2010 Community Health Needs Assessment

10 Johnston County Community Health Assessment 2006 - 2010 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 1PageTable of Contents • History of Johnston County … … … … … … … … … … … … … … 3 • Geographic and Demographic Data … … … … … … … … … … … 3 - 4 • CHA Process — 2009 - 2010 … … … … … … … … … … … … … … 8 • Primary Data Qualitative — Survey Results … … … … … … … … 9 • Secondary Data Quantitative … … … … … … … … … … … … … 18 • MATCH Data … … … … … … … … … … … … … … … … … … … … 39 • Healthy Carolinians Partnership … … … … … … … … … … … … … • Community Priorities … … … … … … … … … … … … … … … … … • Action Plan … … … … … … … … … … … … … … … … … … … … 2PageHistory of Johnston County Johnston County 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 , and Lenoir counties and part of Wilson Smithfield , Johnstons first town , grew up at the site of Smiths Ferry on the Neuse River 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 erecting 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 Taken from the Johnston County Heritage Center’s webpage Geographical Location The County is located in the east central section of North Carolina , situated on the fall zone between the Piedmont and Coastal Plain provinces The County seat , Smithfield , is located on North Carolinas central principal river , the Neuse , which is a major water source for the County The County border is located approximately 15 miles southeast of Raleigh , North Carolina and 45 miles north of Fayetteville , North Carolina There are 79185 square miles of land area in the Countys 506,377 acres Johnston County is ranked 3rd in the number of farms based on the 2007 Census of Agriculture However the number of farmers in the county is steadily declining from 1,700 in 2000 to 1,245 in 2007 Farmland in the County is primarily devoted to crops In 2009 , Johnston County ranked in the top ten for the following crops vegetables , fruits , nuts , berries , oats , soybeans , sweet potatoes and tobacco Johnston County is number two in the state for the production of flue - cured tobacco and competes with Sampson County for top state production of Tobacco The Johnston County rankings for agriculture in 2009 are second in cash receipts in vegetables , fruits , nuts and berries , second in flue - cured tobacco , fourth in sweet potato production , eighth in soybean production , eighth for total cash receipts in the state , ninth in cash receipts in Greenhouse and nursery See chart below 2009 Johnston County Agricultural Rankings Rank Category # 2 Tobacco Production # 2 All Vegetables Fruits Cash Receipts # 3 All Crops Cash Receipts # 4 Sweet Potato Production # 8 Soybean Production # 8 Total Farm Cash Receipts # 9 Greenhouse and Nursery Cash Receipts Average annual climate is 58 degrees Fahrenheit and the average rainfall is 52 inches Average snow is 5 inches and the County elevation is 155 feet The gentle , rolling hills and inclines compose the topography of Johnston County 3PageJohnston County is bordered by Nash County northeast , Wilson County northeast , Wayne County southeast , Sampson County south , Harnett County southwest , Wake County northwest The county is divided into seventeen townships Banner , Bentonville , Beulah , Boon Hill , Clayton , Cleveland , Elevation , Ingrams , Meadow , Micro , ONeals , Pine Level , Pleasant Grove , Selma , Smithfield , Wilders , and Wilson Mills Cities and Towns include Archer Lodge , Benson , Clayton , Four Oaks , Kenly part , Micro , Pine Level , Princeton , Selma , Smithfield , West Smithfield , Wilsons Mills , Zebulon part Overall , Johnston County remains basically rural However , rural areas are becoming more suburban due to the county’s growth Based on 2009 State Demographics , 29 of the county’s residents lived in incorporated towns or municipalities ; there were 119,317 residents in non - municipalities Demographic Characteristics The projected population for 2009 was 168,825 Based on demographic profiles from 2000 – 2009 , there was a 382 increase in the county’s population Johnston County is the 5th of the fastest growing county in the state The projected population for 2010 is 174,876 and 205,125 for year 2015 A 346 change of growth is expected from 2010 to 2020 The Population Density for 2010 estimates that there are 221 people per square mile in Johnston County , compared to 154 people per square mile in year 2000 2009 Population Estimates by Gender Total Population 2009 estimate 168,525 2009 Totals Males 83,925 498 Females 84,599 502 2009 Population Estimates by Race Ethnicity The Countys population for 2009 is estimated at 822 White , 156 African - American , 05 Indian or Alaska Native , 08 Asian , 09 two or more races Those of Hispanic or Latino Origin make up th 117 of the total population Johnston County is ranked 13 in the state in total population The Hispanic or Latino population has increased from 103 in 2005 to 117 in 2009 Based on the 2005 American Community survey , the Hispanic Latino population will be the largest minority group in the US North Carolina has the fastest growing Latino population in the country , with an increase of over 400 in the past decade Race Johnston County North Carolina White 822 737 African American 156 216 American Indian and Alaska Native 05 13 Asian 08 20 Two or more races 09 13 Hispanic or Latino Origin 117 77 4PagePage pageNumber5In 2009 Johnston County population estimate for children between the ages 0 – 19 reflects an estimated 28 of the total population Children 0 – 4 years 12,221 5 – 9 years 11,896 Adolescents 10 – 14 years 12,068 15 – 19 years 11,817 2009 0 - 19 Age Group Population 12,400 Population 12,200 12,000 of11,800 # 11,600 0 – 4 years 5 – 9 years 10 – 14 years 15 – 19 years Years 2009 0 - 19 Age Group male vs female 12,200 12,104 12,100 12,000 11,900 2009 11,781 11,800 11,700 11,600 10 – 19 years 10 – 19 years Males Females 5PagePage pageNumber62009 Population Estimates by Age Years 2000 Census of Total Population 2009 of Total Population Estimate 0 to 4 9,565 7 12,221 7 5 to 9 9,267 7 11,896 7 10 to 14 8,291 6 12,068 7 15 to 19 7,322 6 11,817 7 20 to 24 7,286 5 9,957 5 25 to 34 20,950 17 21,560 12 35 to 44 20,771 17 30,261 17 45 to 54 15,935 13 24,656 14 55 to 64 10,540 8 17,387 10 65 to 74 6,700 5 9,845 5 75 to 84 4,122 3 4,776 2 85 + 1,151 9 1,773 1 Total 121,900 168,217 2009 Population Estimates by Age 35,000 30,000 tion 25,000 2000 ulaCensus 20,000 15,000 2009 opEstimate 10,000 P 5,000 0 4 9 24 34 44 54 64 74 84 4 9 85 + 1 1 to to to to to to to to to to to 0 5 10 15 20 25 35 45 55 65 75 Age Groups Data Summary • The largest population age group is between 35 and 44 years of age • The data correlates to health risk conditions that place these groups at risk For example , a high young adult population is at risk for injury , HIV , etc ; 18 of the population is over 55 and at risk for heart disease , cancer disability , etc • The median age based on 2010 projected data for the County is 373 6PagePage pageNumber7Year round vs seasonal population 2010 Estimate of Migrant and Seasonal Farmworkers SFW during Peak Harvest County Migrant SFW Johnston 1300 700 7PagePage pageNumber8Community Health Assessment Process To develop our Community Health Assessment , the CHA process and survey information was presented to our Healthy Carolinians Partnership , the Living Well Partnership LWP of Johnston County The Living Well Partnership became a certified Healthy Carolinians Partnership in 2005 and serves as one of the liaisons between the Health Department and the community The members of this partnership include public and private entities serving the residents of Johnston County Attachment A During the 2006 Community Health Forum , data from previous community surveys and Johnston County health statistics were presented to the partnership members After review of the data , the membership endorsed the 4 areas of concentration for the LWP to implement health programs diabetes , obesity , tobacco cessation , and access to care Multiple programs were developed and implemented during the intervening years In 2009 , the LWP hosted a community forum to discuss health concerns in our county , particularly access to care for adults The Care Share Alliance and Community Care of Wake and Johnston Counties partnered with the Partnership to sponsor the event The programs being implemented for the then current health concern areas and the need for the development of the new Community Health Assessment process was discussed The members were asked to solicit community participation in the process and to encourage completion of the health survey being developed Once surveys were developed , they were distributed at meetings , community forums throughout the county , in the faith community , and during health fairs The surveys were available on - line and by hard copy The data was collected and presented to the Agency Head Round Table initially and later to the CHA Priority Development Team After review of the primary and secondary data , the priorities were chosen As some of the priorities for our county were unchanged from previous years , some action plans were continued and expanded while some new plans were developed The CHA will be presented to the Board of Health , the Board of Commissioners , Community Leaders , and the media It will be available on our website and at the Health Department by request 8PagePage pageNumber9Primary Data 9Page0The Living Well Partnership and community members were able to collect 397 surveys , including internet surveys The survey contained 51 questions which were separated into Five Parts Attachment B Some surveys were incomplete We suspect the length of the survey contributed to the number of unanswered questions The survey results will be utilized throughout this document Part One Quality of life Statements In this section , survey participants were asked how they felt about the following six statements The results are as follows Statement 1 There is a good healthcare system in Johnston County consider the cost and quality , number of options and availability of healthcare in Johnston County There is a good healthcare system in Johnston County N 390 68 Strongly Agree 187 Agree 35 Neither Agree or Disagree Strongly Agree 67 Disagree 33 Agree Strongly Disagree Neither Agree or Disagree 0 50 100 150 200 Disagree Strongly Disagree Statement 2 Johnston County is a good place to raise children consider the quality and safety of schools and child care programs , after - school programs , and places to play in the county Johnston County is a good place to raise children N 391 95 Strongly Agree Strongly Agree 225 Agree 34 Agree Neither Agree or 21 Disagree Neither Agree or Disagree 16 Strongly Disagree Disagree 0 100 200 300 Strongly Disagree 10Page1Statement 3 Johnston County is a good place to grow old consider the county’s elder - friendly housing , transportation to medical services , recreation , and services for the elderly Johnston County is a good place to grow old n 388 81 Strongly Agree Strongly Agree 183 Agree Agree 70 Neither Agree or Disagree Neither Agree or Disagree 37 Disagree Disagree 17 Strongly Disagree Strongly Disagree 0 50 100 150 200 Statement 4 There is plenty of economic opportunity in Johnston County consider the number and quality of jobs , job training , higher educational opportunities , and availability of affordable housing in the county There is plenty of economic opportunity in Johnston County N 382 17 Strongly Agree Strongly Agree 117 Agree Agree 75 Neither Agree or Disagree Neither Agree or Disagree 128 Disagree Disagree 45 Strongly Disagree Strongly Disagree 0 20 40 60 80 100 120 140 11Page2Statement 5 Johnston County is a safe place to live consider how safe you feel at home , in the workplace , in schools , at playgrounds , parks and shopping centers in the county Johnston County is a safe place to live n 385 Strongly Agree Agree 61 Strongly Agree 236 Agree 45 Neither Agree or Neither Agree or Disagree 25 Disagree Disagree 18 Strongly Disagree Disagree 0 50 100 150 200 250 Strongly Disagree Statement 6 There is plenty of help for individuals and families during times of need in Johnston County consider social support in the county neighbors , support groups , faith community outreach , community organizations , and emergency monetary assistance There is plenty of help for individuals and families during times of need in Johnston County n 383 51 Strongly Agree Strongly Agree 155 Agree Agree 58 Neither Agree or Disagree Neither Agree or Disagree 81 Disagree Disagree 38 Strongly Disagree Strongly Disagree 0 20 40 60 80 100 120 140 160 12Page3Part Two Community Problems and Issues In this section , survey participants were asked to select up to five items from the list below Number them in order of importance , where 1 is the most important and 5 is the least important Question 7 Which health problems have the largest impact on the community as a whole List of Health Problems # of Responses Obesity or being overweight 166 Diabetes 133 Teen pregnancy 129 Motor vehicle accidents 119 Heart disease heart attacks 116 Cancer 104 Sexually transmitted diseases STDs & HIV 96 Aging problems Alzheimers , arthritis , hear or vision loss , etc 85 Mental health – depression , schizophrenia , suicide , etc 75 Asthma 65 Infectious or contagious diseases - - TB , salmonella , pneumonia flu , etc 54 Dental health 48 Birth defects 27 Stroke 24 Gun - related injuries 20 Other injuries – drowning , choking , home or work related 20 Infant death 18 Autism 17 Lung Disease - emphysema , etc 15 Kidney disease 12 Liver disease 10 Neurological disorders - - Multiple Sclerosis , muscular dystrophy , ALS 5 13Page4Question 8 Which individual unhealthy behaviors have the greatest impact on the community List of Unhealthy Behaviors # of responses Alcohol abuse 208 Drug abuse 195 Having unsafe sex 143 Reckless or drunken driving 135 Smoking or tobacco use 123 Lack of exercise 109 Not seeing a doctor for regular checkups 105 Poor eating habits 101 Violent behavior 84 Not using child safety seats 61 Not using seat belts 57 Not seeing a dentist 42 Not getting immunizations shots to prevent disease 38 Not getting prenatal pregnancy care 0 Suicide 0 14Page5Question 9 Which community issues have the largest impact on the quality of life in Johnston County List of Community issues # of responses Unemployment 170 Lack of adequate health insurance 148 Affordability of health services 133 Low income or poverty 123 Dropping out of school 114 Domestic Violence 88 Child abuse or neglect 85 Inadequate or unaffordable housing 83 Racism 79 Homelessness 72 Availability of positive teen activities 66 Lack of transportation options 60 Violent crime murder assault , etc 57 Availability of child care 54 Availability of healthy family activities 49 Lack of recreational facilities parks , trails , community centers , etc 48 Elder abuse or neglect 41 Availability of healthy food choices 41 Lack of health care providers 37 Animal control issues 32 Rape or sexual assault 31 Lack of culturally appropriate health services 27 Pollution air , land , water 25 Unsafe or unmaintained roads 24 Bioterrorism 5 15Page6Part Three Personal health In this section survey participants were asked questions about their personal health Question 10 How do you rate your own health How would you rate your own health N 313 111 120 76 100 59 43 80 60 # of people 22 40 2 20 0 healthy healthy Healthy Healthy Healthy Healthy Un Un Somewhat Very Mostly Very health status 16Page7Question 11 Where do you get most of your health information Where do you get most of your health information 169 180 160 140 120 100 80 60 41 40 38 40 12 20 6 3 2 0 0 t ital rnet hool zines Family Church Lines TV Pharmacis Hosp Other Inte Sc Maga Help & iends or or Books Fr Nurse octor , D Question 12 Where do you go most often when you are sick or need advice about your health Where do you go most often when you are sick or need advice about your health N 324 135 140 120 100 77 Doctors Office 80 Health Department # of votes 60 38 Hospital 29 28 40 Medical Clinic 17 Urgent Care Center 20 Other 0 Doctors Health Hospital Medical Urgent Care Other Office Department Clinic Center Options 17Page8Summary of Survey Results The top ten health problems with the largest impact in our community Obesity Overweight , diabetes , teen pregnancy , motor vehicle accidents , heart disease heart attacks , cancer , STDs , aging problems , mental health issues , and asthma The top ten unhealthy behaviors with the greatest impact on our community Alcohol abuse , drug abuse , having unsafe sex , reckless or drunken driving , smoking or tobacco use , lack of exercise , not seeing a doctor for regular check - ups , poor eating habits , violent behavior , and not using child safety seats The top ten issues with the largest impact on quality of life Unemployment , lack of adequate health insurance , affordability of health services , low income or poverty , dropping out of school , domestic violence , child abuse or neglect , inadequate or unaffordable housing , racism , and homelessness Most of those surveyed thought agree or strongly agree that there was a good healthcare system in Johnston County 65 The percentage of those who think Johnston County is a good place to raise children 82 , a good place to grow old 68 , and a safe place to live 77 were also high There was a larger percentage of those surveyed who felt that Johnston County did not have good economic opportunities 46 — only 34 felt that there was good economic opportunity Survey respondents were largely female 86 , aged 25 – 54 70 , and married 55 They represented all areas of our county Employment status showed 47 to be employed full - time , 20 unemployed , 8 employed part - time Compared to our 2002 - 2006 Community Health Assessment , the top concerns were health insurance coverage and access to care , affordable medicines , health care for seniors , crime , and diabetes 18Page9Secondary Data 19Page0Health , Function & Well Being The North Carolina State Center for Health Statistics polled 300 to 400 residents by phone randomly in Johnston County in 2009 concerning the following health risk factor and these were the results § 35 stated they were in poor health § 164 had no current health insurance § 301 had no personal doctor § 249 could not see a doctor due to cost § 332 were not getting recommended physical activity § 259 reported having High Blood Pressure § 72 1 take medications for High Blood Pressure regularly § 407 reported being diagnosed for High Blood Cholesterol § 157 diagnosed with Asthma § 299 diagnosed with arthritis § 273 of Johnstonian’s smoke § 142 are disabled § 81 diabetes prevalence § 34 never had blood sugar tested for diabetes § 274 provided care in past month to family friend with long term illness § 444 have been tested for HIV § 796 did not recognize all heart attack symptoms § 749 did not recognize all stroke symptoms § 483 reported having at least one alcoholic drink in the past 30 days 20Page1Mortality Leading causes of death 2005 – 2009 Age Adjusted Death Rate Ranking Johnston Johnston NC NC County County Diseases Rate Ranking Rate Ranking st st Heart Disease 1917 1 2647 1 nd nd Cancer 1856 2 1869 2 rd th Cerebrovascular Disease 505 3 469 4 th rd Chronic Lower Respiratory Disease 470 4 482 3 th th Accidents 286 5 308 5 th th Alzheimer Disease 283 6 227 8 th th Diabetes 236 7 241 6 th th Pneumonia & Influenza 194 8 184 10 th th Kidney Disease 187 9 212 9 th th Motor Vehicle Injuries 176 10 233 7 th th Septicemia 138 11 145 11 th th Suicide 120 12 105 12 th th Liver Disease 91 13 79 13 th th Homicide 70 14 46 14 Acquired Immune Deficiency Syndrome th th AIDS 42 15 37 15 In 2009 , there were 1,168 deaths in Johnston County The five - year adjusted rate is 8883 versus 8327 for the state , meaning Johnstonians are at a slightly higher risk for dying compared to North Carolinians Death rates for minorities , males , especially minority males and the elderly over 65 are substantially high A comparison of Johnston County’s mortality rate to North Carolina with regard to specific age groups indicates that all of the following rates are higher than the State 0 – 19 year olds for motor vehicle injuries ; and 20 – 39 year olds for motor vehicle injuries ; 40 - 64 year olds for heart disease ; 65 - 84 years old total deaths ; 85 years and over heart disease , diabetes , pneumonia and influenza Infant Mortality Preterm Birth Numbers Based on five year adjusted rates 2005 – 2009 , the County’s fetal death rate was 61 vs the State’s rate of 83 The 2009 County infant death rate was 66 which is lower than the State rate of 79 North Carolina infant mortality rate is one of the highest in the nation A total of 20 perinatal deaths registered fetal and neonatal deaths occurred in the County during 2009 21Page2Although the County’s fetal and infant mortality rates were lower than the State’s , there is still a disparity between whites and minority populations The fetal death rate 2005 - 2009 for white children was 51 compared to 84 for minority children The infant death rate for 2005 - 2009 white children was 45 compared to 147 for minority children The number of reportable SIDS deaths in 2008 was 2 compared to 3 in 2009 Fetal Deaths Fetal Death Rate Infant Deaths Infant Death Rate 2006 23 97 13 56 2007 12 48 22 89 2008 12 47 16 63 2009 9 37 16 66 Low birth weight infants weighing less than 5 lbs 8 oz are decreasing in the County The County th ranks 29 in the State for low birth rate babies Low Birth Weight Infants 2006 - 2009 250 206 209 188 174 200 150 # of Infants 100 Infants 50 0 2006 2007 2007 2009 Years Prenatal Care Based on prenatal care data for 2005 - 2009 , the percent of woman receiving prenatal care in the first trimester in Johnston County was 88 compared to the state percentage of 821 , reflecting improvement Drop - ins are pregnant women receiving no prenatal care County statistics show a decrease in the number of drop - ins from 2007 - 2009 Two OB - GYN group practices are located in Smithfield and one group practice is located in Clayton In addition , several Family Physicians provide prenatal services at Johnston Medical Center In 2002 , Johnston Medical Center opened a Women’s Health Pavilion The Women’s Pavilion improved delivery and post - partum care with five birthing rooms , two observation rooms , 16 post - partum rooms and an expanded nursery Deliveries – Johnston Medical Center Year Private JCHD Tri - County Drop - Ins Total 2006 905 340 35 1280 2007 957 341 51 1349 2008 965 337 37 1339 2009 1002 325 22 1349 22Page3Facts related to the above data § There were 2421 total births in the county for 2009 , of which 1349 were in county births and 1,072 442 births delivered out of the county § The County’s Drop - In rate has been as high as 51 in 2007 and as low as 22 in 2009 for women delivering at the Johnston Medical Center with no medical prenatal history The rate in 2009 was the lowest rate in the past four years § The 2005 - 2009 State Centers for Health Statistics indicated that live birth rates were higher in Johnston County than the state , 154 county vs 141 state The 2009 pregnancy rate for Johnston County was 761 vs 789 for the state County data for 2009 § Women in childbearing years defined as ages 18 - 44 comprise 366 the Countys total female population § A total of 2,726 pregnancies occurred with 296 abortions and 9 fetal deaths § Johnston County has a lower fertility rate than the state 604 vs 628 § The rate of smoking during pregnancy decreased from 2007 - 2008 , but an increase is noted from 2008 - 2009 Smoking During Pregnancy Year Number Rate 2006 182 78 2007 205 83 2008 110 43 2009 184 76 23Page4Morbidity Cancer Rates Johnston County Total Cancer Incidence and Mortality Rates Cases Rate Deaths Rate 2006 NC 44,319 4855 17,267 1927 2006 Johnston County 576 4335 246 1949 2007 NC 46,175 4907 17,425 1887 2007 Johnston County 625 4555 253 1963 2010 Projection NC 49,586 n a 18,969 n a 2010 Johnston County Projection 826 n a 302 n a Heart Disease Rates High Cholesterol According to the 2009 BRFSS , 775 of Johnstonians had blood cholesterol checked and 708 of had blood cholesterol screening in the past year Of those surveyed , 407 had been told by a medical professional that their blood cholesterol is high High Blood Pressure Approximately 30 of Johnstonians have high blood pressure Of those , 72 are taking blood pressure medications Infectious Disease The data from the State Center for Health Statistics shows the number of STD cases has decreased for Gonorrhea , Syphilis , Chlamydia , HIV and AIDS from 2008 - 2009 Year Gonorrhea Syphilis Chlamydia HIV AIDS 199 12 364 31 22 2006 146 10 254 13 12 2007 229 5 524 65 43 2008 128 4 407 23 20 2009 24Page5Tuberculosis In 2009 , the state of North Carolina had 11 counties with greater than 4 cases of tuberculosis , Johnston County had 7 cases In 2006 , Johnston County experienced the lowest case rate of 26 per population During 2006 - 2009 , Johnston County averaged 725 cases of TB per year In North th Carolina , there were 189 cases of TB identified to be pulmonary in 2009 North Carolina ranks 26 in overall US case rates for tuberculosis The state during 2005 – 2009 noted slight decrease in drug resistant TB Johnston County had one multi - drug resistant MDR TB case in 2007 The cases of drug resistant tuberculosis in the county continue to decrease Cases of Tuberculosis in Johnston County Total TB Cases 2006 4 8 2007 1 MDR 2008 10 2009 7 25Page6Johnston County Communicable Disease Cases 2006 2006 2007 2007 2008 2008 2009 2009 Cases Johnston NC Johnston NC Johnston NC Johnston NC 807 629 Not Campylobacter 10 5 7 384 378 Available 123 153 Not E Coli 5HTOX 4 4 2 71 78 Available Haemophilus 55 59 Not 2 2 0 60 61 Influenza Available 100 66 Not Hep A 1 2 12 52 25 Available 154 128 Not Hep B 1 1 0 61 138 Available 772 898 Not Hep B Carrier 3 3 8 362 1084 Available 17 17 Not Hep C 1 0 11 37 13 Available 30 53 Not Lyme Disease 0 0 31 29 65 Available Pneum 41 44 Not 0 1 1 30 23 Meningitis Available 842 664 Rocky Mount Not 17 11 74 313 259 Spotted Fever Available 1691 1845 Not Salmonella 34 31 44 908 842 Available 160 105 Not Shigellosis 1 0 3 147 266 Available 162 168 Not Strep A 0 1 1 117 85 Available 237 326 Not Whooping Cough 0 8 8 79 213 Available 26Page7Chronic Disease Diabetes BRFSS results for 2009 § 114 have been told by a doctor that you have diabetes § 542 have not been to a diabetes self management class § 295 of those surveyed are taking insulin Asthma BRFSS results for 2009 § 157 of Johnstonians surveyed have been told they have asthma § 122 still have asthma § In 2009 , there were 219 1302 rate per 100,000 hospital discharges with a primary diagnosis of asthma in Johnston County 64 1769 rate per 100,000 of the hospital discharges where children ages 0 - 14 Health Care In 2009 , Johnston County had approximately 128 medical physicians and 32 dentists The need for medical providers is evident by the County Health Rankings report from 2009 in which th Johnston County is ranked 96 of 100 counties in access to care Year Healthcare Providers 2009 Number of Physicians 128 2009 Physicians per 10,000 population 76 2009 RNs per 10,000 population 401 2009 Dentists per 10,000 population 19 2009 Pharmacist per 10,000 population 62 Special At - Risk Population Johnston County’s seasonal and migrant workers population for 2009 is estimated to be 2,000 In addition , many workers bring their families , young and old , who require medical services The demand to provide health care for these special populations continues to increase The Johnston County Health Department has increased its bilingual staff from 5 in 2004 to 20 in 2009 to accommodate the health care language barriers The Federally Qualified Health Center , CommWell Health , formerly Tri - County Health Center , provides medical , dental , and behavioral health services at the Newton Grove site in Sampson County Benson Area Medical Center provides safety net services through the Federal Farm Workers Program 27Page8Safety net providers in our community , including CommWell Health , Benson Area Medical Center and Johnston County Public Health Department , provide medical services not only to the growing Latino population , but also the underserved The Johnston County Mental Health Center provides behavioral health services in Smithfield In 2007 , CommWell Health opened a clinic in the Johnston County community of Four Oaks and plans to expand to the Smithfield area Poverty and Insurance Coverage According to the NC Rural Economic Development Center 2000 estimate , 128 of Johnston County residents had incomes below the poverty level The median family household income in 2009 was 54,089 Per capital income for Johnston County residents in 2009 was 23,399 as compared to the State at 29,322 Families include a household of one or more related persons living in the same household Female households with children and no husband present comprise 287 poverty families in Johnston County In 2005 - 2009 , 14 percent of people were in poverty Twenty percent of related children under 18 were below the poverty level , compared with 13 percent of people 65 years old and over Ten percent of all families and 29 percent of families with a female householder and no husband present had incomes below the poverty level During 2009 , 606 persons received aid through the Work First Program , 19,639 persons received aid through Food and Nutrition programs , representing 9,257 households In 2009 , 27,620 individuals were Medicaid eligible which represents 16 of Johnston County’s total population Children and adolescents under the age of 18 represent 20 of the poverty population The elderly 65 years old and over constitute 125 of the poverty - stricken Medicaid Eligible Date Children 1 - 18 Pregnant Women NCHC 01 2006 9,344 423 2159 01 2007 10,156 408 2408 01 2008 11,217 446 2,601 01 2009 12,060 449 2,862 Community Care of Wake and Johnston Counties ’ Medicaid Carolina Access Patients seen by Providers with 5 chronic illnesses Asthma Diabetes CHF COPD Obesity Totals 611 535 158 317 103 The 2008 - 09 data estimates for uninsured individuals in Johnston County are in the mid - high to high range Children 0 - 18 Adults 19 - 64 Total 0 - 64 Johnston Number Percent Rank Number Percent Rank Number Percent Rank County 5,857 121 High 24,617 237 Mid - High 30,474 200 Mid - High 28Page9Dental Health There are approximately 50 dentists in Johnston County at this time Twelve of these take Medicaid There remains a gap for uninsured citizens There are three clinics that provide sliding fee services that are within a sixty mile radius Those services are available in Wake , Greene and Sampson counties In the past four years , the county Dental Hygienist screened 13,817 pre - K through fifth grade children and provided toothbrushes From 2006 - 2007 to 2008 - 2009 , there was an increase of 2,127 children screened In October 2008 , the fluoride mouth rinse program was implemented in five Johnston county schools and 2,658 students received the mouth rinse Also in 2008 , the dental sealant program was implemented in one Johnston County school Dental education is provided in the county to students , teachers , home school students and parents Outreach is provided at the Library during Summer School reading program , our “ More at Four ” program and at Health Fairs The number of children receiving dental varnish in 2006 was 1,363 and 2,369 in 2009 This has been a significant increase and is accredited to our local physicians and nurses in the county Johnston County Fluoride Varnish Services Number of unduplicated children 0 - 4 Number of visits where children 0 - 4 received receiving fluoride varnish from enrolled fluoride varnish from a medical provider CY physician IMB services 2006 1,363 1,858 2007 1,400 1,930 2008 1,838 2,551 2009 2,369 3,333 29Page0Barriers to Access to Healthcare There are multiple barriers to access to healthcare These include affordable insurance coverage , no insurance , unemployment , language barriers , transportation , and number of providers accepting new TH patients The 2009 MATCH Data ranks Johnston County 96 of 100 counties in North Carolina in Clinical Care , which includes access to care and quality of care One of the Johnston County initiatives addressing access to care for adults is Project Access The Johnston County Health Department also has a Primary Care Clinic serving the underserved in the county Project Access of Johnston County Project Access was initiated in 2007 by a group of concerned citizens under the leadership of Charles E Williams , MD The initiative provides health care to the uninsured , low income residents of Johnston County A grant from Kate B Reynolds Charitable Trust in Winston - Salem , NC and supported by Johnston Health Hospital provides the financial support for the program The project is supported by local physicians accepting clients into their practice to provide free care The hospital accepts the same clients for free lab work and x - rays Entrance into the program is based on 175 of the Federal Poverty Level and proof of income is required The client must be uninsured The number of physicians , including specialists , providing care through the program in 2009 was forty four In 2009 , 185 clients were provided with care through this initiative Women are provided physicals and mammograms through state and private grants offered at the Johnston County Public Health Department A clinic for the clients on a waiting list is held at JCPHD Physicians Nurses Health Educators and other volunteers from the community volunteer their time Community volunteers include private physicians and their staff , hospital personnel , Health Department personnel and church volunteers Johnston County Health Department Primary Care Clinic The Johnston County Health Department Primary Care Clinic is staffed by a physician and a physician extender with multiple support staff The clinic serves as a medical home for many uninsured patients and accepts Medicare , Medicaid , and some private insurance The clinic uses patient medication assistance programs to assist clients with medications and grant programs to provide annual screenings for women From 2008 – 09 , there were 2,300 unduplicated patients with a total of 5,072 encounters 30Page1Determinants of Health Education The Johnston County Public School system served 32 , 063 students in 2009 and consists of 43 schools , one Academically Intellectually Gifted AIG center and two new high schools opened in 2009 Johnston County Schools employ over 4,000 employees , of which 2,251 are classroom teachers Overall , 797 of all Johnstonians possess a high school education A Bachelor’s degree or higher educational training is held by 173 of the County’s population In 2005 - 2009 , 80 percent of people 25 years and over had at least graduated from high school and 19 percent had a bachelors degree or higher Twenty percent were dropouts ; they were not enrolled in school and had not graduated from high school North Carolina Drop - Out Johnston County Drop - Out Rates per Fiscal Year Rates per Fiscal Year th th th th 9 – 12 Grade 9 – 12 Grade 2005 – 2006 504 2005 – 2006 508 2006 – 2007 524 2006 – 2007 539 2007 – 2008 497 2007 – 2008 492 2008 – 2009 427 2008 – 2009 458 School Drop - Out Totals th th 7 – 12 Grade 2007 – 2008 457 2008 – 2009 426 2009 – 2010 348 Johnston County Schools Five - Year Comparison Dropout Rate Grades 9 - 12 School Year 04 - 05 05 - 06 06 - 07 07 - 08 08 - 09 Clayton High 327 300 299 278 227 Middle College - - 1739 1500 1040 253 North Johnston High 441 453 526 491 527 Princeton High 384 364 309 432 542 Smithfield - Selma High 653 650 799 741 776 South Campus High 4176 3878 4381 4359 5085 South Johnston High 359 513 583 535 540 West Johnston High 281 375 350 297 216 Johnston County 446 508 539 492 458 North Carolina 474 504 524 497 427 31Page24 - Year Comparison Graduation Cohort Rate School 2007 2008 2009 2010 Clayton High 835 836 869 851 JCS Middle College 833 875 833 906 North Johnston High 747 763 721 680 Princeton High 788 811 769 804 Smithfield - Selma High 665 640 611 608 South Campus High 167 150 67 241 South Johnston High 802 737 706 722 West Johnston High 815 832 812 842 Johnston County 751 751 728 744 State of NC 695 699 717 742 Johnston Community College JCC aids Johnstonians in higher education , enrolling an estimated 6,000 curriculum and 11,000 continuing education students annually JCC is ranked th 16 among the 58 colleges in North Carolina’s Community College System in enrollment There are 21 schools of higher education within a two - hour drive Attachment C Crime Statistics from the NC Department of Justice show a decrease from 2008 – 2009 in violent crime in Johnston County North Carolina Dept of Justice 2009 Johnston County Crime Statistics Offense Category 2006 2007 2008 2009 Murder 12 5 4 2 Rape 26 32 50 40 Robbery 117 109 135 84 Agg Assault 328 308 291 246 Burglary 1,497 1,453 1,685 1,685 Larceny 2,882 2,908 2,860 2,528 MV Theft 399 424 395 333 Total 5,261 5,239 5,420 4,918 32Page3Neighborhoods Johnston County is the 5th fastest growing county in the state But due to the economic downturn , there was a declining demand for new building permits New residential building permits from 2006 - 2009 decreased from 1,097 to 475 In 2009 , 75 well and 697 septic tank permits were issued , most in the areas best serviced by I - 40 , Benson , Clayton and Cleveland County areas New Building Permits 200 - 2009 1200 1097 980 1000 800 609 # of Permits 600 475 400 200 0 2006 2007 2008 2009 Years Year Septic Permits Well Permits 2006 1326 150 2007 1452 205 2008 962 115 2009 697 75 Much of Johnston County’s growth is due to its proximity to Research Triangle Park and to Raleigh , the States capital The fastest growing townships are in the western part of the county adjacent to Wake County According to the Office of State Budget and Management estimates , the western township of Clayton grew from 8,126 to 14,333 from 2000 - 2009 , a 76 increase The availability of rental housing is increasing ; however , home ownership is dominant In 2009 , there were 46,696 owner occupied dwellings and 16,723 renter occupied dwellings Income assisted housing is available through the various Housing Authorities Johnston County , Smithfield , Selma and Benson Numerous units are equipped for the elderly and handicapped Council on Aging has 127 housing units for elderly and disabled adults over the age of 62 years 33Page4Overweight Obesity Rates Adult obesity affects 271 of Johnstonians 2009 BRFSS According to NC - NPASS , childhood overweight affects 175 of children 2 - 4 and obesity affects 303 of children 5 – 11 The ADA estimates 1 in 6 overweight adolescents aged 12 – 19 have pre - diabetes Prevalence of Obesity in Children Ages 2 - 4 Years 200 150 NC 100 Johnston Co 50 00 2000 2004 2008 122 149 154 NC 155 172 175 Johnston Co Prevalence of Obesity in Children Ages 5 - 11 Years 400 NC 200 Johnston Co 00 2000 2004 2008 206 238 257 NC 245 339 303 Johnston Co 34Page5Family Planning There are an estimated 31,018 women of child - bearing age in Johnston County The Family Planning Waiver program has expanded income guidelines that offer services to working women and men The high parity rate of 201 is slightly lower than the state’s 204 , for the adjusted years of 2005 - 2009 The county’s rate is118 for short birth intervals of less than 6 months , compared to North Carolina’s 129 The teenage mothers health risk factors are twice that of the adult child bearer Their risk factors include maternal mortality , complications ie ; hemorrhage , pre - eclampsia , toxemia , etc , and pre - term birth From 2009 to 2008 , the number of teen pregnancies in Johnston County decreased from 296 to 257 Eight pregnancies were reported in 2008 and four pregnancies were reported in 2009 for the 10 - 14 age group reflecting a slight decrease In addition , girls 18 years old and younger had 172 th pregnancies in 2009 Johnston County is ranked 58 in teen pregnancies Motor vehicle injuries Johnston County Rank 2005 – 2009 # 15 Injury Crashes 1,559 # 2 Fatalities 33 A sudden increase in deaths due to motor vehicle accidents among 15 - 19 year olds in 2007 led Johnston County to develop strategies to address this issue There was a decrease in the total number of deaths due to motor vehicle accidents amongst the 15 - 19 year old age group in 2008 and 2009 WIC The Women , Infants , and Children WIC Program provides services to pregnant , postpartum , and nursing women and to children up to five years of age A participants household income must be below the 185 of the Office of Management and Budget Poverty Guidelines The participant must be medically certified to be a nutritional risk , for example , they must show evidence of abnormal weight gain during pregnancy ; growth problems such as stunting , underweight or obesity ; iron - deficiency anemia ; or inadequate dietary pattern WIC is a preventive program , providing supplemental foods , nutrition education and improved access to health care in order to reduce and prevent the incidence of nutrition - related health problems in pregnancy , infancy and early childhood The 2006 Johnston County Health Department WIC caseload was 3,127 This had increased to 3770 by 2010 35Page6Unemployment Rates The unemployment rate for North Carolina was 109 in 2009 The unemployment rate as of September 2009 was 95 in Johnston County 2006 39 2007 41 2008 58 2009 95 The top 5 employers in the county are Johnston County Schools , Talecris Biotherapeutics , Inc Bayer , Johnston Health , County of Johnston , and Wal - mart Attachment D Physical Environment The Environmental Health Division has enforcement responsibility for a variety of County , Local and State Programs The environmental division employs 16 people including support staff In Johnston County there are several significant environmental health issues affecting the County Major issues include • Subdivisions and mobile home parks are rapidly increasing which place a tremendous threat on the quality of ground water and the high amount of waste water being disposed of in concentrated areas , including pesticide petroleum products and inorganic chemicals and nitrates Note A significant percentage of Johnston County residents still obtain water from a private well source Johnston County is only one of about 35 counties that enforce local well rules These rules required sampling before the well is placed in use The Environmental Health Division samples wells for a variety of contaminants • Enforcement of standards for lead abatement to day care facilities , migrant housing , regulations governing food , lodging and institutional standards , public swimming pools , tattoo parlors , special food events Ham and Yam , Mule Days , etc have placed significant burdens on resources • Johnston County is typically one of the leading counties in the state with the amount of onsite waste water permits and inspections • The Environmental Health Division is responsible for enforcing a portion of the Johnston County Minimum Housing Code as it pertains to maintaining certain standards for rental properties to help promote safe and healthy places to live • Emerging public health and environmental issues in the areas of West Nile Virus , In - Door Air Quality molds and mildews Out Door Air Quality for Carbon Monoxide from Automobiles and Neuse River Basin regulations will place additional responsibilities on the Environmental Division The Environmental Health Division has regulatory responsibility in the decontamination of methamphetamine labs 36Page7Preparedness Epidemiology Response Team The Johnston County Health Department has a deployable EPI - Response Team on call 24 7 The team members consist of the health director , communicable disease nurses , environmental health specialists , health educators and administrative support Other health care professionals within the Health Department act as an additional pool of resource personnel , including the preparedness coordinators and registered dieticians County agencies , such as animal control , law enforcement and emergency management , serve as additional resources for the EPI - Response Team The EPI Response Team , in collaboration with local , state , and PHRST Team partners , has investigated • An E - coli infection in a 23month old associated with a goat • A Varicella outbreak in the school system which included ten confirmed cases • Pertussis diagnosed in a Daycare • A Hepatitis A outbreak associated with a local restaurant • A Salmonella outbreak associated with a local church reunion The team planned and dealt with the H1N1 pandemic flu which included providing mass clinics and health alerts to the community , media and medical providers In 2009 , the team participated in a research study done by UNC involving the use of portable GIS systems Members of the EPI team have also been involved with the development and revision of the County Special Needs Shelter Plan Johnston County Public Health Preparedness is supported by Public Health Regional Surveillance Team Three This elite team of specialists consists of a Physician Epidemiologist , an Industrial Hygiene Consultant , Pharm D and an Administrative Specialist The Team Three region includes Bladen , Cumberland , Harnett , Hoke , Johnston , Lee , Moore , Richmond , Robeson , Sampson , Scotland and Wayne counties The Johnston County Local Emergency Planning Committee LEPC is a federally mandated committee including membership from o Business and Industry o Emergency Response groups such as fire , medical , and law enforcement o Community groups General public o Media o Hospitals o Environmental interest o Universities o Elected officials , State local o Transportation personnel o Owners and Operators of Covered Facilities o Public Health Officials 37Page8The mission of the LEPC is to effectively plan for emergencies involving hazardous materials Johnston County is at increased risk for county wide emergencies due to interstates 95 and 40 that dissect the county and train rails that travel through the city limits Some of the responses by Emergency Management having pubic health implications over the past few years have included a diesel fuel spill , natural gas leak , hydraulic fluid spill , and a stump dump fire The LEPC is also responsible for establishing procedures and programs that make it easy for citizens to understand and have access to the information that industry submits One public health goal has been to have members of the LEPC sign on to be a Point of Distribution POD in an emergency situation During the H1N1 pandemic flu in 2009 , multiple partners signed POD agreements Indoor and outdoor air quality The air quality in Johnston County includes particle pollution from sources such as auto and farm equipment emissions and ozone pollution Other pollutants like dust , carbon based particles and airborne acid droplets contribute to premature deaths The effects are particularly harmful on citizens diagnosed with asthma , emphysema and bronchitis Harmful pollutant exposure can trigger asthma attacks , wheezing , coughing and respiratory irritation in individuals with sensitive airways The American Lung Association publishes the air quality grades for each county in North Carolina Johnston County’s Ozone grade is “ F ” This means that nine days over the standard we are in the Orange Ozone category and one or more days in the red or purple or maroon category The Orange category means it is unhealthy for the sensitive population Unhealthy air quality puts citizens with chronic disease like asthma , emphysema , diabetes and cardiovascular disease at greater risk for systems from air pollution Indoor air pollution sources stem from secondhand smoke , biological pollutants such as molds , pollen , viruses , dust mites , cockroaches and animal dander Secondhand smoke contains some 200 known poisons including chemicals that cause cancer , carbon monoxide and formaldehyde Combustion pollutants include fuel burning stoves , water heaters that use gas , or other fuel to burn in the home The most dangerous indoor pollutant is carbon monoxide which can cause death Other indoor pollutants that we use every day are our household cleaning agents Lead in Johnston County According to the Johnston County Website , the major source of lead contamination in our county comes from plumbing in old and newly constructed homes In 1986 lead plumbing was banned nationally As a result , plumbing was changed to copper but the solder used also had the lead contaminate The solder with the heavy lead content was banned for use on drinking water pipes in 1985 Lead is also found in faucets and can be a source of contamination Plastic is the only plumbing in which lead is not found Steps are listed on our website to take in order to test and reduce the amount of lead in drinking water In 2007 , 2044 children were tested in Johnston County with 3 confirmed cases of elevated blood levels Through the Health Department , an Environmental Health Specialist and the Lead Nurse investigate lead cases 38Page9Water Quality in Johnston County The Johnston county public utilities office publishes a water quality report annually and submits it to the citizens of the county The source of our county’s water is the surface water of the Neuse River The Neuse River begins in Durham county and flow over 190 miles to the Pamlico Sound The county also purchases water from the town of Smithfield and Benson Benson’s source of water is the Cape Fear River Water is purified in a five step system and then stored in elevated storage tanks According to the EPA , drinking water including bottled water contains small amounts of contaminants that do not necessarily pose health threats Sources of water contamination can include the following virus and bacteria from livestock wastes and sewage treatment plants Other contaminants may be in water runoff , industrial plants , oil and gas production and domestic wastewater discharges Johnston county reports a low level of non - dangerous contaminants in our water chlorine and chloramines which are added to control microbes , fluoride which is added for strong teeth but also found in discharge from fertilizer and aluminum factories , and copper and lead due to corrosion of plumbing systems Transportation Options One of the Countys greatest assets is its proximity to two major highways , 301 and US 70 , and to two interstates , I - 95 and I - 40 But , public transportation for citizens is limited to Johnston County Area Transportation System JCATS The system offers transportation to all Johnston County residents In - county clients are transported to Health and Human Services Agencies such as the Health Department , DSS , Mental Health , Council on Aging , Johnston County Industries , Vocational Rehab , and more The system allows necessary trips to the pharmacy , grocery store , shopping center and other places for personal needs JCATS business hours are 6 00 am till 5 00 pm , Monday through Friday The seating capacity for the JCATS passenger vehicles is 16 - 26 seats A phone call 24 to 48 hours in advance is recommended to reserve a JCATS ride In addition , JCATS offers an out of County service The van seats 11 and transports clients to tertiary medical centers such as Chapel Hill , Wake Medical , Duke and the Veteran’s Administration Hospital from 8 am till 5 pm on Mondays through Thursdays On Tuesdays only , they transport to Greenville , Goldsboro and Wilson JCATS expanded its services to the general public , for a fee of 200 in county and 1500 out of county , one way The routes operate from Smithfield county seat to Clayton , Princeton , Selma and Benson Approximately 44 of the households in Johnston County are without a car 39Page0JCATS includes Provider Information , ie Jannie’s Ride Fiscal Year runs from July 1 - June 30 Year Total Rides 2006 57,680 2007 78,722 2008 85,801 2009 88,017 JCATS includes Provider Information , ie Jannie’s Ride Fiscal Year runs from July 1 - June 30 Year Total Miles 2009 941,197 2010 996,415 40Page12009 MATCH Data MATCH Mobilizing Action Toward Community Health is a joint project of Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute to rank each county in the state based on broad measures of health risk behaviors , outcomes , and associated health determinants The rankings reflect broad based community health indicators Johnston County Overall Rank • # 32 Health Outcomes morbidity and mortality • # 50 Health Factors health behaviors , clinical care , social and economic factors , physical environment Johnston County Subcategory Rank Health Outcomes • # 18 Mortality • # 52 Morbidity Health Factors • # 67 Health Behaviors tobacco use , diet and exercise , alcohol use , and high risk sexual behavior • # 96 Clinical Care access to care and quality of care • # 23 Social and Economic Factors education , employment , income , family and social support , and community safety • # 58 Physical Environment air quality and the built environment 41Page2Healthy Carolinians Partnership In an effort to more efficiently address chronic diseases , the county applied for and received state certification in 2005 as a Healthy Carolinians county and the “ Living Well Partnership of Johnston County ” was formed The Partnership’s Mission “ To serve as a multidisciplinary partnership which enhances community well being by assessing , planning , promoting , implementing and evaluating programs to improve the health status of the citizens of Johnston County ” In early 2006 , the Partnership held its first Community Health Forum Attendance was high and three sub - committees were successfully formed The focus areas for the subcommittees were Diabetes Prevention and Management , Adult and Childhood Obesity and Smoking Cessation A fourth subcommittee , Access to Care , was eventually formed The Diabetes Subcommittee of the “ Living Well Partnership ” developed a plan to address diabetes prevention and self management A portable banner display was developed for exhibition throughout the county Banner display locations include health and human service agencies , local businesses , government agencies and medical facilities A collaborative partnership has been established between Cooperative Extension and the Health Department to offer a four part educational series The Adult and Childhood Obesity Subcommittee implemented “ The Families Eating Smart and Moving More ” program in one African - American church and one Latino church Four programs were offered at each church - one program per quarter January , April , July and October and each program consisted of four two - hour evening sessions The Smoking Cessation Subcommittee offered smoking cessation classes biannually Education was offered at schools , worksites , churches , and other community agencies An “ I QUIT ” Tree was displayed annually The Access to Care Committee partnered with Project Access to improve availability of healthcare to the residents of Johnston County Setting Community Priorities The Johnston County Community Health Assessment Committee met to determine the priorities for 2010 – 2014 Johnston County Health Department surveyed 397 Johnston county citizens regarding what they see as the top health concerns of the County Summation of the survey results included these top health concerns obesity , diabetes , teen pregnancy , motor vehicle accidents , heart disease , and cancer The issues with the largest impact on quality of life were unemployment , lack of health insurance , and affordable health services The results of the survey and the secondary data for ur county were shared with a Board of Health Member and a local Round Table comprised of Johnston County Agency Heads The agencies represented included the following DSS , County Commissioners , Mental Health , Juvenile Justice , the County School system The Community Health Assessment Committee , which included a Board of Health member , Health Director , Nursing Director , Health Education Specialist and a local college nursing student , reviewed the results The community survey was compared to our mortality morbidity rates and other county statistical data The following top health priorities were adopted to be addressed in our County Cardiovascular Disease , Cancer , 42Page3Obesity , Diabetes , Access to Care , and unintentional injuries The addition of cancer and unintentional injuries to our priorities reflects the increase in cancer and motor vehicle deaths in our county Action Plans • Cardiovascular Disease Diabetes Obesity o Continue Smoking cessation classes and programs ; expand to local work - sites o Nutrition classes at local churches , senior centers , and businesses o Continue Annual 3K Walk o Continue Wise Woman Project , screening and referral for blood pressure and cholesterol o Perform cholesterol screenings on high risk children in the Health Department Child Health Clinic o Perform BMI screenings during Health Department events o Provide nutrition education for children at risk for obesity o Expand the school garden program in the elementary schools o Expand the ADA Certified Diabetic program to local providers o Blood glucose screenings at health fairs , churches , senior centers , businesses o Continue medication assistance program for Johnston County Health Department patients • Cancer o Continue NC Breast and Cervical Cancer Control Program o Continue the Susan G Komen for the Cure Triangle Affiliate Grant o Expand education programs to community agencies and the faith community o Promote smoking cessation classes in all Health Department clinics and community events • Access to Care o Support Project Access clinics providing in - kind donation of the Health Department facility and staff o Work with Project Access and Safety Net Providers to develop a strategic plan for funding to provide care to the uninsured in our county ie HealthNet funding , etc o Continue care through the Primary Care Clinic of the Health Department for the underserved and provide a primary care home for Project Access patients o Encourage the Office of Rural Health to review the Johnston County Health Professional Shortage Area HPSA score to assist with recruiting providers to the community • Unintentional Injuries o Support the Teen Driving Safety Committee by continuing to provide a public health presence o Provide safety initiatives through Safekids of Johnston County Coalition o Recommend policy changes through the Child Fatality Prevention Task Force 43Page