HNC 2030 Scorecard: Onslow County

Story Behind the Curve

The 2018 Onslow County Community Health Needs Assessment identified Substance Use Disorders (SUDs) as a top health issue wihin the community. Adult smoking was highlighted as a major health concern, with an indicator score of 2.25 (indicator scores represent a weighted average of comparison scores ranging 0-3, with 0 being the best outcome and 3 indicating the worst outcome). In fact, the adult smoking rate in Onslow County is 19.1%, higher than that of both North Carolina (17.9%) and the US (17%). None of the adult smoking rates met the Healthy People 2020 goal of 12%. Alcohol misuse is another major area of concern, with an indicator score of 2.4. Onslow County has a alcohol-impaired driving death rate of 36.5%, which is again higher than that of North Carolina (31.4%) and the US (29.3%). There was no trend for this observation. Similarly, the rate for excessive drinking in Onslow County is higher at 22.6% when compared to 16.7% in North Carolina and 18% in the US. These rates fall below the Healthy People 2020 goal of 25.4%. Overall, Onslow County has higher rates in every substance abuse category in the table above in comparison with North Carolina and the US.

In an effort to improve services and community resources while streamlining communication between stakeholders, the Onslow County Health Department, along with the partners below, began a Substance Abuse related task force, the Strategic Opioid Advanced Response (SOAR) Team. This taskforce focused their efforts in the areas of concern mentioned above, with an emphasis on the Opioid Epidemic. With the rise of drug overdose deaths in the community due to the COVID-19 pandemic, the taskforce continues to grow and provide the community with knowledge of services and resouces. Recent efforts include a "Street Sheet" that outlines substance abuse resouces in the community, a multi-pronged social media campaign, and the recent proposal of a new Tobacco Rule. 

Partners

• Onslow County Government 
• Onslow County Sheriff Office 
• Onslow County Emergency Services 
• City of Jacksonville 
• City of Jacksonville Public Safety 
• Dix Crisis Intervention
• Onslow County Schools 
• NC Cooperative Extension Office 
• Onslow Memorial Hospital 
• Onslow County Department of Social Services 
• Integrated Family Services 
• Sneads Ferry Hope 
• Wilmington Treatment Center 
• RHA
• Trillium Health Resources
• One Place 
• Jacksonville VA
• Caring Community Clinic 
• Coastal Horizons 
• Cohen Military and Family Clinic 
• Peers Family Development 
• True Justice 
• ACT Associates 

What Works

The Onslow County Health Department (OCHD) has found that social media, especially during the COVID-19 Pandemic, is a powerful medium that has allowed the agency to engage with the community despite isolation and stay-at-home orders. OCHD has effectively utilized this affordable platform to reach the public and continues to connect with the community. The most recent social media-driven Public Service Announcment (PSA) received high levels of engagement, with 2,643,326 reactions and 118 shares.  

Why Is This Important?

From the 2018 Community Health Needs Assessment (CHNA), community survey respondents identified Substance Abuse as the top issue impacting quality of life in Onslow County. Both English and Spanish survey respondents listed substance abuse prevention as a topic that the community needs more information about. In fact, Substance Abuse was raised ten times in the focus group sessions as an issue in the community, especially as it relates to alcohol use and opioid abuse/misuse. Several participants felt that there is overprescribing of opioids and that there is a belief within the community that addiction will never happen to them. Alcohol use among the active military population was also raised as a concern during the focus group discussions. With the onset of the COVID-19 Pandemic, Onslow County Health Department and community partners have found that continued education, discussions, and outreach is essential in creating a community that has equitable access to vital social services.

What We Do

The Onslow County Health Department works collaboratively with local and state partners through various programs and initiatives to provide awareness of direct and secondhand tobacco use and how it relates to preventable morbidity and mortality. 

Who We Serve

We serve individuals in Onslow County that are interested in recieving tobacco awareness, education, programs, and other services. 

How We Impact

The Onslow County Health Department (OCHD) has engaged in numerous tobacco prevention initiatives in the community in recent years. Annually, OCHD participates in Red Ribbon Week in partnership with Onslow County schools and Community Prevention. OCHD also provides education to youth through social media campaigns on the health and safety hazards of vaping. In 2019, OCHD hosted a youth round table discussion to further educate Onslow County teens on the risks associated with vaping and tobacco use. Additionally, the organization is currently in the planning process of creating a new Tobacco Rule.

What We Do

The Strategic Opioid Advanced Response Team (SOAR) team is a multidisciplinary task force that works to further the prevention of substance misuse in Onslow County. SOAR is dedicated to improving the opioid response in the community through a collaborative effort among local government, community stakeholders, and concerned citizens. The team works on initiatives to raise awareness, provide education, and investigate solutions to address the issue of drug misuse within the community.

Who We Serve

This task force is dedicated to improving the opioid response in Onslow County through a collaborative effort among local government, community stakeholders, and concerned citizens. 

How We Impact

SOAR works collaboratively with community partners to provide awareness of prevention, treatment of, and recovery from Substance Use Disorders (SUDs), while also advocating for equitable and readily-available resources for all Onslow County residents. 

SOAR recently engaged in the Opioid Response Project (ORP), a two-year learning collaborative designed to support ten North Carolina community teams addressing the opioid epidemic in their local communities. The specific goals of this project were to: (1) plan, deliver, and continuously refine activities in support of local community teams responding to the opioid crisis, (2) strengthen the capacity of local community teams for planning, implementing, monitoring, and sustaining their community programming, (3) strengthen collaboration and connections around the opioid response efforts, and (4) disseminate resources and findings to a larger set of stakeholders.

ORP was grounded in the Collective Impact Model (CIM), with community teams participating in a systematic approach that included a series of forums, webinars, and meetings, as well as access to resources and technical assistance. In addition, the community teams completed planning and implementation worksheets to facilitate progress towards their local efforts. The ORP was led by University of North Carolina (UNC) School of Government (SOG) faculty and coordinated by the ncIMPACT Initiative. A report of the ORP findings on the process, outcome, and formative evaluations were synthesized to reflect learnings at both the ORP and community-team levels. The evaluation approach was guided by a logic model, evaluation questions of interest to the ORP stakeholders, and a data collection plan. Sources of data included project documents, surveys, and interviews. The report also included a list of recommendations going forward.

What We Do

In an effort to provide widespread education and awareness of Substance Use prevention, treatment, and recovery, the Onslow County Health Department (OCHD) has invested in both paid and organic social media content. The campaign elements has included shared materials from the State, CDC, and other credible sources, along with the creation of a Public Service Announcement, social media posts, digital billboards, and geo-fenced digital advertising.

Who We Serve

Residents and followers of the Onslow County Health Department social media pages.

How We Impact

The increased importance of social media as a platform for communication and engagment with residents in recent years, especially with the onset of the COVID-19 pandemic, presents an unique opportunity for OCHD to explore new methods of health promotion.

What We Do

In May of 2018, Onslow County established their first ever post-overdose reversal response team (Quick Response Team-QRT) to respond to and follow up with overdose patients as well as to improve the continuity of care. This team has been instrumental in establishing contact with patients who have experienced an overdose event, encouraging them to participate in treatment programs, as well as collecting data to assist in not only tracking the patient's progress but also to provide various data to EMS and OCHD.

Who We Serve

Patients who have recently overdosed, persons living in recovery, and families of individuls who have overdosed. 

How We Impact

Post Overdose Response Team must follow-up with an individual who has recently overdosed within 24 to 72 hours. This follow-up visit allows the cross-functional group to direct the indivdual and their family to treatment services, counseling services, and other prevention resources. The program also provides a great opportunity to build relationships with people who use drugs in the community and create connections that may offer a variety of wraparound health and social services, even if that connection occurs at a later time.

What We Do

Project Med-Drop is a community-wide medicine disposal safety initiative led by various agencies to educate the community on safely disposing of expired or unwanted medication, providing convenient locations throughout the community to dispose of medication, and participating in the semiannual National Prescription Drug Take Back Day.

Who We Serve

All Onslow County residents. 

How We Impact

Project Med-Drop provides education to members of the community to raise awareness on the risks associated with keeping unwanted medications, including accidental poisoning and prescription drug addiction. The initiative also emphasizes the impact of improperly disposing medications, such as by pouring medications down the toilet or the sink, and how it harms people, animals, and the environment. The promotion of Medication Disposal locations helps to ensure that medications in the community get disposed of safelyand will not be used by others. 

Story Behind the Curve

Secondary data from the 2018 Community Health Needs Assessment showed that Onslow County scored poorly in quality of life in regards to access to exercise opportunities and healthy foods. Focus group data gathered during the same timeframe identified a lack of physical activity opportunities throughout the county and a need for healthier food selections. In an effort to increase the amount of free and accessible physical activities within the county, the Onslow County Health Department (OCHD) created the "Second Saturday Step Up" initiative, which held free, monthly classes open to the public. Due to COVID-19, OCHD was forced to pivot in the direction of addressing food insecurity within the community. OCHD partnered with Onslow County Senior Services to provide food boxes for individuals experiencing food insecurity while under isolation due to either testing positive or coming into contact with someone who tested positive for COVID-19. As the community began the recovery process due to COVID-19, OCHD offered a "Healthy For Life" class, which focused on healthy eating on a budget.

Partners

Onslow County Senior Services

Onslow Memorial Hospital

Onslow County Department of Social Services

Onslow County Center NC Cooperative Extension

City of Jacksonville

Onslow County Parks and Recreation

Jacksonville Recreation and Parks

Onslow County Animal Services

What Works

OCHD has found that thinking creatively about what motivates or attracts residents to participate in events has helped to increase attendance and sustained engagement. Examples include gifting healthy food boxes for participants in the Healthy for Life program, as well as creating a nontraditional yoga class called "Kitten Yoga."

Why Is This Important?

Improving access to safe physical activity locations and healthier foods will benefit the community and improve the overall health of Onslow County residents. This is the baseline of chronic disease prevention. Our initiatives increase awareness of how to attain a healthier lifestyle and increase community engagement in various health-related activities.

County Health Ranking Map

Limited access to healthy foods

Percentage of population who are low-income and do not live close to a grocery store.

The 2020 County Health Rankings used data from 2015 for this measure.

CHR Link to County Level Data

What We Do

Healthy for Life® is a community-based nutrition and well-being program created by Aramark and the American Heart Association (AHA) that focuses on empowering people to make healthy food, nutrition, and lifestyle choices. The program incorporates interactive components, such as demonstrations on healthy shopping and cooking. Ultimately, the goal of Healthy for Life® is to equip individuals and families with the tools to seek and prepare healthy food, and to show participants how to use these skills to help them accomplish their goals and reach their potential every day. This program focuses its impact on communities across the U.S. and is built on a framework that emphasizes literacy and culinary skills.

Who We Serve

Healthy for Life® is geared towards heads-of-households who are responsible for meal-planning or anyone interested in learning new ways to integrate healthy cooking and eating into their lives.

How We Impact

The goal of Healthy for Life® is to change dietary practices, including increasing the consumption of fruits, vegetables, and whole grains. The program recognizes that community-based health and wellness programs create a sense of empowerment and ownership, which helps to improve overall health in a sustainable way.

Story Behind the Curve

Survey results from the 2018 Community Health Needs Assessment revealed that "other chronic diseases," including chronic kidney disease (in the Medicare population) and rheumatoid arthritis, are higher in Onslow County in comparison to the rates in North Carolina and the U.S. In order to most effectively allocate resources and fulfill Community Health Improvement Plans (CHIPs), the Community Health Advisory Team (CHAT) decided to expand the category of Chronic Diseases to include not only rheumatoid arthritis and chronic kidney disease, but also high blood pressure, diabetes, and COPD. In doing this, the team would focus on one of the root causes of prevention: Weight, Nutrition, and Exercise. 

CHAT believes that if efforts are focused on means of prevention through better access to healthy foods, opportunities for exercise, and weight management, this will prevent the development or progression of chronic diseases. 

Partners

Onslow Memorial Hospital 

Realo Pharmacy 

Caring Community Clinic 

NC Oral Health Section 

Naval Medical Center Camp Lejuene 

Onslow County Parks and Recreation 

Onslow County Government 

Onslow County Partnership for Children

What Works

The Onslow County Health Department (OCHD) and partners have found that focusing in the areas of Diabetes prevention and management would be more familar to residents and so would create greater incentives for participation. OCHD has implemented several Diabetes-related programs, including the Diabetes Prevention Program, also known as "Group Lifestyle Balance," and a Diabetes Self Management Class (DSME). These are two examples of evidence-based programs that encourage community engagement and educate participants on how to achieve positive, sustainable change in their daily lives.

Why Is This Important?

What We Do

The Group Lifestyle Balance^TM Program provides education, encouragement, and necessary tools to help individuals reach their healthy lifestyle goals. This program is designed for non–diabetic, overweight adults at risk for developing Type 2 diabetes and cardiovascular disease. The program includes 12-week Core sessions, 4 bi-weekly/monthly Transition sessions, and 6 monthly Support sessions. Participants are taught how to self-monitor weight, how to track and learn more about healthy eating/physical activity, as well as how to problem-solve and stay motivated. The goals of Group Lifestyle Balance^TM Program are for participants to lose 7% of weight through healthy eating and to consistently complete 150 minutes of brisk, physical activity each week.

Who We Serve

The Group Lifestyle Balance^TM Program provides education, encouragement, and necessary tools to help individuals reach their healthy lifestyle goals. This program is designed for non–diabetic, overweight individuals age 18 and older who have pre-diabetes and/or metabolic syndrome, conditions that increase the risk for developing Type 2 diabetes and cardiovascular disease.

How We Impact

The Group Lifestyle Balance^TM is a lifestyle change program which focuses on healthy eating and increasing physical activity. The goals for the program are for participants to achieve weight loss of 5-7% and for them to maintain 150 minutes of brisk physical activity each week. The GLB focuses on 3 components: nutrition, activity, and behavioral changes. As a result of making healthy lifestyle changes, many individuals do lose weight, as well as reduce their risk for diabetes and cardiovascular disease. The evidence–based Group Lifestyle Balance^TM program, adapted from the Diabetes Prevention Program (DPP), is designed to help individuals make lifestyle changes to both prevent diabetes and prevent or treat the metabolic syndrome.

What Is It?

The Onslow County Health Department (OCHD) has been active in using social media to post both original social media content, as well as sharing posts from credible sources, focused on chronic disease education, awareness, programs, resources, etc. This content is shared across multiple platforms owned by OCHD in an attempt to engage with local audiences to create an educated community. 

Who We Serve

OCHD social media followers, health-minded and/or invested individuals in the agencies, as well as clients of health department services. 

Experience and Importance

The COVID-19 pandemic changed the way that OCHD has been able to provide educational materials to residents. Typically, the health department utilizes traditional outreach activities and client visits to engage with community members and clients. Due to the limitations of stay-at-home orders, however, the agency had to transition to more virtual engagement activities. The health department met the community where they were in how they received their health-related information, which meant that expanding OCHD's social media precense was crucial.

Progress on CHIPs

Like many local health departments, the Onslow County Health Department (OCHD) was forced to think out of the box to fulfill Community Health Improvement Plans (CHIPs) and reach the community throughout the COVID-19 Pandemic. OCHD focused on virtual and social platforms to conduct meetings and presentations, while also sharing important and informative educational materials.

Chronic Diseases

• Since OCHD was not able to conduct events such as “What’s Your Next 10?” or Second Saturday Step Up, they used online platforms to reach the community. OCHD hosted a Facebook Live Nutrition Panel and received great feedback. The video reached over 9,000 people, 1,572 post engagement, 56 reactions, 36 comments and 16 shares.   

• OCHD hosted a Group Lifestyle Balance that began as in-person classes, but due to COVID-19 morphed into virtual classes taught over Zoom. Out of the initial 12 participants, 4 dropped the class due to the change. However, despite the change those that finished the class completed their goal and met the goal of 5% weight loss. The group on average lost 16.3% of their starting weight.

Substance Abuse 

• OCHD began an Overdose Fatality Review (OFR) board, in partnership with Jacksonville Public Safety. This initiative uses a multi-disciplinary team to conduct in-depth reviews of overdose fatalites to identify trends, improve the system of care, and identify opportunities for intervention. This program is one of the first in the State of North Carolina.

• The Strategic Opioid Advanced Response (SOAR) team implemented a Public Service Announcement (PSA) campaign to raise awareness of substance misuse, share local resources, and provide education to residents. This campaign also promoted the virtual recovery resources available during the COVID-19 pandemic.

• In conjunction with the Onslow County Extension Office, OCHD assisted with the Empowering Youth and Families Program (EYFP). This program provides education to youth and their caregivers to reduce substance use, improve parenting skills to assist youth in making healthy choices, strengthen family relationships, and to empower families to lead community change.

Morbidity and Mortality Changes Since Last CHNA

• In 2020 there were 68 COVID-19 fatalities, most of which were 65+ with underlying conditions. 
• In 2020, the number of overdose deaths in Onslow County was the highest ever recorded.
• We have seen a decrease in routine vaccinations within the last year. 
• Suicide deaths in Onslow County continue to increase throughout the pandemic. 

Emerging Issues Since Last CHNA

• COVID-19 vaccinations, variants and spread will continue to be issues for local health departments. 
• Mental Health Concerns are also ongoing issues in the community that have spiked an increase in suicide and overdose deaths. 
• Social determinates of health and health equity along with topics of social justice are also emerging issues and topics of conversations for local health departments and communities. 

New/Paused/Discontinued Initiatives Since Last CHNA

The Onslow County Health Departments Diabetes Self Managment (DSME) classes have been paused due to classes traditionally being held in person and due to COVID-19 were paused. This class will continue once social distancing limitations and requirements are lifted.