Vision Statement 

Lincoln County’s 2025 Community Health Needs Assessment (CHNA) was completed in collaboration with the Lincoln County Partnership for Health. Guided by a shared vision, the Partnership seeks to promote health and wellness for all residents through education, awareness, and prevention, grounded in strong community collaboration and collective action to address local health needs. 

Purpose of the Community Health Needs Assessment 

The purpose of the Community Health Needs Assessment (CHNA) is to systematically identify and analyze key health issues, disparities, and social determinants affecting the well-being of residents in Lincoln County. This assessment serves as a foundational tool for guiding public health planning, policy development, and community-based interventions over the next three years. 

This assessment was conducted to gain a deeper understanding of the health challenges and needs faced by our community. The goal is to use this information to develop targeted programs and policies that address these needs effectively. This assessment is part of our ongoing commitment to improving the health and quality of life for all residents of Lincoln County. 

Leadership 

Lincoln County’s 2025 Community Health Needs Assessment (CHNA) was led collaboratively by the Lincoln County Health Department, United Way of Lincoln County, and Atrium Health following a traditional leadership structure. The assessment was drafted by the Community Health Division of the Lincoln County Health Department in partnership with United Way of Lincoln County. 

Partnerships/Collaborations 

Regional/Contracted Services 

The Lincoln County Health Department leveraged regional collaboration and contracted support to enhance the 2025 CHNA process. The Central Carolina Community Collaborative (CCCC) provided guidance, resources, and technical assistance, ensuring consistent methodology and supporting community engagement. Additional contracted services through the CCCC included data management and visualization tools to streamline analysis and reporting, helping to strengthen the overall quality and usability of the assessment. 

Methodology Overview and Theoretical Framework 

To conduct the 2025 Community Health Needs Assessment (CHNA), Lincoln County employed a mixed-methods approach that integrated both quantitative and qualitative data sources to ensure a comprehensive understanding of the community’s health status and needs. Quantitative data was gathered from publicly available sources such as the U.S. Census Bureau, Centers for Disease Control and Prevention (CDC), state and local health departments, and hospital discharge data. This data provided insights into key health indicators, including chronic disease prevalence, behavioral health trends, access to care, and social determinants of health. To complement this, qualitative data were collected through community surveys, focus groups, and key informant interviews with stakeholders representing public health, healthcare, education, business, and underserved populations. The assessment process was guided by a steering committee composed of local leaders and subject matter experts, ensuring that the methodology was inclusive, equitable, and aligned with national best practices. Data were analyzed using descriptive statistics and thematic coding, and findings were validated through community feedback sessions to ensure accuracy and relevance. 

The Population Health Model was used to guide Lincoln County’s community health needs assessment process in hopes of promoting consistency and alignment with work at the state level. The Population Health Model, also known as the County Health Rankings Model, was used as the framework for Healthy North Carolina 2030: A Path Toward Health as well as Healthy People 2030 which helps guide work at the federal level (North Carolina Division of Public Health, 2022). 

Collaborative Process  

Lincoln County’s Partnership for Health team worked from October 2024-October 2025 to identify three health priorities for the County. Steps included: 

• Establishing the CHNA team in October 2024; 

• Reviewing a draft of the Community Health Opinion Survey in January 2025; 

• Promoting survey participation between February –April 2025; 

• Meeting to check in regarding survey progress in May 2025; 

• Community Health Forum in August 2025; 

• Analyzing primary and secondary data in September 2025; and 

• Selecting top health priorities in September 2025.    

Overview of Key Findings 

Behavioral health emerged as a critical concern in Lincoln County. Excessive drinking and binge drinking rates are higher than average, with 21.1% and 19.6% of adults reporting these behaviors, respectively. Behavioral Risk Factor Surveillance System (BRFSS), 2022. Retrieved from https://www.cdc.gov/brfss Substance use, particularly e-cigarette, smokeless tobacco use, and opioid use, is also prevalent, placing Lincoln County in the top quartile nationally for these issues. The built environment in Lincoln County presents several challenges. While 67.58% of residents have access to exercise opportunities, the walkability index is moderate at 5.49. A notable 36.00% of residents face low food access, and 11.50% of households experience severe housing problems. These factors contribute to barriers in accessing essential services and maintaining healthy lifestyles.

Socio-economic conditions in Lincoln County reveal a mixed picture. The median household income is above the state average at $79,003 yet the poverty rate is 12.54%. The unemployment rate is relatively low at 3.55%, indicating a strong job market. However, housing affordability remains a significant issue, with only 26.68% of respondents believing there are affordable places to live.

Access to healthcare services is a major concern. A significant portion of residents, 33.91%, reported delaying medical care in the past year. Additionally, 25,475 residents have unmet mental health provider needs, and the county has only 5.19 mental health treatment facilities per 100,000 residents, indicating a critical gap in mental health services. Mental health support is a significant need, with residents emphasizing the necessity for long-term care resources.

In September 2025, Lincoln County, in collaboration with the Lincoln County CHNA steering committee, used the primary and secondary data to identify the top health concerns in the county and select key priorities to focus on over the next few years. Several areas were identified as significant health concerns and needs in the county, including mental health, lack of transportation, affordable housing, access to affordable childcare, and substance use. These issues were discussed in depth with the Community Health Needs Assessment Steering Committee and narrowed down using the Hanlan Method.

Priority Health Needs 

Criteria such as the seriousness of the issue, availability of resources, feasibility of intervention, and alignment with agency capacity were used to determine the top health priorities. As a result, Lincoln County selected the following health issues to focus on in 2025-2028: 

1. Transportation 

2. Behavioral Health 

3. Access to Affordable Childcare  

4. Adverse Childhood experiences (ACEs) 

Recommendations and Next Steps/Future Implications 

Based on the findings of the 2025 Community Health Needs Assessment, Lincoln County recommends a multi-faceted approach to address the most pressing health challenges identified. 

To address transportation barriers, we recommend expanding flexible, affordable, and accessible options that connect residents to healthcare, employment, and childcare services. Enhancing public and non-emergency medical transportation can reduce missed appointments and improve access to essential resources, particularly for older adults, low-income and/or rural populations. Potential future implications without intervention may include continued disparities in healthcare access and employment stability. Implementation may include partnering with local transit providers, exploring on-demand ride programs, and leveraging state and federal funding to expand rural routes and subsidized rides.

To combat behavioral health concerns, we recommend strengthening community-based services, expanding access through school-based and telehealth programs, and reducing stigma by promoting trauma-informed and culturally competent practices. Expanding the behavioral health workforce and increasing coordination between healthcare providers, schools, and community partners will be critical to improving access to care. Without intervention, Lincoln County may continue to see increased rates of mental health crises, substance use, and emergency service utilization. Implementation efforts may include the development of a behavioral health coordination council, increased telehealth capacity in rural areas, and community education efforts focused on prevention, early intervention, and resiliency.

To improve access to affordable childcare, we recommend increasing the supply of high-quality childcare options through community partnerships, facility development grants, and workforce incentives. Childcare shortages have been identified as a barrier to employment and economic growth, especially for working families with limited incomes. Without additional resources, families may continue to struggle to find affordable and reliable childcare, impacting workforce participation and child development outcomes. Implementation strategies may include collaborating with local employers and educational institutions to develop childcare workforce pipelines, expanding childcare subsidies, and pursuing funding to support new or expanded childcare facilities.

Priority 4 focuses on adverse childhood experiences (ACEs). While this priority will be secondary to the top three identified priorities, the importance of ACEs is strongly recognized, and there is a clear desire to better understand their prevalence and impact within the community. Addressing ACEs will require strengthening prevention and early intervention efforts. Promoting trauma-informed care, supporting family stability, and increasing awareness of ACEs can reduce long-term health impacts and improve outcomes for children and families. Without proactive measures, ACEs may contribute to higher rates of behavioral health issues, chronic disease, and generational trauma. Implementation strategies may include training educators and service providers in trauma-informed practices, integrating ACEs screening into health and social service programs, and expanding family support and education initiatives.

These recommendations aim to improve health outcomes and build a healthier future for all residents of Lincoln County.

References

Refer to pages 43-45 in the 2025 Lincoln County Community Health Needs Assessment 

Lincoln County selected the following health issues to focus on: 

1. Transportation 

2. Behavioral Health 

3. Access to Affordable Childcare  

4. Adverse Childhood experiences (ACEs)