Introduction

In 2021, the Onslow County Health Department (OCHD) conducted its triennial Community Health Needs Assessment (CHNA) in collaboration with Onslow Memorial Hospital.  The CHNA provides data from local, state, and federal levels, including a community survey, to assess the needs of those in Onslow County.  A report was created to present an analysis of findings and establish the health priorities for the community.  

The 2021 Community Health Needs Assessment can be found on the health department website. In the years where the CHNA is not conducted, the Health Department issues a State of the County Health (SOTCH) report. This 2023 SOTCH report provides updates on progress made on health priorities outlined in the Community Health Improvement Plans. 

Community Health Improvement Plans

In 2022, OCHD worked diligently at evaluating the data provided through the CHNA to set strategies and programs addressing health priorities identified in the assessment. These include chronic illnesses, obesity, access to healthcare, substance use disorder, and preventative health.  To address these priorities, Community Health Improvement Plans (CHIPs) were developed. Each plan is designed with programs to help address the health priority and work toward a healthier community.  The four CHIPs are Mental & Behavioral Health, Healthy Living, Health Equity & Health Disparities, and Physical Activity & Exercise. 

Onslow County at a Glance¹ 

[1] “Onslow County, North Carolina.” U.S. Census Bureau Quickfacts, US Census Bureau, www.census.gov/quickfacts/fact/table/onslowcountynorthcarolina/PST045222. Accessed 26 Jan. 2024.

Health Equity & Health Disparities

Health behaviors and the prevalence of risk factors among various subpopulations have major impacts on health outcomes. Risk factors such as tobacco use, obesity, poverty, and other factors significantly increase the likelihood of worsened health outcomes. Health disparities are “preventable differences in the burden of disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups, and communities.”²

Programs around tobacco use, preventative screenings, and food security were priorities in the Health Equity and Health Disparities CHIP. According to the Centers for Disease Control and Prevention, the commercial tobacco industry uses tailored marketing and advertising to target some groups and communities, including people with low socioeconomic status. For example, current tobacco use prevalence is higher among uninsured adults, enrolled in Medicaid, or other public insurance compared to adults with private insurance or Medicare only. While tobacco use is prevalent in Onslow County, food insecurity also ranks higher than in the state and nation. According to the Food Research and Action Center (2022), people experiencing food insecurity are vulnerable to obesity, poor nutrition, and many diet-related diseases, such as diabetes and heart disease, which have been associated with food insecurity.³

In addition, The Health Department wants to ensure individuals access and take advantage of preventative care and screenings. Improving access to community resources and health services, including preventative care, is vital for all residents of Onslow County to attain optimal and equitable health outcomes. 

The Health Equity & Health Disparities CHIP consists of five programs: QuitlineNC Referrals, Catch My Breath Vaping Prevention, an Onslow County Food Security Assessment, Preventative Screenings Awareness, and Onslow Memorial Hospital’s Health Disparities Data Dashboard.

QuitlineNC

How Much Number of individuals referred to QuitlineNC by healthcare providers and community partners. 

How Much Number of providers and partners who refer patients to QuitlineNC.

In 2023, 20% of adults were tobacco users in Onslow County, which is higher than the 17% reported for the state of North Carolina.⁴    QuitlineNC is a free program offered by the NC Department of Health and Human Services.  This service offers free coaching for tobacco and vaping cessation as well as providing participants with nicotine patches and lozenges.  The program is available to all residents of NC regardless of insurance status. Quitline coaches provide a tailored “quit plan” to individuals and help them in their goal to quit tobacco and vape products. Different programs are available for a variety of priority populations, such as pregnant women and Hispanic/Latinx individuals. Residents throughout North Carolina can access the free tobacco cessation resource by a provider referral or through a self-referral by contacting QuitlineNC via call, text, or visiting their website.

In 2022-2023, OCHD health educators worked to raise awareness of QuitlineNC among healthcare professionals in Onslow County. Health educators connected with counselors, pediatric specialists, and family providers. OCHD also actively engaged with established referral sites in Onslow County, ensuring these providers were equipped with the latest information about QuitlineNC and reinforcing the opportunity to refer patients. Alongside these efforts, health educators also presented vaping information to bring awareness to the health effects associated with the rising vaping epidemic among youth.

In Spring, 2023, OCHD with Vitalink Marketing introduced a campaign to promote QuitlineNC and referrals to the free service. This campaign included YouTube, radio, and social media advertisements.

Establishing agreements with healthcare providers and community partners serving Historically Marginally Populations (HMPs) to refer individuals to affordable and accessible tobacco cessation can help increase equitable access to resources and reduce tobacco use.

Catch My Breath

How Much Number of Catch My Breath trainings held.

How Much Number of Participants Who Have Completed Catch My Breath Trainings.

OCHD health educators began implementing the evidence-based, CATCH® My Breath Youth E-Cigarette Prevention Program to the community in January 2023 as a part of the Community Health Improvement Plan and the Healthy Communities strategy by the North Carolina Division of Public Health. 

In 2023, 200 classes were taught with a total of 997 youth participants. Data collection is done based on a school calendar year. From January 2023 to June 2023, health educators taught a total of 112 CATCH® My Breath classes and reached 385 students.  From July 2023 to December 2023, health educators taught a total of 88 classes, reaching 612 students. 

Onslow County Youth Services has been a continuous partner through 2023 where OCHD has provided 80 CATCH® My Breath classes to steadily enrolled students.  OCHD has gained partnerships with 12 other youth-centered agencies and educational institutions to implement the CATCH® My Breath Program and continues to look for new opportunities to reach additional youth populations. For more information, please contact community_relations@onslowcountync.gov.

Food Security Assessment

How Much Number of Community Surveys Received

How Much Number of Focus Group Participants

In 2023, the Onslow County Health Department completed a Food Security Assessment (FSA) for Onslow County. This assessment aimed to measure the strengths and weaknesses of the local food system and identify strategies to help increase access to healthy foods around the county.  

As of 2021, Feeding America’s Map the Meal Gap study concluded that 13.4% of adults and children are considered food insecure in Onslow County.⁵  While food insecurity itself is a major concern, it is also linked to chronic health conditions like obesity, diabetes, cardiovascular disease, and kidney disease.⁶  These conditions raise annual healthcare costs by an estimated $1,800 per person.⁷  However, these conditions are preventable, and the FSA was a first step to preventing these compounding health effects in our county.

The research involved analyzing interactive maps, mapping locations of food outlets, distributing community surveys, and conducting focus groups. OCHD collected a total of 374 community surveys and conducted six focus groups. The questions asked in the survey and focus groups included health status, transportation, accessing information, and social support. The surveys were distributed to individuals throughout the county with a focus on reaching high-risk populations. 

Transportation was highlighted as a dominant barrier to accessing food. Almost 40% of the people surveyed do not have access to a personal vehicle when they need to go grocery shopping. Instead, 20% of people reported finding a ride with someone else. While having this social support in times of need is beneficial, this means they can only access food according to another person’s schedule. The other top responses included 12% walking to the store and 7% relying on public transportation. These methods of getting to the grocery store or food pantry do not allow these individuals to carry many food items with them, especially as shelf-stable foods like cans are heavy. Additionally, information from the focus groups suggested that people may be scared to use the bus system by themselves or not know how to use public transit.

Nine key themes emerged from the primary and secondary data of the assessment. Within these nine themes, a total of 20 strategic recommendations for improvement were made. These recommendations will be considered in future work to improve access to healthy foods. One recommendation that has been put into action is the expanded distribution of the Health Department’s Community Resource Guide to community organizations in all corners of the county.

Implementing this strategy improves access to information and awareness of free and affordable resources available to county residents. The resource guide contains a variety of health-related resources, including a master list of food distribution sites throughout Onslow County.

Preventative Screenings

How Much Number of social media posts that OCHD publishes to announce prevention screenings in the community. 

How Much Number of social media posts that OMH publishes to announce prevention screenings in the community.

OCHD and Onslow Memorial Hospital aim to increase awareness and promote the importance of preventative screenings taking place throughout the community via social media platforms.

The 2023 RWJ County Health Rankings show in 2020, 38% of Onslow County female Medicare enrollees ages 65-74 received an annual mammography screening. In comparison, peer counties Craven, NC, and Alamance, NC had annual mammography screening ratings of 53% and 39% respectively. Similarly, flu vaccination efficacy trended lower with only 48% of Medicare fee-for-service enrollees having received a flu vaccine; while Craven County, NC, and Alamance County, NC saw 59% and 54% adherence respectively.⁴

OCHD has a presence on Facebook, Twitter (X), Instagram, and LinkedIn each consisting of tailored content for followers. Promoting, sharing, and distributing information regarding affordable preventative screenings to increase accessibility and awareness of services. Breaking the accessibility barrier will assist in the prevention and early detection of chronic diseases and cancer. In 2023, OCHD created 18 social mediaposts promoting preventative screenings.  These screenings were available through the health department and community agencies. OCHD obtained an engagement rate (the number of times followers see the post and engage by reacting or sharing the post) of 2.9% across its four social media channels with a total of 4,382 impressions (the number of times the posts have been seen in a social media feed, but not necessarily engaged with) within a total of 15 posts. The average social media engagement rate falls between 1-5%. OCHD continues to increase its online presence and promote preventative screenings on its social platforms. 

Healthy Living

Health behaviors and risk factors have a major impact on an individual’s ability to achieve better health outcomes. Onslow County residents should utilize resources available in the community to help increase healthy behaviors and reduce their risk factors. Residents should also have access to needed health services. Onslow County data shows that chronic conditions and other health-related topics such as breastfeeding, nutrition, and access to affordable health services are still priority issues for the county. Leading causes of death in Onslow County include cancer, heart disease, chronic lower respiratory diseases, cerebrovascular diseases, and diabetes.⁸ 

Eating healthy, avoiding excess alcohol, regular physical activity, and practicing good sleep habits can help reduce the likelihood of chronic diseases. Healthy behaviors are easier to form in childhood and adolescent years to prevent chronic diseases. For infants, breastfeeding can help provide short- and long-term protection against illnesses and diseases such as asthma, obesity, type-1 diabetes, and sudden infant death syndrome (SIDS).⁹  As of October 2023, Onslow County estimates 46.9% of infants receiving WIC benefits are breastfed. 

Onslow County continues to promote Women’s and Children’s Health services to promote healthy living and decrease areas of concern such as the Onslow County is the teen birth rate. The NC State Center for Health Statistics reported for 2020 that Onslow County ranked 90 out of 100 for the teen birth rate (1 – best, 100 – worst). Teen pregnancies have immediate and long-term results for teen parents and their children.¹⁰  CDC data links teen pregnancies and births to high school dropout rates and the risk of lower educational attainment among girls and their children.¹¹  
The Healthy Living CHIP consists of six programs: Healthy for Life, Faithful Families, Breastfeeding Friendly Designations, Women’s and Children’s Health Services, and Julie’s Pink Warrior Project.

Healthy for Life

How Much Number of Healthy For Life Participants

How Much Number of participants indicating increased confidence in making healthier behavior changes (pre/post-tests).

OCHD teaches the American Heart Association’s Healthy For Life® program each month to promote healthy living, wellness, nutrition, and smart choices. The Healthy for Life® program consists of monthly topics ranging from healthy cooking and recipes to smart shopping and budget-friendly grocery lists. 

The Healthy For Life® program is taught monthly by a Public Health Educator. Participants join via Zoom and complete a pre- and post-survey to gauge increased knowledge and awareness of food, nutrition, and healthy habits.

OCHD held satellite classes with the Onslow County Main Branch Library to extend the reach to community members across the county and provide opportunities for individuals to come in person and learn together. In 2023, 89 participants attended Healthy For Life Classes.

Faithful Families

How Much Number of Participants in the Faithful Families Program That Went to 50% or More of the Sessions.

how well Percentage of participants indicating increased regular physical activity (pre/post-tests).

Faithful Families is an evidence-based intervention program that connects with faith-based communities to promote healthy living among individuals, families, and local communities. By providing nine sessions consisting of nutrition, meal preparation, food safety, and physical activity education, participants can make informed changes to their health behaviors and improve their overall health. Faith communities and organizations are important health advocates, and Faithful Families can support community health improvement work to decrease health disparities. In these nine sessions, health educators from OCHD implement the health and nutrition aspect of the program, while a lay leader from the partnering organization conducts the spiritual component of the program.

In January 2023, the Health Department began Faithful Families with the Sandy Run Missionary Baptist Church in Jacksonville, NC. The first cohort at Sandy Run Missionary Baptist implemented a policy/environmental change that each member would drink a bottle of water during each church meeting. In June 2023, the Community Relations Division began the second cohort of the Faithful Families program with Sandy Run Missionary Baptist Church. The second cohort averaged 15 participants who attended 50% or more of the sessions. In September 2023, a new cohort began with River of Life Church in Jacksonville. The River of Life cohort averaged 22 participants who attended at least 50% of the program’s sessions. 

Breastfeeding Friendly Designations

How Much Number of businesses and organizations submitting applications for breastfeeding friendly designation.

How Much Number of businesses and organizations to obtain breastfeeding friendly designation award.

OCHD has continued to work toward increasing the awareness of breastfeeding-friendly designations offered through both the North Carolina Breast Feeding Coalition (NCBC) and the North Carolina Department of Health and Human Services (NCDHHS). Consequently, fostering these initiatives will encourage and improve breastfeeding within the community. Breastfeeding enhances the prospects of infants attaining improved health outcomes and provides a myriad of health benefits to both mothers and babies. OCHD aims to work in conjunction with community collaborators to enhance breastfeeding rates. By expanding the roster of local businesses and partners recognized as breastfeeding-friendly, there will be an increase in the availability of nurturing environments, motivating more mothers to embrace breastfeeding.

In 2023, The Health Department's Community Relations Division connected with businesses and employers to educate them on the benefits of being a breastfeeding-friendly designation site and if interested, supplied the business with the application to submit to the NCBC and/or NCDHHS. In 2023, 67 Onslow County organizations were educated on breastfeeding-friendly designation opportunities. The NCBC’s website updates the list of awardees biannually, in March and August. As of August, 18 new organizations were awarded the NCBF Coalition’s designation in 2023.

Women’s and Children’s Health Services

How Much Number of OCHD referrals to PEERS Family Development. 

how well WIC Participation Numbers

how well Percent of engagements with the social media post regarding Women's & Children's Services

OCHD offers a wide variety of preventative health services for the community. Services for women's and children's health include Maternal Health, WIC, Family Planning, Child Health, Immunizations, and the Breast and Cervical Cancer Control Program. Services are offered to individuals with private insurance, Medicaid, and those who are uninsured. OCHD utilizes a sliding fee scale to ensure that health services are accessible and affordable. Onslow Memorial Hospital offers a variety of services and community support to improve Women's and Children's Health, including monthly "Understanding Breastfeeding Classes" to expectant families looking for more information regarding breastfeeding and interaction with an International Board-Certified Lactation Consultant, which helps to support breastfeeding in the community. The Onslow Memorial Hospital Foundation also collaborates with radiology to provide screening 3D mammograms for the underinsured and uninsured through "Julie's Pink Warrior Project." 
Improved awareness and utilization of OCHD preventative services and Onslow Memorial Hospital's Breastfeeding Support Services will improve population health, specifically for women and children. Increased utilization of preventative services will improve health outcomes and lower health risks. 

The Women's and Children's Health Services program is tracked by three performance measures: Women, Infants and Children (WIC) program participation, referrals to Parents, Education, Empathy, Rapport, and Support (PEERS) Family Development, and social media posts for services offered by the county. 

In 2023, WIC had a monthly average of 7,360 individuals participating in the program. OCHD also made 54 referrals to PEERS Family Development for education and/or services.
Onslow Memorial Hospital Julie's Pink Warrior Project offers free mammograms to women in need.  OCHD refers their clients who need mammograms to Onslow Memorial Hospital.  In 2023, Onslow Memorial Hospital held its annual "Miles for Mammos" 5K to raise money for Julie's Pink Warrior Project. In 2023, OMH provided 2,212 mammograms.

Mental and Behavioral Health

Adverse Childhood Experiences (ACEs), substance use, and mental and behavioral health are priorities for Onslow County. The prevalence of poor outcomes such as lack of mental and behavioral health treatment, opioid use and death, child abuse, and juvenile crime show the need for additional support in this area. From July 2022 to June 2023, Child Protective Services received 3,620 reports and assessed 1,942 of those.  651 of those assessed were found to have child maltreatment involved. During that same time, 166 children were in foster care¹² echoing the need for additional support services for adults who use drugs and suffer from mental and behavioral health conditions. 

Drug overdose deaths are continuing to impact people living in Onslow County. In 2022, 81% of drug overdose deaths in Onslow County involved illicit opioids.¹³  Additionally, in 2023, there were 151 opioid overdose emergency department visits in Onslow County.¹⁴ 

Overdose Fatality Review

  How Much Number of recommendations proposed to reduce substance use overdose deaths.

  How Much Number of overdose fatalities reviewed

The Overdose Fatality Review (OFR) Team consists of numerous city, county, and healthcare partners that meet quarterly to review substance use overdose deaths in Onslow County to determine what services individuals accessed before their death. Ultimately, the mission of the team is to facilitate a deeper understanding of the missed opportunities for prevention and intervention that may have prevented an overdose death.

Adverse Childhood Experiences Training

how well Percent of training participants with increased knowledge on ACEs (pre/post test). 

How Much Number of participants trained in Adverse Childhood Experiences.

Adverse Childhood Experiences (ACEs) can be classified as negative experiences that take place during childhood and/or teenage years such as, but are not limited to neglect, witnessing suicide or violence, abuse, bullying, and other traumatic events that may occur. Youth who experience ACEs can have a greater risk of developing negative health conditions such as chronic health problems or mental illness in their adult years.¹⁵  Onslow County PEERS Family Development Center and Onslow County TASCO (Turning Adversity into Success for Children in Onslow) offer training to increase awareness of the impact of ACEs and provide support services to help families and children in Onslow County.  

ACEs training helps participants identify children in need, understand the impact of ACEs, identify risk and protective factors, and locate resources to help those impacted by ACEs. Increased awareness of ACEs and protective factors will enable participants to better serve their communities and identify opportunities to improve the lives of children in Onslow County.
In 2023, 366 individuals throughout the community were trained in Resiliency and ACEs. 

Prevention Specialist Referrals

How Much Number of patients referred to the Methodist Home for Children’s prevention specialist.

OCHD partners with Methodist Home for Children Prevention Specialists to refer uninsured patients and those who do not qualify for OCHD care management services to receive additional support. This support may come in many forms and aims to address several social determinants of health including food pantry services, housing referrals, mental/behavioral health referrals, substance use treatment and recovery referrals, transportation, and affordable health services. 

Patients who may be struggling with mental/behavioral health or substance abuse often need additional resources. The additional support for OCHD clients, offered by the prevention specialist, will bridge the gap to improve accessibility to available community resources when they may not otherwise receive support. 
From January to November 2023, 112 client referrals were made from OCHD to the Methodist Home for Children for these additional support services.  

Operation Medicine Drop

How Much Number (in pounds) of drugs collected.

Onslow Memorial Hospital partners with the Jacksonville Police Department to hold Drug Takeback programs in the community for the public to dispose of unwanted and/or unneeded medications. All medications are accepted on a no-questions-asked policy. Along with drug takeback events, there are also designated locations in the community where the public can drop off unused medications. In 2023, the Jacksonville Police Department collected 303 pounds of unwanted medications.

Physical Activity & Exercise

Physical activity and the availability of spaces and/or opportunities to be physically active can have a significant impact on the health of a community. Physical activity reduces the risk of chronic conditions such as cardiovascular disease, type 2 diabetes, many types of cancer, depression/anxiety, and dementia. By promoting and developing events and programs that encourage physical activity, Onslow County will increase physical activity opportunities for residents to improve their health.

According to 2023 County Health Rankings, Onslow County is ranked 39 out of 100 counties (1 being the best, 100 being the worst) for adult obesity. Of adults aged 18 and older, 34% report a body mass index equal to or greater than 30km/m^2 (age-adjusted). In 2020, 9.3% of males and 9.2% of females, in Onslow County, aged 20 years and over, were diagnosed with diabetes. (CDC, US Diabetes Surveillance System, 2022). 

The Physical Activity and Exercise CHIP consists of 3 programs: Prevent T2 - Diabetes Prevention Program, Physical Activity Opportunities, and Health Education at Community Events.

Diabetes Prevention Program

How Much Number of Participants Enrolled in the Diabetes Prevention Program Annually. 

How Much Number of participants that average 150 minutes of physical activity a week.

The CDC's Prevent T2 Diabetes Prevention Program (DPP) is a year-long lifestyle change program for individuals who have screened positive for prediabetes. The goal of the program is to delay or prevent the onset of type 2 diabetes. Throughout the annual program, participants track their food, activity, and weight each week as they form new habits and stay accountable for their behavior change. By the end of the program, the goal is for participants to lose and maintain at least 5-7% of their body weight and maintain at least 150 minutes of physical activity each week.

In July 2023, a new, year-long Prevent T2 DPP cohort began. There are nine individuals enrolled in the program and all nine have seen success between lower body weight, increased physical activity, lower blood sugar numbers, and non-scale victories such as clothes fitting better, feeling more energized, and decreasing daily sugar intake. All nine participants have reported getting at least 150 minutes of physical activity each week.

While it is not required for all participants to report their A1C, three of the participants reported a lower A1C level within the first 18 weeks of the program. As a cohort, the participants lost a total of 116 pounds and participated in a collective 28,000 minutes of activity as of December 2023.

Physical Activity Opportunities

How Much Number of participants in physical activity programs presented by the health department.

how well Percentage of engagements that the social media physical activity posts receive.

OCHD and OMH partner with Onslow Parks and Recreation, Onslow Senior Services, and other community partners to promote affordable physical activity opportunities throughout the county via social media. By increasing the awareness of affordable physical activity opportunities, more residents are likely to take advantage of accessible ways to engage in healthy behaviors and improve their health. 

In 2023, OCHD created 18 posts promoting social media throughout the community.  OCHD maintains a steady 2.85% engagement rate with the post, remaining at the top of the 1-3% average.

OCHD also partnered with Onslow County Parks & Recreation and Onslow County GIS to develop a physical activity map that show all available parks and outdoor trails and recreation to promote physical activity.  The map can be filtered for specific activities such as sports, kayaking, trail, and more. Interested residents may view the map on the health department's website under the Community Health Living tab.OCHD also has partnered with community organizations for physical activity classes throughout 2023.

Footnotes/Sources

[2] “Health Disparities.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 31 Jan. 2017, www.cdc.gov/aging/disparities/index.htm.

[3] “Onslow, North Carolina.” County Health Rankings & Roadmaps, University of Wisconsin Population Health Institute, Robert Wood Johnson Foundation, www.countyhealthrankings.org/explore-health-rankings/north-carolina/onslow?year=2023. Accessed 15 Jan. 2024.

[4] “Onslow, North Carolina.” County Health Rankings & Roadmaps, University of Wisconsin Population Health Institute, Robert Wood Johnson Foundation, www.countyhealthrankings.org/explore-health-rankings/north-carolina/onslow?year=2023. Accessed 15 Jan. 2024.

[5] Feeding America Research. (2019, July 17).

[6] Berkowitz SA, Basu S, Gundersen C, Seligman HK. State-Level and County-Level Estimates of Health Care Costs Associated with Food Insecurity. Prev Chronic Dis 2019;16:180549. DOI: http://dx.doi.org/10.5888/pcd16.180549

[7] Feeding America Research. (2019, July 17). The healthcare costs of food insecurity. https://public.tableau.com/app/profile/feeding.america.research/viz/TheHealthcareCostsofFoodInsecurity/HealthcareCosts

[8] NC State Center for Health Statistics. “Detailed Mortality Statistics Report, 2021 Onslow County Deaths.” Https://Schs.Dph.Ncdhhs.Gov/Data/Vital/Dms/2021/OnslowCounty.Pdf.

[9] “Why It Matters.” Breastfeeding, Centers for Disease Control and Prevention, 31 July 2023, www.cdc.gov/breastfeeding/about-breastfeeding/why-it-matters.html.

[10] NC Department of Health and Human Services, NC State Center for Health Statistics. “2020 NC Resident Pregnancy Rates.” Https://Schs.Dph.Ncdhhs.Gov/Data/Vital/Pregnancies/2020/Table2B-2020-Pregpubrates-1519Preg-v2.Pdf, 2020.

[11] “About Teen Pregnancy.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 15 Nov. 2021, www.cdc.gov/teenpregnancy/about/index.htm.

[12] Onslow County Department of Social Services. “Onslow County DSS Foster Child Statistics.” 15 Dec. 2023.

[13] “Drug Overdose Deaths.” Opioid and Substance Use Action Plan Data Dashboard, NCDHHS, www.ncdhhs.gov/opioid-and-substance-use-action-plan-data-dashboard. Accessed 5 Feb. 2024.

[14] “Drug Overdose ED Visits.” Opioid and Substance Use Action Plan Data Dashboard, NCDHHS, www.ncdhhs.gov/opioid-and-substance-use-action-plan-data-dashboard. Accessed 5 Feb. 2024.

[15] “Adverse Childhood Experiences (ACEs).” Violence Prevention, Centers for Disease Control and Prevention, 29 June 2023, www.cdc.gov/violenceprevention/aces/index.html.

Onslow County has experienced few fluctuations in morbidity and mortality rates following the 2022 SOTCH. The information below includes updated data. 

County Health Rankings

County Health Rankings & Roadmaps (see Table 3) is a program of the University of Wisconsin Population Health Institute. County-level data, which is collected from different sources, on health behaviors, clinical care, social and economic factors as well as the physical environment are provided in their profile reports. 

Figure 1 shows each county's ranking based on the length and quality of life. Onslow County fell from 23 to 29 in ranking; however, the county is still in the higher middle range (Higher 50% - 75%). Onslow County is shaded in the second lightest green with a rank of 29 out of 100 (1 being the best, 100 being the worst) in North Carolina counties.
Some of the factors and categories that contribute to Onslow County's ranking by County Health Rankings & Roadmaps can be seen in Table 3. Details for the state are provided along with the red and green arrows indicating whether the county’s status is better or worse comparatively.  

The rate of sexually transmitted infections (number of newly diagnosed chlamydia cases per 100,000) in Onslow County remains greater than that of the state, as of 2022. Although the county rate has remained high, there has been a steady decline since 2019, which peaked at a rate of 1,180 cases per 100,000, as seen in Graph 5.¹⁷ In 2023 health educators worked to educate teens and young adults in the county about the family planning services offered at the health department by incorporating resource cards at outreach events and adding QR codes to the back of youth tobacco cessation cards. OCHD distributed 1,730 condoms at outreaches throughout 2023 and posted 23 family planning social media posts to spread awareness and education to the community.

Suicides  

In 2020 Onslow County had a suicide rate of 28.3 per 100,000 individuals whereas the state rate was 15.3 per 100,000 individuals. Of those suicides, 67.3% were inflicted by a firearm in Onslow County compared to 60.7% by firearms statewide.¹⁸ In 2021, 81% of firearm deaths in Onslow County were identified as suicides.  OCHD has received gun locks from NCDHHS which are distributed at outreaches and events to individuals that have firearms in their homes. Lethal Means Safety, an evidence-based practice, makes suicide methods less available or more difficult to immediately access (i.e. gun locks and safes). According to SAMHSA, the time between thinking and acting on a suicide is often less than 10 minutes.  Increasing Lethal Means Safety can allow for intervention or for the individual to seek help.¹⁹ 

Mortality

The most recent data from NCDHHS shows a consistent report for the top five causes of death in Onslow County, from 2020 – 2021, with the exception of a spike in COVID-19 deaths.²⁰  The top five causes of death include cancer, heart disease, chronic lower respiratory diseases, accidents, and COVID-19. North Carolina’s reported leading causes of death are comparable with the exception of stroke outnumbering chronic lower respiratory diseases.²¹ 

The cancer mortality rates in Onslow County compared to the state from 2017 – 2021 show discrepancies. The age-adjusted mortality rate per 100,000 for lung cancer in Onslow County was 62, whereas the state was 39. In the United States, approximately 80% to 90% of lung cancer fatalities are attributed to cigarette smoking.²²  To increase the awareness of free cessation resources to North Carolina citizens, health educators informed local providers about the benefits of becoming referral sites for QuitlineNC. Health educators also taught 200 classes surrounding vaping prevention and education in an effort to prevent new tobacco users. The age-adjusted mortality rate per 100,000 for all cancers combined was 199 for Onslow County and 155 for the state. In an effort to combat these differences, OCHD promotes known free and low-cost screenings offered to the community.

Footnotes/Sources

[16] “Onslow, North Carolina.” County Health Rankings & Roadmaps, University of Wisconsin Population Health Institute, Robert Wood Johnson Foundation, www.countyhealthrankings.org/explore-health-rankings/north-carolina/onslow?year=2023. Accessed 15 Jan. 2024.

[17] “NCD3: North Carolina Disease Data Dashboard.” Facts & Figures: N.C. Communicable Disease Reports, NCDDHS, Dept. of Public Health, 24 Jan. 2024, https://epi.dph.ncdhhs.gov/cd/figures.html. Accessed 6 Feb. 2024.

[18] “Suicide Trends and Demographics.” NC Injury and Violence Prevention Branch: NC Violent Death Reporting System, NCDHHS, dashboards.ncdhhs.gov/t/DPH/views/NCVDRSDashboard/NC-VDRSDashboard?%3AshowAppBanner=false&%3Adisplay_count=n&%3AshowVizHome=n&%3Aorigin=viz_share_link&%3AisGuestRedirectFromVizportal=y&%3Aembed=y. Accessed 5 Feb. 2024.

[19] Delphin-Rittmon, Miriam  E. “Lethal Means Safety for Suicide Prevention.” SAMHSA, Substance Abuse and Mental Health Services Administration, 29 Sept. 2023, www.samhsa.gov/blog/lethal-means-safety-suicide-prevention.

[20] NC State Center for Health Statistics. “Detailed Mortality Statistics Report, 2021 Onslow County Deaths.” Https://Schs.Dph.Ncdhhs.Gov/Data/Vital/Dms/2021/OnslowCounty.Pdf.

[21] “North Carolina.” National Center for Health Statistics, Centers for Disease Control and Prevention, 12 Sept. 2023, www.cdc.gov/nchs/pressroom/states/northcarolina/nc.htm#lcod.

[22] “What Are the Risk Factors for Lung Cancer?” Lung Cancer, Centers for Disease Control and Prevention, 31 July 2023, www.cdc.gov/cancer/lung/basic_info/risk_factors.htm#:~:text=In%20the%20United%20States%2C%20cigarette,Many%20are%20poisons.

Housing

Onslow County continues to explore ways to meet the needs of its citizens who are in search of affordable and accessible housing. According to the North Carolina Housing Coalition, 33% of Onslow County are cost-burdened (families that spend 30% or more of their income on housing) compared to state at 28%.^{23 24}   

The HUD Fair Market Rent Documentation System states the Fair Market Rent values in Onslow County for 2023 are $1,352 for a three-bedroom residence.²⁵  That amounts to 27.1% of the median annual income for Onslow County over a 12-month period. Although Fair Market Rentals are not above the cost-burdened threshold of 30%, many rental properties throughout Onslow County are between $1,200 and $1,750 per month for a three-bedroom dwelling.²⁶  

New & Emerging Drugs

Fentanyl, methamphetamine, and cocaine remained the drugs most frequently found in deaths caused by overdoses in Onslow County in 2022-2023 (Onslow County Register of Deeds Data, 2023).  While continuing to address these trends is a priority, OCHD has analyzed data and worked with community partners to identify new and emerging drug trends.  

Previously used as homeopathic treatment, mitragynine (commonly known and sold as kratom), has significantly increased in Onslow County as a drug found in illicit overdose cases and commonly used with these drugs.  Though it has not been found as a primary cause of death in Onslow County, the presence of xylazine in the drug supply was detected in late 2023 in the county by law enforcement.  Law enforcement also reported concerning reports of two new synthetic drugs, niatezene and bromazolam.  While these drugs have yet to appear in Onslow County, the UNC Street Drug Analysis Lab has identified their presence in the northeastern section of the state as late as October 2023.²⁷   

As a bright spot in the battle against opioid use, Community Paramedics in Onslow County are investigating the use of a new nasal spray opioid antagonist, nalmefene (sold as Opvee).  This drug was approved for use in late spring 2023.  While somewhat more cost-prohibitive, the treatment is intended to target the emerging array of synthetic opioids presenting in the drug supply and has a longer effective period than traditional opioid antagonists.

Footnotes/Sources

[23] “The 2024 Housing Need in Onslow County.” Onslow County Profile, North Carolina Housing Coalition, nchousing.org/wp-content/uploads/2017/01/NCH-CountyProfile-Onslow.pdf. Accessed 13 Feb. 2024.

[24] “The 2024 Housing Need in North Carolina.” North Carolina Profile, North Carolina Housing Coalition, nchousing.org/wp-content/uploads/2017/01/NCH-CountyProfile-NC.pdf. Accessed 13 Feb. 2024.

[25] HUD Economic and Market Analysis Division. “FY 2023 Fair Market Rent Documentation System.” FY2023 FMR Documentation System 3-Bedroom Rent Calculation, HUD, www.huduser.gov/portal/datasets/fmr/fmrs/FY2023_code/2023bdrm_rent.odn?year=2023&cbsasub=METRO27340M27340&br_size=3. Accessed 13 Feb. 2024.

[26] “Onslow County 3 Bedrooms Rentals.” Microsoft Bing Real Estate, Microsoft, www.bing.com/homes/map?q=onslow+county+rentals+3+bedroom&form=000074. Accessed 13 Feb. 2024.

[27] UNC Street Drug Analysis Lab data. University of North Carolina. 2024.

New Programs

CATCH Vaping Prevention Train the Trainer

To complement the CATCH My Breath Vaping Prevention program the Community Relations Division had two health educators complete Train the Trainer Training. The county is home to 40 public schools²⁸, seven Department of Defense schools²⁹, and close to 20 private schools, which serve more than 34,000 children aged 5–18 years old.³⁰ Providing the training to community partners allows for a larger educational reach and supports the sustainability of the CATCH My Breath program. 

From July 2023–December 2023, the health educators taught 35 community partners from multiple disciplines, ranging from teachers to dental hygienists. Each partner is given the opportunity to shadow an OCHD Health Educator or to have one present when teaching their first CATCH My Breath program. Eight of the trained community partners were public health and tobacco treatment specialists from Naval Medical Center Camp Lejeune and Marine Corps Community Services. These individuals have a plan to deliver the vaping prevention program among the seven Department of Defense schools in 2024. 

Data is collected on programs taught by community partners through an online post-class survey. Southwest High School was the first trained location to report their attendance of 126 ninth-grade health and physical education students, in December 2023. 

Overdose Fatality Review (OFR) Program Restructure

In 2023, a new Standard Work Plan was developed for the Onslow County Overdose Fatality Review (OFR) to improve practices and lead the county in adherence to national best practices.  The Standard Work Plan is an 18-step outline of work that begins twelve weeks prior to the quarterly OFR.  The outlined and descriptive steps serve to keep both the facilitator and moderator on track with timing and gathering data pertinent to each upcoming review. 

This plan not only engages OFR community partners with face-to-face interaction to obtain case information but also implements a new recommendation meeting the month following the general review.  The recommendation meeting will work with agency partners to execute recommendations suggested during the OFR.  Collaboration for community change is key in this newly developed practice.

Agencies involved in Onslow County’s OFR are genuinely more engaged and collaborate more effectively using this new Standard Work Plan.  Through this new process, the OFR meetings have transitioned to in-person meetings to promote engagement.

Footnotes/Sources

[28] District Detail for Onslow County Schools, National Center for Education Statistics (NCES), nces.ed.gov/ccd/districtsearch/district_detail.asp?ID2=3703450. Accessed 29 Jan. 2024.

[29] Camp Lejeune Schools, Department of Defense, 17 Mar. 2021, www.dodea.edu/americas/mid-atlantic/camp-lejeune-schools.

[30] Bureau, US Census. “Quickfacts, Onslow County, North Carolina.” Census.Gov, 8 Oct. 2021, www.census.gov/programs-surveys/sis/resources/data-tools/quickfacts.html.