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State of the
COUNTY
F~~ALTH
Report
Orange County, NC
How to Get Involved 2 Orange
County, NC: Promoting and
.Protecting Health 3 Leading
Causes of Death 4 Health
Disparities 4 Access to Care 5
Current Hot Topics 6 Health
Promotion 8 Adolescent Health 9 ~
Child Health 11 Mental Health and
Substance Abuse 12
Transportation 13
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December .2009
Acknowledgments
Healthy Carolinians of Orange County would like to thank the following individuals for their contributions to the
creation of the 2009 State of the County Health Report.
^ Diana Bass, UNC Hospital Beacon Child and Family Program
^ Sarah Blacklin, Carrboro Farmers Market
^ Patty Clarke, Orange County Social Services
^ Billie Guthrie, Mental Health Association and the Community Backyard
^ Jamy Albo McGee, UNC Wellness Center
^ Patrick McIntyre, Orange County Partnership for Young Children
^ Jamie Rohe, Orange County Department of Housing and Community Development
^ Nidhi Sachdeva, Orange County Health Department
^ Aviva Scully, Orange County Schools
^ AI Terry, Orange Public Transportation
^ Judy R. Truitt, OPC Area Program
^ Stephanie Willis, Chapel Hill-Carrboro City Schools
^ Peggy Yonuschot, OPC Area Program
^ Healthy Carolinians of Orange County Officers
^ Orange County Health Department Staff
Join us! How to Get Involved
We invite you to become a member of Healthy Carolinians of Orange County (HCOC). Membership is free and
open to anyone who lives or works in Orange County. You can volunteer in whatever capacity works best for
you:
^ Members may commit to serve on a standing committee working to address the leading health concerns
in our county.
^ Members may commit to serve as a resource person and contribute their expertise when needed.
^ Members may volunteer to help out with one-time projects or events.
^ Members may commit to receiving information about HCOC activities and disseminate this information
to neighbors, friends and others in the community.
To join, contact Nidhi Sachdeva, Acting Healthy Carolinians Coordinator at (919) 245-2440 or
nsachdeva@co.orange.nc.us.
Membership information and applications are also available on the Orange County Health Department/HCOC's
website at www.co.orange.nc.us/healthycarolinians.
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Purpose
This 2009 State of the County Health Report provides
an update of health concerns, and actions being
taken to address them. It uses the most recent data
to highlight county demographics, the leading causes
of morbidity and mortality, and progress toward
addressing the leading health concerns identified in
the 2007 Community Health Assessment. The
prioritized health issues are: 1) Access to health care;
2) Health promotion; 3) Adolescent health; 4) Mental
health and substance abuse; and 5) Transportation.
Orange County, NC: Promoting and Protecting Health
A letter from the Health Director
Orange County residents have much to celebrate!
While we have many challenges that will make our
communities stronger and healthier, overall we
continue to have healthy residents. This 2009 State
of the County Health Report, compiled annually,
provides a snapshot of updated health statistics and
activities towards meeting community priorities. We
hope that the community finds this report easy to use
with valuable information.
The Orange County Healthy Carolinians Partnership
has much to be proud of this year. Under the able
leadership of Bobbie Jo Munson, Healthy Carolinians
Coordinator, Orange County Healthy Carolinians
achieved re-certified status for 2009-2013 and for the
third time. Ms. Munson stepped into the role as
Coordinator during a crucial time in the 2007
community assessment process and carried through all
activities flawlessly. Sadly, we also bade her farewell
this summer as she pursued a different career path.
We are recruiting for a new coordinator and expect to
fill that position soon after the New Year.
It is a tribute to our partners, that even with a staff
vacancy, Healthy Carolinians Committees continue to
see significant progress toward accomplishing their
action plans for community improvement focused on
the prioritized health issues. I would like to extend a
special thank you to Nidhi Sachdeva, Health
Promotion Coordinator for the Orange County Health
Department who stepped in on top of her other duties
to compile this report and keep the fire burning.
Thanks also to our strong community leadership; to
Mark Sullivan, last year's Healthy Carolinians Chair;
and to Myra Austin, our current Chair.
The Orange County Health Department is proud to
sponsor Healthy Carolinians of Orange County. The
commitment of more than 45 community agencies,
individuals, and businesses; and the dedication of
hundreds of volunteer hours make this partnership
one with strong bonds. Our residents are truly the
beneficiaries!
Dr. Rosemary L. Summers, DrPH
Orange County Health Director
Leading Causes of Death in Orange County (2004-2008)
The leading causes of death in Orange County, NC
continue to be cancer, heart disease, and cerebro-
vascular disease. Health disparities and lifestyle
behaviors such as smoking, physical inactivity, and
poor diet are linked to many of these leading causes
of death.
Overall, Orange County has a lower age-adjusted
death rate than the State averages in all categories.
Death rates attributed to colon, pancreatic, and lung
cancer continue to decrease, and are lower than the
State rates. However, the death rates due to breast
and prostate cancer have increased over the past
decade, and are still above the State rates.'
Cancer remains the top cause of death in the County;
and the number of cases is expected to increase as
the population ages. In 2006, 586 cancer cases$
were reported in Orange County. After the gender-
specific cancers (i.e. prostate and breast), lung
cancer is the second most common cancer in both
men and women. In Central North Carolina, lung
cancer incidence rates in males have been steady,
while death rates have been decreasing. For
females, the incidence rates have been increasing,
and death rates due to lung cancer have been steady
in the past few years.9
In 2008, North Carolina ranked 17`h in the nation with
the highest prevalence of adult diabetes,10 which is
an ever growing problem in Orange County.
Compared to last year, the diabetes death rate in
Orange County has increased, while the State's rate
has slightly decreased. Furthermore, the minority
death rate in Orange County (44.6 per 100,000) is
significantly higher than the overall rate (17.7) and
the Caucasian rate of 12.3 per 100,000. This shows
that many minority residents are not receiving or
accessing adequate preventative care or treatment
for their illness.
Health Disparities
Minorities living in Orange County continue to suffer
from higher rates of death due to many of the leading
causes of illness than Caucasians. Minority residents
are 3.6 times more likely to die from diabetes
complications, and 5 times more likely to die from
kidney disease (see Table below).
Factors contributing to health disparities include
socio-economic status, level of education, access to
health care services, real or perceived discrimination,
poverty/inadequate funds to pay for services, lack of
insurance, fear and distrust of the system, lack of
transportation, and a possible language barrier.
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Access to Health Care
Immigrant and Refugee Health
Several local agencies have initiated or expanded
programs to reduce the health disparities
experienced by immigrant and refugee populations in
Orange County.
Between 2006 and 2009, three new refugee
resettlement agencies opened, totaling four triangle-
based agencies. As a result, Orange County
experienced a notable increase in the number of
refugees, mostly from Burma, resettling in Carrboro
and Chapel Hill.
In response, the Orange
County Health Department
formed an interagency group to
raise awareness about the new
population from Burma and to
collaborate in providing
accessible and appropriate
services for the County's
newest residents. These
collaborations have resulted in several successful
efforts.
UNC Hospital's Interpreter Services Department
provided aloes-cost, intensive Medical Interpreter
training to 10 local Karen and Burmese community
interpreters.
Orange-Person-Chatham (OPC) Area Program
responded to the need for refugee mental health
services by providing cultural competency training for
clinicians. This training included mental health,
substance abuse, crisis services, access and school-
based services providers. OPC has also co-located a
therapist at Piedmont Health Services to provide
assessment and therapy one evening each week in
order to serve the large number of Karen and
Burmese-speaking County residents in need of
services.
The Orange County Health Department continues to
provide communicable disease screening to all
refugees resettling in the county. To help improve
disease surveillance, the Personal Health Services
division began using the new web-based North
Carolina Electronic Disease Surveillance System
(NCEDSS) for tracking disease outbreaks and for
tracing contacts. The system also has a central
repository of public health communicable disease
data. Following screening, newly arrived refugees are
referred to community medical providers for ongoing
care including Carrboro Community Health Center
and UNC Family Medicine.
The Chapel Hill-Carrboro City Schools (CHCCS) and
the Health Department worked together to provide a
one-time vaccination clinic to efficiently immunize
newly arrived refugee students.
The Health Department also partnered with a student
intern, a former refugee herself, to create resources
to assist agencies with appropriate referrals, and to
provide refugee clients with community navigation
tools. The resource list, bus route brochures, and
community clinics maps are posted on the Health
Department's Immigrant and Refugee Health
Resources webpage.
In addition, the Orange County Health Department
facilitates a Latino Health Coalition (established in
April 2007). The Coalition connects health
professionals working with Latinos in order to provide
more accessible and coordinated medical, dental and
other health services for the growing Latino
population.
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Project Homeless Connect
The Orange County Ten-Year Plan to End Chronic
Homelessness includes Orange County and the
Towns of Chapel Hill, Carrboro, and Hillsborough.
The intergovernmental Partnership to End
Homelessness is a collaborative effort, to realize the
goals of the plan through implementation of identified
strategies.
Orange County's Department of Housing and
Community Development organizes Project
Homeless Connect each year to offer a range of
services to people experiencing or at risk of
experiencing homelessness in Orange County. The
event brings together human service professionals
and agencies from across the county. The third
Annual Project Homeless Connect event was held on
October 8, 2009.
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Project Homeless Connect events have proven13 to
be successful one-stop resource links for the
homeless population. The services offered include
housing, employment, health care and dental
screenings, mental health care, veteran and social
service benefits, legal services,14 haircuts, food,
clothing, and more.
Partners for the event included the Town of Chapel
Hill, local government/county services (including fifty
Public Health Reserve Corps volunteers), UNC-
Chapel Hill, Piedmont Health Service; medical and
dental providers, faith based organizations, civic
organizations, local businesses, Triangle United Way,
among others.
"Are we our Brother's Keeper?"
United Voices of Efland-Cheeks, in collaboration with
the University of North Carolina at Chapel Hill, Shaw
University, and Orange County Health Department,
continued a cardiovascular disease research study in
African-American churches, entitled "Are we our
Brother's Keeper?". An evaluation was conducted on
the impact of scripture, sermon, prayer and song and
African-American men's adherence to their
cardiovascular care plan. The study is anticipated to
continue through Fall 2010.
Service Delivery Changes
Due to the economic downturn this year, Medicaid
reimbursement to medical providers was cut to help
balance the State Budget. Particularly hard hit were
case management services to high-risk pregnant
women and children with developmental delays. A
19.4% reduction resulted in the Health Department
needing to refocus services to maintain hands-and-
eyes on populations at risk. Concentration will be on
post-partum/newborn home visiting, skilled maternal
home visits, and psycho-social counseling services.
Case management services will continue at a
reduced service level
Current "Hot Topics"
Seasonal and H1 N1 (Swine Flu)
In April 2009, a new strain of influenza A virus
subtype H1 N1 was first identified and began to
spread globally. The outbreak reached pandemic
proportions by June 2009.15
In September, the state expanded reporting for flu
deaths and hospitalizations for flu-like symptoms. As
the virus continued to circulate in the community, the
Health Department geared up for an extra busy 2009-
2010flu season. In Fall 2009, the health department
began a combination of traditional seasonal and
novel H1 N1 flu vaccine initiatives, including walk-in
and even mass vaccination clinics at various
locations.
Planning for the distribution of H1 N1 vaccine to
priority groups identified by the Centers for Disease
Control was particularly difficult as the amount of
vaccine received varied from week to week.
Nonetheless, procedures were developed and carried
out to vaccinate prioritized groups.
Vaccine availability is also coordinated with local
medical providers to assure that practices are able to
vaccinate their patients.
Inf~cmation & Clinics
To fully implement extensive public health initiatives
such as mass vaccination clinics, acommunity-wide
effort is required. For this, the Orange County Health
Department works in collaboration with many
partners -- such as the Orange County and Chapel
Hill-Carrboro City Schools, Emergency Services, the
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Sheriff's Office, the Red Cross, Orange County
Public Health Reserve Corps and CERT volunteers,
and various County Government offices.
See the website for the latest vaccination information
http://www.co.orange. nc.us/health/
Pertussis
Pertussis, also known as `whooping cough' is a
bacterial disease characterized by uncontrollable
coughing. Local Pertussis cases, particularly in
school settings, required intense investigation and
follow-up this past year. From November 2008
through June 2009, 26 confirmed Pertussis cases
were reported, and 900 contacts were notified to
receive recommended or required antibiotic
treatment.
Emergency Preparedness
Public Health Reserve Corp (PHRC) and
Community Emergency Response Team (CERT)
Large-scale public health emergencies, like the 2009
flu pandemic, may quickly overwhelm the Health
Department's primary health and medical
responders. Hence, it is important to have a reserve
of volunteers who can help meet local health needs
after a disaster, either natural or man-made.
The Public Health
Reserve Corps
(PHRC) is one of the
Orange County
Health Department's
community-based
volunteer programs.
The PHRC consists
of health professionals and other community
members with specialized skills that strengthen the
Health Department's ability to respond to local public
health emergencies. Currently, there are 323 PHRC
volunteers and 176 CERT volunteers. The volunteer
program is constantly being expanded by offering
more training opportunities for volunteers and
outreach to community members.
Various preparedness efforts are underway. The
CERT program is another volunteer based program
sponsored by the Health Dept and Orange County
Emergency Services which provides training to
community members to prepare them for an
emergency if first responders are delayed or
unavailable. CERT volunteers learn basic
preparedness skills to help out their family and
neighbors. CERT training was provided to various
teams in Orange County including Sports Endeavors,
which was the first Business CERT in Orange
County. The CERT program also became involved
with several Cub Scout and Boy Scout troops to
teach emergency preparedness and first aid. PHRC
nurses and other volunteers assisted with various
vaccination clinics; and the PHRC and CERT
programs participated in multiple community outreach
projects, such as the Safety Saturday event in
September sponsored by Lowe's Home Improvement
to distribute emergency preparedness information to
families and community members.
Diabetes Self Management Education
Local data show that many Orange County residents
with type 2 diabetes are not receiving the necessary
care and education to effectively manage their
disease. The 2006 Orange County Behavioral Risk
Factor Surveillance Survey (BRFSS) estimated that
only 55% of those diagnosed with type 2 diabetes
had taken a program in diabetes management. This
equates to 2,305 county residents who have been
diagnosed but not received education on how to
manage their disease.
To address this issue, the Health Department
received atwo-year grant from the Kate B. Reynolds
Charitable Trust to start a Diabetes Self Management
Education (DSME) program. This award came after
the Health Department's acceptance to provide
DSME as a multisite under the `umbrella' of the N.C.
Division of Public Health's American Diabetes
Association Recognition Program. In September the
Health Department began offering the DSME
program to Orange County adults who have type 2
diabetes.
Research shows that DSME improves diabetes
knowledge and self-care behavior, as well blood
glucose numbers, weight loss, and overall quality of
life. The DSME program's goal is to achieve better
self management of diabetes, increase access to
care through an active treatment and referral
network, improve health outcomes, and reduce
healthcare costs. The program consists of four
elements:
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Health Promotion
In Orange County, 29% of children aged 2-18 years
are overweight or obese. Among the 2-4 year olds,
15.8% are overweight's; among the 5-11 year olds,
35.7% are overweight or obese." ;and among the
youth (aged 12-18 years), 31 % are obese.18
Chapel Hill-Carrboro City Schools {CHCCS) conducts
student fitness assessment of students in grades K-
10 at the beginning and end of each school year,
including Body Mass Index (BMI). Approximately
10.1 % of students enrolled in Physical Education are
identified as having a BMI > 25. More significantly,
only 24.7% of students are able to achieve the 50`h
percentile on fitness assessment skills. While
CHCCS BMI data suggests fewer overweight
students, it does connote that students are not
physically fit. Increased BMI and decreased fitness
becomes more evident as students age.
Health Promotion Committee
Given these alarming statistics, reducing childhood
obesity has become the primary focus for the Health
Promotion Committee of Healthy Carolinians of
Orange County. The committee has adopted a
comprehensive approach to addressing the obesity
problem, and is coordinating its activities with a
number of sectors and agencies.
This year, the Health Promotion (HP) Committee
created a Physical Activity and Nutrition Resource
Guide. This is a compilation of information from all
the organizations within Orange County, public and
private, that offer services addressing physical
activity and nutrition of children of all ages. This
Resource Guide was distributed to Healthy
Carolinians partners, health provider offices, and to
the public.
After completing the Guide, the HP Committee
partnered with twelve Orange County organizations
(e.g. local government, businesses, churches, both
school districts, and the UNC Health Care System) to
launch the "Eat Smart Move More" Consistent
Messaging Campaign. The campaign ran during the
summer months (May-August) and consisted of four
key messages around physical activity and healthy
eating. Partners were trained and encouraged to
adopt or integrate the messages into their existing
programs and communication channels.
1 ~ ^~ ~~
x Move More
Orange County
Besides promotional efforts by each community
organization, ten advertisements and articles written
by members of the HP Committee were published in
four local newspapers. The estimated number of
people reached through partners alone (i.e. not
including newspaper readership) was about 19,500
people. The Committee plans to conduct a smaller
Phase II campaign in 2010 to promote two additional
Eat Smart Move More messages.
In November 2009, Candice Watkins-Robinson,
Health Communication Specialist for the Orange
County Health Department, received afirst-place
Excellence in Communications Award for the ESMM
Campaign Tool kit from the NC Association of
Government Information Officers.
The HP Committee also started a Pediatric Obesity
Initiative (POI) in July 2009. In collaboration with the
UNC School of Nursing students, Pediatric Obesity
Toolkits were created for four Orange County clinics.
Also, physicians, nurse practitioners and physician
assistants, clinical staff, and office manager/front
desk staff attended training on Universal Assessment
guidelines, Staged Treatment strategies, and the
development of
Motivational Interviewing
skills for reinforcing
positive behaviors and
counseling against ~`~ -
negative behaviors or risk i~ ~ l °``
factors. The Health `, ..~
Promotion group will now '°R ~'"""
expand the POI by
partnering with school
nurses from both districts.
Many local agencies also continued to offer services
to improve health promotion among young children
and their families. These agencies include the Chapel
Hill-Carrboro YMCA, the Health Department,
Cooperative Extension, Orange Partnership for
Young Children, Triangle SportsPlex, the three Parks
and Recreation Departments in the County, and
many more.
8
N T
In addition to Healthy Carolinians projects, some
other Orange County programs that are addressing
Childhood Obesity include the following:
Eating Smart
1) Local farmers markets. Hillsborough Farmer's
Market and NC Farm Fresh and the Carrboro
Farmers Markets have increased in popularity and
are working to make local foods and fresh fruits and
vegetables more available to the community.
The Carrboro Farmers' Market has made great
strides in increasing access to local food with the
creation of the Farmer FoodShare, which is a
program that collects fresh market fruits and
vegetables from farmers and shoppers and
distributes them to a network of social service and
hunger relief agencies in underserved
communities. In just 5 months, Farmer FoodShare
collected over 12,000 pounds of produce and
distributed it to hunger relief centers throughout
Orange, Wake, and Durham counties.
3) Hope Garden is a collaborative effort between
University of North Carolina students and the Chapel
Hill Parks and Recreation Department. UNC students
have developed a garden on Town property and
partnered with local restaurants and after-school
groups to provide locally-grown produce.
Moving More
1) Chapel Hill-Carrboro City Schools received a Carol
M. White Physical Education Program (PEP) Grant
and is currently in year two of a three year program.
The purpose of the PEP Grant is to provide funds to
local educational agencies and community-based
organizations to initiate, expand, and improve
physical education programs (including after school
programs) for students in one or more grades from
kindergarten through 12 in order to make progress
toward meeting State standards for physical
education by providing funds for equipment, support,
and the training and education of teachers and staff.
Funds are being used to increase amount and level
of intensity of physical activity across all grades.
2) Established in 2007 by the Orange County
Partnership for Young Children, the Growing Healthy
Kids (Community Gardens) Program has helped over
75 children and families learn the advantages of
growing their own.fruits and vegetables. In Spring
2009, a third garden was created in Carrboro with
support from Duke Energy. All gardens have been
made possible by the Town of Carrboro, the Orange
County Cooperative Extension, and the Health and
Wellness Trust Fund of North Carolina. Recent
evaluation data shows that after completing the
program, parents reported an 88% increase in the
number of fruits available in their home, and a 126%
increase in the number of vegetables.
2) The Move It! program, also part of the Healthy
Kids Campaign, provides scholarships for families to
take part in local physical activity programs. The
program granted access to 50 families who might
otherwise not have had the opportunity to participate.
Of the children who received a Move It! Scholarship,
76% had not previously participated in a local
physical activity program. This program is organized
by the Parks and Recreation Departments in
Carrboro, Chapel Hill, and Orange County; the
Chapel Hill-Carrboro YMCA; and the Triangle
SportsPlex.
Adolescent Health
Orange County continues to focus on adolescent
health issues, with a current emphasis on reducing
drug and alcohol use and associated risky behaviors
among youth. Data shows that many youth across
the County use alcohol, tobacco and other drugs.
For alcohol use, the 2009 Youth Risk Behavior
Survey (YRBS) conducted by Chapel Hill-Carrboro
City Schools (CHCCS) shows that 31.3% of their high
school students drank alcohol in the past 30 days;
27.7% had at least 5 or more drinks in a row at least
once in the past 30 days; and 18.6% rode in a car
with a person who had been drinking alcohol at least
once in the past 30 days. For marijuana use, 17.4%
reported use in the past 30 days. For both alcohol
and marijuana, there appears to be a direct
correlation between drug use and grade level (6-12).
Advocates for Adolescents Coalition
Due to the limited number of agencies working with
youth in the northern part of Orange County, and the
limited opportunities for social and recreational
activities for youth in this area (as noted in the 2007
Health Assessment), the Healthy Carolinians
Advocates for Adolescents (AFA) Committee has
focused its efforts on youth in Hillsborough and
Northern Orange County.
AFA's goal is to address the problem of underage
alcohol and drug use in Northern Orange County and
Hillsborough. AFA has strengthened its partnership
9
with the Community Backyard (CBY) program to
create a Coalition to address these issues. The
Coalition has since expanded to include additional
community segments-all of which were represented
in November 2009 at the second Annual Community
Forum on Alcohol and Drug Use among Teens
These segments of the community include health
care professionals, schools, law enforcement,
government agencies, businesses, youth, parents,
media, youth-serving agencies, faith or fraternal
organizations, civil or volunteer groups, and others.
Although there is a strong representation from most
sectors, the AFA Coalition aims to better engage the
faith community and parents. One way that parents
have been getting involved is through the Safe
Homes Network (SHN), for which parents sign a
good faith pledge to not knowingly allow youth (under
21) to consume or use alcohol or illegal drugs at their
home, on their property, or at gatherings they are
hosting. The AFA Coalition also plans to recruit
parents participating in the SHN to create an active
Parent Council for northern Orange County.
In the southern part of the county, Healthy
Carolinians has been an active partner with the
Coalition for Alcohol and Drug Free Teenagers
(CADET), an organization that has increased
community awareness about the problems
associated with underage alcohol and drug use.
CADET, in partnership with CHCCS and Healthy
Carolinians, instituted a SHN and developed parent
and community education programs on adolescent
substance abuse. For example, Talk it up! Lock it up!
and Operation: Medicine Cabinet are CADET
campaigns encouraging parents to be pro-active in
denying teen access to alcohol and prescriptive
drugs in the home and is supported by CHCCS and
the Chapel Hill Police Department.
AFA Coalition members also participated in Project
Graduation-a drug and alcohol free venue to
celebrate graduation; and in National Night Out,
where they worked with neighborhood watch
agencies and law enforcement. Since there is an
unmet need for transportation in the upper half of the
county, AFA contracted with the Orange County
Department of Transportation to provide
transportation to 25 families in the Fairview, Whitted
Forest and Gateway communities.
In September, Teens for
Healthy Living, the
newly formed Youth
Leadership Council,
hosted an alcohol and
drug free event called
Free Fair All for their
peers and families. ~~M
Activities included a DJ,
raffle prizes, games and food; as well as educational
components like booths, alcohol/drug related trivia
games, hourly readings of relevant statistics, and a
mock-car crash organized by the Hillsborough Police
Department in cooperation with Orange County EMS.
In addition, the AFA Coalition is working closely with
the Pacific Institute for Research and Evaluation
(PIKE) to analyze existing data on the prevalence of
alcohol and substance use among adolescents in
Hillsborough and Northern Orange counties; and to
develop the tools for parent surreys, youth and
parent focus group questionnaires, and a community
readiness assessment.
The information thus collected will be used to refine
the 2010 Action Plan, inform upcoming environmental
and policy change efforts, and build on the
momentum created by the ongoing activities of the
Coalition.
Orange County Tobacco. Reality. Unfiltered. (TRU)
The Orange County Youth Tobacco-Use Prevention
Program trains TRU Peer Educators to teach others
through interactive activities, media literacy, and
advocacy programs about the dangers of tobacco
use. The TRU Program has a strong collaboration
with both school districts in the County, and has an
established presence in each of the five local high
schools. During the past six years, the program has
trained 130 TRU Peer Educators and made a
significant impact on health outcomes in Orange
County.
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TRU is a student-led program funded through a grant
first received in 2003 from the NC Health and
Wellness Trust Fund (HWTF). In June 2009, the
Orange County Health Department was awarded
$274,848 in funding from HWTF to continue the
program from 2009-2012. According to the 2009
10
Youth Risk Behavior Survey (YRBS), there has been
a significant reduction in the number of young people
using tobacco products.
According to local school YRBS data, teen smoking
rates have steadily decreased over time in Chapel
Hill-Carrboro City Schools from 2005 (15.32%) to
2007 (12.31%) to 2009 (10.6%).The percentage of
youth who have never smoked increased from 63.2%
in 2001 to 72% in 2007. Similarly, the number of high
school students who have never smoked increased
steadily from 54% in 2001 to 80.7% in 2008 in the
Orange County Schools District.
During the 2008-2009 school year, 42 Orange
County TRU Peer Educators reached over 2,000
youth and adults through school and community
events, training, and presentations on tobacco
prevention and cessation. One highly publicized
event was the 2009 Kick Butts Day (KBD) Carnival
organized by the Cedar Ridge High School TRU
group at a local shopping center.
The KBD event reached over 100 community
members with tobacco prevention activities and
cessation materials. Keynote speaker Reena
Roberts, a cancer survivor featured in the statewide
TRU commercials, cited the event as her first
community-based speaking engagement. TRU Peer
Educators also conducted Merchant Education
presentations with six local non-compliant vendors,
encouraging them not to sell tobacco products to
minors.
In September 2009, the Orange County TRU
Program, led by Pam Diggs of the health department,
received the 2009 Kathy Kerr Outstanding Health
Education Project Award from the North Carolina
Chapter of the Society for Public Health Education.
Child Health
Child abuse and neglect remain areas of serious
concern. During the period January to November
2009, 1251 children were reported for
abuse/neglecUdependency. Of these reports,
19.5% were found substantiated or in need of
services-a slight decrease from the previous
year.'s
Advocates for Children Committee
Child health was a top health priority identified in
the 2007 Health Assessment; and has continued to
be the focus for the Healthy Carolinians Advocates
for Children (AFC) Committee.
Many local organizations, including the Orange
County Department of Social Services, UNC
Hospitals' Beacon Program, Orange County Rape
Crisis Center, the Health Department and others,
offer programs and services to support children and
families at risk of abuse. The AFC Committee
collaborates with these organizations to raise
awareness of child abuse and neglect.
In April 2009, the AFC
Committee, in partnership
with the Chapel Hill Police
Department and the
Hillsborough Exchange Club,
held its third annual Real
Men Rock event for the
prevention of Shaken Baby
Syndrome (SBS). Over 50
families attended the event
and received information on SBS and child abuse
prevention. As part of the Real Men Rock campaign,
the Orange County Sheriff's Department distributed
child IDs to parents. The AFC distributed educational
materials to Orange County pediatricians and family
practice physicians to pass on to new and/or expectant
parents. Real Men Rock posters were also distributed
to the physicians to post in their waiting and clinic
rooms.
The fourth annual Real Men Rock event will be held
April 24, 2010. There has been discussion around
expanding the event by including a lunch seminar
beforehand; inviting additional partners to join (e.g.
representatives from the Period of Purple Crying
Program at the National Center on Shaken Baby
Syndrome); and reaching out to child care providers.
In addition to Real Men Rock, the AFC Committee
continued to raise awareness about child health issues
through its Brown Bag Lunch series. Over 50 people
attended the most recent session on Youth and Drugs,
which indicated a high level of community interest in
the topic. Future Brown Bag Lunch topics will include
Kids and Smoking and Self Injury and Teens.
In addition, an "Early Childhood Resource Notebook:
Meeting the Needs of Children Birth through Five" was
created. This resource manual, which has been very
well received, includes a comprehensive listing of
mental health providers that serve children from birth
through five years of age.
11
The Healthy Kids Campaign Program has
implemented the ABCs of Good Health program at
nine childcare centers, and has reached 132
children since its inception. The program, led by a
health department employee, uses a curriculum
based (NAPSACC) approach to working with child
care teachers. It provides information and training
on how to implement better nutrition and physical
activity in the child's daily routine; and is supported by
a grant from Blue Cross and Blue Shield of North
Carolina Foundation.
In addition, the Health Promotion Committee is working
to reduce childhood obesity.
Mental Health and Substance Abuse
Per the NC Division of Mental Health, Developmental
Disabilities and Substance Abuse (DMH/DD/SA)
Services Community Systems Progress Report for 4"'
Quarter State Fiscal Year 2008-2009, adults in need
of mental health services in Orange County number
5,572. Of these, 29% were documented to receive
help via Medicaid and IPRS services. During the
same period, 2,634 children and adolescents were
estimated to be in need of mental health services, and
36% (941 youth) of these received needed support
from Medicaid and IPRS services.
Adults and children in need of mental health services
also received help via Medicare, Health Choice,
private insurance, and publicly funded assistance
(such as Orange County and non-Unit Cost
Reimbursement).
Estimates from the same source indicate that there
are 10,381 adults in need of substance abuse
services in Orange County. Of these, 6% (606 adults)
received Medicaid and IPRS services. Seven hundred
children were estimated to need help with substance
abuse, and 11% (74 youth) were served using these
same services. Numbers served do not include
individuals receiving services paid for by non-Unit
Cost Reimbursement (non-UCR) funds, including
grant-funded substance abuse services, which is a
significant group of consumers.
Like most counties, Orange County is working to
address the challenges brought about by significant
reductions in funding for MH/DD/SA service delivery
and system management, as well as the rate
reductions that impact many Medicaid funded
services. In September 2009, State level legislation
mandated the discontinuation in 2010 of Community
Support services; this will leave a hole in the
continuum of services available to people in need of
assistance. Funding for Crisis Services has,
fortunately, been protected.
Orange-Person-Chatham (OPC) Area Program-
Orange County's Local Management Entity for
MHlDDlSA Services-continues to work diligently to
preserve services whenever possible to reduce impact
on County residents, protect the stability of the
provider community, and identify providers and
services to fill gaps in the provision of critical services.
OPC continues to collaborate with existing providers
and community stakeholders to strengthen the overall
service system.
Mental Health and Substance Abuse Committee
New mental health and substance abuse initiatives at
work in Orange County include the following. In
January 2009, the Mental Health and Substance
Abuse (MH&SA) Committee of Healthy Carolinians of
Orange County released a Directory of Mental Health
Services. This directory seeks to increase knowledge
of and access to available mental health services in
Orange, Person and
Chatham counties. It
includes general
information about state a~~~ry or Me~~~ Hed~~
and county mental ~~~~~'~ ti~
health services,
including emergency 2~9
and crisis services, ~.
governmental and non-
governmental
agencies, and a listing
of private mental ~w~~
~~n,~,
health providers. Y ~~°~
Made possible by the OPC Area Program, the Mental
Health Association Orange County (MHA-OC)
transformed the Directory into aweb-based,
searchable database (by specialty services, provider
name, insurances accepted, and more). Both
resources may be accessed at
www. mhaorangeco.org.
The MH&SA Committee also dedicated itself to the
launch of the Pro Bono Counseling Network. With
funding from OPC Area Program and Strowd Roses,
Inc. (a charitable foundation), the Network began
providing services in January 2009 under the
organizational umbrella of MHA-OC. The Network
recruits mental health professionals to provide
counseling services on a pro Bono basis to individuals
who fall into the gap between those
12
~.z::i
covered by public assistance programs and the
privately insured. The program serves individuals with
low-to-moderate incomes who are ordinarily mentally
healthy but have experienced a stressful event or
circumstance, and who lack the funds for obtaining
the needed therapy. To date, 45 matches have been
made between individuals in need of help and
volunteer therapists, 25 of whom were in Orange
County.
Finally, implementation of Crisis Intervention Team
(CIT) training is underway. A coalition of agencies
(OPC Area Program, National Alliance on Mental
Illness, MHA-OC, Chapel Hill Police Department,
UNC Chapel Hill Public Safety and Freedom House
Recovery Center) will bring the first area CIT class to
Orange County in Hillsborough during January 2010.
This training represents a formalized partnership
between MH/DD/SA service agencies, advocates and
law enforcement.
CIT is apre-booking jail diversion program designed
to improve the outcomes of police interactions with
people with mental illness. The program provides 40-
hours of specialized training to sworn law enforcement
officers in order to decrease incidents of incarceration
of persons with mental illness for misdemeanor
charges. It also connects persons in mental health
crisis to appropriate services rather than the criminal
justice system; decreases officer injury rates;
decreases use of force occurrences; decreases
consumer injury rates; and creates an earlier
opportunity to engage consumers in mental health
services.
Transportation
For many residents in northern Orange County,
including children/students, older adults, persons
living with disabilities, and those who do not have
access to a personal vehicle, the lack of
transportation continues to be a barrier to accessing
medical, recreational, and social services.
However, there has been some notable progress
over the past year. Orange Public Transportation
coordinated with Triangle Transit and Chapel Hill
Transit to provide a new service to the 420 route
(Hillsborough to Chapel Hill public route). The
changes allowed Chapel Hill Transit to provide peak
hour service on this route with larger capacity buses
that can serve more riders.
Orange Public Transportation and Chapel Hill Transit
have held public forums to gather information on a
possible Chapel Hill/Carrboro in-town shuttle. Using
New Freedom grant funds, a route may be developed
that would allow seniors to be picked up at specific
locations and taken to desired drop points.
In addition, using Congestion Mitigation and Air
Quality (CMAQ) Improvement Program grant funds,
the Orange Public Transportation and the town of
Hillsborough are developing a public route for
Hillsborough. This would be a fixed route that would
allow connection to the 420 route and desired
locations within Hillsborough, and would connect to
an existing park/ride lot.
Although there is no formal HCOC committee
working on transportation needs in Orange County,
the Advocates for Adolescents Committee's long
term goal is to improve transportation for residents,
particularly for students in the northern part of the
county.
13
ti.... f r .µ. r-~.. .
Data Sources
1 State and Ccunty Quick Facts: Orange County, NC.U.S. Census Bureau. http://quickfacts.census.gov/gfd/states/37/37135.html
2 Orange County Profile, August 2009. Economic Development Intelligence System. http://www.co.orange.nc.us/ecodev/documents/EDISProfile.pdf
3 2006-2008 American Community Survey 3-Year Estimates, North Carolina Fact Sheet. US Census Bureau. httpJflactfinder.census.gov/servleUDataselMainPageServlet=
4 Orange County Profile, August 2009. Economic Development Intelligence System. http://www.co.orange.nc.us/ecodev/documents/EDISProfile.pdf
5 2006-2008 American Community Survey 3-Year Estimates, North Carolina Fact Sheet. US Census Bureau. httpJ/facttinder.census.gov/servleVDatasetMainPageServlet=
6 "Current ESC Workforce Information " N.C. Employment Security Commission. Accessed November 2009. http://eslmi23.esc.state.nc.us/countycard<ndex.aspx
7 2004 - 2008 NC Resident Race-Specific and Sex-Specific Age-Adjusted Death Rates. http://www.schs.state.nc.us/SCHS/da[a/databooWCD21 B racespecificsexspecific rates.rtf
8 Cancer Profiles: A fact sheet produced by the North Carolina Central Cancer Registry (CCR), August 2009. http://www.schs.state.nc.us/SCRs/CCR/cp2009/Orange.pdf
9 Cancer Profiles: A fact sheet produced by the North Carolina Central Cancer Registry (CCR), August 2009. http://www.schs.state.nc.us/SCHS/CCR/cp2009/Orange.pdi
10 Diabetes in North Carolina: North Carolina Diabetes and Control Fac[ Sheet, September 2009. http J/www.ncdiabe[es.org/~df/DIABETES%201N%,20NC%20WEB.pdf
11 2004 - 2008 NC Resident Race-Specific And Sex-Specific Age-Adjusted Death Rates. http://www.schs.state.nc.us/SCRs/data/databooWCD21 B%20racespedficsexspecific % 20rates.rtf
12 2004 - 2008 NC Resident Race-Specific And Sex-Specific Age-Adjusted Death Rates. http://www.schs.state.nc.us/SCRs/data/databooWCD21 B%,20racespecificsexspecific%20rates.rtf
13 "Project Homeless ConnecP NC Department of Healthand Human Services. http://www.dhhs.state.nc.us/homeless/phc.htm
14 "Project Homeless Connect Orange County, Talking Points" http)/www.co.orange.nc.us/housing/documents/MicrosoftWord-PHCTalkingPoints2009.pdf
15 Chan, Dr. Margaret (June 11, 2009). "Wald now at the start of 2009 influenza pandemic". World Health Organization.
http)/www.who.inVmediacentre/news/statemen[s/2009/h1 n 7 ~andemic~hase8_20090611 /en/index.html.
16 "Prevalence of Obesity, Overweight, Healthy Weight, and Underweight in Children 2-4 Years of Age by County." North Carolina Nutrition and Physical Activity Surveillance System (NC-
PASS). 2008. http://www.eatsmartrtwvemorenc.conVDatalrexts/2008%,20Ages % 202%20to%204.pdf
17 `Prevalence of Obesity, Overweight, Healthy Weight, and Underweight in Children 5-11 Years of Age by County." North Carolina Nutrition and Physical Activity Surveillance System
(NC-PASS). 2008. http://www.eatsmartmovemorenc.coMDatalTex[s/2008%20Ages%205%20to%2011.pdf
18 "Prevalence of Obesity, Overweight, Healthy Weight, and Underweight in Children 12-18 Years of Age by County "North Carolina Nutrition and Physical Activity Surveillance System
(NC-PASS). 2008. http://www.eatsmartmovenarenc.com/DatalTeMS/2008%20Ages%2012%20to%2018.pdf
19 Patty Clarke, Orange County Sorial Services. Novert~er 25, 2009
Healthy
• Carolinians
of Orange
County
Healthy Carolinians of Orange County
Orange County Health Department
300 W. Tryon Street
Hillsborough, NC 27278
Phone: 919.245.2440
http://www.co. orange. nc. us/healthycaroli nians
,..
Q
A service of Orange County Government. "~~ ~•~""•
14