Community Health Assessment 2011 - Catawba County Health Partners [PDF]

Community Health Assessment 2011 Prepared by: Catawba County Public Health 3070 11th Avenue Drive SE, Hickory, NC 28602 828.695.5800 www.catawbacountync.gov/phealth

Table of Contents 2011 Catawba County Community Health Assessment Introduction…………………………………………………………………………………………………………………

1

Catawba County’s Health Priorities………………………………………………………………………………….

4

Community Profile………………………………………………………………………………………………………..

8

Access to Care………………………………………………………………………………………………………………

18

Cancer………………………………………………………………………………………………………………………... 25 Communicable Disease………………………………………………………………………………………………….

33

Diabetes……………………………………………………………………………………………………………………… 38 Heart Disease and Stroke……………………………………………………………………………………………….

44

Immunizations……………………………………………………………………………………………………………..

49

Infant Mortality…………………………………………………………………………………………………………….

53

Influenza and Pneumonia……………………………………………………………………………………………….

59

Injury and Violence………………………………………………………………………………………………………..

64

Mental Health………………………………………………………………………………………………………………

71

Nutrition and Physical Activity………………………………………………………………………………………..

73

Oral Health………………………………………………………………………………………………………………….

78

Overweight and Obesity………………………………………………………………………………………………..

83

Preparedness……………………………………………………………………………………………………………....

90

Senior Health……………………………………………………………………………………………………………….

94

Sexually Transmitted Diseases and HIV/AIDS……………………………………………………………………

101

Substance Abuse…………………………………………………………………………………………………………

107

Teen Pregnancy……………………………………………………………………………………………………………

114

Tobacco………………………………………………………………………………………………………………………

119

Acknowledgements………………………………………………………………………………………………………

124

Appendices Communications Plan…………………………………………………………………………………………………… 127 2011 Catawba County Community Health Assessment Survey…………………………………………….

128

2011 Catawba County Community Health Assessment Survey Results………………………………….

132

Healthy North Carolina 2020 Objectives…………………………………………………………………………..

138

Catawba County Health Resource Directory……………………………………………………………………

142

Community Health Assessment 2011

Introduction Overview Every four years, local health departments across North Carolina are required to conduct a Community Health Assessment (CHA) in their respective counties. The CHA is a comprehensive statistical benchmark intended not only to define a county’s health status, but also to inform and guide decisions by a variety of stakeholders regarding the community’s core health issues. The 2011 Catawba County Community Health Assessment:     

Represents the systematic collection, assembly, analysis, and dissemination of information about the health of Catawba County. Identifies important health indicators related to illness, death, and high-risk behaviors in Catawba County. Defines Catawba County’s health assets, needs, and priorities. Results from a collaborative effort dependent on community input and participation. Is facilitated by Catawba County Public Health.

In July 2010, Catawba County Public Health (CCPH) assembled a CHA Action Team comprised of CCPH mentors and more than 50 community members with expertise in various health issues. This team collaborated on gathering, analyzing, and reporting issue-specific data and developments since the county’s previous assessment in 2007.

Data Collection To ensure a comprehensive assessment, the CHA must utilize both primary (collected directly) and secondary (collected from other sources) data. To accomplish this, Catawba County’s CHA Action Team:     



1

Created a primary data collection tool – the 2011 Catawba County Community Health Assessment Survey – and distributed it to more than 3,000 residents. Utilized electronic and paper versions in both English and Spanish to facilitate broad participation. Collected more than 2,000 responses; 500 were required, and a minimum of 1,200 was needed to ensure statistical relevance in relation to county population. 1,996 responses were tallied; incomplete surveys and those from respondents with zip codes outside the county were not counted. Gathered relevant secondary data from local, state and national sources listed in each section. Survey demographics were fairly consistent with Catawba County demographics, with the following notable differences: o The survey had a higher response rate from females (76.6%) when compared to the percentage of females in the county (50.6%). o The percentage of African American respondents (15.7%) was nearly double the percentage of African Americans in the county (8.4%). o The percentage of Asian respondents (1.9%) represented approximately half of the county’s total percentage (3.5%). o Overall, survey respondents were more educated than the total county population, with fewer respondents indicating receipt of a high school diploma (23.5% compared to 30.7% in county) Community Health Assessment 2011

Introduction o

and more respondents indicating receipt of a bachelor’s degree (17.6% compared to 12.8% in county) or a graduate/professional degree (15.8% compared to 4.9% in county). The Hispanic response rate (7.9% compared to 8.4% in county) and white response rate (79.8% compared to 81.7% in county) were fairly close. Income levels of respondents were also fairly close to county demographics.

Report Compilation The CHA Action Team compiled individual health issue reports with the following components:        

Overview: A brief description of the health issue and its current status. Catawba County Data: A compilation and analysis of the most current and relevant county-level data available. National or State Data: A compilation and analysis of the most current and relevant state or national data available. Assets: A comprehensive list of assets currently in place to address the issue in Catawba County. Opportunities: A needs analysis with recommendations to improve the issue in Catawba County. Conclusions: A brief summary of key findings. Notable Trends: Highlights of statistical trends since the 2007 Catawba County CHA. In some sections, trending is limited or not possible due to incompatible data sets or lack of comparable data. Did You Know: Data of interest to help frame the issue or highlight important facts.

Additional Sections In addition to specific health issue reports, the 2011 Catawba County CHA includes the following information:     

2

Community Profile: An analysis of Catawba County’s current health environment, including demographic and socioeconomic data. Catawba County’s Health Priorities: A summary of the priority determination process, results, and rationale. Healthy NC 2020: A review of the Healthy NC 2020 health objectives and where Catawba County currently stands in relation to them. Catawba County Health Resource Directory: A listing of health-related resources in Catawba County. A detailed analysis of issue-specific resources and gaps is included in each section. Acknowledgements: Recognition of the individuals who contributed their expertise to the CHA.

Community Health Assessment 2011

Introduction A FEW NOTES ABOUT DATA… 

The 2011 CHA represents the most current data available at the time of publication. In most cases, 2011 data had not been released; in many cases, 2010 data was also not yet available. While every effort has been made to include the newest data possible, some reports were not released in time to be included. However, Catawba County Public Health publishes a State of the County’s Health (SOTCH) report every December (excluding CHA years) to update local and state data on an annual basis. This report, along with the CHA, is available on the Catawba County Public Health website (www.catawbacountync.gov/phealth) and the Catawba County Health Partners website (www.catawbacountyhealthpartners.org).



Peer county data is included in four sections – Access to Care, Cancer, Overweight/Obesity and Substance Abuse. Because these four issues are considered priorities for Catawba County, peer data analysis has been included to help determine the magnitude of the issues not only in comparison to the state, but also in comparison to counties with similar populations, demographics and rural/urban ratios. Following state designations in the NC-CATCH data collection system, Catawba County’s peer counties are identified as Davidson, Gaston, Iredell, and Randolph.

3

Community Health Assessment 2011

Health Priorities Overview North Carolina’s Community Health Assessment (CHA) guidelines require the participation of the community not only in the creation of the CHA, but also in the identification of the county’s health priorities from CHA findings. Once local priorities are identified, communities create and implement action plans to help improve outcomes over time. A health priority is an issue that:   

Demands immediate action by nature of its magnitude and severity in the community. In most cases cannot be remedied by one entity or one change alone. Requires broad-based community effort to change outcomes and reverse statistics.

Following the 2004 Catawba County CHA, three local health priorities were named: access to care, childhood obesity and substance abuse. A fourth priority, cancer, was added following the 2007 CHA.

Priority Determination On October 25, 2011, findings from the 2011 Catawba County CHA were shared with a group of community stakeholders to gather input toward determining Catawba County’s health priorities for the next four years (2012-2015). Participants scored each issue from 1 to 5 (with 1 being very low and 5 being very high) on the following criteria: 

Magnitude: How big is the problem? How many individuals does the problem affect, either actually or potentially? In terms of human impact, how does it compare to other health issues?



Seriousness of Consequences: What degree of disability or premature death occurs because of the problem? What would happen if the issue were not made a priority? What is the level of burden on the community (economic, social or other)?



Feasibility: Is the problem preventable? How much change can be made? What is the community’s capacity to address it? Are there available resources to address it sustainably? What’s already being done, and is it working? What are the community’s intrinsic barriers, and how big are they to overcome?

Scores were tallied, and the final results were presented to the Catawba County Health Partners board for review. Catawba County Health Partners, a nonprofit organization managed by Catawba County Public Health, fosters partnerships to sustainably improve Catawba County’s health priorities through broad-based, long-term change strategies. The board evaluated the organization’s and community’s capacity to effect sustainable impact on the top-ranking issues and recommended four priorities for the Catawba County Board of Health’s approval. These recommendations represent a continuation of Catawba County’s current health priorities: Obesity: Local statistics for obesity are rising at alarming rates, especially among children. Health Partners’ Eat Smart Move More Catawba County coalition is actively implementing policy, systems and 4

Community Health Assessment 2011

Health Priorities environmental change strategies to improve nutrition and physical activity in the community. Because these are also major risk factors for diabetes, heart disease/stroke, and cancer, the work of this coalition addresses several major health issues in the county. Access to Care: Rising unemployment continues to make this a major concern in Catawba County. With pending healthcare reform on the horizon, helping the community navigate new requirements – and close remaining gaps in coverage – will be even more critical for Health Partners’ Access to Care coalition over the next four years. Cancer: Certain cancers – such as colon and lung – present significant opportunities for prevention. In Catawba County, where cancer is the number-one killer, the need to promote prevention is evident. This includes improving access to screenings and helping decrease cancer incidence in minority populations (particularly with prostate cancer) through the Health Partners’ Cancer Task Force. Substance Abuse: Substance abuse is viewed as a “winnable battle” due to its highly preventable nature. Health Partners’ A.S.A.P. of Catawba County coalition has generated significant momentum behind efforts to change the environment of easy alcohol availability for youth in Catawba County, and a continuation of these efforts is still needed to help prevent alcohol abuse and dependency. On December 6, 2011, the Catawba County Board of Health approved Catawba County Health Partners’ recommendation to continue the county’s focus on these four priorities through 2015. Per state guidelines, Catawba County Health Partners will collaborate with Catawba County Public Health to develop action plans for each priority, submit them to the state in June 2012, and begin implementation in July 2012. Full results and rankings follow.

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Community Health Assessment 2011

Health Priorities Community Health Summit Results (Ranked): October 25, 2011 Health Topic

Total Score

Obesity/Overweight

830

Nutrition/Physical Activity

778

Access to Care

777

Diabetes

777

Cancer

744

Heart Disease/Stroke

737

Substance Abuse

729

Tobacco

667

Senior Health

664

Teen Pregnancy

661

Mental Health

623

STDs, HIV/AIDS

621

Injuries/Violence

618

Infant Mortality

576

Oral Health

550

Communicable Disease

541

Preparedness

516

6

Overall 1. Obesity/Overweight 2. Nutrition/Physical Activity 3. Access to Care + Diabetes (tie) 5. Cancer 6. Heart Disease/Stroke 7. Substance Abuse 8. Tobacco 9. Senior Health 10. Teen Pregnancy Magnitude 1. Obesity/Overweight 2. Access to Care 3. Nutrition/Physical Activity 4. Diabetes 5. Heart Disease/Stroke Seriousness of Consequences 1. Obesity/Overweight 2. Access to Care 3. Diabetes 4. Cancer 5. Heart Disease/Stroke Feasibility 1. Obesity/Overweight 2. Nutrition/Physical Activity 3. Substance Abuse 4. Cancer + Diabetes (tie)

Community Health Assessment 2011

Health Priorities Community Health Summit Results (Unranked): October 25, 2011 Health Topic

Magnitude

Seriousness of Consequences

Feasibility

Total Score

Access to Care

4.4

4.4

3.6

12.3 (777)

Cancer

3.9

4.2

3.7

11.8 (744)

Communicable Disease

2.5

2.8

3.1

8.6 (541)

Diabetes

4.2

4.3

3.7

12.3 (777)

Heart Disease/Stroke

4.0

4.1

3.6

11.7 (737)

Infant Mortality

2.6

3.4

3.1

9.1 (576)

Injuries/Violence

3.1

3.5

3.2

9.8 (618)

Mental Health

3.5

3.4

3

9.9 (623)

Nutrition/Physical Activity

4.3

4.1

4.0

12.3 (778)

Obesity/Overweight

4.5

4.5

4.1

13.1 (830)

Oral Health

2.8

2.9

3

8.7 (550)

Preparedness

2.5

2.9

2.7

8.2 (516)

Senior Health

3.7

3.5

3.3

10.5 (664)

STDs, HIV/AIDS

3.2

3.4

3.2

9.9 (621)

Substance Abuse

3.9

3.9

3.8

11.6 (729)

Teen Pregnancy

3.4

3.6

3.5

10.5 (661)

Tobacco

3.4

3.7

3.4

10.6 (667)

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Community Health Assessment 2011

Community Profile Description Catawba County – comprised of Brookford, Catawba, Claremont, Conover, Hickory, Long View, Maiden and Newton – was established December 12, 1842. Located in the foothills of the Blue Ridge Mountains, this Western North Carolina county encompasses 405 square miles and, according to U.S. Census Bureau 2010 results, is home to 154,358 residents.

Education There are 44 public schools in the County as well as Lenoir-Rhyne University, a 109-year-old private liberal arts institution, and Catawba Valley Community College. The County is also home to ASU-Hickory (formally known as the Hickory Metro Higher Education Center) and the NC Center for Engineering Technologies, which offers undergraduate and graduate degree programs.

Arts and Leisure Catawba County boasts 7 golf courses, which are playable year-round due to the temperate climate. Hickory Motor Speedway offers auto racing and has been in continuous operation for more than four decades. Bass fishing tournaments are held from March through October on Lake Hickory and Lake Norman. The Hickory Crawdads minor league baseball team has been playing in Catawba County since 1993, and the Greater Hickory 8

Community Health Assessment 2011

Community Profile Classic at Rock Barn (a PGA TOUR Champions Tour event) has been played in Conover since 2003. The arts are also well represented in Catawba County with symphony, theater, choral, and more locally available. The Hickory Museum of Art is the second oldest museum in North Carolina and is known for its concentration of 19th and 20th century American art. The Catawba Science Center recently added a planetarium and aquarium to its already existing science and exploration center. Catawba County also offers a variety of recreation facilities, parks, and pools across the County.

Economy The Hickory-Lenoir-Morganton Metropolitan Statistical Area (Hickory MSA), composed of Alexander, Burke, Caldwell, and Catawba Counties, is corporate headquarters for more than 40 businesses with at least $500 million in sales. Recognized worldwide as the furniture manufacturing center of the United States, Catawba County remains an industrial and retail center for the region. The traditional industries of furniture, hosiery, and textiles have been replaced by technologically-advanced industries such as fiber optics and plastics. At the same time, Catawba County continues to transition from a manufacturing-based economy to a service-based economy, driven in part by the growth of medical services. Catawba County is a major medical corridor, with two hospitals (one county-owned, one private), a large and growing medical community, and several nursing and retirement homes. The county’s largest employers are Catawba County Schools (over 2,000), Frye Regional Medical Center (1,500-2,000), Catawba Valley Medical Center (1,500-2,000), and Merchant Distributors International (1,500-2,000). In addition, the area attracts tourists which generate millions of dollars annually for the local economy. Despite these positive trends, the Hickory MSA has lost 46,000 jobs since the first quarter of 2000, mostly in manufacturing. Since 2000, Catawba County has lost net 25,000-plus jobs, primarily in apparel, furniture, hosiery, 6and fiber optics. In 2009, Catawba County lost more than 7,000 jobs. As of January 2011, Catawba County’s unemployment rate was 12.6%, nearly three percentage points higher than the North Carolina unemployment rate of 9.8%. Catawba County is also being impacted by the national foreclosure crisis. Between 2000 and 2010, the number of foreclosure cases increased from 284 to 975. The 975 foreclosures for Catawba County in 2009 were the most ever recorded in a single year.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The unemployment rate for Catawba County has more than doubled from 6% to 13%.

Population The Hickory MSA is the eighth largest in the State of North Carolina with a population of approximately 365,000 in 2010. From 2000 to 2010, Catawba County’s population increased by 8.9% from 141,685 to 154,358. While all ethnic groups grew between 2000 and 2010, the Hispanic population group grew at the fastest rate 9

Community Health Assessment 2011

Community Profile (from 7,886 in 2000 to 13,032 in 2010). All age groups in Catawba County have grown in the past 10 years, with the elderly (65 years old and older) increasing most rapidly. High immigration rates and an aging population will continue to put stress on government services and health care providers. The following tables show demographic details and recent population changes in Catawba County. Population Demographics, 2010 Group

Catawba County

Population

North Carolina

154,358

9,535,483

Percent of Females

50.6

51.2

Percent of Males

49.4

48.8

Percent Under 5 Years Old

6.5

7.0

Percent Under 18 Years Old

23.8

23.9

Percent 65 Years Old and Over

13.9

12.7

Percent of Whites

81.7

68.5

Percent of African Americans

8.4

21.5

Percent of Asian/Pacific Islanders

3.5

2.2

Percent of Hispanics/Latinos*

8.4

8.4

385.9

195.7

Population per Square Mile

*Included in various other races Source: 2010 Census, U.S. Census Bureau

Catawba County Population Changes, 2000 to 2010 2000

2010

Number of People Population % Number of People Population % Hispanic Population

7,886

5.6

13,032

8.4

Asian/Pacific Islander Population

4,221

3.0

5,405

3.5

All other Populations

129,578

91.4

135,921

88.1

Overall Population

141,685

100.0

154,358

100.0

Source: American Community Survey, U.S. Census Bureau, 2010

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Community Health Assessment 2011

Community Profile Greater Hickory Metropolitan Planning Organization (MPO) and Hickory MSA Population Projections, 2000-2035

2007

2035

Growth 20072035

283,787

294,519

404,035

109,516

37.2%

1.14%

Alexander County

33,603

36,554

41,450

7,847

21.5%

1.05%

Burke County

89,145

88,241

118,474

29,602

33.5%

1.11%

Caldwell County

77,708

79,237

100,460

22,752

28.7%

1.09%

Catawba County

141,686

152,891

213,518

60,627

39.7%

1.20%

342,142

356,923

473,902

120,828

33.9%

1.10%

Year Greater Hickory MPO Planning Area

Hickory MSA

2000

Percentage Growth 2007-2035

Percentage Average Annual Growth 2002-2035

Source: Greater Hickory MPO, U.S. Census Bureau, WPCOG Data Center, 2009

The U.S. Census has projected that North Carolina will become the 7th most populous state by 2030, with over 12.2 million residents. This move up from the current 11th place is expected to happen as the state passes Michigan, New Jersey, Ohio, and Georgia in total population. The NC state demographer has projected that North Carolina's population will increase by 54.6% between 2000 and 2030. Catawba County Educational Attainment Levels, 2009 Group

Population

Percentage

107,772

100.0%

Less than 9th Grade

8,412

7.8%

9th to 12th Grade, (No Diploma)

14,355

13.3%

High School Graduate (Includes Equivalency)

33,068

30.7%

Some College, No Degree

24,028

22.3%

Associate’s Degree

8,919

8.3%

Bachelor’s Degree

13,743

12.8%

Graduate or Professional Degree

5,247

4.9%

Percent High School Graduate or Higher

n/a

78.9%

Percent Bachelor’s Degree or Higher

n/a

17.6%

Population 25 Years and Older

Source: American Community Survey, U.S. Census Bureau, 2010

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Community Health Assessment 2011

Community Profile Catawba County Income Levels, 2009 Income Level

Households

% of Households

Less than $25,000

17,160

29.5

$25,000 to $50,000

16,796

28.9

$50,000 to $74,999

10,008

17.2

$75,000 to $99,999

7,063

12.2

$100,000 to $200,000

6,082

10.5

931

1.6

$200,000 or More Median Household Income (Dollars)

$41,116

Source: American Community Survey, U.S. Census Bureau, 2010

Catawba County Unemployment Rates, 2007-2009 Year

Catawba County

2007

5.9

2008

7.5

2009

14.6

2010

13.0

Source: Bureau of Labor Statistics-US Department of Labor, 2011

Catawba County Poverty Rates, 2009 Group

Percent Living Below Poverty Level

All Individuals

14.3

Under 18 Years

20.1

Related Children Under 5 Years

21.0

Related Children 5 to 17 Years

19.7

18 to 64 Years

12.6

65 Years and Over

11.4

Source: American Community Survey, U.S. Census Bureau, 2010

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Community Health Assessment 2011

Community Profile Catawba County Average Monthly Recipients of USDA Food Assistance Program, FY 2000- FY2010 Year

Catawba County Recipients

% of Population

Expenditures ($ millions)

North Carolina Recipients

% of Population

Expenditures ($ millions)

FY 2000

5,322

3.8%

$4.1

506,736

6.3%

$381.6

FY 2003

9,751

6.6%

$10.7

624,167

7.4%

$677.0

FY 2006

14,123

9.4%

$15.6

842,363

9.5%

$932.7

FY 2008

15,891

10.2%

$19.7

942,265

10.2%

$1,156.2

FY 2010

23,457

15.2%

$30.0 est.

1,294,732

13.6%

$1,636.4 est.

Source: NC Department of Health and Human Services

Poverty: A Key Determinant of Health Access to and quality of healthcare is related to insurance status, which is commonly related to socioeconomic status. In 2010, 16.9% of the Catawba County population was uninsured, with many living at the lower rungs of the socioeconomic ladder. As of 2009, 58.4% of households in Catawba County earned $50,000 or less. Although only 1% of Catawba County families receive Work First (previously Aid to Families of Dependent Children), there is a growing “working poor” population in the county. In 2009, 14.3%, or more than one in seven – of Catawba County residents lived in poverty. The number of persons living in poverty in Catawba County has increased 77%, from 12,806 in 2000 to 22,657 in 2009. Since 2000, Catawba County has experienced a 60% increase in persons receiving Medicaid and a 341% increase in food assistance recipients from 5,322 to 23, 457. About 46% of Catawba County’s workforce is women, many of whom are single parents. Many of these women work in service industries that require different shifts, hours and weekends. Such scheduling impacts children as only four licensed daycare centers in Catawba County provide second-shift daycare and none provide thirdshift; 9 licensed homes provide second- and third-shift childcare.

Children’s Services Child Abuse and Neglect: In fiscal year 2010, Catawba County Social Services received 2,570 reports of suspected child abuse and neglect that involved more than 5,000 children. Of these reports, 1,604 were accepted following assessment. Abuse (burns, fractures, internal injuries, sexual abuse) was involved in 9% of these reports, and 91% were reports of neglect (lack of supervision, parental substance abuse, injurious environment). Ongoing, in-home Child Protective Services (CPS) were offered to 547 families during 2010; 92% of families involved with CPS during the previous year did not experience a recurrence of child maltreatment within a 12 month period. In 2010, 117 children entered foster care in Catawba County – a decrease from 2009, when 173 children entered foster care. Approximately 50% of children in foster care are ages 0-5. The median stay in foster care for 13

Community Health Assessment 2011

Community Profile children reunified with their parents in 2010 was 6.5 months, compared to North Carolina’s median stay of 9.3 months. Median length of stay for children who are adopted is 20.2 months, compared to the North Carolina’s average of 27.5 months. Impact of the Economy: The economic downturn in Catawba County has had a profound impact on children in the community. In 2010, 44.6% (10,045) of food assistance recipients were 20 years old or younger. Children are also experiencing food insecurity, as reflected in the free and reduced lunch data for the three school systems in Catawba County. In 2009-10, 47% of children in Catawba County Schools (the largest school system) received free or reduced lunch, and 60% of children in both Newton-Conover City Schools and Hickory City Schools qualified for free or reduced school lunch. The living arrangements for children in the county also reflect the economic downturn. In a 2011 point- in-time homeless count, 36 children were identified as homeless of 265 individuals surveyed. More than 7,800 children in the county receive child support from absent parents, with the average child support payment at $187.39 per month. High unemployment in the county has negatively affected the collection of child support and the average payment amount. According to 2008 census data, 85.9% of children in Catawba County live with their parents as compared to 89.1% of children in North Carolina. However, 9.5% (3,538) of children live with their grandparents, and 3% (1,116) live with another relative as compared to 6.8% and 2.5% of North Carolina children, respectively.

Environment The Catawba County Environmental Health Division supports the mission of Catawba County Public Health and the North Carolina Department of Health and Human Services’ Division of Public Health and Environmental Health Section by providing local environmental health education and enforcement programs. Authority and regulatory requirements for administration and enforcement of individual environmental health programs is provided by North Carolina General Statute and rules adopted by the North Carolina Commission for Health Services. The focus of environmental health programs in North Carolina is to promote public health goals and ensure best public health practices regarding food and institutional sanitation, sub-surface sewage disposal, ground water protection, investigation of health hazards, and other environmental health concerns. Food, Lodging and Institutional Sanitation (FLI): FLI is the only program for permitting, conducting regular inspections, and investigating complaints in these types of facilities. In the last several years, temporary or mobile food service, festivals and other mass gatherings, tattooing establishments, and new public swimming pool regulations have fallen under the FLI regulatory umbrella. Required inspections of foodservice establishments have increased 7.8% over a 12-year time period (since 1998). Passage of more stringent food stand regulations during that time period increased the average number of required inspections for those facilities by 3.6% in 2010. On-site Water Protection (OSWP): The primary responsibilities of the OSWP program are the evaluation, permitting, inspection, and approval of sub-surface wastewater disposal systems and private water supply wells 14

Community Health Assessment 2011

Community Profile in areas not served by public water and sewer systems. The program is instituted by North Carolina General Statute and designated to protect public health by helping to ensure safe and effective wastewater disposal and protection of water resources. In addition to these stated responsibilities, OSWP further helps protect the public and environment through environmental investigations resulting from public complaints and in cooperation with other environmental agency investigations. The importance of OSWP in North Carolina is multifaceted. Septic tank systems serve approximately 50% of North Carolina’s residents, and large numbers of rural residents have a private well as a primary water supply. In 2010, 719 total permits were issued in Catawba County. Proper placement, inspection, and maintenance of these localized systems are matters of public health and safety, as well as significant front line mechanisms for basic environmental protection. Childhood Lead Poisoning Prevention: In Catawba County, an average of 2,433 children per year (2007 to 2009) was screened for elevated blood lead levels (data for 2010 and 2011 not yet available). Catawba County Environmental Health investigated six individual reported cases involving lead-exposed children since January 2008. While this is a relatively low number of reported cases for a county of similar population, a few cases were quite serious in nature and extent of the exposures. Interestingly, few of these investigations were successful in determining specific lead exposure sources. In none of the cases investigated was lead-based paint identified as a potential source, which is often the primary focus of lead investigations. A variety of reasons may contribute to this, including the prevalence of lead-tainted imports (particularly toys) from China, exotic and imported food products, and cultural behaviors. Public Swimming Pools: Amendments to the North Carolina Rules Governing Public Swimming Pools that require closing public swimming pools not in compliance with the Virginia Graeme Baker Pool and Spa Safety Act were approved by the Commission for Public Health in 2010. The act requires all public swimming pools to replace their suction drains with new safety drain covers and all single-drain pools to install a secondary means of preventing entrapment. The act was passed in response to high drowning rates among young children and deaths and injuries associated with suction drain entrapment in swimming pools, wading pools, and spas. It authorized the U.S. Consumer Product Safety Commission to enforce more stringent pool drain safety requirements and encouraged states to adopt effective pool fence or barrier standards to keep small children away from pool hazards. In order to ensure full compliance with the accepted standards well ahead of proposed compliance deadlines, Catawba County Environmental Health has proactively worked with public swimming pool owners since 2008, providing education and technical consultation. As a result of these ongoing efforts, all public swimming pools operating inside the county have incorporated the necessary upgrades and remain in compliance with the required standards. Air Quality: In Catawba County, air quality measurements are based on fine particulate matter and ozone. Fine particulate matter can cause serious health problems, including coughing or breathing difficulties, aggravated asthma, development of chronic bronchitis, irregular heartbeat, nonfatal heart attacks, and even premature death in people with heart or lung disease. High levels of ozone can cause irritation of the respiratory system, reduced lung function, aggravation of asthma, and inflammation and damage to the lining of the lungs. It may 15

Community Health Assessment 2011

Community Profile also weaken the immune system against disease. Children, the elderly, adults who are active outdoors, and people with respiratory disease are most at risk of health consequences from high levels of fine particulates and ozone. As part of the Clean Air Act, the Environmental Protection Agency (EPA) sets standards every five years for PM 2.5 and ozone to protect public health. Fine Particulate (PM2.5) Monitor Readings in Catawba County, 2004-2009 Three-Year Average

(Micrograms per Cubic Meter)

2004 to 2006

15.38

2005 to 2007

15.23

2006 to 2008

14.18

2007 to 2009

12.58

Source: Environmental Protection Agency (EPA) and North Carolina Division of Air Quality (NCDAQ), 2011

The EPA declares an area at non-attainment for PM 2.5 if the three-year average at the monitor is higher than 15 micrograms per cubic meter. Through 2007, Catawba County received non-attainment status. The current three-year average (2007-2009) stands at 12.58 micrograms per cubic meter, well below the federal standard. In November 2011, the EPA changed the county’s status back to attainment for the PM standard. Ozone Monitor Readings for Catawba County, 2004-2009

Three-Year Average

Lenoir Monitor Parts Per Million

Taylorsville Monitor Parts Per Million

2004 to 2006

0.074

0.076

2005 to 2007

0.079

0.076

2006 to 2008

0.078

0.075

2007 to 2009

0.073

0.071

2008 to 2010

0.070

0.069

Source: Environmental Protection Agency (EPA) and North Carolina Division of Air Quality (NCDAQ), 2011

Catawba County’s attainment status for ozone is affected by two monitors (located in Lenoir/Caldwell County and Taylorsville/Alexander County). The EPA declares an area non-attainment for ozone if the monitor has a three year average of more 0.084 parts per million. Both monitors have been below the standard since 2003. Several actions have been taken to reduce ozone and PM 2.5 levels in Catawba County. Catawba County and Catawba County Public Health remain active members of the Early Action Compact. This agreement to reduce ozone between local governments, the North Carolina Division of Air Quality and EPA has been a great success in Catawba County and has been recognized nationally.

16

Community Health Assessment 2011

Community Profile References         

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17

Catawba County Social Services. Annual Report 2010. http://www.catawbacountync.gov/events/DSSAnnual2010.pdf Catawba County Web Reports, WLS Tracking Flags and Evaluations, http://inspector.catawbacountync.gov/webreports/wrmenu_eh.asp Catawba County Web Reports, Smoking Complaint Inspections Export, http://inspector.catawbacountync.gov/webreports/wrmenu_eh.asp Jill D. Moore. Public Health. County and Municipal Government in North Carolina, Article 41, 2007. http://www.sog.unc.edu/pubs/cmg/cmg41.pdf North Carolina Coalition to End Homelessness. 2011 Point-in-Time Count: Balance of State. http://www.ncceh.org/attachments/contentmanagers/825/BoS_by_County_2011.pdf North Carolina Division of Air Quality (NCDAQ), 2010 Monitoring and Emissions Data, http://www.ncair.org/ National Environmental Services Center. Pipeline Newsletter. Summer 2008, Vol. 19, No. 1. http://www.nesc.wvu.edu/pdf/WW/publications/pipline/PL_SU08.pdf North Carolina Employment Security Commission (NCESC), https://www.ncesc.com/default.aspx North Carolina Employment Security Commission (NCESC), March 2011. County Unemployment Rates for January Released. http://www.ncesc1.com/pmi/rates/PressReleases/County/NR_Jan_2011_CountyRates.pdf North Carolina Department of Public Instruction. http://www.ncpublicschools.org/ North Carolina Division of Social Services. http://www.ncdhhs.gov/dss/ North Carolina Division of Public Health, Tobacco Prevention and Control Branch, December 2010. Smoke Free NC. http://tobaccopreventionandcontrol.ncdhhs.gov/smokefreenc/ North Carolina Department of Environment and Natural Resources, Division of Environmental Health, March 2010. The Experience. http://www.deh.enr.state.nc.us/images/newsletters/Exp%20v7%20March2010-1.pdf North Carolina Department of Environment and Natural Resources, Division of Environmental Health, Children’s Environmental Health Branch, September 2009. Childhood Blood Lead Level Surveillance Data. http://www.deh.enr.state.nc.us/Children_Health/Lead/Surveillance_Data_Tables/2009AnnualTable.pdf United States Census Bureau. 2010 Census. http://2010.census.gov/2010census/ United States Census Bureau. 2010 American Community Survey. http://www.census.gov/acs/www/ United States Environmental Protection Agency (USEPA). http://www.epa.gov/ United States Environmental Protection Agency, February 2002. Onsite Wastewater Treatment Systems Manual, EPA publication EPA/C25/R-00/008. http://www.epa.gov/owm/septic/pubs/septic_2002_osdm_all.pdf Western Piedmont Council of Governments. http://www.wpcog.org/.

Community Health Assessment 2011

Access to Care Overview The issue of access to healthcare has neither been more prominent nor more contested in the United States than it is today. With the passage of the Patient Protection and Affordable Care Act (PPACA) in 2010, mandatory healthcare coverage for all United States citizens by 2014 is on the horizon. While some parts of the bill – such as increased insurance coverage for children – have already been enacted, it continues to face legislative and legal hurdles that may cause it to be repealed. Regardless of future healthcare reform, the number of uninsured individuals is currently on the rise. This increase has been attributed to a number of causes, including a severely weakened economy, rising healthcare and health insurance costs, growing unemployment, language and cultural barriers, and declining employmentbased health insurance coverage. With a higher than average unemployment rate, the ability to access insurance coverage and medical care continues to decline for Catawba County residents. A number of health access issues may arise for adults without insurance. The uninsured are less likely to receive clinical preventive services; may delay or forgo physician visits and needed treatment; are more likely to be diagnosed with later-stage cancers; and are more likely to die from trauma or serious acute conditions. In the United States, low income persons face the greatest health access barriers and are the least likely to be insured. In 2011, the U.S. Department of Health & Human Services set federal poverty guidelines at incomes of $10,890 or less for an individual and $22,350 or less for a family of four. Since racial and ethnic minorities are more likely than whites to have incomes beneath the federal poverty level, they are also more likely than whites to be uninsured. Education is also closely linked to health care access. Individuals who are more educated report lower morbidity for most common acute and chronic diseases; an additional four years of education lowers five-year mortality rates by 1.8 percentage points. In North Carolina, the Hickory-Morganton-Lenoir Metropolitan Statistical Area (Hickory MSA) ranks last for overall educational attainment.

Catawba County Data Uninsured Estimates for Catawba County and North Carolina, 2010 Catawba County

North Carolina

Uninsured Estimates for Children (under 18)

5.6%

7.7%

Uninsured Estimates for Adults (18-64)

24.6%

23.6%

Total Population

16.8%

16.8%

Source: U.S. Census Bureau, 2010 American Community Survey 18

Community Health Assessment 2011

Access to Care 



 



 

According to the U.S. Census Bureau’s American Community Survey, 16.8% of Catawba County’s total population was estimated to be uninsured in 2010. This equals the percentage for North Carolina for the same year. Demographic analysis reveals significant minority disparities among the uninsured in Catawba County: 15.6% of the white population, 24.1% of the black/African American population, and 36.3% of the Hispanic/Latino population was uninsured in 2010. In 2010, 18.9% of the employed labor force in Catawba County was uninsured. In Catawba County, educational attainment is significantly linked to healthcare coverage: 7.0% of individuals with a bachelor’s degree or higher were uninsured in 2010, compared to 21.3% of individuals receiving only a high school diploma or GED. When compared to North Carolina, a smaller percentage of Catawba County children were estimated to be uninsured and a slightly larger percentage of Catawba County adults were estimated to be uninsured. Catawba County’s 3-year estimate for the uninsured (2008-2010) was 16.5% for the total population, indicating that the percentage of uninsured has remained fairly steady post-recession. In 2007, 16% of the total county population was uninsured. The most current numbers represent a 5% increase in the uninsured population.

2011 Catawba County Community Health Assessment Survey

7.8%

Question asked on survey: Where do you go most often for health care when you are sick? (Check one.)

2.7%

1%

4%

0.9%

7.5% 3% 4%

69%

Private Doctor's Office Health Department Free Clinic Hospital Emergency Room Urgent Care Center Walk-in Clinic Pharmacy 



 

19

The 2011 Catawba County Community Health Assessment Survey found that 23% of people surveyed do not have a medical home. These results are close to the results of the 2010 Behavioral Risk Factor Surveillance Survey (BRFSS), which indicated that 72.9% of adults surveyed have one person they think of as their personal doctor or health care provider. In 2009, 16.2% of adults surveyed in Catawba County reported that they needed to see a doctor in the past 12 months but could not. In a 2008 survey of uninsured persons by Catawba County Health Partners, 82.3% of respondents reported that finances were the main reason they did not go to the doctor. The same survey showed Community Health Assessment 2011

Access to Care 



that 64.6% of respondents were unemployed and 47.6% had been without insurance for 5 or more years. According to the 2010 BRFSS survey, 32.8% of Catawba County adults indicated that there had been a time when they did not fill or refill a medication prescribed by a doctor. Of those respondents, 44.4% indicated that they did so because they could not afford to pay for the medicine. In Catawba County, the percentage of people below the poverty level rose from 9.1% (n = 12,688) in 2000 to 14.3% (n = 22,457) in 2009, a 77% increase. In many cases, a person’s poverty level has a direct correlation to ability to afford insurance or pay out-of-pocket for medical care. Access to Healthcare Providers Catawba County

North Carolina

Dentists per 10,000

4.5

4.3

Physicians per 10,000

23.4

21.2

Primary Care Physicians per 10,000

8.2

9.0

Source: NC-CATCH, 2008

 

As of 2008, Catawba County exceeded state rates of dentists and physicians per 10,000 population and had slightly lower numbers for primary care physicians than North Carolina. The number of primary care physicians has slightly decreased in relation to the population; in 2006, Catawba County had 9.1 physicians per 10,000 population. Peer County Data Access to Care 25.0%

20.0% 19.2% 15.0%

16.8%17.1%

Catawba 15.5%14.9%

Davidson 12.4% 11.7% 10.9%10.7%10.4%

10.0%

Gaston Iredell Randolph

5.0%

0.0% Percent Uninsured, 2010

Percent of Children Uninsured, 2009

Source: U.S. Census Bureau, 2010 American Community Survey; Kids Count Data Center, 2009

20

Community Health Assessment 2011

Access to Care 

Catawba County’s adult uninsured rate ranks third among peer counties, while its uninsured rate for children ranks second.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The rate of primary care physicians per 10,000 population in Catawba County has decreased by 9.9%.  Catawba County’s uninsured population has increased by 5%.

National or State Data   





In North Carolina, nonelderly persons (between the ages of 0 and 64) below 100% of the federal poverty level represent 39% of the state’s uninsured. According to the NC Office of Minority Health (2010), 23.1% of African Americans, 28.3% of American Indians, and 65.0% of Hispanics/Latinos are uninsured in North Carolina. Hispanics/Latinos in North Carolina face significant healthcare barriers and are more likely to report not being able to see a doctor due to cost, not having a personal doctor, and fair or poor health than both whites and African Americans. The U.S. Census Bureau’s 2010 Supplement to the Current Population Survey reveals that the number of nonelderly uninsured in the U.S. rose to 50 million in 2009 (17%) from 44.8 million in 2005, an increase of 5.2 million persons – representing almost one in five nonelderly persons in the U.S. Since 2005, employer insurance premium contributions have increased 20% and worker contributions have increased 47% across the U.S., which has been a contributing factor to the increased numbers of individuals without insurance.

DID YOU KNOW?  In the U.S., spending for healthcare services continues to rise both in total expenditures ($1.4 trillion in 2011; $3.1 trillion projected for 2012) and as a share of the country’s gross national product (14.1% in 2011; 17.7% projected for 2012).

Assets     

21

The Greater Hickory Cooperative Christian Ministry’s (GHCCM) health clinic provides primary medical care and medications at no charge to uninsured adults who are within 200% of the federal poverty level. In Newton, the Clinic for People without Health Insurance is operated by Dr. Wofford; a fee is charged depending on the patient’s ability to pay. St. Joseph’s Hispanic Clinic in Newton serves mainly Spanish-speaking clients, many of whom lack insurance. Medical Access for Catawba County (MACC) is a partnership comprised of volunteer physicians and GHCCM to provide chronic disease management for the low-income and uninsured. Catawba Valley Community College has offered a medical interpreter class for the past two years and is now transitioning the module into a “Health and Human Services Interpreter Class.” Community Health Assessment 2011

Access to Care 

  







 





Catawba County Health Partners’ Access to Care coalition continues to develop programs (such as MACC and the interpreter class) to address healthcare access, which has been designated a health priority for the county since 2005. The United Hmong Association and Centro Latino offer interpreter services for medical appointments. Catawba County Social Services coordinates a medication discount program that offers cards for discounted medications to anyone without a prescription card. Catawba County Public Health (CCPH) offers an array of medical and preventive health services along with interpreters as needed. Some services have eligibility requirements, while others are available to the general public. CCPH helps enroll children in North Carolina Health Choice (NCHC), which provides access to free or reduced-price comprehensive care for children whose families make too much money to qualify for Medicaid but too little to afford rising health insurance premiums. Public Health’s School Health program operates the Kids In Need (KIN) Fund, which helps cover the cost of basic healthcare – including preventive, diagnostic and treatment services; prescribed medications; and some dental work – for eligible children who lack medical coverage. Catawba County residents have access to two major hospitals, Catawba Valley Medical Center (CVMC) and Frye Regional Medical Center (FRMC), which provide medical, educational, and emergency care services to the region. CVMC’s primary care practices (Catawba Valley Medical Group) accept patients with Medicaid. Greenway Public Transportation, the county’s mass transit system, provides bus, dial-a-ride, flex route, and reduced-rate paratransit (for the disabled per ADA guidelines) services. Routes cover the “medical corridor” around both hospitals and along Tate Boulevard, where many medical offices are located. In coordination with Hickory-based medical practice Bowen Primary & Urgent Care PA, Patient Physician Cooperative (PPC), a nonprofit organization, offers access to primary care, urgent care, and diagnostic services (such as lab work) to those without insurance for a low monthly fee. The Program for All-Inclusive Care for the Elderly (PACE) is a federal program mostly funded through Medicaid and Medicare that provides care and services five days a week to people who otherwise would need nursing home care. Palliative CareCenter & Hospice of Catawba Valley, Lutheran Services for the Aging, Adult Life Programs, and CVMC have worked together to bring the service to the area.

Opportunities 

  

The county’s major healthcare providers are investigating the possibility of establishing a Federally Qualified Health Center (FQHC) in Catawba County. An FQHC receives federal funding to provide comprehensive primary and preventive care services to underserved populations regardless of ability to pay. The MACC partnership, which increased access to chronic care for the low income/uninsured, is a model that can be duplicated for other medical needs (such as access to specialized care) in the community. Greenway Public Transportation is developing a “Friends in Transit” program that would provide free transportation to and from medical appointments for those who lack other transportation options. By 2014, healthcare reforms are expected to include mandatory health insurance for all U.S. citizens; availability of insurance coverage for individuals with pre-existing conditions; the creation of state health insurance exchanges; and changes to Medicaid and Medicare coverage.

Conclusions 

22

Catawba County has experienced an increase in its uninsured population.

Community Health Assessment 2011

Access to Care 



Catawba County’s rising unemployment rate, increase in the percentage of persons below the poverty level, growing Hispanic/Latino population, and lower overall educational attainment are key health access indicators. If upheld, national healthcare reform legislation will dramatically increase access to insurance and medical care in Catawba County.

References 

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23

Catawba County Public Health, February 2011. Community Health Assessment (CHA) Survey Results, 2010-2011. http://www.catawbacountyhealthpartners.org/CHASurveyResults10.pdf Employment Security Commission of North Carolina, February 1, 2011. Unemployment Rates Decrease In Over Half of North Carolina’s Counties in December. http://www.ncesc1.com/PMI/Rates/PressReleases/County/NR_Dec_10_CountyRate.pdf Institute of Medicine, February 2009. America’s Uninsured Crisis: Consequences for Health and Health Care. http://www.iom.edu/Reports/2009/Americas-Uninsured-Crisis-Consequences-for-Health-andHealth-Care.aspx Kaiser Family Foundation, 2011. Health Insurance/Costs. http://www.kff.org/insurance/index.cfm Kaiser Family Foundation, 2009. State Health Facts - North Carolina: Nonelderly Uninsured. http://www.statehealthfacts.org/profileind.jsp?sub=40&rgn=35&cat=3 Kaiser Family Foundation, December 2010. The Uninsured: A Primer. http://www.kff.org/uninsured/upload/7451-06.pdf Catawba County Chamber of Commerce/Leadership Catawba, January 13, 2011. Catawba County and Hickory MSA Trends. L. Picker. The Effects of Education on Health. The National Bureau of Economic Research Digest, March 2007. http://www.nber.org/digest/mar07/w12352.html NC-CATCH, 2009. Catawba County Health Profile. http://www.ncpublichealthcatch.com/ReportPortal/design/view.aspx NC-CATCH, 2008. Dentists per 10,000 Population: Catawba County. http://www.ncpublichealthcatch.com/ReportPortal/design/view.aspx NC-CATCH, 2008. Physicians per 10,000 Population: Catawba County. http://www.ncpublichealthcatch.com/ReportPortal/design/view.aspx NC-CATCH, 2008. Primary Care Physicians per 10,000 Population: Catawba County. http://www.ncpublichealthcatch.com/ReportPortal/design/view.aspx North Carolina Department of Health and Human Services, Division of Public Health, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County: Health Care Access. www.schs.state.nc.us/SCHS/brfss/2010/cata/persdoc2.html North Carolina State Center for Health Statistics and Office of Minority Health and Health Disparities, June 2010. Racial and Ethnic Health Disparities in North Carolina Report Card. http://www.epi.state.nc.us/SCHS/pdf/MinRptCard_WEB_062210.pdf North Carolina State Center for Health Statistics and Office of Minority Health and Health Disparities, July 2010. North Carolina Minority Health Facts: Hispanics/Latinos. http://www.epi.state.nc.us/SCHS/pdf/Hispanic_FS_WEB_080210.pdf Pew Hispanic Center, 2011. Data and Resources: Catawba County, North Carolina. http://pewhispanic.org/states/?countyid=37035 United States Department of Labor, June 2011. Unemployment Rates for Metropolitan Areas. http://www.bls.gov/web/metro/laummtrk.htm United States Census Bureau, June 3, 2011. State and County Quick Facts: Catawba County, North Carolina. http://quickfacts.census.gov/qfd/states/37/37035.html Community Health Assessment 2011

Access to Care 

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24

United States Census Bureau, American Community Survey 2008-2010 and 2010. Health Insurance Coverage Status (Catawba County and North Carolina, 1-year and 3-year Estimates). http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_1YR_S270 1&prodType=table United States Department of Health and Human Services, January 2011. 2011 HHS Poverty Guidelines. http://aspe.hhs.gov/poverty/11poverty.shtml United States Department of Health and Human Services, Centers for Medicare & Medicaid Services, 2009. National Health Expenditure Fact Sheet. https://www.cms.gov/NationalHealthExpendData/25_NHE_Fact_Sheet.asp

Community Health Assessment 2011

Cancer Overview Cancer is a group of more than 100 different and distinctive diseases characterized by the uncontrolled growth and spread of abnormal cells. It continues to be the 2nd leading cause of death in the United States, surpassed only by heart disease. However, in North Carolina and Catawba County, 2009 data indicates that cancer is the leading cause of death for all ages, genders, and races. Prevention and early detection are imperative in affecting survival, which varies greatly by cancer type and stage at diagnosis. Risk factors of cancer are divided into 2 groups: hereditary or acquired abnormalities, and environmental factors. Hereditary or acquired abnormalities include hormonal and immune system disorders. These cancers cannot be prevented, but regular screenings can detect cancers at an early stage when they are most treatable. Environmental factors include tobacco, diet and obesity, infections, radiation exposure, lack of physical activity, and environmental pollutants. These cancers may be preventable with behavioral changes and medical interventions. Treatment options may include, but are not limited to, surgery, chemotherapy, radiation therapy, immunotherapy, and biologic therapy. These treatments can be used individually or in combination. Clinical trials may be an alternate treatment option. Ultimately, the treatment option depends upon the diagnosis, health of the patient, and stage of cancer.

Catawba County Data    

Combining male and female cancer diagnoses, lung cancer leads in the number of new cases, and mortality rates continue to increase. Colorectal cancer incidence and mortality rates are also rising. Breast cancer continues to be the most frequent cancer diagnosis in women; however, the mortality rate has declined. Prostate cancer remains the most frequent diagnosis among men; however, rates of new cases and mortality remain constant. New Cancer Cases

Mortalities

2007

2008

2009

2007

2008

2009

Breast

110

123

133

20

29

16

Colorectal

80

74

81

30

26

31

Lung

100

146

126

85

102

114

Prostate

115

123

117

15

15

16

Source: North Carolina Central Cancer Registry (new cases for 2009 show projections)

25

Community Health Assessment 2011

Cancer 2011 Catawba County Community Health Assessment Survey

Question asked on survey: In the last 12 months, have you participated in any of the following cancer screenings? (Check all that apply.)

60.0% 50.0%

52.4%

46.5%

40.0% 30.0% 20.0%

11.7%

16.7%

11.0%

15.0%

13.6%

10.0% 0.0%



Based on the data above, women are more likely to get recommended cancer screenings (breast and cervical) than men (prostate). The number for colorectal cancer screening – which impacts both men and women – is the lowestreported screening among all residents surveyed.



DID YOU KNOW?  Catawba County has maintained a higher rate of all cancer deaths through 2009 as compared to North Carolina. Driving the trend is an increase in colorectal cancer deaths among all populations and lung cancer deaths particularly in white males.

 Lung cancer is by far the leading cause of death among both men and women. The North Carolina State Center for Health Statistics shows that from 2005 – 2009 in both Catawba County and North Carolina, more people died of lung cancer each year than of colorectal, breast, pancreatic, and prostate cancers combined.

 Cancer has become the leading cause of death in the world. According to John Seffrin, American Cancer Society CEO, it is “potentially the most preventable and curable of all life-threatening disease facing humankind.”

26

Community Health Assessment 2011

Cancer Cancer Death Rates, 2005-2009 Catawba County

North Carolina

White Population

200.0

183.3

Minority Population

215.2

209.8

Female Population

163.4

155.7

Male Population

265.0

238.2

Total Population

201.4

188.8

White Population

26.1

20.9

Minority Population

52.8

53.3

Total Population

27.7

26.0

White Population

24.8

22.4

Minority Population

21.9

29.9

Total Population

24.3

23.9

White Population

64.4

58.8

Minority Population

46.7

53.6

Female Population

42.4

42.4

Male Population

95.2

79.7

Total Population

63.2

58.0

White Population

20.4

15.5

Minority Population

33.0

21.7

Female Population

17.1

14.2

Male Population

27.8

20.2

Total Population

21.2

16.7

Prostate Cancer (Male)

Breast Cancer (Female)

Trachea, Bronchus, & Lung

Colon, Rectum, & Anus

Source: State Center for Health Statistics, 2005-2009, deaths per 100,000 (age adjusted) *Data in red indicates rates based on small numbers (fewer than 20 cases) and should be interpreted with caution.

27

Community Health Assessment 2011

Cancer Breast Cancer:  Catawba County’s breast cancer death rates are fairly close across white (24.8) and minority (21.9) populations and when compared to North Carolina’s overall rate (24.3 to 23.9).  According to the 2011 Catawba County Health Assessment Survey, women appear to be getting screened for gender-specific cancers at significantly higher percentages than men. Colorectal Cancer:  In Catawba County, the male death rate (27.8) is significantly higher than the female death rate (17.1).  Colorectal cancer is the 2nd-highest diagnosis in men and women, yet it has the lowest screening rate among those surveyed. According to the 2011 Behavioral Risk Factor Surveillance Survey, 61.8% of adults age 50 and older have had either a sigmoidoscopy or a colonoscopy. Screening rates are significantly higher among whites (64.6%) than minorities (41.1%). Lung Cancer:  Men in Catawba County die from lung cancer at a rate (95.2) that more than doubles the rate for females (42.4).  The death rate for the white population (64.4) is significantly higher than that of the minority population (46.7). Prostate Cancer:  Prostate cancer is the leading cancer diagnosis in men but has a low screening rate among those surveyed.  While prostate cancer is one of the most common types of cancer and incidence is high, mortality cases are significantly low. Peer County Data

Cancer, One Year Mortality Rates, 2009 200 195 194.7 190 Catawba

185

Davidson

180 180.2

179.8 175 170

173.8

174.7

Gaston Iredell Randolph

165 160 Total Population Source: NC Health Data Explorer, 2009



28

Compared to cancer mortality rates in peer counties, Catawba County’s morality rate is relatively close to four out of five of the counties.

Community Health Assessment 2011

Cancer Peer County Data Cancer, One Year Mortality Rates, 2009 200 195 194.7 190 Catawba

185

Davidson

180 180.2

179.8

Gaston

175 170

173.8

Iredell

174.7

Randolph

165 160 Total Population Source: NC Health Data Explorer, 2009



While Catawba County’s cancer death rates are lower than its four peer counties, the minority death rate in Catawba County is significantly higher.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The prostate cancer death rate for minority males in Catawba County has decreased by 35.1%.  The colon, rectum and anus cancer death rate for minorities in Catawba County has increased by 70.1%.

National or State Data     



29

The colorectal cancer death rate among the minority population in North Carolina (21.7) is significantly lower than Catawba County’s rate (33.0) but higher than the U.S. minority death rate (19.6). North Carolina has a higher rate of lung cancer deaths among the white population than among minorities, which is the opposite of Catawba County. While female lung cancer death rates for North Carolina and Catawba County are identical (42.4), the male rate for the state (79.7) is significantly lower than that for Catawba County (95.2). The lung cancer death rate for females in North Carolina (42.4) is higher than the national rate (40.6). This is also true for men in North Carolina (79.7) compared to men nationwide (68.8). Minority men in North Carolina die from prostate cancer at twice the rate of whites. The low number of minority deaths reported in Catawba County from 2005-2009 does not provide adequate data for analysis or comparison to North Carolina and the United States. Skin cancer is the most common form of cancer in the United States. The rate of skin cancer deaths per 100,000 for North Carolina was 19.8, ranking North Carolina 28th of 50 states. Community Health Assessment 2011

Cancer Assets Breast Cancer:  The Breast and Cervical Cancer Control Program (BCCCP) through Catawba County Public Health (CCPH) aims to ensure early detection for low-income women ages 40-64.  CCPH’s Women’s Preventive Health clinic provides preventive physicals, breast exams and education on self breast exams.  A partnership between Catawba Valley Medical Center (CVMC) and CCPH offers mammograms to eligible women utilizing CVMC’s Mobile Mammography Unit.  Additional free mammograms are available for eligible women through CCPH due to funding provided by Centro Latino and the Through Healing Eyes Foundation.  The NC Foothills Affiliate of Susan G. Komen Race for the Cure raises money at the local level to support breast cancer prevention and treatment efforts in Catawba County. This includes the opportunity for CCPH to refer eligible women with breast abnormalities for diagnostic testing and surgical follow-up. Frye Regional Medical Center (FRMC) offers mammograms utilizing funding through the affiliate.  The Catawba County Breast Cancer Coalition provides breast health education classes to community groups.  Breast cancer support groups and programs include Through Healing Eyes’ Strides to Recovery (CVMC), New Beginnings Yoga (CVMC, FRMC), Breast Friends (FRMC), Hearts of Hope (CVMC), Look Good Feel Better (American Cancer Society-ACS), and Reach to Recovery (ACS).  CVMC and FRMC offer a range of services aimed at prevention, early detection, and treatment of breast cancer. These include digital mammography, BSGI (Breast Specific Gamma Imaging), breast MRI (Magnetic Resonance Imaging), and patient navigation services.  FRMC is approved as an Accredited Breast Center by NAPBC (National Accreditation Program for Breast Centers).  The Catawba County Home Extension Camisole Project provides camisoles and care bags to breast cancer patients. Colorectal Cancer:  FRMC offers CT colonography screening and patient navigation services for colorectal cancer patients.  Catawba County Health Partners’ Cancer Task Force focuses on colorectal cancer prevention, early detection, and education.  Gastroenterology Associates offers in-house colon cancer screenings and colonoscopies. Lung Cancer:  CCPH, CVMC, and FRMC have educators on staff to provide tobacco prevention programs.  CVMC and FRMC promote the ACS Freshstart Smoking Cessation Program to help smokers quit.  The NC Smoke-free Restaurants and Bars Law was passed in 2009 and implemented in 2010. This law requires all North Carolina public restaurants and bars to be smoke-free. Prostate Cancer:  CVMC and FRMC provide free prostate screenings annually.  The ACS Man to Man Support Group is available to prostate cancer patients and survivors.  Catawba County Health Partners’ Cancer Task Force focuses on prostate cancer prevention, early detection, and education. All Cancers:  ACS holds a strong presence as a community resource through education and events, including several cancer support groups and Relay for Life. 30

Community Health Assessment 2011

Cancer     

   

Carolina Oncology offers treatment services for all cancers. CVMC and FRMC are approved as Comprehensive Community Cancer Centers by the American College of Surgeons. CVMC and FRMC offer the ACS “I Can Cope,” “Life Goes On,” and “Road to Recovery” cancer support programs. CVMC and FRMC each have a sun health educator on staff to promote skin cancer prevention. CVMC and FRMC offer a range of services aimed at early detection and treatment, including Inpatient /Outpatient Chemotherapy, Radiation Oncology Centers, Specialized Surgical Care, CT/PET (Computerized Axial and Positron Emission Tomography), Cancer Resource Centers, and Enterstomal Therapy. The Catawba County Wig Bank provides free gently-used and new wigs for cancer patients. The Palliative CareCenter and Hospice of Catawba Valley provides specialized care and volunteer services to cancer patients and their families. The Greater Hickory Cooperative Christian Ministry’s medical clinic makes referrals for clients diagnosed with cancer. CLIMB (Children’s Lives Include Moments of Bravery) is a grief support program offered through CVMC for children of cancer patients.

Opportunities 



 

Although many cancer prevention and early detection programs are available in Catawba County, racial disparities continue to exist in cancer deaths. Improved outreach to minority communities will lessen those disparities. Despite widespread progress in tobacco control throughout the county, lung cancer deaths have increased among Catawba County’s white population and are particularly high among men. Efforts must focus on smoking prevention, reduction, and cessation in the county’s adult population. There are few colorectal and lung cancer prevention and early detection assets in Catawba County; efforts need to be made to close these gaps through education and screening. Resources and funding opportunities for screenings, prevention and treatment are needed by a large number of county residents.

Conclusions    

Breast, lung, colorectal, and prostate mortality rates among all populations in Catawba County are higher than in North Carolina. Catawba County has locally-available, state-of-the-art cancer diagnosis and treatment facilities. Education must be continued to inform residents of the risk factors – and how to avoid or minimize them – for all types of cancers. Access to and awareness of screening opportunities must be provided and promoted to increase early cancer detection and improve treatment outcomes.

References  

31

Catawba County Public Health, 2010 State of the County Health Report, 2010: http://www.catawbacountyhealthpartners.org/2010SOTCHReport.pdf Catawba County Public Health, Community Health Assessment (CHA) Survey Results, 2010-2011: http://www.catawbacountyhealthpartners.org/CHASurveyResults10.pdf

Community Health Assessment 2011

Cancer       

32

National Cancer Institute, Surveillance Epidemiology and End Results, SEER Stat Fact Sheets: Breast, 2011: 2011: http://seer.cancer.gov/statfacts/html/breast.html National Cancer Institute. Surveillance Epidemiology and End Results, SEER Stat Fact Sheets: Colon and Rectum, 2011: http://seer.cancer.gov/statfacts/html/colorect.html National Cancer Institute, Surveillance Epidemiology and End Results, SEER Stat Fact Sheets: Lung and Bronchus, 2011: http://seer.cancer.gov/statfacts/html/lungb.html North Carolina State Center for Health Statistics, North Carolina Central Cancer Registry, 2010 Report, 2011: http://www.epi.state.nc.us/SCHS/data/cancer.cfm North Carolina State Center for Health Statistics, North Carolina Central Cancer Registry, Catawba August Cancer Profile, 2009: http://www.epi.state.nc.us/SCHS/CCR/cp2009/Catawba.pdf North Carolina Annual Cancer Reports, obtained data from Catawba Valley Medical Center and Frye Regional Medical Center, 2011. North Carolina Central Cancer Registry, obtained data from Catawba Valley Medical Center, 2011.

Community Health Assessment 2011

Communicable Disease Overview Communicable or infectious diseases are all caused by microorganisms, such as bacteria, viruses, fungi, or parasites. While many communicable diseases are passed from person to person, some are transmitted through bites from insects or animals. Others are acquired by ingesting contaminated food, water, or other exposures in the environment. There are 94 different diseases mandated by law as reportable to the North Carolina General Communicable Disease Branch. These include illnesses that are food borne (such as salmonella and E.coli), airborne (such as flu), bloodborne (such as HIV/AIDS), waterborne (such as cholera and dysentery), and vector borne (including those from insect bites, such as Rocky Mountain spotted fever [RMSF] or West Nile virus). In addition to legally reportable diseases, communicable disease includes a variety of other public health concerns, such as MRSA, lice, and dog bites. Another category of communicable disease is healthcare-associated infections (HAIs) including central lineassociated bloodstream infection (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilatorassociated pneumonia (VAP), surgical site infection (SSI), multi-drug resistant organism (MDRO) transmission, Methicillin-resistant Staphylococcus Aureus (MRSA), and clostridium difficile (c. diff) infection. Some communicable diseases, such as measles and chickenpox, are preventable through vaccination. Frequent and thorough hand washing can also help protect individuals from some communicable diseases. Treatment ranges from over-the-counter medications to hospitalization and intravenous antibiotics. As the epicenter for communicable disease in Catawba County, Catawba County Public Health (CCPH) receives and tracks reports of all reportable communicable diseases affecting Catawba County residents from area providers. This enables CCPH staff to coordinate the following communicable disease related activities in collaboration with the North Carolina General Communicable Disease Branch:    

Promptly investigate disease outbreaks and unusual situations and to implement control measures to minimize further transmission of disease. Monitor disease-reporting by physicians and laboratories in order to detect trends. Provide a channel of communication between CCPH, private physicians, and hospital and occupational infection control personnel as an essential part of disease control efforts. Explain public health interventions and disseminate health education messages to the community in order to enhance disease control efforts.

Because some communicable diseases (such as HIV/AIDS, influenza, pneumonia, and sexually transmitted diseases) are covered in detail in other sections of the Community Health Assessment and local data is not available for others, this report focuses primarily on hepatitis A, hepatitis B, pertussis (whooping cough), salmonellosis (salmonella), and tuberculosis (TB).

Catawba County Data 

33

In 2010, there were 82 reports of diagnosed communicable diseases (not including sexually transmitted diseases). Community Health Assessment 2011

Communicable Disease 

In response to these reports, 430 investigations occurred. Because one case may require screening and follow-up among several at-risk individuals, investigation efforts generally outnumber diagnosed cases. Communicable Disease Rates in Catawba County and North Carolina Catawba County

North Carolina

Hepatitis A cases

1.0

445.0

Hepatitis A rate (per 100,000)

0.1

1.0

Hepatitis B cases

9.0

658.0

Hepatitis B rate (per 100,000)

1.2

1.5

Pertussis cases

12.0

885.0

Pertussis rate (per 100,000)

1.6

2.0

Salmonellosis cases

123.0

7689.0

Salmonellosis rate (per 100,000)

16.4

17.6

Source: State Center for Health Statistics, 2003-2007 (most recent data available)

 

As shown in the table above, Catawba County had fewer new cases than North Carolina of hepatitis A, hepatitis B, salmonellosis (salmonella), and pertussis (whooping cough) across 2003-2007. Compared to rates reported from 2001-2005, the incidence of salmonella has more than doubled in Catawba County (increasing from 7.8 to 16.4). Whooping cough rates have increased from 1.1 to 1.6, and rates both hepatitis A and B have dropped slightly (from .5 to .1 for hepatitis A and from 1.8 to 1.2 for hepatitis B).

Tuberculosis (TB) Cases and Rates in Catawba County, 2006-2010 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0

4.0

4.0

2.5

2.5 2.0

1.0

1.0

0.7

2006

Cases 1.3

Rates

0.6

2007

2008

2009

2010

Source: NC TB Control, North Carolina Public Health



34

Although TB rates in Catawba County have been inconsistent across the past five years, the incidence of TB in the county remains extremely low.

Community Health Assessment 2011

Communicable Disease National or State Data 





    

As of 2009, North Carolina ranked 26th in the country based on TB case rates (2.7 per 100,000). This can be viewed as significant progress; in 1980, North Carolina was ranked as the 3rd highest state for TB case rates. According to 2009 rates of TB (per 100,000) in North Carolina, the rate for males (3.4) is almost twice the rate for females (1.9); the rate for Asians is very high (16.1); the rate for Blacks/African Americans (5.3) is three times that for whites (1.5); and the rate for Hispanics /Latinos (7.8) is almost 4 times that for non-Hispanics (2.2). North Carolina is seeing an increase in the number of pertussis (whooping cough) cases each year. In North Carolina, 127 confirmed cases of pertussis were reported in 2005. This number jumped to 326 confirmed cases of pertussis in 2007. In 2010, North Carolina reported 343 cases. Salmonella infection causes more hospitalizations and deaths in the United States than any other type of germ found in food and accounts for $365 million in direct medical costs each year. Hepatitis B affects 1.25 million Americans each year, and over half are Asian-Americans. About 5,000 persons will die each year in the United States from hepatitis B-related liver disease. In 2009 and 2010, North Carolina reported the 2nd highest number of cases in the nation of Rocky Mountain Spotted Fever (RMSF), a disease transmitted to people by ticks. Although RMSF cases have been reported throughout most of the contiguous United States, five states (North Carolina, Oklahoma, Arkansas, Tennessee, and Missouri) account for over 60% of RMSF cases.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The hepatitis rate in Catawba County has decreased by 80.0% for Type A and 30.3% for Type B.  The pertussis rate in Catawba County has increased by 45.5%.  The salmonella rate in Catawba County has increased by 110.3%.

Assets 

35

The Catawba County Public Health (CCPH) Communicable Disease division: o Utilizes the North Carolina Electronic Disease Surveillance System (NCEDSS) to monitor patterns of top communicable diseases. o Works to prevent and control the spread of communicable diseases by investigation, implementation of preventive and control measures, and education of the public and medical community. o Monitors and controls TB through x-ray, preventive drug treatment, and online NCEDSS surveillance. o Monitors and utilizes the NCEDSS reporting tools for Catawba County as well as surrounding counties for potential crossover of disease activity. o Ensures treatment of all North Carolina reportable communicable diseases diagnosed locally. o Has access to epidemiologists, infectious disease physicians, and other communicable disease experts through contract with the North Carolina General Communicable Disease Branch. o Conducts an annual tetanus, diphtheria, and pertussis (TdaP) vaccination program for all children entering 6th grade.

Community Health Assessment 2011

Communicable Disease 

CCPH’s Environmental Health division provides education and enforcement of state and local regulations regarding food sanitation, sub-surface sewage disposal, and other environmental concerns to individuals and businesses in Catawba County. CCPH’s Communicable Disease nurses have a collaborative partnership with infectious disease nurses at Catawba Valley Medical Center (CVMC) and Frye Regional Medical Center (FRMC) to monitor and report potential outbreaks and educate the community. CVMC and FRMC both have infectious disease physicians on staff.





DID YOU KNOW?  A person with pertussis will infect almost everyone in his or her household if those people are not vaccinated.

 1 in 6 Americans will get sick from food poisoning this year alone. Food poisoning sends more than 100,000 Americans to the hospital each year.

 Assuming an estimated survival of 25 years, the annual health care costs for the affected U.S. population with chronic hepatitis is $360 million.

 Hepatitis A is one of the few foodborne or waterborne illnesses that can be prevented by vaccination.

Opportunities   

  

Disseminate prevention education and promote preventive measures, such as vaccination and handwashing, more proactively throughout the community. Help prevent the spread of communicable disease by ensuring people know how to recognize signs and symptoms and where to get treated. Utilize the school nurse program to disseminate vaccines to decrease the incidence of preventable communicable diseases, such as tetanus, diphtheria, pertussis, HPV, and meningitis among the schoolage population. Distribute immunization information to parents through local day cares, pre-K programs, and home school associations. Partner with local providers to improve the reporting of communicable diseases and the monitoring of trends in the community. Employ an epidemiologist in the county who can consult on various public health issues of concern.

Conclusions   

36

Salmonella and whooping cough rates are rising in Catawba County, while hepatitis A and B rates are decreasing. Significant disparities exist for tuberculosis rates among both black and Hispanic/Latino populations. More community education and constant improvement of surveillance can help prevent the onset and spread of communicable disease in Catawba County.

Community Health Assessment 2011

Communicable Disease References   







 





 

37

Annual surveillance reports published by CDC. Centers for Disease Control and Prevention, June 2011. Making Food Safer to Eat. http://www.cdc.gov/vitalsigns/FoodSafety/index.html Centers for Disease Control and Prevention. Notice to readers: Final 2005 reports of nationally notifiable infectious diseases. MMWR: Morbidity and Mortality Weekly Report, Volume 55, Number 32, August 18, 2006. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5532a4.htm Centers for Disease Control and Prevention. Notice to readers: Final 2007 reports of nationally notifiable infectious diseases. MMWR: Morbidity and Mortality Weekly, Volume 57, Number 33, August 22, 2008. Report, http Centers for Disease Control and Prevention. Notice to readers: Final 2009 reports of nationally notifiable infectious diseases. MMWR: Morbidity and Mortality Weekly Report, Volume 59, Number 32, August 20, 2010. http://www.cdc.gov/mmwr/PDF/wk/mm5932.pdf Centers for Disease Control and Prevention. Notice to readers: Final 2010 reports of nationally notifiable infectious diseases. MMWR: Morbidity and Mortality Weekly Report, Volume 60, Number 32, August 19, 2011. http://www.cdc.gov/mmwr/PDF/wk/mm6032.pdf Centers for Disease Control and Prevention. Type of Healthcare-associated Infections (HAI). November 2010. http://www.cdc.gov/HAI/infectionTypes.html North Carolina Department of Health & Human Services, Division of Public Health, Epidemiology Section, March 2011.Tuberculosis Control: TB Rates by County 2006-2010. http://www.epi.state.nc.us/epi/gcdc/tb/ratebycounty.html North Carolina Department of Health and Human Services, Division of Public Health, Epidemiology Section, Communicable Disease Branch. Introduction to Communicable Disease Surveillance and Investigation in North Carolina course. North Carolina Department of Health and Human Services, Division of Public Health, Communicable Disease Branch, Tuberculosis Control Program, April 2010. Tuberculosis Statistics for North Carolina 2009. http://epi.publichealth.nc.gov/tb/pdf/tbannual2009.pdf NC General Communicable Disease Control Branch North Carolina State Center for Health Statistics

Community Health Assessment 2011

Diabetes Overview Diabetes (Diabetes Mellitus or DM) is a group of diseases characterized by high blood glucose levels that result from defects in the body’s ability to produce and/or use insulin. There are 4 diagnoses related to diabetes: type 1, type 2, gestational, and prediabetes. The cause of diabetes is not fully understood, but the onset of both type 1 and type 2 can be attributed to family history and environmental triggers. Type 1, previously called juvenile diabetes or insulin dependent diabetes mellitus (IDDM), is most often diagnosed in children and young adults. In type 1 diabetes, the body stops producing insulin. Although inheriting risk factors from both parents does increase the risk of developing type 1 diabetes, most people who inherit risk factors do not develop diabetes; an environmental trigger, such as illness or stress or even weather, is needed. Research shows that the white population has the highest rate of type 1 diabetes. Type 1 diabetes accounts for approximately 5% of all diagnosed cases of diabetes. Type 2 is the most common form of diabetes and accounts for 90-95% of all diagnosed cases. In type 2 diabetes, the body either does not produce enough insulin or does not use the insulin properly. Approximately 23 million Americans have been diagnosed with type 2 diabetes, and many more are unaware that they are at high risk. Type 2 diabetes is more common among minorities and the older population. A family history of type 2 diabetes is one of the stronger risk factors for developing the disease. Obesity is also a strong risk factor for type 2 diabetes, especially among young people and those with a family history of obesity. Gestational Diabetes (GDM) is diagnosed during pregnancy. Women diagnosed with GDM are more likely to have a family history of diabetes, especially on the maternal side. Older mothers and overweight women are also at a higher risk. In a majority of cases, GDM resolves after delivery; however, 20-50% of women diagnosed with GDM develop type 2 diabetes within 5-10 years. Prediabetes is a relatively new diagnosis for individuals with higher than normal blood glucose. Recent research has shown that some long-term damage to the body, especially the heart and circulatory system, may already be occurring during prediabetes. People with prediabetes are 1.5 times more likely to develop cardiovascular disease than people with normal blood glucose. Studies and research have shown that people with prediabetes can delay or prevent by up to 58% the onset of type 2 diabetes through lifestyle changes. Overall, the risk of death among people with diabetes is approximately twice that of people of similar age without diabetes. People with diabetes are 2 to 4 times more likely to develop cardiovascular disease; other complications include blindness, kidney disease, nervous system disease (neuropathy), and non-fatal amputation.

38

Community Health Assessment 2011

Diabetes Catawba County Data Diabetes Death Rates in Catawba County and North Carolina, 2005 - 2009 Catawba County

North Carolina

24.4

18.8

57.4

46.8

21.3

27.6

34.9

21.1

26.9

24.0

White Population Minority Population Female Population Male Population Total Population

Source: State Center for Health Statistics, 2005-2009, deaths per 100,000 (age adjusted)   

When compared to state data, Catawba County residents have a higher rate of mortality from diabetes. Minorities are at a substantially higher risk of diabetes-related deaths in both Catawba County and the state. Men die from diabetes at a higher rate than women in Catawba County; statewide, the female death rate is higher. Diabetes as a Leading Cause of Death by Age in Catawba County Age 20-39 40-64 65-84 85+

Rank among Top 10

Death Rate per 100,000

8

1.4

5

21.9

5

139.2

8

294.4

Source: State Center for Health Statistics, 2009



39

Diabetes is the 5thleading cause of death among adults ages 40-84 in Catawba County.

Community Health Assessment 2011

Diabetes 2011 Catawba County Community Health Assessment Survey 6%

Question asked on survey:

49%

Do you have a family history of diabetes?

45%

Yes

 

No

I don't know

According to the 2011 Catawba County Community Health Survey, approximately half of the respondents were aware of a family history of diabetes. Further analysis of the survey showed the following: o A higher percentage of whites reported having a family history of diabetes. o When comparing income, the $50,000 to $74,999 range showed a higher percentage of family history of diabetes.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  Catawba County’s diabetes death rate has decreased by 8.3% for whites, 30.4% for minorities and 12.1% for the total population.

National or State Data   

  

40

Diabetes is currently ranked as the 7thleading cause of death nationwide and in North Carolina; however, it is likely to be underreported as a primary cause of death. As of 2009, diabetes was the 8th leading cause of death for the white population and the 4th leading cause of death for the black population in North Carolina. As of 2008, an estimated 643,000 North Carolinians, or 9.3% of the total state adult population, had been diagnosed with diabetes. Another 232,000 were estimated to have undiagnosed diabetes, and 376,000 adults were estimated to have prediabetes. In 2008, North Carolina’s African Americans had the highest diabetes prevalence at 15.6%, followed by the state’s Native Americans at 12.4%. More than half of the adults diagnosed with diabetes in North Carolina were also obese (2008). North Carolina 2008 data indicates that there is a correlation between higher educational attainment and income levels and incidence rate of diabetes. Incidence levels decrease as educational and income levels increase. o Adults with less than a high school education had a higher prevalence rate of diabetes (13.6%) as compared to college graduates (6.3%). o Those with household incomes of less than $15,000 had the highest prevalence rate of diabetes (16.7%) as compared to those with household incomes of $75,000 or higher (5.4%). Community Health Assessment 2011

Diabetes 



The 2011 National Diabetes Fact Sheet shows that 25.8 million (8.3%) children and adults in the U.S. have diabetes. There are 18.8 million diagnosed cases, an estimated 7 million undiagnosed cases, and 79 million prediabetes cases. The national Diabetes Prevention Program (DPP) showed that lifestyle intervention to lose weight and increase physical activity reduced the development of type 2 diabetes by 58% during a 3-year period. The reduction was even greater, 71%, among adults over 60 years of age.

DID YOU KNOW?  25.8 million adults and children in the United States (8.3% of the population) have diabetes. th  Diabetes is the 7 leading cause of death in the United States.  About 215,000 people younger than 20 years had diabetes (type 1 or type 2) in the United States in 2010.  About 1.9 million people age 20 or older were newly diagnosed with diabetes in 2010 in the United States.

Assets 



  





41

Catawba Valley Medical Center (CVMC) and Frye Regional Medical Center (FRMC) are recognized by the American Diabetes Association for meeting the National Standards for Medical Care for DiabetesSelf Management Education. Piedmont Endocrinology is recognized by the American Association of Diabetes Educators for meeting Diabetes Education Standards. The practice also employs three board-certified endocrinologists (one of whom is fluent in Spanish), a physician assistant, and a Certified Diabetes Educator. The above-mentioned facilities have Certified Diabetes Educators (CDE) on staff and offer comprehensive diabetes education (for fee or insurance). CVMC and FRMC offer support programs for adults and children with diabetes. CVMC offers the following programs: o Classes that teach patients how to use insulin and insulin pump training. o Taking Charge of Your Diabetes, an educational program in conjunction with North Carolina Cooperative Extension to help adults manage Type 2 diabetes. o Diabetes education in English and Spanish to Good Samaritan Clinic patients. o Blood sugar screenings (monthly) and free cooking demonstrations at the Health First Center, including special presentations during National Diabetes Month (November). o Fasting blood sugar and lipid panel screenings for patients. FRMC offers the following programs: o Continuing education on a quarterly basis for adults, children, and insulin pumpers. o A partnership with the Hickory Foundation YMCA to provide free annual cardiac risk assessment, including blood sugar screening for diabetes and prediabetes. o Educational programs on prediabetes, carbohydrate counting, foot care, weight management, healthy eating, reducing risks of diabetes, and insulin pump training and management. The Catawba Valley Community College (CVCC) Diabetes Education Center was developed through the joint efforts of CVCC, FRMC, CVMC and The Greater Hickory Cooperative Christian Ministry (GHCCM). This free program for the uninsured and underinsured provides classes that cover diabetes; exercise; medication management; prevention; complications and coping; and tips for meal planning. It is currently not accredited but works closely with CVMC. The center serves patients from GHCCM and the Medical Access for Catawba County program. Community Health Assessment 2011

Diabetes 

Piedmont Endocrinology offers comprehensive diabetes education, insulin pump training and management, and patient use of Continuous Glucose Monitoring (CGMS).

Opportunities 

    

Catawba County residents who are uninsured, underinsured, have high deductibles or whose benefits do not specify comprehensive diabetes care lack adequate diabetes education, resources for supplies, and access to related medical exams. Specialized diabetes education and outreach is needed for large segments of the Hmong and Latino communities due to language differences and lack of insurance. Health care providers must take a leading role in referring patients to diabetes educators. Patients need comprehensive education to prevent long-term and often irreversible complications. Employers would benefit from continuing education regarding the importance of including provisions in employee insurance plans for diabetes education, treatment, and supplies. Investigate the possibility of applying to participate in a state-based diabetes treatment program for the population that is not eligible for traditional or GHCCM chronic disease management services. The North Carolina Diabetes Education Recognition Program offers funding and guidance to develop diabetes self-management education programs through local public health agencies. Although this is already covered by both hospitals and Piedmont Endocrinology, it may be an opportunity to enhance those services if needed.

Conclusions   



Diabetes is one of the fastest growing chronic diseases in America. If uncontrolled, it has the potential to “break the health-care bank.” The diabetes epidemic will result in increases in heart disease, stroke, kidney disease, blindness, amputations, and other serious, costly, life-long complications. The CDC estimates that 1 in 3 adults could have diabetes by 2050 if the current trend of diabetes continues. Research has shown that lifestyle interventions to prevent or delay Type 2 diabetes in individuals with prediabetes can be feasible and more cost-effective than medication.

References      

42

American Diabetes Association, 2011. Diabetes Basics. http://www.diabetes.org/diabetes-basics Catawba County Public Health, February 2011. Community Health Assessment (CHA) Survey Results, 2010-2011: http://www.catawbacountyhealthpartners.org/CHASurveyResults10.pdf Centers for Disease Control and Prevention, 2011. Diabetes Data &Trends. http://apps.nccd.cdc.gov/DDTSTRS/default.aspx Centers for Disease Control. 2011 National Diabetes Fact Sheet. http://apps.nccd.cdc.gov/DDTSTRS/default.aspx Centers for Disease Control and Prevention, 2011. Get the Facts on Diabetes. http://www.cdc.gov/features/DiabetesFactSheet/ Centers for Disease Control and Prevention, 2011. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf Community Health Assessment 2011

Diabetes 





43

North Carolina Department of Health and Human Services, Division of Public Health, Diabetes Prevention and Control, September 2009. North Carolina Diabetes Prevention and Control Fact Sheet. http://www.ncdiabetes.org/library/_pdf/DIABETES%20IN%20NC%20WEB.pdf North Carolina Department of Human Services, Division of Public Health, State Center for Health Statistics, 2011. Death Counts and Crude Death Rates Per 100,000 Population for Leading Causes of Death, By Age Groups in NC 2005 – 2009. http://www.epi.state.nc.us/SCHS/data/databook/ North Carolina Department of Human Services, Division of Public Health, State Center for Health Statistics, August 2009. Medical Care Costs for Diabetes Associated with Health Disparities Among Adults Enrolled in Medicaid in North Carolina. http://www.epi.state.nc.us/SCHS/pdf/SCHS160.pdf

Community Health Assessment 2011

Heart Disease and Stroke Overview Heart disease and stroke fall under the umbrella of cardiovascular disease (CVD). Once considered a disease primarily of aging males, we now know that CVD frequently strikes in the prime of life and is an equal killer of men and women. CVD includes the second and fourth leading causes of death in North Carolina — heart disease and stroke — and is also a major cause of premature death and years of potential life lost. Heart disease is a term that includes several heart conditions, the most common of which is coronary heart disease (CHD). CHD is a narrowing of the arteries leading to the heart. A heart attack occurs when the heart is deprived of enough oxygen due to a blockage of these arteries, which can cause the heart muscle to die or become damaged. Stroke is the third leading cause of death and one of the leading causes of disability in the nation. It occurs when the flow of blood to the brain is interrupted, usually from a blood clot or broken blood vessel. This can cause the loss of abilities controlled by that part of the brain, such as speech or motor skills. The 7 major risk factors for CVD are tobacco use, poor nutrition, inactivity, obesity, diabetes, high blood pressure, and high cholesterol. Prevention and control of these risk factors may help reduce the chances for developing heart disease and stroke. Changes in lifestyle and/or the use of prescription medication are frequently recommended for those at risk. Immediate treatment of a heart attack or stroke increases the likelihood of patient survival. CVD is influenced by the physical, social, and political environment, including the following:  Maternal and child health  Access to educational opportunities  Availability of healthy foods, physical education, and extracurricular activities in schools  Opportunities for physical activity  Access to healthy foods  Quality of working conditions and worksite health  Availability of community support and resources  Access to affordable, quality healthcare

Catawba County Data Heart Disease Death Rates, 2005-2009 Catawba County

North Carolina

White population

185.8

188.2

Minority population

189.4

217.8

Female population

142.2

154.8

Male population

249.2

247.3

Total population

187.2

194.7

Source: State Center for Health Statistics, 2005-2009, deaths per 100,000 (age adjusted)

44

Community Health Assessment 2011

Heart Disease and Stroke    

Of the leading causes of death in Catawba County, heart disease is ranked second. It was displaced by cancer as the leading cause of death in 2010. Heart disease death rates are significantly higher among men than women in both the county and the state. The county’s total population heart disease death rates have significantly declined from 226.8 (20012005) to 187.2 (2005-2009). The total and white populations in Catawba County have lower heart disease death rates than state rates. Stroke Death Rates, 2005-2009 Catawba County

North Carolina

White population

54.7

47.5

Minority population

63.0

66.2

Female population

55.6

49.6

Male population

55.0

52.5

Total population

55.5

51.3

Source: State Center for Health Statistics, 2005-2009, deaths per 100,000 (age adjusted)

   

Stroke death rates are higher among minorities but are even across genders in Catawba County. Catawba County has lowered its stroke death rates per 100,000 population by 20%, from 69.4 (20002004) to 55.5 (2005-2009). Of the leading causes of death in Catawba County, stroke is ranked fourth. The total and white populations in Catawba County have higher stroke mortality rates than state rates. Risk Factors for Cardiovascular Disease (CVD)

Questions asked on Survey (Percentage that responded “yes” to the following questions)

Catawba County

North Carolina

Are you a current smoker?

22.9

20.3

Do you consume five or more servings of fruits or vegetables daily?

77.6

79.4

Do you participate in leisure time physical activity?

71.9

73.6

Does your BMI fall into either overweight or obese category?

57.0

65.4

Have you ever been told by a health care professional that you have diabetes?

8.0

9.6

Have you ever been told by a health care professional that you have high blood pressure?

33.1

31.5

Have you ever been told by a health care professional that your blood cholesterol is high?

38.7

40.0

Source: North Carolina State Center for Health Statistics – 2009 BRFSS survey

45

Community Health Assessment 2011

Heart Disease and Stroke 

Of the 7 risk factors for stroke and heart disease, Catawba County fares worse than the state in 4 (tobacco use, nutrition, physical activity, and high blood pressure).

2011 Catawba County Community Health Assessment Survey

Question asked on survey: How often do you check your risk factors, such as blood pressure or cholesterol, for heart disease and stroke?

At least once a year

7.7% 10.4%

23.1%

58.8%

When my doctor suggests it Never Don't know/ not sure



According to the 2011 Catawba County Community Health Survey, more than 80% of the individuals surveyed in Catawba County said they check risk factors for CVD. Survey demographic analysis reveals the following: o Gender does not play a role in whether someone does or does not check risk factors. o Age greatly affects how often someone checks risk factors. After age 35, the percentage of people who get checked at least once a year noticeably increases.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The heart disease death rate in Catawba County has decreased by 9.3% for whites, 24.9% for minorities and 10.4% for the total population.

 The stroke death rate in Catawba County has decreased by 16% for whites, 18% for minorities and 16.2% for the total population.

National or State Data      

 46

CVD causes 31 percent of all deaths in North Carolina. Heart disease has been the number 1 cause of death in North Carolina until 2010, when it dropped to number 2 behind cancer. 1 in 5 CVD deaths among North Carolinians occurs among those younger than 65. Stroke is the 3rd leading cause of death and the leading cause of disability in North Carolina. According to the NC Stroke Registry, North Carolina has the sixth highest stroke mortality rate in the nation. It was fourth highest in 2007. The stroke belt is typically defined to include the states of Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Virginia due to ageadjusted stroke mortality rates more than 10% above the national average in those states during 1980. Stroke costs North Carolina an estimated $1.05 billion annually. Community Health Assessment 2011

Heart Disease and Stroke DID YOU KNOW? 

CVD accounted for more than $500 billion in health care expenditures and related expenses in 2010 alone.



If all forms of major CVD were eliminated, life expectancy in the United States would rise by nearly 7 years.

Assets        

   

Catawba Valley Medical Center (CVMC) and Frye Regional Medical Center (FRMC) offer comprehensive cardiac rehabilitation programs. Both hospitals employ stroke and cardiovascular case managers to assist patients through the recovery process. FRMC hosts the Heart Helpers support group for CVD patients and their families. FRMC sponsors educational opportunities for Catawba County EMS personnel to learn about early detection of heart attacks. CVMC’s Health First Center offers a Heart to Heart class on CVD and risk factors, free blood pressure and cholesterol screenings, and other classes and programs related to CVD risk factors. Since 2007, FRMC has been identified as a regional facility for early treatment of heart attacks as part of the RACE initiative in North Carolina (Reperfusion of Acute MI’s in Carolina Emergency Rooms). FRMC and the American Heart Association sponsor an annual fundraising event to raise research funds and encourage CVD awareness and education. Both hospitals provide resources to address CVD risk factors, such as tobacco cessation programs, diabetes control centers, bariatric surgery and weight management programs, healthy eating and nutrition classes, and cholesterol and blood pressure screenings. FRMC is a certified Stroke Center. CVMC has a Stroke Team that does stroke risk analyses at health fairs and yearly at the Health First Center. CVMC’s Health First Center performs routine blood pressure checks. Medical Access for Catawba County (MACC), offered through Greater Hickory Cooperative Christian Ministry, provides heart disease and hypertension management to low income and uninsured populations.

Opportunities    



47

Hospitals can help influence outcomes for heart attack patients by developing and implementing strategies to improve the time between arrival at the hospital and treatment. Many Catawba County residents need more knowledge about CVD risk factors, signs and symptoms, and the importance of rapid treatment. Educational programs need to be tailored based on education level, preferred language, and cultural differences and should be offered on-site to church, business, and civic groups. Participate in Mission Lifeline, an American Heart Association initiative that educates the public and Emergency Medical Service providers in recognizing heart attack symptoms and providing appropriate response. Although the healthcare practitioners in Catawba County have worked to decrease language barriers and cultural insensitivity, particularly for the Latino and Hmong populations, barriers still exist in all arenas. Community Health Assessment 2011

Heart Disease and Stroke   

Workplace programs should be initiated or enhanced to include CVD-related screenings, education, health incentives and access to nutritional foods. CVD is often treated with medication, which can be costly. Physicians should take a patient’s ability to pay into account before prescribing expensive medications. Because noncompliance can lead to less than optimal management of the controllable risk factors for stroke and hypertension, continued education about the importance of following medication and treatment guidelines is critical.

Conclusions   

While on the decline and lower than state averages, the combined impact of heart disease and stroke on Catawba County remains significant. Catawba County residents have a large number of CVD treatment, technology, and education resources at their disposal. Engaging the community in risk factor prevention is a key step toward reducing the impact of CVD.

References         

48

American Heart Association, February 2010. Heart Disease and Stroke Statistics 2010 Update. http://circ.ahajournals.org/cgi/content/full/121/7/e46 American Heart Journal, November 2006. Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments (RACE): Study Design. http://www.ncbi.nlm.nih.gov/pubmed/17070144 Centers for Disease Control and Prevention, August 2011. Heart Disease Prevention and Health Promotion. http://www.cdc.gov/chronicdisease/resources/publications/ Centers for Disease Control and Prevention, January 2011. North Carolina: Burden of Chronic Diseases. www.cdc.gov/nccdphp/Publications/ H.J. Fullerton, J.S. Elkins, S.C. Johnston. Pediatric Stroke Belt: Geographic Variation in Stroke Mortality in U.S. Children. Stroke, Volume 35, Number 7, July 2004. National Stroke Association, 2011. What Is Stroke. http://www.stroke.org/site/PageServer?pagename=stroke North Carolina Department of Health and Human Services, State Center for Health Statistics, Indicator Fact Sheet, 2009: http://www.schs.state.nc.us/schs United States Department of Health and Human Services, 2011. Healthy People 2020: Heart Disease and Stroke. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=21 World Health Organization, January 2011. Cardiovascular Diseases (CVDs). http://www.who.int/mediacentre/factsheets/fs317/en/index.html

Community Health Assessment 2011

Immunizations Overview Controlling the spread of infectious diseases through immunizations is one of public health’s most remarkable accomplishments. Vaccines are among the most successful and cost-effective tools available for preventing disease and death. They help protect individuals from developing serious diseases and also protect entire communities by preventing and decreasing the spread of infections. We now have resources available to protect children and adults against thirteen diseases, which in the past have caused disability, suffering, and premature death. Most vaccinations are recommended during early childhood and are required by the time children enter kindergarten. The North Carolina Immunization Program (NCIP) strives to meet two goals: to keep children in their medical homes, and to remove cost as a barrier to age-appropriate immunizations. The NCIP provides many of the vaccines required for school entry, at no charge, for eligible children present in the State of North Carolina from birth through 18 years of age. Through the NCIP, vaccines are distributed to health care providers at no charge. Well over 95 percent of health care providers in North Carolina who administer vaccines to children participate in this program. The state also continues to provide age appropriate immunizations to children with Medicaid, no insurance, underinsured, and American Indian/ Alaskan Natives. The North Carolina Immunization Registry (NCIR) is a secure web-based clinical tool that gives patients, parents, healthcare providers, schools, and childcare facilities access to complete and accurate immunization data. The NCIR can also create reminder recall letters that go out to parents and caregivers to schedule age appropriate immunizations for their child. Vaccines for adults are also administered throughout the state. While no vaccines are required for adults, many receive vaccinations for influenza, pneumonia, shingles, tetanus, and hepatitis B, all of which are highly recommended. Vaccines are also available for individuals traveling to foreign countries that have diseases that are not prevalent in the United States.

DID YOU KNOW?  For the past five years, Catawba County’s childhood immunization rates have remained steady.  A recent study by the CDC found that the use of the seven standard childhood vaccines will prevent more than 14 million cases of disease and more than 35,500 death of the lifetime of children born this year. The associated savings are nearly $10 billion per year.

 Add the cost savings associated with patients not having to seek care and parents not having to take time off work to be care for sick children and the savings to society increases to more than $40 billion annually.

49

Community Health Assessment 2011

Immunizations Catawba County Data Percent of Children Up-to-Date Between Ages 19-35 Months 78.3%

80% 75%

73.0%

70% 65% 60% Catawba County

North Carolina

Source: NC Child Health Report Card, 2010



In Catawba County, the percentage of children who receive recommended immunizations between the ages of 19 and 35 months is only 73.0%. This indicates that more than one-quarter of this population is at risk of acquiring vaccine-preventable diseases on Catawba County.

Percent of Kindergartners Immunized Appropriately 99.9%

100.0% 98.0%

96.5%

96.0% 94.0% 92.0% 90.0% Catawba County

North Carolina

Source: NC Child Health Report Card, 2010



Due to the fact that schools mandate up-to-date immunization records for all children entering kindergarten, higher compliance rates for required vaccinations among this age group are notably higher in both Catawba County and North Carolina. Catawba County’s percentage of vaccination compliance is 3.4 percentage points higher than the state.

National or State Data 

50

According to the 2010 National Immunization Survey, North Carolina had 77.0% of children immunized with 4 DtaP, 3 Polio, 1 MMR, 3 Hepatitis B, 3 Hib, and 1 Varicella (4:3:1:3:3:1) among children 19-35 months of age. The national average was 74.9%. Community Health Assessment 2011

Immunizations 

For every dollar spent on the United States childhood immunization program, 5 dollars in direct costs and 11 dollars in additional costs to society are saved. Approximately 42,000 adults and 300 children in the United States die each year from vaccinepreventable diseases.



Percent of Children Vaccinated in United States, 19-35 months, 2010 93.3%

94.0%

91.8%

91.5%

92.0%

90.4%

90.4%

90.0% 88.0% 86.0%

84.4%

84.0% 82.0% DtaP

poliovirus

MMR

HiB

hepatitis B

varicella

Source: National Immunization Survey, 2010



Compared with 2009, coverage increased in 2010 for many vaccine-preventable diseases, including measles, mumps and rubella (MMR), rotavirus, pneumococcal disease, hepatitis A, and Haemophilus influenza type B (Hib). In contrast to other health services, where substantial disparities between whites and minorities persist, immunization rates did not differ by racial or ethnic groups for most vaccines in 2010.



NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The percent of Catawba County children entering kindergarten in compliance with immunization requirements has shown minimal increase, from 99.0% to 99.9%.

Assets       

51

Physician offices throughout the county offer most recommended and required vaccinations to patients. Hickory ID Consultants, a Catawba Valley Medical Center clinic, offers a wide variety of infectious disease immunizations. In Catawba County, 85% of private practices are now using NCIR. This enables physicians to access immunization records and make recommendations for patients as needed. Catawba County Public Health (CCPH) offers the following services to ensure maximum immunizations to the community: Childhood vaccinations are provided for all children and adults. Vaccines may be free or have a fee depending on eligibility and insurance status. Community outreach clinics for influenza and TdaP vaccines are provided by public health. School nurses work closely with the school systems and routinely review and audit student records to ensure that immunizations are up to date. Nurses ensure all students are compliant with required Community Health Assessment 2011

Immunizations 



vaccines before entering kindergarten (DtaP, Polio, MMR, Hepatitis B, Hib, Varicella) and sixth grade (TdaP) or anytime a student enters the school system. Children’s vaccination records are reviewed in The Special Supplemental Nutrition Program for Women, Infants, and Children (commonly known as WIC) when receiving food vouchers. This additional step aids in increasing vaccination rates. A wide variety of immunizations recommended for travel to foreign countries is available and provided upon request.

Opportunities 

   

The state will no longer provide required immunizations for fully insured children. This elimination of universal vaccine coverage for children will mean more parents may have to pay for their children’s required shots. The NCIR is unable to run specific reports for a county, such as demographic information. Individualized NCIR training for providers would help assure successful utilization of all NCIR functions. Deviations from the recommended vaccination schedule have increased due to private physicians who track immunizations for child patients who do not come in for regular age-appropriate check-ups. Partnerships with private practices to conduct immunization clinics will enable more children to have access to vaccines.

Conclusions   

The percentage of kindergarteners appropriately immunized for school in Catawba County has increased to 99.9%. North Carolina and Catawba County have seen slight decreases in 19-to-35-month-old immunization rates over the past four years but remain above the national average. The North Carolina Immunization Registry (NCIR) continues to be an essential mechanism to provide Catawba County greater access to complete, accurate, and relevant immunization data. More utilization of this tool will help ensure children and adults maintain appropriate immunizations.

References      

 

52

Action for Children North Carolina: www.ncchild.org North Carolina Immunization Branch: http://www.immunizenc.com/ Centers for Disease Control and Prevention. National Immunization Survey 2010. http://www.cdc.gov/vaccines/stats-surv/nis/default.htm#nis Centers for Disease Control and Prevention, September 2010. Estimated Vaccination Coverage 2009, 19-35 Months. http://www.cdc.gov/vaccines/stats-surv/nis/data/tables_2009.htm#overall North Carolina State Center for Health Statistics: http://www.schs.state.nc.us/SCHS/catch/ North Carolina Department of Health and Human Services, Department of Public Health, January 2011. Healthy North Carolina 2020: A Better State of Health, Objectives: Immunizations. http://publichealth.nc.gov/hnc2020/objectives.htm Centers for Disease Control and Prevention. Vaccines and Immunizations http://www.cdc.gov/VACCINES/ Hickory ID Consultants: http://www.catawbavalleymedical.org/hickory-infectious-disease-consultants

Community Health Assessment 2011

Infant Mortality Overview Infant mortality is defined as the death of a baby within its first year of life. The top three causes of infant mortality among all racial and ethnic groups in North Carolina are prematurity and low birth weight, birth defects, and Sudden Infant Death Syndrome (SIDS). Prematurity and Low Birth Weight: Premature babies are those born before 37 full weeks of pregnancy are completed. Approximately 67% of babies born prematurely also have low birth weight, which is measured at less than 5 pounds 8 ounces. This combination puts a baby at significant risk of health problems, disabilities, and death. The lower the birth weight, the greater the baby’s risk of health problems Mothers who have given birth to a premature baby are more likely to have a pre-term birth in a subsequent pregnancy. In February 2011, the U.S. Food & Drug Administration approved 17P (17 alpha hydroxyprogesterone caporate) injections to help reduce the risk of premature births among pregnant women with a history of at least one pre-term birth. Weekly injections have been shown to reduce the risk of pre-term birth by more than one-third. The average cost of 17P treatment is one-tenth that of a pre-term birth in North Carolina. Birth Defects: Birth defects are conditions that cause structural changes in one or more parts of the body; are present at birth; and have a serious, adverse affect on the baby’s health, development or functional ability. According to the Centers for Disease Control and Prevention, birth defects account for more than 1 of every 5 infant deaths. Some birth defects can be prevented if the mother takes steps to increase her chances of a healthy pregnancy. These include taking 400 milligrams of folic acid daily; abstaining from alcohol, smoking and illegal drugs; getting appropriate vaccinations; and obtaining appropriate prenatal care. SIDS: Sudden Infant Death Syndrome is the unexpected, sudden death of a child under age 1 in which an autopsy does not show an explainable cause of death. According to the National Institute of Child Health & Human Development, SIDS is the leading cause of death in children between 1 month and 1 year of age nationwide and occurs most often between the ages of 2 and 4 months. While the exact cause of SIDS is not known, providing a safe sleeping environment has been shown to help reduce the risk. Prenatal care, which includes regular medical check-ups to monitor the health of both mother and baby, has been shown to significantly improve birth outcomes. According to the National Women’s Health Information Center, babies of mothers who do not get prenatal care are 3 times more likely to have a low birth weight and 5 times more likely to die than those born to mothers who do get care.

DID YOU KNOW?  In 1988, North Carolina had the highest infant mortality rate in the nation. Since that time, North Carolina’s infant mortality rate has decreased by 44.4%.

 According to the March of Dimes, a healthy infant costs around $3,325 in the first year of its life, while a premature birth costs around $32,325.

53

Community Health Assessment 2011

Infant Mortality Catawba County Data Catawba County

North Carolina

White Population

3.99

3.92

Minority Population

11.61

8.84

Total Population

5.25

5.35

White Population

6.29

5.84

Minority Population

14.16

13.07

Total Population

7.57

7.94

White Population

8.07

7.38

Minority Population

13.2

13.38

Total Population

8.92

9.13

White Population

84.13

84.42

Minority Population

75.24

76.30

Total Population

82.73

82.13

White Population

14.92

11.5

Minority Population

12.92

9.85

Total Population

14.6

11.04

Neonatal Mortalitya

Infant Mortalityb

Percent Low Birth Weightc

Percent Prenatal Care Initiated in 1st Trimester

Births to Mothers Who Smoke

Source: State Center for Health Statistics, 2006-2010; Percent Prenatal Care & Mothers Who Smoke: 2005-2009 *Data in red indicates rates based on small numbers (fewer than 20 cases) and should be interpreted with caution. a b c Deaths under 28 days per 1,000 live births. Deaths under 1 year per 1,000 live births. Percent of live births weighing less than 5 lbs. 8 oz.

  

54

According to the chart above, low birth weight affects a higher percentage of the minority population in Catawba County. Compared to the total population in Catawba County, a smaller percentage of African American mothers obtain prenatal care. Although the minority neonatal and infant mortality rates are based on low incidence, they indicate that minorities are disproportionately affected by both. Community Health Assessment 2011

Infant Mortality  

  

Catawba County’s neonatal and infant mortality rates are slightly lower than those in North Carolina. Over the past decade, infant mortality and percent low birth weight have remained fairly steady in Catawba County. The total population infant mortality rate for 2001-2005 was 7.1 per 1,000 live births, which has incrementally increased to 7.57 for 2006-2010. Similarly, the total population percent low birth weight increased from 8.4% in 2001-2005 to 8.9% in 2006-2010. The infant mortality rate was 9.3 in Catawba County in 2010. This is the highest rate in a decade. Infant mortality rates have been declining in North Carolina overall, but increasing in Catawba County. The minority infant mortality rate was 14.06 in Catawba County from 2006-2010, over twice the rate of the white infant mortality rate of 6.29.

Percentage of Births to Mothers Who Smoke, Catawba County and North Carolina, 2007-2010 30 25

12.9

12.4

20

11.5

11.0

15 10

North Carolina 15.3

15.2

14.7

14.6

2007

2008

2009

2010

Catawba County

5 0

Source: State Center for Health Statistics, 2007-2010

 

As shown by the graph above, smoking among pregnant women is slightly but steadily decreasing across both Catawba County and the state. Catawba County’s percentage of births to women who smoke remains higher than state averages.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The infant mortality rate for blacks in Catawba County has decreased by 30.6%.  The neonatal mortality rate for whites in Catawba County has increased by 15.8%.  The percentage of blacks initiating prenatal care in Catawba County has increased by 12.6%.

National or State Data   

55

North Carolina is 8th highest in the nation for infant mortality. In 2010, there were 122,302 births in North Carolina. The state’s infant mortality rate was 7.0, which was the lowest in the state’s history and represented an 11.4% decrease from the 2009 rate of 7.9%. The 2006-2010 infant mortality rate in North Carolina was 7.9. North Carolina ranks very poorly among other states. Community Health Assessment 2011

Infant Mortality 

   

The largest decrease in infant mortality in the state in 2010 was among African American infants, a reduction of 19.6% from 2009. However, the African American infant death rate was twice that of other races at 12.7 in 2010. In 2010, the number of SIDS deaths in North Carolina totaled 53. This is a decrease from 98 deaths in 2009 and 128 deaths in 2008. There was a 46% reduction in reported cases of SIDS from 2009 to 2010. The United States infant mortality rate was 6.8 deaths per 1,000 live births in 2007. A 20 year study on newborn death rates around the world found that the United States ranked 41st out of 45 industrialized countries for newborn deaths (babies under 4 weeks of age). According to the March of Dimes, approximately 1 in every 12 babies born in the U.S. is born with low birth weight.

Assets    

  

 

  

The Catawba County Public Health (CCPH) Prenatal Program provides comprehensive prenatal care to low-income women in Catawba County and surrounding counties. CCPH’s Prenatal Program provides 17P at no charge to low-income pregnant women at high risk for pre-term birth, as recommended by the American College of Obstetrics and Gynecology. The CCPH Prenatal Program offers smoking cessation counseling to pregnant women to encourage them to quit smoking. CCPH Pregnancy Care Managers provide case management services to Medicaid eligible, high-risk maternity patients during their pregnancy and up to 8 weeks after delivery. The purpose of this program is to resolve issues that could adversely affect the unborn or newborn baby. CCPH’s Newborn Home Visitation Program provides a home visit to all deliveries from its prenatal practice to ensure continuation of health services for mother and baby. CCPH’s Care Coordination for Children (CC4C) provides community based interventions for children to maximize health outcomes and targets the highest risk and highest cost children for care management. CCPH offers the Women, Infants, and Children Program (WIC) to ensure that both mother and baby receive proper nutrients and vitamins during critical periods of growth and development before and after delivery. WIC also provides a Breastfeeding Peer Counseling Program, which is designed to improve infant health by increasing the practice of breastfeeding. Many local agencies and organizations serving Catawba County’s residents work closely with the March of Dimes in an effort to prevent low birth weight infants. Catawba County Public Health employs SIDS counselors who provide prevention education to the general public on a regular basis. The interagency Child Fatality Prevention Team identifies deficiencies in the delivery of services to children and families by public agencies, makes and carries out recommendations for changes that will prevent future child deaths, and promotes understanding of the causes of child deaths. Catawba County Schools’ Early Head Start program provides services to pregnant women to assist in prevention of low birth weight infants. Catawba County Schools’ Parents as Teachers program provides home visits focused on child development and parenting skills for parents of infants from birth – 5 years. CCPH partners with Catawba Pediatric Associates to provide a medical home with quality preventive and acute health services for children ages 2 weeks – 20 years.

Opportunities 

56

Increase efforts to engage minority populations in available educational resources regarding causative factors and preventive measures for infant mortality. Community Health Assessment 2011

Infant Mortality  

More targeted education is needed among all populations regarding the importance of receiving prenatal care within the first trimester. More community education is needed during prenatal, postpartum, and well-child visits to better inform parents about measures to prevent SIDS.

Conclusions 

 

Consistently higher rates of neonatal mortality, infant mortality, and low birth weight among minorities indicate an ongoing gap between white and minority birth outcomes in Catawba County. This may be partially due to the fact that fewer minority women initiate prenatal care in the first trimester. Infant mortality can be significantly reduced by medical and behavioral interventions, which are present in the variety of services offered in Catawba County. Making expectant mothers more aware of actions they can take to prevent infant mortality continues to be a key factor in reducing rates.

References 

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

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57

Catawba County Health Partners, 2007 Catawba County Community Health Assessment, http://www.catawbacountyheatlhpartners.org/community.asp Centers for Disease Control and Prevention, February 2011. Facts about Birth Defects. http://www.cdc.gov/ncbddd/birthdefects/facts.html Department of Health and Human Services , North Carolina State Center for Health Statistics, Community Health Data Book, 2011, http://www.schs.state.nc.us/SCHS/ Department of Health and Human Services, North Carolina State Center for Health Statistics. 2010 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2010/2010rpt.html Department of Health and Human Services, North Carolina State Center for Health Statistics. 2009 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2009/2009rpt.html Department of Health and Human Services, North Carolina State Center for Health Statistics. 2008 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2008/2008rpt.html Department of Health and Human Services, North Carolina State Center for Health Statistics. 2007 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2007/2007rpt.html Department of Health and Human Services, North Carolina State Center for Health Statistics. 2006 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2006/2006rpt.html Department of Health and Human Services, North Carolina State Center for Health Statistics. 2005 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2005/2005rpt.html Department of Health and Human Services, North Carolina State Center for Health Statistics. 2004 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2004/2004rpt.html Department of Health and Human Services, North Carolina State Center for Health Statistics. 2003 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2003/2003rpt.html

Community Health Assessment 2011

Infant Mortality 

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58

Department of Health and Human Services, North Carolina State Center for Health Statistics. 2002 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2002/2002rpt.htmll Department of Health and Human Services, North Carolina State Center for Health Statistics. 2001 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2001/2001rpt.html Department of Health and Human Services, North Carolina State Center for Health Statistics. 2000 North Carolina Infant Mortality Report. http://www.schs.state.nc.us/SCHS/deaths/ims/2000/2000rpt.html March of Dimes, 2011. 2011 Premature Birth Report Cards. http://www.marchofdimes.com/mission/prematurity_reportcard.html March of Dimes,2011. Prematurity Campaign. http://www.marchofdimes.com/mission/prematurity_indepth.html National Institute of Child Health & Human Development, 2010. Sudden Infant Death Syndrome (SIDS). http://www.nichd.nih.gov/health/topics/sudden_infant_death_syndrome.cfm National Women’s Health Information Center, U.S. Department of Health & Human Services, March 2009. Pre-natal Care Fact Sheet 2009, http://www.womenshealth.gov/publications/ourpublications/fact-sheet/prenatal-care.pdf North Carolina Healthy Start Foundation, September 2010. Healthy Start Happenings Newsletter. http://nchealthystart.org/Happenings/Newsletters/Sept_2010.htm T.J. Mathews, M.F. MacDorman. Infant Mortality Statistics From the 2007 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports, Volume 59, Number 6, June 29, 2011. http://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_06.pdf United States Food & Drug Administration, February 4, 2011. FDA approves drug to reduce risk of preterm birth in at-risk pregnant women. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm242234.htm?sms_ss=email&at _xt=4d50034cbfa7fa33%2C0 World Health Organization, Neonatal Mortality Levels for 193 Countries in 2009 with Trends since 1990: A Systematic Analysis of Progress, Projections, and Priorities. PLoS Medicine, Volume 8, Number 8, August, 2011. http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001080

Community Health Assessment 2011

Influenza and Pneumonia Overview Influenza (also referred to as the flu) is a contagious viral infection of the respiratory system (nose, throat, and lungs) that can cause mild to severe illnesses and at times lead to death. The flu affects 5-20% of the U.S. population and causes an estimated 36,000 deaths annually. While everyone is at risk for the flu, children younger than 5, adults 65 years and older, pregnant women, and individuals with certain medical conditions are at higher risk for contracting the virus. Pneumonia, which affects only the lungs, is responsible for more than 50,000 deaths in the United States each year and is the leading cause of death for children worldwide. It is most often caused by bacteria or viral infections and is contracted when the immune system is temporarily weakened. As with influenza, those most at risk of developing pneumonia are the elderly, the very young, and people with chronic conditions or impaired immune systems. Unlike influenza, pneumonia is not usually contagious. The best way to prevent the flu and pneumonia is to get vaccinated each year. It is recommend that everyone 6 months and older get the flu vaccine annually. The seasonal flu vaccine protects against the three influenza viruses that research suggests will be most common. Children under 9 years of age who haven’t been vaccinated against the flu in the past need two doses of flu vaccine. Because pneumonia is often a complication that arises from the flu, the flu vaccine can help prevent both illnesses. A bacterial pneumonia vaccine is also available and is recommended for adults over 65 or at high risk. It is worth noting that in 2009, the world experienced its first flu pandemic in more than 40 years. The influenza was called H1N1 and was a unique combination of virus genes never previously identified. Unlike traditional flu, the H1N1 strand was causing the majority of illness and deaths in persons 65 years old and younger. The Centers for Disease Control and Prevention’s (CDC) mid-level range estimates for H1N1 in the United States were approximately 61 million cases, 274,000 hospitalizations, and 12,470 deaths during the period of April 2009 to April 10, 2010.

Catawba County Data Pneumonia/ Influenza Death Rates per 100,000, 2005-2009

59

Catawba County

North Carolina

White population

24.9

19.9

Minority population

9.1

18.1

Female population

20.1

17.7

Male population

33.1

22.8

Total Population

23.9

19.7

65-84 years of age*

91.2

75.4

Over the age of 85*

828.2

592.7

Source: State Center for Health Statistics, 2005-2009,*SCHS, 2004-2008 *Data in red indicates rates based on small numbers (fewer than 20 cases) and should be interpreted with caution. Community Health Assessment 2011

Influenza and Pneumonia   

For ages 0-99, influenza and pneumonia combined were tied with diabetes as the 8th leading cause of death in Catawba County in 2009. Death rates for pneumonia/flu are substantially higher in Catawba County as compared to North Carolina. Individuals over the age of 85 are at greatest risk for death from the diseases.

2011 Catawba County Community Health Assessment Survey

Yes

Question asked on survey:

No: Do not get sick

7.9%

Do you get a flu shot each year?

No: Do not like getting shots

6.9%

No: Do not like going to the doctor No: Can't pay for it

7.9% 3.3% 5.6%

54.2%

0.7% 4.7%

8.8%

No: Believe the vaccine is ineffective No: Believe it causes sickness No: Side effects No: Other









The 2010 Catawba County Community Health Assessment Survey found that 45.8% of Catawba County adults do not get an annual flu vaccine, which is the most effective means of preventing the disease. Further demographic analysis revealed the following: o Females are more likely to get a flu shot than males. o Higher education level increases someone’s likelihood of getting a flu shot. o People over the age of 65 are more likely to get a flu shot (84.6%) as opposed to those under the age of 65 (62.1%). o Whites are much more likely to get a flu shot than are minorities. According to the 2010 Behavioral Risk Factor Surveillance Survey (BRFSS) for Catawba County, 42.5% of respondents indicated they had received a flu shot in the past 12 months. This number is close to the 45.8% reported in the Community Health Assessment Survey (above). BRFSS data mirrors the demographic breakdown above; it indicates that fewer men (39.0%), minorities (32.9%), and adults age 18-44 (27.2%) reported receiving a flu shot than women (46.4%), whites (44.8%) and adults age 45 and older (72.8%). BRFSS data shows that only 24.9% of adults in the county have ever received a pneumonia shot, with the highest concentration in the 45-and-older age range (33.7%).

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  Catawba County’s influenza and pneumonia death rate has decreased by 12.5% for the total population and 15.1% for the 85-and-older population.

60

Community Health Assessment 2011

Influenza and Pneumonia National or State Data Received an Influenza Vaccination in the Past Year in United States 70%

64%

60% 50% 40%

41%

39%

30%

25%

20% 10% 0% Children 6 months to 17 years

Adults 19-49 years

Adults 50-64 years

Adults 65 years and over

Source: CDC National Health Interview Survey, 2010

     

In 2010, 59.0% of adults age 65 and over in the United States and 71.2% in North Carolina had ever received a pneumonia vaccination. Influenza and pneumonia combined are the 8th leading cause of death in the United States and the 4th leading cause of death among persons age 65 or older. In the U.S., 90% of influenza associated deaths occur among adults 65 years and older. Influenza season usually begins in October and can last until May. While flu outbreaks can occur as early as October, most flu activity peaks in January or later. The CDC estimates that from the 1976-1977 season to the 2006-2007 flu season, flu-associated deaths ranged from a low of about 3,000 to a high of about 49,000. States are not required to report individual seasonal flu cases or deaths of people older than 18 years of age to the CDC.

DID YOU KNOW?   

Flu is the leading cause of death for any vaccine-preventable disease in the U.S. The flu vaccine cannot cause flu illness. The viruses in the vaccine are either killed (flu shot) or weakened (nasal spray vaccine), which means they cannot cause infection. Globally each year, pneumonia kills more than 1.5 million children younger than 5 years of age.

61

Community Health Assessment 2011

Influenza and Pneumonia Assets  



  

Catawba County Public Health’s (CCPH) Immunization Clinic provides influenza and pneumonia vaccines to the general public for a fee depending on insurance status. In 2010, the vaccine company Sanofi Pasteur, Inc., began providing a Fluzone High-Dose influenza vaccine specifically designed for people over 65 years of age. Fluzone High-Dose vaccines contain 4 times the amount of antigen compared to regular flu shots, which is intended to create a stronger immune response. Flu and pneumonia vaccines are accessible in the community from many physician offices, Frye Regional Medical Center (FRMC) and Catawba Valley Medical Center (CVMC). These vaccines have recently increased in availability as pharmacies have begun offering the shots as well. CVMC and FRMC both review the immunization status of all admitted patients who are diagnosed with influenza or pneumonia and recommend both vaccines for patients who have not received them. CCPH partners with CVMC’s Health First Center and various community locations to conduct flu clinics. CCPH implemented an award-winning flu vaccine promotional campaign representing general and atrisk populations – “Arm Yourself Against the Flu” – to increase awareness and vaccination rates during the 2010-11 and 2011-12 flu seasons.

Opportunities 





Immunizations are typically viewed as a preventive method for children but not adults. However, adults as well as children need them for diseases such as influenza and pneumonia. Adults over age 65 and those who fall into high-risk categories should get the pneumonia vaccine and all adults, with few exceptions, should get the influenza vaccine annually. A commonly cited reason for not getting flu and pneumonia vaccinations is the mistaken belief that the vaccines will cause the disease. There is a need to educate the public and dispel this myth while providing correct information about the risks and benefits of vaccines and encouraging people to get vaccinated. The CDC and the Advisory Committee on Immunization Practices (ACIP) recommend that all healthcare workers get an annual flu vaccine; however, fewer than half report getting one. Vaccinating more healthcare workers can protect their patients, as well as themselves and their families.

Conclusions  

Flu is a highly preventable disease. Nearly half of adults in Catawba County do not get a flu shot; misinformation contributes to the low vaccination rate. Populations most at risk for both influenza and pneumonia are the elderly, the very young and those with chronic conditions and compromised immune systems. However, most people can benefit from a flu vaccination.

References    

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Centers for Disease Control and Prevention, 2011. Current Features: Pneumonia. http://www.cdc.gov/Features/Pneumonia/ Centers for Disease Control and Prevention, February 2010. Fast Facts: Pneumonia. http://www.cdc.gov/nchs/fastats/pneumonia.htm Centers for Disease Control and Prevention, February 2011. Fast Facts: Influenza. http://www.cdc.gov/nchs/fastats/flu.htm Centers for Disease Control and Prevention, August 2011. The Flu Season. http://www.cdc.gov/flu/about/season/flu-season.htm Community Health Assessment 2011

Influenza and Pneumonia 

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63

Centers for Disease Control and Prevention, June 2011. Estimating Seasonal Influenza-Associated Deaths in the United States: CDC Study Confirms Variability of Flu. http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm Immunize North Carolina (2011), www.immunizenc.org National Foundation for Infectious Diseases (2007) www.nfid.org North Carolina Department of Health and Human Services, State Center for Health Statistics, October 2010. Leading Causes of Death in North Carolina 2009. http://www.schs.state.nc.us/SCHS/deaths/lcd/2009/allcauses.html North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County: Flu Shot. http://www.schs.state.nc.us/SCHS/brfss/2010/cata/FLUSHOT4.html

Community Health Assessment 2011

Injury and Violence Overview Motor vehicle crashes, falls, homicides, domestic violence, child abuse and neglect, and drug overdoses are just some of the tragedies reported every day in communities and on the news. Injuries and violence are commonplace in society. Many people accept them as “part of life,” but the fact is that most events resulting in injury, death, or disability are predictable and therefore preventable. Injury and violence are serious public health problems due to their impact on the lives of individuals, families, and society. In Catawba County, injuries (unintentional and motor vehicle) are currently listed among the top three causes of death for individuals ages 0 to 64. Unintentional injury is the 6th leading cause of death in the county, and motor vehicle injury is ranked 10th. Injury prevention strategies focus on environmental design, product design, human behavior, education, and legislative and regulatory requirements that support environmental and behavioral change. For example, this includes laws requiring the use of seat belts and motorcycle helmets. The word violence is used to describe any abusive or aggressive behavior that is either enacted upon another individual or performed on oneself. This category serves as an umbrella for a number of acts including child abuse, rape, assault, suicide, and homicide.

Catawba County Data Death Rates by Violence in Catawba County and North Carolina Catawba County

North Carolina

Homicide

6.8

7.0

Suicide

14.8

12.0

Source: State Center for Health Statistics, 2005-2009, deaths per 100,000 population (age adjusted)

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64

When compared to North Carolina, Catawba County has a higher suicide rate and a lower homicide rate. Of the 276 respondents to the 2010 Catawba County Behavioral Risk Factor Surveillance Survey (BRFSS) on physical violence, 12.1% said that a partner or ex-partner had physically hurt them more than 12 months ago. Comparatively, 13.3% said a stranger had physically hurt them more than 12 months ago, and 5.0% said someone they knew had physically hurt them more than 12 months ago. None of the respondents reported being physically hurt by any of the above in the past 12 months.

Community Health Assessment 2011

Injury and Violence Injuries and Resulting Hospitalizations or Deaths in Catawba County Catawba County

Assault Self-Inflicted Unintentional Other TOTAL

Emergency Department Visits

678

236

13,089

775

19,803

Hospitalizations

32

183

855

901

2,523

Deaths

15

30

78

0

128

Source: North Carolina Injury and Violence Prevention Branch; 2008, ED Visits and Deaths; 2007, Hospitalizations

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65

As the chart above indicates, preventable injuries (unintentional and self-inflicted combined) comprise the vast majority of total injuries in Catawba County. The average charge per case in hospitals for injuries and poisoning was $45,814 in 2009 in Catawba County. The total injuries and poisoning cases in hospitals in Catawba County cost $60.4 million in 2009. According to 2010 State Center for Health Statistics data, injury disproportionately affects individuals ages 20-34. Of the 283 respondents to the 2010 Catawba County BRFSS survey of traumatic brain injury, 4.7% indicated they had had a traumatic brain injury in their lifetime. Of those, 32.1% were caused by motor vehicle or motorcycle crash; 27.4% were caused by a fall; 22.6% were the result of a stroke or aneurism; 5.8% were sports-related; and 12.1% were due to unnamed causes. According to BRFSS, 15% of adults ages 45 and older in Catawba County reported falling at least once in the 3 months prior to the survey, and 45.4% of these falls caused an injury. Results of a 2010 Catawba County youth gang assessment, which interviewed 51 community professionals representing 19 community institutions in Catawba County that deal with troubled youth, indicate the following: 88.2% of those interviewed responded that they believe gangs are a problem in their community or school. What sort of problems, if any, gang activity presented in their community or school: o 58.8% responded violence or threats of violence (intimidation/fighting/assault/bullying) o 51.0% responded home/auto larceny If they are aware of gang activity in their community, what issues do they think contribute to its existence? o 37.8% responded lack of parental presence/supervision o 11.8% responded ignorance/denial of gang existence by community institutions o 11.8% responded lack of concern by community institutions If they are aware of gang activity in their community, do they believe it is increasing, decreasing, or staying the same as in previous years? o 43.1%: increasing o 47.1%: about the same or decreasing

Community Health Assessment 2011

Injury and Violence Catawba County Fatalities by Motor Vehicle Crashes 29

30 26

25 25

23 20

20

Involving Speeding

15 10

7

10 10

9

8

9

Involving Alcohol-Impaired Driver (BAC= .08+)

10

Total

7 5

5

3

0 2005

2006

2007

2008

2009

Source: National Highway Traffic Safety Administration, 2005-2009

 

 

As reflected by the data above, the number of fatalities by motor vehicle crashes in 2009 is the highest dating back to 2005 and represents an increase of 12% from 2008. Catawba County ranked 7th on the list of the top 10 North Carolina counties with the most fatalities by motor vehicle crashes in 2009. From 2005-2009, 2009 was the deadliest year for motor vehicle fatalities. An analysis of the data indicates that alcohol-impaired drivers are significant factors in motor vehicle crash fatalities in Catawba County. Speeding is also a key factor. Of 23 child fatalities in Catawba County during 2009-2010, 17% were due to motor vehicle crashes. Catawba County Seatbelt Usage When Riding in a Car 2.2% 0.6%

1.9%

Always Nearly Always

7.6%

Sometimes Seldom 87.7%

Never

Source: Catawba County BRFSS, 2010

66

Community Health Assessment 2011

Injury and Violence  

According to 210 BRFSS data on seat belt use, all of the respondents stating they “never” use a seat belt were male. The top-reporting “always” respondents to the survey were minorities and adults age 45 or older.

National or State Data 



 

   

  

As of 2008, the top 5 leading causes of injury-related death in North Carolina were motor vehicle crashes (1,498 deaths); unintentional poisoning (1,015 deaths); falls (741 deaths); firearm/self-inflicted (668 deaths); and firearm/assault (465 deaths). In 2008, 1,884 North Carolina residents died by violence. The pattern by gender was the same for both suicides and homicides; approximately three-fourths of victims were male and one-fourth was female. The patterns of suicides and homicides differed by race; 88% of suicide victims were white, while only 9% were black. In 2008, the leading cause of death for North Carolinians ages 5 to 34 was motor vehicle crashes. In 2009, 16% (4,898) of the 30,797 fatal motor vehicle crashes in North Carolina involved driver distraction. This represents an increase from 2005, in which 10% of fatal motor vehicle crashes involved driver distraction. Of the total number of people injured in motor vehicle crashes in North Carolina, 22% were injured in crashes involving driver distraction. One in 3 motor vehicle crash deaths involves a drunk driver in the United States. In 2009, there were an estimated 429.4 violent crimes per 100,000 inhabitants of the U.S. This is a decrease of 5.3% from 2008. In 2009, aggravated assaults accounted for the highest number of violent crimes reported to law enforcement (61.2%) across the U.S. Robbery comprised 31%, forcible rape accounted for 6.7%, and murder accounted for 1.2%. There are more than 180,000 deaths from injury each year in the United States- 1 person every 3 minutes. Injuries, unintentional and intentional, are the leading cause of death for people age 1-44 in the United States. In the United States, injuries cost more than $406 billion annually in medical costs and lost productivity.

Assets 

 





67

Catawba County’s Child Fatality Prevention Team meets on a quarterly basis to review child deaths and propose recommendations. This team, in conjunction with the Community Child Protection Team, developed a Distracted Driving Committee to focus on risk awareness and prevention of distracted driving. Catawba County Public Health (CCPH) provides child safety seats to eligible families for a small fee in an effort to reduce the number of injuries and fatalities for children from motor vehicle crashes. Catawba Valley Medical Center (CVMC) serves as the lead agency for the Safe Kids Catawba County coalition. Safe Kids Catawba County performs routine child safety seat inspections in the community, oversees several permanent checking stations, provides discounted-price car seats to needy families in order to ensure proper seat installation, and conducts an annual health fair to raise awareness of childhood injuries. Law enforcement agencies in Catawba County actively promote North Carolina’s “Click It or Ticket” and “Booze It and Lose It” campaigns. They participate in community health fairs and work with the school systems to ensure teens are aware of the dangers associated with driving while intoxicated. Following the death of a Bandy’s High School student at the hands of a drunk driver, citizens and students in the community established the Another Night Alive, Make A Call phone line. This line Community Health Assessment 2011

Injury and Violence



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

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

   

68

provides students in the Mill Creek Middle School and Bandy’s High School communities with a safe, non-judgmental, and confidential ride home if they are in an uncomfortable and potentially dangerous situation or if a driver is under the influence and may not be able to drive safely. Catawba Valley Community College (CVCC), in conjunction with the Safety and Health Council of North Carolina, offers “Alive at 25,” a 4-hour defensive driving course designed for teens that have been charged with a minor traffic violation in the 25th District or for any teen wishing to take the course. Child restraint laws have been upgraded to require that all passengers under the age of 16 be in a proper restraint; a stricter booster seat law has also been enforced to mandate use of the seat until a child reaches the age of 8 or a weight of 80 pounds. North Carolina has a mandatory child bicycle helmet law that requires every person under age 16 to wear an approved bicycle helmet when operating a bicycle on any public road, public bicycle path, or other public right-of-way. Catawba County Social Services (DSS) established a Community Standard for Child Abuse and Neglect document that can be used to gauge both the presence and severity of child abuse and neglect. The Rape Crisis Center is funded through the United Way to assist women who have been sexually assaulted. Some Catawba County communities engage in Neighborhood Watch programs to decrease the incidence of violence, theft, or burglary in their neighborhoods. CVMC has 4 Sexual Assault Nurse Examiners (SANE) who offer victims prompt, compassionate care and comprehensive forensic evidence collection. The Children’s Advocacy Center offers an awareness course, “Darkness to Light,” which educates parents, caregivers, and community members about sexual abuse. The Hickory Police Department has implemented the Gang of One task force, which aims to prevent atrisk youth from joining gangs by establishing programs that provide positive activities for youth wanting to separate from gang activity. Each school system offers classroom guidance lessons through the Students Trying Out Peace (STOP) program to address issues such as conflict resolution, handling bullying or teasing, identifying sexual harassment, and anger management techniques. Peer mediation is available to all students as a violence prevention alternative. Counselors are available in all schools to address the various needs of the students. The counselors maintain student confidentiality; however, appropriate action is taken and referrals are made if needed. The Nurturing Program, led by DSS, reaches approximately 90 parents annually, most of whom have been involved in substantiated reports of child abuse or neglect. Hispanic Outreach, conducted by DSS, addresses violence, child abuse, rape, and teen pregnancy. Its primary goal is to help prevent child protective service reports through self-sufficiency with early involvement in Work First services. Family Net, a program within DSS, offers the Sexual Abuse Intervention Program (SAIP), an enhanced treatment program that provides comprehensive evaluation and treatment to legally adjudicated adolescent sex offenders to protect both current and future victims from further sexual victimization and abuse. The Family Guidance Center, funded by United Way, offers a First Step program that offers shelter to victims of family violence. The Catawba County Sheriff’s Department offers a Conflict Resolution Center that provides techniques to handle combative situations and anger management. Each school in Catawba County employs resource officers who are on campus at all times to minimize and control situations which may arise among the students. CCPH’s Women’s Preventive Health Clinic screens all patients for emotional, sexual, and physical abuse, and nurses are available to counsel patients on request. Community Health Assessment 2011

Injury and Violence Opportunities           

Offer incentives to teenagers who complete a driving safety course, such as lower insurance rates. Secure funding for a driving test track for students to practice safe driving. Offer driving safety courses to the Hispanic community through churches and Centro Latino. Secure funding to utilize impaired driving simulators in driver’s education. Assess driver’s education curriculum for areas of improvement regarding safe driving practices. Expand Safe Kids Catawba County partnerships and programs offered in the community. Encourage law enforcement to organize Neighborhood Watch groups in communities and/or neighborhoods that do not already have them. Offer self-defense classes in the community through workplaces, recreation departments, churches, and fitness centers. Provide gang initiation prevention programs to youth and parents at schools, churches, businesses and community centers. Offer the “Darkness to Light” awareness program to adults at schools, churches, businesses and community centers. Work with businesses to offer mental health services, such as employee assistance programs and other resources, in order to prevent suicide and help manage other mental health issues.

Conclusions   

The large majority of injuries that occur are preventable. Motor vehicle crashes are responsible for the most injury deaths in Catawba County and North Carolina. Resources for victims of violence and abuse are abundant in Catawba County, but more advocacy for prevention of violence and abuse is needed.

References        

  

69

Catawba County Health Partners, August 2007. Development Assets: Newton-Conover/ Catawba County/ Hickory City Schools. http://www.catawbacountyhealthpartners.org/Youth.pdf Centers for Disease Control and Prevention. The Incidence and Economic Burden of Injury in the United States, http://www.cdc.gov/ncipc/factsheets/CostBook/Economic_Burden_of_Injury.htm Centers for Disease Control and Prevention, September 2010. The Burden of Injury and Violence: A Pressing Public Health Concern. http://www.cdc.gov/injury/overview/index.html Centers for Disease Control and Prevention, October 2011. Drinking and Driving: A Threat to Everyone. http://www.cdc.gov/vitalsigns/DrinkingAndDriving/index.html#Introduction Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Webbased Injury Statistics Query and Reporting System (WISQARS) www.cdc.gov/ncipc/wisqars E.K. Moscicki. Epidemiology of completed and attempted suicide: toward a framework for prevention. Clinical Neuroscience Research, Volume 1, Issue 5, November 2001. North Carolina Department of Health and Human Services, Division of Public Health, Chronic Disease and Injury Section, Injury and Violence Prevention Branch. www.injuryfreenc.ncdhhs.gov North Carolina Department of Justice, State Bureau of Investigation, Division of Criminal Information, June 2011. Crime in North Carolina- 2010. http://crimereporting.ncdoj.gov/public/2010/ASR/2010%20Annual%20Summary.pdf North Carolina State Center for Health Statistics (SCHS), 2011. http://www.sprc.org/stateinformation/PDF/statedatasheets/nc_datasheet.pdf C. Sanford, S.W. Marshall, S.L. Martin, T. Coyne-Beasley, A.E. Waller, P.J. Cook, T. Norwood, Z. Demissie. Deaths from Violence in North Carolina, 2004: How Deaths Differ in Females and Males. Injury Community Health Assessment 2011

Injury and Violence    

70

Prevention, Volume 12, Supplement 2, December 2006. http://injuryprevention.bmj.com/content/12/suppl_2/ii10.full Suicide Prevention Resource Center, September 2008. North Carolina Suicide Prevention Fact Sheet. United States Department of Health and Human Services, National Institute of Mental Health, January 2001. In Harm’s Way: Suicide in America. http://www.sprc.org/library/event_kit/nimh_harmsway.pdf United States Department of Justice, Federal Bureau of Investigation. Uniform Crime Reports. http://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2010/crime-in-the-u.s.-2010/index-page Western Piedmont Council of Governments, Catawba County Youth Gang Assessment, 2010. http://www.wpcog.org/files/publications/25th%20Youth%20Gang%20Assessment.pdf

Community Health Assessment 2011

Mental Health Overview Over the past four years, mental health care has undergone significant changes in Catawba County. What had traditionally been considered a county-specific service was expanded into a Local Managing Entity (LME) format covering both Burke and Catawba counties. This structure is set to expand even further within the coming year, merging three LMEs to consolidate services across eight North Carolina counties. Mental Health Partners (MHP) is the LME for publicly-funded mental health, developmental disability, and substance abuse services in Burke and Catawba Counties – serving a combined population of approximately 250,000. As such, MHP provides oversight of local providers, administers funds, and ensures quality services to residents. The mission and commitment of MHP is to manage and assure a person-centered, family-oriented, outcome-based system of services. In partnership with their providers, MHP expects a quality services system that satisfies and empowers consumers to pursue their highest potential. MHP is governed by a board of directors from Catawba and Burke Counties. MHP employs an area director who is responsible for administering LME and supervising the 54 experienced, full time staff members whose responsibility is to maintain a network of private behavioral health providers and work to ensure that consumers have access to quality, appropriate services close to home. As a result of excellence in administering the LME, MHP achieved National Accreditation in 2009 from the Commission of Accreditation of Rehabilitation Facilities (CARF) as a Service Management Network.

Catawba County: Changes to Service Delivery Model During the 2010 Legislative Session, the North Carolina General Assembly raised the minimum population threshold for LMEs to 300,000 by July 2012 and 500,000 by July 2013. Many LME catchment areas do not meet the population requirements; therefore, mergers are taking place across the State. Locally, Mental Health Partners, Pathways LME and Crossroads Behavioral Healthcare are working together to merge by July 1, 2012. Area Boards of Directors and Consumer and Family Advisory Committees gave their support for the proposal. Soon thereafter, an application was made for the Expansion of the Medicaid 1915 (b)(c) Waiver. The Boards of County Commissioners for Burke, Catawba, Cleveland, Lincoln, Gaston, Iredell, Surry and Yadkin counties also approved this proposal. The application and plan for implementation were submitted to the state in May 2011 and approved on July 22, 2011. The new organization will become operational July 2012, and the Medicaid Waiver will be effective January 2013.

2011 Community Mental Health Needs Assessment An abbreviated Community Mental Health Needs Assessment for Burke and Catawba counties was conducted in March 2011. The more prominent identified gaps in the service array were as follows: Substance abuse treatment and services for Burke County residents. The lack of transportation in Burke and Catawba Counties.

71

Community Health Assessment 2011

Mental Health Additional services to Intellectually Developmentally Disabled (IDD) children and adults who lack CAPMR/DD funding. Residential treatment, halfway houses and extended care options. Expansion of array of Peer Support Services. Inpatient beds for adolescent consumers. Bilingual staff, including therapists. Overall capacity, including in-take and services for those with Medicaid and Medicare. Following the pending merger and implementation of the Medicaid Waiver, a full and comprehensive Community Mental Health Needs Assessment will be conducted. To review the abbreviated 2011 Community Mental Health Needs Assessment, visit the following web page: http://www.mentalhealthpartners.org/DOCS/Performance%20Information/MHP%20Community%20Needs%20 Assessment%202009.pdf.

Empowering People ~ Strengthening Community

Information about Mental Health Partners, the provider network, available services and access, and the upcoming merger of Mental Health Partners, Pathways LME, and Crossroads Behavioral Healthcare can be found on the MHP website, www.mentalhealthpartners.org, or by calling 828-327-2595 in Catawba County and 828-439-2535 in Burke County.

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Community Health Assessment 2011

Nutrition and Physical Activity Overview Inadequate physical activity and poor nutrition are two major contributing factors to the prevalence of chronic disease in the United States, including rising obesity rates among adults and children. Together, physical inactivity and unhealthy eating are the second leading preventable cause of death in North Carolina. A proper balance of nutrition and physical activity is essential for disease prevention and lifelong health. Regular physical activity is necessary to maintain a healthy weight. It helps reduce the risk of cardiovascular disease, diabetes, osteoporosis, and colon cancer and helps build a healthier body by strengthening bones, muscles, and joints. Physical activity also improves depression and anxiety, enhances the immune system, and helps reduce high blood pressure and arthritis pain and disability. The recommendations for an adequate amount of physical activity are 30 minutes of moderate physical activity per day, 5 days per week; or vigorous physical activity for 20 or more minutes per day, 3 or more days per week. A healthy, nutritious diet reduces the risk of hypertension, heart disease, diabetes, overweight and obesity, some types of cancers, and other chronic illnesses. Individuals can achieve proper nutrition by eating a variety of foods that supply the recommended amounts of fat, protein, carbohydrates, water, vitamins, and minerals. Five or more servings of fruits and vegetables per day are recommended and added fats, sugars, and sodium should be limited. A healthy eating plan is determined on an individual basis by age, sex, height, weight, and physical activity level.

Catawba County Data According to the 2010 Behavioral Risk Factor Surveillance Survey (BRFSS) of Catawba County, 66.5% of adults reported that they participated in physical activities other than their job. This number is lower than the reported 74.3% of North Carolina adults. Demographic breakdowns indicate that men and women in Catawba County are equally physically active, with 66.8% of men and 66.1% of women reporting participation in physical activities other than their job. Age was also fairly evenly reported, with 63.4% of 18-to-44-year olds and 69.2% of 45-and-older adults reporting additional physical activity. Race, education, and household income all showed disparities in the amount of additional physical activity. Almost three-fourths, 73%, of the white population reported additional physical activity, as compared to 39.1% of the minority population surveyed. Adults with some college or more (75.8% vs. 55.9% for those with high school or less education) and incomes greater than $50,000 (83.2% vs. 57.2% for adults with less than $50,000 in income) also reported significantly higher percentages of physical activity.

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Community Health Assessment 2011

Nutrition and Physical Activity 2011 Catawba County Community Health Assessment Survey

Physical Activity Question asked on survey: The recommendation for physical activity is 30 minutes a day 5 days a week (2 ½ hours per week). Pick the main reason that keeps you from getting this much physical activity.

Nothing. I get this much activity 3%

I don't have time to exercise

12% 36%

10%

I feel like I get this at my work I am physically disabled

4%

I don't like exercise

9% 26%

There is no safe place to exercise Other

Analysis of the results from the survey reveals the following: o Retired persons exercise more than any other job status. o The self-employed get more exercise than those who are employed for wages. o Students, more than any other job classification, indicate that they do not like to exercise. o Students and persons who are employed for wages state that they do not have time to exercise more than any other group. o People of lower education feel that they get a workout while at work more so than those with a higher education.

DID YOU KNOW?  Children form many of their behaviors regarding nutrition and their level of activity at a young age, and those habits are usually carried throughout adulthood.

 Increased usage of technology (e.g., television, video games, computers) over the years has contributed to a more sedentary lifestyle and therefore less physical activity for both children and adults.

 Research shows that families that eat dinner together at least 5 times a week are more likely to eat healthier and have healthier weights.

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Community Health Assessment 2011

Nutrition and Physical Activity 2011 Catawba County Community Health Assessment Survey Nutrition Nutrition Question asked on survey:

Nothing. I eat 5 or more servings a day I just don't think about it

One recommendation for healthy eating is to eat at least 5 servings of fruits and vegetables a day (not french fries or potato chips). Pick the main reason that keeps you from eating this way.

9.9% 12.5%

36.5%

9.3%

I don't know how to prepare them I don't have time to fix them

0.6% 3.4%

I (or my family) won't eat them

27.8%

They're too expensive Other

National or State Data According to their parents, over 91% of North Carolina children ages 5-10 engage in 60 minutes or more of physically active play on a typical day. Over 45% of children under the age of 10 in North Carolina watch at least 2 hours of television on a typical day. Approximately 24% of high school students spend 3 hours or more watching TV on a typical school day. In North Carolina, 36% of high school students spend 3 or more hours a day playing video/computer games or using a computer for non-school related interests In North Carolina, 46% of high school students report that they engage in 60 minutes or more of physical activity on 5 or more days per week. Since 2001, the percentage of North Carolina adults getting the recommended amount of physical activity has gradually increased from 42% in 2001 to over 46% in 2009. In North Carolina, 56% of adults drink 1 or more sugar sweetened beverage, such as sweet tea or soda, on a typical day. The percentage of North Carolina children ages 5-10 getting 5 or more servings of fruits and vegetables per day has declined by 8% since 2005, with 58% currently meeting recommendations. In North Carolina, only 16.9% of high school students are getting 5 or more servings of fruits and vegetables per day. North Carolina is ranked 43rd in the United States for fruit and vegetable consumption among adults. In 2001, approximately 25% of adults consumed the recommended 5 or more servings of fruits and vegetables per day. As of 2009, this number decreased to approximately 20%. 75

Community Health Assessment 2011

Nutrition and Physical Activity Assets Catawba Valley Medical Center’s (CVMC) Health First Center offers aerobics for seniors and healthy cooking classes. YMCA of Catawba Valley offers physical activity programs, fitness centers, and various sports leagues for children and adults. Several local private fitness centers offer memberships and other services, such as personal training and nutritional counseling. Girls on the Run of Catawba Valley is an after-school running program for girls in grades 3-8 that helps teach the value of physical activity. Stretch-n-Grow classes are offered to participating preschoolers with the goal of building a foundation for lifelong healthy food choices and consistent physical activity. Catawba County operates 3 large public parks that provide opportunities for residents to walk, hike, canoe, fish, and bike, along with other outdoor activities and educational programming. In addition, the cities of Hickory, Conover, Newton, Maiden, and Catawba maintain 36 public parks which offer a variety of outdoor activities. Hickory Farmers Market and Conover Farmers Market operate on a seasonal schedule and offer a wide selection of fresh, locally grown produce. Both CVMC and Frye Regional Medical Center (FRMC) offer nutritional counseling to patients. CVMC also operates a fitness center that offers memberships to the public. Project HOPE (Help Our People Eat) harvests fruits and vegetables from a local garden for use at the Hickory Soup Kitchen, Eastern Catawba County Christian Ministries, and The Corner Table. North Carolina Cooperative Extension offers a multitude of nutrition and physical activity classes and programs. Examples include Eat Smart, Move More North Carolina; Revitalize Your Recipes; and The Shake on Salt. CCPH’s Women, Infants and Children (WIC) Program provides nutrition education and healthy food vouchers to pregnant women, mothers and children from birth to age 5 to promote the healthy development of babies and young children.

Opportunities While some worksites have implemented wellness programs that encourage better nutrition and physical activity, more could benefit from offering this service to their employees. Worksites and schools could also benefit from providing healthier cafeteria and vending machine options for their employees. Because children learn habits from their parents, there is a need for more classes and activities that involve families and more opportunities to encourage families to eat together. Events and activities that improve physical activity and nutrition need more promotion to help increase involvement. Rural areas of the county lack convenient access to grocery stores stocked with a variety of healthy food options. They also lack convenient access to fitness centers. While most people are aware of the importance of exercise and nutrition to their health, many could use additional incentives or motivation to help make these factors a consistent part of their everyday lives.

76

Community Health Assessment 2011

Nutrition and Physical Activity Conclusions Adequate physical activity and nutrition are major contributing factors to good overall health. Lack of one or both can lead to illness and chronic disease. Knowledge, personal choice, and access are the primary factors affecting a person’s ability to be physically active and eat well. Despite an abundance of information about the benefits of physical activity and proper nutrition, most people do not consistently follow recommended guidelines. Children who develop healthy eating and physical activity habits at a young age stand a better chance of maintaining those habits as adults.

References         

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Catawba County Public Health, February 2011. Community Health Assessment (CHA) Survey Results 2010-2011. http://www.catawbacountyhealthpartners.org/CHASurveyResults10.pdf Centers for Disease Control and Prevention, 2011. Obesity and Overweight. http://www.cdc.gov/obesity/index.html Centers for Disease Control and Prevention, 2011. Physical Activity for a Healthy Weight. http://www.cdc.gov/healthyweight/physical_activity/index.html Eat Smart, Move More North Carolina, December 2010. Physical Activity, Nutrition, and Obesity in North Carolina. http://www.eatsmartmovemorenc.com/Data/Texts/Quick%20Facts.pdf Eat Smart, Move More North Carolina. Physical Activity and Nutrition Data Resources. www.EatSmartMoveMoreNC.com/Data/Data.html Eat Smart, Move More North Carolina, May 2009. The Burden of Obesity in North Carolina. http://www.eatsmartmovemorenc.com/ObesityInNC/Texts/OBESITY_BURDEN_2009_WEB.pdf Harvard School of Public Health, 2011. The Nutrition Source. http://www.hsph.harvard.edu/nutritionsource/ Mayo Clinic, October 2011. Water: How Much Should You Drink Every Day? http://www.mayoclinic.com/health/water/NU00283 North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County: Exercise. www.schs.state.nc.us/SCHS/brfss/2010/cata/exerany2.html North Carolina Healthy Schools. 2009 N.C. Youth Risk Behavior Survey, High School Report. http://www.nchealthyschools.org/docs/data/yrbs/2009/highschool/statewide/summary-graphs.pdf

Community Health Assessment 2011

Oral Health Overview Poor oral health is a significant health problem experienced by many people in our county and across the United States. Adults and children needlessly endure pain from oral diseases and disorders, tooth loss, and oral infections. Tooth decay ranks as one of the most common chronic diseases in the United States and worldwide. In fact, the Surgeon General’s report in 2000 found that for children ages 5-17, tooth decay was 5 times more common than asthma. Equally disturbing is that complications of tooth decay can lead to more serious conditions, such as cardiovascular disease, stroke, diabetes, and poor pregnancy outcomes. Although knowledge about how to prevent dental disease has existed and been practiced for decades, it still remains a significant heath problem for all ages. The good news is that tooth decay and other oral diseases that affect our population are preventable. The combination of dental sealants and fluoride has the potential to nearly eliminate tooth decay in school-age children. No matter what age, access to dental treatment and preventive services, coupled with proper home care of teeth and good nutrition, can alleviate the unnecessary pain and medical complications associated with dental disease.

Catawba County Data  

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78

According to 2009 data released by Cecil G. Sheps Center at UNC-Chapel Hill, the number of dentists per 10,000 people was the same for North Carolina and Catawba County. Catawba County boasts 54 general dentist practices, 20 dental specialty practices (including oral surgery, orthodontists, periodontists, and pediatric dentists), 1 school of dental hygiene at Catawba Valley Community College (CVCC), and 1 free dental clinic that serves low-income adults at Greater Hickory Cooperative Christian Ministry (GHCCM). Sixteen general dentist practices and 9 specialty practices (4 orthodontists, 2 oral surgeons, and 3 pediatric dentists) provide dental services to children with Medicaid. Nine general practices and 3 pediatric dentists accept children age 4 or younger with Medicaid. Fourteen general dental practices in Catawba County accept adult Medicaid patients. As of 2008, only 59% of Catawba County is on community fluoridated water systems. This is compared to 86% in North Carolina and 64% in the United States. It should be noted that all public schools in Catawba County do receive fluoridated water. The 2011 Catawba County Community Health Assessment Survey revealed that low and middle income people only go to the dentist when they have a problem, not for regular check-ups. According to the North Carolina Assessment Data for the 2008-2009 school year, approximately 14% of Catawba County children entered kindergarten with untreated dental decay compared to 17% in North Carolina. During fiscal year 2010-11, Kids In Need (KIN) allocated $20,852.99 for 48 children to receive necessary dental care. During fiscal year 2010-11, Catawba County Public Health (CCPH), through a grant award by Catawba County Partnership for Children, allocated $23,688.96 for 13 children ages 1-5 to receive necessary dental care. CCPH ensured 231 low-income adults received urgent dental care through an annual budget allocation of $11,550.00 to the GHCCM dental clinic. Community Health Assessment 2011

Oral Health Children with Oral Health Issues

Average Number of Decayed, Missing and Filled Primary Teeth in Kindergarten

North Carolina

Catawba County

1.50

1.29

Percent of 5th Graders with Permanent Teeth Free of Decay

74%

79%

Percent of 5th Graders with Sealants

44%

62%

Source: NC State Center for Health Statistics – Oral Health Section 2008

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Catawba County’s average number of decayed, missing, and filled primary teeth for kindergarten children is less than the state average. Catawba County’s rate of 5th graders with decay free permanent teeth is higher than the state average. A positive difference for Catawba County is that the percentage of 5th graders with sealants is significantly higher than the state average. Medicaid Eligible Children Using Dental Services North Carolina Ages 1 – 5 years Ages 6 – 14 years Ages 15 – 20 years Overall (ages 1 – 20 years)

Catawba County

45%

38%

63%

72%

47%

59%

53%

56%

Source: Division of Medical Assistance Calendar Year, 2010

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79

Catawba County’s rate of individuals ages 1-20 who used dental services is slightly higher that the state rate. However, the percentage of Catawba County Medicaid eligible children ages 1-5 utilizing dental services is less than the state for the same age group. Of Medicaid eligible individuals ages 1-20 residing in Catawba County, 44% did not use dental services in 2010.

Community Health Assessment 2011

Oral Health Adults Who Have Had Permanent Teeth Removed Due to Tooth Decay or Gum Disease

2004 2010 % Change

North Carolina

Catawba County

54.3%

57.8%

46.7%

52.1%

16%

11%

Source: North Carolina State Center for Health Statistics – 2004 and 2010 BRFSS survey

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Over 50% of adults in Catawba County report having permanent teeth removed because of tooth decay or gum disease. However, Catawba County experienced a decrease in adults with tooth loss of 11% between 2004 and 2010. According to the 2010 Catawba County Behavioral Risk Factor Surveillance Survey (BRFSS), adults who are non-white, have a household income of less than $50,000, or have attained an at or below high school educational level are significantly less likely to receive dental care.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The average number of decayed, missing, and filled primary teeth in Catawba County kindergartners as decreased by 19.4%.

 The percent of Catawba County fifth graders with sealants has increased by 14.8%.

National or State Data      

In 2010, 47% of adults in North Carolina reported having had permanent teeth removed due to tooth decay or gum disease. One-third of children ages 6-19 years in the United States have sealants. Although children from lower income families are almost twice as likely to have decay as those from high income families, they are only one half as likely to have sealants. In the United States, 3 times as many smokers have gum disease as people who never smoked. One-fourth of United States adults ages 65 and over have lost all of their teeth. Older adults, smokers, and disabled people are at greater risk for tooth loss.

Assets 

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80

Catawba County Public Health (CCPH) has entered a new partnership with Catawba County Schools Early Head Start program to ensure a dental home beginning at age 1 for up to 80 at-risk young children for preventive dental care. In November 2010, North Carolina launched the Dental Home Initiative for Early Head Start programs. The North Carolina Oral Health Section provides a public health dental hygienist to serve Catawba County. CCPH assists this state position by providing administrative and operational support. Community Health Assessment 2011

Oral Health  

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CCPH oversees the school nurses and Early Childhood Support Team nurses that support the state dental hygienist in providing follow up and dental education. Seventeen high risk elementary schools in Catawba County participate in the Fluoride Mouth Rinse Program. Ninety percent of the students participate in the sodium fluoride solution rinse once a week for 32 weeks in the school year to provide protection against cavities. CCPH has an on-site dental clinic which serves children ages 3 – 21 and accepts Medicaid, North Carolina Health Choice, Smart Start dental funds for qualifying children, Kids In Need funds, and selfpay clients. The site is used as a training facility for new dentists, assistants, and hygienists entering the dental profession. The North Carolina Oral Health Program coordinates Give Kids A Smile, which provides dental care and information to low-income children in partnership with 26 schools from the 3 public school systems, Catawba County School Health Nurses, the CVCC dental hygiene program, Western Piedmont Dental Assisting Program, 22 dental offices, and community volunteers. Through this program, more than 3,000 children receive dental health education and approximately 300 children receive free dental care. Greater Hickory Cooperative Christian Ministry (GHCCM) offers free dental services to low-income and eligible adults.

Opportunities  

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The Catawba County Public Health Dental Practice improvement project will expand services available to patients and families and lay the foundation to double the current patient service capacity. Promote the expansion of public water systems in Catawba County, given that the percentage of Catawba County residents receiving fluoridation through public water systems (59%) is quite a bit lower than North Carolina (86%) and the United States (64%). Increase the number of dentists in Catawba County for younger children ages 1-5 and children with special medical, developmental, and emotional needs. Find alternate sources of funding as funding is decreased for dental prevention programs such as North Carolina Oral Health Section Dental Hygienists and Seal the State campaign; Smart Start- Early Childhood Support Team Nurses; and Medicaid rates for preventive and treatment services. Decreased funding could have a significant impact in the progress that has been made in oral health for children. Provide oral health outreach and education targeted toward low income and minority populations. Explore dental preventive and treatment options for low income, mentally disabled, and older adults.

DID YOU KNOW?  The percentage of Catawba County Medicaid eligible children ages 1 -20 utilizing dental services has increased from 29% in 2006 to 56% in 2010.

 In 2009, an estimated $109 billion was spent on dental services in the United States.  Between 2004 and 2009, there was a 42% decline in dental decay among kindergarten children in Catawba County as compared to a 26% decline in kindergartners statewide during the same time period.

Conclusions 

81

Dental care for children in Catawba County overall has improved; however, only a little over half of Medicaid eligible children used the dental services available to them in 2010. Community Health Assessment 2011

Oral Health  

National, state, and local information indicates that a dental disparity still exists for low income and minority children, and they are less likely to participate in routine dental preventive care. Dental access for Medicaid eligible and low income adults is limited to GHCCM for adults without insurance and 14 dentists who accept Medicaid for adults in Catawba County.

References  

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Catawba County Public Health, August 17, 2011. Schedule of Dental Services Funded. Centers for Disease Control and Prevention, July 2011. Preventing cavities, gum disease, tooth loss, and oral cancers: at a glance 2011. http://www.cdc.gov/chronicdisease/resources/publications/AAG/doh.htm. Centers for Disease Control and Prevention, February 2011. Water Fluoridation Reporting System (WFRS) Reports. http://apps.nccd.cdc.gov/wfrs/reports_html_162.asp. Centers for Disease Control and Prevention. Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis—United States, 1988-1994 and 1999-2002. Morbidity and Mortality Weekly Report, Volume 54, Number SS-3, August 26, 2005. http://www.cdc.gov/MMWR/PDF/ss/ss5403.pdf Cindy W. Sigmon, RDH, Dental Hygienist, North Carolina Oral Health Section, Division of Public Health, June 28, 2011. Catawba County Dental Resource List. Institute of Medicine, 2011. Advancing Oral Health in America, Chapter 2: Oral Health and Overall Health and Well-Being. http://books.nap.edu/openbook.php?record_id=13086&page=27 Institute of Medicine, April 2011. Advancing Oral Health in America report brief. http://www.iom.edu/~/media/Files/Report%20Files/2011/Advancing-Oral-Health-inAmerica/Advancing%20Oral%20Health%202011%20Report%20Brief.pdf North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey results 2004: Catawba County oral health: Permanent teeth removed. http://www.schs.state.nc.us/SCHS/brfss/2004/cata/rmvteeth.html. North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey results 2010: North Carolina oral health: Permanent teeth removed. http://www.epi.state.nc.us/SCHS/brfss/2010/cata/RMVTETH3.html North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey results 2010: North Carolina oral health: Visited dentist. http://www.epi.state.nc.us/SCHS/brfss/2010/cata/_DENVST1.html North Carolina Department of Health and Human Services, Division of Public Health, Oral Health Section, November 2009. NC County Level Oral Health Assessment 2008-2009. http://www.ncdhhs.gov/dph/oralhealth/library/includes/AssessmentData/20082009%20County%20Level%20Oral%20Health%20Status%20Data.pdf North Carolina Department of Health and Human Services, Division of Public Health, Oral Health Section, November 2005. NC County Level Oral Health Assessment 2004-2005. http://www.ncdhhs.gov/dph/oralhealth/library/includes/AssessmentData/20042005_County_Level_Oral_Health_Data.pdf North Carolina Department of Health and Human Services, Division of Public Health, Medical Assistance. Percent of Medicaid Eligible Children Using Dental Services for Calendar Year 2010 for North Carolina and Catawba County, emailed document per special request (# 2011-01258) on April 20, 2011.

Community Health Assessment 2011

Overweight and Obesity Overview The incidence of obesity in the United States continues to rise. In 2009, only Colorado and the District of Columbia had a prevalence of obesity less than 20%. The Centers for Disease Control and Prevention (CDC) indicates that more than two-thirds of states (38) including North Carolina have adult obesity rates above 25%. Overweight and obesity are measured by body mass index (BMI), a number that calculates weight and height and, for most people, correlates to a person’s amount of body fat. According to the CDC, adults with a BMI between 25 and 29.9 are considered overweight; those with a BMI of 30 or higher are considered obese. For children and teens, BMI is calculated differently to account for normal differences in body fat between boys and girls and among various ages. Overweight for this group is generally defined as a BMI equal to or greater than the 95th percentile of BMI values on the CDC’s growth chart. Even with these considerations, overweight and obese children are more likely to become overweight and obese adults. Childhood obesity is reaching epidemic proportions and is putting today’s youth on a course to potentially be the first generation to live shorter, less healthy lives than their parents. Being obese or overweight is a major factor in increasing one’s risk for chronic diseases, such as diabetes, hypertension, and cardiovascular disease. Other health complications include asthma, sleep apnea, respiratory problems, and joint problems. More and more, these health issues are being diagnosed in overweight or obese individuals of all ages, including young children.

Catawba County Data Percentage of Adults Overweight and Obese Population

Overweight

Obese

North Carolina Total

36.7%

28.6%

Catawba County Total

47.1%

24.9%

Men

57.8%

20.9%

Women

33.8%

29.9%

White

48.2%

24.9%

Minority

42.4%

25.7%

H.S. or less

45.7%

23.3%

Some college +

48.3%

26.3%

Earning less than $50,000

48.7%

22.o%

Earning $50,000+

44.1%

27.0%

Source: Behavioral Risk Factor Surveillance Survey, 2010

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Community Health Assessment 2011

Overweight and Obesity 

According to the previous chart, 72.0% of adults surveyed in Catawba County were overweight or obese as compared to 65.3% in North Carolina. Overweight trends higher in Catawba County, but obesity trends lower when compared to North Carolina’s percentages. The incidence of overweight in men is significantly higher than in women, but a larger percentage of women are obese. In Catawba County, higher educational attainment is in line with higher percentages of overweight and obesity. Higher income is in line with a lower percentage of overweight adults, but a higher percentage of obese adults. The minority population has a lower percentage of overweight adults but a slightly higher percentage of obese adults when compared to the white population. When compared to 2007 data, the total percentage of overweight and obese adults has risen significantly from 60.2% to 72.0%.

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2011 Catawba County Community Health Assessment Survey Question asked on survey:

Question asked on survey:

Do you consider yourself to be overweight?

Have you intentionally lost weight and kept it off in the past 12 months?

32%

Yes

47.8% 52.2%

No

Yes No

68%

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The chart above shows that 52.2% of adults surveyed in Catawba County consider themselves to be overweight. Of those surveyed, 32% had taken an active role in weight management by intentionally losing weight and keeping it off. Demographic analysis of the results revealed that females are more likely to consider themselves overweight than men; 55.9% of whites consider themselves to be overweight; and 41.9% of blacks consider themselves overweight.

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DID YOU KNOW?  Obese workers have up to 21% higher health care costs compared with those of healthy weight. An overweight or obese adult will accrue $250,000 in lost productivity over the course of his or her career.

 Obese children are almost six times more likely than children with healthy weights to have an impaired quality of life, equal to that of children undergoing treatment for cancer. 84

Community Health Assessment 2011

Overweight and Obesity Percentage of Overweight/Obese Children Age Group

Catawba County

North Carolina

2-4 year olds

34.30%

31.20%

5-11 year olds

30.50%

42.90%

12- 18 year olds

49.50%

46.10%

Total for 2-18 year olds

38.10%

34.20%

Source: NC-NPASS (North Carolina-Nutrition and Physical Activity Surveillance System), 2009 (overweight and obesity combined)



As the data above shows, the percentage of children in Catawba County who are overweight and obese is higher than percentages in North Carolina for every category except 5-to-11-year-olds.

Childhood Obesity Trends in Catawba County 2006 - 2009 60.00% 49.50%

50.00% 40.00%

34.30%

38.10% 30.50%

30.00% 27.40%

20.00% 10.00%

2006

32.50% 23.80%

2010

17.70%

0.00% 2-4 year olds

5-11 year olds

12-18 year olds

Total for 2-18 year olds

Source: NC-NPASS, 2006, 2009

  

85

According to the graph above, the percentage of overweight and obese children ages 2-4 in Catawba County has nearly doubled since 2006. The percent of overweight and obese children ages 12-18 has significantly increased, while percentages for children ages 5-11 have remained relatively stable. Over the past five years, the total percentage of overweight and obese children has increased from less than one-fourth to more than one-third.

Community Health Assessment 2011

Overweight and Obesity Peer County Data Childhood Overweight/Obesity Ages 2-18, 2009 45.00% 40.00% 35.00%

38.10% 34.20%

30.00% 25.00%

30.20%

30.40%

30.70%

Catawba Davidson

20.00%

Gaston

15.00%

Iredell

10.00%

Randolph

5.00% 0.00% Overweight and Obese Source: NC-NPASS, 2009



Catawba County’s percentage of overweight and obese children is higher than that for peer counties. This can be attributed to the percentage of children ages 2-4 who are overweight and obese in Catawba County (34.3%), which is significantly higher than percentages for other peer counties.

National or State Data   

     



86

North Carolina is ranked 10th for obesity in the country. Two in every three adults in North Carolina are overweight or obese. The percentage of North Carolina adults who are obese has more than doubled in the last two decades, from approximately 13% in 1990 to approximately 30% in 2009. This represents an increase of more than 1.9 million adults. Among North Carolina children and youth ages 6-17, 35.5% are overweight (18.6%) or obese (16.9%). In North Carolina, 32% of children ages 10-17 are overweight or obese. Over 1 in 4 North Carolina high school students, 27%, are overweight or at risk of becoming overweight. Among children ages 2-4 who participate in the Women, Infants and Children (WIC) Program in North Carolina, 31% are overweight or obese. In the United States, 63.1% of adults and 27.8% of children are overweight and obese. According to the 2009 Pediatric Nutrition Surveillance System, nearly one-third of the 3.7 million lowincome children ages 2-4 surveyed in the United States were obese or overweight, and 541,000 were obese. Nationally, the prevalence of childhood obesity has tripled in the last 40 years and is now the second leading cause of preventable death.

Community Health Assessment 2011

Overweight and Obesity Percentage of North Carolina Children (Age 10-17) Who Are Overweight or Obese, by Parent Education, 2008

Percentage of Children

60 50

50% 43% 38%

40 30%

19%

30

19%

20 10

26% Obese Overweight

11% 24%

20%

19% 15%

0 Less than High School

High School Some College College Graduate Graduate Parent Education Source: Eat Smart Move More North Carolina, 2008



The chart above indicates that in North Carolina, the prevalence of overweight or obesity in children ages 10-17 decreases as the level of educational attainment rises among parents.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  Childhood overweight and obesity in Catawba County has risen by 93.8% for 2- to 4-year-olds; 52.3% for 12- to 18-year-olds; and 60.1% overall for 2-to 18-year-olds.

Assets 

  

 

87

Catawba Valley Medical Center’s (CVMC) Healthy House is a grant-funded obesity prevention (children ages 3-4), treatment (children ages 4-12), and research center that is free to participants who are either self-referred or referred by a healthcare provider. The Solmaz Institute at Lenoir-Rhyne University is an obesity prevention, treatment, and research facility serving children 13-19 regardless of their ability to pay. Catawba County Public Health’s (CCPH) School Nurses annually screen to track BMI in selected grades and provide resources to parents whose children fall outside the recommend weight range. Catawba County Health Partners’ Eat Smart Move More Catawba County coalition, recently funded by a national grant, is implementing policy, systems, and environmental change strategies to help reduce childhood obesity in Catawba County. Frye Regional Medical Center (FRMC) and CVMC both offer bariatric surgery programs staffed by case managers, who also lead monthly support groups. CVMC’s Weight Management Center is supported by a multidisciplinary team of medical professionals, registered dieticians, behavioral specialists, exercise trainers, and weight management consultants. Community Health Assessment 2011

Overweight and Obesity  

CCPH offers a range of services to both adults and children that address overweight, such as the WIC Program and Adult Preventive Health. Childhood obesity is on the national agenda as a result of First Lady Michelle Obama’s sponsorship of Let’s Move, a childhood obesity prevention program.

Opportunities 





While Catawba County has two excellent and innovative obesity programs for children (Healthy House and The Solmaz Institute), it lacks a medically-supervised, research-driven, low-cost obesity prevention model for adults. In addition to focusing on individual behavior change, opportunities exist throughout the county to create a healthier environment – e.g., finished sidewalks, bike routes/paths, joint use agreements for fitness facilities, safe neighborhoods – that can provide accessible, low-cost opportunities for increased physical activity. Improving access to healthy foods for children and adults throughout the county, especially in the county’s food deserts (neighborhoods and rural areas that lack fully-stocked grocery stores), can increase opportunities for healthier eating.

Conclusions  



Overweight/obesity is a major health issue for both children and adults in Catawba County because it contributes to the development of serious chronic diseases in increasingly younger age groups. There is more work to do with regard to preventing childhood obesity; however, the Catawba County community is also in need of more accessible, medically supervised prevention programs for adult obesity. Policy and environmental change initiatives that make healthy choices in nutrition and physical activity available, affordable, and easy will likely prove most effective in combating obesity over the long-term and will help make the healthy choice the default choice in Catawba County.

(Please see the Physical Activity and Nutrition section for more information related to Overweight and Obesity.)

References 

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88

American Public Health Association, Partnership for Prevention, United Health Foundation, November 2009. The Future Costs of Obesity: National and state estimates of the impacts of obesity on direct health care expenses. http://www.americashealthrankings.org/2009/report/Cost%20Obesity%20Report-final.pdf Be Active North Carolina, June 2008. Tipping the Scales. http://209.200.69.140/threepercent/download/Tipping_the_Scales.pdf Catawba County Public Health, February 2011. Community Health Assessment (CHA) Survey Results, 2010-2011. http://www.catawbacountyhealthpartners.org/CHASurveyResults10.pdf Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health. 2009 National Youth Risk Behavioral Survey Overview. http://www.cdc.gov/HealthyYouth/yrbs/pdf/us_overview_yrbs.pdf Centers for Disease Control and Prevention, National Diabetes Surveillance System. County Level Estimates of Obesity – State Maps: North Carolina: 2008. http://apps.nccd.cdc.gov/DDT_STRS2/CountyPrevalenceData.aspx?StateId=37&mode=OBS Community Health Assessment 2011

Overweight and Obesity    

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89

County Health Rankings, 2008. Catawba, North Carolina: Adult Obesity. http://www.countyhealthrankings.org/north-carolina/catawba/11 Eat Smart Move More, North Carolina, December 2010. Physical Activity, Nutrition and Obesity in North Carolina Quick Facts. http://www.eatsmartmovemorenc.com/Data/Texts/Quick%20Facts.pdf Eat Smart Move More, North Carolina, 2008. The Burden of Obesity in North Carolina. http://www.eatsmartmovemorenc.com/ObesityInNC/ObesityInNC.html Health and Wellness Trust Fund, Fit Together, 2004. About Obesity. http://www.fittogethernc.org/aboutObesity.aspx North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2009: Catawba County. http://www.schs.state.nc.us/SCHS/brfss/2009/cata/topics.html North Carolina Department of Health and Human Services, Division of Public Health, State Center for Health Statistics, North Carolina Child Health Assessment and Monitoring Program (CHAMP). 2009 CHAMP Topics. http://www.schs.state.nc.us/SCHS/champ/2009/topics.html North Carolina Department of Health and Human Services, Division of Public Health, Nutrition Services Branch, North Carolina-Nutrition and Physical Activity Surveillance System (NC-NPASS). Nutrition Services, 1995-2009. http://www.nutritionnc.com/nutrsurv.htm North Carolina Healthy Schools. Youth Risk Behavioral Survey 2009. http://www.nchealthyschools.org/data/yrbs/ North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County: Body Mass Index Grouping: http://www.schs.state.nc.us/SCHS/brfss/2010/cata/rf1.html Trust for America’s Health, June 2010. F as in Fat: How Obesity Threatens America’s Future 2010. http://healthyamericans.org/reports/obesity2010/

Community Health Assessment 2011

Preparedness Overview The terrorist attack of September 11, 2001 forever changed national, state, and local preparedness. Prior to the attacks, emergency responders were primarily responsible for being prepared and taking care of those requiring assistance. That responsibility has now broadened to include a wide variety of agencies in all jurisdictions. North Carolina’s Office of Public Health Preparedness defines preparedness as “enhancing the capability and readiness of public health and health care systems, communities, and individuals to identify, prevent, protect against, respond to, and recover from public health emergencies whose scale, scope, timing, or unpredictability threatens to overwhelm routine capabilities.” It applies to man-made disasters, such as terrorist attacks, and natural disasters such as fires, tornadoes, floods, hurricanes, and evolving outbreaks of communicable disease. From a Public Health point of view, preparedness relates to any incident that may threaten or harm the health of residents on a large scale. In the event of a local disaster, utilizing a coordinated and comprehensive crisis response strategy is critical to preventing harm and loss of life. Catawba County Public Health (CCPH) and Emergency Management (EM) staffs are trained in the Federal Emergency Management Agency’s Incident Command System, which guides federal and state response to crisis situations. If a health emergency were to occur, CCPH has partnerships and response plans in place with EM, Catawba Valley Medical Center (CVMC), Frye Regional Medical Center (FRMC), fire and law enforcement, and other response agencies. CCPH’s role may include things such as distributing medication, establishing special needs shelters, or investigating outbreaks of foodborne illness. Response strategies place a priority on assisting people with special needs. In the context of emergencies and disasters, a working definition of people with special needs includes members of the community with little or no ability to successfully address, implement, or be fully responsible for their own emergency preparedness, response, or recovery. This includes people whose life circumstances leave them unable or unwilling to follow emergency instructions, as well as anyone unable or willing to fully access or use traditional disaster preparedness and response activities.

Catawba County Data 2011 Catawba County Community Health Assessment Survey Question asked on survey: Does your household have a written disaster evacuation plan for how you will leave your home in case of a large-scale disaster or emergency that requires evacuation?

14%

86%

Yes

90

No

Community Health Assessment 2011

Preparedness 

 











 



According to the 2011 Catawba County Community Health Survey, only half of those who responded believed that they would be capable of taking care of themselves and their families for up to 72 hours without electricity. Respondents are even less prepared to handle other emergency events, such as flooding and ice storms. The 2010 Behavioral Risk Factor Surveillance Survey (BRFSS) reveals that 88.9% of residents have a 3day supply of nonperishable food for everyone in their homes; 49% have a 3-day supply of water. According to 2010 BRFSS data, 64.4% of Catawba County residents would use cell phones as their main method or way of communicating with friends in a large-scale disaster or emergency. 18.3% said they would rely on a landline, and 6.3% didn’t know. The 2010 BRFSS survey also indicated that 41.8% of Catawba County residents would rely on radio as their main method of getting information from authorities in an emergency, followed by television (27.6%). If a mandatory evacuation order were issued in Catawba County, 92.3% would evacuate, 3.4% would not, and 4.4% are not sure. Reasons for not evacuating include lack of trust in officials (22.9%), concern about property (24.9%), and concern about pets (20.4%). Comparatively, 4.3% of North Carolina residents say they would not evacuate, but only 12% report a lack of trust of officials. Catawba County Emergency Management and CCPH have enlisted additional training for staff to effectively handle preparedness related events. CCPH staff has a 100% completion rate for this training, well exceeding the state’s 80% requirement. CCPH’s Strategic National Stockpile Plan for mass medication distribution must be submitted annually for review and scoring from the state. Catawba County’s most recent submission scored 95.5% in June 2011, which surpasses the state average of 52.5%. Every 7 years, CCPH distributes free Potassium Iodide (KI) pills to residents within the 10-mile Emergency Planning Zone (EPZ) around McGuire Nuclear Station for use in the event of a nuclear disaster. In 2010, 446 doses of KI were distributed to 140 households within the county, although Catawba County has approximately 1, 700 residents that live within the 10-mile EPZ. More than 90 partnerships were formed to respond to the H1N1 pandemic in Catawba County, which occurred between 2009 and 2010. Within Catawba County there are 28 pre-identified emergency shelter locations. The decision to open a specific shelter is based on the area affected and the root cause of needing the shelter. Not all shelters would be operational for one singular event; use would be based specifically on the incident that has occurred. In 2010, 433 residents were listed on the Special Needs Database that is maintained by Catawba County Emergency Management with information supplied by Catawba County Social Services, CCPH, and community partners. Less than 1% of the population within Catawba County has a physical condition that would require additional assistance if an event occurred.

National or State Data 



91

In 2003, Homeland Security Presidential Directive 8 established policies strengthening the preparedness of the United States to prevent and respond to threatened or actual domestic terrorist attacks, major disasters, and other emergencies. It requires a national domestic all-hazards preparedness goal; establishes mechanisms for improved delivery of federal preparedness assistance to state and local governments; and outlines actions to strengthen preparedness capabilities of federal, state, and local entities. The N.C. Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) provides statewide early event detection and timely public health surveillance to public health officials and hospital users. This enables communities to respond quickly to disease outbreaks and, if possible, minimize their impact. Community Health Assessment 2011

Preparedness DID YOU KNOW?  To be prepared, a family should have enough non-perishable food and 1 gallon of water per person per day for a minimum of 3 days.

 Approximately 1,700 Catawba County residents live within a 10-mile radius of a nuclear power plant.  There are 28 pre-identified shelters located within Catawba County.  CCPH partnered with more than 90 surrounding physician offices, hospitals and businesses to distribute flu vaccine during the H1N1 pandemic of 2009-2010.

Assets 



 

  

  

 

92

Catawba County has numerous agencies within the county that focus on preparedness. These include American Red Cross; Catawba County Emergency Management; Catawba Valley Medical Center; Frye Regional Medical Center; all three school systems (Catawba County Schools, Hickory City Schools, and Newton Conover Schools); Lenoir-Rhyne University; Catawba Valley Community College; Citizen Corps; and United Way. Catawba County maintains a Local Information Team that is capable of communicating critical information, including preparedness messages, quickly and efficiently through several venues during a crisis. Catawba County Emergency Management manages plans to be prepared for all hazards, including all natural and man-made disasters. Catawba County has access to expertise and additional workforce help from a Public Health Preparedness Regional Team based in Charlotte. The team provides expertise in epidemiology, industrial hygiene, and pharmacy. The State of North Carolina provides services in epidemiology, communicable disease, preparedness, and immunizations, as well as oversight for any additional expertise that may be needed. The North Carolina Office of Emergency Medical Services Western Branch field office is located in Catawba County. Citizen Corps is a council comprised of representatives from Emergency Management, Fire Services, United Way, Sheriff’s Department, Public Health, Community Watch, Red Cross, Cooperative Christian Ministries, and local businesses. The council coordinates resources, volunteers, and activities to ensure the safety of Catawba County citizens through preparedness education, information, and training. CCPH provides preparedness materials to the families of more than 2,000 second graders during annual facility tours. CCPH partners with the local television station, WHKY-TV, to broadcast free preparedness public service announcements. Catawba County has Community Emergency Response Teams (CERT) and offers CERT training periodically throughout the year to educate people about disaster preparedness for hazards that may impact their area and train them in basic disaster response skills, such as fire safety, light search and rescue, team organization, and disaster medical operations. An automated Community Alert System that contacts residents through their phone or e-mail is used within the county to notify residents of various crisis-related scenarios that may affect them. CCPH has a designated Epidemiology (EPI) Team that meets regularly and takes advanced training to monitor illness rates and respond to outbreaks within the community. Community Health Assessment 2011

Preparedness 

CCPH maintains a Risk Communication Plan to ensure the appropriate and accurate delivery of critical information to county residents in the event of a health crisis.

Opportunities       

Increase the number of people within the county with a preparedness plan by promoting its importance and providing education. Incorporate new businesses, partners, and agencies into the Local Information Team to help expedite crisis communication throughout the community. Offer preparedness education to businesses and their employees. Increase county-wide communication capabilities by installing appropriate and compatible technology and hardware, such as more 800MHz radios. Develop and implement a county-wide preparedness public service campaign. Improve special needs shelter operation preparedness through training and exercises. Increase the number of people in the county within the 10-mile EPZ who receive doses of KI.

Conclusions  

Catawba County has well-defined and well-coordinated response plans and resources in place in the event of a disaster. Although county-wide response plans are in place, more individual and family preparedness plans will minimize the burden on the county’s response efforts and enable a more efficient and effective response effort.

References 

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93

North Carolina Department of Health and Human Services, Division of Public Health, Office of Public Health Preparedness and Response, 2011. Bioterrorism and Disease Surveillance. http://www.epi.state.nc.us/epi/phpr/ North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County: General Preparedness. http://www.epi.state.nc.us/SCHS/brfss/2010/cata/topics.html#gp United States Census Bureau, 2010. State & County Quick Facts: Catawba County, North Carolina. http://quickfacts.census.gov/qfd/states/37/37035.html United States Department of Homeland Security, Federal Emergency Management Agency, October 2011. North Carolina Disaster History. http://www.fema.gov/news/disasters_state.fema?id=37 United States Department of Homeland Security, March 2011. Presidential Policy Directive /PPD-8: National Preparedness. http://www.dhs.gov/xabout/laws/gc_1215444247124.shtm

Community Health Assessment 2011

Senior Health Overview Adults age 65 and older are among the fastest growing age groups in the nation. In the United States, this population numbered over 40 million in 2010 and is projected to be about 71 million in 2030 and 88.5 million in 2050. The baby boomers (born between 1946 and 1964) are mainly responsible for this growth in the older population; 2011 marked the first year baby boomers joined the older adult category. By 2030, all baby boomers will be categorized as older adults. This population growth will place new demands on resources to ensure the health needs of people 65 and older are met. The current economic environment has further burdened a service system that was already feeling the pressure of a rising older population, years of decreasing public funding, and increasing costs for supportive health services. As a result of the recession, public resources for aging services are dwindling—at exactly the time they are needed most, both to serve growing numbers of current older adults and to prepare systems and communities for the arrival of more than 73 million baby boomers as older adults. As demands for services and resources increase, more funding will be required for community-based services to assist older adults with managing health issues, remaining in their homes, and avoiding premature placement in long-term care facilities. Older adults who practice healthy behaviors (e.g., physical activity, nutritious diet, abstaining from tobacco); take advantage of medical preventive services (e.g., cancer screenings and immunizations); and continue to socialize and communicate with family and friends are more likely to remain healthy, live independently, and incur fewer health-related costs. Essential components to keeping older adults healthy are preventing chronic diseases, reducing associated complications, and engaging in physical activity. The ability to complete basic daily activities may decrease if illness, chronic disease, or injuries limit physical or mental ability of older adults. Long-term care (LTC) is a range of services and support that help older adults meet their health or personal needs over a long period of time. LTC includes home-based care (provided by family and friends or a paid caregiver); community-based care such as adult day care, meals, and transportation services; and facility-based care such as assisted living and nursing home. There are several payment sources for LTC, including personal funds; government health insurance programs, such as Medicare and Medicaid; and private financing options, such as long-term care insurance.

Catawba County Data      



94

In Catawba County in 2010, 14.1% of the population (21,773 people) was age 65 and older. This is projected to grow to 17.8% (35,052 people) by 2030, a growth rate of 60.9%. In 2010, 29.2% of older adults 65 years and older lived alone in Catawba County. In 2009, 31% of older adults in Catawba County lived in rural areas. Baby boomers comprised 25% of the total population in Catawba County in 2010. From 2005 to 2009, 34% of older adults age 65-74 and 50.2% of older adults age 75 and older were below the poverty level or considered low-income. In 2009-2010, $50,638,124 was spent on health related expenditures in Catawba County for adults age 60 and older, including both public and consumer expenditures. In the same fiscal year in North Carolina, $3,152,181,395 was spent. In 2009, 1,746 older adults received home health services in Catawba County. It is projected that 1,812 will receive some type of service in 2012. Community Health Assessment 2011

Senior Health 

In 2009, a Livable and Senior Friendly Community Survey was conducted in Catawba County to obtain information on the quality of life of seniors. The survey of older adults found: o A little over 80% rate their health as good, very good, or excellent. o Over 90% rate their quality of life as good, very good, or excellent. o 76% know where to get help with obtaining medications. o 44% rank “assistance with personal care” as a high need. o 49% place “home delivered meals” as a high need. o 55% state “transportation” is a high need. o 58% list “long-term care costs” as a high need. o Approximately 63% know the types of senior services available in Catawba County and know how to access or apply for these services. o 42% believe that there is not adequate community support for caregivers of older adults. Leading Causes of Death in Catawba County and North Carolina, Ages 65-84, 2005-2009

Catawba County

Rate per 100,000

1. Cancer- all sites

1046.0

Rate per 100,000

North Carolina 1. Cancer- all sites

962.4

2. Diseases of the heart

753.5

2. Diseases of the heart

804.5

3. Chronic lower respiratory diseases

356.9

3. Chronic lower respiratory diseases

276.1

4. Cerebrovascular disease

236.4

4. Cerebrovascular disease

213.7

5. Diabetes mellitus

139.2

5. Diabetes mellitus

114.6

6. Alzheimer’s disease 7. Nephritis, nephritic, & nephrosis

128.7

6. Alzheimer’s disease 7. Nephritis, nephritic, & nephrosis

102.6

8. Pneumonia & influenza

80.7

8. Pneumonia & influenza

74.0

9. Other unintentional injuries

64.4

9. Septicemia

65.1

10. Septicemia

56.2

10. Other unintentional injuries

61.6

84.2

87.6

Source: State Center for Health Statistics, 2005-2009, death rates per 100,000



The top 6 leading causes of death for the older adult population in Catawba County are all chronic diseases. Chronic disease disproportionately impacts the older adult population and is associated with decreased quality of life, disability, and increased healthcare and long-term care costs.

DID YOU KNOW?    95

Health care costs for a 65-year-old are typically 4 times more than those of a 40-year-old. The average monthly cost for long-term care in an assisted living facility in NC (2010) was $3,397. By the year 2030, roughly 1 out of every 5 Americans will be an older adult. Community Health Assessment 2011

Senior Health 2011 Catawba County Community Health Assessment Survey Healthcare Concerns

Question asked on survey: What is your biggest concern about healthcare for yourself after the age of 65?

2%

Access to care

3% 5%

4%

Cost of healthcare 11% Choice of doctors Availability of specialists Transportation to/from appointments Other

75%



3 out of 4 people (75%) surveyed in Catawba County stated that their biggest concern about healthcare after the age of 65 was the cost of healthcare. Question asked on survey: If you were homebound or suffering from major illness, would you have access to a caregiver?

Access to Care Yes

27% No 53% 20%

 

96

Don't know/not sure

Slightly more than half the respondents stated they would have access to a caregiver if they were homebound or suffering from major illness. Of those surveyed, 20.2% would not have access to a caregiver if they were homebound or suffering from major illness, and nearly a third were unsure.

Community Health Assessment 2011

Senior Health National or State Data 

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

  

The number of persons age 65 and older in North Carolina (13% of the state’s total population) increased by 26% between 2000 and 2010. Between 2010 and 2030, North Carolina’s 65+population is projected to increase by more than 400,000 persons per decade, reaching 2.14 million (or about 18% of the state total) by 2030. In 2008, North Carolina ranked 10th in the nation in size of the 65+ population. From 2008 to 2018, North Carolina will lose 61,000 workers each year to retirement, creating a "talent deficit" in the workforce of over 12,000 workers per year. In North Carolina, 43% of older adults have a disability. North Carolina currently has over 170,000 older adults with Alzheimer's disease or other types of dementia. By 2030, the total number is projected to rise to over 300,000. In 2009, the most frequently occurring chronic conditions in older adults were hypertension (38%), diagnosed arthritis (50%), all types of heart disease (32%), any cancer (22%), diabetes (18%), and sinusitis (14%). More than 8 out of 10 people age 65 and older take at least 1 prescription drug. The cost of long-term care in North Carolina is lower than the average cost for long-term care in the United States. In 2010, the cost of long-term care in North Carolina included: o Average daily nursing home rate (private room): $204 o Average daily nursing home rate (semi-private room): $182 o Average monthly cost in assisted living facility: $3,397 o Home health aide average hourly rate: $18 o Adult day services daily rate: $47 In 2009, approximately 9 million older adults in the United States needed long-term care. By the year 2020, this number will increase to 12 million. Most will receive informal care; family and friends are the only caregivers for 70% of older adults. Alzheimer’s disease is the most frequent cause of dementia in older adults and affects approximately 50% of those over 85. Older adults represent about 41% of diabetes cases. Prescription drug costs for adults with diabetes are 4 times those of the general population. More than one-third of older adults fall each year, making falls the leading cause of injury for older adults. Of those who fall, 20-30% suffer injuries that reduce mobility and independence.

Assets 

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97

The Eldercare Locator, located at www.eldercare.gov, is a free United States Administration on Aging service and is administered by the National Association of Area Agencies on Aging. It provides the public with information about resources on aging issues through its toll-free telephone number, website, and partnerships with other agencies. The Foothills Office of the Western Carolina Chapter of the Alzheimer’s Association is located in Hickory and offers many patient and family services, such as support groups. Alzheimer’s Support Group meets on the third Tuesday each month at 7:00 PM at Lutheran Home in Hickory. Western Piedmont Council on Governments Area Agency on Aging is located in Hickory. The Area Agency on Aging (AAA) works within a federal mandate to inform, advocate, and plan for community services on behalf of older adults and their families/caregivers. The North Carolina Senior Tar Heel Legislature, a group of senior representatives from each county in the state, advocates on behalf of older adults to elected officials. Increased funding for services is always submitted to the North Carolina General Assembly as a top priority each year. Catawba County Social Services operates several nutritional programs for older adults in Catawba County: Community Health Assessment 2011

Senior Health o

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98

Meals on Wheels volunteers deliver hot and nutritious meals to homebound older adults; $1129 provides for an older adult for one year. o The Congregate Meal Program and Seniors Morning Out provide a nutritious lunch along with health and wellness activities, fellowship, monthly grocery shopping, and activities. o The Frozen Meals program provides frozen meals to homebound older adults who are not on a Meals on Wheels route. o The Nutritional Supplements (Boost/Ensure) program provides one case of a nutritional supplement drink a month to older adults who may be at nutritional risk and/or cannot chew or swallow solid foods. The Meals on Wheels Pet Food program provides pet food to meals on wheels recipients. The program delivers pet food because older adult pet owners who are in difficult financial situations may share their meals with their pet or buy food for their pet in lieu of personal necessities. Adult day care programs in Catawba County are operated by Adult Life Programs. The program offers care and supervision to elderly or disabled adults, providing their caregivers respite and allowing them to work. There are centers in Conover, Hickory, and Maiden. The Hickory center is the only day adult healthcare site in Catawba County. Catawba County Home Health Agency is ACHC accredited. Their services include skilled nursing care, physical therapy, occupational therapy, speech therapy, certified home health aides, and medical social workers. More than 20 home health care agencies serve the Catawba County area. West Hickory Senior Center is a multipurpose senior center that offers multiple classes, income tax assistance, recreational and volunteer opportunities, and programs including health promotion to older adults aged 60 years and older. Greenway Public Transportation provides reduced-rate transportation to medical appointments and shopping for adults age 60 and older. For older adults who lack transportation, Viewmont Pharmacy provides a delivery service within 5 miles for a small fee. Rite-Aid offers a free prescription medicine delivery service for all customers. The Project Lifesaver program, administered by the Catawba County Sheriff’s Department, is an innovative rapid response program aiding victims and families suffering from Alzheimer’s disease and related disorders such as Down syndrome and autism. By forming partnerships with local law enforcement and public safety organizations, Project Lifesaver deploys specially trained teams with the most reliable technology available to quickly locate and return wandering adults and children to their families and caregivers. Are You Okay?, a program provided by the Catawba County Sherriff’s Department, is a computerized telephone program that automatically dials the phone number of an older adult at a set day and time. If the older adult cannot be reached after a second call, a designated contact person is called. If no contact can be made with the older adult or the contact person, a deputy is dispatched to check on the older adult. North Carolina Baptist Aging Ministry (NCBAM) has a local representative available to assist adults age 65+ and their families by providing information, referrals, and assistance with resources to meet various needs. The Program of All Inclusive Care for the Elderly (PACE at Home) assists adults age 55+ who have been certified by the state to need nursing home care, live within 45 minutes of the program location, and can safely live in the community. The program provides an adult day care that includes nursing, physical, occupational and recreational therapies, prescription drugs, meals, nutritional counseling, social work, and personal care. The program has a doctor and nurse practitioner on site and also provides door-to-door transportation to and from the older adult’s home. Community Health Assessment 2011

Senior Health   

Palliative CareCenter and Hospice of Catawba Valley provides hospice, palliative, and end-of-life care to patients with an incurable illness, as well as support for their families. Catawba County has 6 nursing homes with 870 beds, 10 adult care homes with 595 beds and 7 family care homes with 41 beds. A Regional Ombudsman is available to assist local residents and families with complaints or questions they may have regarding long-term care.

Opportunities     

Educate the community about the growth of our aging population and the resources required to support the impact to our infrastructure, and encourage a call to action to prepare for this impact. Engage all community organizations that interact with the baby boomer population to encourage disease-preventing and health-promoting behaviors and other strategies. Determine the greatest needs facing our community related to an aging older population and advocate with elected officials for the appropriate resources to meet those needs. Explore the disparities between race and gender with respect to older adult and aging issues, such as health care, long term housing, and skilled care, and develop strategies to target at-risk populations. Alzheimer’s disease and arthritis are specific areas of greater concern due to longer lifespan and population growth. Acquiring resources, medical providers with expertise in Alzheimer’s and Arthritis, and family support services is an important step to ensuring our community is prepared for greater numbers of these diseases.

Conclusions   

As we age, we are more at risk of illness and disability but fewer support systems are in place. With baby boomers nearing retirement age, the volume of older adults with a greater propensity for disease and disability could easily overburden our health infrastructure. As a community, we must aggressively address the gap in resources, health care, and support services that will be in high demand within the next 10-20 years.

References 

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99

Administration on Aging, June 2010. Projected Future Growth of the Older Population: By State, 20052030: Aged 65 and Above: Number of Persons 65 and Over. [Excel data set]. http://www.aoa.gov/AoARoot/Aging_Statistics/future_growth/future_growth.aspx#state American Psychological Association, April 1998. Older Adults’ Health and Age-Related Changes: Reality Versus Myth. http://www.apa.org/pi/aging/resources/guides/older-adults.pdf Centers for Disease Control and Prevention, Administration on Aging, Agency for Healthcare Research and Quality, and Centers for Medicare and Medicaid Services, 2011. Enhancing Use of Clinical Preventive Services among Older Adults. http://www.cdc.gov/features/PreventiveServices/Clinical_Preventive_Services_Closing_the_Gap_Repo rt.pdf Centers for Disease Control and Prevention, March 2011. Physical Activity for Everyone: Guidelines: Older Adults. http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html Centers for Disease Control and Prevention, May 2011. Healthy Aging: Helping People to Live Long and Productive Lives and Enjoy a Good Quality of Life. http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/Healthy_Aging_AAG_508.pdf Center for Medicare and Medicaid Services, January 2008. Quick Facts about Programs of All-inclusive Care for the Elderly (PACE). http://www.npaonline.org/website/download.asp?id=2378 Community Health Assessment 2011

Senior Health  

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100

Family Caregiver Alliance, 2005. Fact sheet: Dementia. http://www.ncdhhs.gov/aging/ad/FCA_DementiaFactSheet.pdf Federal Interagency Forum on Aging-Related Statistics, July 2010. Older Americans 2010: Key Indicators of Well-Being. http://www.agingstats.gov/agingstatsdotnet/main_site/data/2010_documents/docs/oa_2010.pdf N. Brossoie, K.A. Roberto, S. Willis-Walton, and S. Reynolds, September 2010. Report on Baby Boomers and Older Adults: Information and Service Needs. http://www.n4a.org/pdf/ELReport_r2.pdf National Center for Chronic Disease Prevention and Health Promotion, November 1999. Physical Activity and Health: Older Adults. http://www.cdc.gov/nccdphp/sgr/olderad.htm National Clearinghouse for Long Term Care Information, n.d. Paying for Services. http://longtermcare.gov/LTC/Main_Site/Understanding/Cost/Index.aspx North Carolina Division of Aging and Adult Services, 2011. Alzheimer's Disease and Other Dementias. http://www.ncdhhs.gov/aging/ad.htm North Carolina Division of Aging and Adult Services, February 2011. Catawba: Schedule of Expenditures by County, Funding Source, Service and Service Category for Clients 60+ Years of Age: SFY 2009-2010. http://www.ncdhhs.gov/aging/expendData/catawba.pdf North Carolina Division of Aging and Adult Services, n.d. North Carolina: Schedule of Reported Expenditures by Funding Source and Major Service Category: SFY 2009-10. http://www.ncdhhs.gov/aging/ExpendData/Table3-B_2010.pdf North Carolina Division of Aging and Adult Services, June 2010. NC 65+ population by urban and rural divide, 2009. http://www.ncdhhs.gov/aging/demograpic/RuralUrbanPop65.pdf North Carolina Division of Aging and Adult Services, September 2011. County profiles: Catawba. http://www.ncdhhs.gov/aging/cprofile/catawba.pdf United States Census Bureau, May 2010. The Next Four Decades: The Older Population in the United States: 2010 to 2050. http://www.aoa.gov/aoaroot/aging_statistics/future_growth/DOCS/p25-1138.pdf United States Department of Health and Human Services, 2011. Healthy people 2020: Topics and Objectives: Older Adults. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=31

Community Health Assessment 2011

Sexually Transmitted Diseases and HIV/AIDS Overview With up to 75 percent of sexually active men and women getting a sexually transmitted disease (STD) during their lifetime, STDs remain a major public health challenge in the United States. STDs are infections that are acquired and transmitted by intimate sexual contact. While substantial progress has been made in preventing, diagnosing, and treating certain STDs in recent years, the Centers for Disease Control and Prevention (CDC) estimates that 19 million new infections occur annually. Almost half of those are among young people 15 to 24 years of age. Untreated STDs can lead to long-term health consequences, particularly for adolescent girls and women. The CDC estimates that untreated gonorrhea and chlamydia cause infertility in at least 24,000 women in the United States each year. In addition, disproportionately high rates of STDs are diagnosed among racial and ethnic minorities across the United States and North Carolina. Public health law requires the reporting of chlamydia, gonorrhea, syphilis, and human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS) by local physicians, area hospitals, and health departments. Any positive STD lab result is entered into the North Carolina Electronic Disease Surveillance System (NCEDSS) for tracking and follow-up. Chlamydia is the most commonly reported STD in both the United States and North Carolina, and it can cause serious complications in females if left untreated. Gonorrhea is the second most commonly reported notifiable STD in the United States. Because many cases of STDs go undiagnosed — and some common viral infections, such as human papillomavirus (HPV) and genital herpes, are not reported to CDC at all — reported cases of chlamydia, gonorrhea, syphilis, and HIV/AIDS represent only a fraction of the true burden of STDs in the United States.

Catawba County Data Chlamydia, Gonorrhea, and Syphilis Cases/Rates, 2010 Catawba County

North Carolina

581

42,167

365.1

449.5

186

14,153

116.9

150.9

Syphilis Primary and Secondary - Cases

0

396

Syphilis Primary and Secondary - Rate (per 100,000)

0

4.2

Chlamydia cases Chlamydia rate (per 100,000) Gonorrhea cases Gonorrhea rate (per 100,000)

Source: North Carolina HIV/STD Surveillance Report, 2010

101

Community Health Assessment 2011

Sexually Transmitted Diseases and HIV/AIDS Chlamydia Diagnoses in Catawba County, 2006-2010 600

581

580 560

535

540 520 500 480

459

460 440

424

425

420 400 2006

2007

2008

2009

2010

Source: North Carolina Electronic Disease Surveillance System (NCEDSS), 2006-2010

 



Chlamydia infections have increased by 36.7% from 2008 to 2010, particularly in the 18-to-24-year-old population. This rise can be partially contributed to better reporting and screening practices. According to the NCEDSS, 84.8% of chlamydia and gonorrhea cases in Catawba County affected women in 2010. This likely reflects a combination of factors, including biological differences that place females at greater risk for STDs than males and higher STD screening rates among young women. While Catawba County only had 3 cases of primary and secondary syphilis in 2009 and zero in 2010, the disease has been re-emerging as a public health threat in North Carolina with a 28% statewide increase from 2008 to 2010. Catawba County HIV and AIDS Cases of First Diagnosis, 2010 16 14 12 10 8 6 4 2 0

15

8

HIV - Cases

AIDS - Cases

North Carolina HIV and AIDS Cases of First Diagnosis, 2010 1600 1400 1200 1000 800 600 400 200 0

1487

796

HIV - Cases

AIDS - Cases

Source: North Carolina HIV/STD Surveillance Report, 2010 102

Community Health Assessment 2011

Sexually Transmitted Diseases and HIV/AIDS Catawba County and North Carolina New HIV and AIDS Case Rates, 2010 20 15.9 15 10

9.4

8.5 5

5

Catawba County North Carolina

0 HIV - Rate per 100,000

AIDS - Rate per 100,000

Source: North Carolina HIV/STD Surveillance Report, 2010

 

HIV and AIDS rates per 100,000 are noticeably lower in Catawba County as compared to North Carolina. In Catawba County, HIV has predominantly affected white males and men who have sex with men (MSM). However, statewide trends show minority populations are disproportionately affected and women are increasingly affected by this disease. This statewide trend is beginning to be mirrored in Catawba County, with 37.5% of new HIV/AIDS cases being diagnosed in racial minorities and 25% in women.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The gonorrhea rate in Catawba County decreased by 22.0% from 2007 to 2010.  The chlamydia rate in Catawba County increased 37.0% from 2007 to 2010. 

National or State Data    



 103

With 45,190 cases in 2009, North Carolina is ranked 14th in the nation for chlamydia cases per 100,000. Males accounted for 8,795 cases, while females accounted for 36,132 cases. The rate of chlamydia infections in the United States increased by 3% in 2009 and is up 19% from 2006. Blacks represented almost half of all reported chlamydia cases (48%). With 15,125 cases in 2009, North Carolina ranks 7th in the nation for gonorrhea cases. The 20-24 age group had the highest reported numbers of gonorrhea for both males and females. According to 2009 data, gonorrhea cases have declined steadily in recent years in the United States. Gonorrhea has declined approximately 10 % over the past year and 17% since 2006. This drop has been smaller for blacks than for whites and Hispanics. Blacks accounted for 71% of all gonorrhea cases in the United States in 2009, although they account for only 14% of the population. The gonorrhea rate among blacks is 20 times higher than whites and almost 10 times higher than Hispanics in the United States. In 2009, North Carolina ranked 8th in the nation for reported primary and secondary syphilis cases. Community Health Assessment 2011

Sexually Transmitted Diseases and HIV/AIDS 

    

Syphilis cases in the United States rose by 5% in 2009 and by 39% since 2006. The largest increase in syphilis has been seen among men who have sex with men (MSM), which accounted for nearly twothirds of syphilis cases (62%) in 2009. The national syphilis rate for blacks is 9 times higher than whites and 4 times higher than Hispanics. As of 2010, the estimated number of people living with HIV in North Carolina was 25,074. In 2009, North Carolina was ranked 7th out of 40 states that report HIV cases for the number of HIV cases statewide. African Americans represented 66% of all HIV cases diagnosed in North Carolina in 2009 (rate of 69.7 per 100,000). The highest rate was among adult/adolescent black males (106.3 per 100,000). In total, the CDC estimates that there are approximately 19 million new STD infections each year which cost the U.S. healthcare system $16.4 billion annually.

DID YOU KNOW?  STDs are 100% preventable.  In 2009, a total of 1,244,180 cases of chlamydia were reported to the CDC in the United States. This was the largest number of cases ever reported for any condition.

 The cost of STDs to the United States healthcare system is estimated to be as much as $16.4 billion annually.

 Individuals who are infected with sexually transmitted infections are two to five times more likely than uninfected individuals to acquire HIV infection if exposed to the virus.

 One-third of people living with HIV/AIDS do not know they are infected because they have never been tested.

Assets 

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

104

Educational programs on sexual health and STDs are presented by ALFA (Advancing Life. Fighting AIDS), Catawba County Public Health (CCPH), the American Red Cross, and the Council on Adolescents of Catawba County upon request by community groups. CCPH offers free HIV and STD screening to anyone requesting services. CCPH also provides educational materials and counseling on risk reduction measures. ALFA provides medical case management, referral services, support programs for HIV infected individuals, Housing Opportunities for People Living with AIDS, prevention education programs, free HIV screening and client counseling, and awareness events. Participants in prevention programs through Catawba County Social Services, such as Teen Up, receive information about STDs. Local physicians provide testing and treatment for patients presenting with STD-like symptoms. Fairgrove Primary Health Clinic provides comprehensive medical care and labs, medical case management, medication assistance, referrals for specialty care, and support services for individuals living with HIV. Region II Network of Care coordinates and evaluates HIV/AIDS services provided in the region. Community Health Assessment 2011

Sexually Transmitted Diseases and HIV/AIDS  

CCPH is a participant in the state-recommended Opt-Out Program, which provides HIV testing to everyone being seen for any clinic service unless declined by the client. CCPH partners with ALFA to offer confirmatory HIV testing to any positive screening tests performed during ALFA’s outreach services.

Opportunities   

    

 

Medically accurate information about STD testing and treatment must become more accessible to all ages, races, and ethnic groups. Community outreach is needed to connect with individuals who do not routinely visit a clinic for testing or treatment due to fear of the stigma associated with STDs. HIV and STD prevention education should be developed with the active involvement of parents, be locally determined, and be consistent with community values. It should address the needs of youth who are not engaging in sexual intercourse and youth who are currently sexually active, while ensuring that all youth receive effective education to protect themselves and others from HIV and STD infections. Promoting and increasing screening for STDs and HIV among high risk populations, such as blacks, Hispanics/Latinos, young adults, and MSM, is critical to preventing and treating STDs. There is a need for factual information about STDs for persons beyond high school age that can be disseminated in locations where young adults congregate. Expand the utilization of opt-out HIV testing to emergency departments, primary physician offices, and urgent care facilities. Expand HIV and STD testing in local jails and prisons to identify new cases and prevent the spread of disease. Increase available AIDS Drug Assistance Program (ADAP) funds to provide essential, life-sustaining drugs to low income, underinsured or uninsured HIV-positive individuals, which will reduce the possibility of infection to others as well as improve the overall outcome for the HIV infected client. Promote and encourage screening among men to help prevent the spread of undiagnosed STDs. Promote and encourage the CDC’s recommendations for screening at-risk populations, such as gonorrhea screening for high-risk sexually active women; annual screening for chlamydia for women under age 26; and annual screening of sexually active MSM for syphilis, gonorrhea, chlamydia, and HIV.

Conclusions    

105

Chlamydia is more prevalent than other reportable STDs in Catawba County and is on the rise, both in Catawba County and across the United States. Minorities, women, and young adults are disproportionately affected by STDs. A lack of mandated reporting for many STDs, such as HPV and genital herpes, means that the true impact of STDs on the health of the community is unknown. Because many STD and HIV cases go undiagnosed, consistent education, testing, and prevention practices are critical to stopping the spread of STDs.

Community Health Assessment 2011

Sexually Transmitted Diseases and HIV/AIDS References 

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106

A.A. Adimora, V.J. Schoenbach, F.E. Martinson, T. Coyne-Beasley, I. Doherty, T.R. Stancil, R.E. Fullilove. Heterosexually transmitted infection among African Americans in North Carolina. Journal of Acquired Immune Deficiency Syndrome, Volume 41, Issue 5, April 2006. Catawba County Communicable Ledger 2010, accessed by Sara Jamieson on 6/27/11. Centers for Disease Control and Prevention, November 2009. Sexually Transmitted Diseases in the United States, 2008: National Surveillance Data for Chlamydia, Gonorrhea, and Syphilis. http://www.cdc.gov/std/stats08/2008survFactSheet.PDF Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, March 2010. STD Disparities Summary. http://www.cdc.gov/nchhstp/newsroom/stddisparitiessummary.html Centers for Disease Control and Prevention, November 2010. STDs in Men Who Have Sex with Men. http://www.cdc.gov/std/stats09/msm.htm Centers for Disease Control and Prevention, November 2010. STDs in Adolescents and Young Adults. http://www.cdc.gov/std/stats09/adol.htm Centers for Disease Control and Prevention, November 2010. Trends in Sexually Transmitted Diseases in the United States: 2009 National Data for Gonorrhea, Chlamydia and Syphilis. http://www.cdc.gov/std/stats09/trends2009.pdf Centers for Disease Control and Prevention, November 2010. National Overview of Sexually Transmitted Diseases (STDs), 2009. http://www.cdc.gov/std/stats09/natoverview.htm D.T. Fleming, J.N. Wasserheit. From epidemiological synergy to public health policy and practice: The contribution of other sexually transmitted diseases to sexual transmission of HIV infection. Sexually Transmitted Infections, Volume 75, Issue 1, February 1999. J.N. Wasserheit. Epidemiologic synergy: Interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sexually Transmitted Diseases, Volume 19, Issue 2, March-April 1992. North Carolina Department of Health and Human Services, Division of Public Health, Epidemiology Section, Communicable Disease Branch, Communicable Disease Surveillance Unit, February 2011. North Carolina HIV/STD Quarterly Surveillance Report: Vol. 2010, No. 4. http://epi.publichealth.nc.gov/hiv/pdf/vol10no4.pdf North Carolina Department of Health and Human Services, December 2010. Sexually transmitted diseases other than HIV/AIDS in North Carolina. http://epi.publichealth.nc.gov/hiv/epiprofile1210/Chapter_7.pdf North Carolina Department of Health and Human Services, Division of Public Health, Epidemiology Section, Communicable Disease Branch, Communicable Disease Surveillance Unit, August 2010. Syphilis Morbidity 2009. http://www.epi.state.nc.us/epi/hiv/pdf/NCSyphilisMorbidity2009.pdf North Carolina Electronic Disease Surveillance System, Event Line List by Create Date Report (1/1/2010 to 12/31/10, Chlamydia and Gonorrhea, Catawba County), Run by Sara Jamieson on 6/24/2011. North Carolina Electronic Disease Surveillance System, 2011. Reports Section. https://ncedss.ncpublichealth.com

Community Health Assessment 2011

Substance Abuse Overview Alcoholism, drug dependence, and addiction, collectively known as substance abuse disorders, are complex and costly problems. Most scientists and medical researchers now consider dependence on alcohol and/or drugs to be a long-term illness such as asthma, hypertension, or diabetes. Across the country, substance abuse is rising among all age groups and genders. This rise is driven in large part by increases in marijuana use and other drugs, including ecstasy, methamphetamines, and the nonmedical use of prescription drugs. Substance abuse prevention, diagnosis, and treatment are difficult for several reasons. Many individuals with substance abuse problems either do not recognize they have a problem or do not seek treatment. The few who do seek treatment may encounter problems accessing it due to service availability or cost. Individuals with cooccurring disorders – who have a mental health diagnosis and a substance abuse addiction – require even more specialized treatment services.

Catawba County Data Percentage of Catawba County Adults Consuming One or More Drinks on Days They Drank 45.0%

40.0%

40.0% 35.0% 29.1%

30.0% 25.0%

17.2%

20.0% 15.0%

10.8%

10.0% 2.8%

5.0% 0.0% One Drink

Two Drinks

Three Drinks

Four Drinks

Five or More Drinks

Source: Behavioral Risk Factor Surveillance Survey (BRFSS), 2010





107

Results of the 2010 Behavioral Risk Factor Surveillance Survey (BRFSS) show that most adults in Catawba County do not abuse alcohol: 54.5% of county respondents did not have a single drink in the 30 days preceding the survey. Of those surveyed, 10.8% indicated they drank five or more drinks when they drank in the 30 days preceding the survey. Comparatively, 3.6% of Catawba County adults indicated that they are heavy drinkers. Community Health Assessment 2011

Substance Abuse 



 

According to BRFSS, 9.2% of adults report that they engage in binge drinking. Age range and gender are factors; 13.9% of adults age 18-44 report binge drinking as compared to 5.3% of adults age 45 and older, and men (13.1%) are more likely to be binge drinkers than women (4.8%). Drug Treatment Courts are specialized community courts designed to help stop the abuse of drugs, alcohol, and related criminal activity. In its 9 years of operation, only 18.4% of the court’s graduates have been arrested for committing new crimes. In 2010, there were 789 DWI arrests compared to 534 in 2004. In addition, there were 124 drug arrests in 2010. In Catawba County, the majority of people who present at hospital emergency rooms with substancerelated problems are Caucasian males, ages 30-49. Percentage of Catawba County Students Reporting Substance Abuse Annual %

Monthly %

Alcohol

43.5

20.4

Tobacco

25.6

15.3

Marijuana

18.7

11.6

Uppers

4.8

2.6

Downers

4.1

2.4

OxyContin

4.6

2.1

Inhalants

3.7

1.5

Ecstasy

3.2

1.5

Meth

1.9

1.3

Hallucinogens

2.5

1.2

Steroids

2.1

1.2

Heroin

1.5

1.0

Source: PRIDE Student Questionnaire, 2008 

108

Results from the 2008 PRIDE Student Questionnaire (a random sample of students in grades 6, 8, 10, and 12 from all three Catawba County public school systems) indicate: o Alcohol, tobacco, and marijuana are the substances most often used by Catawba County youth, with alcohol being the substance of choice. o The average age that kids begin drinking in Catawba County is 13.3 years old. Community Health Assessment 2011

Substance Abuse



o 23% reported getting drunk at least once in the past two weeks. o 20% rode one or more times in a car with a driver who had been drinking. o 14% of 12th graders drove one or more times in the past 30 days after drinking. o 83.1% perceived parental disapproval for alcohol use. o 74.7% perceived alcohol use to be harmful or very harmful. o 43.2% perceived alcohol was fairly easy or very easy to get. o 13.9 years is the average age of first marijuana use. o 30% of seniors reported past year marijuana use. o 93.6% perceived parental disapproval for marijuana use. o 72.3% perceived marijuana use to be harmful or very harmful. o 31.7% perceived marijuana was fairly easy or very easy to get. o 22.6% reported any illicit drugs use in the past year; 13.7% in the past 30 days. Alcohol Purchase Surveys conducted in 2009 found 38% of retailers in Catawba County would have sold alcoholic beverages to underage customers. In 2011, only 20% of retailers would have sold to underage customers.

Peer County Data Estimated Number With Substance Abuse Problem, Ages 12-17 1,400 1,200 1,000

1,277

1,011

1,001

1,025

Catawba 897

800

Davidson Gaston

600

Iredell 400

Randolph

200 0 Estimated # With Substance Abuse Problem Source: NC-Catch, 2008



Compared to peer counties, the number of youth estimated to have a substance abuse problem in Catawba County ranks in the middle of the five counties and is very close in number to three of the five.

109

Community Health Assessment 2011

Substance Abuse Peer County Data Estimated Number With Substance Abuse Problem, Ages 18-25 4,500 4,000 3,870

3,500 3,000

3,048

2,500

Catawba 2,854

2,862

2,757

Davidson

2,000

Gaston

1,500

Iredell

1,000

Randolph

500 0 Estimated # With Substance Abuse Problem Source: NC-Catch, 2008



Catawba County ranks second among five peer counties for adults ages 18-25 estimated to have substance abuse problems.

National or State Data     

   

110

Among North Carolina youth surveyed (ages 12 to 17), 9.48% reported current use of illegal drugs; and among adults ages 18-25, 19.49% reported current use of illegal drugs. Among North Carolina adults 26 years of age or older, 5.59% reported current use of illegal drugs. The rate of past month alcohol use in North Carolina among all persons age 12 or older was 45.39%. It was estimated in 2009 that the cost of substance abuse and addiction to state programs comprises 17.6% of the North Carolina state budget. The National Survey on Drug Use and Health (NSDUH) from 2008 to 2009 shows the overall rate of current illicit drug use among the United States population age 12 and older rose from 8.0% in 2008 to 8.7% in 2009. In the United States, the nonmedical use of prescription drugs rose from 2.5% of the population in 2008 to 2.8% in 2009. Individual ecstasy use in the United States rose from 555,000 in 2008 to 760,000 in 2009, and methamphetamine use rose from 314,000 to 502,000 individuals during this time. In the United States, nearly 90% of people who abuse or depend on alcohol or illicit drugs never seek treatment. An estimated 6.8% of Americans age 12 and older reported heavy drinking in 2009.

Community Health Assessment 2011

Substance Abuse DID YOU KNOW? Catawba County Youth Risk Behavior Survey data from 2005 to 2009 shows:

 An increase in teens abstaining from alcohol use.  A decline in teens that consume larger quantities of alcohol in one occasion.  An increase in teens abstaining from marijuana use.  A decrease in teens using cocaine, inhalants, and methamphetamines.

Assets 

         



 



111

A.S.A.P. of Catawba County is working to improve the environment in Catawba County that makes it easier for underage youth to obtain alcohol. They conduct routine Alcohol Purchase Surveys to help ensure merchant compliance with alcohol sales laws and also aim to help parents prevent youth access to alcohol in the home. The Cognitive Connection provides assessment, prevention, counseling, and treatment to individuals, groups, and families. Family N.E.T. delivers psychiatric and substance abuse services, individual group and family therapy, assessment, day treatment, and case management. McLeod Addictive Disease Center is a methadone clinic which provides outpatient and day treatment. Catawba Valley Behavioral Health (CVBH) delivers psychiatric and substance abuse services through its Assertive Community Treatment (ACT) team. Doris Lasley and Associates provides DWI assessment and DWI counseling services. Catawba Valley Medical Center (CVMC) provides inpatient multi-disciplinary short-term treatment, crisis intervention, and chemical detox. Frye Regional Medical Hospital (FRMC) provides medical detox, assessment, individual and group counseling, prevention, and 12-step meetings. Flynn Christian Fellowship Home and Safe Harbor are halfway house rehabilitation programs. Mental health and substance abuse treatment providers are working together to provide comprehensive treatment services to individuals with co-occurring disorders. Catawba County’s Drug Treatment Court (DTC) enhances and monitors the delivery of treatment services to chemically dependent adult offenders while holding those offenders accountable in complying with their court-ordered treatment plans. The Criminal Justice Partnership (CJPP) of Catawba County is a state-funded grant program that provides outpatient substance abuse services, aftercare, and transportation to eligible probationers. During FY 2009-2010, the goal number of offenders to be served in Catawba County was 70; actual offenders served were 103 with a successful completion rate at 59%. The statewide successful completion rate for FY 2009-2010 was at 48%. The number of offenders who obtained or maintained employment while in the CJPP during FY 2009-2010 was at 41% for Catawba County The Multipurpose Resource Center’s services include substance abuse counseling and housing assistance. Mental Health Partners has a contractual agreement with Family Net to provide screening and referral services by a Qualified Substance Abuse Professional for clients involved with the Work First Program, Child Protective Service Program, and/or the Food Assistance Program. Community Care of North Carolina Program (CCNC) partners with treatment providers to help clients with Medicaid access substance abuse and/or mental health services. Community Health Assessment 2011

Substance Abuse 

  

The North Carolina Department of Juvenile Justice and Delinquency Prevention Program (JCPC) supports funding in Catawba County to assist in reducing and preventing juvenile delinquency by effectively intervening, educating, and treating youth. The Cognitive Connection implemented a suboxone treatment service, which is a medication-assisted treatment program for opioid dependence. Recovery support systems are available, including Peer Support, Alcoholics Anonymous, Narcotics Anonymous, Ala-Non, Ala-Teen, NAMI, Christ Church, and Exodus Homes. Mental Health Partners provides a care coordination service for both Catawba and Burke County consumers who are admitted to a state facility or are in jail, which could involve linking the consumer with a substance abuse service provider.

Opportunities  

   

Increase the number of inpatient beds for medical detox in Catawba County hospitals or at non-medical detox centers to meet the needs of people with addiction. Increase the currently scarce number of residential and outpatient youth treatment options in the county, including facilitating the acceptance of youth under the age of 18 at local non-medical detox centers. Increase access to health and dental care for individuals without insurance, which includes a high percentage of individuals with addiction issues. Improve funding and sustainability of addiction-related services in the community to help meet growing demands. Determine ways to provide housing for addicts, many of whom are not able to stay off drugs long enough to qualify for existing services. Increase the number of psychiatrists and psychiatric care options in the county for addicts and individuals with co-occurring disorders.

Conclusions  



Teen alcohol use in Catawba County negatively affects the community by contributing to harmful and or illegal behaviors and can result in injury or death. Despite a number of agencies and organizations that focus on substance-related issues, many individuals who need assistance are unable (due to unemployment or economic hardships) or unwilling to access it. Greater surveillance is needed to evaluate the nature and scope of risky substance-related behaviors in order to identify opportunities for prevention.

References    



112

A.S.A.P. of Catawba County. 2009-2010 Alcohol Purchase Surveys. Catawba County Substance Abuse Coalition, 2008. Pride Survey Questionnaire Report for Grades 6-12: http://www.catawbacountyhealthpartners.org/questionnaire.pdf Centers for Disease Control and Prevention, June 2010. Youth Risk Behavior Surveillance, United States, 2009. http://www.cdc.gov/healthyyouth/yrbs/index.htm North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County Alcohol Consumption: Any Drink in Past 30 Days. http://www.epi.state.nc.us/SCHS/brfss/2010/cata/DRNKANY4. North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Community Health Assessment 2011

Substance Abuse 

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113

Survey Results 2010: Catawba County Alcohol Consumption: Average Number of Drinks. http://www.epi.state.nc.us/SCHS/brfss/2010/cata/avedrnk2.html North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County Alcohol Consumption: Binge Drinking. http://www.epi.state.nc.us/SCHS/brfss/2010/cata/_RFBING4.html North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County Alcohol Consumption: Drinking Frequency. http://www.epi.state.nc.us/SCHS/brfss/2010/cata/alcday4.html North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County Alcohol Consumption: More Than 5 Drinks. http://www.epi.state.nc.us/SCHS/brfss/2010/cata/drnk3ge5.html The Council of State Governments, November 2009. The Economic Impact of Substance Abuse. http://www.csg.org/policy/documents/TIA_FF_Substance_Abuse.pdf United States Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse (NIDA), August 2010. Drugs, Brains, and Behavior: The Science of Addiction. http://www.nida.nih.gov/scienceofaddiction/sciofaddiction.pdf United States Department of Health and Human Services, Substance Abuse and Health Services Administration, Center for Substance Abuse Treatment, 2004. What Is Substance Abuse Treatment? A Booklet for Families. http://kap.samhsa.gov/products/brochures/pdfs/WhatIsTx.pdf United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. New Survey Data Show Drug Use Rising. SAMHSA NEWS newsletter, Volume 18, Number5, September/October 2010. http://www.samhsa.gov/samhsanewsletter/Volume_18_Number_5/SeptemberOctober2010.pdf United States Department of Health and Human Services, Substance Abuse & Mental Health Services Administration, Office of Applied Studies, n.d. Annual Averages Based on 2007-2008 National Survey on Drug Use and Health: North Carolina http://oas.samhsa.gov/2k8State/AppC.htm#TabC-1 United States Department of Health and Human Services, Substance Abuse & Mental Health Services Administration, Office of Applied Studies, September 2010. Results from the 2009 National Survey on Drug Use and Health. http://oas.samhsa.gov/NSDUH/2k9NSDUH/2k9Results.htm#3.1

Community Health Assessment 2011

Teen Pregnancy Overview Teen pregnancy and childbearing carry substantial social and economic costs through both immediate and long-term impact on teen parents and their children. Teen mothers are more likely to drop out of school, have lower educational attainment and income, and incur increased demand for healthcare and foster care services. Growing percentages of teen moms are also likely to have subsequent (two or more) pregnancies during their teen years. Their children are more likely to have lower school achievement, higher school dropout rates, higher incarceration rates, higher teen birth rates, and higher unemployment rates in adulthood. While teen pregnancy rates have declined over the past two decades at the national, state, and local levels, their impact has not – particularly among minorities. According to the Centers for Disease Control and Prevention (CDC), non-Hispanic black youth, Hispanic/Latino youth, American Indian/Alaska Native youth, and socioeconomically disadvantaged youth of any race or ethnicity experience the highest rates of teen pregnancy and childbirth. These disparities are seen not just across the United States, but also in North Carolina and Catawba County. Because teen pregnancy is viewed as a “winnable battle,” teen pregnancy prevention is one of the CDC’s ten priorities in public health. Evidence-based teen pregnancy prevention programs typically address specific protective factors on the basis of knowledge, skills, beliefs, or attitudes related to teen pregnancy. Programs such as this are occurring on a local level through North Carolina House Bill 88’s Healthy Youth Act, which passed in 2009. The Healthy Youth Act requires North Carolina schools to provide comprehensive sex education using evidence-based methods for students in grades 7-9. Previously, the only sex education that was permitted in most schools in Catawba County was related to the abstinence-only model. The comprehensive model includes education regarding the use of contraceptive methods, STDs, and dating violence. Although North Carolina mandates that comprehensive sex education is provided in all schools, parents may exclude their children from participating.

Catawba County Data Teen Pregnancy Rates (15 – 19 years of age) (per 1,000 population)

Catawba County

North Carolina

White Pregnancies

51.8

45.4

African American Pregnancies

83.1

80.2

Hispanic Pregnancies

119.1

118.4

Total Teen Pregnancies

55.8

56.0

Source: North Carolina State Center for Health Statistics, 2009

114

Community Health Assessment 2011

Teen Pregnancy 

    

The chart above shows teen pregnancy rates for ages 15-19 for the most recent year available (2009). Catawba County’s teen pregnancy rate among each race is higher than North Carolina’s but slightly lower than the state’s average rate. The teen pregnancy rate for Hispanics (119.1) in Catawba County is almost 2.5 times higher than white pregnancies (51.8) and almost 1.5 times higher (83.1) than African American pregnancies. African American teen pregnancy rates (83.1) are almost 1.5 times higher than white teen pregnancy rates (51.8) in Catawba County. In 2009, there were 297 teen pregnancies among 15-19 year olds and 3 among 10-14 year olds in Catawba County. Teen pregnancies represent 13.9% of the total number of pregnancies in the county in 2009. In 2009, repeat teen pregnancies among 15-19 years old in Catawba County rose from 25.4% in 2008 to 31% , which is higher than North Carolina in 2008 (28.4%) and 2009 (28.6%).

2011 Catawba County Community Health Assessment Survey

Question asked on survey: To prevent teen pregnancy and sexually transmitted diseases, which of the following should be taught in school? (Check one.)



27% 73%

Prefer Comprehensive Sex Education Prefer Abstinence-only Sex Education

The 2010 Catawba County Community Health Survey showed that 72.6% of adults in Catawba County prefer that comprehensive sex education should be taught during schools rather than abstinence-only sex education.

DID YOU KNOW?  In 2008, teen pregnancy accounted for more than $10.9 billion in costs to United States taxpayers, $392 million in North Carolina, and $7,038,000 in Catawba County for increased healthcare and foster care, increased incarceration rates among children of teen parents, and lost tax revenue because of lower educational attainment and income among teen mothers.

 In North Carolina, 51.1 % of teens reported having sexual intercourse in 2009, while only 9.9% of parents believe their child is sexually active.

 Every 28 minutes, a North Carolina teen becomes pregnant.  The children of teenage mothers are more likely to have lower school achievement and drop out of high school, have more health problems, be incarcerated at some time during adolescence, give birth as a teenager, and face unemployment as a young adult.

115

Community Health Assessment 2011

Teen Pregnancy National or State Data    

  

More than 19,000 North Carolinians between the ages of 10 and 19 get pregnant each year, which has given North Carolina the 14th highest teen pregnancy rate in the nation. For North Carolina teens ages 15-19, the Hispanic birth rate (118.4 per 1,000) nearly equaled white (45.4 per 1,000) and African American (80.2 per 1,000) teen birth rates combined in 2009. In 2009, the teen birth rate in North Carolina (56.0) was significantly higher than the U.S. rate (41.5). North Carolina minority teen moms are more likely to have repeat pregnancies in their teen years. In 2009, 16% of white teens had a subsequent pregnancy and 24% of black and Hispanic teens had subsequent pregnancies. The overall teen pregnancy rate in the United States declined 37% between 1991 and 2009. Girls born to teen parents in the United States are nearly 33% more likely to become teen parents themselves, continuing the cycle of teen pregnancy. By age 22, approximately 50% of teen mothers earn a high school diploma as compared to 90% of teen girls who do not give birth during adolescence.

NOTABLE TRENDS: SINCE REPORTED IN THE 2007 CHA…  The minority teen pregnancy rate has decreased by 24% in Catawba County.

Assets 





  

The Council on Adolescents of Catawba County teaches comprehensive sexual education programs throughout Catawba County, providing uniform, medically accurate, age appropriate information to help teens avoid early sexual involvement and prevent teen pregnancy. In 2010, there was a 20% knowledge increase among teens who participated in these programs. Catawba County Social Services offers therapeutic programs for at-risk teens (Teen Up in middle school and Upward Connection in high school) that have helped prevent 99% of 363 students from causing a pregnancy. The Catawba County Public Health (CCPH) Women’s Preventive Health clinic provides physical exams, lab tests, birth control methods, and comprehensive education to all females who are in their childbearing years. Young Men of Integrity is an award-winning local program specifically targeted to male teens identified as being at risk of becoming teen parents, potential substance abusers, or school dropouts. Girls on the Run, which is sponsored by the YMCA, is an athletic program that has been shown to guide teen girls into making responsible and healthy choices that prevent teen pregnancy. CCPH has partnered with both the United Hmong Association and Centro Latino to ensure that minorities have accurate information about the family planning and STD services available at CCPH.

Opportunities   

116

Required comprehensive sexual education past 9th grade could help prevent pregnancies among teens that are increasingly sexually active in high school. Comprehensive pregnancy prevention interventions are needed for teens that have had one or more pregnancies. More programs to educate and involve parents and mentors in the sexual education of their children are needed. Community Health Assessment 2011

Teen Pregnancy   

Parents need to be encouraged to have open communication with teens regarding sexual messages that teens are exposed to via television, the internet, and texting. Financial support is needed to continue the pregnancy prevention programs currently in place, particularly those for Hispanic teens due to the rising teen pregnancy rate for this group. More programs addressing pregnancy prevention among young men are needed.

Conclusions   

While overall teen pregnancy rates in Catawba County are declining, subsequent teen pregnancies and minority teen pregnancy rates are rising. There is a need for continuing reproductive health and safety classes to prevent and reduce teen pregnancy rates in Catawba County. While legislation has helped implement more comprehensive sexual education in local middle schools, additional efforts are needed to reach students in high schools.

References 

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117

Adolescent Pregnancy Prevention Campaign of North Carolina. 2009 NC Resident African American Teen Pregnancies Ages 15-19 by County of Residence. http://appcnc.org/images/file/2009_AfricanAmerican_pregnancies_15-19.pdf Adolescent Pregnancy Prevention Campaign of North Carolina. 2009 NC Resident Hispanic Teen Pregnancies Ages 15-19 by County of Residence. http://appcnc.org/images/file/2009_Hispanic_pregnancies_15-19.pdf Adolescent Pregnancy Prevention Campaign of North Carolina. 2009 NC Resident White Teen Pregnancies Ages 15-19 by County of Residence. http://appcnc.org/images/file/2009_white_pregnancies_15-19.pdf Adolescent Pregnancy Prevention Campaign of North Carolina. 2009 North Carolina Repeat Teen Pregnancies Ages 15-19, http://appcnc.org/images/file/2009_repeat_pregnancies.pdf Adolescent Pregnancy Prevention Campaign of North Carolina. 2009 North Carolina Reported Teen Pregnancies - Ranked Ages 15-19. http://appcnc.org/images/file/2009_pregnancies_ranked_15-19.pdf Catawba County Public Health, February 2011. Catawba County Community Health Assessment Survey Results, 2010-2011. http://www.catawbacountyhealthpartners.org/CHASurveyResults10.pdf Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health, 2009. HIV, Other STD, and Teen Pregnancy Prevention and North Carolina Students. http://www.cdc.gov/healthyyouth/yrbs/pdf/hiv/nc_hiv_combo.pdf North Carolina Department of Health and Human Services, State Center for Health Statistics, August 2009. Basic Automated Baby Yearbook 2008: Catawba County resident births for 2008: By Age of Mother and Birth Order for All Women. http://www.epi.state.nc.us/SCHS/births/babybook/2008/catawba.pdf North Carolina Department of Health and Human Services, State Center for Health Statistics, June 2010. North Carolina Statewide CHAMP Survey Results 2009: Sexual Behavior: Believe Child is Sexually Active. http://www.schs.state.nc.us/SCHS/champ/2009/k21q02.html North Carolina Department of Health and Human Services, State Center for Health Statistics. 2009 NC Resident Pregnancy Rates 1,000 Population: Females Ages 15-19, by race, perinatal care regions, and county of residence. http://www.epi.state.nc.us/SCHS/data/databook/CD9B%20pregpub%20rates%201519.html The National Campaign to Prevent Teen Pregnancy, June 2011. Counting It Up: The Public Costs of Teen Childbearing in North Carolina in 2008. http://www.thenationalcampaign.org/costs/pdf/counting-itup/fact-sheet-north-carolina.pdf Community Health Assessment 2011

Teen Pregnancy  

118

The National Campaign to Prevent Teen Pregnancy, June 2011. Counting It Up: The Public Costs of Teen Childbearing: Key Data. http://www.thenationalcampaign.org/costs/pdf/counting-it-up/key-data.pdf The National Campaign to Prevent Teen Pregnancy, 2011. Counting It Up: Cost of Teen Childbearing Calculator. http://www.thenationalcampaign.org/costs/calculator.asp

Community Health Assessment 2011

Tobacco Overview Tobacco use continues to be the leading cause of death and disease in the United States. Each year, approximately 443,000 Americans die prematurely due to tobacco-related diseases, which are more than the number of deaths attributed to alcohol, car accidents, suicide, AIDS, homicide, and illegal drugs combined. Tobacco use is a primary risk factor for heart disease and stroke and has been linked to numerous types of cancer. Tobacco use by teens is of increasing concern, as 80% of current smokers started before the age of 18. The earlier a person engages in tobacco use, the more likely he or she is to carry this habit into adulthood. Research shows that 70% of all smokers wish they could quit. Exposure to secondhand smoke (also known as environmental tobacco smoke, or ETS) is also harmful to health, increasing the risk for heart disease, lung cancer, and respiratory system problems. ETS is particularly harmful to children, causing or contributing to sudden infant death syndrome (SIDS), respiratory infections, slowed lung growth, and severe asthma attacks. Just as there is no risk-free level for primary tobacco use, there is no risk-free level for secondhand smoke; even a small amount is dangerous.

Catawba County Data Smoking Frequency Among Adults in Catawba County, 2010 70%

62.9%

60%

55.3%

50% 40% 30%

32.4% 22.2%

20%

Catawba County

26.1% 26.2% 14.9%

North Carolina

12.3%

10% 0% Every Day

Some Days

Former

Never

Source: BRFSS, 2010





119

Participants in the 2010 Behavior Risk Factor Surveillance System Survey (BRFSS) were asked to classify their smoking frequency. The findings above indicate that Catawba County has a lower percentage of adults who smoke every day than in North Carolina overall. The percentage of current adult smokers in North Carolina in 2010, 19.8%, exceeds the percentage for the nation as a whole at 17.3%.

Community Health Assessment 2011

Tobacco

Percent of Respondents

Catawba County Current Smokers 30 22.7

25 20

22.3

22.1

22.9

17.2

2005 16.8

2006

15

2007

10

2008

5

2009

0

2010

Source: BRFSS, 2005-2010



As the graph above indicates, the percentage of people in Catawba County who identified themselves as “current smokers” remained fairly steady from 2006 through 2009 before dropping to its lowest percentage – just 16.8% in 2010. According to the same survey, only 2.2% of Catawba County citizens reported being everyday smokeless tobacco users.



Percentage of Catawba County Youth Reporting Tobacco Use, 2008 Grade Tobacco Use

Total %

Smoked cigarettes in last 30 days

10.8

Use smokeless tobacco in last 30 days

4.3

6th

8th

10th

12th

2.4

6.0

14.9

19.8

1.4

0.9

6.5

8.4

Source: 2008 Catawba County Pride Survey

    

According to the chart above, a small but significant number of students said they smoked cigarettes or used smokeless tobacco at least once within a 30-day period. Prevalence increases as students go up in grade: 3.8% of sixth graders and 28.2% of high-school seniors indicated use of some form of tobacco, the majority being cigarettes. According to the 2008 Catawba County Pride Survey, the earliest age of onset of use of tobacco among 6th to 12th graders in Catawba County is 11. In 2008, 14% of 6th graders reported that they believe cigarettes do not cause harm. In 2008, 49.9% of 12th graders reported tobacco as very easy to get.

National or State Data   120

Emergency room visits by North Carolinians experiencing heart attacks have declined by 21% since the January 2010 start of the state’s Smoke-Free Restaurants and Bars Law. In the United States, approximately 20.6% of adults and 19.5% of teens continue to smoke. Community Health Assessment 2011

Tobacco   

Cigarette smoking results in 5.5 million years of potential life lost in the United States each year. Nationally, tobacco use is responsible for 1 in every 5 deaths. More than one-third of kids who try smoking cigarettes become regular, daily smokers before leaving high school. In 2009, the federal government increased the sales tax on cigarettes from $0 .61 per pack to $ 1.01 per pack. Effective June 2009, the Food and Drug Administration (FDA) was granted the authority to regulate the sales, advertising, and ingredient content of all tobacco products marketed in the United States.

 

Percentage of North Carolina Youth Reporting Tobacco Use, 2009 Currently Use Any Tobacco Product

Currently Smoke Cigarettes

Currently Use Spit Tobacco

Middle School Students

10.5%

4.3%

3.0%

High School Students

25.8%

16.7%

8.5%

Source: 2009 North Carolina Youth Tobacco Survey

  

According to the chart above, just over a quarter of high school students in North Carolina report using a tobacco product. The percentage of North Carolina high school students who smoke is nearly double that of those who use spit tobacco. 3,805 middle school students and 3,301 high school students in North Carolina participated in the 2009 survey.

DID YOU KNOW?  Smoking is responsible for more than $5.96 billion in annual health care and lost productivity costs in North Carolina.

 Since the North Carolina Health and Wellness Trust Fund began funding tobacco prevention efforts in 2003, the rate of decline in high school smoking has nearly tripled. Middle school rates have also declined. The data translates into 53,000 fewer teen smokers since 2003.

 Cigarette smoking prevalence among adults in North Carolina has declined from 25.9% in 1995 to 19.8% in 2010.

Assets 

121

Catawba County Schools, Catawba Valley Community College, Catawba County Government, Catawba Valley Medical Center (CVMC), and Frye Regional Medical Center (FRMC) have policies prohibiting the use of tobacco on campus.

Community Health Assessment 2011

Tobacco 

 

    

Catawba County Public Health (CCPH) has received funding from the North Carolina Health and Wellness Trust Fund and the North Carolina Department of Health to facilitate tobacco prevention programs and policies. CVMC and FRMC offer free smoking cessation classes. House Bill 2 (Session Law 2009-27, commonly known as the North Carolina Smoke-free Restaurants and Bars Law) was passed in 2009 and implemented in 2010. This law requires all North Carolina public restaurants and bars to be smoke free. School nurses and prenatal clinic staff at CCPH are trained to conduct 5 A’s tobacco cessation counseling. CCPH received funding from March of Dimes to facilitate a prenatal smoking prevention and cessation program. Catawba County Social Services’ Teen Up program offers a tobacco education component that encourages teens to stay tobacco free. A throat cancer survivor employed by FRMC speaks with young people in the community about the dangers of tobacco use. North Carolina has its own Quitline to assist residents in quitting tobacco use. The Quitline number is 1800-QUIT-NOW, and it is available 7 days a week.

Opportunities Catawba County has numerous services available to assist both youth and adults in achieving their goal of cessation; however, many of these services are not readily marketed in the schools or in the community. While both North Carolina and Catawba County have made great progress in protecting residents from secondhand smoke, there is room for continued improvement to encourage all workplaces and public places to prohibit smoking. Comprehensive tobacco control includes counteradvertising and promoting smoke-free environments, both of which are potential areas for greater advocacy in Catawba County.

Conclusions  

Smoking in Catawba County continues to trend downward among youth but has shown a slight increase among adults. Despite steady declines in smoking prevalence, adult smoking rates remain high. This suggests the need for increased efforts to prevent youth initiation, increased cessation among established smokers, and increased cigarette taxes to reduce consumption in continuing smokers.

References    

122

American Cancer Society, 2011. Tobacco and Cancer. http://www.cancer.org/Cancer/CancerCauses/TobaccoCancer/index American Cancer Society, June 2011. Tobacco-Related Cancers Fact Sheet. http://www.cancer.org/Cancer/CancerCauses/TobaccoCancer/tobacco-related-cancer-fact-sheet Campaign for Tobacco Free Kids, September 2011.Toll of Tobacco in the United States of America. http://www.tobaccofreekids.org/research/factsheets/pdf/0072.pdf Catawba County Substance Abuse Coalition, December 2008. Pride Survey Questionnaire Report for Grades 6-12. http://www.catawbacountyhealthpartners.org/questionnaire.pdf Community Health Assessment 2011

Tobacco 

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123

Centers for Disease Control and Prevention. Cigarette Smoking among Adults and Trends in Smoking Cessation –United States 2008. Morbidity and Mortality Weekly Report, Volume 58, Number 44, November 13, 2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5844a2.htm Centers for Disease Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Division of Adolescent and School Health, October 2008. Tobacco Use and the Health of Young People. http://www.cdc.gov/HealthyYouth/tobacco/facts.htm Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, February 2011. Tobacco Use: Targeting the Nation’s Leading Killer- At a Glance 2011. http://www.cdc.gov/chronicdisease/resources/publications/aag/pdf/2011/Tobacco_AAG_2011_508.pdf North Carolina Department of Health and Human Services, Division of Public Health, Chronic Disease and Injury Section, Tobacco Prevention and Control Branch, March 2010. North Carolina Youth Tobacco Survey 2009. http://www.tobaccopreventionandcontrol.ncdhhs.gov/data/yts/index.htm North Carolina Department of Health and Human Services, Division of Public Health, North Carolina Tobacco Prevention and Control Branch, Epidemiology and Evaluation Unit, November 2011. The North Carolina Smoke Free Restaurants and Bars Law and Emergency Department Admissions for Acute Myocardial Infarction. http://tobaccopreventionandcontrol.ncdhhs.gov/smokefreenc/docs/TPCB2011SFNCReport-SHD.pdf North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County: Tobacco: Current Smoker. http://www.schs.state.nc.us/SCHS/brfss/2010/cata/_rfsmok3.html North Carolina Department of Health and Human Services, State Center for Health Statistics. BRFSS Survey Results 2010: Catawba County: Tobacco Use: Currently Use Smokeless Tobacco. http://www.schs.state.nc.us/SCHS/brfss/2010/cata/USENOW3.html North Carolina Department of Health and Human Services, State Center for Health Statistics, BRFSS Survey Results 2010: Catawba County: Tobacco Use: Smoking Status. http://www.schs.state.nc.us/SCHS/brfss/2010/cata/_smoker3.html North Carolina Health and Wellness Trust Fund. Tobacco Prevention and Cessation Initiatives. www.healthwellnc.com/tobacco.aspx United States Department of Health and Human Services, 2011. Healthy People 2020: Topics and Objectives: Tobacco Use. http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=41 United States Food and Drug Administration, 2009. Overview of the Family Smoking Prevention and Tobacco Control Act. http://www.fda.gov/downloads/TobaccoProducts/GuidanceComplianceRegulatoryInformation/UCM24 6207.pdf

Community Health Assessment 2011

Acknowledgements Catawba County Public Health wishes to thank all agencies and individuals who contributed their time, information, leadership, participation, and expertise in compiling this Community Health Assessment (CHA).

Action Teams Cancer Mentor – Lindsey Smith, Council on Adolescents Teresa Jarrett, Frye Regional Medical Center Melanie Lutz, Catawba Valley Medical Center Hani Nassar, Klingspor/Cancer Task Force Barbara Rush, American Cancer Society JoAnn Smith, Frye Regional Medical Cancer Communicable Disease Mentor – Lynne Laws, Catawba County Public Health Linda Greene, Catawba County Public Health Alisa Leonard, Catawba Valley Medical Center Lisa Meosky, Frye Regional Medical Center Dr. Wheaton Williams, Fairgrove Primary Health Community Profile & Introduction Mentor – Amy McCauley Catawba County Public Health Beth Brandes, Catawba County Department of Social Services Taylor Dellinger, Western Piedmont Council of Governments Douglas W. Urland, Catawba County Public Health Dawn Wilson, Catawba County Department of Social Services Diabetes Mentor – Leigh Anne Charles, Catawba County Public Health Dr. Rodman Barber, Piedmont Endocrinology Kim Hentschel, Catawba Valley Medical Center Bonnie Irvin, Frye Regional Medical Center Linda Johnson, Piedmont Endocrinology Environmental Health Mentor – Mike Cash, Catawba County Public Health Glennie Daniels, North Carolina Cooperative Extension Amanda Kain, Catawba County Utilities and Engineering Tracey Paul, Catawba County Public Health Health Coverage Mentor – Amy McCauley, Catawba County Public Health Dr. Roger Baker, Greater Hickory Cooperative Christian Ministries Bobby Boyd, Chairman, Access to Care Coalition Dr. Sarah Gareau, Lenoir-Rhyne University Kim Walters, NC Access Care

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Heart Disease & Stroke Mentor – Cindi Bowman, Catawba County Public Health Kathy Lail, Frye Regional Medical Center’s Heart Center Peggy Messick, Catawba Valley Medical Center Immunizations Mentor – Sara Jamieson, Centers for Disease Control & Prevention Susan Huffman, Unifour Pediatrics Debbie Johnson, Catawba County Public Health Lynne Laws, Catawba County Public Health Dorian Maltba, Catawba Pediatrics Infant Mortality Mentor – Rhonda Stikeleather, Catawba County Public Health Gail Henson, Early Head Start Jennifer McCracken, Catawba County Public Health Influenza & Pneumonia Mentor – Sara Jamieson, Centers for Disease Control & Prevention Injuries Mentor – Jennifer McCracken, Catawba County Public Health Robert Broome, Broome Insurance Eric Hunsucker, Nationwide Insurance Chip Ivey, Hickory Police Department Sara Jamieson, Centers for Disease Control & Prevention Debbie Leger, Catawba Valley Medical Center Alton Price, Catawba County Sheriff’s Department Mental Health Mentor – Beth Schlosser, Catawba County Public Health Melissa Cline, Mental Health Partners Judy Dahlstrom, Mental Health Partners Vickie Dieter, Family Support Network/HOPE Michelle Hamby, Frye Regional Medical Center John Hardy, Mental Health Partners Nutrition & Physical Activity Mentor – Julie Byrd, Catawba County Public Health Phil DiCasolo, Eat Smart Move More Catawba County Leigh Anne Charles, Catawba County Public Health Cissy Fish, Community Advocate Mack McLeod, Hickory Parks and Recreation

Community Health Assessment 2011

Acknowledgements Oral Health Mentor – Kelly Isenhour, Catawba County Public Health Dr. Patrick Maddy, Catawba County Public Health Cindy Sigmon, NC Oral Health Section Overweight & Obesity Mentor – Tracey Paul, Catawba County Public Health Dr. Vondell Clark, The Healthy House Holley Dagenhardt, Blue Cross/Blue Shield of NC Stacey DeLong, Curves Michelle Rimer, Solmaz Institute Lynn Winkler, The Healthy House Preparedness Mentor – Chantae Lail, Catawba County Public Health Mike Helton, Catawba Valley Medical Center Karyn Yaussy, Catawba County Emergency Services Senior Health Mentor – Alice Layne, Catawba County Public Health Kelsey Johnston, Lenoir-Rhyne University MPH Candidate Sheila Weeks, Western Piedmont Council of Governments Sexually Transmitted Diseases & HIV/AIDS Mentor – Sylvia Yates, Catawba County Public Health Rodney Tucker, ALFA Substance Abuse & Tobacco Mentor – Jennifer McCalley, Catawba County Public Health Louise Ackerman, Lenoir-Rhyne University Gordon Cappelletty, Family NET of Catawba Valley Kevin Ussery, Catawba Valley Medical Center Julie Walker, Cognitive Connection Teen Pregnancy Mentor – Sarah Lawson, Catawba County Public Health Trish Beckman, Catawba Valley Medical Center Dr. Scott Chatham, Catawba Women’s Center Lindsey Smith, Council on Adolescents Alice Whitener, Council on Adolescents

Compiled and submitted December 9, 2011 by Catawba County Public Health.

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Appendices Communications Plan 2011 Catawba County Community Health Assessment Survey 2011 Catawba County Community Health Assessment Survey Results Healthy North Carolina 2020 Objectives Catawba County Health Resource Directory

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Communications Plan Overview The 2011 Catawba County Community Health Assessment provides a point-in-time evaluation of the health of the county. The information contained in the document is intended to be used and shared, in whole or in part, by countless stakeholders as they work toward improving health and healthcare delivery. As such, communicating the results and availability of the CHA to the community – and particularly to stakeholders who can utilize and benefit from its information – is a key part of the CHA process.

Communications Plan Action

Timeframe

Present CHA findings to key constituents

October 25, 2011

Present CHA findings and priorities to Board of Health,

December 6, 2011

Catawba County Manager, and Catawba County Public Health Management Team Submit CHA to State

December 9, 2011

Post CHA on Catawba County Public Health and

December 12, 2011 – forward

Catawba County Health Partners websites E-mail CHA web link to key constituents

December 2011

Disseminate press release to local media announcing

December 2011

CHA findings, availability and priorities Print hard copies of the CHA and distribute

December 2011 – January 2012

to key stakeholders Make reference copies available to public

January 2012 - forward

at Catawba County Public Health Create and disseminate a “public friendly” CHA tip sheet

January 2012 – forward

Schedule community presentations to promote CHA

January 2012 – forward

findings and priorities

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2011 Catawba County Community Health Survey This survey is part of the community health assessment currently in progress in Catawba County. The community health assessment is a process of learning about the health status of our community. We will use this information to identify needs and concerns about our community and then develop ways to address those needs. This survey is anonymous and should take less than 10 minutes of your time to complete. Thank you for your participation. Catawba County Public Health Section 1: Demographic Information Gender:

____ Male

How old are you? (Check one.) ____ 18 - 20 ____ 21 – 24 ____ 35 – 44 ____ 45 - 54 ____ 65 -74 ____ 75 or older

____ Female

____ 25 – 34 ____ 55 – 64

Race: ____ Black or African American ____ Asian ____ Native Hawaiian or Other Pacific Islander

____ American Indian or Alaskan Native ____ White ____ Bi-racial/Multi-racial

Are you of Hispanic or Latino origin*? ____ Yes ____ No *The Census Bureau defines “Hispanic or Latino” as “a person of Cuban, Mexican, Puerto Rican, South or Central American or other Spanish culture or origin regardless of race.” What is the highest level of school, college or vocational training that you have finished? (Check one.) ____ Some high school, no diploma ____ Some college (no degree) ____ High school diploma or GED ____ Graduate or professional degree ____ Associate Degree/Vocational Training ____ Bachelor’s degree ____ Other:________________________________________ Are you married? ___ Yes

___ No

How many people live in your household? _________ What was your total household income last year, before taxes? (Check one.) ____ Less than $10,000 ____ $10,000 to $14,999 ____ $20,000 to $24,999 ____ $25,000 to $34,999 ____ $50,000 to $74,999 ____ $75,000 to $99,000 What is your zip code? ____________________ Are you currently…? (Check one.) ___ Employed for wages ___ Self-employed ___ Out of work for more than 1 year ___Out of work for less than 1 year 128

___ A Homemaker ___ A Student ___ Retired

____ $15,000 to $19,999 ____ $35,000 to $49,999 ____ Over $100,000

Section 2: Check ONE answer for each question. 1. Where do you go most often for health care when you are sick? (Check one.) ___ Private Doctor’s office ___ Health Department ___ Free Clinic ___ Hospital Emergency Room ___ Urgent Care Center ___ Walk-in Clinic ___ Pharmacy ___ Other_______________________ ___ I don’t go anywhere when I am sick. 2. Do you think smokers would be more or less likely to quit using tobacco if their workplace or other public places go smoke free? (Check one.) ___ More likely to quit ___ Less likely to quit ___ Doesn’t matter ___ I don’t know 3. What is the main reason you would drive after drinking alcoholic beverages? (Check one.) ___ I can’t afford a taxi. ___I only had one or two drinks. ___ I don’t have a designated driver. ___ I do not drive after drinking. ___ I don’t have far to drive. ___ Does not apply. ___ I feel fine enough to drive. 4. The recommendation for physical activity is 30 minutes a day 5 days a week (2 ½ hours per week). Pick the main reason that keeps you from getting this much physical activity. (Check one.) ___ Nothing. I get this much physical activity. ___ I don’t have time to exercise. ___ I feel like I get this at my work. ___ I am physically disabled. ___ I don’t like exercise. ___ There is no safe place to exercise. ___Other______________________________ 5. One recommendation for healthy eating is to eat at least 5 servings of fruits and vegetables a day (not French fries or potato chips). Pick the main reason that keeps you from eating this way. (Check one.) ___ Nothing. I eat 5 or more servings a day. ___ I just don’t think about it. ___ I (or my family) won’t eat them. ___ I don’t have time to fix them. ___ I don’t know how to prepare them. ___ They’re too expensive. ___ Other_______________________________ 6. How often do you use birth control or contraception to prevent pregnancy during sexual intercourse? (Check one.) ___ Every time ___ Sometimes ___ Rarely ___ Never ___ Does not apply 7. Do you have a family history of diabetes? (Check one.) ___ Yes ___ No ___ I don’t know 8. In the past six months, have you allowed a baby (ages 0-12 months) to sleep in the same bed with you? (Check one.) ___ Yes ___ No ___ Does not apply to me 9. Do you consider yourself to be overweight? (Check one.) ___ Yes ___ No 10. Have you intentionally lost weight and kept it off in the past 12 months? (Check one.) ___ Yes ___ No

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11. To prevent teen pregnancy and sexually transmitted diseases, which of the following should be taught in school? (Check one.) ___ Abstinence until marriage ___ Comprehensive sex education (including abstinence, other birth control methods and STD prevention) ___ None of the above 12. In the past 12 months, have you experienced diarrhea, vomiting or nausea that you thought was caused by food poisoning but did not seek medical care? (Check one.) ___ Yes __ No 13. How often do you check your risk factors, such as blood pressure or cholesterol, for heart disease and stroke? (Check one.) ___ At least once a year. ___ Never. ___ When my doctor suggests it. ___ Don’t know/not sure 14. Have you received a flu shot in the last 12 months? (Check one.) ___ Yes ___ No, I don’t get sick ___ No, I don’t like getting shots ___ No, I don’t like going to the doctor ___No, I cannot pay for the shot ___ No, I am worried about the side effects ___ No, I believe the vaccine is ineffective ___ No, I have gotten sick or know someone who has gotten sick from the vaccine ___ Other ___________________________ 15. Do you visit a dentist regularly? (Check one.) ___ Yes ___ No, I can’t afford it. ___ No, I don’t have dental insurance.

___ No, I only go when I have a problem. ___ No, I don’t need dental care. ___ No, I don’t like going to the dentist.

16. If you were homebound or suffering from major illness, would you have access to a caregiver? (Check one.) ___ Yes ___ No ___ Don’t know/not sure 17. What is your biggest concern about healthcare for yourself after the age of 65? (Check one.) ___ Access to care ___ Availability of specialists ___ Cost of healthcare ___ Transportation to/from appointments ___ Choice of doctors ___ Other _________________________ 18. Have you experienced problems getting medications due to cost? (Check one.) ___ Yes ___ No

Section 3: Check ALL answers that apply to each question. 1. Where do you find out about local news or events? (Check all that apply.) ____ Billboards ____ Blogs ____ Church ____ Email updates ____ Friends and family ____ Internet ____ Magazines ____ Newspapers ____ Radio ____ School ____ TV ____ Workplace ____ Social network websites (Facebook, MySpace) ___ Other: ________________________ 130

2. In the last 12 months, have you experienced any of the following issues? (Check all that apply.) ___ Mood Swings ___ Suicidal Thoughts ___ Anxiety ___ Domestic Violence ___ Depression ___ None of the above 3. In the last 12 months, have you participated in any of the following cancer screenings? (Check all that apply.) ___ Breast (mammogram) ___ Mouth/Tongue ___ Prostate (PSA blood test) ___ Cervical (pap smear) ___ Skin ___ Other _______________________ ___ Colorectal (colonoscopy) If you did not have a cancer screening in the last 12 months, why not? (Check all that apply.) ___ I don’t have time. ___ I don’t know where to go. ___ Other _________________ ___ I can’t afford it. ___ Does not apply to me. 4. Do you do any of the following in an effort to help the environment? (Check all that apply.) ___ Reusable bags ___ Limit use of central heating/cooling ___ Carpooling ___ Buy local fruit and vegetables ___ Public transportation ___ Try to only buy locally made or grown products ___ Turn it off when not in use (lights, television, ___ Buy energy efficient appliances DVD player, computer) ___ Drive a hybrid vehicle ___ Recycle ___ Other __________________________ ___ Buy ‘green’ products 5. Which of the following do you feel you and your family are prepared to handle for up to 72 hours (3 days) without emergency assistance? (Check all that apply.) ___ Loss of power (electricity) ___ Not prepared ___ Flooding ___ Don’t know/not sure ___ Ice storm

You have completed the Catawba County Community Health Assessment Survey. Thank you for your participation. Catawba County Public Health

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2011 Catawba County Community Health Assessment (CHA) Survey Summary Report Survey Respondents:

1,996

Demographic Breakdown Gender:

Female

76.6%

Male 18 - 20 21 – 24 25 – 34 35 – 44 45 - 54 55 – 64 65 - 74 75 or older

23.4% 5.5% 5.6% 15.8% 21.0% 21.2% 19.1% 7.1% 4.6%

White Black Asian American Indian Bi-racial/Multi-racial Native Hawaiian/ Pacific Islander

79.8% 15.7% 1.9% 0.6% 1.9% 0.2%

Ethnicity:

Non-Hispanic Hispanic

92.1% 7.9%

Education:

Some high school, no diploma 7.7% High school diploma or GED 23.5% Some college (no degree) 20.4% Associate Degree/Vocational Training 13.0% Bachelor’s degree 17.6% Graduate or professional degree 15.8% Other (please specify) 2.0%

Age:

Race:

Married:

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Yes No

57.2% 42.8%

Household Size: 1 2 3 4 5 6 7 8 9 10 11 12 or more

15.7% 32.3% 20.0% 18.8% 7.9% 3.2% 0.8% 0.5% 0.4% 0.2% 0.0% 0.2%

Income: Less than $10,000 $10,000 to $14,999 $15,000 to $19,999 $20,000 to $24,999 $25,000 to $34,999 $35,000 to $49,999 $50,000 to $74,999 $75,000 to $99,000 Over $100,000

16.3% 7.8% 4.1% 7.6% 10.6% 11.5% 17.4% 13.4% 11.5%

Zip Code: 28601 28602 28603 28609 28610 28613 28650 28658 28673 28682 Other

25.7% 20.8% 0.7% 2.7% 4.5% 13.6% 5.0% 18.4% 1.5% 0.4% 6.8%

Employment Status: Employed for wages Self-employed Out of work for more than 1 year Out of work for less than 1 year A Homemaker A Student Retired

59.7% 4.3% 9.1% 4.5% 5.5% 11.1% 12.4%

The recommendation for physical activity is 30 minutes a day 5 days a week (2 ½ hours per week). Pick the main reason that keeps you from getting this much physical activity. (Check one.) Nothing. I get this much physical activity. 36.2% I don’t have time to exercise. 26.5% I feel like I get this at my work. 8.7% I am physically disabled. 4.3% I don’t like exercise. 10.1% There is no safe place to exercise. 2.7% Other (please specify) 11.5% Retired persons exercise more than any other job status (63.8% get the recommended amount). One recommendation for healthy eating is to eat at least 5 servings of fruits and vegetables a day (not French fries or potato chips). Pick the main reason that keeps you from eating this way. (Check one.) Nothing. I eat 5 or more servings a day. 36.5% I just don’t think about it. 27.8% I (or my family) won’t eat them. 3.4% I don’t have time to fix them. 9.3% I don’t know how to prepare them. 0.6% They’re too expensive 12.5% Other (please specify) 9.9% Education level does not influence the amount of fruits and vegetables a person eats. Do you consider yourself to be overweight? (Check one.) Yes 52.2% No 47.8% 55.9% of whites consider themselves to be overweight while 41.9% of blacks consider themselves overweight. Have you intentionally lost weight and kept it off in the past 12 months? (Check one.) Yes 32.0% No 68.0% Do you have a family history of diabetes? (Check one.) Yes 49.5% No 44.9% I don’t know 5.6% 57.9% of blacks reported having a family history of diabetes as opposed to 48.2% of whites. How often do you check your risk factors, such as blood pressure or cholesterol, for heart disease and stroke? (Check one.) At least once a year. 58.8% When my doctor suggests it. 23.1% Never. 10.4% Don’t know/not sure 7.7% Age greatly affects how often someone checks their risk factors. After the age of 35 the percentage of people who get checked at least once a year noticeably increases.

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In the last 12 months, have you participated in any of the following cancer screenings? (Check all that apply.) Breast (mammogram) 46.5% Prostate (PSA blood test) 11.7% Skin 16.7% Colorectal (colonoscopy) 11.0% Mouth/Tongue 15.0% Cervical (pap smear) 52.4% Other (please specify) 13.6% If you did not have a cancer screening in the past 12 months, why not? (Check all that apply.) I don’t have time. 4.1% I don’t know where to go. 8.3% I can’t afford it. 20.1% Does not apply to me. 63.7% Other (please specify) 8.3% How often do you use birth control or contraception to prevent pregnancy during sexual intercourse? (Check one.) Every time 22.9% Sometimes 5.2% Rarely 2.2% Never 13.0% Does not apply 56.6% 17.2% of people who are not married reported rarely or never using contraception methods. 57% of the people who answered the question are married. To prevent teen pregnancy and sexually transmitted diseases, which of the following do you think should be taught in schools? Abstinence until marriage 22.2% Comprehensive sex education (including 72.6% abstinence, other birth control methods and STD prevention) None of the above 5.2% In the past 12 months, have you experienced diarrhea, vomiting or nausea that you thought was caused by food poisoning but did not seek medical care? (Check one.) Yes 15.9% No 84.1% Do you get a flu shot each year? (Check one.) Yes No, I don’t get sick No, I don’t like getting shots No, I don’t like going to the doctor No, I cannot pay for the shot No, I am worried about the side effects No, I believe the vaccine is ineffective No, I have gotten sick or know someone who has gotten sick from the vaccine No, please specify another reason below 134

54.2% 8.8% 4.7% 0.7% 5.6% 6.9% 3.3% 7.9% 7.9%

The higher the education level, the more likely someone is to receive a flu vaccine. The likelihood of getting a flu shot steadily increases with age. Whites (69%) are more likely to get the flu shot than blacks (53%). Males are twice as likely to list “I do not get sick” as a reason for not getting the shot as compared to women. Women get vaccinated for the flu slightly more often than men (65.8% and 61.5% respectively). Do you think smokers would be more or less likely to quit using tobacco if their workplace or other public places go smoke free? (Check one.) More likely to quit 41.4% Less likely to quit 9.7% Doesn’t matter 29.7% I don’t know 19.1% What is the main reason you would drive after drinking alcoholic beverages? I can’t afford a taxi. 0.8% I don’t have a designated driver. 1.1% I don’t have far to drive. 1.1% I feel fine enough to drive. 4.0% I only had one or two drinks. 12.1% I do not drive after drinking. 31.3% Does not apply. 49.6% In the past six months, have you allowed a baby (ages 0-12 months) to sleep in the same bed with you? (Check one.) Yes 5.0% No 51.9% Does not apply to me 43.1% In the last 12 months, have you experienced any of the following issues? (Check all that apply.) Mood Swings 26.1% Anxiety 32.0% Depression 30.7% Suicidal Thoughts 4.3% Domestic Violence 2.0% None of the above 52.0% Do you visit a dentist regularly? (Check one.) Yes No, I can’t afford it. No, I don’t have dental insurance. No, I only go when I have a problem. No, I don’t need dental care. No, I don’t like going to the dentist.

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58.7% 17.9% 8.0% 11.0% 2.6% 1.8%

What is your biggest concern about healthcare for yourself after the age of 65? (Check one.) Access to care 10.7% Cost of healthcare 75.2% Choice of doctors 3.9% Availability of specialists 2.2% Transportation to/from appointments 3.2% Other (please specify) 4.8% If you were homebound or suffering from major illness, would you have access to a caregiver? (Check one.) Yes 52.4% No 20.2% Don’t know/not sure 27.4%

Where do you go most often for health care when you are sick? (Check one.) Private Doctor’s office 68.6% Health Department 4.3% Free Clinic 3.1% Hospital Emergency Room 7.5% Urgent Care Center 2.7% Walk-in Clinic 1.0% Pharmacy 0.9% I don’t go anywhere when I am sick. 7.8% Other (please specify) 4.0% 23% of people do not have a medical home. (Free clinic, ER, Urgent Care, Walk-in clinic, Pharmacy) The working poor to lower middle class, $20,000 to $35,000 are the least likely to get any sort of care when they are sick. Have you experienced problems getting medications due to cost? (Check one.) Yes 34.1% No 65.9% Do you do any of the following in an effort to help the environment? (Check all that apply.) Reusable bags 58.6% Carpooling 14.4% Public transportation 6.5% Turn it off when not in use (lights, television, DVD 87.2% player, computer) Recycle 71.1% Buy ‘green’ products 28.4% Limit use of central heating/cooling 51.7% Buy local fruit and vegetables 39.5% Try to only buy locally made or grown products 17.4% Buy energy efficient appliances 48.7% Drive a hybrid vehicle 1.8% Other (please specify) 2.8%

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Which of the following do you feel you and your family are prepared to handle for up to 72 hours (3 days) without emergency assistance? (Check all that apply.) Loss of power (electricity) 53.6% Flooding 13.3% Ice storm 42.6% Not prepared 23.9% Don’t know/not sure 22.1% Where do you find out about local news or events? (Check all that apply.) Billboards Blogs Church Email updates Friends and family Internet Magazines Newspapers Radio School TV Workplace Social network websites (Facebook, MySpace) Other (please specify)

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11.9% 2.8% 28.1% 29.4% 53.7% 51.1% 16.9% 60.3% 44.1% 15.8% 75.7% 33.6% 22.8% 1.6%

Healthy NC 2020 Overview Every ten years, the North Carolina Division of Public Health sets long-term goals to help focus efforts toward improving key health issues across the state. The Healthy North Carolina (NC) 2020 health objectives are designed to improve the health status of every North Carolinian and mobilize the state to focus on a common set of health objectives. These objectives are indicated with a 2020 Target number, which represents a marked statistical improvement from the state’s 2010 baseline. More information about Healthy North Carolina 2020 can be found online at http://publichealth.nc.gov/hnc2020/. The chart below outlines the Healthy NC 2020 objectives and how Catawba County’s 2011 CHA data compares to those goals – acknowledging, however, that the state’s objectives are intended to be met within the next ten years. Please note that in some cases, comparable or matching sets of local data are not available to make a direct correlation between Catawba County’s current health status and the Healthy NC 2020 objectives. In these instances, the Catawba County data is represented with an N/A.

Healthy NC 2020 Objectives & 2011 Catawba County Data Healthy North Carolina 2020 Objectives

NC 2020 Target

2011 Catawba County

13.0%

16.8%

15.0%

N/A

0%

5.1%

79.2%

N/A

60.6%

40.6%

Tobacco Use 1. Decrease the percentage of adults who are current smokers

2. Decrease the percentage of high school students reporting current use of any tobacco product 3. Decrease the percentage of people exposed to secondhand smoke in the workplace in the past seven days

Physical Activity and Nutrition 1. Increase the percentage of high school students who are neither overweight nor obese 2. Increase the percentage of adults getting the recommended amount of physical activity

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Community Health Assessment 2011

Healthy NC 2020 3. Increase the percentage of adults who consume five or more servings

29.3%

22.4%

9.9

N/A

2. Reduce the unintentional falls mortality rate (per 100,000 population)

5.3

N/A

3. Reduce the homicide rate (per 100,000 population)

6.7

10.1

30.9%

N/A

8.7%

N/A

22.2

9.4

1.92

2.96

6.3

9.3

6.8%

14.3%

26.4%

20.4%

4.7%

5.8%

6.6%

13.7%

fruits and vegetables per day Injury 1. Reduce the unintentional poisoning mortality rate (per 100,000 population)

Sexually Transmitted Diseases/Unintended Pregnancy 1. Decrease the percentage of pregnancies that are unintended 2. Reduce the percentage of positive results among individuals aged 15-24 tested for chlamydia 3. Reduce the rate of new HIV infection diagnoses (per 100,000 population) Maternal and Infant Health 1. Reduce the infant mortality racial disparity between whites and African Americans 2. Reduce the infant mortality rate (per 1,000 live births) 3. Reduce the percentage of women who smoke during pregnancy Substance Abuse 1. Reduce the percentage of high school students who had alcohol on one or more of the past 30 days 2. Reduce the percentage of traffic crashes that are alcohol-related 3. Reduce the percentage of individuals aged 12 years and older reporting any illicit drug use in the past 30 days

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Community Health Assessment 2011

Healthy NC 2020 Mental Health 1. Reduce the suicide rate (per 100,000 population)

8.3

18.7

2.8

N/A

82.8

N/A

91.3%

73%

13.5

22.59

5.5

N/A

56.4%

38%

1.1

1.29

38.4%

52.1%

1. Decrease the percentage of individuals living in poverty

12.5%

14.3%

2. Increase the four-year high school graduation rate

94.6%

81.9%

36.1%

43.7%

2. Decrease the average number of poor mental health days among adults in the past 30 days 3. Reduce the rate of mental health-related visits to emergency departments (per 10,000) Infectious Disease/Foodborne Illness 1. Increase the percentage of children aged 19-35 months who receive the recommended vaccines 2. Reduce the pneumonia and influenza mortality rate (per 100,000 population) 3. Decrease the average number of critical violations per restaurant/ food stand Oral Health 1. Increase the percentage of children aged 1-5 years enrolled in Medicaid who received 2. Decrease the average number of decayed, missing, or filled teeth among kindergartners 3. Decrease the percentage of adults who have had permanent teeth removed due to tooth decay or gum disease Social Determinants of Health

3. Decrease the percentage of people spending more than 30% of their income on rental housing

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Community Health Assessment 2011

Healthy NC 2020 Environmental Health 1. Increase the percentage of air monitor sites meeting the current ozone

100%

100%

95.0%

N/A

3.5

N/A

161.5

165.2

8.6%

9.5%

10.1

17.1

79.5

76.9

90.1%

82.2%

8.0%

27.8%

38.1%

28%

standard of 0.075 ppm 2. Increase the percentage of the population being served by community water systems (CWS) with no maximum contaminant level violations 3. Reduce the mortality (among persons on CWS)rate from work-related injuries (per 100,000 population) Chronic Disease 1. Reduce the cardiovascular disease mortality rate (per 100,000 population) 2. Decrease the percentage of adults with diabetes 3. Reduce the colorectal cancer mortality rate (per 100,000) population) Cross-Cutting 1. Increase average life expectancy (years) 2. Increase the percentage of adults reporting good, very good, or excellent health 3. Reduce the percentage of non-elderly uninsured individuals (aged less than 65 years) 4. Increase the percentage of adults who are neither overweight or obese

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Community Health Assessment 2011

Health Resource Inventory Following is a directory of healthcare resources in Catawba County that has been compiled from a variety of sources, including Catawba County’s local hospitals and human service agencies. In addition, each CHA section lists other local Assets specific to each health issue. For some time, Catawba County has had a fairly consistent number of primary care physicians and dentists relative to the county’s population size. Residents also have access to a variety of specialized services within the county or through relationships with medical and/or trauma centers in outlying areas (notably Charlotte and Winston-Salem). With high unemployment in Catawba County, it is anticipated that demand for more providers who accept Medicaid – from primary care providers to specialty practices – will continue to grow. Specialty physicians are also needed to provide care to patients referred from the county’s low-cost/free clinics. While the county has a flexible public transportation system, an expansion of transportation options would benefit residents throughout the county. Hospitals Catawba Valley Medical Center 810 Fairgrove Church Road SE Hickory, NC 28602 (828) 326-3000 Physician Referral Line: (828) 324-2273 www.catawbavalleymedical.org Low-cost/Free Clinics Catawba County Public Health 3070 11th Ave. Dr. SE Hickory, NC 28602 www.catawbacountync.gov/phealth

St. Joseph’s Catholic Church Good Samaritan Clinic 720 W. 13th Street Newton, NC 28658 (828) 465-2878

Additional Healthcare Resources Patient Physician Cooperative - PPC, 325-0950 Medicaid Family/Children – Social Services, 6955712 Medicaid Adult – Social Services, 695-5692 Medical Assistance for Catawba County (MACC) (chronic disease management), (828) 327-0979, ext. 233 Services for the Blind, 695-5605 142

Frye Regional Medical Center 420 North Center Street Hickory, NC 28601 (828) 315-5000 www.fryemedctr.com

Greater Hickory Cooperative Christian Ministries (GHCCM) 31 1st Avenue SE Hickory, NC 28602 (828) 327-0979 www.ccmhickory.com The Clinic for People Without Health Insurance 105 N. Main Avenue Newton, NC 28658 (828) 466-2330 Dr. Ben Wofford

Services for the Deaf and Hard of Hearing, 1-800205-9920 CareLine, 1-800-662-7030

Community Health Assessment 2011

Health Resource Inventory Prescription Assistance Bowman Drug Company, Conover, 464-1354, www.bowmandrug.com Catawba County NACo Discount Drug Plan, 6955714 Medassist, www.medassist.org Access 2 Wellness, www.access2wellness.org Transportation Greenway – Bus & Vans, 464-9444 Medicaid Transportation for Medical (DSS), 6955608 Shelters 5th Street Shelter, Statesville, 704-872-4045 Salvation Army, 322-8061 Safe Harbor Rescue Mission, 326-7233 Family Care, 324-9917 Family Guidance/First Step, 322-1400 Habitat for Humanity, 328-4663 Blue Ridge Community Action (Weatherization & Repairs), 438-6255 Food Assistance Greater Hickory CCM, 327-0979 Corner Table, Newton, 464-0355 Eastern Catawba Cooperative Christian Ministry, 465-1702 Food Assistance, Catawba County DSS, 6955693/695-5694 Living Word Fellowship (Tuesday only 5-6pm), 3254773 St John’s Lutheran Church, 464-4071 Soup Kitchen, Hickory, 327-4828 Meals on Wheels, DSS, 695-5610 Hickory Church of Christ (1st and 3rd Tuesdays), 4644983

143

Counseling and Referral Only Family Guidance Center/First Step, 322-1400 Consumer Credit Counseling, 322-7161 Family Net, 695-6500 Mental Health Partners (LME), 1-877-327-2593 Women’s Resource Center, 322-6333 Rape Crisis Center, 322-6011 United Way Volunteer Center, 324-4357 Catawba Valley Legal Services, 1-800-849-5195 Child Support Unit, Catawba County Social Svcs., 695-5611 / 695-5612 Child Care Assistance Catawba County Day Care Unit, 695-5721 Community Schools Program, 464-9355 Children’s Resource Center, 695-6565 Head Start, 464-8875 Smart Start, 695-6505 Early Childhood Center – Sweetwater, 387-3689 Parenting and Tutoring Parenting Network, 465-9295 Catawba County Schools, 695-2600 Hickory Public Schools, 322-2855 Newton – Conover Public Schools, 464-3191 Centro Latino, 441-2493 Single Parent Association, 1-800-704-2102 Family Net, 695-6500 Child Service Coordination, 695-5771 Cultural Resources Centro Latino, 441-2493 United Hmong Association, 324-2322 Substance Abuse Cognitive Connection Counseling Group, 327-6026 Safe Harbor Rescue Mission, 326-7233 Exodus Homes, 324-4870 Flynn Home, 324-8767

Community Health Assessment 2011

Health Resource Inventory Physician Directory Allergy & Asthma Hickory Allergy & Asthma Clinic 220 18th St Cr SE Hickory, NC 28602 Phone: 828-322-1275 Inglefield, Joseph T. MD Anesthesiology Western Piedmont Anesthesiology PO Box 488 Conover, NC 28613 Phone: 800-221-5630 ext 2031 Chimiak, James M. MD Gildersleeve, Ronald C. MD Harline, Corbin DO Hill, Thomas R. MD McKenney, Todd W. MD Rinaldo, Frank E. MD Williams, Larry T. MD Cardiology Catawba Valley Cardiology 3521 Graystone Place, SE Conover, NC 28613 Phone: 828-326-2354 Luney, Derek J. MD Steg, Brian D. MD Piedmont Cardiology Associates 2660 Tate Blvd SE Hickory, NC 28602 Phone: 828-261-0009 Alexander, Daniel DO Alkoutami, Ghassan N. MD Morrison, John A. MD Paspa, Philip A. MD Patrone, Vincent J. MD Rerkpattanapipat, Pairoj MD Schultz, Richard D. MD

144

Stern Cardiovascular Clinic 4324 Quail View Road Charlotte, NC 28226 Phone: 980-355-1959 Stern, Herbert J. MD The Sanger Clinic 1001 Blythe Blvd, Ste 300 Charlotte, NC 28203 Phone: 704-373-0212 Bengur, Ahmet R. MD Bensky, Andrew S. MD Herlong J. Rene MD Paolillo, Jr., Joseph, MD Riopel, Donald A. MD Sliz, Nicholas B. MD Smith, Richard T. MD Western Piedmont Heart Centers /Hickory Cardiology Associates, PLLC 1771 Tate Blvd SE - Ste 201 Hickory, NC 28602 Phone: 828-324-4804 Dy, Johnny R. MD Hearon, Brian P. MD Isserman, Steven M. MD McDonald, R. Norman MD Miller, Ryan V. MD Patel, Sanjay K. MD Ross, Andrew M. MD Wiley, Thomas M. MD Catawba Mammography Phone: 828-326-3858 Dentistry Dale Spencer, DDS 1170 Fairgrove Church Rd SE Hickory, NC 28602 Phone: 828-328-6118 Spencer, Dale E., DDS

Michael Wimberly, DDS 1183 Fairgrove Church Rd SE Conover, NC 28613 Phone: 828-466-2488 Pediatric Dentistry Growing Smiles Pediatric Dentistry 430 West 20th St Newton, NC 28658 Phone: 828-464-9220 Penland, Ross, DMD Smile Starters 508 10th St. NW Conover, NC 28613 Phone: 828-469-3000 Dermatology Dermatology Center of Hickory 245 11th Avenue NE, Ste. 200 Hickory, NC 28601 Phone: 828-328-3500 Pruitt, Jerry L. MD Hickory Dermatology 1985 Tate Blvd SE Hickory, NC 28602 Phone: 828-328-4449 Salomon, Richard J. MD Wold, Karen T. MD Piedmont Plastic Surgery & Dermatology Center 1771 Tate Blvd SE, Ste 202 Hickory, NC 28602 Phone: 828-325-9849 Boswell, April A. MD Hunt, Dori L. MD Johnson, Charles S. MD Bergamo, Bethany M. MD

Community Health Assessment 2011

Health Resource Inventory Reed Dermatology 1870 N Center St Hickory, NC 28601 Phone: 828-322-7546 Fisher, George B. MD Reed, Charles N. MD Emergency Medicine Catawba Valley Emergency Physicians 810 Fairgrove Church Rd SE Hickory, NC 28602 Phone: 828-326-3850 Crain, Bert J. MD Curtis, Rachel, L. MD Einfalt, Eric S. MD Einstein, Norman Z. MD Fisher, William G. MD Geertz, Christopher E. MD Giometti, Jon. MD Greer, Gary W. MD Huggins Jr, H. Lawson MD Wesselman, David M. MD Williamson, Steven G. MD Endocrinology Piedmont Endocrinology 311 9th Ave Dr NE Hickory, NC 28601 Phone: 828-322-7338 Barber, Anthony R. MD Chira, Ebele C. MD Donepudi, Venkatarama S. MD Ear, Nose, and Throat Carolina ENT Head & Neck 304 10th Ave NE Hickory, NC 28601 Phone: 828-322-2183 Cost, Jamey L. MD Griesen, Dawn E. MD Harrill, Willard C. MD Jarrett, William A. MD Mauldin, Frank W. MD Seshul, Merritt J. MD Williams Jr, Robert C. MD 145

Family Medicine Bethlehem Family Practice 174 Bolick Lane - Ste 202 Taylorsville, NC 28681 Phone: 828-495-8226 Faruque, Mark A. MD Vass-Eudy, Kimberly R. DO Catawba Family Practice 200 2nd St SW PO Box 914 Catawba, NC 28609 Phone: 828-241-2377 Chi, H.Y., MD Catawba Valley Family Care 105 B South Main Ave. Newton NC 28658 Phone: 828-464-7770 Patel, Shital MD Claremont Family Practice 2890 S Lookout St PO Box 490 Claremont, NC 28610 Phone: 828-459-7324 Hamilton-Brandon, Luredean G., MD Conover Family Practice Crown HealthCare, PA PO Drawer 1239 Conover, NC 28613 Phone: 828-464-3821 Coffey III, David G MD Kahill, Ailisa H. MD Long, William E. MD Michael, Douglas W. MD Vierling, Brian S. MD Crossroads Family Medical Care 3121 Plateau Rd Newton, NC 28658 Phone: 704-276-9200 Parker, Bill Jack MD

Family Medical Associates 50 Macedonia Church Rd Taylorsville, NC 28681 Phone: 828-632-7076 Merrill, Steven C. MD Okuboye, Deji O. DO Generations Family Medicine Crown HealthCare, PA 212 29th Ave NE Hickory, NC 28601 Phone: 828-485-2762 Caporossi, Lisa M. MD Chambers, Dana L. MD Bruce M Goodson, MD 1251 16th St NE Box 11223 Hickory, NC 28603 Phone: 828-322-7700 Goodson, Bruce M. MD Graystone Family Health 3511 Graystone Place Conover, NC 28613 Phone: 828-326-9355 Gold, Steven A. MD Laney Jr, Thomas MD Greater Hickory Family Practice 2336 1st Ave SW Hickory, NC 28602 Phone: 828-431-4988 Gill, Daniel N. MD Hart Family Practice 221 13th Pl NW - Ste 202 Hickory, NC 28601 Phone: 828-322-8484 Cavendish, Aimee, MD Hart, R. Eric MD Don L. Hoover, MD, PA 1940 Briarwood-Suite A Hickory, NC 28602 Phone: 828-294-3116 Community Health Assessment 2011

Health Resource Inventory Maiden Family Practice 137 Island Ford Rd PO Box 368 Maiden, NC 28650 Phone: 828-428-2446 Chesson, Andrew L. MD Schultz, Curtis D. MD Stump, Teresa, DO Newton Family Physicians 767 W 1st St Newton, NC 28658 Phone: 828-465-3928 Forshey, Alan G. MD Lopina, Bart J. MD Peltzer, David E. MD Sherfey, Shannon M. MD Story, Alan W. MD

Southeast Catawba Family Practice 6127 S Hwy 16 PO Box 809 Denver, NC 28037 Phone: 704-483-0340 Restino, Elizabeth MD Springs Road Family Practice 2359 Springs Road Hickory, NC 28601 Phone: 828-256-9853 Nelson, John D. MD The Healthy House 810 Fairgrove Church Rd SE Hickory, NC 28602 Phone: 828-326-3410

North Hickory Family Practice 212 29th Ave NE Hickory, NC 28601 Phone: 828-326-0658 Sanderson, Steven L. MD Welch, Carl L., MD

Unifour Family Practice 2712 Hwy 127 S Hickory, NC 28602 Phone: 828-294-4100 Duralia, David R. MD Lee, Robert H. MD

Northeast Family Practice 2386 Springs Rd NE Hickory, NC 28601 Phone: 828-256-2112 Kauth, Brian G. MD Larson, Sean M. MD Wilkinson, John D. MD

Viewmont Family Practice 221 13th Ave Pl NW Hickory, NC 28601 Phone: 828-324-1699 Summers, Shane O., MD Witke, Christopher J., MD

Rudisill Family Practice 211 A Hwy 127 South Hickory, NC 28602 Phone: 828-322-5915 Rudisill, Elbert MD Sai Clinic PO Box 848 Rutherford College, NC 28671 Phone: 828-879-3400 Sathiraju, Gowri D. MD

146

Westpointe Family Health Center 2651 Morganton Blvd Lenoir, NC 28645 Phone: 828-759-2000 Moore Jr, Reginald G. MD

Gastroenterology Gastroenterology Associates 415 N Center St - Ste 300 Hickory, NC 28601 Phone: 828-328-3300 Allport, Simon J. MD Diamonti, Gregory N. MD Koscheski, Caroll D. MD Meier, John H. MD Nikrooz, Pouneh N. MD Richardson, Gaa O. MD Wright, Frank D. MD Lawrence M. Caldwell II, MD 24 S Brady Ave PO Box 849 Newton, NC 28658 Phone: 828-464-4550 Caldwell II, Lawrence M. MD Gynecology A Woman’s View 915 Tate Blvd SE - Ste 170 Hickory, NC 28602 Phone: 828-345-0800 Bilhorn, Denise MD Lovin, Vickie W. MD The Center for Women’s Specialties 915 Tate Blvd SE-Ste 162 Hickory, NC 28602 Phone: 828-485-2822 Lentz, Samuel S. MD The Woman’s Clinic 1205 N Center Street Hickory, NC 28601 Phone: 828-328-2901 Bishopric, F. Alice, MD Boyd, Robert D. MD Carroll, Nicole S. MD Merta, Steven R. MD

Community Health Assessment 2011

Health Resource Inventory Infectious Disease Hickory ID Consultants 810 Fairgrove Church Rd SE Hickory, NC 28602 Phone: 828-326-2145 Williams, Wheaton J. MD

Swisher Internal Medicine, PLLC 30 13th Ave NW Hickory, NC 28601 Phone: 828-324-0100 Swisher, Jenette T. MD

Internal Medicine Adult Internal Medicine, PA 21 18th Ave NW Hickory, NC 28601 Phone: 828-267-2246 Carter, Lawrence S. MD

Neonatology Neonatology & Pediatric Acute Care Specialists, Inc 352 2nd St NW PO Box 1305 Hickory, NC 28603 Phone: 828-345-0877 Berry, David B. MD Wellman, Samuel D. MD

Bowen Primary & Urgent Care 1470 9th Ave Dr NE Hickory, NC 28601 Phone: 828-325-0950 Bowen, Samuel T. MD Catawba Valley Internal Medicine 1771 Tate Blvd - Ste 103 Hickory, NC 28602 Phone: 828-322-1128 Hughes, Garland L. MD Miller, Douglas P. MD Moseley, Jonathan A., MD Price Jr, Billy L. MD Shenoy, Nitin P. MD Internal Medicine & Psychiatric Care of the Piedmont, PLLC 50 Cloninger Mill Road Hickory, NC 28601 Phone: 828-325-0555 Myles, Sidney L., MD Sarvesh Sathiraju, MD Hickory VA Medical Clinic 1170 Fairgrove Church Road, SE Hickory, NC 28602 Phone: 828-431-5600 Sathiraju, Sarvesh MD

147

Nephrology Hickory Adult Medicine & Kidney Specialist 1344 N Center St Hickory, NC 28601 Phone: 828-326-8888 Pisel, Gregory A. MD Piedmont Nephrology & Hypertension Associates 1899 Tate Blvd SE - Ste 2101 Hickory, NC 28602 Phone: 828-327-7788 Harvey, David L. MD Higerd, Michele L. MD Paul, Richard V. MD Turlapati, Lakshmi MD Neurology Armstrong Neurology 1622 Tate Blvd. SE Hickory, NC 28602 Phone: 828-855-2406 Armstrong, James A. MD

Neurology Associates 1985 Tate Blvd SE - Ste 600 Hickory, NC 28602 Phone: 828-328-5500 Conrad, Ryan S., MD Heckaman, James MD Menard, Dale A. MD Weymann, Catherine, A.MD Yapundich, Robert A., MD Neuroscience & Spine 1010 Edgehill Road North Charlotte NC 28207 Phone: 704-446-1900 Mayes, Bruce MD Singh, Rajdeep MD Neurosurgery Catawba Valley Neurological and Spine Services 915 Tate Blvd - Ste 120 Hickory, NC 28602 Phone: 828-327-6433 McCloskey, Scott M. MD Miller, Peter D. MD, PhD Piedmont Neurosurgery, PA 1899 Tate Blvd SE, Ste 2108 Hickory, NC 28602 Phone: 828-327-6500 Jones, David M. MD Rosenfeld Allan G. MD Obstetrics/Gynecology A Woman’s View 915 Tate Blvd SE – Ste 170 Hickory, NC 28602 Phone: 828-345—0800 Faruque, Laura M. MD Harraghy, Claire H. MD Miletich, Alyson H. MD

Community Health Assessment 2011

Health Resource Inventory Catawba Women’s Center 1501 Tate Blvd SE - Ste 201 Hickory, NC 28602 Phone: 828-322-4140 Chatham, Scott T. MD Dufour Jr, Harold C. MD Highland, Robert A. MD Miller, Joel B. MD-GYN Toy, Nancy J. MD Walker, Jason A. MD Whitton, Allison C. MD Wotring Jr, J. William MD-GYN Women’s Institute-CMC Maternal Fetal Medicine 1025 Morehead Medical Drive, Ste. 500 Charlotte, NC 28204 Phone: 704-355-3149 Ernest, Joseph, MD Joy, Saju, MD Piedmont Ob/Gyn 210 13th Ave Pl NW Hickory, NC 28601 Phone: 828-322-3017 Goins, James R. MD Locklear, Brandon E. MD McDonell, Charles F. MD-GYN Richardson, Ryan N. MD Watson-Locklear, Meredith MD Oncology/Hematology Carolina Oncology Specialists 2406 Century Pl, SE Hickory, NC 28602 PO Box 3710 Hickory, NC 28603 Phone: 828-324-9550 Orlowski, Richard N. MD Tate, Michael N. MD

148

Oncology/Radiation Hickory Radiation Oncology 810 Fairgrove Church Rd SE PO Box 2654 Hickory, NC 28603 Phone: 828-326-3856 DelCharco, John O. MD Sigmon Jr, W. Reginald MD Tomlinson, Shannon K. MD

Oursler III, Ralph E. (Trey) MD Williams, Randal J. MD Williams, T. Reginald MD

Western Piedmont Oncology PO Box 700 Valdese, NC 28690 Phone: 828-879-7536 Jones, Gregory L. MD

Orthopaedics Carolina Orthopaedic Specialists 2165 Medical Park Dr Hickory, NC 28601 Phone: 828-324-2800 Brazinski, Mark S. MD Campbell, Donald A. MD Daley, Christopher T. MD dePerczel, John L. MD Geissele, Alfred E. MD Keverline, Jeffrey P. MD Kirkland, Timothy H. MD Liljeberg Jr, Robert L. MD Martin, Christopher R. MD Maxy, Ralph J. MD Sladicka, Stephen J. MD Tiffany, Mark A. MD Walker, Earl W, MD

Oral Surgery Brown and Neuwirth 261 18th St Cr SE Hickory, NC 28602 Phone: 828-327-7867 Brown, Christopher H. DDS Neuwirth, Bryan R. DDS, MD Drs. Darab, & Richardson 3452 Graystone Pl SE PO Box 2526 Hickory, NC 28603 Phone: 828-322-1667 Darab, David J. DDS Richardson, Paul E. DDS Ophthalmology Graystone Ophthalmology Associates 2424 Century Pl, SE Hickory, NC 28602 PO Box 2588 Hickory, NC 28603 Phone: 828-322-2050 Adair, Brian C. MD Chang, Richard I. MD Hargrove, Roderick N. MD Harris Jr, James W. MD Joslyn, Ann K. MD Kelty, Patrick J., MD

Southeastern Eye Center 27 13th Ave NE Hickory, NC 28601 Phone: 828-322-6040 Kirk A. Murdock MD

Hickory Orthopaedic Center 214 18th St SE Hickory, NC 28602 Phone: 828-322-5172 Geideman, William M. MD Hurley, Peter T. MD Johnson, Jeremy C. MD Knapp, Jeffrey A. MD Krenzel, Brian, A. MD McGinnis, Mark R. MD Norcross, Jason MD Pekman, William M. MD Sohagia, Kinjal, MD

Community Health Assessment 2011

Health Resource Inventory Joint Replacement Specialists 36 14th Ave NE – Ste 103 Hickory, NC 28601 Phone: 828-345-6468 Peak, E. Louis MD Palliative Care Caldwell County Hospice & Palliative Care 902 Kirkwood St NW Lenoir, NC 28645 Phone: 828-754-0101 Ray, Thomas M. MD Palliative CareCenter & Hospice of Catawba Valley 3975 Robinson Rd Newton, NC 28658 Phone: 828-466-0466 Cotton, Michael A MD Moffet, Cynthia A. MD Thompson III, William C. MD Pathology Piedmont Pathology Associates 1899 Tate Blvd SE, Ste. 1105 Hickory, NC 28602 Phone: 828-322-3821 Atkins, Mark R. MD Bauer, John M. MD Couch, A. Paul, MD Highland, Kelly E. MD Olympio, Georgia K. MD Parker, James L. MD Patel, Nilesh P. MD Payne, Kerry D. MD Reutter, Jason MD Sterling, Robert T. MD Van Noy, Joanna W. MD Vogel, Joseph V. MD

149

Pediatrics Catawba Pediatric Associates 240 18th St Cr SE Hickory, NC 28602 Phone: 828-322-2550 Barrett, Mark, MD Bates, P. Kenneth MD Bridgeman, Kelly B. MD Froedge, Jerry K. MD Harrill, Kiran C. MD Lowry, Joy E. MD The Childhealth Center 1455 25th Ave Dr NE Hickory, NC 28601 Phone: 828-322-4453 Frierson, Angela M. MD Golub, Tatyana V. MD Luckadoo, Laura J. MD Summer, Kenneth V. MD Unifour Pediatrics 3411 Graystone Pl Conover, NC 28613 Phone: 828-328-1118 Hata, L. Brooke MD Millsaps, David M. MD Spees, Lynn B. MD Physiatry Espiritu Clinic, PLLC 715 Fairgrove Church Road, SE Conover, NC 28613 Mail: 2425 N. Ctr. St #370 Hickory, NC 28601 Phone: 888-898-7130 Espiritu, M. Carmen MD Unifour Rehab Medicine 1333 2nd Street, NE, Ste. 300 Hickory, NC 28601 Phone: 828-328-9200 Coates-Wynn, Geoffrey S. MD

Plastic Surgery Hickory Plastic and Reconstructive Surgery 50 13th Ave NE Ste 2B Hickory, NC 28601 Phone: 328-322-8380 Fewell Jr, Joseph E. MD Siciliano, Steven A. MD Piedmont Plastic Surgery & Dermatology Center 315 19th St. St. SE Hickory, NC 28602 Phone: 828-325-9849 Swank, Gregory M., MD Podiatry Carolina Foot & Ankle 1501 Tate Blvd, SE, Ste. 203 Hickory, NC 28602 Phone: 828-304-0400 Kukla, Robert F. DPM Weaver, Seth A. DPM Williams, Todd A. DPM Carolina Podiatry Center 419B 2nd St NW Hickory, NC 28601 Phone: 828-327-3029 Johncock, William J. DPM Unifour Podiatry 912 2nd St NE Hickory, NC 28601 Phone: 828-267-1916 Grogan, John H, DPM Preventive Medicine Catawba Valley Medical Center Occupational Health 810 Fairgrove Church Rd SE Hickory, NC 28602 Phone: 828-326-3230 Osbahr III, Albert MD

Community Health Assessment 2011

Health Resource Inventory Psychiatry Catawba Valley Psychiatric Services 1120 Fairgrove Church Rd SE Hickory, NC 28602 Phone: 828-326-2828 Branyon, David W., MD Davis, Charles, B. MD Eustice, Isabelle H, MD Sprague, Marie, DO Hickory Psychiatric Center 24 2nd Avenue NE Hickory, NC 28601 Phone: 828-324-9900 McKean, Thomas K. MD Synn, Jay MD New Directions Counseling Services 201 Government Ave, SW, Ste. 305 Hickory, NC 28602 Phone: 828-267-1740 Munoz, Rigardy P, MD Rudy Santoso, MD 1019 Lenoir Rhyne Blvd Hickory, NC 28601 Phone: 828-324-4143 Santoso, Rudy A. MD Pulmonary Hickory Chest, PLLC 1771 Tate Blvd - Ste 103 Hickory, NC 28602 Phone: 828-322-1128 Anderson, Daniel E. MD McKendree E. McNabb, MD 24 2nd Ave NE - Ste 210 PO Box 9498 Hickory, NC 28603 Phone: 828-323-8230 McNabb, McKendree E. MD

150

Radiology Catawba Radiological Associates 18 13th Ave NE PO Box 308 Hickory, NC 28603 Phone: 828-322-2644 Baker, Chandra M MD Battiston, John MD Bools, John C. MD Dyson, Matthew D, MD Farris, Stephen L. MD Frankel, Nicholas N. MD Harlan, Steven D. MD Harper, Keith W. MD Holtzman, Adrian W. MD Jacobs, M. Todd MD Johnson, Eric V. MD Massengill, Alan D. MD Meredith, Eric MD Pearce, R. Edward MD Rautiola, Eric C. MD Scheil, Charles D. MD Tate, Knox R. MD Thorwarth Jr, William T. MD Rheumatology Piedmont Rheumatology 225 18th St SE Hickory, NC 28602 Phone: 828-322-1996 Caldwell, R. David MD McClory, Jill A., MD Payne, D. Dennis MD Surgery Cardiovascular & Thoracic Hickory Heart, Lung and Vascular Associates, PA 420 N Center St Hickory, NC 28601 Phone: 828-323-1100 Carlton, Richard A. MD Hennington, Mark H. MD Purut, Jim M. MD

General Surgery Carolina Surgery and Cancer Center 1501 Tate Blvd SE - Ste 202 Hickory, NC 28602 Phone: 828-485-2707 Locke, Ronald N. MD McCluer, Bryan MD Pabst, Susan J. MD Catawba Surgical Associates 3513 Graystone Pl Conover, NC 28613 Phone: 828-322-8485 Fitzgerald, Dwight M. MD Thompson Jr, Aaron D. MD Hickory Surgical Clinic, Inc 415 N Center St - Ste 102 Hickory, NC 28601 Phone: 828-327-9178 Bradshaw, Peter H. MD Cook, L. James MD Cox, Montgomery H. MD Hata, Jonathan A. MD Kiell, Charles S. MD Parish, Kenneth L. MD E. Gary McDougal MD, PLLC 1899 Tate Blvd SE - Ste 2106 Hickory, NC 28602 Phone: 828-322-9105 Urology Viewmont Urology Clinic 1202 N Center St Hickory, NC 28601 Phone: 828-322-4340 Anderson, Mark J. MD Creighton, Matthew A. MD DeLeary, Geoffrey D. MD Eller, Douglas A. MD Gerrard Sr, Edward R. MD Gerrard Jr, Edward R. MD Hardaway Jr, David M. MD Community Health Assessment 2011

Health Resource Inventory Area Physicians Accepting New Medicaid Patients (as of October 2011) Pediatricians Practice Name Catawba Pediatric Association Center for Ped & Adolescent Med ChildHealth Center Cleveland County Health Dept DeSantis Family Practice (UNDER 18 ONLY) Family Medicine Associates of Lincoln County Goodson Family Practice (UNDER 18 ONLY) Lakeshore Pediatric Center Lincoln Pediatrics Mountain View Pediatrics --Morganton, Lenoir, & Valdese offices Mulberry Pediatrics Newton Family Physicians (UNDER 18 ONLY) Northlake Pediatrics Care Piedmont Healthcare Pediatric Piedmont Pediatric Center Shelby Children’s Clinic

Physicians in Practice Address Drs. Dixon, Froedge, Crocker, Bates, Unifour Medical Harrill, Barringer, Lowry Commons, Hickory Dr. Tilt, Little, Thomas Mooresville

Phone (828) 322-2550

Drs. Luckadoo, Summer, Frierson, Golub Dr.Collins,Elliott,Hardeman,Elwood Dr. Michael DeSantis

Sandy Ridge Rd., Hickory Shelby Hickory

(828) 322-4453

Drs. Mark Keifer and Daniel Koch

Lincolnton

(704) 732-8736

Dr. Bruce Goodson

1251 16th St NE, Hickory Hwy 16 Denver Lincolnton Medical Heights Dr. Morganton

(828) 322-7700

Lenoir Newton

(828) 757-5509 (828) 465-3928

Statesville Statesville

(704) 871-2323 (704) 838-8245

Lincolnton Shelby

(704) 736-0028 (704) 482-1435

Thomas St, Statesville Graystone Place, Conover Valdese

(704) 872-9595

Hwy 127N, Bethlehem Corporate Park Dr., Mooresville Connelly Springs, Lenoir

(828) 495-8226

Statesville Children’s Clinic

Dr. Wissam Nadra Drs. Israel, Mofrad Drs. Jarrah, Whalley, Bachman, Thomas, Carrion, Medina, Robinson, Heckel Drs. Dodds, Dravland, Kinkle Drs. Forshey, Peltzer,Sherfey,Story,Manus Dr. Michelle Borja Drs. Schopps, Bentley, Gessner, Willhide Dr. Ghulam Hussein Dr. Binioni, Hayek, Norman, Eastman, Horsley, Benfield… Dr. Abell

Unifour Pediatrics

Dr. David Millsaps and Lynn Spees

Valdese Family Practice

Drs. Byrd, Arnesman

Adults and Families Bethlehem Family Practice

Dr. Mark Faraque

Bremnor Family Medicine

Dr. Judy Bremnor

Cajah’s Mtn Family Medical Center

Dr. Gould

151

(704) 799-2878

(704) 484-5120 (828) 304-6363

(704) 489-8401 (704) 735-1441 (828) 433-4484

(828) 328-1118 (828) 874-1316

(704) 660-9780 (828) 726-0570

Community Health Assessment 2011

Health Resource Inventory Carolina Family and Urgent Care Carolina Specialty Care Carolina Specialty Care (over age 12 only) Catawba Family Practice

Dr. Voulgaropoulo, Swedlund, Kabar (over 19) Dr. Debra Szostak0Wodec (over 13) Dr. Tondo

Statesville

(704) 871-9731

Statesville Troutman

(704) 872-8711 (704) 528-3721

James Fox

(828) 241-2377

Catawba Valley Primary Care

Dr. London (Ray Osterer, PA)

Claremont Family Practice

Drs. Ross and Cardenas-Andrews

Collettsville Medical Center Family Care Center

Dr. Mathis, Page Drs. Hollo, Inman, Faulkenberry, Long, Katz, Craig, Devries Drs. Merrill, Millsaps

Rosenwald School Rd,Catawba Northwest Blvd, Newton Lookout St, Claremont Collettsville Hwy 16 South, Taylorsville 2nd Ave SW, Taylorsville Morganton Mooresville Hwy 268, Lenoir Main Ave West, Hildebran Taylorsville

(828) 754-6850 (828) 397-5561

Dr. Chesson, Shultz, Pressler Drs. McMenemy, Triplett, Kirksey Dr Freeman, Lauri Black Drs. Gross, Renich, Holmes

Hwy 321, Maiden Main St, Hudson Main Ave, Newton Mooresville

(828) 428-2446 (828) 728-2561 (828) 465-9737 (704) 663-3063

Drs. Kauth, Larson and Maggie Spears Drs. Harlan Hicks, John Nicholson and Anita Misra Dr. William Doheny

Springs Road, Hickory Statesville

(828) 256-2112

Mooresville

(704) 799-7811

Drs. Patel and Nabors

Mooresville

(704) 660-4103

Dr. Rudisill Dr. Restino

211-A Hwy 127 S Hwy 16, Denver

(828) 322-5915 (704) 483-0340

Drs. Vizel, Isfan

(704) 924-9423

Dr.s Voulgaropoulo, Swedlund

Hartness Rd, Statesville Stony Point

Dr. Amrish Patel

Troutman

(704) 528-9903

Family Medicine Associates Greenway Family Practice Haahs, Michael (over age 21 only) Happy Valley Medical Center Hildebran Icard Medical Center Kalala, Jamal (OVER AGE 21 ONLY) Maiden Family Practice Main Street Medical Park Mission Medical Clinic Mooresville Family (formerly PCA Statesville) North East Family Practice Piedmont Healthcare-Old Mocksville Rd Primary Care Assoc-Lake Norman Primary Care AssocWilliamson Rd Rudisill Family Practice SouthEast Catawba Family Practice Statesville Primary Care Stony Point Family Medical Center (over age 21) Troutman Family Medicine 152

Dr. Diaa Hussein Same Drs. Page, Oriel-Comenen Dr. Consing

(828) 464-7800 (828) 459-7324 (828) 754-2409 (828) 632-9736 (828) 632-7076 (828) 430-9120 (704) 799-8182

(828) 632-1234

(704) 838-8249

(828) 585-9373

Community Health Assessment 2011

Health Resource Inventory Unifour Family Health Care Viewmont Family Medicine

Alene Blair, Tanya Dyer Dr. Witke, Summers, Cavendish

Wilson, Dr. Wayne

Dr. Wilson

Young Family Practice

Dr. Leo Young

Conover 13th Ave Pl NE, Hickory Shiloh Church Rd, Bethlehem Statesville

(828) 855-3644 (828) 324-1699 (828) 495-4445 (704) 924-7992

Area Specialty Physicians Accepting Medicaid (as of October 2011) Dentists Accepting Medicaid (Adults and Children) Dr. Gary Hensley, Marion office Claremont office—Drs. Hensley and Gaffney Dr. Bee Yang, Hickory Mountain View Family Dentistry (age 7 and over) Dr. Josh Millsaps (ages 5 & over) Dr. Larissa Mastro (adults only) 828-464-6742 Dr. Bailey, Hudson (age 12 and over)-can do anterior root canals (front teeth) Dr. Purdy and Walsh, Statesville (age 7 and up)** Dr. Yaghi, Huntersville (age 8 and up)** Dr. Glenn Owens, Lenoir (open 8-4, Mon – Thurs) Dr. Pete Miller, Winston Salem (age 4 and up)** Dr. Coyle, Charlotte** Dr. Webber, Charlotte Dr. John Walsh, Charlotte** Dr. William Hawks, Charlotte (extractions only)** Dr. Morris (Statesville) ** **These dentists will see patients to make dentures and/or partials Dentists Accepting Medicaid (children only) Wimberly Family Dental Practice, Hickory Catawba County Public Health (ages 3-21 only) Dr. Pendleton Waldron, Newton Lincoln County Dental Services, Lincolnton (age 3 - 18) Carolina Dental Center (age 1 – 20) Winston Salem Charlotte office, Freedom Drive Charlotte office, Tryon Street Asheville office, Biltmore Ave **These practices advertise for Spanish speaking patients also Dr. Graelin, Charlotte (age 5 and up) Dr. Winters, Charlotte (ages 3 – 15) The Smile Zone (Dr John Lyons), Gastonia Morganton Children’s Dental Center (Dr. Sharon Foreman) Smile Starters,Conover (ages 0-20)

153

828-659-7323 828-459-1400 828-256-3400 828-294-1448 828-322-2977

828-726-0202 704-873-0996 704-439-3601 828-754-2600 336-765-1881 704-364-5223 704-392-9357 704-537-1990 704-334-1755 704-873-0347

828-466-2488 828-695-5800 828-464-9220 704-735-2230 336-777-1272 704-393-3911 704-921-0204 828-350-1076 704-525-2625 704-523-7851 704-396-6166 828-433-5800 828-469-3000

Community Health Assessment 2011

Health Resource Inventory Oral Surgeons Accepting Medicaid (may require a referral from a general dentist) Dr. Neuwirth, Hickory (any age) Dr. Amy Brooks, Morganton (children only) Drs. Smith and Laflin, Winston Salem Dr. Kennon, Charlotte

828-327-7867 828-438-1010 336-765-9550 704-332-1591

Dentists Accepting NC Health Choice Wimberly Family Dental Practice, Hickory Dr. Bee Yang, Hickory Dr. Pendleton Waldron Dr. Conn, Boone (children age 2 and up) Dr. Josh Millsaps (ages 12 & over) Dr. Hatchett, Denver (children age 3 and up) Dr. Weinstein (children under age 16) Carolina Dental Center Morganton Children’s Dental Center The Smile Zone , Gastonia Smile Starters, Conover (ages 0-20)

828-466-2488 828-327-0054 828-464-9220 828-264-5450 828-322-2977 704-489-9919 336-903-1234 see numbers above 828-433-5800 704-396-6166 828-469-3000

Orthodontists Dr. Michael Arlin, Gastonia (ages 10-19) Dr. Penna, Mooresville Dr. Penna, Salisbury office Dr. David Small, Morganton Hamilton & Herring

704-864-0920 704-663-3473 704-633-5942 828-433-1242 828-324-4535

Eye Doctors—Ophthalmologists and Optometrists **patients do not need a referral for eye exams, glasses, or treatment of pink eye. All other eye care services require a referral, so the patient will need to contact their CA doctor. Graystone Ophthalmology Associates 828-322-2050 Newton Vision Center 828-464-4136 Dr. Boyles (Startown Rd) 828-327-4006 Dr. Bisaner (Downtown Hickory area) 828-322-8052 Catawba Valley Eye Center (Hwy 127, Viewmont) 828-327-9679 Family Vision Center (Downtown Hickory area) 828-327-2922 Dr. Crystal Hefner (Conover) 828-464-6030 Maiden Eye Clinic 828-428-9175 Dr. Ralph Maynard (Springs Road) 828-256-6577 Optometric Eye Care Center (LR Blvd—Speaks Spanish) 828-328-3900 LR Eye Care (LR Blvd – Clinic ONLY for Medicaid Eye Exams 828-256-0155 And Glasses) Chiropractors Valley Corners Dr. Sendroff Harkey Chiropractor 154

828-267-0002 828-328-3305 828-324-1444 Community Health Assessment 2011

Health Resource Inventory Transportation Options Greenway Public Transportation (828) 464-9444 Diamond Cab & Yellow Cab (828) 322-5555 Newton Yellow Cab (828) 465-0000

155

Community Health Assessment 2011