In 2021, the Onslow County Health Department (OCHD) conducted its triannual Community Health Needs Assessment (CHNA) in collaboration with Onslow Memorial Hospital. This CHNA provides data from local, state, and federal levels including community surveys to assess the needs of those in Onslow County.  From the data, a report was created to present an analysis for the health priority needs of the community. This report is the 2021 Community Health Needs Assessment.

Community Health Improvement Plans

Throughout the year, OCHD worked diligently at evaluating the data provided through the CHNA to set strategies and programs addressing the prioritized health needs of the community which include: chronic illnesses, obesity, access to healthcare, substance-use disorder, and preventative health. Through these priorities, the Community Health Improvement Plans (CHIPs) were developed. Each plan is designed with programs to help combat 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 Glance(U.S. Census Bureau)

Source

• U.S. Census Bureau, Population Estimates Program (PEP). Updated annually. Population and Housing Unit Estimates.

   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.  

The 2022 Robert Wood Johnson (RWJ) County Health Rankings shows Onslow County has an adult smoking rate of 19% (University of Wisconsin Population Health Institute, 2022). 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 who had some other public insurance compared to adults with private insurance or Medicare only. 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.

The Food Bank of Central and Eastern North Carolina estimates, in 2018-2019, 14.6% of people living in Onslow County were food insecure, and 20.3% of children under the age of 18, in Onslow County, experienced food insecurity during this same period. 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 (Onslow County Profile, 2023). 

The 2022 RWJ County Health Rankings show Onslow County ranked 76th (1 being the best, 100 being the worst) in NC for mammography screenings and 86th in NC for flu vaccinations (University of Wisconsin Population Health Institute). It is essential for all people in Onslow County to have access to needed community resources and health services, including preventative care for them to achieve optimal and equitable health outcomes. 

The Health Equity & Health Disparities CHIP consists of six programs: QuitlineNC Referrals, Catch My Breath Vaping Prevention, an Onslow County Food Security Assessment, Preventative Screenings Awareness, Onslow Memorial Hospital’s “What’s Your Next 10?” as well as Onslow Memorial Hospital’s Health Disparities Data Dashboard.

QuitlineNC

In 2022, 19% of adults are tobacco users in Onslow County, which is equal to the state of North Carolina (University of Wisconsin Population Health Institute, 2022).  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 will provide a tailored “quit plan” to individuals to help them in their goal to quit tobacco and

vape products.

Being an easy, affordable, and accessible resource, OCHD wants to expand the awareness of QuitlineNC—especially to medical providers in the county. In a review of referrals made from July 2021 through May 2022, only 5 Onslow County healthcare provider offices referred a patient to QuitlineNC (Optum Inc., 2022); 42% of people using QuitlineNC services were informed about the resource from media commercials, 35% from family and friends, and only 12% from medical providers (Optum Inc., 2022). Due to this low number of physician referrals, OCHD is offering Lunch and Learn presentations to educate medical staff on the benefits of being a QuitlineNC referral site.

OCHD has partnered with Ernest Watts, Region 8 Tobacco Lead with the North Carolina Tobacco Prevention and Control Branch, to obtain resources and materials for healthcare providers to utilize in-office visits for patients who would like to quit using tobacco and vape products.  While 2022 has consisted of training and obtaining resources and materials, OCHD health educators began promoting the QuitlineNC service to providers in February 2023.

By improving QuitlineNC referral networks, healthcare providers and community partners serving Historically Marginalized Populations (HMPs) across Onslow County will be able to refer more patients to tobacco cessation services. This will ensure HMPs have equitable access to resources to reduce tobacco use, especially among high-risk populations.

  View Performance Measure Progress here:                        

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.

Catch My Breath

Vaping devices have gained popularity over the years and continue to be used by individuals of all ages.  As the prevalence of youth vaping grew, OCHD’s strategy to implement a vaping prevention program in the county began in 2022.  This is also a selected strategy in coordination with the Healthy Communities initiative by the North Carolina Division of Public Health.

OCHD Health Educators were trained through the CATCH® My Breath Youth E-Cigarette Prevention Program to teach the four-session course throughout the community.  In January 2023, Onslow County Health Department presented the CATCH® My Breath program to students through Onslow County Youth Services (OCYS) and the Jacksonville Youth Council.  The program offers engaging activities and presentations to help elementary, middle, and high school students understand the dangers of vaping, the chemicals contained in vaping products, as well as exit strategies and refusal tactics when being offered vape products.  Performance measures for this program include the number of students that participate in the program, as well as students who indicate their intention to abstain from vaping.

As of mid-February 2023, health educators have taught a total of 17 CATCH® My Breath classes and reached 27 students between Onslow County Youth Services and the Jacksonville Youth Council. OCYS will be a continual partnership where OCHD will regularly provide CATCH® My Breath classes to steadily enrolling students.  OCHD continues to recruit youth-centered agencies and educational institutions to partner with and provide the CATCH® My Breath Program. For more information, please contact community_relations@onslowcountync.gov.

  View Performance Measure Progress here:                        

 How Much Number of participants who have completed Catch My Breath trainings.

 How Much Total number of 5th - 12th graders reached.

Food Security Assessment

The hunger crisis has continued to pose a challenge across the nation. A food security assessment was deemed essential to help identify food deserts and food swamps within Onslow County. A food desert refers to a geographical area that lacks healthy food access within a community, whereas a food swamp is a geographical area where there are little to no healthy food options. According to the Centers for Disease Control and Prevention, food deserts are “associated with chronic conditions including obesity, heart disease, and diabetes.”

In 2022, OCHD started conducting research for the Food Security Assessment as a result of the 2021 Community Health Needs Assessment and Advancing Equity initiative from the North Carolina Division of Public Health.  The initial research consisted of scanning numerous interactive maps and indexes to identify the areas within the county that are vulnerable to low access to healthy foods. Low access includes a lack of public transportation, walkability, and/or nearby food outlets. To provide additional context for the areas with limited access to healthy foods and accurate data on locations, health educators also completed a drive-through analysis of the vulnerable areas identified.

 During the second half of the research phase, health educators and interns surveyed the geographical area of Onslow County to pinpoint all full-service grocery stores, convenience stores, gas stations, and additional outlets that distribute food or groceries to the community.  After the locations were mapped, areas were identified as food deserts or food swamps based on access to healthy foods in specific areas. There are on average 1-3 grocery stores in each of the 18 zip codes in Onslow County, but there are no grocery stores in 9 zip codes.

Fast food outlets varied greatly throughout Onslow County: ranging from some zip codes with 0 fast-food outlets and others with 63 to 80 fast-food outlets.

Once the Onslow County profile was created for the food security assessment, the health department began planning for the next phase: surveying the community and holding focus groups. The health department wrapped up 2022 with the development of a community survey, recruiting focus group participants, and planning survey distribution outreaches. Focus groups and gathering community survey input began in early 2023.

In 2023, OCHD posted the community survey on social media platforms, and distributed surveys at Onslow County Senior Services’ five sites, soup kitchen patrons, church congregations, and Care management clientele.

As of February 2023, OCHD has received 215 surveys from the community. Additionally, four out of the six focus groups have been held. The six focus group types are listed in the table to the right.

  View Performance Measure Progress here:                        

 How Much Number of Community Surveys Received

Preventative Screenings

OCHD and Onslow Memorial Hospital aims to increase awareness of and promote the importance of preventative screenings taking place throughout the community via social media platforms. OCHD has a presence on Facebook, Twitter, 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 barrier of accessibility will assist in the prevention and early identification of chronic diseases and cancer. In 2022, OCHD created 15 social media posts from April-December 2022 promoting preventative screenings.  These screenings were available through the health department, as well as community agencies. From June to December 2022, OCHD obtained an engagement rate (the number of times followers see the post and engage by reacting or sharing the post) of 4.6% across its four social media channels with a total of 3,849 impressions (the number of times the posts have been seen in a social media feed, but not necessarily engaged with) within a total of 9 posts. The average social media engagement rate is between 1-3 percent. With a great engagement rate, OCHD is working to increase new views and reach more people in Onslow County.

  View Performance Measure Progress here:                        

 how well Percent of engagements with the social media post regarding available prevention screenings.

 how well Percent of Facebook engagements with a post regarding available prevention screenings.

 how well Percent of Instagram engagements with a post regarding available prevention screenings.

 how well Percent of LinkedIn engagements with post regarding available prevention screenings.

 how well Percent of Twitter engagements with post regarding available prevention screenings.

   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 (NC State Center for Health Statistics, 2019).

Making healthy choices like eating healthy, avoiding too much alcohol, getting regular physical activity, and practicing good sleep habits can help reduce the likelihood of getting a chronic disease. 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) (CDC, 2021). As of July 2022, Onslow County estimates 35.1% of infants receiving WIC benefits are breastfed to reach 40% of infants breastfeeding. 

Another area of concern in Onslow County includes the teen birth rate. The 2022 County Health Rankings show Onslow County as 99 out of 100 for the teen birth rate (1 – best, 100 – worst). Teen pregnancies have immediate and long-term ramifications for teen parents and their children (University of Wisconsin Population Health Institute, 2022). CDC data (2021) links teen pregnancies and births to higher school dropout rates and risk of lower education attainment among girls and their children. 

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

OCHD began the American Heart Association’s Healthy For Life® program in November 2022 to promote healthy living, wellness, nutrition, and smart choices.  The Healthy for Life® program is a  quarterly series consisting of monthly topics ranging from healthy cooking and recipes to smart shopping and budget-friendly grocery lists.

The Healthy For Life® program is held twice a month at different times to give the community the opportunity to attend.  The program is conducted by the Lead Public Health Educator and a WIC nutritionist.  Participants join via Zoom and complete a pre- and post- survey to gauge increased knowledge and awareness of food, nutrition, and healthy habits.

From November 2022 through January 2023, OCHD had a total of 13 Healthy For Life® participants. Given the holidays being a busy time of year, OCHD anticipates an increase in class participation as 2023. OCHD plans to hold satellite classes with the library, offer lunch and learn classes with the Department of Social Services employees, and continue promoting the monthly Healthy For Life® classes on social media and at community outreaches to boost awareness and participation.

  View Performance Measure Progress here:                        

How Much Number of HFL Participants

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

Faithful Families

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 through 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.  During 2022, the Community Relations Team health educators completed the training for Faithful Families and began researching local faith-based organizations throughout Onslow County as potential partners.  In January 2023, the Health Department began Faithful Families with the Sandy Run Missionary Baptist Church in Jacksonville.  

  View Performance Measure Progress here:                        

 How Much Number of participants in the program that went to 50% or more of the sessions.

 How Much Number of participants indicating increased healthy behaviors (pre/post-tests).

Breastfeeding Friendly Designations

OCHD is working toward increasing the number of facilities that are awarded and/or designated as breastfeeding-friendly.  In turn, these actions will promote and support breastfeeding in the community. Breastfeeding improves the likelihood of infants achieving better health outcomes and provides a host of health benefits for mothers and babies. OCHD will collaborate with community partners to improve breastfeeding rates by improving community access and support for nursing mothers and babies. By increasing the number of local businesses and partners who are designated as being breastfeeding-friendly, more mothers will have access to supportive environments and be encouraged to breastfeed. 

In 2022, The Health Department’s Community Relations Team connected with businesses and employers to educate on the benefits of being a breastfeeding friendly designation and if interested, supplying the business with the application to submit to the North Carolina Breastfeeding Coalition. In 2022, 24 Onslow County organizations submitted applications to become breastfeeding friendly designations. The North Carolina Breastfeeding Coalition website updates the list of awardees twice a year, in March and August.

  View Performance Measure Progress here:                        

 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.

 Women’s and Children’s Health Services

OCHD offers a wide variety of preventative health services for the community. Services pertaining to women’s and children’s health include Maternal Health, Women, Infants, and Children (WIC), Family Planning, Child Health, Immunizations, and 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, especially the health of 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: WIC participation, referrals to Parents, Education, Empathy, Rapport and Support (PEERS) Family Development, and social media posts for services offered by the county.  In October 2022, the WIC program’s target goal for enrollment was 6,435.  The actual number of participants in the program was 7,812.  From September to December 2022, OCHD referred 20 individuals 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 2022, Onslow Memorial Hospital held their annual “Miles for Mammos” 5K to raise money for Julie’s Pink Warrior Project.  The event had 166 participants and raised over $19,000.

  View Performance Measure Progress here:                        

 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

   Mental and Behavioral Health                                                      

Adverse Childhood Experiences (ACEs), substance use, and mental and behavioral health problems are major priorities for Onslow County. The prevalence of poor outcomes such as lack of mental and behavioral health treatment, opioid use and/or death, child abuse, and juvenile crime show the need for additional support in this area, especially in prevention of overdose death services. In FY 2021 to 2022, 1610 child protective cases were assessed and of those, 333 cases of child maltreatment were found. During the April 2021 to March 2022 timeframe, there were 255 children in foster care (Onslow County DSS Data, April 2021 to March 2022).

Substance use overdoses are continuing to impact people living in Onslow County. In 2021, 76.5% of drug overdose deaths in Onslow County involved illicit opioids (NCDHHS Opioid Dashboard, 2021). Additionally, in 2021, 111.1 drug overdose emergency department visits per 100,000 residents occurred in Onslow County (NCDHHS Opioid Dashboard, 2021).

Onslow County has a variety of resources dedicated to addressing mental and behavioral health and substance abuse across the community. Despite of this, 47.6% of Onslow County survey respondents chose mental and behavioral health as a top health behavior that people in the community need more information about (2021 CHNA Community Survey). Improving awareness and access to these resources will help ongoing prevention efforts.

The Mental and Behavioral Health CHIP consists of five programs: ACEs Trainings, Prevention Specialist Referrals, Overdose Fatality Review, Operation Medicine Drop, and Mental Health/Substance Use Disorder Screening and Referral.

Overdose Fatality Review

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 prior to 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.

OCHD created a charter for the OFR team that contains confidentiality and affiliation agreements. Once signed, these agreements are valid from 2022 through the end of 2023. To inform new members about OFR, the charter also includes an overview of OFR, its mission, background, scope, team objectives, and requirements of the team's participants. As Onslow County's team is in the stage of developing the best route to propose recommendations on how to prevent future overdose deaths, multiple team members attended the 2023 National Forum on OFR to learn how other teams across the country develop their recommendations.

  View Performance Measure Progress here:                        

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

 How Much Number of overdose fatalities reviewed

Adverse Childhood Experiences Training

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 (CDC, 2021). Youth that experiences ACEs can have a greater risk of developing negative health conditions such as chronic health problems or mental illness in their adult years (CDC, 2021). 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.

From August to December 2022, 138 individuals around the community were trained on Resiliency and ACEs awareness.  To further the efforts of ACEs awareness and TASCO's mission, OCHD’s Health Educators were trained to conduct resiliency and ACEs Awareness training.

  View Performance Measure Progress here:                        

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

 How Much Numbered of participants trained in Adverse Childhood Experiences.

Prevention Specialist Referrals

OCHD partners with Methodist Home for Children Prevention Specialists to refer patients who are uninsured, and/or do not qualify for OCHD care management services to receive additional support. This support may come in many forms, 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. 

Onslow County began prevention specialist referrals to the Methodist Home for Children in August 2022.  From August to December 2022, 63 referrals have been made.

  View Performance Measure Progress here:                        

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

Operation Medicine Drop

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 through the community that the public can drop off unused medications. In 2022, the Jacksonville Police Department collected 539.4 pounds of unwanted medications.

  View Performance Measure Progress here:                        

 How Much Number (in pounds) of drugs collected.

   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 2022 County Health Rankings, Onslow County is ranked 47th out of 100 counties (1 being the best, 100 being the worst) for adult obesity. Of adults aged 18 and older, 35% report a body mass index equal to or greater than 30km/m² (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

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 to 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. The program is designed to provide regular education on nutritious eating to prevent the onset of type 2 diabetes Participants find ways to increase their daily activity, set goals, learn stress managements skills, and discover strategies for working through their barriers and setbacks. The program starts with three months of weekly, hour-long classes, then moves to biweekly classes for three months. In the last 6 months the program transitions to monthly classes, which is considered the “maintenance phase”.

In February 2022, a new, year-long Prevent T2 DPP cohort began. Since beginning the program, seven individuals have successfully completed DPP. All seven participants have reported getting at least 150 minutes of physical activity each week. Four of the participants have reached and maintained at least a 5% weight loss of their overall body weight. The greatest body weight loss for a single participant, during 2022, was 20%. While it is not required for all participants to report their A1C, two of the participants reported a lower A1C level throughout the duration of the program. As a cohort, the participants lost a total of 75 pounds and participated in a collective 34,900 minutes of activity throughout the year.

  View Performance Measure Progress here:                        

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

 How Much Number of participants enrolled in the program annually.

Physical Activity Opportunities

OCHD and Onslow Memorial Hospital will 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 will be likely to take advantage of accessible ways to engage in healthy behaviors and improve their health. 

Increasing awareness of affordable physical activity opportunities will increase knowledge and participation in the programs that are available to the people of Onslow County. Engaging with the community in this way will increase the utilization of available resources and help community members achieve better health outcomes through increased physical activity. 

From June to December 2022, OCHD created 16 posts promoting social media throughout the community.  OCHD maintains a steady 3% engagement rate with the post, remaining at the top of the 1-3% average.

  View Performance Measure Progress here:                        

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

Sources

• 2021-2022 Onslow County Profile. (2023). http://foodbankcenc.org. Retrieved February 28, 2023, from http://foodbankcenc.org/wp-content/uploads/2022/10/2022-2023-County-Profiles_Onslow.pdf
• Optum Inc. (2022) How did you hear about the program?, QuitlineNC Data Reports 2022 - Onslow County.
• Number of participants who have completed Catch My Breath trainings.  https://scorecard.clearimpact.com/Measure/Embed/100166844. Accessed 05 February 2023
• Pike SN, Trapl ES, Clark JK, Rouse CD, Bell BA, Sehgal AR, et al. Examining the Food Retail Choice Context in Urban Food Deserts, Ohio, 2015. Prev Chronic Dis 2017; 14:160408. DOI: http://dx.doi.org/10.5888/pcd14.160408external icon.
• Mason G, Roholt S. 2006. Promoting, Protecting and Supporting Breastfeeding: A North Carolina Blueprint for Action. North Carolina Division of Public Health, Raleigh, NC.
• 2022 and 2023 Small DDAs and QCTs | HUD USER. (n.d.). https://www.huduser.gov/portal/sadda/sadda_qct.html. Accessed 25 February 2023.
• University of Wisconsin Population Health Institute (n.d.). Onslow, NC. Www.Countyhealthrankings.org. Retrieved January 9, 2023, from https://www.countyhealthrankings.org/explore-health-rankings/north-carolina/onslow?year=2022

Onslow County has seen additional changes in morbidity and mortality rates since the 2021 CHNA has been released. Details on updated data as well as contributing factors and analysis of these changes are listed below.

County Health Rankings

County Health Rankings & Roadmaps 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. Physical inactivity has increased from 20% in 2021 to 29% in 2022 according to the County Health Rankings data.

Figure 8 shows each county’s ranking based on the length and quality of life. Onslow County is shaded in the lightest green with a rank of 23 out of 100 (1 being the best, 100 being the worst) in North Carolina counties.

(The green arrows depict areas of health improvements since the last reporting period. The red arrows represent data that has worsened since the last reporting period.)

Some of the factors and categories that contribute to Onslow County's ranking by County Health Rankings & Roadmaps can be seen in the table above. Alcohol-impaired driving deaths have decreased by 7% since the previous reporting period. In 2019, the number of newly diagnosed chlamydia cases (per 100,000) rose to 1,175, which continues to climb higher than the state’s number of cases (per 100,000). New social media awareness and community presentations are planned for 2023 to address this concern (University of Wisconsin Population Health Institute, 2023).

Although Onslow County had 45 teen births (per 1,000) among 15 to 19-year-olds, it has declined by three since the 2021 CHNA. (University of Wisconsin Population Health Institute, 2022) Efforts to inform teens in the county of the family planning services we offer include adding resource cards to our outreach events.

The most recent data on the leading causes of death in Onslow County shows that chronic lower respiratory deaths declined by 27% from 2019 to 2020.  One of the possible factors includes the beginning of the COVID-19 pandemic.  With quarantines in place across the nation, in 2020, the transmission rate of common respiratory infections made a significant drop.  The decrease in the number of lung infections could have contributed to the 27% decline in chronic lower respiratory deaths. Another contributing factor could be the coding methods used to categorize the cause of death. Individuals with chronic lower respiratory disease, who contracted COVID-19, were at a higher risk of dying.

As of February 8, 2023, 61% of Onslow County residents have completed their initial COVID-19 vaccination series (NCDHHS, 2023).

Suicides

The number of suicides in the previous four years has fluctuated very little causing them to remain at a rate that is greater than North Carolina (13.2 per 100,000, in 2020) (CDC, 2022).

(Onslow County Register of Deeds)

Sources

• NCDHHS; COVID-19 Vaccination Progress for Onslow County. (2023, February 8). In North Carolina Department of Health and Human Services. Retrieved February 10, 2023, from https://covid19.ncdhhs.gov/dashboard/vaccinations
• NCEDSS; North Carolina Electronic Disease Surveillance System. (n.d.). In North Carolina Electronic Disease Surveillance System. Retrieved February 8, 2023, from https://nccovid.dph.ncdhhs.gov/login.do
• Onslow County Deaths. (n.d.). Onslow County Register of Deeds. Retrieved February 13, 2023.
• Suicide Rates by State. (2022, March 17). www.cdc.gov. https://www.cdc.gov/suicide/suicide-rates-by-state.html
• University of Wisconsin Population Health Institute (n.d.). Onslow, NC. Www.Countyhealthrankings.org. Retrieved January 9, 2023, from https://www.countyhealthrankings.org/explore-health-rankings/north-carolina/onslow?year=2022

Mental Health Impacts

The COVID-19 pandemic caused various mental health impacts on the United States population. From January to June 2019, four in ten adults, in the United States, reported anxiety or depressive disorders during the pandemic (Kaiser Family Foundation, 2021). With the impact COVID-19 had on mental health, overdose deaths increased by 72% between 2019 and 2020 (NCDHHS, 2021). Other adverse outcomes in the mental health of adults, in the United States, in 2020, include difficulty sleeping or eating and worsening chronic conditions (Suicide Rates by State, CDC).

Unemployment can have a negative impact on mental health, increasing the likelihood of depression in adults (CDC, 2015). The unemployment rate in Jacksonville, North Carolina in June of 2018 was 5% and increased to 6% in June of  2021 (U.S. Bureau of Labor Statistics). The North Carolina Department of Commerce stated that Onslow County moved from Tier Two in 2022 to Tier One in 2023, with Tier One being the most distressed and Tier Three being the least distressed. Tiers are determined by four main factors: average unemployment rate, median household income, percentage of population growth, and adjusted property tax base per capita. The county’s recent increase in the unemployment ranks heavily influenced the shift in tiers (NC Department of Commerce, 2022).

One in five Americans will experience a mental illness each year (CDC, 2021). Factors such as Adverse Child Experiences (ACEs) and/or substance use can impact an individual’s mental health (National Library of Medicine, 2020). Long-term health risks such as depression and/or anxiety can result from drinking alcohol over time or excessively (CDC, 2022). Each year, counties are ranked on a scale of 1 to 100 in North Carolina with rank number one considered the best ranking for various health factors and outcomes. Onslow County was ranked 86 out of 100 for excessive drinking and 71 out of 100 for alcohol-impaired deaths in 2022 (County Health Rankings, 2022).

Drug Epidemic

The Kaiser Family Foundation stated that 12% of adults, in 2020, reported an increase in alcohol consumption or substance use. There were 4,041 drug overdose deaths in North Carolina in 2021; over 700 more compared to 2020.

Illicitly manufactured fentanyl could have contributed to more than 77% of overdose deaths in North Carolina, in 2021 (Kaiser Family Foundation, 2021). According to the NC Office of the Chief Medical Examiner toxicology data, there were 258 fentanyl-positive deaths in September 2021 compared to 298 fentanyl-positive deaths in September of 2022. Drug overdose mortality in North Carolina continues to climb yearly, with the most recent increase in data from 2,266 drug overdose deaths in North Carolina in 2019 to 3,146 drug overdose deaths in North Carolina in 2020.

To help combat the drug epidemic in Onslow County, the Onslow County Board of Commissioners passed Resolution 21-019 regarding the Opioid Settlement at a regular meeting in September of 2021. A Memorandum of Agreement was also signed outlining the guidelines for tracking and using the funds. The agreement allowed counties to choose services from an approved list to address the opioid epidemic in their communities. Onslow County gathered a group of stakeholders to meet, review data, and make recommendations on the services needed. On February 6, 2023, the Onslow County Commissioners passed resolution 23-002 outlining the spending plan for Onslow County for the remainder of the fiscal year 2022-2023 regarding the Opioid Settlement funds. These activities are all included in those authorized in the original agreement and are priorities from the stakeholder's group. This plan will be updated annually based on recommendations of the stakeholder group as they consider the needs of our community.

In addition, The Healing Place of New Hanover County is an evidence-based program that provides detox and long-term residential services to adults with a substance abuse diagnosis. This contract secures up to 10 beds for Onslow County residents to receive services at The Healing Place. Payment is a daily per diem based on actual usage. The Healing Place began taking residents on February 1, 2023 and is the first in Eastern North Carolina. The need for access to long-term treatment beds was identified as a priority by the SOAR Sub-Group in the Onslow County Settlement Funds Report 2022 (Onslow County Board of Commissioners, 2023).

Sources

New

Med-South

The Med-South Lifestyle Program is an evidence-based behavior change intervention incorporating a Mediterranean dietary pattern for the southeastern population and guides participants through making lifestyle changes in eating and physical behaviors. The program is delivered in four monthly, individual counseling sessions that last roughly 45 to 60 minutes each, in addition to a brief 15-minute phone call in-between sessions to check on the participant’s goals and progress with the program. After four monthly 1:1 sessions are completed with the phone call check-ins occurring in-between the monthly sessions, there is a phone call check-in at months six and eight of the program, and the participants will come in person at month 10 of the program to complete their last blood pressure and weigh in. The program utilizes REDCap to track participants’ weight, blood pressure, and goals the participants as well as the percentage of the goal that is reached at different checkpoints throughout the program.

In July 2022, OCHD recruited Health Department staff to pilot the Med-South program. Eligibility requirements include: must be aged 18 to 80, be able to make decisions about dietary intake, and not have advanced kidney disease or diagnosis of malignancy or cancer. Those interested in the program provided their contact information, which was then forwarded to the UNC Team for the screening and enrollment process. The Med-South Lifestyle Program kicked off its first counseling session in September 2022, with a total of 18 participants fully enrolled in the program. As of February 2023, 17 out of 18 participants are still enrolled in the program, and 13 out of the 17 enrolled participants have completed all 4 of the 1:1 counseling sessions and have entered the maintenance phase of the program.

Discontinued

Diabetes Self-Management Education

Onslow County WIC and Nutrition Services discontinued the Diabetes Self-Management Education Support Program due to internal and external factors.  In response to this, OCHD began the American Heart Association’s Healthy For Life® program.  The program is held twice per month by a Health Department Nutritionist and Health Educator. Different series from the curriculum are implemented quarterly and various topics are offered monthly. The program is held virtually and is free for the public to attend with no registration necessary (more details can be found at https://bit.ly/ochdhealthyforlife).

Data/Evaluation CHIP

The Data and Evaluation CHIP was established to support the four CHIPs developed by OCHD, Onslow Memorial Hospital, and community partners. Originally, the Data and Evaluation CHIP was designed to serve a supportive role to enhance the efficacy of other CHIPs and provide a strategy for transparency with community partners to access statistics and data regarding the county.  Since this CHIP was regarded as supportive and played a passive role to the Health Department and its community agency partners, the Data & Evaluation CHIP was removed from the scorecard but work on the programs continues to meet the goals of the data and evaluation programs including a shared data dashboard.