Progress on the priorities for Johnston County Communty Health Improvement Plan can be found by clicking on the links to the following programs:

Narcan Distribution

JCATS 

Peer Support Specialist Training

Mobile Telehealth Program

Based on the performace measures listed above from our 2021 CHNA, the following progress has been made.

Johnston County's Mobile Telehealth Program through UNC Health Johnston has offered 

Narcan distribution that began in 2018 is continuing to be an integral part of the opioid settlement funds activities. Since reciving Opioid Settlement Funds in 2022, Johnston County has distributed over 3,000 doses of Narcan into the hands of the community, EMS, fire departments, and local organizations/churches.

The number of doses of Narcan administered in Johnston County from January 2023-March 2023 by community and EMS was 95.

Transportation has been an issue for Johnston County for the last few CHNA cycles. We lack a true public transportation system. JCATS (Johnston County Area Transit System) exists for medical transport only. In March of 2023, JCATS launched a new ride-share program called Quick Ride. The quick ride program allows for rides Monday-Friday 7am-6pm in and around Smithfield and into Selma. This is a fee for service transportation option much like Uber.

Mobile WIC services have alleviated the need for Transportation to WIC appointments. Prior to Covid in 2020, WIC was offered at 3 sattelite locations (Clayton, Benson & Princeton).

No significant changes in Mortality have occurred in Johnston County within the last year since completing our CHNA in 2021. 
During our last CHNA Covid was impacting our mortality and morbidity numbers significantly. The number of deaths related to Covid-19 has decreased in 2022, compared to 2021.

Diabetes⁵

Type 2 Diabetes can lead to heart disease, stroke, kidney failure, blindness, and lower-limb amputation.  Recent research has also shown a connection between diabetes and dementia, hearing loss, and some forms of cancer.  Diabetes increases the risk of early death, and diabetes-related complications can lower quality of life. About 422 million people worldwide have diabetes and 1.5 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. In Johnston County, 11% of adults age 20 and older are diagnosed with Diabetes⁸. This is roughly 25,000 people. Johnston County Public Health offers a Diabetes Prevention Program to provide information and education on lifestyle changes for healthy living to delay or prevent type 2 diabetes.

Many times a diabetes diagnosis can be prevented. Since January of 2023, Johnston county public health department has offered 2 year long evidence based diabetes prevention programs to the Johnston County Community.

Covid-19 & Increased Substance Use

Covid-19 continues to present many challenges in education, identification, treatment andrecovery, both short and long term. There have been several new strains/mutants of the virus creating a necessity for additional types of vaccines for prevention and treatments for recovery and wellness. Since 2020, Covid has had periods of low incidence and periods of high incidence. Covid incidence in Johnston County has been on an overall downward trend since mid 2022, likely due to covid-19 vaccinations⁹. Johnston County Public Health continues to offer Covid-19 information, education, testing, vaccinations. At-home Covid-19 tests are also available daily.

Tobacco and alcohol use increased during the Covid-19 pandemic. In 2020, In Johnston County, 18% of adults were current cigarette smokers¹⁰. In 2021 that number increased to 20%. Over the last two decades alcohol deaths increased around 2.2% per year, however, between 2019-2020 deaths involving alcohol jumped to 25.5%, totaling 99,107 deaths in North Carolina. Tobacco use increased Pandemic-related anxiety, boredom, and irregular routines were cited as major drivers of increased nicotine and tobacco use during the initial COVID-19 shutdown, according to research just released by Columbia University Mailman School of Public Health researchers⁷. Johnston County has a youth empowerment group, a group of high schoolers who provide peer education on the dangers of substance use. Quarterly evidence based smoking cessation classes are offered by the health department.

Mental Health-Social Isolation⁶

Loneliness and social isolation in older adults are serious public health risks affecting a significant number of people in the United States and putting them at risk for dementia and other serious medical conditions. A report from the National Academies of Sciences, Engineering, and Medicine (NASEM) points out that more than one-third of adults aged 45 and older feel lonely, and nearly one-fourth of adults aged 65 and older are considered to be socially isolated. Older adults are at increased risk for loneliness and social isolation because they are more likely to face factors such as living alone, the loss of family or friends, chronic illnesses and hearing loss.  In 2021, 14% of the population in Johnston County was 65 or older¹¹. This number continues to grow as Johnston County is the fastest growing county in the state.

The effects of social isolation on mental health are a challenge during the best of times, but social isolation has taken on a new meaning during the coronavirus pandemic. As bars, restaurants, schools, and shopping centers closed, and we were all instructed to social distance with our immediate families at home, the opportunity for social interaction was greatly reduced.

Social isolation can exacerbate existing mental illnesses and it can make feelings of loneliness intensify, creating some serious negative effects on the health and well being of us all. These include Increased risk of Anxiety and Depression, faster cognitive decline and progression of Alzheimer’s disease, increased stress, increased drug and alcohol use, and increased risk of heart disease. Johnston County Public Health and Johnston County Behavioral Health in collaboration with its partners continue to offer assessments, evaluations, education, interventions and treatments (outpatient, individual and group counseling). In addition, Johnston County Public Health partners with Community and Senior Services to offer programs for seniors to encourage socialization.

Opioid use and misuse

In 2021, 3,961 people died of a suspected opioid overdose in North Carolina, a 21% increase from 2020. More than 760,000 people in the United States have died of opioid use since 1999, and in North Carolina that number is 13,000 people¹². Between July 2021 and July 2022 alone, more than 100,000 people have died of a drug overdose. In Johnston County, that number increased by 40% in 2021. Accidental drug overdose is the number one cause of accidental deaths in North Carolina and nationwide. In March of 2022, North Carolina Reported a 40% Increase in Overdose Deaths in 2020 Compared to 2019. 

Opioids, sometimes called narcotics, are substances that act on opioid receptors to produce morphine-like effects. Medically, they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, and suppressing cough. Opioids, sometimes called narcotics, are medications prescribed by doctors to treat persistent or severe pain.  Opioids include drugs such as heroin and prescription pain medications such as morphine, codeine, methadone, oxycodone (Oxycontin, Percodan, Percocet),  hydrocodone (Vicodin, Lortab, Norco), fentanyl (Duragesic, Fentora), hydromorphone (Dilaudid, Exalgo), and buprenorphine (Suboxone). The U.S. Department of Health and Human Services declared the opioid crisis a public health emergency in 2017. Local and state public health agencies have been rolling out treatment and prevention programs that include medication assisted treatment such as methadone and suboxone clinics.

In July 2022, Johnston County received funds from the state of North Carolina from the Opioid Settlement to address the opioid epidemic. Johnston County will receive $8.1 Million to be spent over 18 years, to implement mitigation and prevention activities listed below. A preliminary plan will be updated as needed over the grant period based on community needs.

        Category                                                                                   Strategy

References:

5. Centers for Disease Control and Prevention.  What is Diabetes?.  CDC.gov/diabetes/basics/diabetes.html. Retrieved 2/1/2023

6. National Academies Press. nap.nationalacademies,org/catalogs/25665.  Social Isolation and Loneliness in adults. Retrieved 2/1/2023

7. Columbia University Mailman School of Public Health researchers. https://www.publichealth.columbia.edu/public-health-now/news/covid-19-lockdown-linked-uptick-tobacco-use.  Retrieved 2/1/2023

8. Diabetes Prevalence. County Health Rankings. (n.d.). Retrieved February 28, 2023, from https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-outcomes/quality-of-life/diabetes-prevalence?year=2022&county=37101 

9. NCDHHS Covid Cases and Deaths Dashboard. (2022). Retrieved February 28, 2023, from https://covid19.ncdhhs.gov/dashboard/cases-and-deaths 

10. Adult Smoking. County Health Rankings. (n.d.). Retrieved February 28, 2023, from https://www.countyhealthrankings.org/explore-health-rankings/county-health-rankings-model/health-factors/health-behaviors/tobacco-use/adult-smoking?keywords=275&f%5B0%5D=type%3Astates&f%5B1%5D=type%3Acounties&year=2020&county=37101

11. Census Quick Facts. Census.gov. (2021). Retrieved February 28, 2023, from https://www.census.gov/quickfacts/fact/table/johnstoncountynorthcarolina/PST045221

12. The Impact of Opioids. MorepowerfulNC.org. (2017). Retrieved February 28, 2023, from https://www.morepowerfulnc.org/get-the-facts/the-impact/#:~:text=More%20people%20die%20from%20opioid,lives%20to%20unintentional%20opioid%20overdoses.

Priorities discontinued from 2018 CHNA:

• Heart Disease & Stroke: Johnston Health's goal was to obtain The Joint Commission Stroke Certification, and it was achieved in 2021.
• Respiratory Diseases: Although patients will continue to be referred to a smoking cessation program, respiratory diseases was not selected as a priority, instead tobacco cessation will fall under Substance Use.