Executive Summary

Executive Summary

Vision Statement

The vision of the Community Health Needs Assessment is that residents of Halifax County are empowered to lead healthy lifestyles. The assessment outlines the community’s current health status. Based upon findings, steps have been developed to implement interventions, as well as, community resources identified to address these health issues.

Leadership

The 2021 Halifax County Community Health Needs Assessment is a bi-sectoral partnership involving Halifax County Health Department, Health Director Bruce Robistow and ECU Health North Hospital, President Jason Harrell.  Halifax County Health Department and ECU Health North Hospital also collaborated with Health ENC, Melissa Roupe, Chair for primary and secondary data analysis.  The Community Health Needs Assessment team is comprised of many participants representing area agencies in Halifax County, North Carolina.  Many local organizations assisted ECU Health North Hospital, the Halifax County Health Department, and Healthy Halifax Partners, with the creation of the assessment.

Partnerships/Collaborations

Regional/Contracted Services

The 2021 Halifax County Community Health Needs Assessment was developed through a partnership between the Halifax County Health Department, ECU Health North and Health ENC, with ECU Health North and the Halifax County Health Department serving as the fiscal sponsors.

Theoretical Framework/Model

The Socioecological model was utilized throughout the development of the Community Health Needs Assessment process.  The needs assessment engages all levels of community collaboration including primary data from surveys and focus groups as well as secondary data.  Engagement was targeted from all levels of the model including interpersonal (families), individual (knowledge), organizations and community engagement to adapt public policy through successful implementation of programs.

Collaborative Process Summary

The Halifax County Health Department and ECU Health North collaborated with Health ENC to provide the community with a needs assessment survey opportunity.  The survey was distributed through multiple outlets for community input from April 2021 - June 30, 2021 with 399 surveys completed for analysis.  The top eight priorities identified in the assessment were prioritized by community members, selecting the top areas of health to focus on over the next three years.

Key Findings

The CHNA findings are drawn from an analysis of an extensive set of secondary data provided by the state of North Carolina and in-depth primary data from community leaders, health and non-health professionals who serve the community at large, vulnerable populations, and populations with unmet health needs. Through a synthesis of the primary and secondary data the significant health needs were determined for

Table 1. Significant Health Needs

Next Steps

This report describes the process and findings of a comprehensive health needs assessment for the residents of Halifax County, North Carolina. The prioritization of the identified significant health needs will guide community health improvement efforts of Halifax County. Following this process, Halifax County (Halifax County Health Department and ECU Health North) will each outline how they plan to address the prioritized health needs in their implementation plan.

Priorities

Health Priorities

The Roanoke Valley Community Health Initiative and Healthy Halifax Partners participated in a prioritization activity to determine the three leading health concerns to be addressed between 2022 and 2024. The worksheet asked that each of the eight concerns be ranked according to three criteria: Magnitude of the Problem, Seriousness of the Consequences, and Feasibility of Correcting the Problem.  During the Roanoke Valley Community Health Initiative and Healthy Halifax Partners meeting, the results from the prioritization process were reviewed and discussed. The following final health concerns were named as the focus for the next three-year cycle, 2022-2024.

1. Obesity

2. Maternal, Fetal and Infant Health

3. Substance Abuse (Mental Health Crisis Intervention)

Why Is This Important?

What We Do

CATCH My Breath is the only evidence-based youth nicotine vaping prevention program for grades 5-12 that has been proven to substantially reduce students’ likelihood of vaping. A peer-reviewed study of CATCH My Breath found that students in schools that implemented the program were half as likely to experiment with e-cigarettes over the following 16 months, compared with those in schools that did not receive the program. The publication of the findings in Public Health Reports – the official journal of the U.S. Surgeon General – makes CATCH My Breath the first evidence-based vaping prevention program. The study also found the program increased student knowledge of vaping dangers and positive perceptions about choosing a vape-free lifestyle. Kelder, S. H., Mantey, D. S., Van Dusen, D., Case, K., Haas, A., & Springer, A. E. (2020). A Middle School Program to Prevent E-Cigarette Use: A Pilot Study of “CATCH My Breath.” Public Health Reports, 135(2), 220–229. https://doi.org/10.1177/0033354919900887

Who We Serve

The Halifax County Health Department works with local middle schools in Halifax County Schools, Roanoke Rapids Graded School District and Weldon City Schools to implement CATCH My Breath.  The curriculum is offered during the school day during the PE class and is offered to 7th and 8th grade students. Currently the program is the planning and establishing partnerships with the school administration and faculty. 

How We Impact

The overall goal of CATCH My Breath is to prevent the initiation of e-cigarette use among preteen and teen adolescents. The program is designed to help students:

• Discover that non-use of e-cigarettes is the norm for adolescents
• Identify reasons why young people might start using e-cigarettes
• Recognize the subtle, and not so subtle, messages in e-cigarette advertising
• Practice skills for resisting peer pressure and advertising pressure to use e-cigarettes
• Decide on their personal reasons not to use e-cigarettes and set goals for future non-use

The intended outcomes are to ensure that students will:

• Resist their own curiosity, peer and advertising pressure to experiment with e-cigarettes
• Understand that e-cigarettes are addictive, unhealthy, and not as popular as they think
• Influence friends and peers not to use e-cigarettes

What We Do

Halifax County Health Department promotes and supports the implementation of the Medicine Drop Take Back Initiative.  The local health department partners with the Halifax County Sheriff's department twice a year, fall and spring to implement the event.  

Who We Serve

The citizens of Halifax County and surrounding areas have the opportunity to bring unused and expired medications to the event to be properly disposed of by the Halifax County Sherriff's Department. 

How We Impact

The initiative removes unused and expired medication from the home and the community reducing the access to drugs and overall impacting the risk of potential risks associated with drugs that can be harmful is used improperly. 

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Story Behind the Curve

The Halifax County Health Department is pleased to present the 2022 State of the County Health Report.  The report is part of an annual update to the Community Health Needs Assessment.  The purpose of the report is to provide key indicators of community health and wellbeing while reviewing health concerns selected as priority areas from the previous health assessment.  The report reviews progress made in the last year on priority areas selected while reviewing any changes in the data that guided the selection of these priorities.  The report will be shared with Healthy Halifax Partners (Healthy Carolinians Partnership), community agencies, stakeholders and members of the Board of Health.  Hard copies will be available in our department and electronically at Document Center • Halifax County, NC • CivicEngage (halifaxnc.com)

Progress on CHIPs

Substance Abuse

• The Halifax County Health Department has partnered with local middle schools to implement the CATCH My Breath Vape Prevention Program to over 125 students.  CATCH My Breath is an evidenced-based vape prevention program designed to be implemented in a school setting for grades 5-12. CATCH My Breath is a peer-led teaching approach that empowers students with the knowledge and skills needed to make informed decisions about e-cigarettes. The program educates students on the social pressures to vape and strong refusal skills.  Students enjoyed the program including creating their own social media campaign on the dangers of vaping, how to say no and the harmful ingredients.
  Catch My Breath - Vape Education - Tobacco Youth Prevention

• Halifax County Substance Use Coalition formed in May 2022 with participation from a variety of organizations including local health care facilities, health department, emergency management, Department of Social Services, Trillium and community organizations. The coalition share resources, concerns, challenges, ideas, and identify strengths and gaps to address substance abuse while reviewing substance use data.
• The Halifax County Health Department partners with local Sheriff’s Department to promote and participate in the bi-annual Medicine Drop “Take Back Initiative “at various locations throughout the county. The event offers a safe place for the public to dispose of unused, unwanted and expired medication. All medicine is collected by the Halifax County Sheriff’s Office. The upcoming scheduled "Take Back Initiative" Medicine Drop event is scheduled for April 22, 2023.   
• Naloxone Lock Box Initiative is a collaboration between Halifax County Emergency Services and Halifax County Health Department to provide naloxone lock boxes to the community as requested. The program is promoted through the Halifax County Substance Use Coalition. The health department has given the Halifax County Emergency Services naloxone lock boxes for the community.  
• The health department partnered with three agencies/providers to educate and encourage enrollment in the NC Quit Line E-Portal registration.  A total of two agencies/providers have enrolled in the NC Quit Line E-Portal database.  Providers are able to refer patients who can benefit from the NC Quit Line services.

Obesity

• The CATCH program, Coordinated Approach to Child Health, is promoted within 15 schools Prek-8^th providing classroom and school resources to increase physical activity during the school day and at home.  The program has 4 components including classroom activities, school administration, school nutrition/cafeteria and parental component to incorporate at home. Walk and Bike to school events were held in May and October 2022 with representation from all elementary and middle schools in Halifax County.
• The Halifax County Health Department partnered with various agencies to promote access to healthy foods.  Partnership with Halifax County Council on Aging increased access to healthy foods through a farmer’s market program for seniors.
• Collaboration with Roanoke Valley Community Health Initiative provided fresh produce, healthy snacks and water for all schools in Halifax County and various summer camps.
• The collaboration with host agency Halifax County Cooperative Extension increased access to healthy foods by volunteering at food bank pop up markets and encouraging corner stores to provide healthy food options in stores. 
• The health department continues to support access to healthy foods by supporting school meals for all children through the NC Alliance for Health.
• Working on Wellness is an employee-based wellness program providing various programming to employees including CPR training, quarterly blood drives and wellness seminars focused around behavior change to improve health.  The WOW program partners with the Northeast NC Partnership for Public Health to promote an annual walking challenge.  Healthy snack bars are available throughout multiple county buildings promoting healthy eating. 

Maternal, Fetal and Infant Health:

• The health department provides the Baby’s Easy Safe Sleep program, reaching over 200 participants this year.  The safe sleep program is designed for expecting mothers, as well as mothers and care givers of children under the age of 1.  The program educates on the importance of back to sleep and SIDS prevention.
• Ready Set Baby is a breastfeeding education program designed for pregnant mothers and family support.  Reaching over 100 participants this year, participants receive items to help aid in the beginning of their breastfeeding journey in the home. 
• The Car Seat Safety Program is a new program offered to mothers and fathers with children under the age of 8 or 80 pounds.  The health department has certified car seat technicians who provide education and installation component.  The program has served over 250 car seats.    

Morbidity and Mortality Changes Since Last CHA

2019 Leading Causes of Death in Halifax County 

The top 3 leading causes of death in Halifax County, cancer, diseases of the heart and cerebrovascular diseases, has remained the same since 2021-2022 Community Health Needs Assessment. 

NC SCHS: Interactive Health Data: Health Data Query System (ncdhhs.gov)

Prevalence Diagnosed Diabetes 
In Eastern North Carolina, 13.4% of the population has been diagnosed with diabetes compared to 12.7% of North Carolina.  Over the past years, the prevalence of diagnosed diabetes is higher in Eastern North Carolina than North Carolina.
NC SCHS: Statistics and Reports: BRFSS: Survey Results (ncdhhs.gov)

Cardiovascular Disease 
In Eastern North Carolina, 9.7% of the population has a history of cardiovascular disease compared to 9.8% of North Carolina.  Over the past three years, the history of cardiovascular disease has slightly decreased in Eastern North Carolina.
NC SCHS: Statistics and Reports: BRFSS: 2021 Survey Results for Eastern North Carolina (ncdhhs.gov) 

Obesity in Adults 
In Eastern North Carolina, 39.2% of adults 18 years and older are classified as obese compared to 36.0% of North Carolina.  Over the past years, the obesity rate continues to climb in Eastern North Carolina and North Carolina. 
NC SCHS: Statistics and Reports: BRFSS: Survey Results (ncdhhs.gov)

Obesity in Children 
In Halifax County, 20.2% of children ages 2 to 4 enrolled in the WIC program classified as obese compared to 15.9% of North Carolina.  Over the past years, the obesity rate continues to climb in Halifax County among the children ages 2 to 4 who are enrolled in the county WIC program. 
The Facts - Eat Smart, Move More NC (eatsmartmovemorenc.com)

Infant Mortality Rates
The infant mortality rate for Halifax County has decreased from 13 per 1,000 live births to 9.5 per 1,000 live births, but is higher than the North Carolina rate of 6.9 per 1,000 live births.
NC SCHS: Statistics and Reports: Vital Statistics (ncdhhs.gov)

Emerging Issues Since Last CHA

An emerging concern that has seen a recent spike throughout the county is e-cigarette use among youth in particular. School districts across the county are seeing an increase in e-cigarette use among middle and high school students.  The health department is implementing the evidence based CATCH My Breath curriculum within middle schools.  Opioid abuse is an emerging health concern nationwide.  Halifax County continues to see the detrimental effects as well.  In order to raise awareness of treatment and medication drop boxes, we continue to offer marketing through social media outlets to educate about the dangers and risks of e-cigarette use. 

The infant mortality rate for Halifax County (9.5 deaths/1,000 live births) has not met the Healthy NC 2030 target rate of (6.0 deaths/1,000 live births).  Halifax County has a higher proportion of babies who are born low birth weight (12.0%) or very low birth weight (2.8%) compared to the state average for those indicators of infant health (9.2% and 1.7%, respectively).  Although the infant mortality rate has decreased over the past year, the rate in Halifax County remains higher than the rate in North Carolina.  Programs such as the safe sleep program is offered in Halifax County to reduce the infant mortality rate in Halifax County.
NC SCHS: Statistics and Reports: Vital Statistics: Infant Mortality Statistics 2020 (ncdhhs.gov)

There has been a significant decrease in the number of children who die from motor vehicle injuries over the past decade.  However, motor vehicle injuries are still the leading cause of death for children 4 years and older.  Approximately 50 children, under the age of 12, are fatally injured in car crashes each year in North Carolina with 40 percent of children killed in car wrecks being unrestrained.   In 2021, injuries were the leading cause of death among North Carolina children ages 1 to 17 comprising 61% of all (non-infant) child deaths with 19% from motor vehicle injuries. 
https://ncchild.org/vehicle-safety/ 
https://webservices.ncleg.gov/ViewDocSiteFile/75667 

In 2022, Halifax County has seen a 5.6% decrease in breastfeeding initiation rates since 2019.  The breastfeeding initiation rate in Halifax County is 51.7% compared to 74.7% in North Carolina. The health department continues to offer the Ready Set Baby breastfeeding program to all pregnant women providing the benefits of breastfeeding and education for their breastfeeding journey.
https://www.nutritionnc.com/wic/wicLAR.htm 

Contributing economic, socioeconomic, and environmental changes in Halifax affect the health of many especially in rural areas.  Due to the demographics of Halifax County and being a rural county, many citizens do not have access to transportation to receive medical care.  Halifax County Health Department offers gas vouchers to patients to assist with transportation needs.  Most of the medical offices are located in Roanoke Rapids, which can be more than a 30-minute ride from the farthest communities in Halifax County.  

New/Paused/Discontinued Initiatives Since Last CHA

Halifax County identified obesity, substance abuse (mental health), and maternal, fetal and infant health as health priorities in the 2021-2022 Community Health Needs Assessment.

New Initiatives
Car Seat Safety Program with Certified Car Seat Safety Technicians
Community Gardens with partners
Halifax County Substance Use Coalition formed in May 2022

Paused initiatives
Minority Diabetes Prevention Program

Progress on CHIPs

Morbidity and Mortality Changes Since Last CHA

Emerging Issues Since Last CHA

New/Paused/Discontinued Initiatives Since Last CHA