 72 691 2010 70 2011 40 68 2011 66 20 64 0 NorthCarolina Johnston County North Carolina Johnston County Note - Due to changes in weighting methodology the data for 2011 BRFSS is not comparable to previous years for the above charts See BRFSS Technical Notes for methodology changes PagePage pageNumber55 Fruit and Vegetable Consumption Five or more 8,33 per day Percentaege 30 206 165 168 20 137 10 0 North Carolina Johnston County 2009 2011 Note - Due to changes in weighting methodology the data for 2011 BRFSS is not comparable to previous years for the above chart 2010 data is unavailable See BRFSS Technical Notes for methodology changes Johnston County Action Plan ? Increase opportunities for exercise in the community by fostering environments conducive to physical activity ? Increase availability of Farmer’s Market and access to healthy foods in communities throughout the county ? Increase the amount of fruits and vegetables consumed on a daily basis Progress to Date ? In 2012 , Johnston County Health Department , as lead health department for Region 7 including Franklin , Granville , Halifax , Nash , Vance , Warren , and Wilson , received the Community Transformation Grant CTG Project The CTG is a five year project funded through the NC Division of Public Health by the Centers for Disease Control CDC and focuses on developing and implementing initiatives to prevent chronic disease , promote healthier lifestyles , and reduce health disparities and control health care spending One focus of the project is on increasing access to physical activity through joint use agreements and healthy eating The active living strategic team is currently working on the comprehensive land use plan for the Town of Archer Lodge The development of the comprehensive plan is an eighteen month process of determining community development and goals while assuring there is a health component included in the plan The grant has increased the number of enhanced farmers ’ markets and community supported agriculture programs through working 30 with the Clayton Farm and Community Market and Lee’s Produce in Johnston County ? In April 2013 , Johnston County Health Department sponsored its annual Walk for Health event that is focused on promoting physical activity in Johnston County In total , there were 90 participants who utilized the Greenway Trail for physical activity during the event Since the Greenway trail has been developed , many Johnston County residents continue to utilize the trail on a daily basis ? In 2011 , Johnston Health Health Quest implemented the SilverSneakers Fitness program This is a wellness and exercise program with emphasis on helping older adults live healthy and 31 stay active Currently , there are 1,075 members participating in the program ? In the fall of 2011 , Clayton Parks and Recreation started a community garden that is used for teaching purposes and also provides Clayton Area Ministries with fresh produce to help serve residents in need of food With the help of cooperative extension , three gardening classes are scheduled annually to assist with planting and harvesting vegetables By the end of 2013 , it is 9 estimated that 700 - 900 lbs of produce will be harvested from the community garden ? For the 2012 - 2013 school year , a total of three elementary schools were involved in the school garden program offered through Cooperative Extension of Johnston County The schools involved in the program , Fours Oaks Elementary , East Clayton Elementary , and Cooper Elementary exposed students to a variety of vegetables At the end of the school year , students were able to try each vegetable during their salad party PagePage pageNumber66 Diabetes Healthy North Carolina 2020 Objective Decrease the percentage of adults with type II diabetes In Johnston County , diabetes is the seventh leading cause of death Diabetes is a chronic disease with several health implications including heart disease , nephropathy , neuropathy , foot problems , and vision impairment Obesity and lack of physical activity are major risk factors in developing diabetes Johnston County had 64 of its residents diagnosed with diabetes in 2011 compared to 135 in 10,27 11 2010 In 2011 , 68 of residents were diagnosed as pre - diabetic or borderline diabetic 10 , 27 , 29 Percent of Individuals told by a doctor they have diabetes 20 135 Percentage 13 15 102 87 63 81 98 71 10 64 2009 5 2010 2011 0 Johnston Wayne Union Harnett Wilson County Note - No data in Behavior Risk Factor Surveillance System BRFSS for Harnett and Wilson Counties for the above chart See BRFSS Technical Notes for methodology changes 2012 Percent of Individuals told by a Doctor 2011 Percent of Individuals told by doctor 28 that you have pre - diabetes or borderline they have Diabetes 11 diabetes 150 15 111 111 Percentage99 Percentage932 921 10 100 5 50 68 79 0 0 Eastern Piedmont Western Yes No NC Regions North Carolina Johnston Johnston County Action Plan ? Improve diabetes self - management for those currently diagnosed with diabetes Progress to Date ? The Diabetes Recognition Program DERP is a self - management class for diabetics offered by the health department In 2012 , there were a total of 121 patients in the DERP program The results of the program revealed a 25 reduction in HgbA1c levels and improved glucose 12 control Of the 131 participants , 100 did monthly foot exams and 15 returned for their 12 three month follow - up in the program ? In 2012 , the health department and community partners implemented the Living Healthy Diabetes Self - Management program The program provides participants with different techniques to help manage their diabetes as well as other problems associated with the chronic disease In 2013 , there were a total of 18 participants who completed the program at the health department ? Johnston Health is continuing to provide both inpatient and outpatient diabetes education by 14 nurse educators PagePage pageNumber77 Access to Healthcare Healthy North Carolina 2020 Objective Reduce the percentage of non - elderly uninsured individuals aged less than 65 years According to the American Community Survey for 2012 , there were an estimated 197 of uninsured 15 adults between 0 - 64 years of age in Johnston County , slightly higher than the estimated state rate 15 of 166 The rate of health insurance is correlated with the economy and employment since many health insurance plans are employer provided In 2012 , Johnston County had an unemployment rate 16 of 82 NC Department of Commerce compared to the state rate of 95 Although , the rate of unemployment is declining , we continue to have a large number of individuals who are not able to th th receive regular medical care Johnston County ranks at 77 67 in 2012 for Access to Clinic Care 17 according to the 2013 County Health Rankings Below are tables comparing Johnston County to peer counties related to employment , poverty level and health insurance 2011 - 2012 Estimate of Uninsured Aged 0 - 64 by 18 Percent 197 177 178 20 192 172 173 162 137 148 146 15 10 Percent 2011 5 2012 0 Johnston Wayne Union Harnett Wilson County 2011 - 2012 Estimate of Persons Below Poverty 18 Level by Percent 30 26 234 249 25 244 187 173 179 20 152 15 118 Percent 10 10 2011 5 2012 0 JohnstonW ayne Union Harnett Wilson CountyPagePage pageNumber88 15 Unemployment Rate by Percentage 18 156 16 14 rcentage 108 104 12 2010 96 92 10 2011 8 2012 PeEstimate 6420 Johnston Wayne Union Harnett Wilson County Johnston County Action Plan Reduce the number of Johnston County citizens under age 65 that do not have access to health care While we are not able to impact the number of uninsured individuals , our goal is to provide medical care to the uninsured Johnston County is taking the following action steps to meet this goal Progress to Date ? Johnston Health , the County’s hospital system and many other community providers , continue to recruit primary care physicians and specialists to the county ? The HealthNet committee meets on a monthly basis with several partners – Project Access , Community Care of Wake & Johnston County , Benson Area Medical Center , NC Office of Rural Health and Community Care , Johnston County Health Dept , Johnston County DSS , Johnston Health Hospital System , CommWell Health , Cooperative Extension and Mental Health – to address the issues of providing care to the uninsured Multiple initiatives have been implemented to focus on decreasing Emergency Department visits while increasing the number of people with a medical home ? Johnston County Health Department is the lead agency in Health Director’s Region 7 for the Community Transformation Grant Project One area of focus is evidence - based clinical and preventive services The strategies include providing community resources to patients related to chronic disease self management , weight management and tobacco cessation in order to improve their overall health ? The Johnston County Health Department provides access to primary care to the uninsured and low income residents through sliding fee scales based on household income ? Johnston County’s Behavioral Health Division is continuing to expand their provider based to provide additional Behavioral Health Services ? The Patient Protection and Affordable Care Act has provided federal funding for Navigators who will assist community members with obtaining medical insurance coverage to expand access to care for those currently uninsured ? Johnston Health , Johnston County’s hospital system , which includes Johnston Medical Center - Smithfield , has started the expansion of its Johnston Medical Center - Clayton site Currently the Clayton site provides emergency services , outpatient surgery , and imaging The ClaytonPagePage pageNumber99 hospital will have inpatient beds in 2015 , expanding to the western region of the county the reach of emergency and acute care In 2013 , the Johnston Health Board of Commissioners initiated a partnership with the University of North Carolina Health Care in an affiliation agreement This partnership will enhance access to healthcare and specialty services and expand the services available to residents in Johnston County ? With the continued implementation of the Patient Protection and Affordable Care Act , it is expected that a number of the 266 percent 2012 of the 18 - 64 year old uninsured in Johnston County will acquire some medical insurance coverage through Medicaid or the marketplace exchange Some of those newly insured will connect to a medical home in Johnston County or surrounding counties Since the number of health professionals per 10,000 in Johnston County is less than 11 and the mental health provider and dental ratios are 28,279 1 and 5 , 195 1 respectively , a number of those newly insured will have limited access to providersPage010 Cancer Healthy People 2020 Objective Increase the proportion of women who receive a breast cancer screening based on the most recent guidelines Johnston County’s current focus on increasing the number of women who are receiving breast cancer screenings through outreach and education continues to be a success According to the 2013 County Health Rankings website , 71 of female Medicare enrollees have received mammography 18 screening In 2012 there were a total of 22 deaths in Johnston County due to female breast 19 cancer However , there are 155 projected new cancer cases and deaths estimated in 2013 for 20 Johnston County Below is a table comparing Johnston County to peer county data related to breast cancer deaths 2007 - 2011 Breast Cancer Mortality Rates per 100,000 Population 40 334 35 275 30 234 232 228 Rate25 175 20 15 10 50 North Johnston Wayne Union Harnett Wilson Carolina County Johnston County Action Plan Increase the number of women reporting mammogram screening Progress to Date ? Johnston County has partnered with the NC BCCCP to provide screenings for 212 women in the past 12 months ? The partnership with the Rex Mobile Unit has provided 101 screening mammograms in Smithfield to uninsured and low income women ? Project Access makes referrals to the NC BCCCP for uninsured women and Johnston Health donates mammography services for Project Access clinic patients Page111 Injury Prevention Healthy People 2020 Objective Reduce motor vehicle crash - related deaths Objective Increase age - appropriate vehicle restraint system use in children Unintentional injuries have been one of the leading causes of death in Johnston County over the last several years According , to Johnston County Teen Crash Data from 2008 - 2012 , Johnston County 22 ranked 3rd in the state with 23 teen driving fatalities In 2012 , Johnston County ranked fifth in the 22 state In 2012 , vehicular accidents resulted in the death of 2 teenagers , down from four in 2011 Below is a table comparing Johnston County data to peer county data related to teen motor vehicular deaths Motor Vehicle Deaths Involving 21 Drivers Ages 15 - 19 10 9 Deaths 8 2010 of6 4 4 2011 Number 4 3 2012 2 1 0 Johnston Wayne Union Harnett Wilson County The Healthy North Carolina 2020 Objective is to reduce motor vehicle deaths from 138 to the target 124 per 100,000 which reflects a 10 improvement This applies to all age groups , but the incidence of teen deaths from motor vehicular accidents is significant enough to develop interventions specific to teens Johnston County Action Plan Reduce the number of child motor vehicle deaths and encourage the use of safety restraints Progress to Date ? The Johnston County Teen Driving Committee promotes the Johnston County Teen Drivers Program Johnston County Teen Drivers Program is a peer - to - peer safety program for young drivers , involving teenagers directly in developing and delivering monthly driving safety messages and programs Each High School in Johnston County sponsors a Johnston County Teen Drivers Team 23 ? Safekids Coalition of Johnston County Fiscal Year 2012 - 2013 o Permanent Checking Station statistics ? 101 seats were checked through the Permanent Checking Station ? 87 of those seats were found to be installed incorrectly , out of date , recalled , not in working order or were in the wrong seat or no seat at all ? 72 seats were distributed through the Permanent Checking StationPage212 o 8 special car seat clinics or events were held ? 105 seats were checked through car seat clinics or events ? 91 of those seats were found to be installed incorrectly , out of date , recalled or not in working order or were in the wrong seat or no seat at all ? 38 seats were distributed through car seat clinics or events o 7 other Safe Kids events were held to address bike pedestrian safety , fire prevention , poison prevention or other safety needs o There are 23 nationally certified Child Passenger Safety technicians in Johnston CountyPage313 Sexually Transmitted Infections The Centers for Disease Control reports chlamydia as the most prevalent sexually transmitted 34 infections in the United States In 2012 , the number of chlamydia cases was 464 ; however , there were 94 reported cases for gonorrhea The number of chlamydia cases from 2008 to 2012 has always been higher than the reported cases for gonorrhea in Johnston County In 2012 , the number of reported chlamydia cases decreased from the previous year The table below compares the number of chlamydia and gonorrhea cases in Johnston County Sexually Transmitted Infection Cases in Johnston 35 County 2008 - 2012 545 600 524 464 474 of500 407 2008 Number400 cases 2009 229 300 2010 200 128 118 94 82 2011 100 2012 0 Chlamydia Gonorrhea Johnston County had a total of 11 HIV - first diagnosis cases and 12 AIDS diagnosis cases in 2012 In comparing peer counties , Wayne and Wilson County had higher HIV cases than Johnston County The table below compares peer county HIV and AIDS cases 35 HIV and AIDS Diagnosis 2012 18 18 20 of 15 13 12 HIV Disease 11 12 11 r cases First umbeDiagnosis 9 8 10 5 5 AIDS NDiagnosis 0 Johnston Wayne Union Harnett Wilson CountyPage414 Disability and Mental Health Johnston County’s 2012 estimate of total civilian noninstitutionalized population with a disability is 133 This is slightly higher than the North Carolina rate of 130 The 65 years and over population in Johnston County represents the highest percentage of persons with disability at 389 36 see chart below Population North Carolina Johnston County Under 5 years 08 16 5 to 17 years 57 72 18 to 64 years 112 12 65 years and over 366 389 2012 Disability Estimates 4000 3000 Under 5 years 5 to 17 years 2000 18 to 64 years 1000 65 years and over 000 North Carolina Johnston County In 2013 , Johnston County residents reported on average 35 days during the past 30 days as mentally unhealthy n 2,618 In 2012 , that number was 38 days n 2,837 Currently in 2013 the ratio of population to mental health provider in Johnston County is 28,279 1 and the North Carolina 37 rate is 3,186 1 County Health Rankings Page515 New Initiatives County Employee Wellness Center Johnston County Government will open a Wellness Center for county employees in 2014 Since Johnston County government is self - insured , the goal is to provide urgent care , education , and wellness incentives to improve the health of the almost 1,200 county employees Currently , a number of Johnston County employees do not have a primary care provider A major initiative of the center will be to connect county employees to a medical home Active Routes to School Project The North Carolina Department of Transportation and the North Carolina Division of Public Health are partnering to focus on increasing the number of elementary and middle school students that walk and bike to school The Project will hire a coordinator that will work with the Community Transformation Grant Project Active Living Lead to promote system changes at the local and county level As the lead county for Health Director’s Region 7 , Johnston County will house the coordinator and act as the regional finance manager for the project Emerging Issues Increasing Hispanic Population in Schools Johnston County is the 6th fastest growing county in the state The changing demographics of our county are reflected in our public school system , Johnston County Schools In the 2009 - 10 school year , the system had 31 , 831 students Of those students , approximately 16 were Hispanic , 21 black and 62 white Of the total 33,884 students in the 2013 - 14 school year , 20 were Hispanic , 38 16 black , and 59 white Methamphetamine Labs The rise of methamphetamine labs in North Carolina has disproportionately affected many rural counties Since 2010 , the number of meth lab busts by the State Bureau of Investigation has increased in North Carolina from 235 to 561 in 2013 Over 81 are small labs Children are found in one in four meth labs in North Carolina The number of meth lab busts in Johnston County in 2013 39 was 22 , an increase from 15 in 2012 Members of the community are welcome to participate on any committee with a focus on improving the health of the citizens of Johnston County If anyone is interested they can visit the website with meeting dates and locations for the different coalitions Interested parties may contact the Health Education Department at 919 - 989 - 5200 Page616 Data Sources 1 US Census Bureau American Fact Finder 2012 American Community Survey 1 - Year Estimates ACS Demographic and housing estimates Johnston County , North Carolina http factfinder2 censusgov faces tableservices jsf pages productviewxhtml pid ACS_12_1YR_DP 05 & prodType table 2 North Carolina Employment Security Commission Civilian Labor Force Estimates for NC Counties for 2013 http esesc23 escstatencus d4 LausSelectionaspx 3 North Carolina State Center for Health Statistics 2011 Leading Causes of Death in North Carolina http wwwschsstatencus schs data lcd getleadcausescfm 4 Centers for Disease Control and Prevention 2012 Chronic Disease and Health Promotion http wwwcdcgov chronicdisease overview indexhtm 5 North Carolina Health Professions Data System 2011 Health Professionals - State and County Totals http wwwshepscenteruncedu hp prof2011 htm 6 North Carolina State Center for Health Statistics 2010 BRFSS Survey Results North Carolina Counties and Regions Derived Variables and Risk Factors http wwwschsstatencus schs brfss 2010 nc nccr rf2 html 7 North Carolina State Center for Health Statistics 2011 BRFSS Survey Results North Carolina Counties and Regions Exercise http wwwschsstatencus schs brfss 2011 nc nccr exerany2 html 8 North Carolina State Center for Health Statistics 2011 BRFSS Survey Results North Carolina Counties and Regions Fruit and Vegetable http wwwschsstatencus schs brfss 2011 nc nccr DAILY_5 html 9 Clayton Parks and Recreation Phone Communication 2013 , October 30 , with Larry Bailey , Director Clayton Parks and Recreation 10 North Carolina State Center for Health Statistics 2010 BRFSS Survey Results North Carolina Counties and Regions Diabetes http wwwschsstatencus schs brfss 2010 nc nccr diabete2 html 11 North Carolina State Center for Health Statistics 2011 BRFSS Survey Results North Carolina Counties and Regions Pre - diabetes http wwwschsstatencus schs brfss 2011 nc nccr prediabhtml 12 Johnston County Public Health Department Email Communication 2012 , November 16 , with Sherry Creech RN , Primary Care Manager 13 Johnston County Department of Social Services Phone Communication 2013 , November 1 with Tina Corbett , Deputy Director 14 Johnston Health Phone Communication 2012 , November 20 with Patsy Stewart RN 15 Health Insurance Coverage Status 2012 Estimate http factfinder2 censusgov faces tableservices jsf pages productviewxhtml pid ACS_12_1YR_D P03 & prod Type table 16 North Carolina Civilian Labor Force Estimates http wwwncesc1 com pmi rates PressReleases County NR_December2012_CntyRates_Mpdf 17 County Health Rankings 2013 http wwwjohnstonnccom files health 2013CHRSumpdf 18 2013 Johnston County Health Ranking 2013 http wwwcountyhealthrankingsorg app north - carolina 2013 measure factors 50 map 19 Detailed Mortality Statistics 2012 http wwwschsstatencus schs deaths dms 2012 johnstonpdf 20 North Carolina Central Registry Projected New Cancer Cases and Deaths for Selected Sites by County 2013 http wwwschsstatencus schs CCR proj13copdf 21 UNC Highway Safety Research Center Email Communication 2012 November 27 , with Eric Rodgman , Senior Database AnalystPage717 22 Johnston County Teen Crash Data 2008 - 2012 http wwwjocoteendriverscom JoCoTDStatspdf 23 Partnership for Children of Johnston County Email Communication 2013 November 6 with Christina Petersen , Safe Kids Johnston County Coordinator 24 US Census Bureau American Fact Finder 2012 American Community Survey 1 - Year Estimates 2012 Economic Characteristics Johnston County , North Carolina http factfinder2 censusgov faces tableservices jsf pages productviewxhtml pid ACS_12_1YR_ DP03 & prodType table 25 North Carolina State Center for Health Statistics 2011 BRFSS Survey Results North Carolina Counties and Regions Derived Variables and Risk Factors http wwwschsstatencus schs brfss 2011 nc nccr rf2 html 26 North Carolina State Center for Health Statistics 2009 BRFSS Survey Results North Carolina Counties and Regions Derived Variables and Risk Factors http wwwschsstatencus schs brfss 2009 nc nccr rf2 html 27 North Carolina State Center for Health Statistics 2011 BRFSS Survey Results North Carolina Counties and Regions Diabetes http wwwschsstatencus schs brfss 2011 nc nccr DIABETE3 html 28 North Carolina State Center for Health Statistics 2012 BRFSS Survey Results North Carolina Counties and Regions Diabetes http wwwschsstatencus schs brfss 2012 nc nccr DIABETE3 html 29 North Carolina State Center for Health Statistics 2009 BRFSS Survey Results North Carolina Counties and Regions Diabetes http wwwschsstatencus schs brfss 2009 nc nccr diabete2 html 30 Johnston County Health Department Phone Communication 2013 , November 26 , with Jaime Pearce , Lead Grant Coordinator 31 Johnston Health HealthQuest Phone Communication 2013 , November 26 , with Lesley Atkinson , Sales and Marketing 32 North Carolina State Center for Health Statistics 2010 BRFSS Survey Results North Carolina Counties and Regions Exercise http wwwschsstatencus schs brfss 2010 nc nccr exerany2 html 33 North Carolina State Center for Health Statistics 2009 BRFSS Survey Results North Carolina Counties and Regions Fruit and Vegetable http wwwschsstatencus schs brfss 2009 nc nccr _FV5SRVhtml 34 Centers for Disease Control and Prevention 2014 Chlamydia - CDC Fact Sheet http wwwcdcgov std chlamydia STDFact - chlamydia - detailedhtm 35 North Carolina Division of Public Health 2012 HIV STD Surveillance Report Communicable Disease Branch http epipublichealthncgov cd stds figures std12rptpdf 36 US Census Bureau American Fact Finder 2012 American Community Survey 1 - Year Estimates ACS Disability Characteristics Johnston County , North Carolina http factfinder2 censusgov faces tableservices jsf pages productviewxhtml pid ACS_12_1YR_S 1810 & prodType table 37 County Health Rankings Johnston County 2013 Mental Health Providers http wwwcountyhealthrankingsorg app north - carolina 2013 rankings johnston county outcomes overall additional 38 Public Schools of North Carolina 2013 - 2014 Grade , Race , and Sex http wwwncpublicschoolsorg fbs accounting data 39 North Carolina Department of Justice 2013 Map of Meth Lab Busts in North Carolina http ncdojgov Files Top - Issues Fighting - Crime meth - lab - maps 2013 - map - of - meth - lab - busts - in - NCaspx Page818Page